Audit Project Child and Adolescent Psychiatry Southmead CAMHS

1. Audit ProjectChild and Adolescent PsychiatrySouthmead CAMHS “Choice to Partnership transition in CAPA process” Caroline Fell 27th January 2010

2. “choice & partnership approach”background Information • 1st evolved in Richmond CAMHS, later developed and implemented in East Herts CAMHS • Now used in many CAMHS across the UK • North west Bristol CAMHS for **yrs • CAPA • This is a whole clinical system from the beginning of the family’s journey to the end • Referral  choice partnership + specialist

3. Choice • Children and families making informed choices about what services & interventions may be useful to them • Focus on engagement • We should facilitate this using our expertise • We should facilitate conversational curiosity that draws on their strengths • How can the family and young person help themselves between choice and partnership appointments • Reach a “choice point” • Partnership appointment booked at the end of the choice appointment with a clinician/s with the best skills to help

4. Important aspect to CAPA is choosing the partnership clinician 1. It affects the family and therapist position to the Choice by facilitating choice completion, engagement with “change not clinician” and gives family autonomy in their choice 2. It affects the Partnership Appointment by starting with the “right” therapist with the “right” skills 3. It helps plan and manage your teams capacity • Core treatment skills of partnership clinicians (ABCDS) • Assessment • Behavioural • Cognitive • Dynamic • Systemic

5. Cohort • Questionnaire to all choice clinicians • 3/12 period • Those progressing to partnership • Total 17 completed • 2 straight to specialist work

6. The questions...... • Has the work or intervention that you feel to be necessary for this YP/family been discussed with them at the choice appointment? • Was the YP/family asked what skills or “personality traits” they would like in their partnership clinician? • Does your YP/family know of the change in clinician for their partnership appointment at the end of today’s meeting? • Why did you choose the specific clinician that you have assigned for partnership work with this YP/family? • Are you aware of the core work and specialist work that this specific clinician can offer? Please specify a) core skills b) specialist skills • How quickly will your YP/family be seen in a partnership appointment? • Is there anything that you wish was different to ease the transfer of the YP/family from choice to partnership?

7. RESULTS 1. Has the work or intervention that you feel to be necessary for this YP/family been discussed with them at the choice appointment? • 15 out of 17 “yes” • 2 were “briefly” i.e. Introduced to some ideas and possibilities • 1 was “no” • Needed to discuss at team meeting before decision could be made • ? Group supervision at choice clinics

8. 2. Was the YP/family asked what skills or “personality traits” they would like in their partnership clinician? • 9 out of 17 “yes” • 8 out of 17 “no” • “based on clinical needs” • “not relevant” • 2 were put straight into specialist work

9. 3. Does your YP/family know of the change in clinician for their partnership appointment at the end of today’s meeting? • 13 out of 17 “yes” • 2 that were “no” went straight from choice clinician to specialist work with same clinician • 1 other kept same clinician as had seen child in school previously • 1 other had been completing a joint choice, and continued the work in partnership

10. 4. Why did you choose the specific clinician that you have assigned for partnership work with this YP/family? • 14 out of 17 stated clinical skills • 3 out of 17 stated availability • 1 out of 17 stated sex of clinician • 1 out of 17 was due to working with clinician before • 2 out of 17 gave no reason

11. 5. Are you aware of the core work and specialist work that this specific clinician can offer? Please specify a) core skills b) specialist skills • Core skills • “all” • A 9, B6, C6, D7, S6 • 4 “no/ unknown” or left out as went straight to specialist • Specialist skills • All appropriate

12. 6. How quickly will your YP/family be seen in a partnership appointment?

13. 7. Is there anything that you wish was different to ease the transfer of the YP/family from choice to partnership? • “sooner appointments in partnership” • “more partnership appointments” • “partnership appointments in the diary”

14. Audit cycle Set standards measure practice compare against practice identify improvements? suggest &implement changes (to improve clinical care) evaluate and review those changes re-audit

15. Comparisons & Improvements • Ethos of choice  partnership preserved • Facilitation of informed choice re. needs and not “prescribing” • Change clinician • Core skills of partnership clinician • Specialist skills seemed appropriate when stated • Majority seen in partnership within 4 weeks • Time • Lack of partnerships in diary • Sooner appointments • Skills of clinicians ?? • 2 questionnaires stated did not know one or other of core & specialist skills • 3 chose the partnership clinician due to availablity (2 stated nothing)  ? Correct match of clinical skills for that family • Asking what skills the family would want (informed choice if they agree on clinical need?)

16. improvements • VERY LITTLE! • Partnership appointments in advance for all team members • Time (?!) • Updated quarterly and then can opt out? • Information re. team members skills • “skill profile”  may help and improve discussion of clinicians skills to families/ young people at choice • ABCDS • ? Attached to partnership diary

17. Changes to re-audit • Team to have partnership appointments for the next quarter put in the diary by administrative staff. Clinicians responsibility to change them if necessary • Team “skill profile” to be created and knowledge of all clinicians A,B,C,D and S to be understood • Educate entire team re. general principles of CAPA and findings of the audit

18. ? Any questions or feedback