British Columbia was an early and ardent supporter of the EPI approach.
2000 – Provincial EPI Initiative
Several EPI programs were established across the province as a result of inter-ministerial and inter-agency initiatives including training professionals and numerous pilot projects.
2004 – Survey and Training Program
- A survey was commissioned by the BC Schizophrenia Society to assess whether services across BC had started to adopt the principles of EPI that were introduced in 2000. The results revealed considerable variability in the structure, scope, and practices of EPI services. This outcome prompted the Ministry of Health to develop the EPI Standards and Guidelines.
- Launch of the EPI Provincial Training Program operated by the Fraser EPI Program and funded by the Ministry of Children and Family Development, offered training across Canada, and including family physicians.
2010 – EPI Standards and Guidelines
In 2010, Standards and Guidelines were adopted in BC.
The Standards document states that implementation of the standards and guidelines will not be a smooth road but that “…barriers encountered, lessons learned, and successes achieved will guide progress for the future. EPI programs welcome subjecting themselves to empirical scrutiny since they must be accountable if they are to continue to achieve greater successes and better outcomes for clients, families and society.”
The adaptation of the Standards and Guidelines, to date, remains at the community-based programs operating under the auspices of Regional Health Authorities.
It is hoped that not only hospital in-patient units, but other government ministry-operated programs will adopt the standards and guidelines to their services. The priority being those partnered between the Ministry of Children and Family Development (MCFD) and a Health Authority through contractual funding or memorandums of understanding.
1. EPI Advanced Practice Advisory Committee (APP)
EPI Advanced Practice Advisory Committee became operational to support the adoption of the Provincial Standards and Guidelines.
The EPI APP was launched to further the improvement of clinical services via uptake of the Standards and implementation of program evaluation initiatives in addition to plan and provide training, education and support to clinicians across the province
2. EPI Communities of Practice (CoP)
There is a variance of EPI services delivered across BC from full EPI Programs with well-trained clinicians to those who are trying to offer EPI services with much less support, structure and fidelity (EPI-informed). Not all EPI work in BC is delivered within the context of a recognized EPI Program therefore called ‘EPI-informed’.
The CoP is intended to help all clinicians learn about best practices and share their EPI experience and service learnings.
A. Clinicians Community Of Practice (C-CoP): Both EPI-informed clinicians and those working within a recognized EPI program, many of which have received formal training via the EPI Provincial Training Program, require ongoing practice support and education.
B. Managers and Leaders Community of Practice (ML- CoP): is focused on the systemic uptake of the Standards and Guidelines.
C. EPI APP also facilitates support through meetings, ongoing education and sharing of resources on the training website.
3. New Provincial EPI Website
The ML-CoP developed this website which replaced two previous sites operated by Health Authorities in BC – psychosissucks.ca and hopevancouver.com.
All Health Authorities and MCFD have joined the EPI APP and the constituent Communities of Practice.
2012 – EPI Evaluation Framework
Approval (by Provincial Mental Health and Substance Use Planning Council) of the Provincial Evaluation Framework for Early Psychosis Intervention Programs in British Columbia.
This framework translates the standards into measurable indicators and provides tools to collect the resulting data. Ongoing implementation and use of the framework are guided by the EPI APP and the ML-CoP.
The Current State and Future of EPI in BC
Early Psychosis Intervention is recognized as a specialty service by the Canadian Ministry of Health. Still, in BC, a limited number of EPI Programs exist that provide the full range of supports and services outlined in the BC Early Psychosis Intervention Standards and Guidelines. Other services in Health Authorities or MCFD may have trained EPI clinicians, but without the full EPI program, the treatment is limited.
Ongoing funding and commitment to improving the number and quality of services are needed so that every person in BC, affected by psychosis can be assured they are receiving optimal care.
The EPI Advanced Practice (EPI APP) acts as a central hub to link activities at the provincial level and facilitate uptake of the EPI Standards and Guidelines.
The EPI APP focuses on these main activities:
- Provides EPI-specific clinical competency training and continued practice support for mental health clinicians.
- Facilitates knowledge translation and exchange across the province amongst clinicians, clients, family/caregivers, service managers and researchers.
- Ongoing Standards and Guidelines fidelity monitoring of services in both large and small communities. This very important work has shown the inequality in services across the province.
In 2021 the provincial government announced a significant increase in funding for EPI over three years. It is expected that each Health Authority will be able to increase the number and quality of their early psychosis intervention services!
One important priority in 2021 from this funding will be an examination of Child and Youth services for early psychosis operated by the Ministry of Children and Family Development (MCFD). The goal is to promote consistent fidelity of services to EPI best practices so that youth and their family/caregivers seeking treatment for early psychosis know what to expect from all services across the province, regardless of age or location.
The EPI Programs and services interactive map will be updated by the fall of 2021 reflecting the full EPI Programs.