EPI-SET Youth Advisory Committee April 24th, 2020
Attendance: Tallan, Andrea, Sandy, Heather, Augustina, Janet, Karleigh, Sara, Victoria, Mary
Action Items
· Finalize and submit wording on the “Clinician Point of Contact” document – Andrea
· Coordinate a date for the Evaluation Team to return – Andrea
· Send Andrea any questions you want to discuss with the Evaluation Team next time – YAC Members
· Fill out the Electronic Transfer Form if you want to receive your honorarium through direct deposit/cheque – YAC Members
Agenda
Guest Speakers: Implementation Evaluation Team
· Introductions and Icebreaker – “This or That”
Sandy, Janet, Heather and Mary work at CAMH in the Provincial Systems Support Program (PSSP)
The team answered some questions posed by YAC
Q: Why are you working in mental health?
· Each member of the evaluation team described why working in mental health was important to them.
Q: What is NAVIGATE? It is a care program that is like a “curriculum” where all components listed below are offered to every client. The goal is to ensure that all clients are offered the same, high standard of care no matter which clinic they are at or who their clinician is.
· Medication Management
· Individual Resiliency Training (things like goal setting, CBT, psychoeducation)
· Support for Employment and Education
· Family Education
Q: When supporting employment/education, do clients get support if their goals are to do arts? Yes, everything is based on the client’s goals. The type of support probably depends on whether the client wants to focus on the arts recreationally or professionally.
Q: For psychoeducation, what type of education is a client receiving if they’ve had psychosis but don’t have a diagnosis?
· To start, they would learn about psychosis and the options/effects of antipsychotic medication.
Q: Does NAVIGATE include any content about religion/spirituality support?
· NAVIGATE is a framework and it is client-specific, based on a client’s goals. So, it certainly does not exclude working with a client on these topics.
Q: Did I receive NAVIGATE? Not unless you received treatment at CAMH after November 2017. CAMH adopted NAVIGATE after it was evaluated in 2009-2014 in the U.S. at 34 different mental health centres. It was found to improve both symptoms and functioning compared to usual care. Now, the EPI-SET study is looking to see if these outcomes happen in 6 Ontario EPI programs (in Durham, Niagara, North Bay, Sudbury, Waterloo and Thunder Bay regions).
Q: What is EPI-SET? A research study looking at the NAVIGATE model of care for early psychosis intervention. Specifically, the experiences of clinicians delivering it, and of clients receiving it. To ensure the highest quality care, we want to see evidence that it works significantly better than the status quo.
What does the Implementation Evaluation Team do on the EPI-SET project? (refer to slide 3)
· They specifically look at Objective #1: assessing the implementation of NAVIGATE (a.k.a. clinicians using it at their clinics) and whether it leads to improved fidelity to international EPI standards
· Fidelity = following guidelines. To illustrate this, we heard the example of baking a cake. If you don’t follow the recipe, your cake won’t turn out like how it looks on the box!
· Just to clarify – they don’t look at how NAVIGATE is impacting the symptoms and functioning of clients. That is Dr. George Foussias’ speciality on the project (we spoke with him last time!) There are a lot of goals in this project, so many people are involved to focus on each one.
How will they measure the delivery of NAVIGATE and whether it improves fidelity to EPI Standards? (refer to slide 4)
They are using a few different strategies.
1) Rating clinics using the First Episode Psychosis Service Fidelity Scale
a. The Fidelity scale has 33 items. Clinics receive a rating of 1-5 on each item (1 is lowest score, 5 is highest) based on how they are doing with respect to the standards
b. This will happen 3 times throughout the study to see if ratings improve after NAVIGATE is implemented
2) Staff survey
a. When staff are trained, and at other points to get their feedback
b. Seeing how staff feel about NAVIGATE and if staff have the proper supports in place to deliver NAVIGATE
c. This will also happen 3 times during the study
3) Interviews with staff
a. This is to get more detailed feedback about how staff feel about NAVIGATE and the help they received to implement it
What have they done so far?
· Completed Fidelity assessment and staff surveys at the first 3 sites to participate in the study/deliver NAVIGATE (Durham, Niagara and North Bay)
What did they find from these Fidelity assessments? (refer to slides 8-10)
· We looked at 3 of the 33 items on the Fidelity scale
· Item 17 looks at whether the client provides written consent to their treatment plan
o There were good examples of client-centered care at each clinic, but inconsistent documentation to show for it. Also staff might vary is what they offer clients. Since consistent quality and documentation are so important, the clinics received a score of 1 out of a possible 5 score here.
Q: Why does Item 17 rate whether families sign off on care plan?
· Most important for the rating is whether the client themselves signed off on the care plan
· Clients need to consent for their families to have a copy of the care plan
Q: How do clients incorporate families if everyone is far away?
· Especially now, we are seeing that virtual connection is possible (although it may not be exactly the same). Virtual communication should help reduce this barrier.
Q: If a client has a best friend they consider family, does NAVIGATE consider them a family member?
· Absolutely, a client defines their family and this can mean a partner, friend, caregiver, etc. A client consents to who they want involved in their care.
Q: Is there a way to change clinicians/case workers if you connect with one better than another?
· You certainly have the right to express this, it may depend on the availability of staff.
What do we want to hear from the Evaluation Team next time?
· As Janet’s team wasn’t able to complete their presentation at this meeting, for next meeting it was suggested that they go through more Fidelity items and results
· Strengths of the EPI programs that were evaluated
Reviewed the “Clinician Point of Contact” Document
· Edits to the wording were made based on suggestions from the last meeting
· We reviewing the updated wording and made one final suggestion
Honorarium payment method update
· Karleigh brought to my attention the option of receiving your payment through cheque/direct deposit (Thanks Karleigh!)
· If you would like to receive your honorarium this way (rather than an Amazon e-gift card, or a mailed Visa gift card), please fill out the attached form.