memorandum of understanding -...

MEMORANDUM OF UNDERSTANDING

Agreement Between

PARN, Your Community AIDS Resource Network159 King Street East, Suite 302Peterborough, Ontario, K9J 2R8

Phone: 705-749-9110; Fax: 705-749-6310

AND

Peterborough Public HealthJackson Square, 185 King StreetPeterborough, Ontario, K9J 2R8

Phone: 705-743-1000; Fax: 705-743-2897

AND

Peterborough Drug [email protected]

Phone: 705-876-1122 ext. 292

AND

Four Counties Addiction Services Team130 Hunter Street West, Unit 200Peterborough, Ontario, K9H 2K8

Phone: 705-876-1292; Fax: 705-876-9125

A. Purpose

This Memorandum of Understanding (MOU) outlines the terms and understanding between the above named agency partners to collaboratively implement the Peterborough Overdose Prevention Program as described in this document herein.

B. Term of Agreement

This MOU will commence on this the _______ day of _________________ of the year __________.

Originally signed: December 17, 2015Updates: March 2016

This MOU will be reviewed annually by the above named agencies. This MOU may be terminated with mutual agreement or without notice upon breach of any of the terms and conditions. Amendments to this MOU may be made by written agreement of the signing parties. All signing parties are responsible for the review and implementation of the terms and conditions of this MOU on an ongoing basis.

mailto:[email protected]

C. Background

This MOU evolved as a result of a shared commitment to reduce harm associated with the use of opioids in Peterborough City and County. A particular emphasis was placed on providing training opportunities for individuals to build awareness and skills around the best practice strategies to prevent and respond to overdoses resulting from opioid use.

The Peterborough Overdose Prevention Program (herein POPP) has been in official operation since July 2013, although much conversation and planning occurred previously among a variety of local stakeholders. Its original implementation was as a pilot program to determine a model that best suited the needs of residents in Peterborough City and County, while aligning with the resources and capacity available from participating partners. The pilot program was the result of a collaborative partnership between:

PARN, Your Community AIDS Resource Network (herein PARN), The Peterborough Drug Strategy (herein PDS), Peterborough Emergency Medical Services (herein Peterborough EMS), and Peterborough Public Health (herein PPH)

Soon after the launch of the POPP, the Ministry of Health and Long-Term Care granted certain organizations access to the provision of Naloxone at no cost from the Ontario Government Pharmaceutical & Medical Supply Service (OGPMSS). Eligible organizations as outlined in the memo from (name), who is the Manager of AIDS and Hepatitis C programs at the MOHLTC, dated October 4 th, 2013, include:

Public Health Units that manage a core Needle Exchange Program (NEP); Community-based organizations that have been contracted by the local Public Health Unit to

manage a core NEP; and Ministry funded Hepatitis C Teams.

PARN is contracted by PPH to manage the Needle Exchange Program, which has been in place since the year 2000. Initially, PPH had written a medical directive allowing designated Public Health Nurses to dispense Naloxone, which has since transitioned to a policy and procedure as outlined in this MOU. Considering these pieces were in place and in conjunction with the new MOHLTC Naloxone Distribution Program at the time, POPP transitioned to receiving Naloxone from the OGPMSS in August 2014.

After over a year of implementation of the pilot program, the collaborative partnership engaged in discussion in the fall of 2014 to determine whether the POPP model of implementation was sufficient to continue as is or required any adjustments moving forward. At this time an adjusted model of implementation was proposed based on collaborative discussion and then tailored and pitched to decision makers at each partner agency by PDS. The Four Counties Addiction Services Team (herein FourCAST) was engaged as an additional collaborative partner at this time. All partners unanimously agreed that the adjusted model proposed made sense for Peterborough City and County considering the parameters available at the time, which involved making PARN and FourCAST staff available to deliver the education component of the training and then have participants follow-up with the PPH nurse during designated drop-in sessions. Following these adjustments, barriers to access continued and it became clear that a critical success factor was reaching participants in the moment with both the education needed and dispensing of the Naloxone kit. Simultaneously, changes occurred federally and nationally to the status of Naloxone. Specifically, as of June 24, 2016 Naloxone no longer required a prescription to be sold in the province of Ontario. On the same date, the MOHLTC made Naloxone available in pharmacies across the province as part of the Ontario Naloxone Program for Pharmacies. As a result, the Overdose Prevention Steering Committee prepared a briefing note, with a recommendation to evolve the POPP model of

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implementation, which was approved locally. Following this, written permission was granted by the MOHLTC for POPP to implement these changes. As a result, this MOU was adjusted to reflect these changes.

