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Matryoshka Project: lessons learned about early intervention in psychosis programme development.

Chiachen Cheng¹, Carolyn S Dewa, Paula Goering

¹Canadian Mental Health Association - Thunder Bay Branch, First Place Clinic & Regional Resource Centre, Thunder Bay, Ontario, Canada. ccheng@cmha-tb.on.ca

Early Intervention in Psychiatry

|January 29, 2011

Summary

Implementation of early intervention in psychosis (EIP) programs was driven by provider relationships and staff dedication, not solely research evidence. These connections fostered innovation and successful service delivery despite funding challenges.

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Area of Science:

Mental Health Services Research
Psychiatric Epidemiology
Healthcare Management

Background:

Rapid growth in early intervention in psychosis (EIP) services has occurred without specific provincial guidelines.
Understanding the implementation processes of these EIP programs is crucial for optimizing service delivery.
The Matryoshka project specifically investigated the factors influencing EIP program development and implementation.

Purpose of the Study:

To investigate the implementation processes of early intervention in psychosis (EIP) programs.
To identify key influences on EIP program implementation amidst rapid service expansion and guideline scarcity.
To understand how EIP programs are developed and adapted in real-world settings.

Main Methods:

Purposive sampling was used to select five Matryoshka Project EIP programs.
Data collection involved semi-structured interviews conducted via phone.
Interviews were recorded, transcribed verbatim, and analyzed iteratively for emerging themes, with validation from participants.

Main Results:

Provincial EIP networks, advocacy groups, and clinical mentors significantly influenced new EIP services.
Decision-makers relied on peer guidance, with research evidence playing a secondary role to funding constraints and local adaptations.
Despite challenges, programs achieved successes including cross-sector partnerships, quality care, and engaging hard-to-serve populations.

Conclusions:

Provider relationships and front-line staff dedication were more critical for knowledge exchange than research evidence alone.
The adoption of evidence-informed practice is significantly influenced by strong researcher-front-line relationships.
Lack of specific guidelines may have fostered innovation and diversity in EIP program models.