Action Items
Chelsi to connect Simone Dahrouge and Melanie Barwick – done
Chelsi to connect with site leads regarding prescriber calls
Notes
1) Housekeeping items
We will be re-sending out some Outlook/calendar invitations, from an EPI-SET email, so please accept (or decline, if necessary) these as they come to your email.
2) Introduction and Administrative Study Progress Updates
We are making progress with the Waterloo Wellington site. There is a call with Sudbury/Aristotle in two weeks to re-visit with them – there is interest in re-joining the project form the site.
There is also interest in other regions of Ontario to implement NAVIGATE (e.g. Thunder Bay). We are trying to work out a way to do something with them, but more practically and in a less expensive way. We don’t want to wait until the project is over in 3-4 years for them to implement the care model.
Goodbye to Nandini! She was with EPION/PSSP and very helpful and valuable to the project. Welcome to Rebecca Phillips Konigs! She is the Assistant Manager of Special Projects for 7 months. This project is with her, then at the end of January to her replacement.
Both Symposia have been accepted to the EPION conference in November. Sarah will try to see if it is possible to move them to the same day of the conference, which may help to facilitate travel plans (preference on the first day, if possible).
3) Implementation – Training
All of the different NAVIGATE intervention roles/clinicians have been doing post-training calls. In a couple of months, there will be a survey as to how the calls are going and how the remaining calls can be made better and more relevant for the clinicians.
There is still the question of how we are going to onboard and train Waterloo Wellington and other new sites. We are looking at a number of different training models and are working with education services. For example, Education Services has been working on a simulation of module 2 of IRT (goal setting, strengths test, early engagement, etc.). They have created a day-long simulation for this which will be ready to go by approximately the end of September; we can potentially use this to train new people, or for “boosting” people already trained. We are also talking with Education Services about an animated video about the model of care and its aspects. There may also be a possibility of an e-learning for some of the 1st half day of training material/details (we will have a meeting with Education Services about these).
4) Implementation – ECHO
We have put together a planning group with hub members, who will be delivering didactics, facilitating case discussions, etc.
The ECHO project planning committee has developed an eight module curriculum for the 1st launch (1st cycle). This are from the broader 20-module curriculum, which will be implemented fully in the next ECHO cycle. We have also mapped the curriculum to the NAVIGATE modules. Future bridging/work is to build competencies and a framework so it is mapped to overarching ECHO.
We are putting an evaluation plan in place, and we have CME accreditation at U of T.
A more recent discussion has been of when to launch the 1st official session for this cycle. ECHO ONMH typically has a spoke site orientation to the ECHO model, technology, etc. We will likely use the 1st session (in July) as this orientation and move the eight sessions back by a month. The sessions are offered monthly for now, then will be offered more frequently after initial eight session launch. We are excited to get started!
Hub members will be trained on July 15th. The 1st session didactic presentation and case discussion will be done by the hub members.
For sites not fully trained: clinicians will join and observe the ECHO sessions. ECHO is following the NAVIGATE model; if someone hasn’t had initial training, they could still see how components of NAVIGATE could be applied to a case. We will hand out module materials in advance, to have as a reference. These clinicians also would not be part of the initial evaluation. The observing clinicians could participate in discussion based on their experience but they wouldn’t present cases or recommendations, etc. Sanjeev/Latika can help to see how to include non-research sites in the ECHO when they discuss the general training plan.
5) Patient Measures and Outcomes
We have delayed the start of data collection until August 12th, when George is back from vacation
We have added a family measure of functioning, in addition to the patient-reported measures. We have collaborated with the Family Advisory Committee to determine which measures to use.
We have also added a measure of youth engagement with their EPI program, specifically measuring their perception of care quality, their satisfaction with care, and their therapeutic alliance with their clinician. We haven’t picked specific measures yet, and we are discussing with the Youth Advisory Committee currently.
We submitted amendments to the CAMH REB yesterday, and once approved, we will submit to all of the other sites (including Waterloo Wellington).
6) Family Advisory Committee (FAC) Update
The FAC is meeting monthly.
We have been getting FAC members’ feedback on the engagement survey (mentioned above). We’ve also been getting feedback on family measures of patients’ functioning, and which ones to include.