D. Target Audience:

All individuals at risk of opioid overdose, their family, friends and/or support network are eligible to receive overdose prevention & response training. Only active Needle Exchange Program (NEP) clients are eligible to receive a Naloxone kit. We also aim to engage with service providers who serve at risk populations with education about overdose prevention & response.

E. Program Goals

Appendix B depicts the activities and goals within a program logic model. However, a summary of the goals of the POPP are summarized below.

Short-term outcomes include:1. To increase knowledge of at risk individuals, service providers, first responders and family/friends

in Peterborough city and county about strategies to prevent, recognize and respond to an overdose situation.

2. To increase access to Naloxone for individuals at risk of opioid overdose in Peterborough city and county.

3. To increase skills/abilities of at risk individuals, service providers, first responders and family/friends in Peterborough city and county about strategies to prevent, recognize and respond to an overdose situation.

4. To improve 911 call rates related to overdose situations in Peterborough city and county.5. To engage peers as ambassadors to assist in the delivery of overdose prevention training and

knowledge transfer and exchange in the community. 6. To increase awareness among program participants in Peterborough city and county about

Hepatitis C/HIV risk of transmission and testing.

Long-term outcomes include:1. Reduce the number of deaths due to opioid overdose in Peterborough city and county.2. Increase connectedness of individuals who misuse substances to services available.3. Reduce stigma amongst service providers in Peterborough city and county.

F. Roles and Responsibilities:

It is the responsibility of each partner agency named at the outset of this MOU to:

- Know and understand the goals of the Peterborough Overdose Prevention Program

- Know and understand the terms and conditions set out by the Ministry of Health and Long-Term Care directing our responsibilities and accountabilities with respect to distributing naloxone & complimentary materials we receive at no cost as part of the Ontario Naloxone Program.

- Internally adopt and follow a policy & procedure to direct POPP implementation and dispensing of Naloxone at their agency, using the minimum content listed in Appendix C.

- Internally adopt and follow the collective policies and procedures for ordering, transport, storage and reporting associated with the POPP, outlined in Appendix D.

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- Maintain familiarity with each aspect of the program including logistics, training, materials, implementation, and etc.,(see Appendix E & F for further descriptions) in order to facilitate any of the associated tasks at any time if the lead for that piece (as outlined in section G below) is unable to fulfill their lead role due to extenuating circumstances.

- Provide in kind staff time to complete the activities as assigned in section G below according to available capacity of each partner agency.

- Participate in the “Overdose Prevention Steering Committee”, which will meet 4 times per year at minimum, or as needed, to coordinate decisions about the implementation of the POPP. This committee will be made up of at least one representative from each partner agency.

- Ensure that any new staff assigned to tasks associated with the program complete the training program themselves.

The current designated representative(s) to liaise with the MOHLTC as the point of contact in terms of ordering Naloxone and other program supplies and submitting reports is:

(name), PPH

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G. Program Activities & Associated Tasks*Disclaimer* – Each signing partner agency agrees to maintain familiarity with each aspect of the program as outlined below in order to facilitate any of the activities and associated tasks at any time if the designated lead(s) for that piece are unable to fulfill their lead role due to extenuating circumstances. A Lead Agency is defined as the agency/agencies responsible for actively ensuring the tasks of the MOU are accomplished. A Supporting Agency is defined as the agency/agencies responsible for actively assisting the lead agency in ensuring the tasks of the MOU are accomplished.

X = Lead Agency; O = Supporting AgencyActivity PARN PPH PDS FourCAST Associated Tasks

Supportive EnvironmentDevelop and deliver information sessions to interested community members, groups, agencies, and etc. X X O O

Foster the collaborative environment of the partnership. Broader engagement of the community, agencies and partners

to increase awareness of the opioid crisis and overdose prevention.

X X Maintain up-to-date presentation materials.

X X O X Coordinate & deliver presentations.

X(OOPNA/

ONP Sites)

X (MDSC

NO)

Engagement with provincial Naloxone strategy (via MDSCNO, OOPNA, etc) and Provincial group of representatives from the ONP to inform ongoing development of local program.

Use media and social media to increase awareness and educate about overdose prevention, trainings, events, etc.

O X X O Develop and disseminate marketing materials.

Skill Building

Develop & deliver overdose prevention training, including dispensing Naloxone kits to participants.

X X Develop and maintain training content + process for

designated staff trainers, including tracking appropriate information (see Appendix E).

X X O X Deliver and facilitate training process and content to

designated staff trainers

X X X Develop and maintain training content + process for

designated trainers to deliver to eligible and willing participants (see Appendix F).

