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Implementation Committee: May 1, 2019

In Attendance: Sheila, Kerry (for Krista), Jasmyn, Josette, Nandini, Alexia, Sandy, Kelsey, Dayna, Jeff, Mary, George, Chelsi, Sarah


Action Items

  • Remind clinicians and physicians about ECHO calls and to accept the Outlook invite – site leads

  • Provide a brief update on the team teleconference call

  1. Brief site update – site leads

  2. Brief overall update – PSSP

Patient Measures and Outcomes

  • Complete logistics checklist – PSSP and site leads

  • Email about site visits/schedule – Jasmyn Done

Other

  • Updating knowledge translation documents to be shared to everyone in the next few days - Jeff

  • Work to solve record-keeping issues with family – all sites and PSSP

  • Create hyperlinks in the manual table of contents – Dayna / PSSP

  • Look into distributing CAMH diagnosis booklets – Dayna

  • Clarify prescriber role with the sites – PSSP/George/Site Leads

  • Determine best flow through clinic for side effects sheet – PSSP/site leads

  • Remind clinicians and management staff to complete the readiness survey – site leads

 

Minutes

1) Welcome! There were some documents sent around. Sites – nothing additional to add to the agenda besides updates.


2) Update from Jasmyn: Delegation Log – will be getting signatures at some point.


3) Reminder: ECHO call – 4th Tuesday of the month from 12-1pm, starting in July. Everyone will go to this (clinicians, physicians, and directors, PSSP can also come). Starts July 23. Please accept the Outlook Invite that Chelsi sent! If you need it re-sent or have any questions, please email Chelsi.


4) May 6th meeting (next Monday) 9-10am, entire project team call. There is an opportunity to provide an update on implementation: PSSP will do the overarching update, then each site can do a brief update (couple minutes) of the sites of what’s been going well, what’s been challenging, etc.


5) Sent a Terms of Reference

  • Everyone on the call thinks it looks good, it is as expected

  • Will aim to send agenda out on Tuesday mornings, and anyone can feel free to send additional agenda items

  • Can always revisit this document if anything needs updating or changing

  • Feel free to email Alexia if anything comes to mind

  • Otherwise, approved for now!

6) EPI-SET Patient Recruitment and Logistics Checklist

  • Patient-level data collection will start in July

  • In advance of that, we are gathering information about logistical and safety-related needs

  • Site leads will complete the checklist with PSSP

  • Then Jasmyn and Chelsi are going to come do a site visit, meet the team, see the space, and discuss the checklist with the site lead

  • Please let Jasmyn know if you have any questions

  • Jasmyn will follow up about scheduling the site visits

7) Updates and Discussion


Sheila/Durham

  • Meet on a weekly basis to review Navigate Clients

  • 1 on 1 monthly staff meetings with Shelia

  • Recently met with Gorete

  • Waiting to see how full implementation rolls out

  • Kelsey working with clinicians individually by their role

  • Waiting on final signatures to do fidelity work

  • Sheila will sign and scan back to research today, then director can sign, then they are good to go for fidelity

Kerry/Niagara

  • Changed team meeting to weekly for an hour (not biweekly anymore)

  • Starting IRT with all new clients, some existing are getting some modules as necessary

  • Family Group winding down, trying to incorporate Navigate

  • Next time run will have all Navigate material

  • Updated welcome letter

  • Jeff is updating some knowledge translation documents as well that will shared to everyone in the next few days

Josette/North Bay

  • Similar to last time

  • 9 receiving IRT currently

  • 4 families working with family education worker

  • Some challenges with IRT, and Piper has given good feedback to the IRT worker

  • Few bumps in the road, e.g. Amanda had a client (with a bipolar diagnosis) who originally liked Navigate but now that she is depressed she is struggling more with the structure

  • Clinicians are very enthusiastic and working hard

  • Dayna had a few questions:

  1. Trying to work through the best way to capture family data without the liability concerns (North Bay is a hospital) – new electronic files for family members, and having access to those files is concerning for the clinicians – maybe limited access EMR files? Still working on this.

  2. All family members at CAMH have their own chart because they are receiving a service from CAMH.

  3. Another service used to chart vaguely in the youth chart (because youth can have access to their chart)

  4. Lakeridge will do similar process as at CAMH, Lakeridge is not going to open a family file – clients agree to have family involved, so there is a progress note involving both à can’t make a family file unless registered as a client

  5. Niagara – it has previously been documented in the client’s file, and they were doing it vaguely – it is something they have to talk about – probably will have to give parent a file of their own

  6. If family is receiving intervention (e.g. brief crisis intervention sessions) – how does documentation standard apply to them?

  7. Page number of table of contents of manual doesn’t coincide with actual page numbers in manual, this is creating a challenge for the clinicians. They might create hyperlinks in the table of contents to flow through more easily

  8. Education about psychosis information sheet (p134 of IRT manual): very limited in regard to diagnoses presented, and will have to do additional work with clients to explain other diagnoses – is there another sheet they could use that’s already been made? Did Slaight Centre re-create this?

  9. No - Slaight has an information booklet on psychosis that CAMH produces. It has more possible diagnoses, treatment, etc. There is also a bipolar booklet that CAMH produces.

  10. There are other resources out there for psychosis à just make sure the goals of the module are being met, but you can use those tools and augment the tools from Navigate (e.g. don’t say “forget module 2, use this instead” – instead say “augment the content with this”)

  11. They are a publication here at CAMH à can PSSP get hands on those to distribute? Some are downloadable. Dayna will look into these as a source of support.

8) Working with the Prescriber Role

  • Krista was wondering if the prescriber role will have an impact on service delivery, time lines, etc. if they shift how they are doing things from how they are currently doing them

  • o They currently have a prescriber every Wednesday from 10-6, two Fridays and one Thursday (half days)

  • o Will Navigate requirements affect clinic timelines/scheduling/etc.?

  • o The site feels they don’t have enough info. about the prescriber role à they need to know how it is different than what is happening right now with the prescriber

  • PSSP support to sites – are they also having contact with the prescriber?

  • o Kelsey - Going to be attending the clinic times to meet the psychiatrists to have the conversation around the model, the process, and the implications around the flow of work, etc.

  • o George - Contact from PSSP on ground should include prescriber

  • The role in Navigate is very focussed –narrower than what psychiatrists do in practice (that’s fine) – the narrow role should be a core part of what they are doing still, though

  • Implementation hurdle: side effect measure done before EVERY appointment with the psychiatrist. How is it being done? How is the info getting to the psychiatrist so they can use it in the appointment?

  • o Flow of patients into the clinic – if always passing an admin. desk or checking in, maybe there is a paper-copy of the side effect form to do while they wait then take into the apt with the psychiatrist à George’s recommendation

9) Other

  • Site leads remind clinicians to complete the readiness survey (we have 9 out of 15)

  • Those surveys also went to upper management as well, so if you have a connection to those staff as well please remind them

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