Team Lead/Clinical Director Onboarding

Welcome to EPI-NC First Episode Psychosis Programs!

We are glad you joined our team, we hope this will help you navigate your understanding of First Episode Psychosis (FE), Coordinated Specialty Care (CSC), and the role of Early Psychosis Intervention of North Carolina (EPI-NC. Please, ask questions and let us know what you need to best adjust.

First, please contact epi_nc@unc.edu in order to gain access to the EPI-NC Teams folder.

A little about FEP, CSC in North Carolina: Opening in 2005, OASIS was the first FEP program in North Carolina. It was followed by Encompass in Raleigh, Shore in Wilmington, and Eagle in Charlotte. Most recently, AEGIS opened in Asheville and the newest addition is WeCare2 in Burnsville, NC. EPI-NC oversees each of the programs and some of their support includes development and support in achieving program fidelity, technical assistance, training and education, data collection and interpretation to ensure services are evidenced-based and useful to our populations. You are part of a dynamic team of professionals working together to improve care and outcomes for those in our state who experience a first episode of psychosis.

We use an evidenced-based coordinated specialty care (CSC) model centered on education, resiliency, and recovery. The model includes a psychiatrist, family therapist, individual therapist, IPS/SEES counselor, and peer support specialist. Nursing and administrative associates are also an important part of your clinic. Some sites have digital navigators, case managers, or other support staff. The team works together closely to provide psychoeducation, psychiatric medication management, individual therapy, family therapy, education, a multi-family group, employment/education support and peer support services.

FEP CSC is unique due to funding and the associated supports (employer, LME, State of NC and EPI-NC) but they are invested in your program and its success. You have multiple roles at your clinic. First, let’s take a macro level view:

• Team: Spend tie attending your treatment team meetings, any administrative meetings unique to your site, shadowing and learning from existing staff.
• Leadership: Familiarize yourself with your organizational structure (found in the general onboarding orientation), including site specific leadership, LME, State of NC, EPI-NC. Review all current contracts, amendments, fidelity requirements (refer to general onboarding), most recent program fidelity review, State required reporting, EPI-Nc data collection reporting, and budget. Note any deadlines.
• Model: Read the Team Lead NAVIGATE Manual: any additional role you might have on the team. In the coming months you will want to review each of the manuals, so you have a stronger sense of your program’s roles and needs. Additional manuals can be found the NAVIGATE website.
• Community: Identify community stakeholders and set up times to meet with them so you can start to build relationships with possible collaborators (crisis services, local ED, referral sources, possible places to refer if not appropriate for your clinic, basic need resources, local law enforcement, schools). Attend any community meetings that pertain to crisis collaboration, community education, NAMI, etc.

Please review the following training: Basics of Coordinated Specialty Care in Early Psychosis

Next, let’s take a more detailed look. In this document, we will break it down into Administrative and Clinical

Administrative

• Fidelity Guidelines: Establishing or continuing systems that support fidelity compliance.
• Data Collection: Each site is required to collect data on each of their patients on a defined schedule. This data is essential to ensure effective and efficient treatment and support program funding. Please connect with EPI-NC to orient to data collection and with your data navigator for your site-specific process.
• NAVIGATE Model: While we use the NAVIGATE model, other modalities such as DBT, TF-CBT, etc., as clinically indicated may be useful in treatment. While reviewing the NAVIGATE program Director Manual, it would also be advised to become familiar with the other manuals to support the overall team.
• Staff Supervision: When providing staff supervision, it’s important to review the patient stages of recovery and related frequence of sessions, who is responsible for formal relapse prevention planning and training required all within the context of a CSC model. Please refer to fidelity #4, #5, and #9.
• Referral networks can be built and maintained by:
  • Attend any community meetings that pertain to crisis collaboration, community education, NAMI, etc.
  • Identify community stakeholders and set up times to visit so you can start to build relationships with possible collaborators (crisis services, local ED, referral sources, potential places to refer if referral is not appropriate for your clinic, basic need resources, local law enforcement, schools).
• Tracking: Below is a list of items requested by EPI-NC, the state of Nc, LME or site specific. It may be helpful to have a site-specific tracking system or process for referrals and admissions.
  • Patient progress
  • Treatment plan
  • Data collection system (please see fidelity)
    • Relapse prevention plans
    • Patient and family participation
    • Criminal justice involvement, hospitalizations
    • Referrals
    • Admissions
    • Demographics

Clinical

• Fidelity Monitoring
• Model Implementation
  • Individual therapy services should be evidence-based. During the first year of treatment, clients should receive a minimum of 6 sessions of Individual Resiliency Training (IRT). Based on client needs and preferences, other evidence-based therapies may be used following IRT, including but not exclusive: Dialectical Behavioral Therapy, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Social Skills Training, etc.
• Trainings/Consultations (see scheduled ongoing meetings in checklist below). Please note EPI-NC provides training and consultation for each role, is part of the program fidelity, and is an additional support to your team members.
• Treatment Team Meeting: A coordinated specialty care clinic has a higher level of communication regarding each patient and family we serve. This communication primarily occurs at the weekly treatment team meeting. Meetings should include all team members and cover new admissions, clinical crises, complex cases and discharges. Each patient/family should be reviewed every 30 days. Please refer to fidelity #3 and the Team Meetings Sample Agenda.
• New Patients process referral, screening, assessment, admission, treatment, discharge

