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Project Team Meeting: May 6, 2019

Updated: Sep 1, 2022

1) Housekeeping Items

a. Thanks for coming/calling in!

b. Moving forward, there will be a once a month entire project team call

  • i. 1st Wednesday of the month, 12-1pm, starting in June

  • ii. If you can’t make it now, that’s ok, maybe over time you can gradually shift to become available at this time

c. The project is moving forward, Navigate training is complete at the sites, everyone has been in touch with their committees regarding the work that is going on/ will be happening

  • i. Some pieces more front-loaded, some more back-end loaded

2) We have REB and contracts complete/executed at all current sites

a. We waited for full approval everywhere so we can send in the same amendments at each site

  • i. Working on submitting the amendment now

b. We got funding a year ago, good work team!

c. One site originally from the grant (Waterloo Wellington) was on pause, because of lots of change at the site

  • i. They are now back onboard and excited to join the project

  • ii. We can learn how we will onboard sites over the course of the project

d. Budget is on track, a bit underspent this year (typical for a grant like this)

  • i. We are very grateful for in-kind support from PSSP/ECHO/sites and site leads and we are actively fundraising as well

e. Web portal – certain tabs are password protected, some are open to the public

3) Implementation Committee – Training

a. Completed the in-person training with Navigate trainers in middle of February, it was well-received

b. Since then, about a 1.5 month gap between in-person training and full roll-out of Navigate at the sites – sites were trialing different elements of the Navigate program during this time

c. With the start of full implementation at each site, Zoom calls with Navigate trainers for ongoing support have started (and are ongoing right now)

d. We’ve collected feedback around in-person training (feedback will be helpful for onboarding new sites and informing next training steps), and also a readiness assessment at the sites

e. We are helping support the development of ECHO sessions (monthly starting in July) that will help bring teams together to develop community practice

4) Implementation – PSSP General Overview

a. PSSP is working with each site to identify project leads, and to develop site-specific implementation timelines and communication plans (e.g. with clinicians, management, leadership, etc. where needed)

b. Assessing some site readiness with a variety of implementation tools – identifying preliminary gaps and strengths

c. Compiled information, developed site specific implementation and coaching plans

d. Following training in February, there has been a focus on integrating the modules into practice (as of May 1, all sites have implemented Navigate as standard practice)

e. Developed some knowledge exchange products

f. Moving forward is building capacity for data collection and progress documentation, and assessing fidelity

g. Waterloo Wellington site will start soon – we are thinking about this, taking feedback from what’s worked and what hasn’t so far, thinking about scaling

5) Implementation – Durham site update

a. Fully implemented as of April 1 – all new clients get full Navigate implementation

b. Meet with team weekly, update on each role

c. Some clients involved with Navigate pre-April 1st as well (some modules as applicable)

d. Sheila has met with each team member twice to go through client list, update with what modules they are one, etc.

e. 90% of staff fully on board with Navigate

f. One of the SEE workers is leaving at the end of the May (Natasha) so will have to think about how to replace her – she is filling in 2 days a week for someone on disability (can’t replace full time)

6) Implementation – North Bay site update

a. Navigate has been implemented for about a month

b. 22 clients, 9 are getting IRT (some newer clients, some from before full implementation)

c. 4 families meeting with the family worker

d. Focus on formalizing SEE component with outside agency, will meet to iron out the details

e. Clinicians continue to integrate modules into current practice, and we are making sure that documentation is captured as intended (both for clinical and research)

f. Will meet with manager to identify changes that need to be made (e.g. documentation of family without liability, etc.)

7) Implementation – Niagara site update

a. Having weekly meetings (used to be biweekly)

b. 17 clients or so doing Navigate, mostly IRT, some family (all new clients are getting Navigate at this point)

c. Completed a family group

  • i. Tried to fit in Navigate material into it as best as possible

  • ii. Gave binders that were well received

  • iii. 6 families participated the whole time

d. Focus note added into documentation – easily search for Navigate modules that are done, and it says IRT/SEE etc.

8) Implementation – major challenges

a. Niagara – how to organize the paperwork (each person figuring out their own way to do it)

b. Same with Durham – trying to get through all of it, especially IRT, as there is lots of material

c. Old EMR system – will be changed in a year or so, but for now how to document consistently is something to look at

d. EPI-SET will have a team member come to each site for support (logistics, needs, etc., mostly for patient measures and outcomes)

9) Implementation – ECHO

a. Launching 1hr monthly sessions 12-1pm on July 23

b. 4th Tuesday of the month

c. 1st cycle until March 2020 (8 sessions)

d. Working through project plan with the team

e. Scope, deliverables, timeline, and hub team governance are confirmed

f. Need to confirm learning objectives and complete accreditation through CME

g. Need to confirm evaluation framework by end of June

i. Line up with PSSP evaluation

h. Training hub clinicians in May-June

i. Providing orientation and onboarding for participants around early July

10) Service measures and outcomes

a. Doing a fidelity assessment

b. Fidelity assessment will occur over 3 times – baseline assessment, and 2 more occasions

c. Hypothesis: as Navigate is implemented, fidelity to EPI standards will improve

d. Completed fidelity assessment at North Bay and Niagara sites, reports are being completed

e. Feedback will be shared with the sites

f. Just got the green light at Durham – will start right away with fidelity review

i. The clinicians will be more Navigate-focused, and we want to make sure that the baseline interview gets at pre-Navigate practice

g. Also doing a readiness survey – assessing general capacity at the organization to implement new practice, Navigate specific capacity, and motivation to implement

  • i. 2 versions of the survey: the first is for all staff – front line, delivery, management, and a more senior person in the organization as well

