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Guide to Canadian Early Psychosis Initiatives Canadian Mental

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Guide to Canadian Early Psychosis Initiatives Canadian Mental Powered By Docstoc
					Acknowledgements

Introduction                                  2



Early Psychosis Clinical Programs

Calgary, Alberta                              4-5

Halifax, Nova Scotia                          6-7

Hamilton, Ontario                             8-9

Lévis, Quebec                                 10

London, Ontario                               11-12

Montreal, Quebec                              13-14

Ottawa, Ontario                               15

Quebec City, Quebec                           16

Saskatoon, Saskatchewan                       17

Toronto, Ontario                              18

Victoria, British Columbia                    19



Other Early Psychosis Initiatives

British Columbia Early Psychosis Initiative   21-22

BC Regional Demonstration Projects:

Central Vancouver Island                      23

North West                                    23

Okanagan Similkameen                          23-24

South Fraser                                  24

Vancouver/Richmond                            25

Canadian Mental Health Association
                                              26
National Project

Ontario Working Group                         27



Glossary                                      28




             1
Over the past decade, recognition of the        provide descriptions of their activities as
importance of the early phases of psychosis     appropriate. In compiling this Guide,
to the subsequent course of illness and of      balancing breadth with depth proved a
the need to develop effective interventions     challenge: in many instances, much more
has grown at an ever-increasing rate in         could be written.
Canada and around the world. Now, many          Basic elements of early psychosis interven-
centres are gaining the knowledge and           tion are either implicit or explicit in virtual-
experience that will lead to an improved        ly all of the initiatives. Elements include:
capacity for the detection, treatment and
                                                ACCESS
support of those encountering psychosis
                                                • Providing timely access to appropriate
for the first time. The fact that psychosis
                                                  clinical services
most often emerges during adolescence
and young adulthood, severely disrupting        ASSESSMENT
the course of these young lives, has been       • Offering comprehensive assessment
further impetus to the development of             by trained clinicians
effective intervention strategies.              APPROPRIATE TREATMENT
                                                • Establishing a therapeutic relationship
This Guide is an attempt to create a single,
                                                • Providing a multidisciplinary team
comprehensive source of information
                                                 approach to care
regarding the many and varied early
                                                • Providing care in the least restrictive
psychosis initiatives being pursued in
                                                  environment
Canada at this time*. The Guide is intended
                                                • Providing phase-specific, individualized
to serve primarily as a reference tool for
                                                  treatment that includes medication,
mental health planners, practitioners, and
                                                  psychoeducation and psychosocial
decision-makers interested in developing or
                                                  interventions
expanding early psychosis strategies and
                                                • Providing services over time in order to
services in their communities.
                                                  consolidate and sustain gains
The initiatives included in the Guide           FAMILY ENGAGEMENT
represent both clinical programs and            • Engaging, educating and supporting
broader-based projects which may or may           families through the treatment and
not include clinical components. An effort        recovery process
was made to become aware of and include         NORMALIZED RECOVERY CONTEXT
all Canadian programs and projects that         • Supporting reintegration into school
demonstrate a concerted focus on early            and work activities
psychosis intervention, though it is possible
                                                AWARENESS AND EDUCATION
that some were inadvertently missed. As
                                                • Reducing the duration of untreated
well, given that new initiatives continue
                                                  psychosis and supporting recovery
to emerge and existing initiatives continue
                                                  through community outreach and
to evolve, this Guide should be viewed as
                                                  education
a snapshot in time. Data presented herein
                                                • Providing opportunities for ongoing
were collected during the latter part of
                                                  professional development for health
2000 and some of the specific information
                                                  care providers
presented may already be outdated. For
example, data pertaining to case numbers        Programs and projects are listed alphabeti-
will tend to be in constant flux.               cally by location. Contact information is
                                                provided for all initiatives. Taken together,
The information provided by clinical sites,     the quantity and scope of the initiatives
generated by means of a questionnaire, is       profiled in this Guide attest to the high
presented in a relatively standard format       level of interest and activity in Canada
with the exceptions of Ottawa and               today and also serve to illustrate the range
Saskatoon where services are at an earlier      of initiatives that are possible given a com-
stage of development. The program descrip-      munity’s resources and state of readiness.
tions include a listing of basic program
                                                *For an international review of early psychosis programs, see
data and clinical components, and some          Edwards, J., McGorry, P.D., & Pennell, K. (2000). Models of
elaboration of adjunct program initiatives.     early intervention in psychosis: An analysis of service
                                                approaches. In M. Birchwood, D. Fowler and C. Jackson (Eds.),
The broader-based projects were invited to      Early Intervention in Psychosis: A Guide to Concepts, Evidence
                                                and Interventions. Chichester: Wiley & Sons Ltd.



                                                                                          INTRODUCTION
                                           2
Early Psychosis Clinical Programs




              3
      Early Psychosis Treatment        Contact:                              Phone:
      & Prevention Program             Dr. J. Addington                      (403) 670-4836
      Foothills Hospital and           Early Psychosis Treatment             Fax:
      University of Calgary            and Prevention Program                (403) 670-4008
      Dr. Jean Addington,              Department of Psychiatr y             Email:
      Program Manager                  Foothills Medical Centre              jmadding@ucalgary.ca
      Dr. Donald Addington,            1403, 29th Street, NW                 Web site:
      Medical Director                                                       www.ucalgary.ca/cdss/epp
                                       Calgary, Alberta T2N 2T9



FIRST YEAR OF OPERATION                              STAFFING (FTEs)
1997
                                                     Nurse Case Managers                   2.6
TYPE OF SERVICE                                      Family Workers (MSW, MN)              1.5
Outpatient                                           Group Therapist (MSW)                 0.5
TYPE OF PROGRAM                                      Psychologist (PhD)                    0.6
Comprehensive population-based program               Secretarial                           0.7
                                                     Psychiatrists                         0.7
CATCHMENT
930,000                                              KEY CLINICAL COMPONENTS
PROGRAM ELIGIBILITY                                  • Case Management
16 to 50 years of age; non-affective, first          • Psychiatric Management
episode of psychosis; hospitalized for a first       • Medication Management
episode; no more than three months of                • Individual Family Work
prior anti-psychotic drug therapy                    • Family Group
                                                     • Individual cognitive-behavioural therapy
PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT
                                                       Brief cognitive therapy is aimed at three
Approximately one to two weeks
                                                       areas: adaptation to the onset of psychosis
REFERRAL SOURCES                                       and its impact; treatment of secondary
In-patient units (33%); family physicians;             morbidity; and treatment of persistent
community and outpatient psychiatry                    positive symptoms.
services; community agencies; emergency              • Group Programs
rooms; families; schools                             Psychosis Education Group
AGE OF CLIENTS AT ADMISSION                          Teaching patients about the illness
67.8% under 25 years of age                          Recovery Group
OTHER CLIENT DATA                                    12 sessions addressing issues in the
Gender - 66% male, 34% female                        early stages of recovery
MAXIMUM STAY IN PROGRAM                              Moving On Group
3 years                                              12 session evening group addressing
                                                     issues of later recovery for those who
DIAGNOSIS AT ONE YEAR
                                                     have returned to school or work
100% schizophrenia spectrum disorders:
40% schizophrenia; 39% schizophreniform;             Substance Group
21% other psychotic disorders                        10 session group to address issues related
                                                     to substance use
AVERAGE NUMBER OF NEW CASES REFERRED FOR
                                                     ADDITIONAL INITIATIVES
ASSESSMENT ANNUALLY
                                                     Professional Outreach
120
                                                     When the program started, staff visited
AVERAGE NUMBER OF NEW CASES ADMITTED TO              the majority of mental health agencies,
PROGRAM ANNUALLY                                     hospitals, universities and colleges in
80                                                   Calgary. Two years later, they sent letters
ESTIMATED STANDING CASELOAD                          and an information brochure to these
170                                                  settings, and offered to return for another
                                                     visit. Family physicians who admit patients
                                                     to Foothills Hospital were also sent the



                                                                                       CALGARY, ALBERTA
                                                 4
brochure. Family physicians are a common
referral source.
Beginning in September 2000, in conjunction
with the Canadian Mental Health Association,
Alberta South Central Region, program staff
have been providing educational workshops
to teachers and guidance counsellors at the
secondary and post-secondary level, as well
as to community-based health and social
service agencies. These sessions are designed
to raise awareness and provide training to
promote the early identification of young
people who might be experiencing symptoms
of psychosis.
PRELIMINARY PROGRAM FINDINGS
Mean duration of untreated psychosis (DUP)
is 69 weeks; median of 20 weeks. Data
indicate that 72% of clients are in remission
at one year.
SITE RESEARCH INTERESTS INCLUDE:
Outcome evaluation; neurocognitive
functioning; MRI studies; prodromal
research; DUP and pathways to care;
social functioning and social cognition.




