Transcript East Herts Early Consultation Service

CAPA- Choice and Partnership
Approach:
summary of research and
evaluation to 2010
Ann York and Steve Kingsbury
[email protected]
[email protected]
www.camhsnetwork.co.uk
How many studies?
National (3)
 1 UK 2007
 1 England 2009
 1 New Zealand 2010
Local (16)
CAMHS
 2 NZ
 1 Australia
 13 UK
Adult (1)
 1 NZ
Published data: all UK CAMHS
 1 national (England)
 2 UK New Ways of Working
studies
 1 redesign report (Richmond)
 7 local and 1 national: CAPA
book and website
Type of Data
 Quantitative e.g waits: 15
 User views: 10
 Staff views: 12
 Referrer views: 3
National evaluation: England 2009, Mental Health
Foundation
97 teams implementing
 Av 6 out of 11 Key Components,
range 1- 10.5
 waits to a first appointment
dropped from 7-108 weeks
before to 5-12 weeks after
CAPA (N=7)
 Families satisfied
 Reduced demands on the
service
 More formalised team working
and better planning
infrastructure
 Greater transparency for staff
and families

Few teams were implementing
 Job plans (Key component
8)
 Full booking systems (K c
5)
 Handling demand ( K c 3)
Recommendations: including
 CAPA should be rolled out
gradually, for teams to opt-in
 A national support framework
for CAPA should be established
National Survey , 2007 Steve Kinsgbury & Ann York
Online survey
40 teams out of 113 were using CAPA
On average CAPA in place 8 months
Waits:
CAPA teams
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
Before CAPA: average 20 weeks
After CAPA: 73% had waits to Choice of 6 weeks or less
Non- CAPA teams

Wait to first appointment on average 12 weeks. Only 33% had waits of 6
weeks or less
CAPA compliance on items 2-11:
CAPA teams 7.1
Non-CAPA: 2.5
National evaluation NZ 2010
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
Awaiting data analysis Oct 2010!
Evaluation data collection complete.
Local studies (16 CAMHS & 1 GAMHS)
International:
CAMHS
 2 NZ - Capital Coast;
Christchurch
UK (13 CAMHS):
1.
2.
3.
4.

1 Australia- Kirwan
5.
6.
7.
8.
Adult
1 NZ GAMHS- Wellington
9.
10.
11.
12.
13.
Sheffield
Somerset
Lincs
Bristol
Exeter
Gloucs
Stockton (NWW)
Stockport
Glasgow
East Herts (staff)
E Herts (users)
Richmond (NWW)
Richmond (service)
User views


2 NZ
8 UK
Mix of direct interviews and questionnaires
Overwhelming majority extremely positive:
 Seen quickly
 Felt listened to
 Got new ideas
Staff views
Data
 1 NZ
 9 UK
Results
 Increased job satisfaction
 Increased morale
 Anxiety about change
 Improved team working
 More focussed


Love team discussion
Increased learning
Quantitative impacts
Data:
1 NZ
8 UK
Waits
 Pre CAPA: range from 5- 9 months
 Post CAPA: range from 1-6 weeks
Transfer to Partnership

range 66- 90%
Waits to Partnership

4 weeks (some teams developed longer waits due to not implementing
full booking)
DNAs:
 5- 10 %
Adult Mental Health
Data
1 NZ (4 GAMHS)
Waits
Pre CAPA: 35 days
Post CAPA: 20 days
DNAs
Pre CAPA: 3%
Post CAPA: 2.8%
Activity
12% increase in referrals
11% increase number offered appt
11% increase in patients seen
NATIONAL
CAPA Implementation in England
Mental Health Foundation 2009
www.chimat.org.uk/resource/item.aspx?RID=82450
Phase 1
Phase 1 was a national survey of CAMHS in England
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123 staff from 442 teams answered a questionnaire
97 teams stated they were implementing CAPA
53 of these 97 teams completed a more detailed survey:
 on average, were implementing 6 out of the 11 CAPA key
components (range 1 to 10.5).
7 teams supplied audit data pre and post CAPA
implementation:
 waits to a first appointment dropped from 7-108 weeks
before implementation to 5-12 weeks after
Phase 2
Phase 2 involved visits to six CAPA teams
Benefits reported were:
 Reduced waiting times
 92% of families were seen within 13 weeks compared with
the national average of 78%.
 Families were pleasantly surprised at how quick they could
get into the service
 Reduced demands on the service
 More formalised team working and better planning
infrastructure
 Greater transparency for staff and families
Challenges
 Few teams were implementing
 Job plans (Key component 8)
 Full booking systems (K c 5)
 Handling demand ( K c 3)
Result was waits to Partnership.
Teams felt the need for more information and support in how to
apply CAPA to complex and long term cases.
National recommendations
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1.
CAPA should be rolled out gradually, for teams to opt-in
2.
A national support framework for CAPA should be
established
3.
An enhanced training package should be available
4.
A national online network and directory of CAPA
implementers could be developed
5.
The CAPA implementation training and support package
needs to address the commonly held CAPA Myths
6.
Case studies to illustrate how the system can work in
different types of services
Local Implementer recommendations
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1.
Facilitative team management is crucial- an informed manager,
a clinical lead, and an administrative lead (CAPA Key Component 1)
2.
CAMHS teams implementing CAPA need mechanisms to
facilitate effective team working: peer group supervision and regular
away days (CAPA Key Components 10 and 11)
3.
Children’s Trust directories should be used to promote multiagency work or to signpost families
4.
Successful implementation of CAPA should involve staff from a
variety of roles within the CAMHS
5.
Monitoring and feedback are integral prior to, during, and after
the implementation phase
6.
Local regional support systems should appoint a number of local
CAPA champions
Survey of CAPA implementation 2007
Kingsbury & York, 2007
www.camhsnetwork.co.uk/Evaluation/evaluation-web-survey2007.htm
Method
November 2007
 we contacted services known to us and put a request out on an
international discussion forum (FOCUS Mailbase;
[email protected]) through an online questionnaire
 We asked for general information about their services, whether
or not they had implemented CAPA and the impact
 We asked for ratings on items 2 to 11 of the 11 Key Components
of CAPA i.e. omitted Item 1: Management and Leadership (we
hadn’t highlighted this item then)
Results

