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Project Team Meeting: July 8, 2020



Intro & Administrative / Study Progress Updates

  • Protocol amendment: COVID-19 self-assessment measures approved by CAMH REB!

  • These additional questionnaires incorporated will be incorporated into the participant research visits when approved by site ethics boards

  • Site submissions are in progress, so far we have submitted to Durham and received approval from North Bay

Implementation - NAVIGATE Delivery and Site Updates

Sheila (Durham):

Participant Research:

  • Abanti and Dielle continue to attend staff meetings and have found this effective for participant research

  • 10 clients have been referred and interviewed

  • Clinician feedback: some clinicians want to build rapport with clients before presenting the research opportunity so there is still some difference of opinion about when to ask

  • As clinicians start to ask clients and this becomes more successful, it is likely that the culture will shift and it will feel easier to ask

  • Youth Advisory Feedback: from a client perspective, it is always exciting to have the opportunity to give back and so a clinician doesn’t need rapport to present the opportunity

Clinical Operations:

  • Staff continue to work from home primarily, with clients coming in-person for injections or when new to the clinic

  • Still receiving lots of referrals, and have over 120 cases

  • Hired a full-time, permanent mental health clinician, Allison, who is a social worker and will be performing the IRT role for NAVIGATE

Josette (North Bay)

Participant Research:

  • 3 clients are currently enrolled in the research study, with 1 having their 6-month research visit soon

  • The research staff are trying to reach 1 client who was recently referred, and clinicians have helped facilitate

  • Having Dielle and Abanti attend weekly calls has been helpful

  • Feedback from clinicians and YAC indicate that youth tend to prefer emails over phone calls as they can be anxiety inducing

Clinical Operations:

  • 29 clients currently on case load

  • Clients are coming back for face-to-face visits and have the option of virtual

Kerri (Niagara)

Participant Research:

  • 2 clients referred this week!

Clinical Operations:

  • Onboarding some new staff

  • NAVIGATE is now the norm for every client that enters service

  • Clinic is starting to open up more, but is more virtual than usual

Kim (Waterloo-Wellington)

Participant Research:

  • As of last Monday, clients entering the program are being asked about research

Clinical Operations:

  • Have been using NAVIGATE material and are more comfortable with it

  • Family groups are running virtually

  • 200 clients are in the program

  • Kim to follow-up with Sandy regarding the baseline Fidelity assessment

Clinician feedback: experiencing some challenges with the language/terminology in the modules (e.g. “Negative Feelings”) and how flexible they can be with the language.

  • Will be discussing this further at Implementation Committee and suggest this for an ECHO session

  • Kim’s team has a running log with notes about any variations they use, and the rationales behind them to be used for feedback

Project Team feedback re: this challenge:

♣ NAVIGATE is a framework; when providing info on psychosis, it is helpful to know which pieces to cover/key elements. That said, saying things verbatim will not enhance the therapeutic alliance.

♣ Youth advisor agrees that clinicians should be free to have talent/character and deliver info in an authentic way ♣ The U.S. trainers also want clinicians to know that there is some flexibility

♣ This is one of the central challenges of implementation science - how do you deliver a model as it has been designed/studied and have it work with clinicians/patients? This is a really important theme and also relates to a main aspect of the Fidelity evaluation

♣ This is a great question, and makes us think about how we get to the essence of the model without getting stuck on the words

Would it be possible to revise the NAVIGATE manual to use youth-friendly terms?

We will have the implementation leads attend a YAC and FAC meeting to discuss NAVIGATE and this

♣ From an Evaluation perspective: measuring the delivery of NAVIGATE focuses on whether modules are not delivered, and is not as nuanced as to how. Would it be possible to pick up on things like this that clinicians notice about the model’s expectations/adaptations?

Jen (Thunder Bay)

Participant Research:

  • Will be joining patient measures; still need to pitch this to the team and will seek feedback on how other site clinicians received this aspect of the project

Clinical Operations:

  • Still doing virtual care as per usual, seeing more clients face-to-face and doing outreach appointments

  • Virtual family groups are conducted via Northern Innovations on eeNet – you can check it out by looking at #14 here!

  • Will be looking into virtual groups in other disciplines

Youth and Family Advisory Committees

Family Advisory Committee

  • Meeting this Thursday

  • Video: Family advisors will be filming a video about what NAVIGATE and having a coordinated care model means to them

  • The video can be used in both family groups and among clinicians

  • Feedback from Project Team: the video sounds great and for site leads this will be very helpful for onboarding new staff!

  • Will also be giving recommendations based on Fidelity results in collaboration with Sandy and Janet

Youth Advisory Committee

  • We had a great discussion at the last YAC meeting about mental health during the pandemic

  • We will be giving quality improvement suggestions on the Fidelity results, working with Sandy on this

  • YAC still looking for representation from sites

Implementation - ECHO

  • Completed our third summer ECHO session yesterday, presentation on Virtual Groups by Eva Serhal

  • Discussed tips and processes that the CAMH virtual health service applies to virtual groups/virtual care

  • Next session on Tuesday July 21st on Behavioral Activation

  • Good discussion and interaction between sites with 22 site clinicians in attendance

  • Sites prefer more practical clinical skills based ECHO sessions

  • Abanti to follow up with hub team with survey feedback and coordinate next session materials

  • Surveys continue to be done more consistently, and feedback indicates that staff want more practical clinical skills and less formal sessions

  • Currently working with sites and PSSP to find a better time for ECHO sessions for Sept onwards

Patient Measures and Outcomes

Recruitment Update

  • 24 referrals total, 5 from North Bay and 2 from Niagara (we have reached out to them)

  • 13 baselines completed (10 from Durham, 3 from North Bay)

  • First 6-month visit completed

  • Clinicians have been so helpful and we appreciate their hard work!

  • We have attempted to contact all referrals, and have reached out to clinician when we haven’t been able to contact

  • Having Abanti and Dielle attend site meetings have been helpful; we will set up with Sudbury and Waterloo-Wellington

  • Research Orientation meeting completed with Waterloo; Sudbury scheduled for July 16th

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