7. Extended clinical skills in Core work

Separating our clinical service into extended clinical skills at Core Threshold level, supported by Specialist skills at Specific level.

To smooth flow though CAMHS, as well as to be as effective as we can, CAMHS needs to offer a range of intensities and complexities of intervention.

Why separate into Core and Specific clinical work?

Well the gains are:

Many children and families can be helped by Core/threshold level work
Extended Core skills reduces bottlenecks to Specific work
Extended Core skills increase clinical flexibility (fewer queues into specific intervention streams)
Allows us to identify AND PROTECT team/individual capacity for Specific work.

Clinicians in Core work have extended clinical skills and are of equal value to single Specific skills clinicians. The majority of clinical work is carried out in Core work and there is a general principle of Core work first with Specific work added, if required. Finally, most clinicians will do both in their job plan.

This is such an important area that we devote a whole of Chapter 6 to it. But here is a summary:

Core work

Core work is the bulk of what CAMHS services do. It is the bread and butter of CAMHS. Most children and families can and should be seen in Core work and most staff should be able to deliver this work. It generally has more high volume - lower duration work than Specific interventions. As such it should be the first priority of our service. If there is not enough Core work then waiting times for Partnership will grow. Even if there is enough total clinical capacity, too much may be being used in Specific work.

Core Partnership clinicians need a wide range of extended, threshold level clinical skills. See the Alphabet skills later on.

Specific Work

Specific work means using a Specific clinical assessment or therapy skill. Staff delivering such Specific work are likely to have higher training, perhaps to diploma level, and are often capable of supervising others in this skill. Specific work often receives internal referrals (and this can help decide if it is Specific work). Examples include using a structured assessment tool for Autism e.g. the ADI, psychometric assessment, and individual psychodynamic psychotherapy.

What happens if you don’t define Core and Specific work?

If you only offered Core work in your service then families needing more intensive/specific skills or longer-term interventions could not access them. On the other hand, if everyone worked delivering high-intensity, specific interventions then some families would receive a level of help that they did not really need, and that did not give attention to the whole system. Waiting lists to each step/Specific intervention would develop (and this may vary from clinician to clinician). The young person and family experience is likely to be poor as their problem needs to fit the Specific intervention, (a ‘Push’ system) no matter what their preferred style or co-morbidities are.