title: A first step in system improvement: a survey of Early Psychosis Intervention Programmes in Ontario.
abstract: Ontario, Canada is a large province with a geographically dispersed population. Early psychosis intervention (EPI) programmes are available province-wide, with delivery approaches adapted to context. This study examined EPI programme delivery in relation to recently released provincial EPI Program Standards, and variations based on geographic context.
  
  
  
  The data source was a province-wide key informant survey of early psychosis programmes conducted after release of the Standards. Chi-squared tests compared large- and small-area programmes on selected programme structural features and perceived adherence to 19 service components.
  
  
  
  Responses were obtained from 52 programme sites, including 21 small-area programmes with 1 to 2 staff. In general, frequency of EPI delivery was highest for individual assessment and treatment components, and moderate for social supports and family support. Implementation was lowest for public education, early detection and recovery planning. Small-area programmes reported lower implementation for over half of the components, with differences statistically significant for psychiatric assessment and physical health monitoring.
  
  
  
  Since the release of the Standards, the Ontario Ministry of Health has partnered with a provincial network of EPI stakeholders to support practice improvement. This survey identified components where more implementation support is needed, overall and for rural area delivery. Ultimately, systematic monitoring of programme fidelity and measuring client outcomes are key to advancing the quality of EPI programme delivery.
authors.affiliation: Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. janet.durbin@camh.ca.
authors.forename: Janet
authors.initials: J
authors.lastname: Durbin
authors.affiliation: Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Avra
authors.initials: A
authors.lastname: Selick
authors.affiliation: Oriole Research and Design Inc., Picton, Ontario, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hierlihy
authors.affiliation: Performance Measurement and Implementation Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moss
authors.affiliation: First Place, Canadian Mental Health Association - Thunder Bay Branch, Thunder Bay, Ontario, Canada.
authors.forename: Chiachen
authors.initials: C
authors.lastname: Cheng
mesh_terms: D061345:Early Medical Intervention / Q000458:organization & administration* / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D009864:Ontario; D015397:Program Evaluation / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: data collection; early intervention; guideline adherence; psychosis; rural health service