Project Team Meeting: June 3, 2020

ACTION ITEMS:

• Add agenda item to discuss early implementation challenges among site leads for Implementation meeting next week - Dayna

• Coordinate schedule of ECHO Hub facilitators - Abanti

• Follow-up with Niagara Peer Support Worker about research - Abanti

MINUTES:

Administrative: Study Progress Updates

• The CIHR Report draft was circulated to the Steering Committee for review

• Dielle will circulate the budget report to Steering Committee next week

• Dielle met with Thunder Bay regarding contracts to begin patient measures – we are excited to have Thunder Bay for this outcome measures

Implementation – NAVIGATE Delivery

Durham

• Dayna and Abanti attended team meetings to encourage client referrals for research

• Previously, clinicians were concerned about whether patients were appropriate for research but Sheila encouraged them to let clients and research team make those decisions.

• Note: All clients that enter EPI programs are eligible for the research study, important to give them autonomy to decide.

• Will start keeping track internally of how many clients are asked about research and their responses.

• The team is very busy and adjusting, previously doing telephone counselling but adding video with MS Teams this week.

• Received Fidelity assessment and meeting with Evaluation Team to review on Monday

Niagara

• 27 clients are receiving NAVIGATE, most care is still virtual and the clinic is still short on staff

• Next week will see clients in person for metabolic monitoring; psychiatry will remain remote

• Clients will be properly screened for COVID before being able to enter the clinic; the clinic is attached the public health unit

• Hoping that peer support worker on the team will be able to help out with recruitment; Abanti is setting up a meeting

North Bay

• The case load is high: 30 clients with 4 new referrals recently and may get a transfer from Halton program

• Staff change: currently have an interim manager

• Delivery of NAVIGATE has remained consistent, via phone with clients coming in for injections

• Abanti and Dayna met with team to discuss recruitment and 4 North Bay clients are currently enrolled in the research study

• Clinicians will discuss challenges and barriers to recruitment with research team this month

• Clinicians expressed some concern with asking clients about research too much, YAC gave feedback that clients want to be asked about these opportunities
  

Waterloo

• Meeting with research team on June 10th to discuss research process and outcome measures

• 32 clients have received NAVIGATE components as the team gets up to speed

• Before NAVIGATE, clients did not have a formal way to review treatment; it would come up informally and during crises. With NAVIGATE, there are treatment overviews occurring on a monthly basis since case load is high with 180 clients.

• Each staff has been designated to lead on one of the NAVIGATE modules and will be teaching modules to each other.

• Note: as staff teach each other and encounter challenges, these will be great topics to discuss during the bi-weekly ECHOs.

• Waterloo team has notified Abanti that they have scheduling conflict with ECHO as Tuesdays are fully booked.

• In this early stage of implementation, clinicians are expressing the high demand/additional time commitment that learning NAVIGATE requires

  • o This will be addressed at next week’s Implementation Call – as first wave site leads can provide insight/tips

PSSP Update: Implementation Supports

First 3 Sites: Durham, Niagara, North Bay

• Current focus has ranged from support being more hands-on to keep momentum up and support clinicians as they adjust to virtual care, whereas others have requested less based on the need.

• All sites are successfully using the NAVIGATE model as business-as-usual care.

• Goals are moving sites to Full Implementation and identifying the early stages of sustainability planning.

• Currently in the process of adapting internal project tracker, to ensure that the implementation story is being captured in the most meaningful and efficient way. 

Main areas of support at these sites:

• Orientation to changes in organizational leadership

• Onboarding new clinicians

• Providing targeted 1:1 support as needed at all levels of the organization

• Reviewing recommendations within the fidelity reports to address quality improvement.

• Coaching activities currently focusing on research participant enrolment.

Second Wave of Sites: Sudbury, Waterloo-Wellington, Thunder Bay

• All new sites are currently utilizing the NAVIGATE model with their clients.

• Have adapted each new site’s unique coaching plan to keep all areas of a program on track and moving forward

• Also supporting site leadership/clinical teams to address obstacles and identify alternatives, and celebrate successes as they occur.

