Specific Populations

The CCSA Technical Competencies and Behavioural Competencies provide a foundation for understanding and applying a competency-based approach to hiring, performance management and professional development.

CCSA has identified key considerations relevant to adapting the competencies to working with specific populations. The lists of resources reflect skills, knowledge, attitudes and practices that acknowledge the unique environments, needs, history and contexts of specific populations.

As people who provide substance use services, building respect, trust and safety are critical to developing effective relationships. By expanding your understanding of the diversity of people, competencies can be adapted to develop safe and trusting relationships, individualized treatment plans and service delivery that meet people’s needs.

CCSA has identified competencies for working with the following populations:

  • People who have experienced adverse childhood experiences (ACEs) — Understanding the effects of ACEs is important foundational knowledge for anyone working with people who use substances or are at risk of using substances.
  • People at different stages of development (young people and older adults) — To ensure approaches are developmentally relevant and appropriate, considerations take into account the impact of substances at different stages of human development and the influences of psychosocial factors to emphasize approaches that are developmentally relevant and appropriate.
  • People who are pregnant — Considerations include awareness of the intersecting issues that people who are pregnant and use substances often experience (e.g., fear of judgment and avoidance of prenatal care).

The selection of resources in these web pages is based on the results of literature reviews, environmental scans and consultation with subject matter experts. The lists are not exhaustive, but they are a starting point to adapt and tailor CCSA’s competencies to the needs of the specific populations you serve.

Understanding the Effects of Adverse Childhood Experiences (ACEs)

Negative experiences during early childhood influence the developing brain and impact health across our lives. Adverse childhood experiences (ACEs) such as abuse, neglect and household dysfunction are negative, stressful and traumatizing events that occur before age 18 years.

By interfering with healthy brain development, ACEs can increase the risk for negative health and social outcomes in adulthood. While not everyone who experiences ACEs will go on to have mental health and substance use concerns, research shows a relationship between the number of ACEs experienced and the risk for developing physical and mental health problems later in life, including problematic substance use or a substance use disorder.

This foundational information is a key knowledge competency for anyone working with people who use substances or are at risk of using substances. Understanding ACEs informs prevention and service delivery approaches that are effective, trauma-informed and consider the impacts ACEs may have on an individual’s perceptions and responses to different service approaches. Developing competencies in this area can also help challenge perceptions of substance use and reframe it as a health issue, and may help break intergenerational cycles of trauma.

The relationship between ACEs, brain development and health outcomes is not always recognized by service providers, and this remains a gap in professional training for those working with people who use substances.

The learning resources and tools listed below are intended to help address this gap and were selected based on the results of literature reviews, environmental scans and consultation with subject-matter experts. The list is not intended to be exhaustive but is a starting point to adapt and tailor CCSA’s competencies to the needs of the populations you serve and to advance competency development in this area.

Continued Learning: Understanding the Effects of ACEs Resources

ACEs Basics

ACEs & Resilience Training

Brain Story Certification

Brain Builder Learning Cards 

Brain Story Toolkit

Core Curriculum on Childhood Trauma

Trauma-Informed Practice Guide

Adverse Childhood Experiences (ACEs): Interventions to Prevent and Mitigate the Impact of ACEs in Canada

Champion Toolkit

Childhood Trauma Toolkit: A Resource for Pediatric Care Providers

The Benefits of Incorporating an ‘Adverse Childhood Experiences’ Lens in Social Work Practice [webinar]

Cartes d’information pour les bâtisseurs de cerveaux (French)

Older Adults

Although older adults* use substances less than other age groups, as people age the effects of substances and the risk for substance use disorders may increase. Knowledge and understanding of the physical and social changes of aging, as well as how these changes may be impacted by other factors, such as sex, gender, ability, race, socio-economic status, etc., are important considerations in prevention, screening, assessment and treatment competencies.

Changes in social circumstances, such as the loss of a spouse or partner, independence or employment can result in isolation, loneliness and boredom. Older adults may use substances as a way of coping.

Physical changes of aging or chronic health conditions make older adults more susceptible to the negative effects of drugs and alcohol. This can include interactions with medications, effects on cognitive impairment and mood-related conditions, and be a contributing factor to falls.