                                                CALGARY, ALBERTA
                                           5
   Nova Scotia Early                      Contact:                          Phone:
   Psychosis Program                      Dr. David Whitehorn               (902) 464-5998
   The Nova Scotia Hospital                                                 Fax:
                                          The Early Psychosis Program
   and Dalhousie University                                                 (902) 464-6057
                                          Nova Scotia Hospital
                                          PO Box 1004,                      Email:
   Dr. Lili Kopala,                                                         david.whitehorn@nshospital.ns.ca
   Director                               300 Pleasant St.
                                          Dartmouth NS B2Y 3Z9



FIRST YEAR OF OPERATION                                      KEY CLINICAL COMPONENTS
1995                                                         • Medical/psychopharmacological
                                                               treatment
TYPE OF SERVICE
Outpatient                                                   • Patient and family psychoeducation
                                                             • Access to 24 hr/day, 7 day/week
TYPE OF PROGRAM                                                on-call nursing
Multi-component, case coordination                           • Peer Group Sessions - Clients can
CATCHMENT                                                      participate in peer support group
850,000 province-wide; resource to                             sessions. Clients generally choose to
3 neigbouring provinces                                        participate for a period of approximately
PROGRAM ELIGIBILITY                                            6 months. Group size is small and
12-54 years of age; non-affective first                        activities are client-driven.
episode psychosis; less than five years                      • Occupational therapy assessment and
of drug therapy for a non-affective                            referral to community support programs
psychotic disorder                                           ADDITIONAL INITIATIVES
PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT               The program carries out an extensive set
One to three weeks                                           of educational activities. The program has
                                                             developed educational materials, including
REFERRAL SOURCES
                                                             a series of four ‘fact sheets’ for use in
Psychiatrists, family physicians, school
                                                             health facilities across the province, and a
psychologists/counsellors, mental health
                                                             video with discussion guide on psychosis.
programs, families
                                                             Educational sessions are provided on
AVERAGE AGE OF CLIENTS AT FIRST ASSESSMENT                   request to groups or individuals.
21.6 years
                                                             Family Information Sessions
MAXIMUM STAY IN PROGRAM                                      An ongoing series of education sessions
Based on individual need                                     has been designed for families and friends
AVERAGE NUMBER OF NEW CASES REFERRED FOR                     of individuals experiencing first-episode
ASSESSMENT ANNUALLY                                          psychosis. The series consists of seven
120                                                          two-hour sessions delivered one evening
                                                             per week for seven consecutive weeks.
AVERAGE NUMBER OF NEW CASES ADMITTED TO
PROGRAM ANNUALLY
                                                             Group size is generally from 12 to 16
50                                                           people per series. Participants are
                                                             encouraged to attend the full seven
ESTIMATED STANDING CASELOAD                                  session series. Since the sessions began
160 (includes active consultations)*                         in January 1999, 100 family members
*Maximum caseload given current resources.
                                                             have participated. Systematic evaluation
STAFFING (FTEs)*                                             of the sessions is carried out, including
                                                             the use of standardized scales measuring
Psychiatrist                                 0.5             families’ experience of psychosis.
Family Physician                             1.0
Clinical Nurse Specialist                    1.0             Family Support Group
Education Coordinator                        1.0             In January 2000, an Early Psychosis Family
Occupational Therapist                       1.0             Support Group was established. This group
*Core funded positions. Additional staff funded from         offers an opportunity for family members
research grants/contracts.                                   to continue with on-going education on



                                                                                           HALIFAX, NOVA SCOTIA
                                                       6
topics of interest to them, to share                             PRELIMINARY PROGRAM FINDINGS
concerns and information, and to                                 In the first four years of operation, the
provide mutual support to one another.                           program provided full assessments for 400
Early Psychosis Mentorship Program                               clients with schizophrenia and schizophre-
This program is designed to provide                              nia spectrum disorders. Early outcome data
mental health clinicians, representing a                         based on two years of program operation
range of disciplines, with access to the                         suggest that 68% of clients had achieved
latest findings regarding assessment and                         full remission of positive symptoms at 6
treatment of early psychosis. The program                        months, with an additional 22% showing
consists of an initial introductory half-day                     significant symptom reduction. Hospital
workshop, followed by a series of special-                       readmission rates for all clients have been
ized workshops on a variety of topics                            less than 10% per year.
tailored to the needs of participants.                           SITE RESEARCH INTERESTS INCLUDE:
Participants have access to the clinic’s                         Population health outcomes; clinical trials;
consultative services for their own                              brain and cognition; family experience.
practice. Participants are encouraged to
network amongst themselves. Currently,
a network exists of more than 200 mental
health workers from throughout Nova
Scotia and the Atlantic provinces who
have participated.
“Something is not quite right”: Early detection of serious
mental illness, including psychosis
This half-day workshop program is
designed for junior and senior high school
staff (teaching and non-teaching) and
university student services personnel.
Since initiation of the workshop in
February 1999, over 200 staff have
participated from several school boards
and universities in Nova Scotia. Sessions
are case-based, highly interactive, multi-
media presentations. Interested partici-
pants are encouraged to attend the Early
Psychosis Mentorship Program to obtain
more in-depth information on specific
aspects of assessment and treatment of
first-episode psychosis.
Annual Psychosis Conference
The Fourth Annual Atlantic Canada
Psychosis Conference was held in October
2000. This annual one day event provides
a unique opportunity for mental health
practitioners, family physicians, clients,
families and interested community
members to network and hear internation-
ally known key-note speakers address the
topic of early psychosis. The speakers
also present interactive workshops during
the conference.




                                                                                              HALIFAX, NOVA SCOTIA
                                                             7
   Psychotic Disorders Clinic (PDC)          Psychotic Disorders Clinic       Contact:
   Hamilton Health Sciences                  Outpatient Psychiatry            Heather Hobbs
   Corporation, McMaster Site                Hamilton Health Sciences         Phone:
   Dr. Suzanne Archie,                       Corporation, McMaster Site       (905) 521-5018
   Clinical Director                         1200 Main Street W.              Fax:
   Heather Hobbs,                            Hamilton, Ontario                (905) 521-2628
                                             L8N 3Z5                          Email Heather Hobbs at:
   Team Coordinator
                                                                              raymond.hobbs@hwcn.org



FIRST YEAR OF OPERATION                                  AVERAGE NUMBER OF NEW CASES ADMITTED TO
1990                                                     PROGRAM ANNUALLY
                                                          25-30 FEP; (45-70 non FEP)
TYPE OF SERVICE
Outpatient                                                ESTIMATED STANDING CASELOAD
                                                         100 active (38 FEP), 100 alumni (40 FEP)
TYPE OF PROGRAM
Care coordination and shared care                         STAFFING (FTEs)
CATCHMENT                                                Care coordinators (RNs)              1.8
160,000                                                  Psychiatrist                         1.0
PROGRAM ELIGIBILITY                                      Family Educator (RN)                 0.6
16-65 years of age; persons with psychosis               Occupational Therapist               0.4
at any phase are admitted; program is                    Psychometrist                        0.2
tailored to individual needs of clients at                KEY CLINICAL COMPONENTS
each phase, including early psychosis                    • Comprehensive assessment
PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT           • Individual psychoeducation and support
One to two weeks                                         • Family psychoeducation and support
REFERRAL SOURCES OF FIRST-EPISODE (FEP) CLIENTS            (Family Educator role - see below)
Family physicians (59%); in-patient (34%);               • Negotiated treatment agreements
emergency unit; schools, other                           • Low-dose, slow increment antipsychotic
                                                           medications
AGE OF FIRST-EPISODE CLIENTS AT ADMISSION TO PROGRAM
                                                         • Support for reintegration (rehabilitation)
<18 yrs                6%                                • Shared care with family practitioners
18-25                 47%
                                                          THE THERAPEUTIC PARTNERSHIP (TP)
25-30                 17%
                                                         The Therapeutic Partnership (TP) is an
30-35                 15%
                                                         evolving model developed by the Clinic to
>35                   15%
                                                         address the complex needs of the client,
OTHER CLIENT DATA                                        family and treatment team members. It
Gender - 57% male, 43% female; 33% of                    has been in use since the early 90s. It is
first-episode clients using drugs/alcohol at             a model guided by theories of coping and
time of admission                                        adaptation, and premised on shared power
MAXIMUM STAY IN PROGRAM                                  in the decision-making process in order
As needed; active phase of treatment tends               to empower all partners – client, family
to range from 16 to 30 months; clients                   and team members – equally. It is guided
then graduate to alumni status                           by a set of beliefs and values that includes
DIAGNOSIS AT ONE YEAR
                                                         respect, dignity, hope, empowerment,
74.5% schizophrenia spectrum disorders;                  consensual decision making and the
17% bipolar; 8.5% substance-induced                      well-being of all.
psychosis                                                All partners share a series of rights and
                                                         responsibilities. The partnership is built
AVERAGE NUMBER OF NEW CASES REFERRED FOR
                                                         through the pursuit of five complementary
ASSESSMENT ANNUALLY
                                                         tasks: Alliance, Accompaniment,
155 (includes consultations)
                                                         Agreement, Action, and Accessibility
                                                         (the “Five As”).



