Innovating Care and Discovery |Real-time Clinical Care

ED to EPI: Using SMS (Text) Messaging to Improve the Transition from the Emergency Department to Early Psychosis Intervention for Young People with Psychosis 

Many young people presenting to the emergency department (ED) with psychosis do not complete the transition to early psychosis intervention (EPI) services. Funded by the Canadian Institutes of Health Research, Dr. Nicole Kozloff’s “ED to EPI” study aims to evaluate the effect of using (SMS) text messaging — a low-cost, low-complexity, youth-friendly approach — on the transition from acute care to outpatient EPI services. It will also evaluate user perspectives on the intervention to guide future implementation. The study will recruit 16 to 29-year-olds (referred from the ED and other acute services to EPI services at CAMH) for a pragmatic, randomized, controlled trial of a 2-way SMS intervention consisting of reminders, psychoeducation and check-ins. Most measures will be collected by chart review. Participants will also be asked to consent to link their provincial health data to examine healthcare utilization. Participants who receive the text messages will also be asked to complete a survey of user perspectives on the intervention. This has the potential to lead to more young people with psychosis getting appropriate treatment earlier, ultimately reducing the burden of psychosis on young people and their families.

Enhancing Evidence-Based Practice for Youth and Emerging Adults with Early Psychosis: Implementation and Evaluation in Diverse Service Settings (EPI-SET)

With funding from the Canadian Institutes of Health Research Strategy for Patient-Oriented Research, Dr. Aristotle Voineskos is leading the implementation of a model of coordinated specialty care, known as NAVIGATE, in programs across Ontario. The goal of Early Psychosis Intervention – Spreading Evidence-based Treatment (EPI-SET) is to improve care and outcomes for young people experiencing psychosis and their families across Ontario. The project builds on the existing community of practice through the Early Psychosis Intervention Ontario Network and works with CAMH’s Provincial System Support Program facilitators. The use of tele-videoconferencing through ECHO Mental Health Ontario supports a regular community of practice to provide ongoing training support and ensure sustainability. Youth and family advisors consult on all elements of the project. 

“e-NAVIGATE:” Adapting Evidence-Based Early Psychosis Intervention Services for Virtual Delivery

Early psychosis intervention (EPI) services are the standard of care for youth with psychosis, helping them achieve recovery and avoid catastrophic outcomes. A manualized package of evidence-based treatments called NAVIGATE has been increasingly adopted by EPI programs to achieve superior outcomes and standardize care. To curb the spread of the COVID-19 pandemic, EPI services rapidly transitioned to delivering care virtually over the past few years. However, there is little evidence to support virtual delivery of EPI services. Led by Drs. Wanda Tempelaar and Nicole Kozloff — with funding from the Canadian Institutes of Health Research, Ontario Ministry of Health, and University of Toronto Department of Psychiatry Miner’s Lamp Fund — this study will evaluate the implementation effectiveness of an innovative virtual adaptation of NAVIGATE. It will examine how closely virtually-delivered NAVIGATE adheres to the EPI model, and what helps and harms the implementation of virtual services, including health equity factors. Surveys and interviews will evaluate the acceptability of virtual EPI services to patients, family members and clinicians. The project aims to determine which aspects of virtual EPI services work best and for whom, in order to help young people with psychosis receive the best possible care.

Coordinated Specialty Care for Early Psychosis – Expansion to Mood Disorders with Psychosis and Development of Digital Care

With philanthropic support from the Toor Family, a team from the Slaight Centre including Sarah Bromley, Slaight Centre Clinical Manager, and Dr. George Foussias, in collaboration with CAMH Education, has been working on expanding NAVIGATE to address gaps in resources, knowledge and training around psychosis, in the context of bipolar disorder and depression. This has led to the development of dedicated e-learning modules for clinicians to augment Coordinated Specialty Care with the NAVIGATE treatment program with content specifically focused on treatment of bipolar disorder. In addition, this work has led to the development of a digital platform for NAVIGATE that can support ongoing clinician training and delivery of virtual care to youth and their families. For more information about NAVIGATE, please click here.

Community Reinforcement Approach and Family Training in Early Psychosis Intervention (CRAFT-EPI)

Led by Dr. Kozloff, this study — supported by a generous philanthropic gift — investigates the benefits of an evidence-based therapy directed at family members of people with substance-use problems and psychosis. CRAFT aims to increase the motivation of the person with substance-use problems to seek help and decrease their substance use, while also helping reduce family distress. Through a new collaboration, it is now being studied in early psychosis for the first time: individually at McLean Hospital in Boston, MA, and in groups at the Slaight Centre at CAMH. By addressing substance use in early psychosis, this treatment has the potential to fill a major gap, improving outcomes for both youth and families.

Standardizing Approaches to Transitions in Care in Early Psychosis Intervention

Drs. Janet Durbin and Nicole Kozloff, and their team, are leading a Canadian Institutes of Health Research-funded project aimed at standardizing approaches to transitions in early psychosis intervention. This project builds on work by the Early Psychosis Intervention Ontario Network (EPION), synthesizing the best evidence for discharge processes into a standardized package that can be implemented across EPI programs, with the aim of improving patient and clinician experience, patient continuity of care and outcomes, and patient flow through the programs, all at a lower cost to the healthcare system.

Optimizing Mental Health for Young People at Clinical High Risk for Psychosis 

Young people categorized as “Clinical High Risk” (CHR) are considered particularly vulnerable to developing psychosis, and experience significant distress and disability. The CHR period is an important juncture in an individual’s mental health, where appropriate interventions may reduce the risk of progression to several negative outcomes, including the development of schizophrenia. This study, led by Dr. Omair Husain, aims to adapt a comprehensive psychosocial and mental health support program — the Optimal Health Program (OHP) — to improve functioning, reduce distress and build resiliency in CHR individuals. OHP provides a framework to address psychosocial and mental health needs, adopting a person-centred approach that empowers individuals to be at the centre of their own health management. Virtual delivery of OHP, through the development of a companion mobile application, offers a discrete and destigmatising way of accessing care for youth who may be hesitant to seek support.