Component review

We often hear, usually third hand, that in some CAMHS team or other “CAPA isn’t working”. When we get to talk to these teams we have found, every single time, that the model hasn’t been fully applied or expectations that it would fix any demand and capacity imbalance (!) were too high. In fact we have not yet come across a team that have implemented the full model who have not felt it was working well.

So the first step if you feel CAPA isn’t working is to review the 11 key Components of CAPA and see how close to a full implementation you are. You can use the CAPA-CRS (CAPA Components Rating Scale) to do this.

A reminder…

The 11 Key Components of CAPA

The First Component

1. Management and Leadership

We have asked teams what has helped them to implement and sustain CAPA. Overall management style and knowledge plus active involvement and empowerment of clinicians and admin are central to CAPA implementation.

The 3 Choice components

2. Language

The words we use lead us into certain ideas. ‘Assessment’ and ‘treatment’ are things we do to people and may distract us from working collaboratively. Using ‘Choice’ and ‘Partnership’ or other locally chosen words can help re-position us with clients as ‘facilitators with expertise’ rather than ‘experts with power’.

3. Handle Demand

This means making sure that the referrals are appropriate i.e. using eligibility criteria such as referrer seeing child and any appropriate community intervention has happened first, families can chose an initial Choice appointment when their referral is accepted i.e. full-booking and there is also a key focus on not allowing a waiting list to develop by flexing initial Choice capacity.

4. Choice framework

Carrying out the tasks in the Choice appointment of curiosity, honest opinion leading to joint formulation, discussion of alternatives, reaching a Choice Point and engagement. This will probably result in not all families and young people choosing to return for Partnership. Your transfer percentage from Choice to Partnership is a guide to this. Much more than 75% and you probably aren’t engaging their strengths enough or are inadvertently being too problem/pathology focused.

Transfer to Partnership Components

5. Full Booking to Partnership

No internal treatment waits!! This means at the end of the Choice appointment, booking the young person and family into the next Core Partnership appointment, that they choose, that has the clinician with the right skills. This requires having job plans that specify new Core Partnership activity for each clinician as well as a Partnership diary that is available to the Choice clinicians so they can select a clinician and book the family in at the Choice appointment.

6. Selecting Partnership Clinician by Skills

At the Choice appointment you help the family to decide on their goals and then you choose the Partnership clinician/s who have the extended core skills to deliver these goals. You book the family into the next Partnership appointment with the clinician who has these skills. This will usually mean they see someone different from the Choice clinician unless they have the first available appointment and the family chooses to stay with them.

Partnership Components

7. Extended Clinical Skills in Core Work

This component is about having extended Core Partnership skills with additional Specific time in job plans to support that Core work. Core work is the bread and butter of CAMHS but will only be successful if Specific work is available as well (a sandwich is not a sandwich without the filling!).

8. Job Plans

This means having individual and team Job plans with Choice work and Core Partnership new activity numbers, defined Specific work and supporting administration. And a way of monitoring and reviewing them.

Letting Go Components

9. Goal Setting and Care Plans

This means reaching a specific Choice Point with the family and using this to create a Care Plan, preferably written. This is continuously reviewed in Partnership.

10. Peer group Supervision

Small group discussion of on-going work in small groups (no more than 4 staff). You can either do this with different people each time (which Steve’s team likes) or have stable groups (Ann’s team). There are pro’s and con’s to each- do what works for you. This is in addition to any whole team discussion or individual supervision.

Foundation Component

11. Team Away Days

Absolutely crucial!!!!! CAPA will not work without these. Have regular days (at least four a year) that are owned by the team, used to generate a team culture, create flexibility, empower all staff and have fun... Mandatory!