                                                                                        HAMILTON, ONTARIO
                                                   8
Therapeutic Partnership goals are to:             • Share care effectively with family doctors
• Provide an environment that will                • Reduce client dependency on the “system”
  support recovery from psychotic illness         • Provide support to GPs
• Empower clients and members of                  • Support the health of a large number
  their natural social network                      of clients.
• Prevent estrangement and social                 The Alumni Program rests on values of
  marginalization.                                health, recovery, hope, trust and empower-
The TP model includes three phases                ment, and partnership. A trusting relation-
of intervention: assessment, treatment/           ship among clinicians, client and family
rehabilitation, and an “alumni program”.          is requisite.

FAMILY EDUCATOR                                   DATA TRACKING
The Psychotic Disorders Clinic (PDC) has          Quality of life; client satisfaction; relapse
developed and evolved a staff position            rate; rehospitalization; ER use; suicide (and
called “Family Educator” to specifically          attempts); substance use
provide professional support to families          SITE RESEARCH INTERESTS INCLUDE:
whose relative has experienced a psychotic        Program evaluation; alumni study; family
episode. The Family Educator provides             and client satisfaction.
instrumental and emotional support,
education and advocacy for family
members. This family-centered model
of service provision overtly recognizes the
needs of all family members and offers
equal access to team resources during all
clinical phases of assessment, treatment,
rehabilitation and alumni follow-up.
ALUMNI PROGRAM
The Alumni Program is viewed as a novel
approach to continuing care. In operation
since 1993, it has served 100 clients and
their families. It is premised on a chronic
illness model, similar to approaches
applied to chronic conditions such as
diabetes, arthritis or asthma. Clients may
choose to transfer to alumnus status as
their active phase of treatment is
concluded. The program is a form of
shared care that involves a partnership
among the client, family physician, PDC
and other health professionals. Clients
arrange a schedule of visits with their
family physician and similarly negotiate
a schedule for checking in with PDC at
three, six or twelve month intervals.
During these check-ins, the goals and
treatment plans for the next alumni
interval are negotiated. PDC remains an
easily accessed resource to both client and
family physician, and clients may return
to active client status if necessary.
Alumni Program goals are to:
• Provide continuity of care
• Empower clients toward the goal of
  health maintenance



                                                                                     HAMILTON, ONTARIO
                                              9
      Le programme spécifique                    Département de Psychiatrie             Contact:
      d’intervention Premier-Épisode*            Hôtel-Dieu de Lévis                    Dr. Luc Nicole
      Hôtel-Dieu de Lévis                        143, rue Wolfe                         Phone:
      and Laval University                       Lévis, Québec G6V 3Z1                  (418) 835-7155
                                                                                        Fax:
      Dr. Luc Nicole,                            *First-Episode Specific                (418) 835-7199
      Program Coordinator                        Intervention Program




FIRST YEAR OF OPERATION                                    • Individual cognitive-behavioural therapy
1997                                                       • Group interventions - two 1.5 hour
TYPE OF SERVICE                                            sessions weekly for an 8 month period
Outpatient                                                 with 4 to 7 patients per group. Groups
                                                           focus on developing cognitive, emotional
TYPE OF PROGRAM
                                                           and social competence required for inte-
Case management, multidisciplinary team
                                                           gration into school and/or work settings.
CATCHMENT                                                  Group meetings are co-facilitated by an
210,000                                                    occupational therapist and an educator.
PROGRAM ELIGIBILITY                                        ADDITIONAL INITIATIVES
Age 16 years and up                                        • Ongoing professional development
PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT               for treatment team members through
4 to 6 weeks                                                 bi-weekly seminars
                                                           • Awareness raising sessions are provided
REFERRAL SOURCES
Referrals generally come from outpatient                     to mental health teams from CLSCs
clinic psychiatrists at Hôtel-Dieu. Initial                  (community health centres)
assessments are performed at the clinic,                   • Family physicians are educated in a
resulting in 100% intake of these referrals                  series of training conferences about
to the First Episode Program. GPs tend to                    the early signs of schizophrenia.
be the original source of referral to the                  SITE RESEARCH INTERESTS INCLUDE:
outpatient clinic.                                         Study of the evolution of the illness,
                                                           tracking individuals for a 36 month period.
MAXIMUM STAY IN PROGRAM
Based on individual need, but generally
clients are in the program for one year
plus followup at regular intervals.
AVERAGE NUMBER OF NEW CASES ADMITTED TO
PROGRAM ANNUALLY
35
ESTIMATED STANDING CASELOAD
100
STAFFING RESOURCES INCLUDE:
Psychiatrists, social worker, occupational
therapist, psychologist, nurses, educators
and a work integration specialist.
KEY CLINICAL COMPONENTS
• Comprehensive Assessment
• Building a therapeutic relationship
• Medical and pharmacological
  management
• Individual psychoeducation for clients
  and parents
• Multi-family group education




                                                                                              LÉVIS, QUEBEC
                                                   10
     Prevention and Early              Contact:                                    Phone:
     Intervention Program              Dr. Ashok Malla                             (519) 667-6773
     for Psychoses (PEPP)                                                          Fax:
     London Health Sciences            London Health Sciences Centre
                                                                                   (519) 667-6537
     Centre and University             392 South Street
                                                                                   Email:
     of Western Ontario                London, Ontario
                                                                                   akmalla@julian.uwo.ca
                                       N6A 4G5
     Dr. Ashok Malla,                                                              Web site:
     Director                                                                      www.pepp.ca



FIRST YEAR OF OPERATION                                  DIAGNOSIS AT ONE YEAR
1997                                                     87% schizophrenia spectrum disorders; 6%
TYPE OF SERVICE                                          substance-induced psychosis; 4% psychosis
Predominantly outpatient, plus dedicated                 NOS; 2% bipolar; 2% delusional disorder
beds within a 16 bed inpatient Psychosis                 AVERAGE NUMBER OF NEW CASES REFERRED FOR
Unit in a general hospital (London Health                ASSESSMENT ANNUALLY
Sciences Centre).                                        85 (80-90)
TYPE OF PROGRAM                                          AVERAGE NUMBER OF NEW CASES ADMITTED TO
Assertive case management                                PROGRAM ANNUALLY
                                                         55 (50-60)
CATCHMENT
390,000                                                  ESTIMATED STANDING CASELOAD
                                                         105*
PROGRAM ELIGIBILITY                                      *maximum treatment caseload given current resources.
16 - 50 years of age; non-affective, first-
                                                         STAFFING (FTEs)*
episode psychosis; no more than 1 month
of prior antipsychotic drug therapy                      Clinical/Education Leader                1.0
PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT           Nurse Case Managers                      5.0
48 hours maximum to initial screening                    Social Work Case Manager                 1.0
assessment; telephone contact immediate;                 Social Worker (MSW)                      0.6
location of initial screening assessment                 Clinical Psychologist (PhD)              1.0
varies as necessary (clinic, home)                       Secretarial                              1.5
                                                         Psychiatrists                             2.5   (plus Director)
REFERRAL SOURCES                                         *Outpatient services only. Inpatient staffing and
Inpatient (41%); community physicians                    research personnel additional.
(38%); family/self and schools (21%)                     KEY CLINICAL COMPONENTS
AGE OF CLIENTS AT ADMISSION                              • Engagement and formation of
                                                           therapeutic alliance
<18 yrs               19%
                                                         • Case management
18-25                 47%
                                                         • Medical/pharmacological management
25-30                 13%
                                                         • Patient and family psychoeducation
30-35                 10%
                                                         • Individual cognitive-behavioural therapy
>35                   11%
                                                         • Group programs
OTHER CLIENT DATA
Gender - 75% male, 25% female; 71% of                    Recovery through Activity and Participation Group (RAP)
clients using some drugs (mostly cannabis)               The RAP group assists young clients with
or alcohol at time of admission                          the transition back into their regular
                                                         activities by focusing on the life and
MAXIMUM STAY IN PROGRAM                                  social skills that will help them in the
Core program: 2 years. However, after 2                  community. The group is offered as a
years in the program, if a significant                   two hour session, twice weekly for
degree of recovery has not been achieved,                three months.
clients can participate in one additional
year of intensive case management. After                 Youth, Education and Support Group (YES)
2 to 3 years, patients continue in medical               A series of 8 weekly two hour sessions are
management with their respective                         offered to young clients to provide an
psychiatrists in the Program.                            opportunity to discuss the issues they



