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Introduction to the EPI Standards and Guidelines and Other Documents

Over the last decade clinicians, people with early psychosis, families, policy-makers and researchers have increasingly embraced Early Psychosis Intervention (EPI) programs.

EPI programs, whose effectiveness enjoys ever-increasing empirical support, provide timely recognition and assessment, comprehensive interventions and wide-ranging supports that foster optimal individual functioning, autonomy and hope through an engaging and respectful approach.

EPI has been a welcome counter to the pessimism that has previously accompanied the onset and prognosis of a psychotic disorder.

EPI seeks to dispel myths and outdated beliefs about psychotic disorders while generating realistic hope about the benefits that can result from early treatment.

In many ways, EPI has been at the forefront of the system reform needed to prevent the disappointing outcomes that have been associated with past approaches.  EPI programs are specialized and frequently offer a suite of services that may differ in type and intensity from those offered by many existing mental health and substance use services.

EPI programs are especially careful to cultivate initial and prolonged engagement of clients and families by pursuing practices that are sensitive to choice, non-stigmatizing and respectful of diversities such as age and culture.

In addition to services to individuals and families, EPI programs involve educational and informational activities for the public and health professionals that raise awareness, reduce stigma and facilitate early identification and intervention.

British Columbia was an early supporter of the EPI approach and has been actively developing services and policies since 1999.

The Standards and Guidelines for Early Psychosis Intervention Programs were developed at the request of the Mental Health and Addictions Branch, Health Authorities Division,  Ministry of Health, and the Provincial Psychosis Network supported by the Provincial Health Services Authority.

The purpose was to establish a set of standards and guidelines to ensure that all EPI programs in British Columbia provide services that are consistent and adhere to evidence-based best practices. The primary purpose of the document is to make certain that individuals with psychosis (and their families) receive timely, effective and compassionate support through the first years of recovery after the onset of a psychotic disorder.

The Standards and Guidelines are specifically directed at community-based programs operating under the auspices of the current health authorities. It is, nevertheless, hoped that programs operated by other government ministries such as the Ministry of Children and Family Development, will adopt or adapt these recommendations to their own programs and services.

The standards and guidelines in this document are based on a review of the best existing available research evidence with respect to early psychosis interventions. This includes appraisal of existing standards and guidelines from other national and international jurisdictions as well as consultations with national and international research and clinical experts and informed stakeholders. Existing programs were surveyed and focused discussions were held with relevant ministry representatives and stakeholders. Development of the document was guided throughout by ongoing consultation with an invitational advisory committee composed of researchers, regional representatives, providers and clients/family members.

These Standards and Guidelines are organized along the continuum of care from:

  • Recognition (appropriate knowledge of the nature of the problem)
  • Access and Intake (timely, barrier-free assessment)
  • Required Services (professional skills and programming to provide diagnosis and treatment)
  • Program Structure (infrastructure, staffing, education and supervision necessary to maintain the program)
  • Quality Improvement (ongoing process and outcome evaluation to ensure adherence to standards and program evolution)

Each of these categories is broken down into specific subsections.  These include a:

  • Rationale for adoption of the standard
  • Statement about the intended outcome of the standard
  • Description of the nature and application of the standard
  • Minimal, measurable standard set of recommendations for aspirational goals that exceed the minimal standards
  • List of key performance indicators for each standard

The Standards and Guidelines were officially adopted in British Columbia in 2010.  They will need revision as new evidence emerges of effective practices developed and evaluated in the clinical and research communities.  Finally, the indicators shown in the Standards and Guidelines are being re-assessed within the context of an ongoing project that seeks to facilitate uptake of best practices while empirically demonstrating outcomes associated with these services.  The entire Standards and Guidelines may be viewed on this web site here:  http://www.health.gov.bc.ca/library/publications/year/2010/BC_EPI_Standards_Guidelines.pdf

Other Documents About EPI

In addition to the Standards and Guidelines several other documents have been created that describe or support Early Psychosis Intervention in British Columbia.

Documents produced before the Standards and Guidelines included Early Psychosis Guides for: 1) Physicians and 2) Mental Health Clinicians.  These and other documents written primarily for professional audiences may be found here:

www.health.gov.bc.ca/mhd/publications.html#Psychosis

The British Columbia Family Physician Guide also includes sections on early psychosis and may be found here:

http://www.health.gov.bc.ca/mhd/physicians_guide.html