Implementation Committee: May 29, 2019

In Attendance: Jeff, Sandy, George, Chelsi, Jasmyn, Dayna, Janet, Sarah, Kelsey

Regrets: Alexia


Action Items

  • Take a look at post-training call participation survey and make sure language is ideal, see if there are any items to add – George/Sarah (to send to Dayna)

  • Send draft onboarding package – Chelsi

  • Follow up with Niagara around room space flexibility, average client travel costs – Sarah

  • Work with site leads to create update for whole team call – PSSP

  • Follow up with draft tracking logs – Chelsi/Sarah

  • Make tracking/communication tool for SEE – Dayna (Follow up with Sarah)

 

Minutes

Capturing Training Participation

  • Last week there was some difficulty identified with attendance on post-training calls

  • How do we track, and determine why some calls aren’t as well attended as others?

  • Chelsi sent out the attendance list of past calls

  • PSSP developed a plan internally if someone can’t be on a call

  • o They will be checking in around why people aren’t attending

  • Sent out a survey recently - very high level and brief

  1. Asks what the role is at the site, how many calls you’ve attended, some questions around each of the functional roles and the post-training calls (are you finding them beneficial, finding the information helpful, do you know how to get info if you missed a call, etc.)

  2. Not sure if it would go through REDCap or survey monkey, but once it goes out the data will be brought back to the team

  3. Might be a good idea to send it out again in about 4 months, as the calls continue, to make sure the calls are as effective as possible and clinicians don’t lose interest, and to gather relevant feedback

  4. Everyone can take a look at the language to make sure it is ideal, and see if there are any items to add

Onboarding new sites

  • Chelsi and Dayna have been going back and forth about onboarding Waterloo Wellington, and what implementation support will look like

Potential timeline:

  • Chelsi, Sarah, and Dielle have been talking about doing it in phases so sites aren’t overwhelmed

  • Phase 1: overview of project, who is helping them, give them an orientation of PSSP, ECHO, NAVIGATE, EPI-SET, etc. There is a call on Monday with Waterloo Wellington to go over this stuff and give them handouts

  • Phase 2: Administrative on the research side  REB, contracts, family and youth advisory members. For Waterloo Wellington, we are waiting on the CAMH contact for contracts (she is back June 3)

  • Phase 3: Implementation  Links between PSSP specialist and implementation of NAVIGATE. Implementation landscape, clinic hours, clinic structure, staff info, etc.

  • Mid-June – when we are thinking of connecting Waterloo Wellington with a PSSP specialist

  • Phase 4: training phase – we are talking to Sanjeev and education about how to execute this phase

  • Phase 5: ECHO phase – might be earlier, because we want Waterloo Wellington to join when the ECHO calls start

  • Phase 6: research phase (e.g. patient measures and outcomes)

  • If Sudbury is coming, will they have the same phases and timeline?

  • Chelsi believes so, this should be a general onboarding  if other non-research sites come on, they would join the general process (just not do the research portion)

  • Onboarding package (Chelsi will send a draft out):

  1. Overview

  2. Potential PSSP section based on readiness excel spreadsheet – needs to have more detail, have a possibility of a survey being sent out and PSSP expanding on the results of the landscape survey

  3. Each phase as outlined above

  • Might post it on web portal as well – we created an “interested in joining?” webpage

  • It is similar to Youth and Family Advisory Committee onboarding packages Implementation manual in onboarding package?

  • Jeff - thinks it’s a good idea to keep it all together as one package

  • Jeff implementation manual:

  • Checklist, important documents, important timelines, etc.

  • Jeff is also making a new onboarding document for PSSP staff to the project, since we will need more staff support for the new sites

  • Sarah might have some ideas of what could be helpful

  • Need to build in fidelity/readiness surveys as well - fidelity as its own phase? Take out for everyone, or do it for non-research sites? TBD

Research Planning

  • Discussion of Niagara site visit at Steering Committee

  • Summary:

Clinic space & booking

  • There is one shared room where the technology can be mounted

  • It is a high-traffic room, with three different clinical services all using the space

  • In order to book the room, we should book a month in advance

  • They may be able to tentatively book the room when they book the clinic appointment (about a month in advance), through a lot of the clinic room times will be blocked off (e.g. recurring series/meetings, etc.)

  • We would book the room through the clinic

  • Lilly would likely be the point of contact to do this (or Kerri)

  • A clinician or Lilly would likely be the ones to set up the client with the technology, because it is unlikely that they would be able to do it on their own

  • Theoretically we could book research appointments around clinic appointments, but it is unlikely that a client and their family would be able/willing to stay for that long

  • Clients ideally are seen once a month for the first 4 months, then less frequently after that

  • The clinic sees approximately 2 new assessments per week (approx. 8 new clients per month, but this varies)

  • Clinic hours are Wednesday, 10:00am to 5:30pm; 1st and 3rd Thursdays of the month, 10:00am to 5:30pm; the 2nd Friday of the month, 12:00pm to 4:30pm.