                                                                                                LONDON, ONTARIO
                                                 11
confront related to psychosis (e.g., stigma,             and routes to recovery. Recently, a new
peer group pressures, drugs/alcohol, etc.)               video series with an accompanying written
Each week a different theme is discussed.                guide has been developed by PEPP to
                                                         augment the family education process.
Cognitively Oriented Skills Training (COST)
                                                         These materials are best used initially by
COST is a 10 week program for clients who                staff with families, and later by families
are preparing to return to school or work.               on their own or in the context of a
The purpose is to improve skills to compen-              support group.
sate for cognitive deficits.
                                                         Family Support Group
Multiple Family Group Interventions                      Initiated and maintained by PEPP family
Beginning in January 2001, families who                  members, this group provides a great source
have been with PEPP for two years or more                of mutual support and encouragement. It
will be invited to participate in regularly              continues to prove invaluable in terms of
scheduled multiple family group sessions.                raising community awareness and advocat-
ADDITIONAL INITIATIVES                                   ing on behalf of the needs of their loved
School-Based Awareness and Case Detection Program        ones. It is also serving as a model to first-
In 1997, the Program Director and staff                  episode families in other regions of the
contacted one of two local school boards,                country. For additional information,
requesting permission to conduct a pilot                 contact Brenda Wentzell
case detection project in its high schools.              (brenda.wentzell@home.com).
Five schools participated. School officials,             PRELIMINARY PROGRAM FINDINGS
guidance counsellors and teachers first                  DUP Data and Remission Rates
attended an information session focusing                 Mean DUP has decreased from 20 months
on early psychosis detection and the                     (1997-98) to 15 months; median DUP
importance of reducing the duration of                   from 7 months (1997) to 3 months (1999).
untreated psychosis (DUP). One of the                    Significant difference in one year remission
program staff then attended each school                  rate related to DUP observed: of those
for 2 hours weekly as part of the school’s               entering the program with less than six
regular guidance meetings. This process                  months DUP, 82% were in remission at
facilitated a greater understanding of early             one year compared to 58% of those with
psychosis and improved the detection                     a DUP greater than six months (p< .03).
skills among participating school staff,                 Hospitalization
and strengthened the relationship between                Hospitalization rates for initial treatment:
PEPP and the community.                                  53%; 47% are treated as outpatients.
Assertive Community Case Detection Program               Readmission rates at one year: 15-20%.
In January 2000 the Program launched an                  SITE RESEARCH INTERESTS INCLUDE:
assertive case detection program in the com-             Prodromal indicators; development of
munity with a massive poster campaign,                   new psychosocial treatment strategies;
use of local media - including 30-second                 longitudinal/epidemiological outcome
television spots, public forums, direct con-             studies; relationship between DUP with
tact with all educational institutions, health           cognition, quality of life, symptom profiles
care agencies, and community physicians.                 and premorbid adjustment; effect of
Extensive case detection materials have                  phase-specific treatment interventions.
been prepared with assistance from families
and clients. Information pamphlets have
been delivered to most health and social
service agencies in London, and made
available to the public.
Family Psychoeducation Workshop and Materials
A one day, 8 hour workshop is conducted
once every three months in an effort to
inform family members and other interested
individuals about psychosis, interventions



                                                                                            LONDON, ONTARIO
                                                    12
     Early Psychosis Intervention     Contact:                                     Phone:
     Clinic (EPIC)                    Dr. Marc Laporta                             (514) 842-1231 x4393
     McGill University Health         McGill University Health Center              Fax:
     Center, Royal Victoria           Royal Victoria Hospital,                     (514) 843-1644
     Hospital, Allan                  Allan Memorial Institute                     Email:
     Memorial Institute                                                            marc.laporta@mcgill.ca
                                      1025 Pine Avenue West
     Dr. Marc Laporta,                Montreal, Quebec H3A 1A1
     Director


FIRST YEAR OF OPERATION                               STAFFING (FTEs)*
1997                                                  Psychiatrist                                  0.2
TYPE OF SERVICE                                       Resident                                      0.2
Outpatient                                            Nurse                                         0.1
CATCHMENT                                             Occupational Therapist                        0.4
Approximately 250,000                                 Community Worker                              1.0
                                                      *outpatient staffing only.
PROGRAM ELIGIBILITY
                                                      As required:
17 to 30 years of age; recent onset of
                                                      Psychological testing
pre-psychotic or psychotic disorganization
                                                      Psychologist/therapy
of less than one year duration
                                                      Social Worker
PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT        Educator/teacher
Two to three weeks; phone consultations               Also, there is a nurse and occupational
are available to the referring source in the          therapist in a local CLSC who see some
interim.                                              of the patients.
REFERRAL SOURCES                                         KEY CLINICAL COMPONENTS
Crisis Unit; regular out-patient department;             • Establishing a therapeutic alliance
Emergency Room; in-patient units and day                 • Medical and pharmacological management
hospitals; CLSCs (community health cen-                  • Family education and support
tres); schools; GPs                                      • Individual cognitive therapy
AGE OF CLIENTS AT ADMISSION                              • Individual supportive therapy
                                                         • Occupational therapy groups
<18        7%
                                                         • Community-based networks of support
18-25     75%
>25       18%                                         ADDITIONAL INITIATIVES
                                                         Community Linkages: Supporting Detection
OTHER CLIENT DATA
                                                      To enhance the chances of early detection,
Gender - 66% male, 33% female
                                                      EPIC has forged various links with commu-
MAXIMUM STAY IN PROGRAM                               nity-based settings. It is working closely
No predetermined maximum; stays have                  with the Quebec chapter of the Alliance
ranged from 2 months to 4 years.                      for the Mentally Ill (AMI Quebec) who
APPROXIMATE NUMBER OF NEW CASES REFERRED FOR          have an educator who goes into schools to
ASSESSMENT ANNUALLY                                   give information about mental illness. EPIC
25                                                    staff have been directly involved in infor-
APPROXIMATE NUMBER OF NEW CASES ADMITTED TO           mation sessions with teachers, along who
PROGRAM ANNUALLY                                      AMI-Q as well. They have also developed
20                                                    links with school counsellors and some pri-
ESTIMATED STANDING CASELOAD                           mary care settings such as Association
50                                                    Quebecoise de la Schizophrenie, family
                                                      medicine practices, local community
                                                      health centers (CLSCs), crisis units and
                                                      emergency rooms. They organize meetings
                                                      in schools with teachers and administra-
                                                      tors, and have developed links with CLSCs
                                                      as well as possible to facilitate referral.



                                                                                            MONTREAL, QUEBEC
                                                 13
Community Linkages: Supporting Recovery
In order to counter the avoidance of
high-stigma psychiatric services, EPIC has
tried to create intermediate “holding
environments” with agencies with which
they form an extended team extending
beyond institutional bounds. These include
prominently the CLSCs, where patients can
be seen while warming to the idea of
treatment, and community support groups,
where a normalizing stance is upheld - the
main alliance here is with a group called
“Projet-ARC” (Agency for Reintegration in
the Community). Community-based reha-
bilitation work includes behavioural work,
as well as preparation for employment and
academic support and short-term tutoring.

SITE RESEARCH INTERESTS INCLUDE:
Developing early markers for relapse;
understanding the fit between help-seeking
behaviour and interventions offered.




