Original Article Matryoshka Project: lessons learned about early intervention in psychosis programme development Chiachen Cheng, 1,2 Carolyn S. Dewa 2 and Paula Goering 2 1 Canadian Mental Health Association – Thunder Bay Branch, First Place Clinic & Regional Resource Centre, Thunder Bay, and 2 Department of Psychiatry, University of Toronto, Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Corresponding author: Dr Chiachen Cheng, Canadian Mental Health Association – Thunder Bay Branch, First Place Clinic & Regional Resource Centre, 272 Park Avenue, Thunder Bay, ON P7B 1C5, Canada. Email: ccheng@cmha-tb.on.ca Accepted 16 September 2010 Abstract Aim: This part of the Matryoshka project sought to understand the pro- cesses with which early intervention in psychosis (EIP) programmes were implemented and developed. The goals were to understand the key influences of programme implemen- tation in the context of rapid EIP service growth and lack of specific provincial guidelines. Methods: Sampling was purposive and data were collected with semi- structured interviews. Five Matry- oshka Project programmes were successfully contacted. All interviews were conducted by phone, recorded and transcribed verbatim. Emerging themes were analysed iteratively and discussed among authors. Key themes were validated with participants. Results: The new EIP services were significantly influenced by the pro- vincial EIP network, advocacy groups and clinical mentors. EIP programme decision makers often relied on each other for guidance. Although the research evidence assisted pro- gramme decision makers to develop an effective EIP model for their region, implementation was often shaped by funding constraints. Pro- grammes adapted their EIP models according to funding and local service characteristics. The lack of specific guidelines may have allowed innova- tion; programme creativity and diver- sity is consistent with EIP values. Despite the challenges related to geography and staffing, programmes experienced important successes such as partnerships across sectors, quality clinical service and the ability to engage hard-to-serve clientele. Conclusions: Although important, research evidence played only a secondary role. Relationships among providers and services, coupled with the dedication of front-line staff, were more critical to knowledge exchange than written documents alone. These findings stress the importance of researcher–front-line relationships to the adoption of evidence-informed practice. Key words: early intervention, health policy, mental health service, schizophrenia and disorder with psychotic feature. INTRODUCTION In 2004, the government of Ontario invested signifi- cant new funds in the community mental health system. This infusion of new funds was the first increase in funding in community mental health services for many years. Through the 2003 Health Accord for Home Care federal initiative, 1 the Ontario Ministry of Health and Long-Term Care allocated $117 million over a 4-year period. Recognizing the relationship between community mental health services and inpatient care, Ontario was the only province to invest the funds in community mental health services. Services that received funding included early intervention in psychosis (EIP) programmes. EIP received a significant portion of the new funds increasing the number of programmes in the Early Intervention in Psychiatry 2011; 5: 64–69 doi:10.1111/j.1751-7893.2010.00255.x First Impact Factor released in June 2010 and now listed in MEDLINE! © 2011 Blackwell Publishing Asia Pty Ltd 64