Research logistics

  • 2-3 hour research appointments won’t be possible, we will need to split the baseline (at least) into smaller appointments

  • We can’t book the room for more than 1-1.5 hours

  • Clients likely won’t be able to do a 2-3 hour visit, they already have trouble with 70 minute clinic appointments

  • Getting clients to the clinic will be difficult

  • They pay travel expenses for clinic appointments – a lot of their clients live far away, so could be an hour cab ride each direction for example

  • If we decide to see patients in the clinic, we should up the travel compensation from $10 per visit to be able to pay (e.g. an hour each way could be $60 per direction in a cab, as for a lot of them there is also no bus route)

  • Would bringing a research analyst there be possible? If not, it would be a lot more feasible to assess clients in their own location

  • Krista doesn’t love the idea of remote assessments – there is a risk that this won’t go well, especially if they have delusions or hallucinations, etc. around the TV talking to them, etc. She doesn’t have any issues with us doing the assessments outside of the clinic, and we would likely have an easier time recruiting clients if we did assessments this way.

  • Many clients don’t use email or phone calls – we would get more clients if we can text

  • If clients can do the assessments on Zoom on their phone, that would be best. We could text them the zoom link for them to click

  • Will this work with REDCap? Could we have them download the app and do the self-report on there?

  • They see clients often in the evenings, and suggested that we would miss a lot of clients unless we can do evening appointments.

Communication and safety

  • If a client is booked for research, or no-shows, etc. the clinic should get updates (e.g. a weekly update email of who has consented for research, etc.)

  • If possible, they would appreciate if we could share the client’s assessments with the clinical team

  • Krista is happy with our proposed safety plan (would just read over and confirm the written plan once finalized)

  • Assessments in the clinic:

  • Get the clinicians’ cell phone numbers, and if there is a safety issue/consult we would text or call the primary clinician immediately for them to go to the room, then they would continue with their usual safety/risk protocols. We would also have back up numbers, which we would cycle through until we got a hold of someone.

  • We would also have a back-up clinician on-call on the CAMH side, just in case we can’t get a hold of someone at the Niagara clinic. The CAMH clinician may also do a safety assessment if the research analysts aren’t sure of the risk, before contacting the Niagara team (to reduce burden on the Niagara team).

  • We would follow up with a more detailed email to Krista and the primary clinician, to have a record.

  • Assessments outside of the clinic:

  • We would take down the immediate address of the client at the beginning of every call

  • If there is a safety issue/consult, we would have the on-call CAMH clinician do an assessment over video conference. If it is determined that the client needs support, we would call their emergency contact and/or 911, as appropriate. If the client disconnects the video call and we believe there to be sufficient risk, we will call 911.

  • In case of the above safety issue/risks, we would text or call the primary clinician to alert them (on their cell phone). We will also follow up with an email to the primary clinician and to Krista.

Technology

  • They have a tablet, a webcam, and guest wifi login

  • They may need support in terms of a laptop and/or computer security depending on if a tablet will work (with surveys, etc.)

Other

  • Suggested we do a run-through before actually recruiting any clients into the study

  • Question from the site around issue of capacity to do research and psychosis symptoms:

  • “At what stage do you want to enrol them in the study? Many of them are not stable for a period of time when they enter the program. Can they consent if they are floridly psychotic?”

  • We are enrolling new clients to the program, ideally after their first visit.

  • We go through an informed consent process, and we have to be confident they understand the nature of the research and the process in order to continue, otherwise they won’t be cleared to participate

  • If over the course of the study, we have concerns about their ability to give ongoing informed consent to participate, we may put them on hold until they are able to, or withdraw them from the study if necessary

  • Question from the site about how often we see clients? - every 6 months for 2 years

  • Couple of other comments from today:

  • Clinicians shouldn’t make judgments about who is capable for research

  • Suggestion to have 1st appointment face to face if possible, then remote after that if needed

  • More of a warm hand off between clinical team and research team

  • Generally these are outpatients, so if there are significant safety concerns that would preclude from hearing about research  should they be in hospital?

  • Clinical staff may for various reasons feel that a client shouldn’t’ hear about research, but it may not be based on a discussion with the client, they might be judging for them - want to avoid this from an equity perspective

  • Will clients be able to manage a 2-3 hour visit?

  • May be possible to split the research contact into 2, then the person can return to complete within a shorter period of time (ideally before another clinic visit)

  • Follow up with the site to talk about room space, if there’s more flexibility, to try to get 1st assessments done in clinic

  • Also how much is actually spent on travel compensation on average?

  • Sandy - a lot of clients come from an hour away or more in rural areas where there are no busses

  • PSSP – try to go through the process, come up with questions in advance of the site visits

All team call

  • PSSP to work with site leads for the whole team call next week, to prepare an update

Site Tracking Tool

  • Chelsi and Sarah met about a tracking tool for sites for rounds and for reflective practice (NAVIGATE calls it supervision)  they are using the contact forms for clinical use, but how can they capture it at a clinic level and have helpful information during team rounds

  • Template based on a slide from a trainer call

  • Trying to figure out a way to have a buildable template – so we can build from week to week, and sort (e.g. different IRT modules) and be able to have clinical discussions around these

  • Clinicians are using contact forms for themselves, but then there isn’t much else happening – having a bunch of contact forms in the director role is too much

  • Trying to figure out a way to create some tracking – and from a study standpoint, extract some data (e.g. how many people have gotten the first 7 modules?)

  • Access is a possibility

  • Has potential to be data source for monitoring delivery of navigate

  • Chelsi and Sarah will follow up with drafts of these tracking logs

SEE tracking

  • Sarah had a call with Josette

  • Tracking for SEE (outside agency)

  • Talked about a tracking tool – Sarah is emailing Dayna for support in creating this

  • Like a communication tool between the agency and the clinic

  • Dayna will be making a tracking and communication tool that will be helpful when outsourcing the intervention so the site knows and can follow up with the external agency to make sure that all pieces have been covered


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