                                               MONTREAL, QUEBEC
                                          14
      Ottawa First Episode              Contact:                      Phone:
      Psychosis Program                 Ms. Claudia Hampel            (613) 737-8899
      (Programme de la première         Ottawa Hospital               ext. 73062
      intervention de la crise de       501 Smyth Street              Fax:
      psychose, Ottawa)                 Ottawa, Ontario               (613) 737-8085
      The Ottawa Hospital and           K1H 8L6
      University of Ottawa
      Dr. Paul Roy, Director


The Ottawa First Episode Psychosis                will be available to support hospital
Program/Programme de la première                  admissions for the Program as required.
intervention de la crise de psychose              Patients will only be admitted to hospital
(Ottawa) is currently in the early stages         if their illness is sufficiently severe to
of implementation. The Program is actively        render them a risk to themselves or
supported by the Dean of Medicine and             others. The attending psychiatrist from
the Chair of Psychiatry at the University         the Program will supervise inpatient care.
of Ottawa, as well as The Ottawa Hospital         A mobile team will be included in the
and the Ottawa and Cornwall chapters              program to perform assessments in the
of the Ontario Schizophrenia Society.             community and to support patients in
The Program is included in the present            their homes when necessar y.
Functional Plan of the Ottawa Hospital –
General Division. A formal application            Referral sources will include emergency
for expansion funding has been presented          room physicians, community psychiatrists
to the Mental Health Implementation               and general practitioners, college and
Task force in the Champlain Region.               high school staff and the general public.
This application will also be presented           Referrals will be made directly through
to the Deputy Minister of Health for              Program staff via a 24 hour – 7 days
Ontario in January, 2001.                         per week “hotline” which will be
                                                  advertised to referral sources throughout
The Program will serve the population of          Eastern Ontario.
Eastern Ontario and the National Capital
Region, a catchment representing approxi-         Multidisciplinary staff in the community
mately 1.5 million persons. All services          setting will provide care for patients and
will be offered in both official languages.       their families on an individual and group
Criteria for program eligibility include:         basis. Care will be provided for up to 3
age 17 years and up; first-episode psychosis      years and will be tailored to the each
with a maximum of 6 months prior treat-           patient’s specific phase of illness, including
ment with anti-psychotic medication.              the acute early recovery and late recovery
The Ottawa Program will represent an              or stable phases of illness. The key clinical
assertive case management approach to             goals will be to minimize duration of
care. It will consist of a multi-disciplinary     untreated psychosis, optimize recovery
staff, including an attending psychiatrist,       and reintegration for patients, and to
case managers with nursing and social             avoid hospitalization as much as possible.
work training, an occupational therapist,         The Program will also serve as an
a psychologist, a data coordinator, a full        educational and consultative resource
time secretary, as well as a consulting           for families and physicians throughout
pharmacist.                                       the entire catchment area.

The Clinic will be located and provide
most of its services in a community clinic
setting. A maximum of six dedicated first-
episode inpatient beds on the psychiatric
unit at the Ottawa Hospital – General Site,




                                                                              OTTAWA, ONTARIO
                                           15
     Services cliniques pour les                 Polyclinique Sainte Anne            Contacts:
     personnes en début d’évolution              65, Ste. Anne, 2nd Floor            Marie-France Demers,
     d’une psychose, les proches et              Québec City, Québec                 Pharmacist
     les intervenants du réseau*                 G1R 3X5                             Xavier DeVriendt,
     Polyclinique Sainte Anne                                                        Psychiatrist
     Centre hospitalier Robert-Giffard           *Clinical Services for First-       Phone:
     and Centre de recherché                     Stage Psychosis Patients,           (418) 691-0777
     Université Laval Robert Giffard             their families and Network          Fax:
                                                 Professionals                       (418) 691-2667
     Dr. Roch-Hugo Bouchard, Director                                                Email:
                                                                                     mfdemers@total.net


FIRST YEAR OF OPERATION                                     ADDITIONAL INITIATIVES
1997                                                        • Presentations and clinical training
                                                              with GPs
TYPE OF SERVICE
                                                            • Plans to extend gatekeeper training
Outpatient with access to beds at
                                                             with school personnel, community
psychiatric hospital
                                                              pharmacists, community health
CATCHMENT                                                     centre staff
Over 600,000
                                                            SITE RESEARCH INTERESTS INCLUDE:
PROGRAM ELIGIBILITY                                         Psychopharmacology; medication trials;
Over 18 years of age; first-episode                         psychosocial studies; genetic research.
psychosis; schizophrenia focus
PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT
Generally one to two weeks
REFERRAL SOURCES
Mostly GPs and inpatient unit of general
hospital; will take family/self referrals
OTHER CLIENT CHARACTERISTICS
Many using drugs or alcohol at time
of admission
MAXIMUM STAY IN PROGRAM
Two years
NUMBER OF NEW CASES ADMITTED TO PROGRAM
500 admissions over a 40 month period
STAFFING RESOURCESINCLUDE:
Psychiatrists, nurses, social workers,
occupational therapist, clinical
pharmacists, neuropsychologist.
KEY CLINICAL COMPONENTS
• Multidisciplinary approach including
  medical, pharmacological, psychosocial,
  psychoeducational and family
  interventions
• Psychoeducational groups
• Family education and support -
  including home visits and groups
• Client groups address: understanding the
   illness, anxiety management, substance
   abuse, social skills, time management,
   self-esteem, problem-solving, managing
   a budget and other issues related to
   integration.




                                                                                          QUEBEC CITY, QUEBEC
                                                   16
    Early Intervention Program     Contact:                         Phone:
    in Psychosis and               Rose Oxby or Dale Ziolkowski,    (306) 655-8858 (Rose)
    Schizophrenia                  Community Mental                 (306) 655-8859 (Dale)
    Saskatchewan District          Health Nurses                    Fax:
    Health (SDH) and               Adult Community                  (306) 655-8875
    University of Saskatchewan     Mental Health Services
    Dr. D. Keegan                  4th floor, 715 Queen Street
    Dr. S. Shrikhande              Saskatoon, SK S7K 4X4



The Early Intervention Program (EIP) is an
outpatient service which began in May
1999, functioning within the context of
SDH, Mental Health Rehabilitation and
Adult Community Services, the
Department of Psychiatry of the District
and University of Saskatchewan. The catch-
ment of Saskatoon and surrounding region
represents a population of approximately
225,000. All persons within the catchment
who may be experiencing a first episode of
non-affective psychosis, with symptoms of
up to two years duration, are to be referred
to the EIP for rapid evaluation, treatment
and rehabilitation. The maximum stay in
the program is two years.

Referrals to the program must be made
through family physicians or psychiatrists.
Referrals are first contacted by telephone
and the attempt is made to see the person
within 72 hours. The program utilizes an
assertive case management approach with
intensive psychoeducation for clients and
families. Staff consists of two community
mental health nurses and two resource
psychiatrists. In its first seven months of
operation, 41 clients were participating in
the program. The age range of clients has
been 15 to 42 years.

Key clinical components include medical
and pharmacological management,
psychoeducation (individual and group)
for both clients and family members, and
skill building (coping, stress management,
problem solving).




                                                                   SASKATOON, SASKATCHEWAN
                                          17
        First Episode Psychosis             Contact:                              Phone:
        Program                             April Collins, Manager                (416) 535-8501
        Centre for Addiction                                                      x4828
                                            Centre for Addiction
        and Mental Health,                                                        email:
                                            and Mental Health
        Clarke Division                                                           April_Collins@camh.net
                                            Clarke Institute
        Dr. Robert Zipursky,                250 College Street
        Director                            Toronto, Ontario M5T 1R8



FIRST YEAR OF OPERATION                                    AVERAGE NUMBER OF NEW CASES ADMITTED TO
1992                                                       PROGRAM ANNUALLY
                                                           150
TYPE OF SERVICE
Outpatient plus dedicated first-episode                    ESTIMATED STANDING CASELOAD
12 bed inpatient unit                                      155
TYPE OF PROGRAM                                            STAFFING (FTEs)*
Multidisciplinary, time-limited case                       Psychiatrists                           2.0
management                                                 Nurse                                   2.0
CATCHMENT                                                  Occupational Therapist                  1.3
No restrictions, Toronto area, population                  Social Worker                           1.0
4 million                                                  *outpatient staffing only

