Implementation of early psychosis intervention program standards in Ontario: Results from a provincial survey

Research Report Round-up

In brief

Early Psychosis Intervention (EPI) is an evidence-based, recovery-focused care model. In 2011, the Ontario Ministry of Health released as set of standards for EPI Program based on international guidelines and created a Standards Implementation Steering Committee to support system implementation and improvement.

In this Research Report Round-up we provide a summary of the report, “Implementation of Early Psychosis Intervention Program Standards in Ontario: Results from a Provincial Survey.” 

This report presents the results of a survey of EPI programs that the Steering Committee carried out to understand current service delivery in relation to the new standards. The report’s focus is on the 52 program sites that answered the survey and deliver care to young people with first episode psychosis.

Research Report Round-ups are brief summaries of research reports, presented in a user-friendly format.

Read the summary below or download the PDF.

Title and link to report: Implementation of Early Psychosis Intervention Program Standards in Ontario: Results from a Provincial Survey
Authors: Janet Durbin, Sarah Moss, Deborah Hierlihy, and members of the Standards Implementation Steering Committee: Gretchen Conrad, Gordon Langill, Catherine Ford, Nicolle Plante-Dupuis, Terry Bedard, Lisa Jeffs, Chi Cheng, Karen O'Connor
Year: 2012
Location: Toronto

Population addressed: Young people with first episode psychosis

Type of study: Survey
Keywords: Mental health; psychosis; assessment; intervention; prevention; treatment; outreach; education

Contact person/source: Janet Durbin, Centre for Addiction and Mental Health, (416) 535-8501 ext. 6229, janet_durbin [at] camh [dot] net; Karen O'Connor, Canadian Mental Health Association - Toronto Branch, kloconnor [at] cmha-toronto [dot] net

Language: English 

What this report is about

Early Psychosis Intervention (EPI) is an evidence-based, recovery-focused care model. In 2011, the Ontario Ministry of Health released as set of standards for EPI Program based on international guidelines and created a Standards Implementation Steering Committee to support system implementation and improvement.

This report presents the results of a survey of EPI programs to understand current service delivery in relation to the new standards. The report’s focus is on the 52 program sites that answered the survey and deliver care to young people with first episode psychosis. There was a 90% program participation rate.
The survey questions looked at the following six standards:

  • Facilitating access & early identification
  • Comprehensive client assessment
  • Treatment
  • Psychosocial support for the client
  • Family education & support
  • Graduation from the program
  • Each standard addresses multiple service elements. The following survey questions explored implementation for each element: 
  • Global perception of how often able to implement (most of the time, some of the time, not too often)
  • Approaches/practices used
  • Challenges
  • Strategies to support implementation (currently in use or that would help)

The survey findings suggest there is a need to explore topics such as:

  • Opportunities to define and share practice protocols to implement specific elements of the standards
  • Opportunities for centralized supports such as educational tools, training, and outreach
  • The nature and function of networks among EPI programs in Ontario
  • Features of EPI programs that serve family members only (not included in present report)
  • More uniform access to appropriate medical care (psychiatric and primary care)
  • EPI program capacity and accessibility to diverse communities

Programs had higher rates of compliance with elements of the standards that related to direct care, such as medication management and relapse planning, where programs may have more control. They had lower rates of compliance to elements that require outreach and linkage, such as to schools and primary care.

Smaller programs reported more challenges, in part due to staff shortage and rural catchment areas. Programs reported some use of protocols and templates to standardize care.

Average caseloads exceeded those recommended by published models, which resulted in time pressures. Use of translation or interpretation services was low, which raises questions about the accessibility of EPI programs to all Ontarians in need. Most programs belonged to a local EPI service network, which may be a potential source of support.

The Steering Committee also identified the need to look at EPI services where only the family is the client, as well as the seven EPI Standards that were not included in this study. 

How can this report be used

This report offers rich information to explore the perceptions of program stakeholders about the implementation of EPI standards, the factors that advance or hold back EPI implementation, and opportunities to improve practice.