IEPA 2014: Tokyo, Japan Poster Presentation J. DURBIN, D. HIERLIHY, G. LANGILL, C.FORD, K. O’CONNOR, G. CONRAD, C. CHENG

1. 2 3 5 6 7
J. DURBIN1 D. HIERLIHY2 G. LANGILL3 C.FORD4 K. O’CONNOR5 G. CONRAD6 C. CHENG7
FROM PROVINCIAL STANDARDS TO PROGRAM IMPROVEMENT:
EPION’`S CROSS SECTOR COLLABORATION
BACKGROUND
• Ontario, Canada is a large province with a geographically dispersed
population.
• Early Psychosis Intervention (EPI) programs are available province-wide, with
implementation variable and adapted to context
• Program implementation and spread has been supported by a coalition of
EPI stakeholders (programs, families, clients) called EPION.
• In 2011, the Ontario Ministry of Health and Long-term Care released
the Early Psychosis Intervention (EPI) Program Standards and formed
a Standards Implementation Steering Committee (SISC) to support
implementation.
• The SISC is a unique collaboration between the Ministry and EPION.
• SISC’s first project was a province-wide needs survey (described here) to
provide a foundation for follow-up program improvement projects.
•
RESULTS
Ministry of Health
and Long Term
Survey results (figure 2)
• The survey had >90% response rate
• 52 programs – 31 large, 21 small
• Areas of high implementation included: relapse prevention, guideline
adherent anti-psychotic medication use, rapid response times
• Areas of challenge included: community education/ outreach for early
detection and referral, development and regular update of wellness plans,
and client graduation
• Use of standardized protocols to support consistency and quality was
variable.
• Rates of implementation were generally lower for small programs
Follow up activities
• EPION has convened ‘themed’ province-wide think tanks to discuss
responses to the identified practice challenges.
• Potential follow-up projects include: implementing regional-level public
education initiatives, conducting a pilot evaluation of a standardized
electronic metabolic monitoring protocol, developing a family member
buddy system.
• The specific needs of smaller EPI programs are a consistent focus.
APPROACH
• Survey development was based on the Standards, the literature and input
from SISC, and piloted tested prior to finalization.
• One staff informant per EPI program was invited to complete the survey
during spring 2012
• Survey items asked about:
• Program capacity and structure, current practice, challenges to provision
and suggestions for improvement
• Respondents rated frequency of implementation for 16 core practice
components addressed in the Standards
• Results were compared for large & small programs (catchment area
pop<100 000)
CONCLUSIONS
Relapse prevention
Antipsychotic meds use
Response times
Access to psy assessmt
Client psycho-education
Family role in assessmt
Crisis management
Physical health monitoring
Working with IP units
Family support
Family education
Outreach and engagement
Graduation
Wellness plans
Early referral
Role of EPION in Standards Implementation
• Release of EPI Program Standards demonstrated government commitment
to EPI program model in Ontario
• Highly enthusiastic and committed network of EPI Stakeholders (EPION)
provided an important partner to the Ministry
• Lead responsibility for Standards Implementation committee was
transferred from the Ministry to EPION (sector directed improvement model)
• Initial terms of reference for the Committee remain in place, along with
continued high level of involvement of Ministry.
Next Steps
• Work towards increased regional funder (LHIN) engagement
• Identify next project to further quality improvement agenda and strengthen
program capacity to meet the Standards
• Potential areas of focus=
• Building capacity for ongoing fidelity monitoring
• Standardized province-wide client outcome measurement
• Network models to support small programs to provide the full basket of
EPI services
• Develop better linkages with the rest of the health care system
1 ORIOLE RESEARCH
& DESIGN INC.
Acknowledgements: We would like to thank the Standards Implementation Steering Committee for their tireless work on this project and the
EPION providers who’se engagement and commitment to service improvement has made this project possible. Poster graphic design: Carole Lem ,
Research Assistant (St. Joseph’`’s Care Group , Thunder Bay)
Links: http://www.health.gov.on.ca/english/providers/pub/mental/epi_program_standards.pdf
0 20 40 60 80 100 120
Public education
% of programs (n=52)
Standard elements
Large Area
Small Area
Local Health
Integration
Networks
(regional funder)
Early Psychosis
Integration
Ontario Network
(EPION)
Youth/Families Researchers
Care
Figure 1
Figure 2: Percentage of programs reporting ‘implementation
most of the time’ per element- for large and small programs
EP ON Learn more about
EPION here:
www.epion.ca
Download this
poster here:
slidesha.re/1zusRjm
Standards
Implementation
Steering Committee
4 ONTARIO
MINISTRY OF HEALTH
AND LONG TERM CARE