PROGRAM ELIGIBILITY                                        KEY CLINICAL COMPONENTS
18 - 45 years of age; first episode of a                   • Individualized, family-inclusive,
primary psychotic illness; no more than                      multidisciplinary assessment
three months prior anti-psychotic drug                     • Time limited (2 years) multidisciplinary
therapy; not appropriate for those with                      care focused on optimizing outcome
a mood disorder, a general medical                         • Menu of services provided which
condition considered to be the cause of                      include individual and group approaches.
their psychosis, or developmental delays                     These are tailored to the needs of the
                                                             person and his/her family.
PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT
Maximum wait of 2 weeks for outpatient                     ADDITIONAL INITIATIVES
evaluation; triage system in place to                      Community Activities/Outreach
deal with more urgent cases within one                     Activities include ongoing community
work day. Clients are assessed in the                      outreach at different hospitals; an annual
clinic setting.                                            conference on first-episode psychosis that
REFERRAL SOURCES                                           is well-attended by a broad cross-section
Family physicians (30%); in-patient (25%);                 of providers and educators (approx 200
emergency department (25%); community                      attendees); and extensive promotion of
psychiatrists (10-15%); schools and                        the program across the province.
community services (10-15%)                                SITE RESEARCH INTERESTS INCLUDE:
AGE OF FIRST EPISODE CLIENTS AT ADMISSION                  The First Episode Psychosis Program has
                                                           a strong commitment to clinical research
< 16                   5%                                  into the mechanisms underlying the devel-
17-24                 51%                                  opment of schizophrenia and its treatment.
25-29                 15%                                  Neuroimaging approaches have been an
30-34                 13%                                  important component of this research
35 +                  16%                                  program and have been utilized to under-
OTHERCLIENT CHARACTERISTICS                                stand mechanisms of treatment response
Gender – 68% male, 32% female                              and to characterize the brain structure and
MAXIMUM STAY IN PROGRAM                                    function in schizophrenia. Understanding
Two years                                                  the role of cognitive dysfunction in schizo-
                                                           phrenia and characterizing the long-term
AVERAGE NUMBER OF NEW CASES REFERRED FOR
ASSESSMENT ANNUALLY
                                                           outcome of schizophrenia are also major
200                                                        priorities for this program.


                                                                                              TORONTO, ONTARIO
                                                   18
     Schizophrenia Service/          Contact:                        Phone:
     Early Psychosis                 David Butler,                   (250) 952-4410
     Intervention                    Program Coordinator             Fax:
     Victoria Mental                                                 (250) 952-4241
                                     Victoria Mental
     Health Centre                                                   Email:
                                     Health Centre
     Dr. Richard Williams,                                           dwbutler@begbie.caphealth.org
                                     2328 Trent Street
     Director                        Victoria, British Columbia
                                     V8R 4Z3



FIRST YEAR OF OPERATION                                 KEY CLINICAL COMPONENTS
1995 with increasing focus and                          • Assessment
specialization of services for first-                   • Case management
episode cases since 1998                                • Medical and pharmacological
TYPE OF SERVICE                                           management
Outpatient, inpatient and residential                   • Psychoeducation for client and family
                                                        • Group and individualized programs
TYPE OF PROGRAM
                                                        • Residential treatment (specialized for
Case management, including medical
                                                          first-episode)
and psychosocial management
                                                        ADDITIONAL INITIATIVES
CATCHMENT                                               • Community liaison/education
320,000                                                 • Family support group
PROGRAM ELIGIBILITY                                     • Sibling support group
No age restrictions                                     • Educational retreats
PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT          • Member of the British Columbia
2 weeks                                                   Early Psychosis Initiative
REFERRAL SOURCES                                        SITE RESEARCH INTERESTS INCLUDE:
Most common source is GPs.                              National Outcomes study; medication trials
AGE OF CLIENTS AT ADMISSION

< 18 yrs              15%
18-25                 45%
25-30                 30%
30-35                 10%
MAXIMUM STAY IN PROGRAM
Not specified
AVERAGE NUMBER OF NEW CASES REFERRED FOR
ASSESSMENT ANNUALLY
90
ESTIMATED STANDING CASELOAD
Approximately 180 first-episode cases
STAFFING RESOURCESINCLUDE:
A coordinator, psychiatrists, case managers
and access to psychologists, recreational
therapy and occupational therapy.




                                                                                           VICTORIA, BC
                                                 19
Other Early Psychosis Initiatives




               20
 The British Columbia       Project Director:   Project Manager:         Project Coordinator:
 Early Psychosis Initiative Tom Ehmann, Ph.D.   Laura Hanson, Ph.D.      Josephine Hua, B.Sc.
 Mheccu, University         Phone:              Phone:                   Phone:
 of British Columbia        (604) 877-3119      (604) 263-3502           (604) 822-1642
 2250 Wesbrook Mall         Email:              Email:                   Email:
 Vancouver, BC V6T 1W6 tome@intergate.ca        hanson-epi@home.com      jmei@interchange.ubc.ca
 Web site:
 www.mheccu.ubc.ca


BACKGROUND                                        Regional component activities were
The Ministry of Health’s (MOH) Mental             projected to include awareness education,
Health Plan, announced in January 1998,           clinical training, risk prevention and
established a basis for examining mental          community networking to improve identi-
health issues involving early identification      fication, referral, treatment, follow-up and
and intervention for youth and young              support services for young people with
adults with mental illness. Historically,         early signs of severe mental illness and
early identification and intervention             their families.
services for youth and young adults with a
                                                  PHASE ONE IMPLEMENTATION (1999/2000)
serious risk for a mental illness have been       Mheccu was contracted to assist the
identified by the Ministry for Children and       Working Group in planning and
Families (MCF), particularly as they apply        managing the implementation of EPI.
to the development of youth transition            At the regional level, lead MCF and Health
services. These and other joint MCF/MOH           Authority representatives were identified
issues were identified in 1999/00 as priori-      to work with Mheccu and the Working
ties to be addressed in the Child and Youth       Group to advise and collaborate on the
Mental Health Plan to be completed in the         development of EPI.
fall of 2000.
                                                  Based on the above processes, two types
In 1999/00, consistent with the provisions        of regional initiatives were established.
of the Mental Health Plan, the MOH                The first type labelled, “Strategically-
undertook an initiative with one-time             Targeted Initiatives” (STIs) involved
funding of $1.15 million to further the           a total of $552,922 allocated across all
goal of developing prevention and early           18 Health Regions in accordance with a
intervention services for young persons           formula developed by the MOH, the
(ages 13 to 30) at risk for severe mental         Working Group and Mheccu in consulta-
illness.                                          tion with the regional representatives.
A Provincial Inter-Ministry Working Group         Funding was allocated partially (50%)
co-chaired by MOH and MCF was identi-             on the basis of the size of the target
fied to direct the Early Psychosis Initiative     population in each region (the 13 to 30
(EPI). Its overall purpose was to initiate a      year old regional populations); and also
process for ongoing regional inter-ministry       allocated (50%) to ensure that each
prevention and intervention efforts for this      region had a basic allocation sufficient
population. Partners with MOH and MCF             to implement STIs. The awards ranged
include regional health authorities,              from $20,500 to $71,300.
Ministry of Education, regional counselling
and special service representatives, BC           Regions were required to include basic
Schizophrenia Society and the Canadian            education and training activities
Mental Health Association. Coordination           addressing the following priorities:
and implementation leadership is provided         early identification, clinical skill building
by the Mental Health Evaluation and               and improvements in service delivery
Community Consultation Unit (Mheccu),             planning that would be reflected, in part,
a Division of the Department of Psychiatry,       in integrated regional comprehensive
University of British Columbia.                   service protocols involving inter-ministr y
                                                  providers.



                                                                            BRITISH COLUMBIA EPI
                                           21
The second type of initiative labelled                             that clinician specialists will not work in
“Demonstration Projects” (DPs) involved                            isolation as regular communication will be
a total of $300,000 allocated to select                            developed among clinicians, tertiary centres
regions. Through a competitive process,                            and local experts. Given regional coopera-
the following 5 regions or macro-regions                           tion, these clinicians will be able to provide
were funded to conduct projects designed                           services (e.g., in-home assessment and treat-
to implement current best practices in early                       ment) that are not normally conducted.
psychosis intervention during the 2000/01                          3. Further development of educational materials and other
fiscal year: South Fraser, Central Vancouver                       resources including:
Island, Vancouver/Richmond, North West                             • Advanced training materials
and Okanagan/Similkameen. Funding allo-                            • Web site enhancement (including
cations ranged from $19,000 to $81,000.                              discussion groups)
To assist regions in implementing their                            • Modification and translation of materials
regional initiatives and projects, Mheccu                            to make them more culturally appropriate
developed a series of educational materials                        • Support to the Ministry of Education’s
and a web site (www.mheccu.ubc.ca). Most                             school counsellor training on early
of the materials developed are currently                             psychosis
available to the public free of cost on the                        4. Evaluation of Year 1 Strategically Targeted Initiatives and the
web site.                                                          Demonstration Projects

