A First Episode Psychosis (FEP) is one of the most frightening and disabling experiences from which a young person can suffer. Onset occurs in nearly all cases in youth and emerging adults (YEA), a crucial transition time, when major developmental milestones (high school graduation, first intimate relationship, maturation of executive function) occur. An FEP typically occurs in the context of diagnoses of schizophrenia, schizoaffective disorder, substance-induced psychosis, and psychotic bipolar disorder, which when taken together are the most disabling disorders (among all medical illnesses) for YEA.

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Implementing the ‘NAVIGATE’ model of care in Ontario aims to help youth and emerging adults (YEA) suffering from a first episode of psychosis (FEP). Although Ontario already has early psychosis intervention (EPI) programs, our team’s recent work has identified major challenges of delivering coordinated care, particularly those elements of care that enhance recovery. These challenges also exist nationally and internationally. By building on the already existing EPI community of practice through the Early Psychosis Intervention Ontario Network, we will implement NAVIGATE with the help of CAMH’s Provincial System Support Program facilitators.

 

The use of tele-videoconferencing through ECHO Mental Health Ontario, and the processes and protocols that ECHO use provide us with an opportunity to ensure sustainability. Using health administrative data held at the Institute for Clinical Evaluative Sciences (ICES), we can examine system-level outcomes, including hospitalizations, emergency department visits, and outpatient physician visits of YEA suffering from a FEP who are treated with NAVIGATE compared with those treated in EPI programs without NAVIGATE and those who are not treated in EPI programs. In addition, we can also evaluate health care costs. Prior to initiating this project, we obtained the input of YEA with an FEP and family members. We will also continue to measure engagement across the study.

 

This work fulfills the innovative clinical trial mandate through its implementation and measurement plan, along with the strategy for patient-oriented research through the involvement of patients, family members, and policy makers as equal partners.