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Project Team Meeting: October 7, 2020

Admin/REB Update

· We have approval from Durham REB to proceed with COVID assessments during research participant visits

Site Updates

Waterloo

· The research team joins weekly meetings, which has been helpful for staff remembering to refer clients. The goal is to refer at least 1 client per week.

· Currently have 4 family groups running.

· Staffing changes: 2 new staff are starting, and 1 clinician (Paul) is leaving.

o Al mentioned that he is happy to support new staff. 

Durham

· Case load is currently around 120, with 50 of the active cases receiving NAVIGATE (as most clients started before April 2019 and are nearing end of treatment).

· There are 10-15 people on waitlist, which they have not had in the past – but factors include high incidence of cannabis use and staff turnover.

· Staffing: Andre (full-time IRT clinician) is returning in mid-November, Sarde (IRT) is taking on a lot of new cases, and new family clinician/nurse, Brenda has been doing great.

· Family group will be starting next week, with Allison (FE) and Teresa (IRT) co-facilitating.

Niagara

· Case load is currently 110-115 clients; receiving many referrals and seeing a lot of returns of people who were discharged and struggling to find alternative services after the 3 years.

· NAVIGATE has become the norm.

· Fully staffed for first time in many months, with addition of new psychiatrist, Dr. Marc Legault.

· Overall, things are going the same as usual, very busy.

Sudbury

· Received 4 referrals this week, and starting to see an increase.

· Staffing: Carla has temporarily moved to a new opportunity, and Irma is filling in. Megan is a new clinician as well. 

Thunder Bay

· Receiving lots of referrals, with 5 this week so far.

· Had formal launch to NAVIGATE this week.

· Met with research team this morning and reviewed referrals – will start that right away.

· Meeting weekly with clinicians in each of their individual roles as well as team meetings to review how they deliver modules.

· Have plans to begin outreach in community. Jeff has helped with slides to incorporate in community presentation.

· Will be offering family program soon.

North Bay

· Current caseload is 27; a few discharges and new referrals (3 in September).

· Most visits are still virtual (OTN and phone)

o In discussions about transitioning to “face-to-face” psychiatric appointments.

· Team will be sending out surveys to family members to ask if they’d prefer FE delivered individually/via a virtual group/via an in person group to help determine service delivery going forward.

· Did not have a team meeting this week because we were in training.

CFIR Qualitative Interviews

· Purpose: to identify barriers and facilitators for implementation, while clinicians are learning and delivering NAVIGATE. Will help for subsequent roll-outs to other communities. Also gives us an idea of clinical effectiveness and extent intervention is delivered as intended. 

· Melanie will have a team of 2 expert research colleagues conducting interviews over the phone/ZOOM – around 45 minutes long.

· The questions will capture multiple factors, including the characteristics of the intervention, how you were set up for success

· The first 3 sites on the project will be first – hoping to complete REB in next few weeks and set up interviews November-December

o Will work with CAMH team to coordinate

· With the 6 sites – the 3 that were first, we are hoping to complete REB in the next few weeks and set up the interviews through CAMH around NOVEMBER to EARLY DECEMBER

· Interviewing 3 people at each site – Site Lead, IRT and Family Worker

· Questions:

o When do you need names of staff who will be interviewed? Within the next month, Melanie will work with CAMH admin

o Why not interview SEE clinicians?

§ One reason is logistics (budget and time constraints)

§ We also had to consider who might be most familiar with the implementation challenges, and to some degree, SEE clinicians may not have that level of involvement. Site Leads can provide a high level overview of how things are going for all roles.

o Why not include Peer Support Workers in the interviews?

§ Since NAVIGATE does not have a structured component for peer support workers, the practice change experience may not be reflected in this role.

§ EPI-SET addresses some gaps but not all, perhaps future funding could seek to include peer support work

§ Similar to the reason for SEE clinicians above, logistics present an issue. Melanie is happy to widen the scope more, but may be limited by logistics

ECHO

· Great engagement – continuing to build momentum.

o Feedback has been great in guiding the focus of sessions.

o Resource sharing among sites is further facilitating the community of practice

o Frequency change to twice monthly has greatly benefited the community of practice as well.

· Last session discussed Family Education, and family advisors were present. We also learned about the Family Education program at sites.

· Sudbury has been scheduled to present next case, but with staffing changes, the new staff are just starting with NAVIGATE and there are currently no challenges. Would want to present something meaningful and seeking more direction.

o Could discuss adaptation of specific modules to patients/scenarios

o We don’t expect sites to manufacture cases

o Brannon can also help support offline by switching with another site

eNAVIGATE

· Evaluating virtual delivery of NAVIGATE at CAMH, since we all had to quickly transition

· Will look at integrating best practices through CAMH virtual mental health and evaluation approaches

· Involves fidelity assessments, interviewing clinicians/team lead about implementation process, as well as interviewing patients and families about experience receiving care virtually.

· Also looks at service engagement outcomes (are clients more likely to drop out of care when model is delivered virtually?)

· A virtual care satisfaction survey was developed that targets patients/caregivers— provider version will be rolled out soon

· CIHR funding for 1 year and U of T for second year

o 1st year will mostly focus on implementing additional best practices and evaluating model at CAMH

o Will communicate findings to other sites throughout, but second year will involve sites more for resource sharing and learning.

· Want to know what parts of virtual care work well, who does it not work well for, and how to adapt

· Currently gathering information from CAMH clinicians about additional support needed and processes that could be improved  

· Summary: will do what they did with NAV, but at CAMH first. Get implementation going and then share that.

· This is a partner/sub-study with its own grant that integrates in this broader project, learnings can be shared during these meetings

Family Advisory Committee

· FAC put out the video about why they think this work is so important – site leads can show the video to their newer staff

· Next FAC meeting is tomorrow

· Brannon will be reaching out to site leads about having FAC members attend Family Education groups

Youth Advisory Committee

· Great YAC meeting last week

· Also want to create a video, currently outlining what they would want purpose of video to be/content/quality.

· Might explore creating a few short videos, discussing lived experience, EPI-SET, engaging in research, etc.

Patient Measures

· Thunder Bay research orientation meeting complete – will start referring clients now

Summary

166 admissions --> 52 referrals --> 27 scheduled --> 22 enrolled

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