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Issue #2

Dear EPI-SET Team,

It has been a whirlwind three months, I'm sure for all of us, focusing on helping young people and their families with early psychosis, while dealing with the changes and curveballs that the pandemic is throwing. But the team has pulled together. The ECHOs have been fantastic, recruitment is picking up at the different clinics to better understand symptoms and functioning, and the fidelity work is chugging along. Our new(er) sites are coalescing, and it's fantastic to see our efforts spreading further across the province.

Thank you all for your continued dedication, and a special thank you to the front-line clinicians, and our youth and family advisors, who are providing input, feedback, and ideas, that are continuously improving this important work. I hope you all have taken, or will take some time off to get some much needed rest and recharging, as we look forward to continuing our momentum into the Fall. 


- Dr. Aristotle Voineskos

New and Exciting!


Recently the EPI-SET protocol paper was published in the open access journal, 
BMJ Open.

read more >> 

A group from CAMH with many members from the EPI-SET team have submitted a funding proposal to study implementation of NAVIGATE delivered virtually.
read more>>
COVID-19 Questions for Participant Interviews
A recently approved CAMH REB amendment will include COVID-19-related questionnaires during 
participant visits to capture the impacts of the pandemic on symptoms and functioning.
Adapting NAVIGATE for Bipolar Disorder
We are working with CAMH Education specialists to adapt NAVIGATE
for Bipolar Disorder.

Stay tuned!
Youth and Family Engagement
There are currently 5 youth advisors on the committee, with representation from Toronto, Niagara and Durham.

More perspectives are always welcomed! If you know someone between the ages of 14-35 who completed an EPI program, please connect them with us!

  • Updated the clinician script in the "Clinician Point of Contact Flyer" (to be distributed when REB approved)
  • Provided essential feedback on how youth are approached for research. This feedback has been incorporated into REB approved documents. 
  • Reviewed Fidelity results with the Implementation Evaluation team and had great discussions, contributing ideas for quality improvement.
  • Updated YAC Membership Package and Terms of Reference
  • Chose e-gift card offerings for research participants 
  • Two youth advisors are collaborating on the e-NAVIGATE study

There are currently 8 family advisors on the committee, with representation from Durham, Toronto, Niagara and North Bay.

  • Currently, family advisors are filming a video about what this project means to them - to be released soon!
  • Met with the Implementation Evaluation Team and had excellent discussions surrounding Fidelity results, will continue providing quality improvement feedback.
  • Supporting research recruitment strategies
Research Recruitment
The research team has started attending virtual site team meetings regularly to discuss recruitment progress and feedback. 
"Approaching people experiencing psychosis with opportunities for research is a way to empower
           them and reduce stigma."                   
- Youth Advisory Committee
Implementation Update from PSSP
First Wave Sites:
Durham, Niagara, North Bay

  • All sites are successfully using NAVIGATE model as business-as-usual care
  • Goals: move sites to Full Implementation and identify early stages of sustainability planning
  • Currently in process of adapting internal project tracker to ensure implementation story is captured in most meaningful and efficient way. 
  • Main areas of support at these sites
    • Onboarding new clinicians
    • Orientation to changes in organization leadership
    • Targeted 1:1 support as needed at all levels
    • Reviewing Fidelity report recommendations to address quality improvement 

Second Wave Sites:
Sudbury, Waterloo-Wellington, Thunder Bay
  • All new sites are currently utilizing the NAVIGATE model with their clients.
  • Supporting site leadership/clinical teams to address obstacles and identify alternatives, and celebrate successes as they occur.
  • Main areas of support at these sites:
    • Continuing to engage to keep momentum up during the challenges of the time
    • Adapting resources to fit the identified need of a program
    • Supporting the development of group material and supporting the initiation of the research component of the project. 

What's Next?
  • Over the next few months, anticipate continuing more improvement cycles around implementation challenges
    • Focusing on supporting research involvement as Sudbury and Waterloo begin recruitment, and providing different levels of coaching support based on the site.
  • Will utilize Core Components soon to support teams in staying true to the Fidelity of the model in each unique setting while also reiterating the variability in delivery.
  • Also focused on moving forward with Fidelity activities and have been meeting with site leads alongside the Evaluation Team to identify possibilities of shifting to a virtual approach.
Implementation Evaluation
1. Baseline Fidelity Reviews 
 Completed for Durham, Niagara and North Bay

 Connected with 2 of these sites to discuss results, and visit with the third site is being planned. 


While COVID has caused some
delay, we are now planning the baseline fidelity reviews for the second cohort of sites (Sudbury, Thunder Bay, and Waterloo-Wellington).
As with other ‘virtual’ work, we will make some modifications due to continued restrictions but
are looking forward to connecting. 
2. Measuring the Delivery of NAVIGATE 

What We Did
  • Based on a review of NAVIGATE manuals and other key sources, our team has completed a
    Core Components of NAVIGATEdocument
    to guide our measurement of NAVIGATE delivery.

  • The document describes each component of the model, along with the ‘active ingredients’ to deliver and measures to document delivery.
  • We are in the process of obtaining feedback on this work, including input from the U.S. NAVIGATE model developers.
  • Our next step is to review the measures with the sites, including how we can obtain the information we need to measure NAVIGATE delivery.
  • Our aim is to build on current site documentation processes and minimize additional work.
  • In addition to informing the research, we hope these data are useful for site quality improvement work.
3. Youth and Family Advisory Committees     
Our team was excited and inspired in our first meetings with the advisory committees - two each with the Family Advisory Committee and the Youth Advisory Committee.

With both groups, we had detailed discussions on how we are measuring program delivery and the findings from the baseline fidelity results.

We are now exploring ways to authentically incorporate Committee feedback into our work, including adding their practice improvement suggestions to future fidelity reports.
Above and Below:
Site clinicians and hub members keeping the community of practice strong at our recent ECHO on July 21st, 2020.

Thank you to site clinicians for your excellent discussion around Behavioural Activation, sharing your experiences, and all of your hard work adapting care during the pandemic!

has completed its first cycle!

During the first ECHO cycle 
(8 sessions from Sept to April):

  • Site clinicians presented de-identified client cases and received recommendations for care/NAVIGATE from both other sites and CAMH clinicians
  • CAMH clinicians presented on a range of topics like: CBT, medication management, and substance use.

During the summer months, we are conducting less formal ECHO sessions bi-weekly, with each session's topic informed directly by survey feedback.

We will be returning to formal sessions in September. 

We love starting off each session by announcing survey winners! Congratulations to all of our previous winners. Don't forget to fill out your surveys for a chance to win!


Did you know? Project ECHO is now in 37 countries! In Ontario, there are now over 25 ECHO programs, reaching over 1,800 healthcare providers. 

Thanks for reading!
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