Implementation Committee: January 30, 2019

In Attendance: Janet, Dayna, Kelsey, Aristotle, Sarah, Jeff, Jasmyn


Action Items

Operational

  • High level summary of sites to come out next week – for information purposes, feedback related to the sites – PSSP

  • Investigate NAVIGATE Fidelity assessment items

  • Contact Don Addington regarding assessment of fidelity in cases with dose reduction vs. discontinuation vs. lowest effective dose (EPI-NET?) – Janet

  • Site-specific orientation page and IRT tables

  • Send current orientation page and IRT table to Jeff Rocca, Kelsey, Sandy, Mary, Janet– Sarah

  • Make site-specific orientation page and IRT table– PSSP

In-person Training

  • Decide who will come to the in-person training (Zoom or in-person), especially Friday and end-of-day director meetings – PSSP (email Chelsi with response)

  • Specific Outlook invitations for in-person training– Chelsi

  • Friday morning, Process stuff Friday (lunch), director meetings at end of day

 

Minutes

Implementation Team

  • Implementation committee includes clinical, PSSP, ECHO. PSSP should bring the others into this time rather than looking for another time to meet, so everyone understands what everyone else is doing, to clarify roles, facilitate team bonding, etc. This can help us to communicate regularly, be on the same page, and share pieces of implementation that everyone is doing.

In-person Training

  • Training is happening in a couple weeks, which is a unique opportunity for everyone to be in the same place at once. Training is mainly for front line staff – but there is an opportunity for people in other roles to get together in-person on the Friday, after the group has seen the content and front line staff reactions, who the leaders and strugglers are, etc. There are also director meetings at the end of each day (for site leaders, etc.). By Friday there will be a lot more information that might help guide next steps. Maybe this group can meet in person Friday morning with fresh observable data at hand. - For a couple of people travel is a barrier for that week, but there will for sure be representation at the meeting (Mary for sure, Jeff maybe, Kelsey). There is travel the following week so this is challenging, but can at least attend virtually. - At least virtually would be really important, but in person would be ideal. The human element is very important, not just process stuff. Observe and hear questions, get a sense of themes emerging, people’s personalities, etc. Even if you can Zoom into some other parts of the meeting to begin to understand that would be great. Friday would be particularly important. - They will bring that back to their team and see what they can come up with.

  • In the spirit of helping the front line team understand at a higher level than just practice change, on Wednesday, Aristotle is taking the working lunch to talk about the EPI-SET project - so they can understand that it’s part of something bigger (fidelity, outcomes, system level data, etc.). Thursday will be a regular lunch. On Friday, most of the training will be done, so they can hear more broadly about process. PSSP and ECHO can explain at a process level what they’re going to do, which should work well because they have seen the content. Can highlight implementation factors key to making the project a success. So PSSP individuals may want to check in via zoom, as it is a unique opportunity with everyone hearing the same thing at the same time.

  • For the schedule for training Wednesday to Friday Chelsi will provide specific time windows: when Aristotle talks, Friday morning and process stuff Friday, director meetings at end of day (PSSP pick someone to come who would be best - would get more specific info from site leaders to inform implementation process).

Implementation

1. At meetings there will be a Research Analyst or Research Coordinator at meetings to take notes, keep on track, schedule, etc.


2. How we know when sites are ready to implement? How we start recruiting patients in to the study? There is a tool that we could adapt, a checklist that needs to be in place to give the green light to start recruiting patients. The 3 days will be helpful to understand what has to happen and what has to be put in place at the sites for this to happen.

  • Melanie Barwick should be involved, and is on the grant, as the green light might rely on the implementation science pieces that Melanie can help us with.

  • In principle there is some flexibility for each site – it might take 6, 9, 12 months at a given site. There is learning after the training, and we will be working with admin leads to begin the trial process of this. Clinicians can start with one module, start two modules, etc. and we can assess how care providers deliver content, how they intersect to support experience, etc.

  • They should get started with trial and error. It might take a while but the sooner people get started (after the training) the better from a learning point of view – after 2 days the content is fresh but there has to be unlearning as well of what they’ve previously been doing. At a minimal level, should start while it is fresh.

  • The purpose of the 1-1.5 hours on Friday is to figure out how to gently and thoughtfully roll this out, to keep the information fresh as they’ve learned new things without overwhelming them. Getting started early is key.

  • North Bay has already started incorporating modules from pre-training into their work, which is great.

Updates since last call

  • Mary is doing fidelity and can’t be on the call.

