Project Team Meeting: September 2, 2020


ACTION ITEMS:

•Invite Melanie Barwick to next Implementation Call with Site Leads – Andrea/Dayna

•Follow-up with Sandy and Janet regarding Quality Improvement feedback – Augustina/Lillian


MINUTES

Intro & Administrative / Study Progress Updates

•Amendments to incorporate COVID measures in participant research visits have been approved by all sites except Durham.

•Will be meeting with Durham’s REB chair in a few weeks to discuss the amendment

•A different set of amendments regarding the CFIR Qualitative Interviews with clinicians are pending approvals from sites

o Obtained verbal approval from North Bay, waiting on written approval

o Brannon and Dielle will be following-up with the site ethics contacts

•Contract was sent to Thunder Bay and is being finalized, Tiffany will forward contract to Carol


Implementation - NAVIGATE Delivery

Durham

•The clinical team met with Sandy and Janet on Monday to finish reviewing the Fidelity report

•Incorporated feedback from report into documentation; will be ensure documentation has same headers as Fidelity report so that information can be found more efficiently for future assessments

•Also discussed Core Components and how to capture information, will be discussing with staff at next team meeting

•In addition to weekly team meetings, Sheila touches base with each staff member every 6 weeks

•Staff turnover, currently making adjustments: Gorete retired, so hired a new RN that started today; Sarde will be doing IRT full-time; and Jeff will become the intake clinician. The intake clinician role includes a lot of case management, so have decided to rotate this role yearly.

•6 week Family groups will be starting every 2 weeks, led by Alison (IRT) and a family worker

o All info from NAVIGATE binder has been adapted for powerpoint

•Case loads are still large, with each clinician having about 30 clients

•Clinicians are engaging clients through virtual care and seeing clients in their backyards, going for walks



Thunder Bay

•The team is excited to get started on research recruitment, currently working through contracts.

•Implementation launch date is aimed at early October

•Working with each role to establish care pathways – the prescriber has already worked with PSSP to develop care pathway

•Focusing on documentation and how to incorporate requirements into data system

•Family group has a 4-5 series starting in September

•Currently meeting with clients and families virtually through OTN, looking to have some come into clinic

•SEE staff are meeting with clients in community to do walks/physical activity

•Virtual groups are offered 2x per week

o One group is focused on behavioural activation/recovery

o Other group is a wellness group for family and clients, with an education and exercise component


Waterloo-Wellington

•3 clients have been referred to research

•Having Dielle and Abanti attend weekly team meetings has been working well, and is a great visual reminder to refer

•Staff are getting more comfortable with NAVIGATE material

•Good progress made with the chart extraction with Sandy


Sudbury

•Chart extraction for Fidelity assessment has been completed and sent to Sandy, and have discussed strengths and gaps of program to improve going forward

•Staffing: RN is leaving until the end of January, a posting for the position went up today for the Family Education role

•The RN gave feedback about the role, expressing that managing case load and delivering family component can be overwhelming. So looking at how we can meet standards while considering our capacity as a small team.


North Bay

•One client completed their 6-month research visit yesterday, experienced some issues with WebEx but worked it out

•Case load is currently at 27 – some will be discharged soon, including a client that will be referred back to Durham.

•Many clients are preferring virtual visits; currently have option of telephone, OTN or in-person

•Fidelity presentation meeting was well-received by staff



Qualitative Interviews with Clinicians

Purpose: The purpose of these interviews is to understand barriers/success pathways to implementation from a local context, clinicians’ experiences implementing NAVIGATE

•Conducted by Dr. Melanie Barwick, a scientist at UofT and expert in the field of Implementation Science

•We will invite Melanie to the next Implementation Call that includes site leads so that a clear plan can be established, questions answered


Timeline

•Aim to begin by end of October

•Each interview takes approx. 45 minutes


Plan

•1-2 clinicians per site and site lead would participate

o IRT clinician will likely be selected as this is a comprehensive role

o Another clinician representing Family or SEE work may be selected

o We will coordinate with site leads and clinicians for these interviews; site leads can inform them ahead of time so they are aware they will be asked to share their experiences

