Rural and remote early psychosis intervention services: the Gordian knot of early intervention

Abstract

The observed data from these two rural models suggest that there may be differing outcomes. There are limitations to this study, and this paper does not address why there are differences. Future work needs to continue to further explore why differences exist and whether they persist so we can provide equity and quality care for rural and remote populations.

Fidelity scales and performance measures to support implementation and quality assurance for first episode psychosis services

“…The network in Ontario has established program standards (Ministry of Health and Long‐Term Care, ) and the network in British Columbia has published guidelines (Ministry of Health Services, ). Fidelity has been assessed using self‐report surveys of the degree of program implementation (Cheng et al, ; Durbin, Selick, Hierlihy, Moss, & Cheng, ). A self‐report survey of programs affiliated with academic centres across Canada found that most of the surveyed programs offer similar services, in line with published expert recommendations (Nolin, Malla, Tibbo, Norman, & Abdel‐Baki, ).…”

A first step in system improvement: a survey of Early Psychosis Intervention Programmes in Ontario

“…Embedded approaches are often used in rural areas where a central specialist team may be difficult to staff and challenging for clients to access . However, research on effective rural delivery is limited, and national surveys of EPI implementation have reported lower levels of compliance with EPI standards in rural and poorer areas …”

“…During 2005 to 2007, new provincial funding led to a major EPI programme expansion but, in the absence of provincial standards, programmes developed in an ad hoc manner, drawing on general service delivery experience and advice from established programmes . Some adaptations were made in programmes serving rural and remote areas where 14% of the Ontario population of 13.3 million people resides and where the population density can be very low …”

“…[23][24][25] Embedded approaches are often used in rural areas where a central specialist team may be difficult to staff and challenging for clients to access. [26][27][28] However, research on effective rural delivery is limited, 29,30 and national surveys of EPI implementation have reported lower levels of compliance with EPI standards in rural and poorer areas. 23,27 In Ontario, Canada, the importance of early psychosis programmes has been recognized in health policies for over a decade.…”

Implementation and evaluation of a quality improvement project: carepaths for Early Psychosis Intervention Programmes in Northeastern Ontario

“…REIP adopts a hub and spoke model because it best suites its rural geographical context. This model, like the hub and spoke of a wheel, has a hub in a central, urban area, with the spokes as satellite sites . REIP is the central hub with no direct clinical service; it serves as a conduit for the district EPI clinicians to support each other and provides them with training, clinical support and guidance.…”