In Attendance: Aristotle Voineskos, George Foussias, Janet Durbin, Patrick Mitchell, Sarah Bromley, Joanna Henderson, Nicole Kozloff, Melanie Barwick, Eva Serhal, Lillian Duda, Juveria Zaheer, Alexia Jaouich, Claire de Oliveira, Sophie Soklaridis, Jean Addington, Josette Morin, Erin Kennedy, Krista Whittard, Sheila Gallagher, Catherine Ford, Simone Dahrouge, Rebecca Oliveira, Sara Traore, Hugh Johnston, Mary Hanna, Kelsey Jones, Nandini Saxena, Dayna Rossi, Suzanne Zerger, Christine Mitchell, Dielle Miranda, Janaki Joshi, Chelsi Major
Main Discussion Points
REB/Contracts
REB approval from CAMH, North Bay, and Niagara (conditional approval from Durham). Partial execution of North Bay contract (Niagara and Durham pending).
Communication among Committees
Communication between the Steering Committee and the Operational Committees needs to be reciprocal. Steering Committee has the responsibility to engage all committees. Reporting to be standardized to lift burden off of lead representatives. Committees should have agency within themselves to make decisions which would then be reported. Important that the Operational Committees have clarity around the issues that are brought up to the Steering Committee
Frequency of Committees
Committees should meet periodically, at least monthly, bi monthly, or weekly.
Youth/Family Advisory Committee
Introductory meetings have commenced. Need more representation from the sites. Youth/family members to engage site staff during in-person training.
Training Experts
Pre-training calls are coming to a close. In-person training scheduled for Feb 13th – 15th. Post-training support calls are in the planning process. Krista Whittard (Niagara lead) suggested a broad overview of the whole NAVIGATE model would be useful to her staff. Working towards identifying gaps with the U.S. version of NAVIGATE to cater it to our needs.
PSSP
Implementation landscape interview to be scheduled after the in-person training. Fidelity Reviews are underway with chart reviews and staff interviews.
ECHO
Planning of ECHO sessions are underway, starting monthly sessions July 2019 then as NAVIGATE support calls taper off, ECHO is to become more frequent.
Web Portal
Developed as a repository for project content, resources, and scheduling to streamline information sharing. Reduce email burden and use as a sustainable resource.
Scientific Steering Committee
The need to consider publishing the protocol of the grant. Ways to monitor our process overtime, decisions before the 4 years are completed.
Action Items:
Governance
Develop a policy around delegation of the Steering Committee (if the chair is absent) – Steering Committee
Standardized committee reporting to decrease the responsibility burden of lead representatives – Steering Committee
Committees need to decide frequency of meetings – All Committees
Rebecca Oliveria to be listed as part of the service measures and outcomes committee – Chelsi
Add Catherine Ford to the Steering Committee for ministry representation – Chelsi
Youth/Family Advisory
Coordination of family/youth members to speak to site clinicians regarding committee membership at in-person training – Chelsi/Nadia
Implementation Committee
ECHO team to work in a brief update during in-person training – Eva/Sanjeev
Web Portal
Potential documentation of process or minutes from the different committees to be accessed on the portal – Chelsi/Nadia
Scientific Steering Committee
Consideration of publishing the protocol – All Members
Minutes:
What is happening and what is to come:
Had the EPI-SET Launch in Oct 2018. Was a great opportunity to meet the team and learn about the contributions of every stakeholder involved
Currently having pre-training calls with the sites
NAVIGATE in-person training will be taking place over 2.5 days from February 13-15, 2019 in Toronto
NAVIGATE Booster Training calls to take place over 6 weeks from February-March 2019 between sites and CAMH clinicians to develop and practice NAVIGATE skills prior to project implementation
NAVIGATE Implementation in Spring of 2019
REB/Contracts
REB approval from CAMH, North Bay, and Niagara – completed Oct/Nov 2018
Conditional REB approval from Durham – January 2019
Contract signed from North Bay (partial execution)
Durham and Niagara contracts still pending (Niagara to finalize by the end of the month)
Received funding in May and moving quickly with the REB and the contract process -- Thank you to the sites for contributing to helping us out
New Members
1. Youth Advisory Recruitment (5 total members):
2 CAMH members - Sara Traore
1 Niagara member - Coulson Bodogh
1 North Bay member - Matthew Marquis
1 Durham member - Jenell Hogg
1 Lead Representative - Augustina Ampofo
2. Family Advisory Recruitment (4 total members):
1 CAMH members - Hugh Johnston
1 North Bay member - Nicolle Plante-Dupuis
1 Lead Representative - Lillian Duda
Hugh’s introduction: has a daughter with psychosis and went through treatment at Slaight Family Centre for Youth in Transition. At this time Slaight was using the NAVIGATE program, which he thought worked well. Hugh’s retired now and very interested in research
Governance Structure
1. The Steering Committee meets weekly since June 2018. It has representation from every committee. There are 7 different committees, and each group has a set time they meet with the intention of keeping minutes and brining action items forward to the Steering Committee. This is brought forward by the representative from that committee (in-person representation). For example Augustina and Lillian who are leads for the Youth and Family Committee. Combining the lead of each group to have discussions in the Steering Committee meeting
2. High level issues?
o Joanna Henderson:
Communication between the Steering Committee and the Operational Committees need to be reciprocal
Important that these Operational Committees have clarity around the issues that are brought up to the Steering Committee. Example: if a committee decides to bring an action item to the Steering Committee, it is up to the Steering Committee to respond to the item and communicate that response back to said Committee.
