A total of 41 service providers participated in the four workshops, their characteristics are shown in Table 1. Briefly, participants represented a diversity of health professions, primarily counseling/social work (46%), nursing (16%), and peer support/navigation (16%) and worked in integrated youth services (46%), community health (36%), or outreach settings (33%). The most frequent types of substance use services/treatments provided to youth included psychotherapeutic interventions (74%, e.g., motivational enhancement therapy), harm reduction (74%), and screening or early intervention (61%).

Table 1 Characteristics of service provider participants in the four community-based workshops* (n = 41)Overarching empathy and needs themes

The multi-site qualitative analysis led to the identification of three overarching themes (Fig. 1) that provide an in-depth understanding of service providers’ experiences delivering youth opioid use services and needs for improvement. Across the four communities, there was a strong point of connection in service providers’ primary goals to respond to youth in a timely and appropriate manner. However, this goal was met with significant intra- and inter-organizational barriers. To overcome these barriers, participants prioritized intra-organizational opportunities, such as professional development and flexibility in their roles, and stronger inter-organizational knowledge and collaboration between agencies and professionals. Ultimately, higher systems-level limitations shaped these organizational needs and service providers’ ability to meet their goals. As expressed by one participant, “in a big system, I always felt defeated. The system always undermined what I was trying to do as an individual” (Participant 3, small group 1, Prince George). Systems-level innovation to address these needs included increased capacity for services, innovations in youth-specific best practices, and comprehensive support for youth and families/caregivers.

Fig. 1

Overarching themes for improving the delivery of opioid use services/treatments for youth

Responding to youth in a timely and appropriate manner

Across the four communities, service providers’ primary goal was to provide youth with services/treatments that best respond to “what the youth wants and their circumstances” (Participant 2, small group 2, Victoria). Participants in Kelowna and Vancouver specifically described working with youth who have complex needs (e.g., pain, concurrent stimulant use, mental illness, cognitive impairements, homelessness), which meant that they were trying to match services to “the most bothersome thing for them at the time” (Participant 3, small group 2, Vancouver) while also focusing on youths’ imminent safety due to the toxic drug supply.

Participants discussed how service environments were not tailored to youth who use drugs. This included a lack of service settings that are inclusive for diverse youth, including Indigenous youth and 2SLGBTQIA + youth, as described by service providers in Prince George and Victoria. Critical obstacles to meeting youths’ needs also included treatment policies and procedures that were not realistic for youth (e.g., the unrealistic focus on abstinence) and the limited availability of services when referrals were made or in moments when youth were open to engage. Service providers described having to “compromise” in relation to the guidelines and contructs of their professional practice that affected their ability to provide client-centered care. As expressed by this participant, this was difficult to navigate, particularly when youths’ safety might be at risk.

“… how can I get creative with the situation while still providing safe care within these guidelines and this construct that I have to practice in? And how can I like think outside the box and still create a solution, but still, you know, follow the boxes and things that I need to click?…There are certain things that I need to make sure to happen and sometimes it's difficult to creatively get outside of that box and still make those things happen.” (Participant 4, Kelowna).

Without youth-tailored environments, service providers discussed how youth may disengage from services, and thus, aimed to establish good rapport and positive relationships to encourage feelings of safety, decrease shame and stigma, and encourage youth to return. In doing so, they used several different strategies, such as offering bus tickets and food, showing unconditional support, and applying strengths-based techniques.

“I’m trying to build a relationship so that they keep coming back. Because there's not actually a lot that like draws youth to our space, other than like needing supplies and like gear, so some of them will just come and get stuff and then like go, and so I’m trying to build a relationship, so they'll come and seek me out”. (Participant 5, small group 2, Victoria).

To improve service availability, participants prioritized a wider range of “youth-specific services along with a continuum” (Participant 1, small group 3, Vancouver), which included drug checking, safe supply, harm reduction approaches within treatment centres, more MOUD options, interventions for youth using stimulants (e.g., amphetamines), detox and residential treatments, and culturally safe and relevant options that are Indigenous-led. Participants also prioritized improved treatment accessibility through reduced waiting times, longer operating hours (e.g., weekend hours), and transportation between and within communities. Lastly, providers identified the need for safer and more private service delivery environments and opportunities for “the client [to] inform the provider, it's not like the provider's the expert”. (Participant 3, small group 1, Prince George).

Intra-organizational support and inter-organizational collaboration

Participants in each community described encountering organizational silos and poor communication between individual service providers. These challenges resulted in wasted time and resources, inconsistencies between providers, limited trust and confidence in service partnerships, and poor care continuity. As expressed by this participant:

“Physicians have very different prescribing practices…I shadowed at the needle exchange for an afternoon at their OAT [opioid agonist treatment or MOUD] clinic and I found our approaches were quite wildly different, but it was good to know when you're talking to a client, like ‘this is what to expect over here, like this will meet your needs in a way we can't or vice versa’”. (Participant 1, small group 2, Prince George).

Accordingly, participants identified the need for streamlined communication between different service providers and agencies who may be working with the same youth, which would improve youths’ interprofessional support system and handoffs and transitions between providers. This was also identified as a way to encourage resource sharing and fill the gaps they faced with limited organizational supervision and training in best practices.

“If there was some sort of opportunity with interagency case planning… I’m working with a youth right now who yeah has lots of support services, like has a worker, has me, has another outreach worker, social worker, counselor and trying to get them into treatment and we're all like calling, like all four of us are e-mailing the social worker about the same thing and it's just madness. It's inefficient and it's defective”. (Participant 2, small group 1, Victoria).

