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Nurse managers occupy a critical position in leading change on the front line of patient care. They are often recruited from clinical roles and possess a wealth of expertise in providing quality client care. However, novice managers often receive insufficient professional development for their complex roles and require support to obtain leadership and management competencies to function successfully. An internship training initiative was created to support graduate nurses interested in management roles to develop necessary skills for success. The initiative focused on an Individualized Role Development Plan guided by a management competency framework and a robust mentorship model that leveraged support from a network of experienced organizational leaders. This paper examines one nurse manager intern's experience in developing both management competencies and mobilizing mentorship support for personal resilience in a mental health and addictions setting.

Mental health and addictions services are integral to Canada's healthcare system, and yet it is difficult to recruit experienced nurse leaders with advanced practice, management or clinical informatics expertise in this field. Master's-level graduates, aspiring to be mental health nurse leaders, often lack the confidence and experience required to lead quality improvement, advancements in clinical care, service design and technology innovations for improved patient care. This paper describes an initiative that develops nursing leaders through a unique scholarship, internship and mentorship model, which aims to foster confidence, critical thinking and leadership competency development in the mental health and addictions context. The "Mutual Benefits Model" framework was applied in the design and evaluation of the initiative. It outlines how mentee, mentor and organizational needs can drive strategic planning of resource investment, mentorship networks and relevant leadership competency-based learning plans to optimize outcomes. Five-year individual and organizational outcomes are described.

Clients with substance use disorders access care in all areas of the health care system, yet the Canadian nursing literature lacks content on the knowledge, skills, and judgment needed by nurses who work with this population. To address this literature gap, two Advanced Practice Nurses adapted the Canadian Centre on Substance Abuse's Technical Competencies for Canada's Substance Abuse Workforce to include nursing content and theory. This article describes the adaptation process and validation method used by the Advanced Practice Nurses at a large, Canadian urban teaching hospital and includes discussion about actual and potential opportunities for practical application of the adapted framework.

The impact of substance use disorders on the Canadian healthcare system is large, contributing to high use of hospital resources. At the Centre for Addiction and Mental Health (CAMH), Canada's largest mental health and addictions academic teaching hospital, substance use disorders constitute the primary diagnosis of 31% of annual inpatient admissions. Clinical nurse specialists (CNSs) with expertise in addictions are ideally prepared to promote competency development among baccalaureate-prepared nurses who are caring for this population. Despite recent advocacy to advance the addictions nursing workforce in Canada, recruitment of graduate-level CNSs in this field remains a challenge owing to a shortage of candidates with addictions expertise. Healthcare organizations specializing in substance use treatment must use innovative professional development strategies to foster nursing leadership that addresses the complex needs of this clinical population. In this paper, we describe the implementation of an innovative competency-based professional development framework designed to build capacity of CNSs at CAMH.

Individuals experiencing their first psychotic episode report rates of substance and tobacco use that are higher than observed in the general population. In this sample of individuals diagnosed with first episode psychosis, rural/non-rural variations in substance use and smoking behaviour were evaluated. Analyses were performed utilizing data from a sample of individuals enrolled in early intervention programs located throughout the province of Ontario. Based upon population density, two geographical regions were developed: rural and non-rural. Illicit drug use, alcohol consumption, and smoking behaviour were assessed. The total sample consisted of 152 individuals experiencing their first episode of psychosis. Of these individuals, 82 and 70 resided in rural and non-rural areas, respectively. Rural vs non-rural residence was not significantly associated with substance or tobacco use. Regardless of geographical location, early intervention programs for individuals experiencing their first psychotic episode need to incorporate interventions that address substance use.

Community mental health services benefit from measuring clinical outcomes relevant to a community-based context in contrast to medically modeled outcomes. The Multnomah Community Ability Scale (MCAS) addresses broad dimensions of community functioning and was developed for clinical and evaluation purposes. We assessed the structural consistency and fit of the scale as a measure of community functioning through confirmatory factor analysis using a longitudinal sample of individuals (n=408) with severe and persistent mental illness receiving services from community mental health programs. None of the previously hypothesised factor solutions achieved a good fit and a high degree of invariance over time was observed. Through exploratory factor analysis, the possibility of alternative solutions was explored. After exclusion of two of the 17 items, four models--including four-, three-, two- and one-factor solutions--were tested for fit and invariance with no improvement. We discuss our findings of poor fit under the assumption that the MCAS should psychometrically behave as a scale. Alternative interpretations for the tool and suggestions for the use of its items as an index that measures aspects of disability are proposed.

Abstract: Fidelity measurement is an evolving field in mental health case management program evaluation. This article presents an exploratory study in which two separate fidelity measures, the Dartmouth Assertive Community Treatment Scale (DACTS) and the Key Component Profiles (KCP), were used to assess structure and process elements of three mental health case management programs. The programs were studied because they all provided services to seriously mentally ill inner city populations and shared a common context for practice. However, one program followed the Assertive Community Treatment (ACT) model, the other two were Intensive Case Management (ICM) programs, and one of the ICM programs formed a significant partnership with a home care agency for service delivery. The extent to which the DACTS and KCP were able to measure the structure and process similarities and differences of the programs is examined. The results provide information for evaluators on the possible strengths and limitations of each fidelity tool in differentiating various elements of the case management models and reinforce the importance of assessing program fidelity from a multi-dimensional perspective.

Mental health reform, health services restructuring and changes in mental health legislation have resulted in a shift from hospital-based to community-based treatment for individuals with serious and persistent mental illness. A system-wide response to this trend has been the implementation of interdisciplinary Assertive Community Treatment (ACT) teams in the province of Ontario. The need for efficient, cLient-centred versus discipline-centred community care has prompted ACT teams to challenge traditional scopes of practice. This paper describes the Oral Medication Administration Guidelines Project as a mechanism for facilitating innovative team-based work design for oral medication administration in the community. The resulting provincewide guidelines can assist interdisciplinary ACT teams to design relevant training, improve work efficiencies and implement policies and procedures to manage client risk in relation to oral medication administration in the community.