Sarah put the FAC in touch with Education Services who are developing e-learning pilot for the family education in NAVIGATE, and a couple of the FAC members are going through the pilot now and providing feedback. This is for families who can’t actually make it into the clinic.
There is some interest from FAC members in attending the EPION conference; they will discuss it further at the next FAC.
7) Youth Advisory Committee (YAC) Update
The YAC is meeting monthly
They are currently working on giving feedback for the YAC and FAC evaluation measures.
YAC members will also be giving feedback on the engagement measures that patients will be completing as a part of longitudinal assessments.
8) YAC and FAC engagement evaluation
We are looking to assess the engagement of the YAC and FAC members (their ability to contribute and inform the study).
We have one set of tools intended to be delivered at the onset of the committee (or when a new member joins) to capture the intent of the committee members of contributing to the study, what areas they are interested in contributing to, and what type of support they might require. We are adapting tools (PPEET and PCORI) have been used and validated for this purpose. They will be delivered at baseline, then we will provide support.
Throughout the study, we will assess individual members’ experiences using a formative evaluation, so we can adapt the approach that we are using to optimize their ability to engage.
We will also be capturing what areas of the research they are able to inform and the end of the study with a summative evaluation.
The baseline assessment is later starting than we’d hoped. We also want to make sure we understand what is relevant to evaluate from their perspective as advisory committee members. We have edits we’ve gotten from Jasmyn, Lillian, Augustina, and now the measures are with the individual committees. Hopefully get feedback soon, then roll out and support. We want to make sure the research is guided by the people we are trying to serve. Timeline: Youth Advisory Members will return comments early next week on the baseline measure, and Simone will meet with the FAC on July 11th to discuss some questions the members have.
9) Implementation – PSSP
PSSP is creating an Implementation Manual to support the onboarding of new sites.
There has been a continuous review process of the model of EPI fidelity that they’ve been using. The model they’re using has been revised to align more closely with the US tele-fidelity model, with a few exceptions for the Ontario system. They are currently assessing the Durham site (over ½ way through), and are applying the revised processes for sites already assessed (re-rating where needed, to align with this approach). PSSP spoke with sites about this at last week’s implementation call, and are there for questions.
Waterloo Wellington is currently in the process of REB/contracts, once that’s ready they’ll receive an orientation to the EPI fidelity work.
Implementation Outcome meetings are on hold for the summer. There are two new members: Gord Langill, from CMHA Haliburton, and Avra Selick, a doctoral student and evaluation research staff at CAMH. The working group has also been invited to meet with the advisory committees, and it might be a good time to meet in the summer.
In the fall, they are focussed on developing plans for qualitative implementation evaluation, and evaluation of NAVIGATE fidelity.
Front line staff have continued to be supported by implementation specialists. All sites are business as usual with NAVIGATE. They are collaboratively addressing gaps with calls (post-training implementation calls, check-ins, etc.). Sites are trialing and adapting different documentation practices as they move toward full implementation. They are preparing for research actively at this time.
10) Implementation – Site Updates
North Bay:
The case load is 23; 8 clients receiving full IRT, 5 in partial IRT; 4 families involved in family education. Nobody right now in SEE.
Biweekly team reviews are occurring.
Niagara:
18-20 are in IRT.
Niagara is doing family education in a group format, and just finished one with almost 20 people in the group. They are starting a summer group, which is the first time they are doing that (10 in group, it is active now). People like the family content of the modules.
They are having some trouble with documentation. They hopefully have a solution for individual family sessions.
They are struggling with prescriber participation and trying to problem solve that.
Durham:
They continue to meet with clinicians on a monthly basis.
Family workers have facilitated first group, 19 people attended. Clinicians sat in on the session – families became emotional, so it was helpful to have an extra person in the room, especially as some people had to leave the group.
Continuing to use NAVIGATE with all new clients as of April 1st.
11) Other Items
Nikki is still working on the protocol paper, and the goal is to have it ready to submit by the end of the month.
Sunnybrook reached out about a few of our Family Advisory Committee documents, and we are sharing some with them. Thanks to Hugh for connecting us.
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