EPI stands for Early Psychosis Intervention and the program
consists of three parts.
- It is a special type of health care service that provides
the best assistance available to young people who have recently
- EPI provides education to a wide variety of people, including
other mental health professionals, schools, community agencies
and the general public.
- The program is also committed to evaluation and research
in order to understand more about psychosis and to improve
Most early psychosis intervention programs are hospital-based,
adding community outreach as the program grows. The EPI Program
of the Fraser area of British Columbia, Canada (part of the
Lower Mainland of Vancouver), has developed a community-based
approach that links with hospital psychiatry. Our unique approach
provides a full range of clinical services to both adolescents
and adults, and their families. The program is supported
and funded by the Fraser Health Authority and the Ministry
of Children and Family Development.
To improve the mental health and quality of life of young people
with psychosis by promoting early identification and providing
optimal interventions as soon as possible.
Psychosis is Treatable. Recovery is Expected.
Our clinical services
The Early Psychosis Intervention (EPI) Program serves young
people with early psychosis who are between the ages of 13
to 30, and their families. The program bridges youth
and adult mental health services, and links community with
hospital. The program is community-based and devotes
much effort to early detection and rapid assessment. Clinical
services include single-entry intake and assessment, as well
as treatment for people who have had their first episode of
psychosis, whether affective or non-affective. Treatment
components include individual, group and family intervention.
Other program components include community education, evaluation,
and research, as well as assessment and monitoring for young
people at ultra high risk of developing psychosis.
The Fraser area of BC has three EPI Programs, situated in
the south, north and east of the Fraser River. The programs
have adopted the same Service and Clinical Guidelines and the
same hub-and-spoke organizational model. Each program
serves its own sub-region and differs slightly in resources
due to funding, length of time the program has been in existence,
and geographical characteristics.
As shown in the hub-and-spoke diagram below, a multidisciplinary
Central Team serves as the hub for each EPI Program. The
Central Team provides program direction and coordination, clinical
consultation to the community teams, education to professionals
and the public, evaluation of client outcomes and service delivery,
and research activities. The Central Team also provides
the pathway through care and provides certain clinical services
(e.g., groups; family intervention), sharing the care of clients
and families with the Community Teams.The Community Team in
each sub-region serves as the spokes. They are comprised
of designated specialists (EPI Clinicians, EPI Psychiatrists)
providing ongoing early psychosis treatment and case management,
according to locality and age.
Hub and Spoke Model
of the ongoing EPI services are provided by the Community Teams. The EPI Clinician and EPI Psychiatrist provide
the long-term treatment and case management in the client’s
own community. The EPI Clinician serves as the primary
therapist and case manager, providing care to clients and families
that include psychosocial treatment, education, support, and
referrals to adjunct services. The Central Team shares
care with the Community Teams by providing clinical consultation,
urgent psychiatric follow up as needed, group and family intervention,
and other specialized services depending upon sub-regional
program resources (e.g. Vocational Rehabilitation). (More
information about services specific to each sub-area of the
Fraser is outlined below, under the Fraser South, North and
Occasionally, young people experience symptoms or problems
in functioning that are suggestive of psychosis, but do not
meet full criteria. If the assessment indicates that
the client is at ultra high risk (UHR) of developing psychosis,
the Central Team will provide support, education, monitoring,
and outreach. At this time, the EPI Program is not prescribing
antipsychotic medication for UHR clients due to the substantial
risk of false positives. If a client has mental health
issues that require intervention (e.g., anxiety, depression),
the individual will be referred to a mental health team for
treatment during which time the EPI Program will continue to
provide support and monitoring.
In addition to clinical services, the EPI Program across the
Fraser area also provides educational services to the community
and engages in research and evaluation.
Our educational services
In order to support case finding and early detection, community
education is an ongoing and essential component of the EPI
Program. Education is aimed at mental health professionals,
gatekeepers in the community and the general public in the
identification and recognition of early psychosis. Content
of educational presentations include information on the signs
and symptoms that might indicate psychosis, potential benefits
of early intervention, suitable treatments, and the referral
process to the EPI Program. In addition to community
education and program promotion, we have also been active in
raising awareness about psychosis through our public awareness
campaigns utilizing advertising media. In our “Psychosis
Sucks!” campaign, we attempted to send out the message
that psychosis is a treatable condition. Our current
campaign, “How are You Coping?” and “Do You
Know Someone Having Difficulty Coping?” provides more
information on psychosis.
Our evaluation and research activities
The EPI Program conducts ongoing evaluation of outcome and
service delivery, as well as research. We want to know
if people get better in our program. In collaboration
with local universities, we also conduct research funded by
research grants. In the past five years, we have been
examining brain imaging, genetics, cognition, educational histories,
group interventions, treatment adherence, and pathways into
clients and families can expect from EPI
- EPI provides a range of services including medication
management; education (individual and group); stress management
and support; relapse prevention; along with assistance with
other needs such as education, work, housing, drug misuse,
- Another very important aspect of the EPI Program is increasing
knowledge about the challenges of psychosis. Virtually everyone
who enters EPI will be asked to participate in research projects.