  • Since last week: 2 interviews left on Friday, 1 left on North Bay to be scheduled (psychiatrist) then all interviews done for Niagara and North Bay (none for Durham)

  • All data for 2 sites should be in soon, only a couple data collection activities left

  • High level summary coming out next week – for information purposes, feedback related to the sites - About current practices and how they relate to NAVIGATE. - E.g. both sites have a lot lack of structured practices of demonstration around psychoeducation and about treatment planning. Overall, both are currently doing a lot of to fidelity of EPION standards, need for more structure around those pieces. Will put together a high level summary package hopefully in the next week based on data collection so far (there will still be one outstanding psychiatrist interview at that time). - These aren’t rating and reports – don’t have those yet – any learning relevant to training will be summarized and shared (high level) of value going into the training

  • Going to do consensus meetings around ratings, want to align with Ontario and with Don, given what George said this morning [at steering committee meeting] about knowing what NAVIGATE is and what the tool is able to pick up – maybe add Don Addington to the call? - There is a request for applications for a similar EPI network in the US, Don works on that, and the more we can work with our US colleagues the better. A network in Ontario and the US doing similar things would be great. It would be great to bring in Don.

PSSP Overview

1. Alexia mentioned that she was hoping we could provide overview of role of what PSSP is and what the work entails

  • Implementation support based on a sound implementation science framework.

  • Work with agency leads, assess drivers and gaps accordingly. These can compensate for one another – weakness in one area can be overcome by strength in another. Pull from these reviews information regarding current practices and these factors at these sites. Identify risks and issues and implement strategies (risk and issue logs), and share positive impacts, emphasizing the significance of the work.

  • Role is primarily as coaches at site. E.g. motivational interviewing, balance individual learning needs with implementation needs, etc.

  • They are familiar with change management and challenges, want to provide reassurance that they are used to change and resulting complexities, this is what they do with all of their work.

  • The difference in this project is they are used to owning a project, used to having a hand is all of it and knowing all about it. This is different – their role is a piece of the pie. Went through a learning curve finding where they fit among many teams working toward the same goal.

2. The main focus is the sense of urgency, as training happening in 2 weeks – everyone needs to be on same page and communicating clearly, with full transparency – last week’s meeting reiterated that. And that communication needs to be better on their end, but everyone is going in right direction now

  • Focus on open communication, bring more people into Wednesday call, and try to eliminate potential miscommunications. PSSP wasn’t communicating enough with what was going on within the sites

  • From Sarah’s end: the sites ask many questions of her, and then she sends answers and posts on Q&A section of portal. In terms of open communication, she is not sure how to do better on her end. Some issues brought up last week had already been dealt with, or she thought they had been, so making sure PSSP is looped into the answers will help support teams in implementing.

3. Essentially, knowing NAVIGATE and for the fidelity evaluation – it isn’t remarkably new content per se, it’s just the depth and intentionality with which you’re providing these interventions. It’s a practice shift as opposed to foreign content or concepts. That’s the messaging to the teams as well as it’s a framework. This is what our clinicians went through – the anticipation that it is completely new was difficult –but the clinicians have been working in the EPI world so NAVIGATE is not foreign.

  • What clinicians were saying was: we aren’t used to delivering treatment in a consistent modular fashion, we go with the flow and use our tools - the same with prescribing physicians. This is much more structured, protocolized, systematic, which is not the norm in mental healthcare. People think their individualized way of providing care is the best, which isn’t necessarily supported by evidence.

  • On top of that – then how do you coordinate the different care providers on a team with each other? They need to see the content, and see the steps. When dealing with coaching and change management that’s what is going to come up: “we aren’t used to doing things the same all the time.”

  • With our own team a year ago, what their feedback was, with the training and subsequent month of trial and error – they said they didn’t have enough time. The nature of the training wasn’t sufficient – so more simulation and roleplay with our trainers is necessary (previously it was mainly slides, theories, etc.) and there is a need to put it into practice. Time should be taken up by increasing practice, modules, patients. Our team suffered from not having an intentional way of practicing and not building up training.

1-pager of NAVIGATE/ knowledge products

1. Jeff (knowledge broker) established key points adapted to different audiences.


2. 1-pager in response to what the sites were saying (e.g. what does NAVIGATE look like, how will it work?) – was sent around prior to meeting. It is a brief 1 page overview of NAVIGATE, what the different roles are. Also, in the portal is the Powerpoint that George and Sarah did at the first pre-training call that looks at how NAVIGATE helps to operationalize the standards, the day in the life of a patient, etc.

  • Janaki and Sarah came up with it because sites didn’t seem to have that kind of overview of things

3. What PSSP should work on (other knowledge products):

  • Orientation page created to support module 1. It’s somewhat similar to the massive handout in module 1, but tailored to the clinic. Goes through different players in intervention, what’s expected of them, what they can expect from us (using the language in module)

  • If PSSP could inform the site specific content, then they would have this to help with module 1. The handout is quite large and this is helpful to help explain things.

  • We also created a table for IRT that identifies what the topics are in 14 modules and what somebody would be taking away from them – an easy to read orientation. We need your regional input as to the nuances for each of the sites would be a helpful tool to have for them.

  • E.g. North Bay doesn’t have support for employment and education, but have a partnership with PEP so that’s how they’re going to utilize that. I can share ours and the IRT table and see what you can come up with for the specific sites.

  • Sarah send current orientation page and IRT table to Jeff Rocca, Kelsey, Sandy, Mary, Janet

4. Downstream maybe we can start doing some EPION newsletter blog to share with other providers.

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