Within their own organizations, participants discussed time as a major limitation in their ability to build relationships with youth and respond to their needs (e.g., no time to do outreach, provide culturally relevant services), to keep informed on best practices and new services, and for their own self-care. A few participants from Kelowna also noted that it was sometimes unclear how to best coordinate services across different members due to the lack of role clarity. In Vancouver specifically, participants highlighted that there were not enough staff to meet high workload demands due to unaffordable housing options, which caused providers to move away from areas where services were desperately needed or to hold multiple jobs, further contributing to their burnout. Participants also uniquely described feeling immense anxieties about youths’ lives due to the “life or death situation” (Participant 2, small group 3, Vancouver) and the challenge of working within a risk-averse system.

Thus, service providers across the four communities emphasized the need for more support from clinical supervisors/managers and encouragement from their team members for their own mental wellness, as well as less organizational pressures and flexibility in their roles to do what is clinically beneficial.

System-level innovation

At a systems-level, participants focused primarily on the need for improved navigation of services and increased capacity for local service delivery. These needs intersected with participants’ goals to respond to youths’ needs in the moment and the intra-organizational silos that were encountered. Thus, service providers identified the need for a “centralized intake point so we can see what services are available, what the wait list looks like, and what are the inclusion, exclusion criteria, so we're not wasting a bunch of time, that's an inefficiency, like huge” (Participant 1, small group 3, Victoria). Participants also emphasized the need for a provincial clinical records systems to access, with youths’ consent, to improve service continuity.

Additional sub-themes were identified within each community that were distinct to their local context. In Victoria, participants urged for “more beds, more housing, more outreach workers” (Participant 1, small group 2, Victoria). This need rested upon the significant waiting lists encountered when making referrals, and youth having to travel outside their communities for services (e.g., to Vancouver) or to local neighborhoods they were trying to avoid.

In Vancouver, participants stressed that the lack of “coordinated system-level leadership” to the youth opioid crisis underpinned their organizational and individual-level needs. In these discussions, service providers drew comparisons to other chronic conditions or past crises where there was strong leadership that resulted in significant advancements in prevention, treatment, and research:

“From a systemic perspective, there's a lack of leadership. For perspective, when the HIV crisis was happening there was like a cause and how to get there and leadership and you have that a little with the opioid crisis but not anything specific to youth. And so, because of that, everybody is just working from such saddled approaches maybe and then I think you need something to channel it a little bit more and get it out there. So, I think there's no leadership in this crisis, especially for youth. And who is going to take that leadership role? I don't know because we're constantly just putting out fires and not responding to the actual crisis itself.” (Participant 4, small group 1, Vancouver).

Meanwhile in Prince George, service providers described the drug toxicity crisis as being relatively recent in this region of the province, which included remote communities. This led them to prioritize a wider distribution of information about opioid use, services, and MOUD to better reach youth, families/caregivers, and service providers across this large geographic region. In contrast to the other communities, this experience also resulted in their unique emphasis on best practice standards being locally relevant and feasible:

Participant 1: I'd like to know more just what the best practices look like… cuz there's guidelines and things that have been put out and it all looks good on paper, but it's not necessarily feasible.

Participant 3: Or I’ve been doing a lot of research into best practices and a lot of times, they're a couple years old, but that's the most recent thing… Or it's from Ontario, is that even relevant to us? Right, so where are the best practices coming from and do they make sense in that context?…[And] whose job is it to keep us up to date? Like are all of us individually supposed to keep up on our desk when we can or should someone in the province be educating us on what we should be implementing for best practice? (Small group 3, Prince George).

Finally, in Kelowna, participants’ system-level needs focused on a wider acceptance of harm reduction. This need arose when reflecting on the impact that stigma and abstinence-focused approaches have on youth and how harm reduction education in schools, hospitals, and the wider community could lead to earlier intervention and prevention of opioid use.

Ideas for improving the delivery of youth opioid use services and treatments

Across communities, a total of 209 individual ideas were brainstormed to address service providers’ prioritized needs. The ideas for each need theme were summarized are shown in Table 2, along with representative examples and the relevant community(ies). Eight solutions themes were identified to address the need to respond to youth in a timely and appropriate manner. All communities identified a need to expand service delivery locations and engage youth in service planning and monitoring, which had the highest number of individual ideas. The remaining ideas were specific to Victoria and/or Vancouver, including programs that incorporate recreational activities, and specific interventions for youth using stimulants.

Table 2 Service providers’ ideas for improving youth opioid use services/treatments by overarching needs theme

For the overarching need to improve intra-organizational supports and inter-organizational collaboration, the most frequently referenced ideas focused on activities or events that could promote providers’ knowledge of other resources in their community. Examples included regularly distributed newsletters about different organizations, tours of other agencies, social networking sites for service providers to share information, and local conferences bringing all youth service providers together. Several ideas about how to promote service providers’ competencies were also identified, primarily focused on communities of practice, and other unique ideas including book clubs for staff and shadowing opportunities at other clinics. A smaller number of ideas revolved around improving inter-organizational collaboration, such as integrated case management, interagency partnerships to facilitate group-based services, and developing protocols that outline collaborating organization’s roles.

For the overarching system-level innovation need, there was greater variation across the communities in the patterns of ideas themes. In Victoria and Vancouver, many ideas focused on how the system could develop the infrastructure to increase local service/treatment capacity, such as increasing provincial funding allocation through fundraising or re-allocating taxes towards youth housing and services. Additionally, system navigators, integrated services, and provincial service directories/databases were brainstormed to create clearer service pathways. In Vancouver specifically, different types of youth-specific standards (e.g., indicators of success, inclusion and exclusion criteria for services) were identified as solutions to operationalize youth-specific best practices. Meanwhile, universal referral forms and shared consent forms were identified in Prince George and Victoria to reduce unnecessary red tape when accessing services/treatments.