By doing research, we hope to help people get better faster,
more completely and to stay well. Of course, participation
in research is completely voluntary and refusing to participate
will not affect treatment.
- Please find a more detailed description of services that
each of the three areas of the Fraser Region offers below.
Fraser South area
(Surrey, Delta, Langley, White Rock):
Intake Line 604-538-4278
For individuals living in Surrey, Delta, Langley or White
Rock, in addition to treatment and case management by an EPI
Clinician and EPI Psychiatrist in the community, the following
services are also available. Referrals to these services
are through the EPI Clinician or the Central Team in Fraser
We hold a variety of groups for clients and families in different
locations throughout Fraser South. Groups are a great
way to meet, share with, and learn from others who have been
through similar experiences with psychosis. What clients
and families have said that they appreciate the most about
groups is being with others who have experienced what they
are going through and knowing that they are not alone.
Groups for clients include:
- Youth group (ages 13-18) for 6-8 weeks
in a Surrey location. The focus of this group is information
about psychosis and its treatment, street drugs and psychosis,
relapse prevention, coping and social skills, and peer support. The
youth group is held three times per year.
- Adult groups (ages 19 and over) have a
variety of themes, running for 6-8 weeks per group
and in various locations. The first-stage or early
recovery group is educational and focuses on information
about psychosis and its treatment, relapse prevention, coping
skills and stress management. At this time, there are
four second-stage or later recovery treatment oriented groups
that run at different times of the year. We have a
group on social skills training, a women’s group on
healthy boundaries and relationships, a group for concurrent
addictions and psychosis, and another group based on cognitive-behavioural
therapy. The second-stage groups are developed based
on client need and are held when there are enough clients
who have a similar need. Other themed groups may be
developed over time.
Groups for family members include:
- Family education groups are held for families
in a 4-week series at various locations throughout Fraser
South. This group is for family members only and includes
close friends. The focus of this group is on information
about the causes, symptoms, and treatment of psychosis, the
impact of psychosis on the family, and the role of the family
in supporting recovery.
- South Asian family education groups are
held for South Asian families in a 5-week series, located
in Surrey. This group is based on the Family Education
Group and conducted in Punjabi and Hindi.
- Monthly family support groups are open
to all Fraser South EPI families. There are two support
groups held most months. One is held at a White Rock
or Surrey location the last Tuesday of every month except
for July, August and December, and is best suited for families
newer to the program. Another group in partnership
with the BC Schizophrenia Society is held at a Delta location
the 2nd Monday of every month, and is best suited for families
who have been in the program for some time.
- Sibling education group is a single session
information group for adolescent or adult siblings of clients
in the program. Topics include information about
psychosis, genetics, coping with changes, and the value of
family support in client recovery. This group is held when
there are enough interested siblings and the location varies.
- Multi-family therapy groups for prolonged
recovery and concurrent disorders, are under
In addition to the education and support that EPI clinicians
provide to families, in some situations, the EPI Family Therapist
provides complementary family therapy. Family intervention
includes consultation with the EPI clinician, assessment of
the family situation, short-term family therapy, and referral
to other service providers as needed. Each family is
unique, and as such, the intervention offered is tailored specifically
to meet the needs identified at the time of referral. Family
work may involve support and/or education, relationship work
(for any dyad or triad in the family), and/or liaising between
the family and the rest of the treatment team. Family
work may take the form of couple counseling involving spouses
or partners with the individual recovering from psychosis.
Vocational Rehabilitation Services
The vocational supports provided by the EPI Vocational Rehabilitation
Counselor ranges from individualized supports to group activities. Individuals
may work collaboratively with the Vocational Rehabilitation
Counselor engaging in career research activities, vocational
interest testing, informational interviews, job shadowing activities,
and formal work experience placements.
The Vocational Rehabilitation Counselor may also assist the
individual attain employment through employer liaisons, job
search support, resume production and linkage with community
agencies. Other vocational supports may include: liaison
with college and university disabled student services departments
and linkage with organizations that may provide grants and
Vocational supports may also be linked with group activities
through a series of established volunteer work crews in the
community. In the spring and summer, the EPI Program
participates in the City of Surrey’s “Partners
and Parks Program.” This volunteer work crew travels
to a variety of the city parks and engages in such activities
as: landscaping, invasive species removal, bench and table
painting, garbage removal, barrel decoration, and selected
art projects. The volunteer work crew exposes the individual
to a variety of work tasks, supports peer linkage and provides
transferable skills to permit the individual to transition
to competitive employment.
Peer Recreational Activities
Peer recreational activities are sponsored by the EPI Peer
Support Advisory Committee. The committee is made up
of clients in our program and staff members from EPI and Options
Community Services. A goal of the Peer Support Advisory
is to support individuals in their recovery by encouraging
social participation and reintegrating them with community
resources. To do this, the advisory sponsors recreational
events every two months. Examples of activities include
swimming, skating, hockey, baseball, and music night.
