Implementation Committee: February 27, 2019

In Attendance: Mary Hanna, Jasmyn Cunningham, Christine Mitchell, Dayna Rossi, Sandy Brooks, Kelsey Jones, George Foussias, Sarah Bromley, Chelsi Major, Jeff Rocca, Janaki Joshi, Alexia Jaouich


Action Items

Operational

  • Network question to ask at each site - Draft the actual question around network access – Alexia - Subsequently contact sites and inquire – PSSP

  • Regularly share site coaching plans with Implementation Committee – PSSP

  • Sarah will share her list sorted in terms of priority – Sarah - DONE

1 or 2-Pager

  • Reach out to North Bay about what this document’s purpose is – Sarah

  • Edit current document before submitting to REB – Sarah, George, Aristotle

Fidelity/RDT

  • Schedule Durham Interviews (when possible) – PSSP

  • Complete Fidelity reporting summary – PSSP

  • Development of visual timeline of project support for sites as well as a first EPI-SET progress update that will target site funders - PSSP

  • Finalize draft of RDT and send Monday – PSSP - Meet with Steve to put RDT into REDCap next week – PSSP/Steve - Finalize contact list to send RDT to - PSSP

 

Minutes

Updates from Steering Committee

  • We talked about the logo; the training survey/evaluation; and a 1-page information sheet for patients about EPI-SET – having to do edits and clarify who is the target audience (and it needs to go through REB approval), George/Sarah/Aristotle will edit and bring back to Steering Committee.

  • Training evaluation: we looked at it and had a conversation about whether it will tease out if people have found the training valuable in order to be able to implement NAVIGATE, and asking about the method of training, and possible gaps in training. Will add questions and send out, separate from thank you email.

  • We need to do network assessments at the sites about unsecured networks for patient use. If there is a secured network – will patients be allowed on these networks? Are there other networks they can use? We need to check in with each site (PSSP at each site).

6-week Timeline

  • We had a general discussion about the timeline around data collection, and building REDCap pieces. Now we are in the 5-week phase between end of training and people starting NAVIGATE in its entirety. What is the post-training plan?

  • Initially – the goal of the agenda was the PSSP support for the 6-week plan, but bigger discussion, what is Implementation Committee 6-week / 5-week plan?

  • Updates from PSSP: Fidelity and REB. PSSP completed data collection for Niagara and North Bay. They are doing initial ratings for Niagara and have consensus meeting today [Feb 27] with fidelity experts. Looking at summaries to inform PSSP team (beyond that we can decide what sites will get that will be helpful besides reports with ratings). Site leads: summary of role descriptions based on staff involved in interviews. And summary of practices most affected by NAVIGATE that are part of EPION standard. Haven’t heard anything from Durham, so not scheduled yet.

  • RDT (readiness diagnostic tool). Should have feedback from most people, but send by end of day today [Feb 27] if there are any more edits to be made. Will have final draft by Monday. - Will send to Steve to mount to REDCap. - Should meet with Steve early next week to discuss getting it on to REDCap. - Finalizing contact list of who the survey is going to at the sites, then good to go out ASAP beyond that. Will share the revised version.

  • Jeff not on call. He is working on a 1-pager for clients who might be interested in joining the study. - Looked at this at Steering Committee. If providing to patients, needs to go through REB. There is a word version, and Sarah/George/Aristotle will edit before it goes to REB (Jeff forwarded).

  • PSSP Implementation Support 6-week post-training plan/concrete next steps (as sent around in the agenda prior to the meeting): 1. EPI fidelity data collection for North Bay will be wrapped up. We hope that Durham will be scheduled over the next 6 weeks 2. Conduct post-training touch point with sites – establish communication channels - DON 3. Complete initial ratings meetings among assessors and consensus rating meetings with fidelity experts for both North Bay and Niagara 4. Schedule and conduct staff interviews with Durham (contract signing pending 5. Completion of the EPI fidelity reporting summaries, which will includes fidelity reports with ratings and a summary mapping NAVIGATE practices with scale items and this information will also inform the implementation landscape 6. Following pulling that data, we will complete the implementation landscape with sites to map current state of each sit 7. Development of visual timeline of project support for sites as well as a first EPI-SET progress update that will target site funders 8. Development of site specific coaching plan for post initial training that will clearly identify roles, responsibilities, and commitments for all parties involved 9. Continue to track project milestones/activities involved, risks/issues, and journaling around addressing implementation barriers and site engagement 10. Finalize and administer RDT survey to sites

  • Are we missing anything? Want a high level of transparency, we can integrate into the support plan. Sarah had some action items from her notes as well.

  • From the document that Sarah created – she will put items into considerations. - A bunch of stuff would be helpful now, as people are starting to use content, and definitely in the near future as people are ramping up. When we talk, we have different implementation dates, so some of the concrete things that Sarah put in would be of benefit now as people are starting to use the information and provide the intervention model regardless of full implementation. - The orientation module was previously shared with PSSP. The sites can make it their own. The orientation page speaks to the intervention model without saying NAVIGATE and explains what people can expect at the site and what their care is going to be. Would help now – North Bay has already been doing the orientation module with people.

