Research Report Round-up: Building a system to support quality care

What you need to know

To ensure high-quality community mental health and substance use services, capacity to conduct ongoing monitoring and quality improvement (QI) work is needed. . Early Psychosis Intervention (EPI) is an evidence-based practice for supporting youth at early stages of psychosis. In 2011, the Ontario Ministry of Health and Long-Term Care released program standards for EPI programs, and QI has become a sector priority. In recent years the sector started offering fidelity assessments to assess current practice and guide improvement. However, capacity of programs to act on fidelity recommendations or perform improvement work is unknown. Additionally, the EPI sector has no common outcome monitoring system.

Title and link to report: Building a system to support quality care: Current capacity for monitoring and quality improvement in Ontario early psychosis intervention programs.

Authors: Janet Durbin, Provincial System Support Program, Centre for Addiction and Mental Health; Avra Selick, Provincial System Support Program, Centre for Addiction and Mental Health; Gordon Langill, Canadian Mental Health Association, Haliburton, Kawartha, Pine Ridge Branch and Early Psychosis Intervention Ontario Network.

Year and location: 2021, Toronto, Ontario

Population addressed: EPI staff in programs across Ontario

Type of study: Cross-sectional key informant survey of Ontario EPI programs.

Contact person/source: Avra Selick at avra [dot] selick [at] camh [dot] ca

Language: English

What this report is about

The Early Psychosis Intervention Ontario Network and the Centre for Addiction and Mental Health surveyed Ontario EPI programs about their current capacity to use data for monitoring and QI, and to understand what supports are needed to enhance capacity. The survey also asked about perceived value of fidelity assessments, and capacity to report a selected set of performance indicators recommended by the International Early Psychosis Association (IEPA).

Twenty-five programs, about 50% of Ontario EPI programs, completed the survey. Programs reported modest capacity for collecting and using data, with just under half regularly using data for monitoring and QI.  Few programs reported completing formal QI projects. Programs that had received fidelity assessments found them to be relevant and valuable but lacked support for conducting follow-up QI work based on the results. Common challenges included insufficient time and resources, and lack of expertise for accessing, analyzing and reporting data.

Despite these limitations and challenges, there are five measures recommended by the IEPA that most programs are currently able to report. These may provide a foundation to begin common reporting. 

The results in this report may not be fully representative of the sector, but they align with prior sector feedback and with other reports of capacity across the community mental health and addiction system.

How this report can be used

To move the dial on monitoring and QI work, programs need to be equipped with  skills and supports to collect and use data to inform patient care, QI and program planning. This requires dedicated resources and processes, with a multiyear commitment. Specific recommendations include:

  • Expand program  and central supports to conduct and use fidelity assessments. The sector has developed considerable expertise in fidelity assessments but dedicated ongoing support is needed for sector-wide implementation and to support follow-up QI.
  • Develop and implement a common, minimum dataset to measure client outcomes. Development should build on learning from other jurisdictions with robust EPI monitoring systems, be informed by the priorities of Ontario EPI programs and align with the work of the Ontario Mental Health and Addictions Centre of Excellence.
  • Secure funding for data collection infrastructure, including implementation support  so that programs are equipped to collect and use data effectively,  a common platform/strategy for collecting and reporting data, and  central capacity to aggregate and share results to inform sector  QI and policy.