Service Delivery Model
Fraser East area
(Abbotsford, Chilliwack, Mission, Aggasiz,
Intake Line: 1-866-870-7847
The Fraser East EPI Program began serving clients in August
Our mandate is to provide a rapid, direct service to clients
and their families who are presently affected by psychosis
or are at risk of developing psychosis.
We provide initial contact with an intake clinician, treatment
and case management by an EPI Clinician, psychiatric consultation
and a group program.
Our group program focuses on the psychosocial
needs of our clients by providing a venue for social skills
development and interaction with others who have had a similar
life experience. We focus on education about psychosis,
stress management, relapse prevention and the development of
positive coping skills. Cognitive Behavioural Therapy
(CBT) is an important area of treatment and may be provided
based on client need.
The EPI mandate strongly encourages support and education
for families. This has been shown to improve outcomes
for clients and increase wellness for both the individuals
and the family as a whole. We provide a 4-week family
education group, which addresses the need to understand the
illness, the medications and the treatment being provided to
their family member. We also address the emotional impact
on the family, as well as provide tools to assist the family
with their ability to cope in their time of stress and challenges. Most
importantly, the family education group provides an opportunity
for families to meet together, share experience and become
a support to each other.
Our Family Support group offers an opportunity for all EPI
families to meet on a monthly basis, in a casual but supportive
venue, and discuss relevant issues and experiences. In
the future, guest speakers may be invited to address the needs
of the group.
Following the models of the EPI programs in other areas, the
Fraser East area will continue to grow and develop and provide
this excellent service to the communities in the Fraser Valley.
Fraser North area
(Burnaby, New Westminister, Tri-Cities, Maple Ridge)
Royal Columbian Hospital
4th Floor 260 Sherbrooke Street
New Westminister, BC
Intake Line: 604-777-8386
Groups are a powerful and supportive treatment modality that should be adjunct to individual treatment. Groups allow clients and families to meet with others that they can relate to and identify with, thereby decreasing feelings of isolation. Groups assist in providing knowledge and awareness, promoting coping and stress management skills, and improving social supports.
- Psychoeducation and Support Group: 8-10 sessions for youth group (ages 13-18) or adult group (ages 19 and over) in which we focus on information about psychosis including symptoms and treatment, including medication, stress management skills, and relapse prevention.
- Metacognitive Training Group: 8 sessions on education about negative attributions and thoughts which may contribute to cognitive biases, memory recall, and delusional thought processes.
- Self-Esteem Group for Young Women: 6 sessions looking at the roles and images of being female, examining body image issues on self-esteem, and looking at how having psychosis impacts self-esteem.
- Social Outings Group: Activities such as bowling, visiting arts and culture venues, and watching movies.
- Peer Support Group: currently under development
- Family Education Group: 6 sessions for family members to go over psychoeducation related to psychosis, stress management, relapse prevention, recovery, and family dynamics and communication. Series of videos for family members also viewed.
- Family Support Group (TRICEPS): Monthly family support group for family members that have gone through the EPI Family Education Group. The group is organized by family members and consists of informal sharing and discussion, guest speakers, and advocacy for family members with psychosis.
- Sibling Education Group: A single session education and support opportunity for siblings to voice their concerns, ask questions and learn more about the impact of psychosis on their family.
The EPI Program values the input and role that families play in the client’s treatment and recovery process. We also believe that family members require ongoing psychoeducation and support. The EPI Family Therapist provides family therapy sessions related to family dynamics and functioning. Through strengthening familial relationships and understanding, the outcomes for recovery are better. Family intervention can take many approaches according to the unique needs of the family. Family work may or may not involve the client, depending on the family’s circumstances and the client’s wishes.
Referrals to the EPI Program
Referrals to the EPI Program can be made by anyone, including
mental health professionals, general physicians, community
agencies, school counsellors and family members.
Criteria for referral to the EPI Program include:
Persons ages 13 - 30 years who have a suspected or first episode
A. First Episode Psychosis
Acute symptoms of psychosis (i.e., hallucinations, delusions,
disorganized speech or behaviour) Refer to the ‘What
is Psychosis – Signs and Symptoms’ section of
the website for more detail on these symptoms.
B. Attenuated/Transient Psychotic Symptoms
Changes in behaviour, thoughts and emotions, such as:
-A change in perception of objects (things looking or sounding
different) or misinterpretation of events (feeling suspicious
of others at times)
-Developing odd thoughts that seem out of keeping with the
C. Family History Group
Young people who have a relative with a psychotic disorder
(parent or sibling)
A recent deterioration in the ability to cope with life events
and stressors (expressed as poor concentration, decreased motivation,
withdrawal from family and friends, depression or anxiety)
Drug use does not disqualify from referral, if in combination
with the above criteria.
EPI Service and Clinical Guidelines
Need more information? Download a copy of our EPI
Service and Clinical Guidelines here. (Requires Adobe Acrobat Reader)
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