Implementation Committee: August 21, 2019

In Attendance: Susan, Sandy, Kelsey, Alexia, Josette, Delbert, Sarah, Shirley, Sheila, Jen, George, Krista, Mary, Jeff, Hiwot


Action Items:

  • Sarah and George to review possible solutions to address some of the gaps identified in this meeting

 

Minutes:

Susan

  • The purpose of this call is to assess how everything is going. This includes attendance on consultation calls, feedback, percentage of clients or family members involved, organizational issues, etc.

  • There seems to be genuine attempts to change practice.

  • Overall, it is challenging to keep track of everyone on high caseloads.

  • Some concerns include the scarce prescriber time and turnover of SEE’s to do the consult calls. SEE employees are being hired.

  • Received feedback that there might be redundancy experienced by the teams in various calls when asking similar questions.

  • Another challenge is the ability to make home visits to reach those that are hard to engage. This doesn’t seem possible.

Site Updates

Josette (North Bay)

  • We have a small team that is very engaged. They want to see the project succeed.

  • There is a bi-weekly meeting on Tuesdays with the psychiatrist doing consults and her residents. SEE intervention is outsourced so they don’t attend.

  • We don’t have anyone involved with SEE component at this point.

Sheila (Durham)

  • The structure is in place to make it successful. We are meeting every week and have an all staff meeting every month.

  • Getting availability from the doctors is very challenging. One comes in 3 hours per week. The other doctor is here 6 hours per week.

  • Those who were least interested in implementing NAVIGATE are still struggling. Those that were more open are doing ok. We have emphasized to all that we are fully committed to try and participate.

  • According to the numbers, participation is low and staff are doing more non-NAVIGATE work. It’ll take time to wean out 2-3 year old cases and close them. NAVIGATE is implemented fully for new referrals.

  • A SEE worker was recently hired at the end of July.

  • Staff have expressed they don’t feel the modules work in the order presented. Instead, they begin according to where the client is.

  • Some are not finding the calls helpful. It’s not clear why that is.

  • 90% of clients come into the office to see the various staff.

Krista (Niagara)

  • All new clients are being on boarded to NAVIGATE.

  • Staff were informed that the module order is a framework and flexible.

  • For family group, we are completing the second round of NAVIGATE. A binder of materials for the family was provided and this was well received. We had a good turnout for the summer group and we want to run 3-4 groups per year.

  • The team expressed that the calls have not been helpful. They feel like updates rather than learning something new.

  • Some are concerned about how to retain their work as a nurse or social worker while implementing NAVIGATE. Our client group needs distinct nursing role. 80% of Niagara’s contact is in community.

Trainer’s Feedback

Piper (IRT)

  • The material is being used and many are finding value in it. It varies widely by site. IRT consultation calls have been fruitful because people are using materials with a variety of clients.

  • Some are still looking for IRT participants or only doing one. It’s hard to identify who is the accountability to ensure the materials are being used.

  • Niagara and Durham seems spotty, it’s hard to get a sense of buy in. Less penetration/consistency makes it difficult as there’s not a lot of practice going on

  • North Bay is using the material with everyone and has more to bring to the calls.

  • IRT is very flexible. There are certain modules that are really critical, especially module 2. Analysis was completed on the role IRT played in increasing motivation in research. Those who had four or more sessions of module 2 did better. If you start with a module other than 1 or 2, without a good rationale, it can be problematic and flat.

Delbert (Prescriber calls)

  • Implementing change has been a challenge with the prescribers and many express they are very busy. With limited prescriber time, what can be done? We need to have dialogue about this.

  • NAVIGATE uses shared decision making and is into measurement based care, this is something that hasn’t resonated with the prescribers.

  • The prescriber role is complicated because even though there is some flexibility, there are still guidelines. This group has not brought up problems as frequently as other groups. Everything can’t be running smoothly all the time. It’s better to mention cases so all can learn about NAVIGATE principles.

  • We don’t get a lot of participation from psychiatrists on the calls. There was no prescriber in the last call, only nurses from Niagara.

  • Another issue, there is no systematic overview of what the medicine people are receiving. This information would be helpful to identify patterns. This data is not available to assess what is going well or needs to improve.

Shirley

  • CAMH has done their own internal follow up with those trained in February – therefore not on the SEE post-training calls

  • We had one call and people rotated off; we are in a holding pattern, due to SEE clinicians leaving the programs and waiting for new clinicians to be hired.

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