Substance use and older adults can be complex when comorbid conditions exist, such as depression, dementia or chronic pain. Substance use may aggravate existing conditions, or existing conditions (e.g., stroke, dementia) may be mistaken for substance use issues. In some cases, safe substance use may provide relief for some health conditions (e.g., cannabis).

Despite the complex needs, the development of competencies for people working with older adults with substance use disorders is lacking. Some screening and assessment components of guidelines related to mental health and older adults include considerations of substance use disorders, but in general there is a need for competencies and education of regulated and unregulated professionals in this area.

Therefore, we have provided general competencies for working with older adults, as well as information to increase your understanding about substance use and older adults in the resources below.

The selection of resources you will find in these pages is based on the results of literature reviews, environmental scans and consultation with subject-matter experts. The lists are not intended to be exhaustive but are a starting point to adapt and tailor CCSA's competencies to the needs of the populations you serve.

*Definition of older adult: People age 55 years and older - the fastest growing subgroup of the population in Canada.

Continued Learning: Working with Older Adults Resources and Articles


A Competency Framework for Interprofessional Comprehensive Geriatric Assessment

Perceptions of Practitioners and Practitioner Organizations about Gaps and Required Competencies for Seniors' Care among Health and Social Care Graduates and Workers

A Guide to Cannabis for Older Adults

Alcohol and Older Adults

Improving Quality of Life: Substance Use and Aging

Introduction to the CCSMH Guidelines on Substance Use Disorders Among Older Adults

Care Pathway for Older Adults Experiencing Prescription Drug Harms

Best Practice Guidelines for Mental Health Promotion Programs: Older Adults 55+


Addressing Treatment and Care Needs of Older Adults Living with HIV Who Use Drugs

People Who Are Pregnant

People* using substances during pregnancy often experience intersecting issues that require knowledge and skills reflecting appropriate evidence-informed approaches, support, and health care that are essential to healthy and successful pregnancy outcomes. For example, people using substances during pregnancy are often fearful of judgment and may avoid regular prenatal care. Those that are racialized, transgender or non-binary may experience multiple forms of intersecting stigma at the hands of healthcare providers. Barriers to seeking and accessing health care have serious health consequences for the pregnant person and the fetus. Service providers should know that substance use during pregnancy may intersect with violence and other health and social concerns, including intimate partner violence, food insecurity, unsafe or inadequate housing, social isolation and experiences of racism. People who are pregnant are often fearful of having their child removed from them if they disclose their substance use to healthcare providers; if the person is First Nations, the likelihood that their child will be apprehended increases.

Care for people using substances during pregnancy requires a multidisciplinary team approach of coordinated wraparound care that addresses the whole person (physical and mental health and social care needs). Care and services best suited to fully meet the needs of a pregnant person:

  • Are culturally and psychologically safe†;
  • Are anti-oppressive and trauma- and violence-informed;
  • Offer free or subsidized childcare;
  • Are low-barrier and offer access to harm reduction services;
  • Support the person or ensure they have safe and affordable housing, and access to nutritious food; and
  • Recognize and value keeping families intact (i.e., not removing children from the care of their parent[s]) for the health and well-being of all family members.

Pregnancy may be a time of high motivation and concern for a person’s health and well-being and offers a unique opportunity for early intervention and support. Uptake of competencies for working with people who are pregnant can support quality care delivery by identifying the supports and resources needed for successful pregnancy outcomes while also validating each person’s unique pregnancy experience.

Information and resources reflecting these considerations are listed below. The selection of resources is based on the results of literature reviews, environmental scans and consultation with subject-matter experts. The list is not intended to be exhaustive but is a starting point to adapt and tailor CCSA’s competencies to the needs of the populations you serve and to advance competency development in this area. The resources below have been reviewed for content relevance. While most reference use gender neutral language there may be some with inconsistent or outdated language.

*The term “people” is used to be inclusive of all people who can become pregnant, including women, transgender men, and nonbinary and gender nonconforming people.

