Provincial Services. In our very mobile society it is not uncommon for our clients to
be from other districts, regions or parts of the province and these clients are
provided services within the resource capability of funded agencies.
The Ontario Withdrawal Management Standards set out minimum standards of
professional and clinical practice to guide the operation of Withdrawal Management
Services in the Province of Ontario. The standards are clearly defined for each
category of Service delivery.
The authors of this document recognized that, for some agencies, meeting the
Standards may be difficult to attain because of budgetary challenges. None-theless,
we proceeded with the standards as a goal towards quality of care and not as a
reflection of the lowest common denominator.
and addressed Residential Withdrawal Management Services. The first review and
revision was published in 2001 and for the first time addressed the Community
Withdrawal Management Service category that had been developed by the Ministry
of Health and Long-Term Care (MOHLTC). This was followed by a second review
and revision published in 2004 and included all of the prior content, incorporating
revisions. For the first time the Medication Guidelines and Protocols based on
former guidelines from the MOHLTC were addressed as a specific Standard rather
than an appendix to the Standards. Methadone Maintenance was also addressed for
the first time in the 2004 Standards.
The MOHLTC funded the current review and revisions to the Standards and to the
Service Definitions, relevant to withdrawal management, as a special project. There
have been significant changes to the definitions to describe all categories of nonresidential withdrawal management that have developed through innovations in the
field. The Community Withdrawal Management Service (CWMS) definition, as
developed by the MOHLTC has long been accepted as a Service Definition. In
consultation with the MOHLTC, the Standards Working Group has maintained this
definition as developed; however, two new categories to describe the service
activities currently taking place have been developed. The first is Day Withdrawal
Management Service (DWMS) and has been well established in other jurisdictions.
The second new category is Telephone Supported Withdrawal Management Service
(TSWMS) and is an emerging innovation in providing care when barriers to other
categories of withdrawal management exist.
The Ontario Withdrawal Management Standards, as in the past, include standards in
administration, program, client care, education and physical structure. These
standards utilize the revised Withdrawal Management Service Definitions for nonresidential services. Significant research into Best Practices developed by Health
Canada, by other provinces and by international organizations was utilized in the
development of the Standards. The Canadian Council on Health Services
Accreditation (CCHSA) Program Standards, Mental Health Services, 2008 was
utilized as a significant reference. A very large number of the agencies providing
withdrawal management services and all of the Residential agencies are sponsored
by hospitals and these Standards are used to measure Mental Health and Addiction
programs in hospital accreditation processes. Feedback was sought, throughout the
process, from all agencies that deliver withdrawal management services in the
The Standards Working Group also held consultations with other key stakeholders
of the Health Care continuum. These included representatives from the Local Health
Integrated Networks (LHIN’s), MOHLTC, Drug and Alcohol Treatment Information
System (DATIS), and CONNEX ONTARIO.
To facilitate ease of use, the manual is divided into four service delivery sections.
These sections include one for each category of withdrawal management as
outlined in the revised Service Definitions for the withdrawal management sector.
The four sections are Residential Withdrawal Management Services, Community
Withdrawal Management Services, Day Withdrawal Management Services and
Telephone Supported Withdrawal Management Services. This will make it easy for
users to go to the Standard section or sections applicable to the type of service or
services they provide.
This edition of the Ontario Withdrawal Management Standards reflects the ongoing
nature of addressing the ever-increasing complexity of client care during withdrawal,
the provision of exemplary care and the evolution of Withdrawal Management
Services to include innovations and emerging trends and needs. These same issues
inform the need to continually review and revise standards on an ongoing basis. In
addition, it addresses the evolution of innovations in the categories of non-residential
withdrawal management and identifies Service Definitions that defines the activities
undertaken in delivery of care.
The working group of the Withdrawal Management Project appreciates the input
from all colleagues who participated in the revision of these standards. It is the hope
of the working group that the application of these standards will inform the
development or redevelopment of your service policies and procedures and facilitate
your ability to deliver consistent exemplary care throughout the province.