Steering Committee: October 14, 2020

Updated: Sep 6

ACTION ITEMS

· Schedule Aristotle to attend next FAC meeting – Brannon

· Create one-pager of implementation measures efforts for FAC – Janet

· Focus on EPI-SET successes in upcoming newsletter – Andrea

· Share site staffing document with Steering Committee – Sandy/Janet

MINUTES

REB

· Received REB approval from Durham for COVID measures and will begin incorporating into Durham research participant visits

· In process of submitting CFIR amendment to Durham

· Have not heard back from Waterloo but expect approval soon for CFIR

ECHO

· Next Session: this Friday, October 16th on IRT

o Didactic presentation: Tom

o Case presentation: Waterloo

· Last session on Family Education received a lot of positive feedback from sites

· At last Family Advisory Committee meeting, discussed having a family member attend ECHOs regularly. There is an interested family member, and Brannon will follow-up with them.

Patient Measures

· Total Referrals received: 56

· Baseline completed: 23

· Upcoming Participants: 1 this week, 1 next week

· Booking in 6-month visits as well

· Will be following up with each site about evening appointments, and clinicians contacting us during client appointments

· On Implementation Call this afternoon, will discuss recruitment strategies with site leads

· Biggest challenge is getting in contact with referrals

· We have discussed text messaging referrals – this will need to go through the ethics boards and we are planning to incorporate into next round of amendments

YAC

· Augustina has meeting with Sandy and Janet today

· Next meeting: October 23rd

FAC

Feedback from Recent FAC Meeting

· Some members concerned that low recruitment numbers mean project is failing

· There was a question about the data being collected from ICES, and whether we are going to look at outcomes for sites running NAVIGATE and comparing to general population, or only with data from participants who agree to participate in study.

· The FAC recommend that clients opt out of instead of into research

SC Feedback

· The primary objectives of the study are clinical level/implementation outcomes. These are separate from how many participants we recruit.

· We will use ICES to compare NAVIGATE with non-NAVIGATE and non-EPI clinics. It won’t only be linked to participants that are part of this research study, but to all clients at the clinics since ICES is publicly held data.

· While we are trying to improve recruitment (which certainly has not been helped by the pandemic), the other objectives are successes.

o We are still able to evaluate fidelity, implementation, sustainability and health system outcomes.

o Another success is the addition of sites who previously said they could not join

o Focus on these successes in the newsletter

· The RAISE study was the foundational work of NAVIGATE – this study is about implementing NAVIGATE in the Ontario context.

· We are looking at patient outcomes for comparison purposes but it is not the primary outcome of this work. The primary outcome is fidelity to the model.

· ICES data depends on successful implementation because it compares system-level outcomes with in regions with sites doing NAV versus regions with sites not doing NAV

· ICES can only be done at the end of the study because it takes a couple of years for the ICES data to be sorted and unlocked

·  In terms opting in/out for research, since this study deals with multiple REBs, we likely wouldn’t be able to make this kind of system change in time for this study

Next Steps

· Aristotle to attend the next meeting to be available for questions

· It will be helpful for investigators to make it clear that the data collected as part of this study do not impact program funding. The purpose of fidelity is to identify areas for improvement, not failures.

· Look into FAC members attending site meetings to provide input on incorporating the mention of research into their clinical routine, since the advisory voice is so powerful

· Janet has offered to provide a one-pager that summarizes the multiple sources used to measure how the model is being delivered, including but not limited to fidelity

· We will have some early data on whether sites are meeting standard of care better, soon, since 2nd round of Fidelity assessments is starting

e-NAVIGATE

· Early focus of the grant: conducting rapid needs assessment with SCEI care providers to identify gaps in service delivery that CAMH Virtual Mental Health resources, supports and training can help fill

· Using a variety of methods to collect information

o Mostly utilizing existing standing staff meetings for group and breakout discussions to minimize time burden

o Also offering ability to provide anonymous feedback

· Meeting with patient and family advisors on the project to understand their initial impressions of gaps in virtual care and will engage them in getting feedback on proposed solutions

· Aim to schedule a study startup meeting for November 

· Beyond the EPI-SET meeting times, we will likely hold a monthly Steering Committee meeting at a separate time

· Have initiated hiring process and hope to have study staff and REB approval soon!

Fidelity/Janet

Summary on Team Staffing

· Sandy led this work and asked sites for their staffing info and estimates of how much each person’s time is spent on NAV vs other roles

· Purpose: to understand capacity to deliver NAVIGATE for Fidelity outcomes (e.g. how much staff they have)

· Third column from left shows EPI team size – red shows estimated time spent delivering NAV

· Main finding from this data: proportion of staff delivering NAV is significantly lower than team’s staff

o Asked them what they do if they are not doing NAV

o They would describe some of those other tasks as delivering NAV

o So this is based on the team’s estimates

· Would want to do this again near end of study to get an idea of what staffing looks like

· This is site lead perception of what is happening at their sites

· Some tasks are clearly not NAVIGATE (managing OTN, scheduling for clinic) – but there are some  blurry areas (spending a lot of time doing case management).

· In the Ontario context, nurses play an interesting role in NAV. A lot of nurses provide IRT material and also do metabolic monitoring and LAI where in NAVIGATE that is in the prescriber role.

· Would this be a helpful coaching tool for the Implementation Specialists? Yes, especially with that blurriness of what exactly counts as NAVIGATE. Could prompt good discussions. Also very beneficial for internal purposes.

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