Implementation of Early Psychosis Intervention Program ... - EENet

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47Table 11: How often programs include the following elements in the assessment process (Q 66)Assessment Element Response All Large Small Hospital CommunitySitesPresenting symptoms history % usually 100 100 100 100 100Risk assessment % usually 96 94 100 97 96Psychiatrist exam % usually 81 97 57 87 73Physical exam % usually 23 29 14 30 14Neurological screen % usually 15 23 5 20 9Substance use assessment % usually 89 87 91 93 82Justice system use history % usually 85 84 86 87 82Developmental history % usually 83 84 81 93 68Psychosocial assessment % usually 96 97 95 100 91Education assessment % usually 62 68 52 67 55Vocational assessment % usually 52 58 43 50 55Client understanding of episode % usually 90 90 91 83 100Assess cultural/gender issues % usually 83 77 91 77 91Information from family % usually 89 94 81 87 91Large: catchment area population > 100,000 population (31 program sites)Small: catchment area population < 100,000 population (21 program sites)Hospital: hospital is parent organization (30 program sites)Community: community agency is parent organization (22 program sites).Main challenges to providing a comprehensive assessment noted by programs:o Access to physical and neurological assessments.o Educational and vocational – lack of expertise within team, lack of access to area vocationalassessment serviceso Developmental – difficult to access assessment for intellectual challenges and learningdisabilities for adults no longer in the school system; harder to assess when clients do notconsent to family involvemento Some elements were perceived as intrusive by clients/families – e.g., neurological screen.o Some elements were not seen as immediate priority by staff and were assessed after initialassessment – physical, vocational.Strategies suggested by programs for providing comprehensive assessments:o Interdisciplinary approacho Developing a systematic, standardized approach/protocol - e.g., using tools/ standardizedchecklist to ensure comprehensive exam.What would help programs to provide comprehensive assessments:o Better access to psychiatry, psychology, and primary care.o Increased system integration to support access to relevant community services and supports,including vocational, educational, and psychological assessment.o Additional EPI program staffing and funding to facilitate access to external resources andreduce time pressures.o Staff training on standardized assessment and introduction/use of supporting tools includingthe Ontario Common Assessment of Need.o Increased program focus on vocational and educational assessment, perhaps through writtenguidelines.
48Standard 3: TreatmentThe survey examined the following elements in Standard 3:9. Wellness/recovery plans10. Outreach and client engagement11. Anti-psychotic medications treatment12. Physical health monitoring13. Working with inpatient units14. Client and family psychoeducation15. Crisis management16. Relapse prevention17. Use of Ontario Telemedicine Network1. Wellness/recovery plansAs part of the approach to working with EPI clients, Standard 3 stipulates that individualized andclient-centered wellness/recovery plans be negotiated by the client, family and EPI team. Theintent is for the plans to be developed and documented within 4 weeks of the first appointmentand be updated regularly. Wellness/recovery plans include agreements on medical treatment,crisis and relapse prevention, as well as direction on education, psychosocial support for theclient, family support and graduation from the program.Summary of Results:o Only 45% of all sites were able to develop wellness/recovery plans within 4 weeks of thefirst appointment and regularly update them ‘most of the time’.o Only 41% of sites have written procedures in place for creating and regularly reviewingwellness/recovery plans.o Implementation may benefit from a standardized process for generating and reviewing plans.This may include use of tools such as an electronic user-friendly template, computer systemreminders, and recovery plan template specific to EPI.o Some programs may implement this element in concert with the client needs identified inOCAN.
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 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: 46o More funding and more consisten
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
Page 83: 82Englehart,Kirkland Lake,New Liske

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