X O X Recruit participants.X X X Approved staff trainers deliver training and dispense Naloxone

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Activity PARN PPH PDS FourCAST Associated Taskskits to participants using the approved training checklist and supplementary resources (e.g. videos), which includes providing one-on-one support/counselling/referrals as needed

X X X Approved staff trainers provide follow-up, refills and debrief support for trained participants

LogisticsMaintain MOU and program policies and develop new policies as needed relating to program implementation and liability

O X O O Set up and maintenance (see Appendix C & D)

Complete the appropriate documentation.

X X X Approved staff trainers complete a training checklist, with each new participant

X X X Approved staff trainers complete appropriate follow-up paperwork for each returning participant – either Received Naloxone Evaluation OR Given Naloxone Evaluation + any review of the training content upon refilling their kit.

X X X Designated representatives from each agency will collect and

submit outcome data according to MOHLTC requirements (see Appendix H) to PPH via email on a quarterly basis, specifically on April 1, July 1, October 1, January 1.

Designated POPP Steering Committee representative will complete and submit quarterly reports to MOHLTC

Store data and records securely. X X X Store completed paperwork in a secure, locked cabinet, until it is given to designated staff for input into broader program tracking database

Order and store kit materials from Ministry of Health & Long-term Care.

X Complete order form and submit (see Appendix G)*Order for Naloxone and kit supplies must be simultaneous

X Receive and store Naloxone according to Policy & Procedure in Appendix D

EvaluationConduct post-session process evaluation for trainers and general information sessions.

X X O X Print copies of evaluation have available at training Give to participant to complete Collate and store completed forms Compile results to be included in Quarterly reports

Advocate for a community outcome evaluation with community partners

O X

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H. Reporting Requirements.

According to the Agreement for Naloxone and the supplementary Provincial Naloxone Distribution Program Guidelines, POPP is required to comply with the ministry’s reporting requirements, which include the completion and on-time submission of the Provincial Naloxone Distribution Program: Quarterly Reporting Form (see Appendix H). The ministry may require additional details pertaining to the submitted quarterly form and failure to submit could result in suspension of the ability to order naloxone and supplementary supplies.

PPH will be responsible for the completion and submission of this reporting form on behalf of the POPP collaborative partnership. In order to ensure that the quarter reports reflect the activities of the collaborative partnership, “quarterly reporting” will be made a standing agenda item for the “Overdose Prevention Steering Committee” and meetings will be scheduled accordingly so that all partners have the opportunity to contribute feedback to the quarterly reports.

I. Funding.

Staff time to implement POPP will be an in-kind contribution by the partner agencies and will be directed by the capacity available at each partner agency. Funding for program materials outside of what is provided at no cost by the Ministry of Health and Long-Term Care will be determined on an ad hoc basis via the Overdose Prevention Steering Committee.

J. Confidentiality

Client confidentiality will be maintained according to the policies and professional standards of each agency.

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This Memorandum of Understanding for the Peterborough Overdose Prevention Program is the complete agreement between the signing agencies below, and may be amended only by written agreement signed by each of the parties involved.

PARN, Your Community AIDS Resource Network

Authorized Official: _____________________________ _______________________________________Printed Name Signature

_____________________________ ______________________________________Title Date

Telephone(s): ________________________________

E-Mail Address: ______________________________

Peterborough Public Health


_____________________________ ______________________________________Title Date

Telephone(s): ________________________________

E-Mail Address: ______________________________

Peterborough Drug Strategy


_____________________________ ______________________________________Title Date

Telephone(s): ________________________________

E-Mail Address: ______________________________

Four Counties Addiction Services Team


_____________________________ ______________________________________Title Date

Telephone(s): ________________________________

E-Mail Address: ______________________________

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Appendix A - Ministry Memo announcing Naloxone Distribution Program and Eligibility

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Appendix B – Peterborough Overdose Prevention Program Logic Model

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Appendix C – Minimum Policy/Procedure Content for each Agency to Adopt and Follow

Peterborough Overdose Prevention Program – Implementation & Dispensing of NaloxonePOLICY _________ is a collaborating partner of the Peterborough Overdose Prevention Program (POPP), which is an approved site of the Ontario Naloxone Program administered by the Ministry of Health and Long-Term Care (MOHLTC).

______ is committed to implementing the POPP according to the terms & conditions of the signed agreement for Naloxone with the MOHLTC and supplementary local Memorandum of Understanding.

