ACTION ITEMS
Follow-up with Implementation Evaluation team about sites’ strengths from the Fidelity results and more areas of improvement for our feedback – Andrea (in progress)
Pass along survey feedback and see if we can change it to every 3 months – Andrea (in progress)
Fill out the attached honorarium e-transfer document – ALL YAC Members
MINUTES
Janet and Implementation Team
YAC Feedback: Appreciate that NAVIGATE incorporates spirituality, arts and creativity as methods for building resilience.
About the Implementation Evaluation Team, NAVIGATE and EPI-SET
Janet, Mary, Heather and Sandy work as part of the EPI-SET study
EPI-SET is the study and NAVIGATE is the program
NAVIGATE is like a curriculum that includes medication management, individualized resiliency training, support for employment and education, and family education
It can be individualized to a client based on their goals, and ensures that every client is offered the same quality of care
The team assesses whether delivering NAVIGATE leads to improved Fidelity to Early Psychosis Intervention standards (international and Ontario standards).
Fidelity means whether the program is being used as intended/how well it is used
They also assess how ready the clinicians at the sites are to use it with their clients
There are 6 different programs across Ontario being evaluated in the EPI-SET study
The Fidelity results we look at are on the first 3 sites that started
It is important to measure whether the program is being delivered as intended.
Fidelity Results
The Fidelity scale has 33 different parts and is used internationally
We looked at example of some items on the scale and results from the first 3 sites
Example #1: Item called “Treatment/care plan after initial assessment”
A score of ‘1’ means a low percentage of clients signed off on their clinical treatment plan and ‘5’ means most clients at the site signed off on their treatment plan
All sites received a score of ‘1’ on this item
It does not mean that there is no treatment plan, but mostly reflects that documentation was inconsistent
There must be evidence that a client signed off on their treatment plan as it demonstrates client-centered care
Some items on the scale won’t reflect the quality of care, just whether care is present
YAC Feedback: patients signing off on care plan when they are having active symptoms may be a challenge due to symptoms like distrust/suspicion
This is an example of a good opportunity for this group to contribute to quality improvement for sites. How can we improve patient sign-off/involvement in care?
It depends on how patient is reacting to levels of treatment
Should be done in a safe setting, after medication given
If they are an inpatient, approaching them later in their recovery may increase likelihood they will sign off
Overall, it should not happen quickly and is not a one-off thing; rather, the plan needs to evolve and be revisited often
NAVIGATE refers to “shared decision making”, a practice developed by a psychologist who has lived experience with psychosis
It means engaging people in an authentic way at all stages of their psychosis
YAC Feedback: lived experience among staff makes a great difference to care, like peer support workers
YAC Feedback: even thought the measures are strict and may not capture all aspects of care (like care quality), we are glad that the evaluation team is aware of that during evaluation
Example #2: Item called “Patient Psychoeducation”
To achieve a score of 5, clients must have received education about their psychosis/diagnosis from a trained clinician
Results: lots of evidence that sessions occurred, but there was a lack of documentation
The team gave quality improvement feedback to sites to improve documentation
Some sites gave psychoeducation on an “as needed” basis, but NAVIGATE ensures that every client receives the education they need.
YAC Feedback: a positive psychoeducation experience was over web modules, with clinicians delivering theoretical content and people with lived experience also talking about how they education applied to their lives
Example #3: Item called “Family education”
Sites got a 1 if the education was delivered by a clinician not trained to teach about psychosis, and if there were less than 8 sessions delivered.
Family education is included as part of the NAVIGATE “curriculum”
The point of this item is to ensure that the clinician reaches out to the families and let them know it is safe to talk
When conducting chart reviews to see what was documented, the team follows a template and only looks for relevant information. They are very careful to safeguard privacy.
YAC Feedback:
Every family situation is different, and it may be difficult for some families to engage in care or understand
Having virtual family groups may help to encourage busy parents to engage, but it may also come down to how a family member perceives mental health in general.
Equity consideration: when doing chart reviews, keep in mind clinical bias in language about patients
CAMH evaluation team + evaluator from a different EPI Program and sits down with a site clinician to help them with what they’re looking for.
The Implementation Evaluation team also gives sites feedback on how they can improve their practice. YAC Feedback is very valuable in contributing towards this quality improvement.
The YAC would like to know sites’ strengths from the Fidelity assessments as well as what they need to work on so we can provide more quality improvement ideas.
Honorarium
To receive payment through direct deposit/cheque, please fill out the form attached in the email and send back to Andrea ASAP.
Mailing out gift cards will be a bit more difficult during COVID so this will be the easiest way to receive your honorarium.
Research Participants - Progress Update
We currently have 7 youth participants enrolled in the study and Andrea is contacting some more who were interested
Recruitment challenges: some patients have given the go ahead to their clinicians for the research team to contact them about the study, but when I contact them by phone or email, I’ve had some not respond. Do you think that youth/clients would want to be contacted by text message?
YAC Feedback: Yes, this should be an option, but would need to set guidelines on how many times they would be texted. Perhaps a text first confirming that they would like us to contact them would be best.
Engagement Survey:
These surveys are currently completed after each meeting
The anonymous data gets analyzed by a few scientists on the EPI-SET study that specialize in patient partners engaging in research
They recently released a report that covers survey results from the last 6 months
YAC Feedback on completing these surveys:
o We like that there exists an anonymous feedback mechanism about these meetings
o The surveys are annoying to complete every time
o We would like the surveys to go out every 3 months instead