What is CAPA?

Are you wondering what CAPA is?

This webpage gives a brief overview.

CAPA is a clinical system that has been implemented in many CAMHS teams in the UK, Australia and New Zealand. It was developed in Richmond (Ann) and East Herts (Steve) CAMHS - both teams have now run CAPA for many years. It is informed by demand and capacity theory (The 7 HELPFUL Habits of Effective CAMHS) and has links with Lean Thinking, New Ways of Working, Our Choices in Mental Health and You’re Welcome Standards.

At the time of writing (July 09) over 3500 CAMHS staff in the UK, Ireland, New Zealand and Australia have participated our training in CAPA. Many services have gone on to implement CAPA and we know from keeping in touch with people that they have improved the user experience, accessibility and staff satisfaction. Waits have also been reduced or eliminated.

What is the Choice and Partnership Approach?

CAPA brings together:

The active involvement of young people and their families
Demand and capacity ideas
A new approach to clinical skills and job planning.

Services can then:

Do the right things (have a clear working goal with the family and young person)
With the right people (use clinicians with the appropriate clinical skills)
At the right time (without any external or internal waits).

It is:

Can be tailored to fit individual services.
The stance is collaborative.
It ensures informed consent and choice and incorporates care planning and evidence based practice.
It is flexible for young people, their families and clinicians.
It allows services to be clear about what they do and how much they do - as a team and as individuals.
It does not dictate what services or interventions to provide. That is up to you.
It does help you develop a user-led service that is accessible and outcome focused.

CAPA improves services to users by:

Focusing on engagement, therapeutic alliance, choice, strengths, goals and care planning
Improving access by ensuring timely appointments that are fully booked i.e. no waiting lists
Ensuring users are seen by a clinician with the right skills
Use of Outcome measures
Facilitating commissioning and provision of CAMHS by transparency of capacity and services.

There is an emphasis on teams developing a culture of curiosity about their practice, self enquiry and confidence about change.

Details of CAPA

CAPA is focused on the young person and their family. The stance is collaborative and provides choices. For the clinician there is a shift in position from an ‘expert with power’ to a ‘facilitator with expertise’. There are 11 key components, including a change in language, team job planning, goal setting, care planning and peer supervision (see Chapter 3). The service needs to apply eligibility criteria for access. However, the threshold of acceptance needs to be low if information in referral letters is lacking. The aim is to find out from the family whether CAMHS has anything to offer, rather than try to guess this from a letter.

The Choice appointment

When their referral is accepted, the young person and their family are given the opportunity to book an appointment at a time (and ideally place) to suit them. This may be by phoning the service. For more vulnerable families the referrer may facilitate this. The first clinical contact is in a Choice appointment. During the Choice appointment they may choose:

That they can get back on track and do not need to return
To be put in contact with a different agency more suited to help
To return to CAMHS.

If they decide to return they will be able to choose an appointment with a clinician in the service who has the right skills to help them. This next appointment will be the start of Core Partnership work with one or more clinicians with extended clinical skills. Most people will find this is enough to achieve their goals. For some, more specific work may be added to the core work. The Key tasks in Choice are:

Curiosity about the young person’s and families view
And reflecting our opinion; evolving a
Joint Formulation followed by a
Discussion of Alternatives (not all involving CAMHS) ending in
The Choice Point
Maximised by their engagement tasks.

Choice appointments can take as long as are needed to reach a Choice Point. This is where a decision can be made about what is going on and what will help. More than one Choice appointment may be needed (Choice Plus) e.g. if a father is not present, or the teenager. Choice Plus may be done with the referrer or someone from another agency. Choice appointments aim to combine:

Assessment
RISK MANAGEMENT
Motivational enhancement
Psycho-education
Goal setting
Things to try at home/ ‘homework’ or Pre-Partnership work.

The style is conversational, collaborative and strengths based. More details about Choice appointments are in The Details section.

Partnership

Core Partnership is where the bulk of intervention work occurs. It can be done by most clinicians who have extended clinical skills. Extended clinical skills means having a threshold level of competency to deliver a range of common CAMHS assessments and interventions. Core Partnership work involves integrative, multimodal work to help the user meet agreed goals. The Core Partnership worker remains the Key Worker during the pathway. Assessment and reformulation continue throughout contact with the family, in the normal way. Some families will need additional Specific Partnership work, alongside the Core work. This type of work may be delivered at higher intensity or purity than at threshold level. Examples could be individual psychodynamic psychotherapy in conjunction with Core family work, systemic therapy using a one way screen alongside core individual work or additional Specific assessments e.g. psychometry or autism assessment.

Partnership work can be as many or as few sessions as are needed. It must be regularly reviewed against clear goals, through the use of care planning. Contact with the family ends when a review concludes that goals have been met.