Staff employed by ________ will be identified to become a designated trainer of the POPP by agency representatives sitting on the Steering Committee for the POPP, subject to approval by their supervisor.

PROCEDURETo become a designated trainer, these identified staff must complete approved training which involves:

A. Attending an initial group training session (mandatory)B. Completing a review of a resources list (mandatory)C. Completing a mock session (as needed)D. Completing an initial session with a participant, with an existing designated trainer

present and/or having the session recorded for review (as needed)

As the POPP changes/evolves, all trainers will be kept up-to-date and be provided with additional training as needed. Materials are available for all trainers in a collective dropbox folder, which may be accessed at: (link removed)

Once approved as a designated trainer of the POPP, these staff will be responsible for:1. Identifying individuals who are

a. Eligible, i.e. are those for whom Naloxone is indicated, and b. Willing to participate in the program, i.e. have given verbal consent.

2. Providing approved education and skills practice for preventing, recognizing and responding to an opioid overdose

3. Completing appropriate documentation4. Dispensing Naloxone kits, which include:

a. 2 single dose ampoules of Naloxone Hydrochloride 0.4mg/ccb. Zippered casec. 2 retractable syringesd. Glovese. Alcohol swabsf. Vial breakerg. Educational card

5. Upholding confidentiality at all times6. Upholding fidelity of training content7. Reporting to relevant Steering Committee member representing ______ (agency)

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Agency representatives on the POPP Steering Committee will be responsible for keeping up-to-date information about each approved designated trainer, including tracking their status as a trainer. This involves documenting appropriate information in a timely manner in a collective tracking document housed on dropbox, which may be accessed at: (link removed)

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Appendix D – POPP Collective Policies & Procedures

Ordering Naloxone and Complimentary SuppliesPOLICY Naloxone and all complimentary supplies for use as part of the Peterborough Overdose Prevention Program will be ordered according to the Ontario Naloxone Program Guidelines by Peterborough Public Health (PPH), following the MOHLTC’s quarterly schedule. Naloxone & complimentary supplies will be ordered through the Ontario Government Pharmaceutical and Medical Supply Service (OGPMSS).

Each partner agency will maintain a minimum stock supply of materials and submit requests for refills to Peterborough Public Health as needed. For the purposes of the POPP, a minimum stock supply of materials is defined as 10 kits.

PROCEDURE – Between POPP Partner AgenciesRequests for refills will be made by contacting the designated PPH representative.

When the requested supplies are ready, the PPH designated representative will inform the requesting agency/agencies and designated representative from those agencies will arrange a pick-up. Upon pick-up, requesting agencies will sign a log that indicates they received the requested supplies.

Naloxone Storage and TransportPOLICY To ensure the integrity and safety of Naloxone and complimentary supplies, _______ will comply with the following procedure guiding the storage and transport requirements set out by the Ministry of Health and Long-Term Care and product needs.

PROCEDUREStorage:Naloxone and complimentary supplies will be stored in a designated secure location in the ____________ (e.g. Peterborough Public Health (PPH) Sexual Health Clinic). Refrigeration is not required.

Naloxone and complimentary supplies will be assembled upon arrival to Peterborough Public Health (PPH) and will each contain:

- 1mL retractable syringe (x2)- Alcohol swabs (x4)- Pair of size large gloves- 1cc dose of Naloxone (x2)- Cap snapper (x2)- Amp Snapper (x2) – to house Naloxone vials in kit before use- 5 Steps foldable card- All housed in a zippered case

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Transport:Assembled kits containing Naloxone and complimentary supplies will be transported by a designated POPP representative. In the instance that Naloxone will be dispensed at a site that is not the designated space as identified above of ______ (agency), it must be transported by a designated trainer of the POPP. For example, when a designated trainer has arranged to meet a participant in a space other than the agency (i.e. outreach).

Any Naloxone that is not dispensed when taken offsite will be returned to the designated secure location in ____________ (same location at agency as indicated above). In the case where a session runs to the end of the work day offsite, the Naloxone must be stored in the secure location at room temperature and remain in the possession of the designated trainer until such time it can be returned safely.

Reporting Requirements as Ontario Naloxone Program SitePOLICY ___________ (agency) will contribute to the collective reporting requirements of the Peterborough Overdose Prevention Program set by the Ministry of Health and Long-Term Care.

PROCEDUREA representative from each agency named in the MOU will be responsible for collecting all documentation from all approved designated trainers of the POPP at their respective agencies and submitting collated data in a timely manner to Claire Hanlon. Data submitted will align with the reporting requirements of the MOHLTC as indicated on the quarterly reporting form in Appendix H of the MOU.

