Implementation Committee: April 3, 2019

In Attendance: Jasmyn, Chelsi, Dayna, Mary, Kelsey, Sandy, Jeff, Sarah, Sheila, Krista


Action Items:

  • Reminder to sites: please complete in-person training evaluation! site leads/PSSP

  • Reminder to sites: please complete readiness survey! – site leads/PSSP

  • Follow up on Durham contract – Aristotle/Dielle

  • Durham will already be using Navigate during fidelity assessment, they started using it fully this week

  • Document to share with clients and family around family education – PSSP/Jeff

 

Minutes:

Training Evaluation

  • One clinician left a site so we may not want to include them in the numbers for in-person training responses (in the denominator).

  • Remind everyone to please complete this survey!

Fidelity Evaluation

  • Niagara is furthest along in the process because there have been more meetings

  • North Bay’s meeting is next week

  • PSSP had a discussion with Shirley (Navigate trainer) about the fidelity items with regards to Navigate: helped to highlight areas for quality improvement that will be incorporated into the reports, and helped to highlight the areas where Navigate isn’t making that much of an impact

  • Readiness survey has been deployed (7/14 responses so far), there will be a reminder email tomorrow

  • There will also be a physician readiness survey (shorter/more targeted) at some point

  • PSSP will share with sites how to match Navigate to deficit areas (by Ontario EPI standards) in the report and will go through it with site leads – if there is anything else the site lead wants highlighted, let PSSP know

Niagara Update

  • Family group started and will incorporate family modules into the entire group

  • This week on Thursday – PSSP meeting with team and with individual roles to talk about how Navigate is mapping on to what they are doing, both mapping the current state and seeing how Navigate overlays

  • Niagara will look at their intake process and see how it fits with Navigate:

  1. Intake assessment - which staff will take on as primary worker? Currently based on client’s greatest needs - this isn’t consistent with the Navigate model

  2. What are other sites doing around this?

  3. At CAMH: there isn’t a choice of role. People come in and get a case manager/IRT as primary clinician, then they also get SEE and Family and Prescriber

  4. 1st consult done with primary clinician and the psychiatrist

  5. Is the primary clinician the case manager or IRT? If IRT, need to know when to refer based on a case management problem

  6. Roles aren’t discipline specific, they are intervention specific – so need to determine who is the main contact for that person: case manager or IRT?

  7. Might need to just try it out, see if two IRT workers is the right number

  8. Also need to clarify what is case management vs. other Navigate roles

  • Have been using Navigate materials (goals, resilience and coping with symptoms, etc.) and have been finding them helpful

Durham

  • Officially started using Navigate on April 1st

  • One IRT staff will also be intake clinician

  • New referrals will get full Navigate, any existing clients will be offered some of the Navigate material

  • Staff who have used the Navigate material are finding it helpful

  • Contract not fully signed off, can’t do fidelity yet – so will be using Navigate a bit already at the point where they do baseline fidelity assessment

  • Clinicians just need to get comfortable with Navigate and start using it

  • They meet Monday mornings, and are going to follow a similar agenda as what CAMH is using (strengths, goals, etc.)

  • There will be individual meetings as well (monthly)

  • Family workers will be developing a group to do the psychoeducation and also work with people individually – this will start in May

  • Education services at CAMH have been working to have e-learning around the Family piece à this is in final stages of being vetted. This will be a good resource for families who can’t come in, etc.

  • They use a spreadsheet for meetings, to prompt Sheila to ask about client goals, and IRT/Family/See updates. She wanted to make sure they are talking about 25 clients per weekly meeting. They talk about a different 25 clients each time to make sure they aren’t just focussing on the same clients each meeting.

Clinician Contact Forms

  • Clinician contact no longer in REDCap – Mary will share an Excel spreadsheet for now, and eventually ideally roll it into the respective EMR systems.

  • At least some sites have shared drives and a system in place for unique client numbers

  • Clinician contact forms ideally will be embedded in EMRs so clinicians can track without double charting

  • These forms are good from a reflective practice standpoint – how do I know that I’ve done X thing? What can I do to make sure I’m doing the things I need to be?

  1. They can help with transfer of care as well

  2. Helpful for both reflective practice and client tracking

  3. E.g. I haven’t seen this person in 3 weeks, where did we leave off?

  • Chart reviews – will look at some of the clinician contact forms (no longer collecting data for all of these centrally at CAMH)

  • PSSP is helping for the site’s benefit, for their recording and service delivery

  • If using this data beyond site records, then we have to access an anonymized version of it, and it needs to adhere to current standards in the clinic in terms of privacy (this works if they use already standing unique client IDs)

  • Need to have a way for PSSP to sort these by intervention, e.g. if they want to look at a client’s IRT notes vs SEE notes

  1. Krista: can’t build report but can do focus note

  2. Sheila: will have title of note as the name of the module

  3. North Bay: may be able to roll something into EMR updates upcoming

North Bay

  • As of April 1, all new clients are receiving Navigate

  • Prior: was integrating some modules (such as goal setting) into client care

  • The site is focussing on family education role now

  • Also trying to increase buy-in from family members – will benefit from e-learning when that’s available

  • Will try to build-in notes/contact forms into EMR system

  • PSSP is focussing on clinicians working in the community (about 40% of the time currently in the community) and trying to match this to Navigate

  • Trying to avoid role-splitting for now, but exposing both to all of the roles so that they can jump in if necessary

  • Only 2 clinicians: building a plan for onboarding new staff

  • All roles meeting with PSSP regularly (weekly with clinical team, biweekly with manager)

  • Leadership: focus is on adding structure to areas currently lacking structure

  • Emphasis on changes that need to be made, and integrating modules into physician practice

  • Guest network capabilities – has a secure guest network

Communication

  • Need for something to share with clients and family around family education – PSSP will be providing this

  • Sarah shared an orientation page with PSSP Sandy – this is just what standard of care is at the sites

  1. This is what is used in Module 1 (Orientation) along with the chart of what’s included with each module – could be included in a welcome package

  2. More of a shift in how we onboard people than anything else (less emphasis on “getting Navigate” vs “not getting Navigate”)

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