Clinical Operations 

• How can someone begin services with us? FEP clinics provide evidence-based care to a unique population of those who are/might be experiencing a first episode of psychosis. to meet program fidelity standard, more than 95% of admissions must meet the following criteria: Between 15-30 years old, FEP onset no more than 3 years ago or has been a previous client who is appropriate for readmission, and has one of the following diagnoses: schizophrenia, schizoaffective, schizophreniform, brief psychotic disorder, unspecified schizophrenia spectrum and other psychotic do, bipolar with psychotic feature. Rule outs include significant developmental disorder. At times, we might lack diagnostic clarity. These cases can be discussed with your team, during team lead consultation, mentor meeting, or connecting with EPI-NC to seek direction.
• Outreach and Engagement: Early intervention has a significant impact on the trajectory of someone’s recovery process. Outreach and engagement efforts will be collaborating with the entire team.
  • At referral, connect with referral and patient/family member to assess their needs, describe your FEP program (program expectations, why FEP, recover, hope, etc.)
  • Complete screening, describe your program process if they are appropriate (what to expect next), if not appropriate then refer them to another provider
  • Some sites may engage peers to continue outreach and engagement before and during admission process
  • Admission continues the engagement process, helping patients and families understand processes, recovery and overall approach.
  • During treatment, continued outreach/engagement attempts based upon patient/family needs. Identifying obstacles to treatment and interventions that keep them engaged and on track with recovery process
  • The fidelity standard requires the following: 75-100% of referrals are scheduled for intake withing 2 weeks, more than 75% of referrals attend the intake appointment, less than 30% of clients are lost to follow up and the team provides outreach (phone call, text, certified letter, potential home visit) to all people who are lost to follow up – and support patients to overcome barriers to treatment, more than 75% of families are invited to attend an intake evaluation, at 75% of clients agree that the clinical team provides a collaborative approach (this data is collected via patient self-report)
• Please refer to fidelity guidelines #1 and #2
• Frequency of treatment sessions: Frequent clinical encounters are especially important throughout treatment but especially important in the first 6 months. It is recommended patients see several providers each week. As they move through the stages of their recovery, frequency is dictated by what is clinically indicated but typically decreases as symptoms decrease and functional recovery improves. Below are the fidelity standards for your review

In the first 3 months:

Months 3-12

Discharge

• How does someone get discharged from the clinic? There are a variety of ways that someone is ready for discharge from an FEP clinic. Common reasons for discharge are they’ve completed their treatment and no longer need this level of care, they are relocating, they choose a different provider, after admission it is determined they do in fact have another diagnosis (substance use, developmental disorder, etc.) that has become the primary need, or they are no longer engaged despite staff efforts. This would be discussed in treatment team meetings, engagement (if needed) attempts by team members will have been completed, any obstacles to treatment addressed why possible. It is important to provide our recommendations, support their development of a relapse prevention plan, any needed referrals and clear communication about their status and steps if future needs arise. **site specific re-engagement strategies to be developed.

Scheduled Ongoing Meetings

• EPI-NC Consultation(s) 
  • Family Therapy: Last Wednesday of each month from 12pm-1pm
  • Individual Therapy: Second Thursday of each month from 1pm-2pm
  • Peer Support: Every other Monday 3:30-4:30pm
  • SEEs: Every other month, Fridays 9-10am
• Project ECHO: Second Wednesday of each month from 12-1:30pm
• Research Meetings
• Community Stakeholders
• EPI-NC Annual Conference 
• Site Specific (budget, leadership, etc.): Determined by site

Referral Checklist

• Who do we talk to?
  • Person referred, family member listed on referral, referrer advised (for continuity of care and maintaining referral source)
• What do we say?
  • Introduce self, program, how we received referral. Listen/assess needs, complete screening. If Appropriate explain next steps. If not, refer for most appropriate care.
• Who should be at the first appointment?
  • Identified patient and family (support person) member

Admission/Intake Checklist

• Scheduled Intake
  • Welcome in youth friendly space, orient to the process for intake. Introductions.
• Assessment
  • Completed by provider(s) with both identified patient and family (support system) members. Process may be site specific. Another opportunity for program engagement.
• Next Steps
  • Advise of process – may be site specific, ensure they know what to expect next
  • Advise referrer of outcome if appropriate

Orientation Checklist

• Meet with site specific contacts (team members, leadership, LME, state contacts)
• Meet with EPI-NC contacts
• Data collection orientation with EPI-NC and site-specific data navigator
• Review general onboarding orientation
• Review team lead onboarding orientation
• Review fidelity requirements (current fidelity, last review, etc.)
• Orient to necessary trainings, consultations, re-occurring meetings (EPI-NC, State, LME, site specific, community specific)
• Review all NAVIGATE manuals
• NC Health Active Living: a free wellness coaching program NC-HeAL introduction