British Columbia was an early and ardent supporter of the EPI approach.
2000 – Provincial EPI Initiative
EPI substantively arrived in British Columbia in 2000 as a result of an inter-ministerial and inter-agency initiative that spurred interest, trained numerous stakeholders and funded a series of pilot projects designed to begin the implementation of EPI clinical services in the province. As a result, several EPI programs were established across the province.
2004 – A survey of EPI Services reveals considerable variability
In 2004, a survey commissioned by the BC Schizophrenia Society revealed considerable variability in the structure, scope and practices among those providing EPI services in British Columbia. One finding that merited consideration was the higher number of best practices provided by those services designated as EPI programs compared to those who tried to offer early psychosis services within traditional mental health teams.
2010 – EPI Standards and Guidelines
In 2010, Standards and Guidelines were adopted in BC. The standards and guidelines are specifically directed at those community-based programs operating under the auspices of regional Health Authorities. It is, nevertheless, hoped that inpatient programs as well as programs operated by other government ministries will adopt or adapt these to their own services, particularly those that are partnered between MCFD and a health authority through contractual funding or memorandums of understanding. 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.”
2011 – EPI Advanced Practice Committee
The development and adoption of Provincial Standards and Guidelines reinforced the need to develop a Provincial Advisory Committee that would address all EPI-related initiatives and help to facilitate service delivery improvements across the province. One recent activity entailed planning and assisting the dissemination of a newly developed guided self-care toolkit entitled “Dealing with Psychosis: A Toolkit For Moving Forward with Your Life”. This committee, the EPI Advanced Practice Advisory Committee, which consists of representatives from the Health Authorities, MOH, MCFD, consumer groups and others, became operational in 2011.
2011 – EPI Advanced Practice Project (APP) and EPI Communities of Practice (CoP)
Although EPI Programs receive the most focus in BC, there are many areas where clinicians are providing services to persons with early phases of psychosis. Some clinicians are based in Child and Youth Mental Health while others work for Health Authorities or in other community or acute care settings. Often clinicians working outside of formal programs face special challenges including isolation from others working within the same theoretical framework, lack of understanding by supervisors or other management about the differences between effectively working within the EPI framework compared to the adult models such as “chronic disease management” or other approaches typically provided in adult mental health services.
For both those working within designated programs and doing EPI-informed work, ongoing support and education is needed. A new initiative, the EPI APP was launched to provide training, education and support to clinicians across the province and to further the improvement of clinical services via uptake of the Standards and implementation of program evaluation initiatives. Many clinicians who are either in EPI Programs or provide “EPI-informed services” have received formal training via the EPI Provincial Training Program formerly operated by the Fraser EPI Program and funded by the Ministry of Children and Family Development and now running under the auspices of the EPI APP.
Two Communities of Practice (CoP), one for clinicians (C-CoP) and one for managers and leaders (ML-CoP) were formed in Fall 2011 and have been active since. The latter (ML-CoP) is focused on the systemic uptake of the Standards and Guidelines. Peer site reviews of five EPI programs are being carried out under the auspices of the EPI APP. The ML-CoP also undertook the development of this web site that replaces 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
In September 2012, an approach to evaluating uptake of the BC EPI Standards and Guidelines was approved by the Provincial Mental Health and Substance Use Planning Council. The Provincial Evaluation Framework for Early Psychosis Intervention Programs in British Columbia translates the standards into measureable indicators and provides tools by which the resulting data can be collected. The implementation of the Evaluation Framework began in late 2012 and is guided by the EPI APP Advisory Committee and the ML-CoP.
The Future of EPI in BC
Early Psychosis Intervention is firmly embedded in the network of mental health services in BC. However, inadequacies in breadth and depth of services are still evident in most jurisdictions in BC. Expansion and refinement of services will depend upon the continued adoption of evidence-based approaches and the commitment to further build and fund these improvements