PHASE TWO IMPLEMENTATION                                           5. Continuation of regional initiatives (e.g. Year 1 Strategically
                                                                   Targeted Initiatives)
MCF and MOH announced additional
                                                                   In order to support the continuation of
one-time grant funds totalling $350,000 to
                                                                   regional EPI initiatives, $130,000 will be
Mheccu to further the development of EPI
                                                                   directly distributed to the 18 health regions.
($200,000 from MCF; $150,000 from MOH).
                                                                   These funds are to be utilized to further the
The primary goals to be attained with
                                                                   goals of the Strategically Targeted Initiatives
these funds are:
                                                                   as outlined in Year 1. These include work on:
1. The development and dissemination of a document outlining       systemic issues (i.e., regional committee
the goals and procedures for implementing best current practices   formation, referral pathway refinement,
in early psychosis
                                                                   child-adult system bridging, etc.), identifica-
This document is a very important element,
                                                                   tion training and clinical skill building.
along with the EPI Framework, in mapping
out service directions and guiding everyday
clinical practices.
2. Intensive and ongoing clinical training organized by Mheccu
A number of comprehensive and sophisti-
cated assessment and treatment approaches
have been developed around the world.
Service providers in B.C. deserve support
in learning and implementing these
procedures. The Mheccu training will be
much more in-depth and practical than
the types of sessions generally presented
in Year One. The training will focus on
skill development among the attendees.
In order to provide a high quality
educational experience, attendance will
be limited. Regional EPI committees will
decide which service providers from each
region will attend. The underlying
objective is to establish pockets of clinical
expertise in early psychosis across the
province – establishing an interactive
“network of excellence”. It is envisioned



                                                                                                       BRITISH COLUMBIA EPI
                                                             22
     BC EPI Regional             On-Board Contact:                Phone:
     Demonstration Projects      Margaret Derocher,               (250) 709-3040
     CENTRAL VANCOUVER           On-Board Coordinator             Email:
                                                                  margaret.derocher@cvihr.bc.ca
     ISLAND

CENTRAL VANCOUVER ISLAND                             access to treatment services provided in
There are two components to the project:             the least restrictive environmnent; and
Assessment in Early Psychosis                        the development of consultative and
To examine the predictive validity of                education services to rural health
neuropsychological measures, intake                  practitioners. Team members include a
psychological assessments of persons seen            co-ordinator, psychiatrists, an occupational
at the Victoria Early Psychosis Program will         therapist, case managers and psychologists.
be compared with functional outcome                  Program components include direct access
measures taken one year after discharge.             to initial triage, intake assessment within
Also, local assessment teams across                  36 hours of referral, multi-disciplinary
Vancouver Island will be trained in com-             team assessment, assertive case manage-
prehensive multi-disciplinary approaches             ment for up to two years, group therapy
to early psychosis assessment.                       for clients and families, and assistance
                                                     with rehabilitation goals and access to
Non-Urban Pilot Project                              service. The On-Board Program is
The On-Board Program at Duncan will be               especially concerned with bridging
evaluated as a model of rural service deliv-         the service delivery gaps that can
ery. The On-Board Program is intended to             occur between child and adult mental
promote early psychosis awareness; optimal           health systems.


    BC EPI Regional              Contact:                     Phone:
    Demonstration Projects       Marsha Lloyd                 (250) 638-2202
                                                              Email:
    NORTH WEST                                                marsha.lloyd@nwch.hnet.bc.ca


NORTH WEST                                           and treatment. This pediatrician would
Early identification and intervention of             then provide both direct services to first-
psychosis in the North West is impeded               episode clients and act as a regional
by the scarcity of psychiatric services in           consultant for family physicians and
this region. The project consists of the             mental health clinicians working with
intensive training of a local pediatrician           first-episode clients.
in first-episode psychosis assessment


    BC EPI Regional                Contact:                    Phone: (250) 860-7549
    Demonstration Projects         Alice Jensen,               Fax: (250) 868-7791
                                   Early Psychosis             Email:
    OKANAGAN
                                   Coordinator                 alicejensen@bc.sympatico.ca
    SIMILKAMEEN


OKANAGAN SIMILKAMEEN                                  of this project were to: promote the early
This region in south central British                  identification and treatment of symptoms
Columbia represents a catchment area of               of psychosis; reduce delays and improve
approximately 110,000 people. Before this             access to treatment; reduce the frequency
project began, the wait for appropriate               and severity of relapse; reduce the burden
treatment was often extensive, especially             to caregivers and promote family well-
for non-urgent cases. The main objectives             being; and reduce the incidences of


                                                                                  BC EPI REGIONAL
                                             23
secondary morbidity and disruptions to           • Treatment may involve home or
social and vocational functioning. In order        community-based treatment by a mental
to build community awareness of this               health clinician (daily to bi-weekly visits).
initiative, educational seminars have been       • An integrated treatment approach will
provided to as many service providers as           involve the client, family, family
possible, including the dissemination of           physician, psychiatrist, psychologist,
educational materials.                             occupational therapist, and other
This is a community response project that          professionals as required.
will be in service from June 2000 to March       • Education of both the client and family
31, 2001. It involves developing the follow-       members is seen as an important
ing service for clients who are experiencing       component in this treatment approach.
their first episode of psychosis and their       • Once the individual is stabilized, they
family members (or other such caregivers):         will be offered the support of a trained
                                                   peer support worker.
• A rapid response team will conduct
  initial assessments in the person’s home       Data being collected include rate of
  or other community setting (including          inappropriate vs. appropriate referrals,
  the hospital) within a 24 hour period          compliance with medication or
  for acute cases and within a one-week          psychosocial interventions, psychological
  period for non-acute cases. Both adult         testing results (every three months),
  and adolescent cases will be accepted.         reintegration to normal routine, and
• A psychiatric assessment will be               satisfaction of both client and family
  conducted within a 48 hour period.             members with the service.



   BC EPI Regional                Contact:                   Phone: (604) 951-5844
   Demonstration Projects         Karen Tee,                 Fax: (604) 951-5917
                                  Demonstration              Email:
   SOUTH FRASER                                              Karen.Tee@gems4.gov.bc.ca
                                  Project Coordinator


SOUTH FRASER                                     Services are provided by a specialized
The South Fraser Region has a population         early psychosis clinician, mental health
of 575,000 and represents a range of             clinicians, and psychiatrists. Each of the
urban and rural areas. Prior to this             five communities in the region has an
demonstration project, people would              identified mental health clinician and a
access services through a variety of routes.     psychiatrist who undertake primary care
One of the main objectives of this project       of each case. In addition to psychiatric
has been to establish a single point of          and psychosocial interventions, psychoe-
entry to assessment and treatment for            ducational sessions are provided to clients
youth and young adults suspected of              and their families on individual and
experiencing a first episode of psychosis.       group bases. Education and training pro-
The program offers services to persons           vided to professionals and community
13 to 30 years of age. The single point of       agencies through the EPI educational ini-
entry intake process makes access easier         tiative have helped to support early iden-
and there is no waitlist for those at risk       tification and case referrals to the project.
for a first episode of psychosis. Referrals
                                                 The project has two additional compo-
are accepted from families and individu-
                                                 nents: case finding - which is directed at
als as well as a variety of professionals in
                                                 two targeted high risk populations aged
the community. The intake clinician tries
                                                 13 to 30 (genetic risk and/or substance
to make contact with the referring source
                                                 abuse risk); and, a treatment comparison
within 48 to 72 hours.
                                                 study evaluating the impact of psychoed-
                                                 ucation group interventions.



                                                                               BC EPI REGIONAL
                                          24
      BC EPI Regional                        Contact:                               Phone:
                                             Miriam Cohen,Coordinator               (604) 822-9732
      Demonstration Projects
                                             Web site:                              Email:
     VANCOUVER/                              HOPE – Helping to Overcome             mcohen@vanhosp.bc.ca
     RICHMOND                                Psychosis Early
                                             www.hope.vancouver.bc.ca/hope/


VANCOUVER/RICHMOND                                           Interactive Web Site
There are three components to this project:                  The web site will provide general informa-
Appointment of a Regional Case-Facilitator                   tion and responses to specific questions
This individual will act as a resource for                   about diagnosis and management of early
front line workers, will advise about the                    psychosis to clients, family members and
management of individual cases and broker                    front line professionals.
needed services when a provider is unable                    The project provides consultation, assess-
to deliver such services.                                    ment, initial treatment, support, education
                                                             and resource materials for clients, their
First-Episode Rounds
                                                             families and the community. Clinicians
Monthly rounds for professionals to
                                                             can refer directly to the case facilitator.
present and discuss challenging cases.
                                                             The program is accessible to clients
                                                             aged 13 to 30.




