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 developed psychosis.
  
  
• 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 treatment.

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.

Our mission:

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.

Our vision:

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 35, 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

Most 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 East sections.)

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.

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. 

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 care. 

What 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, etc.
   
• 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 South.

Group Intervention

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 development

Family Intervention

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 tuition subsidies.

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, Hope)

Intake Line: 1-866-870-7847

The Fraser East EPI Program began serving clients in August 2005.

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
V3L 3M2

Intake Line: 604-777-8386

Group Intervention:
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.

Client Groups

1. 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.
2. Metacognitive Training Group: 8 sessions on education about negative attributions and thoughts which may contribute to cognitive biases, memory recall, and delusional thought processes.
3. 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.
4. Social Outings Group:  Activities such as bowling, visiting arts and culture venues, and watching movies.
5. Peer Support Group: currently under development

Family Groups

1. 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.
2. 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.
3. 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.

Family Intervention:
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 - 35 years who have a suspected or first episode psychosis.

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:
-Possible hallucinations
-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 person

C. Family History Group
Young people who have a relative with a psychotic disorder (parent or sibling)

AND

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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