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Project Team: February 3, 2021

Attendance: Andrea Alves, Brannon Senger, Tallan Byram, Carol Maxwell, Dayna Rossi, Lillian Duda, Lauren Caruana, Lauren de Freitas, Josette Morin, Sara Rutkowski, Kim Hewitt-McVicker, Janet Durbin, George Foussias, Monica Choi, Sandy Brooks, Nicole Kozloff, Rameiya Paramalingam, Aristotle Voineskos, Victoria Villanueva, Sarah Bromley, Maurey Nadarajah, Sanjeev Sockalingam, Melanie Barwick, Diana Urajnik, Dielle Miranda


Regrets: Anne-Marie Baker Devost, Kerri Nagy



ACTION ITEMS

  • Explore COVID survey preliminary data analysis plan at next Patient Measures meeting – Andrea

  • Respond to the doodle poll Rameiya sent out to coordinate site meetings – CAMH staff/PIs

  • Reach out to prescribers to determine availability/interest in an evening session – Ras

  • Follow-up with first 3 sites around Fidelity assessment support – Janet/PIs

  • Coordinate FAC/YAC attendance at site meetings – Brannon/Andrea


Admin

Site Meetings

  • Rameiya is coordinating an informal touch-base meeting with each site and a small group from the project (clinicians, family/youth advisors, research team)

  • Thank you to all site leads who provided dates in March

  • We are currently coordinating attendees and will send finalized meeting dates out soon

Newsletter

  • The 4th edition of the EPI-SET newsletter will be released in a few days and summarize updates and upcoming work across all project areas


Patient Measures/Recruitment

  • 91 referrals and 44 enrolled

  • 2 more scheduled this week and following-up on some clients who no-showed/wanted to reschedule

  • We are also scheduling in 6-month follow-ups throughout February, and family members (for enrolled participants who consent to have family members participate)

  • Site leads can contact Andrea and Brannon during appointments with clients if you would like us to tell them about the research opportunity (currently this can be done through email, but we are setting up work phones and will send out those details soon).

  • Our research assessments include COVID-related surveys (isolation/resiliency).

  • We will take a look at the data soon and share information that will be helpful for everyone to see, in the same way that Fidelity data has been shared with sites.

Implementation – ECHO

Survey Feedback and Curriculum Planning

  • The hub team will be reviewing survey feedback and planning upcoming curriculum

  • Surveys are a great source of info to determine what topics we should cover – if site leads have any additional input, please let us know at any time, as we want to ensure we respond to different sites’ needs.

  • Survey incentives have been great, and it’s important to have an element of fun!

Attendance and Availability

  • Attendance has trended slightly upwards over the last several months

  • The current time is best for some sites as it does not interfere with lunch

Engaging Prescribers

  • Follow-up on having an evening session on a topic relevant to prescribers’ needs

  • General feedback from sites is that prescribers may be willing to have a session in the evening (too overbooked during the day), but we should get their feedback on:

  • A time of evening that works best

  • A specific need/issue to address

  • Remind prescribers about the type of CME credits they can get

  • Thunder Bay prescriber has confirmed their interest in an evening session

  • North Bay prescriber has EPI time on Tuesdays, but could likely be available for evening

  • Need to be very clear about the objective of this (NAVIGATE, support for challenging scenarios, etc.)

  • New psychiatrist at Waterloo is orientating with George and existing psychiatrist, which is great

  • Feedback from prescribers: role of NAV is unclear and how it differs from existing standard of care – increasing clarity around this is important

Upcoming Sessions

  • Feb 5: Psychosis and Developmental Delays; case presentation by Thunder Bay

  • Feb 19: Measurement-Based Care; case presentation by Niagara

  • March 5: Emotional Regulation Techniques


Site Lead Updates

Waterloo-Wellington

  • Increased peer, family and nursing role to full-time for 2 months, which is important for supporting the peer NAV group.

  • Family groups are going very well with 35-40 individuals in each group, a 4 part-program that includes psycho-education and discharge planning. NAV has helped with the family groups.

  • Challenges: staff still trying to present NAV in a non-formalized way as standard of care, have had a client decline when offered NAV.

    • Feedback: may be helpful to describe the components of the program and present as coordinated specialty care.