                                                                                              BC EPI REGIONAL
                                                      25
 Canadian Mental             Phone:                  Calgary Site Coordinator: Sandy Bray
 Health Association          (416) 484-7750          Phone: (403) 297-1716
 National Office             Fax:                    Email: sandy.bray@cmha-ascr.ab.ca
 2160 Yonge St.,3rd Floor    (416) 484-4617          Manitoba Site Coordinator: Sharon Mulder
 Toronto, ON M4S 2Z3         Email:                  Phone: (204) 878-9239
 Contact:                    l.lines@utoronto.ca     Email: slsm@escape.ca
 Elizabeth Lines,            Web site:               Fredericton Site Coordinator: Jean McBrine
 National Project Manager    www.cmha.ca/english/
                                                     Phone: (506) 458-1803
                             research/projects.htm
                                                     Email: cmhafo@nb.aibn.com


CMHA’s early psychosis intervention              for early psychosis activities. In Calgary,
project, funded by the Population Health         CMHA personnel have been working
Fund of Health Canada, is a 26 month             directly with staff from the Early Psychosis
national initiative which began in February      Treatment and Prevention Program at
1999. Clinicians from clinical/research          Foothills Hospital to train high school
sites in Alberta (Calgary), Ontario              teachers, counsellors and other gatekeepers
(Hamilton, London, Toronto), and Nova            in early identification skills and promote
Scotia (Halifax) are among the advisors          access to the Foothills program. In
to the project.                                  Fredericton, through the work of the local
                                                 project working group and with the sup-
The project is intended to raise awareness
                                                 port of the provincial government, clinical
among professionals, families and other
                                                 services are being reorganized to accommo-
community members regarding the impor-
                                                 date early psychosis services and the
tance of early psychosis intervention, and
                                                 education of mental health professionals,
promote access to appropriate first-episode
                                                 gatekeepers, and the community at large
services, with a focus on youth. Toward
                                                 is underway.
this end, project activities are centred on
the development and dissemination of             The province of Manitoba does not yet
educational resource materials, the facilita-    provide a coherent set of services for
tion of local early intervention activities      young people with early psychosis. There,
through three CMHA sites, and the                a project steering committee, representing
development of a national network of             a wide range of stakeholders, has been
interest and information-sharing.                working to raise awareness regarding the
                                                 importance of early identification and the
In terms of resource materials, the project
                                                 need for appropriate services for youth.
has produced a series of three pamphlets
                                                 Key objectives include community
and an introductory document on early
                                                 education, gatekeeper training, and
psychosis. The pamphlets are available in
                                                 service improvement. A family support
English, French and Chinese. The project
                                                 group, modelled on the PEPP group (see
has also provided support for the produc-
                                                 London, Ontario program description) has
tion of a national, first-episode family
                                                 been initiated by family members in the
newsletter. A video resource for parents
                                                 Winnipeg region. These families are
new to the experience of psychosis in the
                                                 linking with families in London (Ontario),
family is now available. Finally, this Guide
                                                 Halifax (Nova Scotia) and elsewhere in the
is also a product of the project. Most of
                                                 country to establish a national first-episode
these materials are available on the CMHA
                                                 family network. The family newsletter
web site (www.cmha.ca) in both official
                                                 (see above) is a component of this national
languages.
                                                 networking initiative.
The three CMHA sites participating in the
                                                 Through its broad dissemination of
project are: Alberta South Central Region
                                                 resource materials, facilitation of national
in Calgary, Alberta; the provincial-level
                                                 and local level alliances, and site-based
Manitoba Division; and Fredericton/
                                                 activities, CMHA’s national project has
Oromocto Region in Fredericton, New
                                                 been helping to build awareness of the
Brunswick. Sites were chosen for their
                                                 importance of early psychosis intervention
regional representation and in order to
                                                 across Canada.
reflect a range of readiness and capacity


                                                                                 CMHA NATIONAL
                                            26
 The Ontario             Contact:               Centre for Addiction    Phone:
 Working Group           John Trainor           and Mental Health       (416) 535-8501 x2071
 on Early Intervention   Director,              1001 Queen Street W.    Email:
 in Psychosis            Community Support      Room 2075               John_Trainor@camh.net
                         and Research Unit      Toronto, Ontario
                                                M6J 1H4



The Ontario Working Group on Early                  The Working Group has proposed a two-
Intervention in Psychosis is made up of             phase plan to develop a comprehensive
individuals and organizations with the              early intervention capacity in Ontario.
goal of developing an effective treatment           The first phase will feature the develop-
and support system for the early stages of          ment of four Early Intervention Treatment
psychosis. The group is committed to                and Resource Centres. These centres will be
bringing the benefits of early treatment            partnerships between family organizations
to all citizens of Ontario who experience           and clinical treatment programs and will
the onset of psychosis and to providing             deliver assessment and treatment, public
support to their families. The Working              education, community development and
Group is also committed to a partnership            consultation services to the broader mental
approach with government and the private            health system. Phase one will also include
sector to reach its goals.                          a province-wide planning process to lay
                                                    the groundwork for early intervention
The members of the Ontario Working                  across Ontario. Phase two will see the
Group on Early Intervention in Psychosis            implementation of this expanded program.
reflect a variety of mental health
disciplines, families, and consumers.
Departments of Psychiatry at the
University of Toronto, the University of
Western Ontario, McMaster University, and
the University of Ottawa are involved as
well as clinical sites in London, Hamilton,
and Toronto. The Schizophrenia Society of
Ontario and the families involved in the
early intervention program in London are
also part of the Working Group

The Canadian Mental Health Association
at both the national and Ontario levels
is also involved. The Working Group is
coordinated and supported by the
Community Support and Research Unit
and the Schizophrenia and Continuing
Care Program at the Centre for Addiction
and Mental Health.




                                                                       ONTARIO WORKING GROUP
                                           27
Following are the diagnostic catagories
referred to in this Guide. For comprehensive
diagnostic definitions, readers are directed
to the Diagnostic and Statistical Manual
of Mental Disorders, fourth edition (see
reference below).
BIPOLAR DISORDER
Essentially reflects a disturbance of affect
or mood that can be accompanied by
symptoms of psychosis.
DELUSIONAL DISORDER
A type of psychosis consisting of very strong
and fixed beliefs in things that are not true.
DRUG OR SUBSTANCE-INDUCED PSYCHOSIS
Drugs such as marijuana, LSD, ampheta-
mines and alcohol can sometimes cause
the appearance of psychotic symptoms.
Symptoms usually abate once the effects of
the drugs wear off. However, the symptoms
may still require medical treatment.
PRODROME OR PRODROMAL SYMPTOMS
Pre-psychotic symptoms, or warning signs,
that occur prior to the onset of psychosis.
The full complement of prodromal symp-
toms is extensive, and can include such
signs as suspiciousness, depression, sleep
disturbances, social withdrawal, lack of
attention to personal care, and reduced
levels of functioning in school or at work,
among others. The concept is relevant to
the onset of the first episode and to relapse.
PSYCHOSIS NOS (PSYCHOTIC DISORDER NOT
OTHERWISE SPECIFIED)
Psychotic symptoms are present, but there
is insufficient or contradictory information
that preclude a more specific diagnosis.
SCHIZOAFFECTIVE DISORDER
A disorder characterized by episodes of
mania and/or depression in addition to
symptoms consistent with schizophrenia.
                                                    Adapted from:
SCHIZOPHRENIFORM DISORDER                           Czuchta, D., & Ryan, K. (1999). First episode psychosis:
A form of schizophrenia that is character-          An information guide. Toronto, Canada: Centre for
ized by a duration of less than six months.         Addiction and Mental Health, Clarke Institute.
This disorder may resolve or may persist            http://mentalhelp.net/disorders – diagnostic criteria
and progress to other psychiatric diagnoses,        summarized from American Psychiatric Association.
including schizophrenia.                            (1994). Diagnostic and statistical manual of mental
                                                    disorders, fourth edition. Washington, DC: American
SCHIZOPHRENIA SPECTRUM DISORDERS                    Psychiatric Association.
An umbrella term that typically includes            McGorry, P.D., & Edwards, J. (1997). Early Psychosis
schizophrenia, schizophreniform and                 Training Pack. Macclesfield, Cheshire: Gardiner-
schizoaffective disorders.                          Caldwell Communications Ltd.




                                                                                              GLOSSARY
                                               28

				
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