Importance of the Steering Committee to engage all other committees
Policy around delegation. If the Steering Committee chair is absent and a decision needs to be made instantly, who delegates? – Steering Committee
o Simone Dahrouge:
Supports Joanna’s previous points
Operational Committees should be viewed as added value with direct communication
How does the message go from the Steering Committee to the Operational Committees? One person is tasked with the reporting, although how does the group decide? – It should be standardized, at least something to be written down, as it may place too much of a responsibility for Lillian or Augustina to provide the decisions back to their Committee. –Steering Committee
o Aristotle:
The Steering Committee would reflect the Operational Committees – not the intent for that one person to hold all that responsibility, though we still want to have that representation. Reporting should be done in a standardize way.
The committees should have agency within themselves to make decisions, and then to report those decisions to others. The Steering Committee should not be a bottleneck but viewed as a facilitator.
3. Composition of governance structure
Sent out a copy before and asked those to volunteer into groups although with little feedback.
Made sure it was transparent and reflective of people’s expertise and the grant application
No concerns or changes proposed to committee composition
4. Committee meeting frequency
It is about the flexibility and practically of the work
Some working groups are more front heavy – ie. the Implementation Committee; whereas ICES is more on the back end
Committees should be meeting periodically. At least monthly, bi monthly or weekly depending on the committee
The committees should decide meeting frequency based on certain things that arise, the timelines could vary
Sarah Bromley emailed: - I believe Rebecca Oliveira should be listed as part of the service measures and outcomes committee – she is the clinician delegate who is doing the fidelity evaluations with PSSP – Chelsi
Youth Advisory Committee
Introductory meeting scheduled for the end of January 2019
Has at least one representative from each site.
Wants more representation from the sites
Krista Whittard (Niagara lead) – found a youth that was interested although they were not eligible
On the agenda for the youth to talk in-person/through ZOOM to the sites during the in-person training – Nadia
Family Advisory Committee
Introductory meeting December 2018
Meets monthly – have an understanding of what their roles are and the work to be done. Everyone has a positive outlook and realizes how impactful wrap around care can be
Wants more representation from the sites
Sheila Gallagher (Durham lead) – has informed her staff regarding this
Looking into which day would be best for a family member to talk in-person/through ZOOM to the sites during the in-person training –Chelsi
Implementation Committee
1. Training Experts
Trying to build a sustainable model to continue beyond the grant which will be beneficial for care providers as well
Pre training calls with NAVIGATE trainer – ongoing since November 2018 until January 29 2018.
Krista Whittard (Niagara lead) has had communication with Sarah around orientation of NAVIGATE. Her team appreciates the weekly calls, although a broad overview of the whole model would be useful (might help for the training as well). For those who are not IRT, are confused around what they should be doing – although this will be untangled during the in-person training
Aristotle: Working towards identifying gaps with the U.S. version of NAVIGATE to cater it to our needs.
In person training with all NAVIGATE trainers scheduled for Feb 13th – 15th
Post-training support calls – in the planning process
2. PSSP
Implementation Landscape Interview (Alexia Jaouich): - Developed an implementation plan over what the NAVIGATE model will look like, incorporating the experience Slaight staff had at CAMH - Thus far -- implementation specialists have discussed with the sites their assets and completed a site readiness assessment - Waiting until after the in-person training to complete the implementation landscape interview as the sites are busy with pre-training and fidelity reviews. In addition, staff will have a better picture of NAVIGATE after the in-person training.
Fidelity Reviews (Janet Durbin) - Assessments are underway which will provide a baseline picture of how site staff are delivering care, followed by two subsequent fidelity reviews through the four years. - Using Donald Addington’s tool to see the influence of NAVIGATE to the EPI model. An advantage of that is the high validity and the fact it is used in other EPI reviews across the province. Therefore they are allowed to participate in anything fidelity related in the province. - Chart review and interviews (via the tele-fidelity model) – Mary Hanna and Rebecca Oliveria executing these tasks. - Currently, North Bay and Niagara are going through chart reviews and interviews. On hold for Durham as waiting on REB approval
3. ECHO
Starting to plan the echo sessions – using the NAVIGATE content
Each session is to follow the structure model (30 mins didactic presentation followed by discussion). Sessions run between 1 hour to 1.5 hours
Will start off as monthly sessions (July 2019), although as the post-training support calls with the NAVIGATE trainers taper off, ECHO calls will become more frequent.
ECHO sessions will talk about more complex cases and will be a chance to learn from each other. ECHO is super successful around the province, 8 within CAMH, 18 in Ontario, and 500 going on globally.
Suggestion for the ECHO team to work in a brief update schedule during the in-person training -- Eva/Sanjeev
Web Portal
Developed as a repository for project content, resources and scheduling to streamline information sharing- created November 2018
Emailing was overwhelming with all the sites. Created with the goal to reduce email burden and as a sustainability resource (building out the content and to archive things)
Aristotle – potential documentation of process or minutes from the different committees to be accessed on the portal – Chelsi/Nadia
Scientific Steering Committee
The need to consider publishing the protocol of the grant – All members
Open and transparent – we should put into action what we are doing and then once the outcomes are out there is scientific honestly
The public would have access to the course of the project and what actions are to come
Anyone has views? - Joanna – good idea, being able to articulate the research have a real world content approach - Hugh – seen this with other studies, good idea. We would need to feed it so it doesn’t get lost (the need for updates)
Things you can present to: publications or the public
Ministry – ways to monitor our process overtime, decisions before the 4 years are done - Hugh – what is the time from the patient’s data and actual something pulled together - Aristotle – the first year is for administrative aspects, and the final year is for the conclusions with the outcomes. Primary outcome measures at the last year of the project. Sub projects – generate valuable data for the community - Catherine – importance of monitoring process… having the smaller sub projects would be useful.
Would be helpful to have a ministry person on the steering committee
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