A representative determined by the POPP Steering Committee (ideally the same individual who orders supplies) will complete the required reporting form titled Provincial Naloxone Distribution Program: Quarterly Reporting Form (link removed). The POPP Steering Committee will review and contribute content to these reports at quarterly meetings. Following each quarterly meeting, the designated representative will then submit completed reports on-time via email to:

Fiona Sellars, Program Analyst, [email protected] & Hepatitis C Programs, MOHLTC,

5700 Younge Street, 5th Floor,North York, ON, M2M 4K5.

The MOHLTC may require additional details pertaining to the submitted quarterly form. Failure to submit may result in suspension of the ability to order naloxone and complimentary supplies

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Appendix E –Training Process and Content for Becoming a POPP Designated Trainer

Process1. Attend group training session (mandatory)

a. Involves a PowerPoint presentation and skills practiceb. Includes handouts: slides, resources list, and one hardcopy of each form

2. Complete review of resources list (mandatory)a. PowerPoint slides for participants - electronicb. Video resources

i. Eyes Wide Openii. 911 Naloxone

iii. PDS – Context iv. PDS – 5 Stepsv. PDS – What is an Opioid Overdose?

vi. Continuous Chest Compression CPRc. Review Paperwork, including forms and policies/procedures

3. Complete a mock session with existing trainer acting as a participant (as needed)4. Complete an initial session with a client, with existing trainer sitting in and/or record the session

for review (as needed)5. Complete Trainer Orientation Checklist and submit to designated agency representative for

tracking purposes. Designated agency representatives will maintain up-to-date approved trainer list and email listserv.

*As the POPP changes/evolves, all trainers will be kept up-to-date and be provided with additional training as needed.

ContentAll materials are located in a “Trainer Hub” folder on dropbox, which may be accessed at: (link removed)

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Appendix F - Training Process and Content for POPP Participants

Process – NEW Participants1. Determine an individual is eligible and willing to participate in overdose prevention training.2. Complete training checklist with each individual, including practice components

a. Each section of content is mandatory unless highlighted in blueb. Blue sections are supplementary videos, but DO NOT replace:

i. verbal delivery of the information (can use PowerPoint slides as a supplement to this as well), AND

ii. actively practicing the 5 stepsc. For practice components, use materials is blue tubs (orange balls, syringes, water vials,

alcohol swabs or other preferred vial breaker, compression manikin)i. Dispose of used materials in sharps container.

d. Store completed paperwork in a secure, locked cabinet and submit to designated supervisor as training completed.

3. Dispense kit

Process – RETURNING Participants1. Determine reason for individual requiring a refill (expired, administered on another, was

administered on them)2. Complete appropriate paperwork depending on answer to number 1

a. If expired: i. Complete a training refresh

ii. Dispense refill kitb. If administered to another:

i. Complete form Naloxone Administration Evaluation – for administrators of Naloxone

ii. Check-in about support needed –make referrals as appropriateiii. Complete a training refreshiv. Dispense refill kit

c. If administered to themselves:i. Complete form Naloxone Administration Evaluation – for receivers of Naloxone

ii. Check-in about support needed –make referrals as appropriateiii. Complete a training refreshiv. Dispense refill kit

3. Store completed paperwork in a secure, locked cabinet and submit to designated supervisor as completed

ContentAll materials are located in a “Trainer Hub” folder on dropbox, which may be accessed at: (link removed)

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Appendix G – Materials Order Form

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Appendix H - Ministry Quarterly Reporting Form

Provincial Naloxone Distribution ProgramAIDS and Hepatitis C Programs

Ministry of Health and Long-Term Care

Quarterly Reporting Form

Org. Name: Date Submitted:

Contact: Email: Tel:

Key Outcomes for the Quarter

Outcome NumberNumber of clients trained in opioid overdose prevention, who were not trained to administer naloxone

Number of clients trained to administer naloxone

Number of family and/or friends of clients trained to administer naloxone

Number of overdose prevention kits (including naloxone) distributed to clients

Number of clients who administered naloxone, including how many doses were given per overdoseNumber of clients who reported receiving an injection of naloxone, including how many doses were received per client

Number of times that 911 was called when naloxone was administered or received

Number of naloxone refills, including number of vials per refill

Please provide any information you feel is important to report regarding successes or challenges in regards to your naloxone distribution program.

Due Dates: July 15, October 15, January 15, April 15

Your reporting form may be submitted electronically (preferred) to: [email protected] you not be able to submit electronically, you may submit via fax to Fiona Sillars at: 416.326.6413.

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