Steering Committee: October 24, 2018

In attendance: Nandini, Alexia, Lillian, Jean, Nicole, Janet, George, Chelsi, Dielle, Nadia

Action Items: *** are time sensitive

Implementation

• ***Reach out to sites to set up dates for pre-training calls – Nadia/Chelsi

Site Readiness

• ***PSSP and ECHO to provide dates/times for interviews with sites as well as point person from each team who will be reaching out to the sites – Nadia/ Chelsi

• *** SC members to send questions regarding site readiness (Lead-Derek Chechak/Alexia), fidelity (Lead- Mary Hanna/Janet) and ECHO (Lead-Christine Mitchell/Eva) interviews to team leads for each of these component cc’ing Chelsi/ Nadia/Dielle. Please send any questions that you would like added to the interviews in one email.

• *** Overlap between elements of clinical and implementation readiness → Sarah and Alexia to connect, add Sarah to call with implementation specialist to discuss cross-over

• ***After above tasks are completed, introductory email to be sent to sites to coordinate Fidelity, PSSP, ECHO interviews → Dielle

IRT Handouts & Tip-Sheets

• Handout and tip sheets for each IRT module → Sarah/Janaki/PSSP

• What is the timeline for these handouts? Before or after pre-training? – Sarah

Manual Translation

• Get a Word document of IRT module for modifications – Janaki

Administrative & Operational

• ***Durham has one major REB concern that needs to be addressed before the remaining responses and comments are sent out- the re-submission will go to full board review on Nov5th→ Dielle and SC (see attached response from Durham and comment highlighted in red that needs to be addressed)

• Follow-up with legal for site contracts and send out early next week – Nadia

• ***Contract with Piper needs to be completed before pre-training calls – Janaki

• Draft potential schedule of NAVIGATE support calls → different versions and outstanding items– Janaki/George

• Consult model of blended NAVIGATE & ECHO sessions in the States – George to reach out to Susana

• Establish ECHO call timeline – Sanjeev/Eva/Christine

Address Post-Launch Meeting Agenda Points

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Minutes

Implementation

Site Readiness Assessment:

• Janet and Mary Hanna taking the lead reaching out to sites about fidelity review

• Excel spreadsheet is in the T-Drive → missing information from Sudbury and some values from other sites

• Mary Hanna connected with sites for pre-fidelity conversations → sent doodle poll

• PSSP site leads meet twice a week with sites → currently finalizing the landscape interview template

• If any member of the steering committee has additional questions for site readiness reach out to the appropriate PSSP, ECHO or Fidelity point person

• Fidelity, ECHO, & PSSP readiness assessments will be conducted separately but introductory email will be coordinated by Nadia/Chelsi

• Mary Hanna → if Fidelity can’t get a single meeting time with sites they will conduct individual site meetings, already building a relationship in this area

• Alexia → implementation specialist will need to gather site readiness information, there is overlap between clinical and implementation readiness

• Meeting with PSSP, Sarah, Janaki to review site excel readiness document to review staffing mix

Pre-Training Calls

• Modified training based on lessons learned NAVIGATE implementation at CAMH

• Pre-training allows is focused on exposure to the content of NAVIGATE; in-person training focuses on delivery of NAVIGATE

• Only site clinicians receive pre-training; all staff members receive in-person training

• Pre-training call structure and content

• 1st call → led by George & Sarah → high level overview about NAVIGATE, addresses the benefits, connecting the dots with provincial standards and how the intervention operationalizes the standards

• 7 calls with NAVIGATE Trainer (Piper S. Meyer Kalos) about 7 core modules of IRT module

• Need to have contract in-place with trainer before the calls can start

• Proposed start date of November 12th or 19th, 2018

• Sites will receive electronic documentation of NAVIGATE manual prior to pre-training calls

• Susan Gingerich is the lead trainer who will delivery NAVIGATE in-person training on February 6-7-8, 2019.

• In-person training will focus on the other components of NAVIGATE and guiding principles

• Optional modules 8-14 will be explored during trainer follow-up calls over the course of the year

• Piper Training Call Time Suggestions: Tuesday afternoons (1-2pm; 2-3pm; 3-4pm); Wednesday mornings (10-11am or 11-12pm); Wednesday at 4pm – Piper’s availability

Trainer Contracts

• Janaki has previously made the contracts → Piper can sign the contracts as an independent contractor outside her role at her institution, resulting in a faster turnaround time

• Aristotle has already signed the contract and we have received a validation from procurement

Readiness Monitoring Tool

• Requires some knowledge of the intervention before using the survey

• Option to perform the RMT in late February/early March before NAVIGATE is implemented at the sites and after the delivery of in-person training

• Three components of the RMT: motivation, skills and general organizational support for implementing a new intervention

ECHO

• Timeline for ECHO involvement in support calls?

Follow-Up NAVIGATE Calls

• 1 year of support calls from the NAVIGATE trainers, some of which are intervention specific

• IRT calls → bi-weekly for the first 3 months; monthly for the remaining 9 months

• SEE, Family & Prescriber calls → 1 x month for the first year

• Director calls → structure and schedule needs to be determined

• Need to include ECHO calls in the schedule → potential to integrate calls to not overwhelm the sites

• All calls will be an hour and will use Zoom infrastructure

• Will also have other monthly calls with sites about research, implementation progress, etc.

• George Ideas:

• ECHO and IRT could have alternating calls → need coordination between these teams

• Integrate ECHO & NAVIGATE calls into 2 hour blocks per week

• Need to minimize the number of calls per month for the sites

• Someone in the US is developing a blended structure for NAVIGATE & ECHO calls → potential model

• Director calls → Sarah is the point-person for these calls

• Addresses implementation piece and structural/organizational issues

• PSSP also have implementation working on this

• Members of the PSSP and implementation teams could be added to the director calls

• These calls also address site-specific information such as bridging local services with community partners

• Jean has experience with the director manual and calls → the director is the point-person around treatment and research → a lead at each site

• Clinician concerns would be reported to the director and discussed with CAMH during director calls

Manual Translation

• Need to modify some of the content in the manual to speak to Canadian and youth language → this is a challenge because PDF documents can’t be edited

• Janaki is reaching out to Piper about getting a Word version of the IRT manual

• Janaki has tried to reach out to Piper about the IRT manual to get a word document verion → some hesitancy because of fear of changes to core content

• Solution → send translated manual to NAVIGATE for review

• When does this translation component need to be accomplished?

• Compiling IRT tip sheet that distils content of the modules that have been helpful for the Slaight team as well as a condensed overview package for clinicians → when does this need to be ready?

• Mood content → unclear if this is necessary beyond Slaight → do other sites see non-affective psychotic disorders?

Outcomes for Affective & Non-Affective Psychotic Disorders

• Won’t be able to measure mood disorders at systems level because of ICES codes which don’t distinguish between psychotic and non-psychotic mood disorders → comparison group will be limited only to schizophrenia spectrum (codes 295 and 298). Will have to articulate that only a specific cluster is being examined at the system levels.

• The intent is to deliver NAVIGATE to everyone with early psychosis

• Patient outcomes will include affective and non-affective patients

Administrative and Operational:

• Durham-Lakeridge: waiting for comments form a lawyer before sending REB back by end of this week

• Almost have final approval from Sudbury

• Call with North Bay REB on October 20th, 2018

• Waiting for expedited approval from Niagara