Table 1

Stages of implementation to be used in EPI-SET

StageOverarching goalSteps
1. ExplorationTo assess site capacity and need, build engagement
  • CAMH NAVIGATE experts, PSSP implementation specialists and ECHO team meet with each site to explain NAVIGATE, learn about their current staffing and service delivery processes and discuss how to integrate NAVIGATE into their practice.

  • EPI staff complete a site readiness assessment survey and a programme fidelity review is conducted to learn more about site capacities and needs for NAVIGATE implementation.

2. InstallationTo create structures and build capacity for implementation
  • EPI staff and PSSP facilitators meet for an intensive in-person and/or blended in-person and virtual staff training over several days co-led by CAMH NAVIGATE experts and NAVIGATE trainers along with youth and family partners, delivered in lectures, role playing and discussions.

  • PSSP supports preparation, including staff allocation to each NAVIGATE role, how interventions will be documented, how documentation will be used in NAVIGATE supervision and how to prepare for ECHO sessions.

  • The ECHO team works with each site to ensure setup and ongoing functioning of infrastructure for live videoconferencing.

3. Initial implementationTo trial and refine implementation
  • Each site will begin NAVIGATE delivery using feedback from various sources, including ECHO training and coaching, contact and progress notes, and staff meetings to refine the implementation and service delivery processes and to build staff skills.

  • The PSSP implementation specialists will document progress, strategies and challenges to implementation in a structured log that they will share in regular meetings with the NAVIGATE experts and other facilitators for continuous improvement, mindful of site-specific factors and population-specific factors (eg, sex, race/ethnicity, rural vs urban) that may influence implementation.

  • Staff feedback will be used to refine the implementation process.

4. Full implementation and sustainabilityTo stabilise practice so that the implemented practice is routine
  • NAVIGATE is fully embedded into the organisation and can be sustained with internal resources.

  • The ECHO team will work in collaboration with Study sites via videoconferencing technology to create and sustain a community of practice for NAVIGATE implementation and spread beyond the duration of this study, such that it becomes routine practice.

  • After each ECHO session, questionnaires will be used to evaluate satisfaction and inform ECHO modifications, and cases discussed during the sessions will generate implementation recommendations, with surveys approximately 3 months later to evaluate adherence to these recommendations.

  • Pre-knowledge and post-knowledge tests and competence assessments will be used to assess how knowledge changes throughout the ECHO cycle.

  • CAMH, Centre for Addiction and Mental Health; ECHO, Extension of Community Healthcare Outcomes; EPI, early psychosis intervention; EPION, Early Psychosis Intervention Ontario Network; EPI-SET, Early Psychosis Intervention-Spreading Evidence-based Treatment; PSSP, Provincial System Support Program.