When can you keep a client from Choice?
There is no hard and fast rule about always transferring a family or young person to another clinician for Partnership. However, there are good reasons about why the default position should be to do so.
The first is all the factors stated earlier about why the transfer helps, especially in maintaining curiosity. In small teams (or lone workers such as primary mental health workers or looked after children clinicians) this means doing Choice as if you will not see them again, even though you probably will, helps in reaching a Choice Point.
Secondly, it makes best use of the skills mix of your Core team. Here’s an example: you keep the family and young person for some Core family work. You also have Core CBT skills and your Core team is fortunate in having a number of clinicians with family therapy skills but there are fewer with Core CBT. Keeping the family yourself means reduced access for other families to that less available skill (your Core CBT). Lots of people in the team could help them systemically (Core family therapy skills). In another situation the gender or cultural mix may be very uneven and ‘keepsies’ allocations may worsen this. We could call this ‘wine into water’ thinking. We turn our scarce resource into water and pretty soon we run out of wine.
OK having thought about the good reasons to keep selecting another clinician in Partnership, what are some to consider not transferring? These are our ideas but each team of course can come up with their own.
- When the young person has revealed something very personal or traumatic that they do not want to have to tell again. Of course, they might be glad of a chance to say this and move on (our audit on the session being a one-off that made adolescents and families feel more open). Giving them the choice about staying with you (if you have the skills for the goal) or someone else might be helpful.
- When you, as the Choice clinician, have done a huge amount of work in getting to the Choice Point. Some of this may involve working with the multi-agency system, attending professional meetings and this knowledge might be really important to have in the Partnership work.
- User choice! They may just get on with you, feel confident in the Choice you made together and you might have the next appointment! Remember water into wine however.
A tone of sad regret?
There is no doubt that some clinicians really want to help everyone and struggle to separate from their family or young person in Choice. The session might have gone well, they made a connection or the work looked attractive or meaningful. When this happens, how you have talked about the process of selecting the clinician for Partnership is particularly important.
If your literature said this and you positively describe selecting a clinician with the right skills for their goals in the Choice introduction (families nod in agreement here) it will go well. Our audits in Richmond and East Herts showed this. However, if you forget to mention it and at the end of the Choice appointment say in a tone of sad regret ‘I’m sorry but I have to transfer you…’ – it won’t go well. The family and young person will no doubt feel deprived and less enthusiastic about the receiving Partnership clinician.