  • The Cleghorn program which is not participating in EPI-SET has picked up NAV material as well

  • Has COVID/lockdown impacted clients? Just starting to see referrals with stress connected to COVID contributing to their first break and noticing effects there more. People's concerns around COVID and not wanting to see clinicians in person. It would be ideal if they were getting consistent care.


Thunder Bay

  • Currently working on developing documentation processes, improving user-friendliness

  • Family group has been run by an agency; soon, will deliver own family group

  • Looking at peer mentorship with help from Cleghorn which has a great program running

  • Some challenges around engagement/connecting with clients virtually. Some clients are seen face-to-face out of necessity.

    • Also, when introducing NAV there is a lot to explain. Found it helpful to go into detail about the roles

  • Running recovery groups to promote engagement from individuals on various topics

  • Looking at generalized content related to SEE like resume and job readiness

  • Has COVID/lockdown impacted clients? Yes, have seen impact of COVID and increased anxiety/isolation. In terms of exacerbating psychosis symptoms, there may have been 1 or 2 with significant impact. Increasing support and maintaining connection helps them. Definitely increase anxiety, mood, isolation


Sudbury

  • This site experienced a full turnover of staff which made implementing NAV easier because it was their standard of care from the start.

  • Exciting update: current team only had psychiatry care for people 17.5 and higher, but in process of onboarding a new psychiatrist who will see clients from age 15

    • George and Monica are currently onboarding the psychiatrist

    • This will help to eliminate gap in clients receiving prescriber care

North Bay

  • Current case load is 25 with one new referral soon, hoping to get referred for research

  • Things are going smoothly, clients are adapting and liking the virtual care.

  • Groups have not started here but have material set up to start

  • Has COVID/lockdown affected clients? Clients are still connecting with us and are not in the hospital. It has been challenging for some but not too extreme with symptoms.


Durham

  • The team has been very busy and are supporting each other through transition as a new manager is being hired.

  • COVID has definitely affected patients, quite a few are unwell

Implementation Evaluation

  • Fidelity assessments are starting for sites that went live in April-May 2019 since enough time has passed for those teams to deliver NAVIGATE with clients, it’s a good time to reassess fidelity.

  • Have introduced a new NAV measurement tool for team leads to document the experience of a subset of clients.

  • We are listening to feedback from sites on this process; some sites have expressed challenges for supporting data collection right now especially with staffing changes

  • While our team conducted chart reviews for the first phase of Fidelity assessments, we are supporting your sites to do this now due to the pandemic/virtual assessments

  • We recognize this is an increased burden during a challenging time, so we will follow-up to determine what is feasible on your end

  • We will support you and make this work the best way for you

  • We will follow-up with PSSP and the three sites that are involved in this wave of assessments

  • If anyone wants to follow-up after the call, Janet will also be reaching out to sites to further discuss.

  • As a reminder, the site leads join the Implementation calls on the 2nd week of each month (and 4th week is optional).




CFIR – Qualitative Interviews with Clinicians

  • Two research analysts are being hired as independent consultants, legal is drafting contracts

  • Once we are ready, we will coordinate with the first 3 sites to determine best time for the interviews

Advisory Committees Youth Advisors

  • Actively writing scripts and planning the first video

  • Have created a working group with more frequent meetings to focus on video development

  • The goal is to release in April 2021

  • Will highlight the advisors’ experiences with psychosis, what has helped them, and where they are today

  • Reviewed the recruitment poster and approved it for use with participants

Family Advisors

  • Advisors have been happy to participate in the ECHOs, which has also helped deepen understanding of the model of care and the associated challenges

  • Also trying to attend local family groups to support participating in research

    • Aiming to have local FAC members attend but if not, will try to have another member attend

  • Reviewed the new option to consent family members through email and decrease burden

Attending Site Meetings

  • Having the youth/family advisor perspective so important and impactful, would be a benefit to clinicians and provide encouragement through challenges of this work

  • FAC/YAC can offer their perspectives to both staff and clients

  • YAC members are very interested in this outreach

  • Is there a particular meeting at sites where having a family/youth advisor attend would work well?

  • Thunder Bay: having peer support at sessions has been well-received, so having a FAC/YAC member at some point during the orientation discussion would be nice and can fit into the care pathway.

  • Waterloo: a FAC/YAC member is welcome to join RA during the Tuesday research check-in meeting

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