• Pandemic has impacted certain sites more than others, and timelines/focuses within those coaching plans have been modified as a result – certain sites have increased capacity, whereas others less so.

Main areas of support at these sites:

• Continuing to engage to keep momentum up during the challenges of the time

• Adapting resources to fit the identified need of a program

• Supporting the development of group material and supporting the initiation of the research component of the project. 

What’s next?

• Over the next few months, anticipate continuing more improvement cycles around implementation challenges, focusing on supporting research involvement as Sudbury and Waterloo begin recruitment, and providing different levels of coaching support based on the site.

• Will utilize Core Components soon to support teams in staying true to the Fidelity of the model in each unique setting while also reiterating the variability in delivery.

• Also focused on moving forward with Fidelity activities and have been meeting with site leads alongside the Evaluation Team to identify possibilities of shifting to a virtual approach.

ECHO

• The theme of yesterday’s session was “Staying the Course”: discussed new demands/issues coming up with clinical practice and how we can continue to deliver NAVIGATE without drifting from model.

• Engagement was good during this ECHO from all sites, and 24 site clinicians attended

• Abanti is going through survey feedback and bringing feedback to the planning meetings for upcoming sessions

• Our clients and their families will want to know that we are continuing to develop our skills and we should commit to this in the field

• Abanti will be creating a schedule for guest hub facilitators for the coming sessions

• Received approval of our accreditation application - thank you to Jenny and Sanjeev for their help and coordination!

Youth and Family Advisory Committees

FAC Perspective

• It is really encouraging to hear the sites talk about how quickly they have adapted to virtual care and there are challenges and everyone at different stages but continuity of care so important.

• Hopefully, documentation according to the NAVIGATE model helps virtual care and is seen positively by staff, not as a burden to learn because it is important to how service is delivered

• Janet and team will return to FAC to discuss Fidelity results and address weaknesses, FAC are happy to provide input and help

• This is a long study and we are hoping for a positive outcome

• New FAC member is joining this month, meeting on June 11th

YAC Perspective:

• We have had 2 really engaging YAC meetings and it has been so interesting to learn about all the work that goes into ensuring we measure implementation correctly

• We are providing quality improvement feedback based on the Fidelity results and areas for improvement

Referring New Committee Members

• The more perspectives, the merrier! Both committees are happy to have new members. Please refer interested family members to Laura and interested youth to Andrea

• Youth need to have completed or be near completion of EPI services

• Please see this YAC poster and this FAC poster for reference

• Please note these posters and other resources for the patient research portion of the study are conveniently located on our website

Patient Measures and Outcomes

• Referring clinicians have been very helpful in coordinating and booking clients!

• Research team is attending bi-weekly/monthly site meetings to check-in

• Research Orientation Meeting with Waterloo scheduled for June 10th

Recruitment Update

This graph reflects only those clients that have said yes to be contacted about research from Dec 2019 to Jun 2020.

Legend: The solid bars indicate whether a referred patient enrolled in the study and completed the baseline visit. The bars with hatched lines show referred patients that we are still contacting.

Summary:

• 10/15 referrals have been scheduled for baseline, of which 7/10 completed baseline, 2/10 scheduled were no-shows and 1 is booked for next week.

• We are working on booking in 6 of the recent referrals.

• For clients that we have not been able to reach, we have followed-up with referring clinicians to establish contact.
  

Discussion and Feedback

• Overall enrolment target is 400 over the duration of the project; enrolment started later than planned

• From Durham and North Bay clinicians: it may be helpful to mention compensation for participating when clinicians mention the study - we do not have approval from REB for this yet.

• Clinicians are concerned about building initial engagement with their clients before bringing up this research opportunity

• YAC agrees that it is helpful to build rapport before asking

• Research team agreed with clinicians; it might be helpful to ask at the 2nd or 3rd appt. to not overwhelm clients

• It is important to hear the client’s voice and be cautious of clinician bias

• YAC have previously indicated that youth want to be given more opportunities to participate later if they say no initially – we have modified our referral form to incorporate this