  • Clinician contact forms now? Not today, but a way that clinicians are tracking what they’re doing to be able to have formalized trainer calls in April. We won’t be using the data yet, as we haven’t gone to full implementation, but could be helpful for clinicians for “self-reflection,” and moving forward. That’s what the contact forms are.

  • Sarah’s considerations – these are some of the things coming up in conversations between PSSP and sites. Also, they are capturing information in PSSP documentation.

  • What is the best way for PSSP to communicate the content of the site conversations with Sarah etc.? - Even in this call, maybe a 5-min last week update for each of the sites? So it won’t be back and forth/onerous on PSSP. For example, if you were already working on an orientation page, you would update, maybe Niagara wants to see what another site has been going, as a lot of this stuff is common among sites but site-specific. E.g. something that would help with implementation of SEE would be gathering community resources near a site that they can tap into. - PSSP – had conversation with Shelia about partnering with Ontario Shores. Some of this work is happening, so how can we communicate it across the larger group? - Is there any project management software that they use to track these? They use a journaling type of tracker for those, risks, engagement, issues, etc. in their “bimonthly tracker,” which is where the PSSP team can see what is going on amongst the sites. - How would other people know that something like SEE has been addressed? PSSP could give the larger team shared updates on a semi-regular basis/roll up to be less detail oriented. Especially so we aren’t bothering sites about what has been done. - Is there a tool that we can use to improve communication so action items don’t get lost? PSSP will share by email a couple days before the meeting, highlight key points. - Because the tracker has a lot of information, PSSP on a regular basis can provide weekly coaching plans with what they’ve been doing with the sites, might be better than the whole tracker (which might be better on a monthly basis). Coaching plan: what will be worked on in the coming months, site specific.

  • What is the initial implementation timeline? When are they expected to do NAVIGATE fully? - Short answer: now. - Longer answer: it is more of a gradual ramp up. People are starting to work with the content, but they might not have new patients as frequently as CAMH would, so they might have a new patient in 2 weeks, so start with that person, but other people, practice other content with as relevant to them. Might be a gradual ramp up because of pace of their referrals.

  • Assumption: each IRT clinician might not get more than 1 new person every week or 2, so would make sense to start practicing work and implementing the intervention with those new people. - Starting immediately might cause problems with no support, but on the other hand we also don’t want people to get lost – need to practice content and have post-training calls, hear some wording of things that have come up, etc. - Orientation page would be great to have right now. It isn’t ready, but they can still speak to the content as part of module 1 with clients. - Community resources – doesn’t need to be there today, first thing is introduction, assessment of where the client is, etc. Placement might not happen for a bit, so some things don’t need to be a barrier starting to do the work. The only one that might be more of a barrier is MOU with program in North Bay but Dayna is working on that piece.

  • Prioritization – what is critical to start now? What are we working towards? It might be helpful to have a hard timeline and say that we are doing things in the background as well. - How does clinical work align with structure already in place? This 6-week block until beginning of April is where clinical team is having weekly calls with 1) experienced clinicians, then 2) support NAVIGATE trainer calls start, then 3) ECHO calls start. - The nature of those phases is a bit different in terms of intent - 1) experiment/familiarity, 2) build capacity in core content with experience – not helpful without experience 3) rounded discussions about patients – so there has to be wholescale implementation of NAVIGATE for this to happen - Is there a hierarchy? How to perform two interventions (split roles) in Niagara, how do they do this? This came up in the end of day Friday training discussion. Josette’s clinicians decided they need to separate and one do one role and one do the other. That is one of the more pressing implementation hurdles that needs to be sorted out with that team. How two social workers will be able to do two interventions and hold them with equal importance. Challenges are in day two notes that Dayna shared, discussion among sites. - Sarah will share her list in a priority perspective (high/medium/low for 4-6 weeks). But this is just her perspective. PSSP will keep in mind in terms of coaching plans and site discussions. - Niagara was having the most difficulty wrapping their heads around who is doing what. Their site is the most different in terms of implementation from how it was made. Having clinicians with case management only, shared role challenges, will be a lot of attention needed to that clinic in figuring out how to implement and stay true to the model – this was reflected in in-person training discussion. - Sandy – meeting with Krista next week, and the roles are a big thing on the agenda. - CAMH didn’t need to do role realignment really. - We’ve also had prior discussions around split role vs. shared role across two interventions. It’s problematic from a trainer perspective. On the ground we need to figure out what works. If black and white: social worker would do IRT and the most skilled nurse would supervise family, or vice versa. Family tends not to be as heavy – you don’t have all the families at one time, it is more episodic, family could happen in a group by one of the nurses. Sarah doesn’t mind chatting and problem solving: will come down to how her clinicians will come on board with that. Josette’s two clinicians saw difficulties and moved towards separating themselves, which was helpful. Not sure if any of Krista’s clinicians are in the same position. Other piece unique to her: case manager role with the two nurses which can be helpful but what is the pathway to those people – is case manager point person then IRT comes in? Or other way around? - Look at notes from discussion day two and notes around site leads. Mary and Sarah offline will talk about questions regarding the contact form. They will follow up after this meeting, with Dayna as well. More around timing, should we set up on EMR or paper in mean time?

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