Implementation of Early Psychosis Intervention Program ... - EENet

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23implementation needs to be planned and carefully monitored. It also takes time – e.g., 2 to 435, 36years for one agency and longer for a whole treatment system.The study of best practices for implementation has become a formal area of research over the lastdecade (‘implementation science’), and various frameworks have been proposed to guide theadoption/ implementation process. 37, 38 Two framework components are particularly relevant tothe EPI Program Standards. Implementation drivers influence the successful implementation ofa new treatment and operate at multiple levels – individual provider (e.g. staff training, coaching,feedback evaluation), organizational (e.g., leadership, policies, data decision support systems,funding) and external (e.g., financial resources, human resources, training centre, practiceStandards, monitoring feedback). 39 Implementation outcomes pertain to how a practice is beingimplemented and can indicate whether a practice has been implemented as envisioned. Goodimplementation outcomes are necessary preconditions for attaining desired changes in clinical orservice outcomes. 40 In measuring both implementation drivers and implementation outcomes, afeedback process can be instituted whereby implementation drivers can be modified to move41, 42current practice closer to desired practice.The importance of monitoring and linking these components in a feedback process isacknowledged in the Ontario EPI Program Standards, where it is noted that the Standardsprovide a tool that can be used “to identify any weaknesses in current programs and services, anddevelop plans to fill any gaps”. 43 The Ontario Standards make reference to a number ofstrategies to support implementation including: program policies, procedures and servicedelivery protocols; supportive organizational structures; staff orientation and training; datacollection and feedback. Supporting roles for the Ministry and Local Health Integration44Networks (LHINs) are also identified.35 Gotham, 200636 Fixsen, D. L., Blasé, K. A., Naoom, S. F., & Wallace, F. (2009). Core implementation components. Research onSocial Work Practice, 19(5), 531.37 Gotham, 200638 Damschroder, L.J., D.C. Aron, R.E. Keith, S.R. Kirsh, J.A. Alexander, and J.C. Lowery. (2009). Fosteringimplementation of health services research findings into practice: a consolidated framework for advancingimplementation science. Implementation Science, 4.39 Fixsen et al., 200940 Proctor, E.K., J. Landsverk, G. Aarons, D. Chambers, C. Glisson, and B. Mittman. (2009). ImplementationResearch in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Trainingchallenges. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), p. 24-34.41 Fixsen et al., 200942 Gotham, 200643 Ministry of Health and Long-Term Care. 2011 (p.9).44 Ministry of Health and Long-Term Care. 2011 (p.10).
24IISurvey OverviewBackgroundIn 2012, the Ministry formed a Standards Implementation Steering Committee (SISC) to supportimplementation of the Ontario EPI Program Standards. The Committee includes representativesfrom the Ministry, the LHINs, and the OWG, and is provided with technical support fromCAMH.As a first step to understanding current EPI program delivery in Ontario in relation to theStandards, as well as facilitators and challenges to Standards implementation, the Committeeundertook a province-wide EPI program survey. The intention at this early stage in release of theStandards was to seek feedback from the EPI programs about their current practices, and aboutthe extent to which these aligned with the EPI Program Standards. Also of interest was learningabout perceived drivers (facilitators and challenges) to implementation, to flag areas whereadditional support or intervention might be needed. Given that the Implementation Committee ischaired by the Ministry and includes regional (LHIN) and provincial (OWG) stakeholders, therewas a particular interest in identifying organizational and external factors that impactimplementation - where these stakeholders may have an influence. A final aim of the survey wasto count and provide basic descriptive information (e.g., staffing complement and budgetallocation) on the range of programs in the province that are delivering EPI services.Survey aims:1. Describe the structure and capacity of EPI programs in Ontario2. Obtain feedback from Ontario EPI program regarding:a. Perceived alignment of current practice with EPI Program Standardsb. Perceived barriers and facilitators to Standards implementationSurvey DevelopmentA subcommittee of the larger Standards Implementation Steering Committee served as theworking group for this initiative.Development of the survey questionnaire occurred during the fall of 2011. The Ontario EPIProgram Standards provided the general structure for the survey. Thirteen Standards address thebroad range of community outreach, client outreach, family engagement, medical andpsychosocial interventions that are considered to be part of an EPI service. Each Standard is ahigh level domain that is further articulated through a list of specific elements (up to 22 perStandard).To manage the burden of survey completion, a decision was made to focus the survey questionson the following 6 out of 13 Standard domains:o Facilitating access & early identification
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 and 10: 8Executive SummaryIntroductionBackg
Page 11 and 12: 10The graph below reports global pe
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: 22developed by the National Health
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
Page 61 and 62: 60Table 20: Client and family psych
Page 63 and 64: 62Approaches used by programs for c
Page 65 and 66: 64o Difficulties with client and fa
Page 67 and 68: 66Standard 4: Psychosocial Support
Page 69 and 70: 68Main challenges to providing psyc
Page 71 and 72: 70Table 29: Family education and su
Page 73 and 74: 72Standard 6: Graduation from the P
Page 75 and 76:
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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