1. Sent out 15 surveys, have 9 back so far – sent a reminder last Friday, want to get as many as possible completed

2. Took a look at the 9 surveys over the weekend – as you’d expect, people were generally positive about Navigate and about understanding and knowledge to implement; more mixed about actual skills because those are in development; and on the fence about whether this will improve practice, make a difference for clients, and fit into the setting (pretty much expected at this point in the implementation)

3. Will be re-administering the survey on 2 more occasions

  • ii. Also a mini-physician version, has gone out to 2 physicians so far

  • iii. We will now be sending out the survey to the Durham team as well

h. After Waterloo Wellington onboard – will do fidelity and survey with them as well

i. Another piece – next spring, we will be doing a qualitative piece for staff feedback

11) Patient measures and outcomes

a. Committee is meeting biweekly – one focus is on getting things set up internally (measures and databases/structure), another on logistics for patient recruitment

b. Planned start for recruitment in July

c. Setting up referral process from clinical teams

d. Setting up process for e-consent

e. Figuring out and putting in place safety/risk plan for the sites – how this gets managed for clients in clinic, and possibly if seeing clients at home as well

f. Figuring out outstanding technological needs/resources at the sites and logistical flow (e.g. room bookings)

g. Upcoming piece – planned site visit with the sites to ensure we are all on the same page, and address other needs

12) There are outcome measures by objective – there is no agenda for health administrative data because it’s at the end of study. We’ve already managed up-front issues so we can proceed later with the work

13) Youth Advisory Committee

a. Finalizing terms of reference – working with Family Advisory Committee

b. We had a discussion about recruitment – Coulson and Sara drafted amazing recruitment posters specific to Family and Youth Advisory Committees to get more service users on the team

  • i. Will come up with a plan to work with the sites to reach out to additional youth and family members

  • ii. Will also try to recruit some service users from the new site once they are onboarded

c. Augustina is co-facilitating with Karleigh and Jasmyn for Youth Advisory Committee and is doing a great job! She is also attending Steering Committee meetings

d. The Committee was also editing some service user documents for patients at the sites / Patient Measures and Outcomes longitudinal study recruitment

14) Family Advisory Committee

a. Lillian is the facilitator of the Family Advisory Committee

  • i. She has been part of EPI-SET since the beginning (grant level) and is learning lots about what the project wants to accomplish

b. The Family Advisory Committee meets once a month – 2 reps from Toronto, one from Niagara, one from Nipissing right now

c. Family members are terrific, have been sharing stories of families with the mental health system, keen to participate in the process, are committed

d. Want to see how this can improve outcome for patients

e. Put together terms of reference for the group

f. Starting a checklist for orienting family members – there are lots of things happening, and it’s hard for someone just starting to understand all of the part of the project, what their role is in the project, etc.

g. Looking at how to measure engagement in family and youth advisory

i. Putting together questionnaires

15) Measuring engagement in the Youth and Family Advisory Committees

a. Using standard tools to measure two facets of engagement

  • i. “Are you able to contribute?”

  • ii. “How did patient partners change what we are doing/ how is the study better as a result of the contributions”

16) Scientific Governance

a. There is a local FEP conference (EPION) in the fall, and the abstract and symposium are due May 21

  • i. We will submit with a structure according to the outcome measures.

  • ii. Maybe have a part 1 and a part 2 (we only have 60mins per panel) – 1st hour to introduce project/rationale/overview, then 2nd hour to focus in on real challenges of the work (e.g. implementation and the training). EPION is a training organization, so attendees of the meeting are likely most interested in this piece

  • iii. It would be helpful for as many team members as possible to be a part of this, and we will need committee leads’ help.

  • iv. Would love if site leads could be a part of part 2 of the presentation

  • v. We can use the conference as an opportunity to meet as a project team. EPION is in Toronto this year and site leads will likely be here – we can likely have an adjunct half day EPI-SET meeting

b. There are some other conferences we can go to as well down the road

  • i. International early psychosis – Jean is the chair in 2 years’ time in Brazil

  • ii. In 2021 Aristotle is the chair of the Schizophrenia meeting – there will be lots of opportunity to exchange ideas with other jurisdictions doing this work as well

c. We are going to publish the protocol paper, now that we have full REB approval and the project is registered on – then the protocol will be (and already is) in public domain, which helps to maintain transparency and scientific honesty, and tells people what we are doing

  • i. Next step is to submit the protocol to a journal that publishes protocols – Nikki will lead this

d. We need to build a corporate authorship (60-70 team members), which will be a Steering Committee job (which has at least 1 person from each committee, and a number of core team members)

  • i. Some obvious ones (e.g. some of the outcome measures)

  • ii. If the journal allows us to list everyone, then that’s great, then the folks who work on the paper/grant are authors

  • iii. Corporate authorship (e.g. X, Y, Z on behalf of the EPI-SET group) would still come up on PubMED for everyone on it

  • iv. We are a collaborative group, things tend to become obvious based on who does the work

  • v. Can learn as we go along and this is still an open discussion as well

  • vi. There are 4 outcome measures – big things, ton of work, committee members are lead authors on each of those, Steering Committee as well. Other than those (and the protocol paper), what large groups do is create a proposal document (we need to create these) and a data pull document – if anyone wants to write a paper, they 1) create a proposal and identify who the key people are for the author list, submit to Steering Committee, who discusses/approves, then 2) they do the data request (again discussed/approved by Steering Committee), then they can go ahead

  • vii. If people want to use the data/write papers, that’s great! E.g. scientific papers, KE/teaching, policy docs, etc.

  • viii. Papers will be on the portal, and we will keep track of requests as well

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