†A psychologically safe environment for people who are pregnant includes using the correct language (i.e., gender-neutral terms) and being inclusive of all genders in discussions about pregnancy and reproductive health

Continued Learning: Substance Use Health Care and Pregnancy Resources and Articles


FIR Model of Care

Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy

Part 1.3: Setting the Stage — Framework for Practice: Motivational Interviewing [video]

Trauma-Informed: The Trauma Toolkit

Provincial Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder Pregnancy Supplement

Pregnancy and Substance Use: A Harm Reduction Toolkit


Care for Incarcerated Pregnant People with Opioid Use Disorder: Equity and Justice Implications

Issue Brief: Pregnancy and Birthing in Jails and Prisons

Young People

Working with young people* requires a clear understanding of developmentally appropriate care, including knowledge of patterns of substance use and the psychosocial context and culture of young people that may influence substance use. The effects of substance use on a developing brain are different than that of an adult. Additionally, sex and gender, and other intersections outside of age are also helpful to understand to offer and provide the appropriate care and service to young people.

Substance use is more prevalent in young people than any other age group (e.g., alcohol, cannabis prescription opioids). Although most young people use substances safely, they also have the highest prevalence of substance-impaired driving as well as heavy episodic drinking.

Service providers working with young people who use substances should be sensitive to potential accompanying factors — such as childhood trauma, suicide contemplation, gender, sex and experiences of racism, discrimination, stigma or bullying — that may arise at this stage of development. In addition, mental health concerns may emerge and are often concurrent with substance use. The earlier the onset of substance use, the greater the likelihood of negative outcomes later in life. Therefore, early detection and intervention are helpful to achieve greater positive outcomes for young people.

Young people can fall into a gap in treatment services between those for children and those for adults when there are high periods of stress as a result of transitions such as transitioning from secondary to postsecondary school settings or from education to work.

Therefore, building capacity and facilitating a young person’s autonomy about substance use, and ensuring there are effective relationships and networking with a range of services is key in keeping young people connected with helping services across their lifespan.

Considerations related to competencies for professionals who work with young people include:

  • Developmentally and culturally appropriate care considering stage of brain development;
  • Attention to psychosocial context (e.g., mental health, gender exploration, suicide prevention, engagement with legal system, homelessness);
  • Best practices that include strengths-based, person-directed and trauma- and violence-informed approaches;
  • Where appropriate, engagement with family members, caregivers and other social supports, including non-human supports (e.g., land-based approaches, companion animal, equine therapies) as requested by the young person; and
  • Informed consent, capacity building, autonomy in decision making, power dynamics and the relationship between the service provider and service user, with the goal of building safe and trusting relationships.

See the resources below for more information on developing competencies related to working with young people and to improve your understanding about young people and substance use.

The learning resources and tools listed below are based on the results of literature reviews, environmental scans and consultation with subject-matter experts. The lists are not intended to be exhaustive but are a starting point to adapt and tailor CCSA’s competencies to the needs of the populations you serve and to advance competency development in this area.

*The terms “youth,” “emerging adult” and “young person” are often used interchangeably to refer to a group of people in transition from the dependent state of childhood to the independent state of adulthood. The United Nations uses the age range of 15 to 24 years to define youth, but this range can be fluid across different organizations. For the purposes of this discussion, we use the UN’s age range and the term young people because of its person-first perspective.

Continued Learning: Substance Use Health Care and Young People Resources and Articles


Healing Families, Helping Systems: A Trauma-Informed Practice Guide for Working with Children, Youth and Families

Workforce Competencies for Youth Mental Health

Substance Abuse in Canada: Youth in Focus

Youth and Alcohol

Youth and Cannabis

Cannabis and the Developing Brain

Substance Use and Immigrant Youth

Taking the Next Step Forward: Building a Responsive Mental Health and Addictions System for Emerging Adults

Starlings Community: Forward


“We Need to Build a Better Bridge”: Findings from a Multi-site Qualitative Analysis of Opportunities for Improving Opioid Treatment Services for Youth

Beyond a Dreamcatcher: Improving Services for Indigenous Justice-Involved Youth with Substance Use Challenges — A Youth-Led Study


Expanding the competencies of people who work in the substance use field to better understand the context of 2SLGBTQ+ people can help decrease inequities in care and reduce barriers for those who seek support.

