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Steering Committee: November 21, 2018

In attendance: Lillian, Aristotle, Paul, George, Alexia, Janet, Nikole, Sarah, Dielle, Nadia, Chelsi

Action Items:


  • Update Governance Structure for next SC meeting – Nadia/Chelsi/Dielle

  • Follow-up with sites about contracts – Dielle

  • Reach out to Leanne Needham in Peele about psychiatrist - Janet


  • Add Wanda to in-person training → Chelsi//Nadia - DONE

  • Core residents to join in-person training → Aristotle to provide names - Chelsi

  • Create Drop Box (or other platform) for sites with NAVIGATE training materials - Chelsi/Nadia

  • Change monthly call structure with site leads → keep the full hour and split the time between the sites for individual calls – Chelsi/Dielle

  • January 9th 2019 → Steering Committee Meeting to discuss ECHO & post-training calls - SC

PSSP & Fidelity

  • Send training call schedule to Janet & Alexia for coordination purposes → Nadia - DONE

  • Send final version of Implementation Landscape to Dielle/Nadia – Alexia

  • Email sites about preferences for timeline of Implementation Landscape and Fidelity assessments delivery - Dielle

  • Update chart review language in protocols and TAHSN for future REB amendment → SC

Youth & Family Advisory Committees

  • Email sites selection criteria for youth/family advisory committee participation – Dielle - DONE

  • Youth & Family Advisory Committees to start immediately, sites will join in as they are identified - Dielle/Sarah

  • Augustina (youth advisor) to join Steering Committee and to on-board through central training process – Dielle/Karleigh



Contracts & REB:

1. All sites have received contracts and their teams are currently reviewing the documents, follow-up to be conducted in the coming weeks

2. North Bay REB Call → hoping to hear back within a week, minimal questions and concerns

3. DUP metric in the RAISE study provided by Jean → DUP measured as the time from the first symptom (according to SCID and PANSS interviews) until first antipsychotic treatment

4. Update from Dr. Carolyn Steele Gray about ePRO Goal Attainment Tool → George to discuss on December 19th 2-3PM via Zoom.

  • ePRO tool is a web-based dashboard and mobile application for goal setting and monitoring of goal attainment progress. Currently used at Bridgepoint in physical rehabilitation programs

  • To be considered a potential add-on outcome measure for EPI-SET

  • Link to website [ARCHIVED NOW - 8May2019]

Pre-Training Calls

  • First Call on Nov 21st, 2018

  • Content was well-received

  • Sarah & George articulated the goal to understand the implementation of NAVIGATE in local environments to elucidate necessary adjustments to ensure its successful implementation in real world contexts and to translate these findings for future implementation projects.

  • NAVIGATE trainers are more focused on delivering the program with strict role definitions for clinicians

  • CAMH experienced struggles in terms of staffing and workload during implementation

  • The distribution of NAVIGATE roles within and across sites will need to be determined during pre-training calls to determine how to allocate staff performing multiple roles during in-person training

  • Sarah → conducting calls with all sites to discuss staff roles within the NAVIGATE framework

  • Site case managers are currently performing family work and are hesitant to relinquish these roles

  • Potential future issue → if one person delivers two NAVIGATE roles and urgent crises emerge, the delivery of one model component may be compromised.

Additional Site Considerations

  • Aristotle → call with potential Waterloo site to discuss research opportunity and interest in EPI-SET→ site with high likelihood of success (revisit before training starts)

  • North → Bracebridge interested but does not have a psychiatrist

  • Barrie → not considered the North, pure community centre, large clinical team

  • 4 sites is the maximum at this point in time

  • Aim to add fourth site back in before training

  • Leanne Needham from Peele → wants to shift to evidence-based EPI, historically haven’t had psychiatry, this may have changed, Janet to follow-up

  • Core residents joining in-person training → need names


Fidelity & PSSP Coordination

  • Three processes happening at once → Implementation Landscape, Fidelity evaluations and NAVIGATE training

  • Need to develop coordination plan based on site preferences to avoid overwhelming sites with multiple assessments and high volumes of information

  • Drop-Box or other platform to be developed for materials and questions for NAVIGATE pre-training

  • Plan to stagger PSSP evaluations internally → internal coordination

  • Monthly site calls → too site-specific, shouldn’t have all site leads on one call

  • Meeting between PSSP and ECHO to discuss coordination of implementation support → process was discussed


  • Meeting for ECHO and post-training call set for January 9th, 2019 during Steering Committee meeting to discuss call schedule, structure and content

  • Post-training call rotation over 5 week intervals → 4 core NAVIGATE components covered once a week for 4 weeks and 5th week to be a dedicated ECHO session with case consultation

  • Same time as the pre-training calls to maintain consistency (Tuesdays 12PM-1PM, CS Room 853)

  • Site clinical team rounds occur on a weekly basis

Fidelity Reviews & REB Approval

  • Adding fidelity review to the TAHSN → not an easy fit

  • Lack of articulation of chart review process in the REB/protocol/TAHSN → Janet’s concerns

  • Protocol has been approved and contains references to the Fidelity assessments. The TAHSN currently includes Fidelity component via a reference to the approved Protocol.

  • No REBs have mentioned concerns about the chart review components at this point in time

  • Drawing the line between preparatory work and regulated work (chart review) to distinguish which tasks can and can’t be performed before REB approval. Chart reviews will not be performed prior to REB approval.

  • Site REBs don’t see implementation processes as being governed in the same way as research activities involving participants/patients → explicitly stated in email by Durham REB

  • Procedure for chart reviews includes structured interview with selected staff on the phone and then a request administrative aggregate data about caseload, length of stay, etc. Assessors review data sources and make fidelity rating.

  • Fidelity interviews and chart reviews have consent component

  • Option to bolster Fidelity content in the next TAHSN submission.

  • TAHSN relates primarily to human subject research → rationale for not including Fidelity in detailed terms

  • Most effective to streamline all amendments at once

  • Janet would like a more comprehensive overview in the protocol and the TAHSN about fidelity assessments and chart review

  • Low risk situation → more about the optics of not outlining the chart review process in the REB

  • Paul → past chart abstraction study experience → the TAHSN is about ensuring that participants are not identified. The process of accessing the charts is about negotiating with local health record departments, which is locally determined. It is unusual to require consent for chart reviews as one would be working with sites under their local regulatory parameters which are fairly universal

  • The rationale/premise of the chart review is to understand if the clinicians are practicing a standard of care not to understand about personal information

  • Aristotle → Protocol is the gold standard over the TAHSN

Youth & Family Advisory Committees

  • Local family member interested and another has reached out, need to confirm if child received EPI services

  • Karleigh from YouthCAN will on-board lead youth representative who will be joining the steering committee (Augustina)

  • Connie provided names for additional potential patients

  • Start centralized training process for youth as soon as possible → need to review language for IRT handouts

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