Partnership process and Administration
Partnership appointments are all the contacts the family have with the service, after Choice. Partnership work may involve Specific work in addition to Core. This section explains how to set up Partnership.
Organising Initial Partnership Appointments
Full Booking (CAPA Key Component 5) is essential and so if Core Partnership work is needed and chosen by the family, then an initial Partnership appointment is booked before leaving the Choice session. To be able to do this, there needs to be a team Partnership diary that has vacant first Core Partnership appointments available. This could be a paper diary or an electronic system. If Choice is offered in a range of venues then the diary needs to be held centrally so that the Choice clinician can phone in when they are with the family and ask when the free appointments are with the clinician they think will suit the family.
At the end of the Choice appointment the Choice clinician will have an idea of who has the right skills to help this family reach their goals. They find the diary (or phone up if off-site) and offer the next available appropriate appointments to the family.
These vacant first Core Partnership appointments are generated following team and individual job planning (see the Implementation section) which gives everyone an activity number for first Core Partnerships they must offer in a quarter (3 month period). About 6 weeks before the new quarter, everyone needs to put their vacant appointment slots in the diary.
The initial Core Partnership appointments are offered by a range of multidisciplinary CAMHS professionals who have extended, multiple, clinical assessment and treatment skills that we describe as the ‘Alphabet’ skills of Assessment, Behavioural, Cognitive, Dynamic and Systemic (ABCDS). A Core Partnership appointment may be with one or two clinicians depending on the complexity and needs of the family and determined by the outcome of the Choice session.
Partnership Clinics?
Initial Partnership appointments work well when set up as multidisciplinary, parallel sessions in a clinic structure with clinical discussion and peer supervision built in. For example, three clinicians may do three parallel first Core Partnership appointments at 9.00 and two more first Core Partnership appointments at 10.15 (one involving one clinician and another two working together) with a multidisciplinary discussion from 11.30.
Subsequent follow-on Partnership appointments do not have to happen in the Partnership clinic time but can be at other times in the clinicians’ diaries that are convenient for the clinicians and families (as is the case generally in CAMHS). Alternatively, you could organise all follow-on appointments to be in the diaried Partnership clinic. This may result in reduced choice of times for families however. But it may make joint working easier to organise for clinicians. This is for you to decide. Whichever way you decide to organise things, the peer group discussion and supervision of ongoing work from that Partnership clinic can continue to be held within the clinic unless you are offering different venues, in which case the discussion needs to happen when the team is back at base.
Core Partnership does not have to be done in a clinic. If you offer Partnership in a variety of settings (such as schools) then care needs to be taken to ensure that there is a time in the week for peer small group supervision.
Adding other clinicians
Core Partnership clinicians may feel the need to add in another core clinician to aid the work. It can be that these requests are made and discussed in a team meeting. Then the core clinician that joins can count this as part of their quota of new Partnership onsets for the quarter. Or these requests can be made within the Partnership clinic team. The Core Partnership clinician may also add to the Core work by involving a Specialist co-worker. For example, Core work with a family where there has been domestic violence may move to include individual trauma focused CBT for the young person who has PTSD. The initial Core Partnership worker retains the family work and key worker role. Ideally, the Specialist worker joins the Core work, without the family going onto a waiting list (i.e. the resources are pulled to the family, in Lean Thinking terms!). In Richmond, this is done by using a next up rota system for a range of Specialist work.
See the map on Page 24 for a visual description of the relationship and flows between Choice, Core and Specialist Partnership work.
Partnership Paperwork
At the end of the first Core Partnership appointment a written communication is sent to the family, referrer and agreed network summarising the Care Plan (and any risk plan) and review date. It will include a review of the goals developed in Choice, amended if needed, and any reformulation. This can be done in a letter (as in East Herts) or a structured Care Plan (as in Richmond). We encourage you to develop your own paperwork and to ensure this fits with any existing frameworks you need to use, such as the Care Programme Approach. But the important thing is that the family and network get a clear, agreed summary of what is happening and plans made.
Review intervals may depend on the issues or you may decide in the team to have a standard review process (in Richmond cases are reviews are after every 6 sessions for Core work, every 6 months for psychodynamic psychotherapy and every 3 months for the segmented eating disorders clinic). In East Herts we review all after 6 months.
Use of Outcome measures
If you decide to routinely use Outcome measures (generally we think this is a good idea) then the tools and frequency needs to be agreed. The CAMHS Outcome Research Consortium tools (HoNOSCA, C-GAS, SDQ and CHI-ESQ) are a possibility (www.corc.net.uk).