2SLGBTQ+ people continue to experience discrimination, stigma and minority stress — a term used to understand the excess stress that stigmatized groups experience as a result of their social position. As minority stress relates to 2SLGBTQIA+ people, it “is a specific stress process in which SGM [sex and gender minority] experience a sense of shame, separation, or isolation in response to the stigma attached to their sexual orientation or gender identity.” This minority stress contributes to greater risk of experiencing harms associated with reduced mental health, substance use concerns, increased social isolation, higher risk of financial insecurity and housing vulnerability compared to the general population.

This is particularly true for sex- and gender-diverse youth who are at higher risk of experiencing lower socioeconomic status, violence and housing vulnerability and dying by suicide when compared to their cisgender, heteronormative peers.

The minority stress and social inequities experienced by 2SLGBTQ+ people can be more nuanced and complex if an individual is also a racialized or cultural minority. While this is not in scope for the resources reviewed below, these aspects of individual experience should be appreciated when offering care and services.

The identities and definitions within the umbrella term 2SLGBTQ+ can help someone navigate, validate and better understand their gender and sexual identity and expression, and their connection to this umbrella term starts and stops there. While others may also align strongly with the social and cultural constructs within 2SLGBTQ+ communities, but this is not necessarily the case for everyone Ultimately, a person’s gender identity and sexual identity have both general and uniquely individual considerations that should be recognized and appreciated. While the resources listed below are not an exhaustive compendium, they are a starting point intended to increase knowledge and skills as considerations to expand on CCSA’s Workforce Development Competencies.

The cited resources below contain information and practices that are relevant to 2SLGBTQ+ inclusion in mental health and substance use services. Every individual is unique and has a unique understanding of their gender and sexuality (whether 2SLGBTQ+ or not). By building our knowledge of gender and sexual diversity, critically examining systemic factors like homophobia and transphobia, and introducing inclusive practices into our approach, we can offer more welcoming spaces that will better serve and support 2SLGBTQ+ people who may be experiencing harm from substance use or living with a substance use disorder.

Continued Learning: Working with 2SLGBTQ+ people (General)

Suicide prevention and two-spirited people

Creating Authentic Spaces: A Gender Identity and Gender Expression Toolkit to Support the Implementation of Institutional and Social Change

An introduction to the health of two-spirit people: Historical, contemporary and emergent issues. Prince George, BC: National Collaborating Centre for Aboriginal Health

Sexual minorities and suicide

Transgender people and suicide

Continued Learning: Working with 2SLGBTQ+ people (Health Occupations)

Health equity impact assessment: LGBT2SQ populations supplement

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) mental health: A curriculum for psychiatry residents

LGBTQ2S Inclusion playbook – A series of best practices for healthcare environments

Guidelines for gender-affirming primary care with trans and non-binary patients

National LGBTIQIA+ Health Education Center (A program of Fenway Institute) - Toolkits, publications and webinars for health occupations

Restoring the circle: A training program to support Indigenous 2SLGBTQ+ folks with lived experience of gender-based violence (online course)

Promoting 2SLGBTQI+ health equity – Registered Nurses’ Association of Ontario best practice guidelines

Providing trans-affirming care for sexual assault survivors


Young, queer and trans, homeless, and besieged: A critical action research study of how policy and culture create oppressive conditions for LGBTQ youth in Toronto’s shelter system

New patterns of poverty in the lesbian, gay, and bisexual community

The health of LGBTQIA2 communities in Canada: Report of the standing committee on health

Toronto rainbow tobacco survey: A report on tobacco use in Toronto’s LGBTTQ communities

2SLGBTQI suicide prevention research in Canada: Evidence, gaps, and priorities

Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence

Trends in suicidality among sexual minority and heterosexual students in a Canadian population-based cohort study

Vulnerabilities related to COVID-19 among LGBTQ2+ Canadians

Correlates of suicide ideation and behaviors among transgender people: A systematic review guided by ideation-to-action theory