Implementation of Early Psychosis Intervention Program ... - EENet

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9Overview of EPI programs for individuals experiencing psychosisThe survey identified 46 programs delivering care at 52 clinical sites. Program sites variedwidely in size and other characteristics. Sixty percent served catchment areas of greater than100,000 population. These programs reported a mean program budget of $340,000 or more, amean caseload of 50 or more clients per site, employed 3 or more clinical staff and had 3 or moredisciplines or specialties represented on their team. Referred to as large program sites in thisreport, these clinical sites were mainly located in major urban areas such as Toronto, Ottawa andLondon.Forty percent of sites served catchment areas with a population of 100,000 or less. Theseprograms reported a mean program budget of $120,000 or less, and had a mean caseload of 19 orfewer clients per site. Referred to as small program sites in this report, they had 1.1 full timeequivalent (FTE) clinical staff or less. Small program sites were located in mixed urban and ruralareas or rural areas.Models and GeographyThe Standards describe different ways for EPI programs to work together to ensure delivery ofthe full EPI model of care in their catchment areas (page 31). Among the 52 surveyed sites, 9networks (involving 47 sites) were identified. The networks varied in size from 3 to 11 membersand were present in almost every LHIN. Networks included single organizations delivering EPIservices through multiple clinical sites usually spread across a large geographic area, as well aspartnerships among independent organizations to support service delivery. Networks also formedto share non clinical functions such as staff training, educational resource development, andcommunity outreach. The survey did not examine network arrangements in depth and follow-upcould explore the approaches and benefits of these different arrangements.More than half of the surveyed program sites (58 %) reported being sponsored by hospitalorganizations. On average, these sites reported larger budgets and total caseloads compared tocommunity agency sponsored sites. However there was considerable variation and overlap infeatures, and a number of small programs are hospital sponsored.Standards ImplementationThe survey covered 6 out of 13 Standards:o Facilitating access & early identificationo Comprehensive client assessmento Treatmento Psychosocial support for cliento Family education & supporto Graduation from the programSince each Standard addresses multiple service elements, a subset of key elements was identifiedto examine in the survey. Questions addressed: (1) global perception of how often sites were ableto implement the element; (2) current practices; (3) current challenges; and (4) strategies thatmight facilitate/improve implementation.
10The graph below reports global perception of implementation for 12 elements. Detailed resultsfollow per Standard and element.Figure 1: Percent of sites reporting ‘implementation most of the time’ per elementstandard elementsPublic educationEarly referralWellness plansGraduat ionOutreach andFamily educationPhysical healthFamily supportWorking with IP unitsCrisis managementFamily role in assessmtClient psycho-educationAccess to psy assessmtResponse timesAntipsychotic meds useRelapse prevention0 20 40 60 80 100% of sites reporting implementation 'most of the time'Standard 1 Results: Facilitating Access and Early Identification1. Developing an early identification/rapid response system:EPI programs should support local primary care providers, heath and mental health services, theeducational sector and others in contact with youth to identify symptoms of psychosis amongyoung people and make timely referrals to EPI programs:o Overall, programs indicated lower levels of implementation of this element than for otherStandard elements; only 40% of sites reported being able to implement this element ‘most ofthe time.’o Developing and sustaining an early identification and referral network was challengingregardless of whether the EPI program was larger or smaller, or hospital or communityagency based. Challenges pertained to having time, getting access to audiences, maintainingpersistent outreach.o Implementation may benefit from local or regional support (e.g., to conduct outreach to areaproviders, develop educational resources), and from having a plan in place for implementingand monitoring this work.o Programs reported some conflict with implementing this element. Outreach requires havingthe capacity to accept new referrals, and can be problematic if the program is operating atcapacity already. In addition, programs are expected to respond quickly to referrals and arenot supposed to keep a waitlist.2. Public educationEPI programs should build awareness among parents, families, teachers and employers about thesymptoms of psychosis in young people and how to seek help.
Page 1 and 2: Implementation of Early Psychosis I
Page 3 and 4: 2Table of ContentsTable of Contents
Page 5 and 6: 4Key MessagesSurvey Participationo
Page 7 and 8: 6Implementation Supportso Most site
Page 9: 8Executive SummaryIntroductionBackg
Page 13 and 14: 122. Family involvement in assessme
Page 15 and 16: 143. Anti-psychotic medications tre
Page 17 and 18: 16Standard 4 Results: Psychosocial
Page 19 and 20: 18Main Report“It is now well appr
Page 21 and 22: 20agreement; low caseloads (10 to 1
Page 23 and 24: 22developed by the National Health
Page 25 and 26: 24IISurvey OverviewBackgroundIn 201
Page 27 and 28: 26Figure 2: Survey participation re
Page 29 and 30: 28IIISurvey ResultsResults are repo
Page 31 and 32: 30Table 1B: Program details by spon
Page 33 and 34: 32Standard 1: Facilitating Access a
Page 35 and 36: 34o Outreach most often included pr
Page 37 and 38: 36Summary of Results:o Only 31% of
Page 39 and 40: 38o Overall, 40% of programs had a
Page 41 and 42: 40Standard 2: Comprehensive Client
Page 43 and 44: 42What would help programs to meet
Page 45 and 46: 443. Access to psychiatric assessme
Page 47 and 48: 46o More funding and more consisten
Page 49 and 50: 48Standard 3: TreatmentThe survey e
Page 51 and 52: 50o Team processes (e.g., regular t
Page 53 and 54: 52o Using social media and youth fr
Page 55 and 56: 54Table 16: Procedures and protocol
Page 57 and 58: 56o In addition, some programs note
Page 59 and 60: 58Table 19: Working with inpatient
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60Table 20: Client and family psych
Page 63 and 64:
62Approaches used by programs for c
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64o Difficulties with client and fa
Page 67 and 68:
66Standard 4: Psychosocial Support
Page 69 and 70:
68Main challenges to providing psyc
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70Table 29: Family education and su
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72Standard 6: Graduation from the P
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74o An alumni program and services,
Page 77 and 78:
76Topics for Further InvestigationT
Page 79 and 80:
78McGorry, P. (2012). At issue: Coc
Page 81 and 82:
80HealthThorold 4 Early Interventio
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82Englehart,Kirkland Lake,New Liske
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