Thursday, Oct. 19
14:30 – 15:30 (1 hr)
Meeting Room: Parksville (3rd floor – North Tower)
Aristotle Voineskos*, MD, PhD, FRCPC; Aristotle Voineskos, MD, PhD, FRCPC; Nicole Kozloff, MD, SM, FRCPC; Janet Durbin, PhD, MSc; George Foussias, MD, PhD, FRCPC; Sanjeev Sockalingam, MD, FRCPC, MHPE

CanMEDS Roles:

1. Scholar
2. Collaborator
3. Leader

At the end of this session, participants will be able to: 1) Describe the NAVIGATE model for early psychosis care and patient level outcomes following implementation of this model in Ontario; 2) Reflect on barriers and facilitators to implementing the NAVIGATE early psychosis care model across multiple provincial sites; and 3) Identify training needs and how evidence-based education models can support capacity building in early psychosis care.

Despite evidence to support their real-world effectiveness, early psychosis intervention (EPI) programs struggle to deliver consistent, coordinated, recovery-based care. NAVIGATE is an evidence-based, manualized model of coordinated EPI care that incorporates four treatment components: individualized medication management, individual resiliency training, supported employment and education, and family education. Chaired by Dr. Voineskos, this symposium will describe an innovative clinical trial known as Early Psychosis Intervention–Spreading Evidence-Based Treatment (EPI-SET). EPI-SET evaluated the implementation effectiveness of NAVIGATE in six geographically diverse settings, with the aim of improving quality and consistency of care. Dr. Kozloff will examine the current state of early psychosis programs, situating EPI-SET within the broader EPI movement. Dr. Durbin will describe EPI-SET’s primary aim, to assess whether implementation of NAVIGATE improved fidelity to the early psychosis standards (FEPS; Addington et al., 2020). Despite being implemented during turbulent times, study programs sustained and improved EPI practice, particularly in psychosocial treatments and team function. Dr. Foussias will describe longitudinal patient-level outcomes of participants receiving NAVIGATE. Over the first twelve months of NAVIGATE treatment, participants exhibited significant improvements in quality of life (QoL) scores (F[82.2,2] = 13.129, p < 0.001), and functioning (Social and Occupational Functioning Assessment Scale [SOFAS], F[53.9,1] = 47.890, p < 0.001). Dr. Sockalingam will describe the development of an EPI-SET “ECHO” to support training and a community of practice. Among 86 participants, satisfaction domains were highly rated: enhancing clinical practice (3.90/5), reducing social isolation (3.83/5), addressing learning needs (3.99/5), overall satisfaction (4.14/5), and would recommend to others (4.08/5). Sixty per cent indicated that EPI-SET ECHO resulted in practice change.

References:

1. Kane JM, Robinson DG, Schooler NR, et al. Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. Am J Psychiatry 2016;173(4):362–372.
2. Durbin J, Selick A, Langill G, et al. Using fidelity measurement to assess quality of early psychosis intervention services in Ontario. Psychiatr Serv 2019;70(9):840–844.