•Will likely begin with the first 3 sites


Feedback and Questions

•Would be interesting to ask staff members who have been with the EPI program for a shorter vs. longer duration

o Sandy and Janet will be adding questions to the Readiness Survey for the next round of Fidelity assessments that include the length of time a staff has been with the program

•Is this part of the research connected to the question previously posed about whether NAVIGATE was related to staff turnover?

oIt is a structured interview, but there will also be time for open commentary so if there is something you want to raise, observations/ideas, please bring it up

oMelanie is not specifically looking at that, but will be looking at the general impact of NAV on your team, so this will certainly come up

.


e-NAVIGATE

•A sub-set of the EPI-SET investigators/team applied to a CFIR request for rapid response COVID-related mental health/service delivery research

•Dr. Kozloff led the application for a 1 year study examining the virtual delivery of NAVIGATE and it was funded!

•The application was ranked 3rd out of over 100 applications Some of you are aware that the subset of the group applied to CFIR rapid response request COVID related application for mental health/service use and delivery.

•Thank you to all those who contributed to this success!



Youth and Family Advisory Committees

FAC

•The FAC video was distributed and has received positive feedback so far!

o The video shows why family members are participating in the study and value the NAVIGATE model

o Clinical teams can feel free to share the video with their teams, new families that enter their programs, and during family groups.

o Youth gave their family member permission to participate in the video and for the video to be shared

•Lillian will be following up with Sandy and Janet regarding the Quality Improvement feedback for Fidelity


YAC

•This past Friday’s YAC meeting was one of the best we’ve had!

•We focused on how YAC members can contribute meaningfully

•Augustina met with Sandy and Janet to determine which areas of the Fidelity report QI section YAC members could provide feedback on

•YAC members are particularly interested in contributing towards Education

o E.g. developing education materials, and telling their stories

•YAC also interested in creating treatment/crisis plan templates

•Augustina will meet with Sandy and Janet again to get more details for moving forward with feedback


Thank you to Lillian and Augustina for your leadership in Fidelity assessment quality improvement work with the YAC and FAC!


Peer Support at Sites:

•Youth have raised the importance of having access to peer support workers while in an EPI program, as well as opportunity to give back through peer support work after program

•These roles tend to not be advertised, or are offered with low hours despite the high demand

•Some sites have in-house peer support roles, others out-source to community

o In EPI programs outside of this study, there are generally PSWs. Among teams participating in this study:

o Waterloo-Wellington has 2 permanent part-time roles with goal to increase hours

o Durham does not currently have in-house, but Durham Mental Health Service has a community based program

o Thunder Bay had one that was very well-received before COVID

o Niagara has a peer support worker that will be providing family education

o North Bay does not currently have a peer support worker


•It would be great to identify through Melanie’s work whether the presence of a peer support worker has an impact and can be a case for future funding.

•A peer support worker at sites could also help with recruitment for the study


Implementation – ECHO

•We have completed the last summer ECHO

•Sessions will be on Fridays bi-weekly to better accommodate site availability

•The first session of the new cycle will be on September 18th, as many staff will be away on September 4th

•We are working with PSSP to orient sites (especially newer sites) back to the more formal model of ECHO which includes site case presentations

Abanti will be assigning case presentation dates among site equally and randomly

• The curriculum is updated on the website


Patient Measures and Outcomes

•We looked the intake of new clients, number of referrals, and number of baseline research completed by site

•We started receiving referrals from North Bay in January, Durham in March, and Niagara in July – we have noted this on the graphs

•In total, 75.6% of clients have been referred for research

•It is great to see that a high proportion of individuals entering clinics are being referred!

•The research team is continuing to work on contacting and scheduling individuals for research

•Thank you to teams for including the research team in your rounds – we know you are busy and we appreciate your time to have helpful discussions

•Our recruitment target: 4 new participants enrolled every week across all sites (the more sites that refer, the more manageable this target is)

o Recently, we have come close to this target each week

•At the next meeting, we will also be able to include the other sites that have sent in referrals after July

•Site leads requested to show this graph to their teams, and we agree it can be a useful demonstration of their efforts














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