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40 out of 113 people had implemented CAPA
On average, CAPA had been in place for 8 months
Teams received on average 47 referrals per FTE per year: 50%
were in the range 57 to 33 FTE
Waits:
CAPA teams

Before CAPA: average 20 weeks

After CAPA: 73% had waits to Choice of 6 weeks or less
Non- CAPA teams

Wait to first appointment on average 12 weeks. Only 33% had waits
of 6 weeks or less
Compliance with Key Components
CAPA Item
Language
Fully booked to Choice
Choice
Fully Booked to Partnership
Selecting clinician by Skills
Extended core skills
Goal setting
Job planning
Team supervision (small
group)
Team away days
Waiting time to Choice 6
weeks or less
Average score out of 10
maximum CAPA items
Implementing
CAPA
Fully
compliant
with this item
%
77
85
92
77
77
71
51
69
67
Not
implementing
CAPA
Fully
compliant
with this
item %
10
26
31
3
23
44
48
37
55
53
73
44
33
7.1
2.5
NZ National Evaluation 2010
Werry Centre
pending
Local Implementation
References available from Ann
Green Team, Canterbury DHB
NZ Karina Falconer-Beach 2008
National innovation Award report:
TRIALLING THE CHOICE AND PARTNERSHIP APPROACH: RIGHT TIME, RIGHT
INTERVENTION WITH THE RIGHT PEOPLE
Method:
Dec 2007 to April 2008
Compared CAPA in Green Team to 2 pre CAPA cohorts in previous 2 yrs
8 month development phase
Skills mapping
2007/08 CAPA gp: 51 families (52 children)
5-12 yrs
2006/07 Pre CAPA gp 1: 33 families
5-12 yrs
2005/06 Per CAPA gp 2; 33 families
2-12 yrs
Green Team (2)
Quantitative
 750 refs pa, accept 450
 5.5.FTE
Waits:
 Pre CAPA: 6-9 mths
 12 mth internal waits.
Post CAPA:
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Lower first appt DNA rate in CAPA gp
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Transfer to Part: 90% with 13.4% DNA
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Time to discharge:
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At 6 mths over 50% CAPA gp closed cf 32% gp 1 and 23% gp 2
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Co-work rate CAPA: 84%
Green Team (3) User experience
Goals set:
 CAPA gp: 82%
 Gp 1 and 2: 0
Family friendly letters:
 CAPA: 98%
 Gp 1 and 2; 0% or no letter at all
Satisfaction:
Choice Que:
 High satisfaction
 Independent Phone call:
 9/10 happy
 No formal complaints (usually 2-3)

CAPA: reduction in CBCL scores post treatment
Green Team (4) staff experiences
Choice done by experienced staff

Work satisfaction Que:
CAPA staff reported more satisfied, felt more valued and enjoyed
work more than non CAPA staff
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Attitude to families shifted to more collaborative
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Easier to ‘let go’ of families with CAPA

Felt like a burden been lifted.
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Green Team (5) other
CAPA-CRS: 86% full implementation
GPs and referers: post discharge- positive
Lincolnshire Stephanie Stockbridge, Anne Thompson, 2007
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7 mths preparation
Started Feb 2007
15 FTE
20 refs pw
Waiting list of 77- blitz
Daily ref screening
Results
 Waits:
Pre CAPA: 25 wks
Post: 6 wks

Trans to Partnership rate: 80%

Co-therapy rate: 57%
 100% staff satisfied with offering Choice
 CAPA-CRS: 66 % compliance at 6 months
Bridgeton, Glasgow
Implementation in Under 12s service

SDQ
 CHI ESQ
 Clinician Que
Results
Waits
Pre CAPA: 9 mths
Post: a few weeks
DNA 6%
User feedback:
N=28 (response rate 34%)
Majority very satisfied
Wendy Jenkin, 2006
Bridgeton (2)
Staff views:
 N=7:
 Initial anxiety
 Use clearer language
 Focussed
 Sense of partnership with families
 Clarity
 More relaxed
 More systematic
 Less stress in team
GP/referrer feedback:
 N=52
 Good service
 Feedback reports rather long but clear
Sheffield
Nevyne Chaloub, 2009
CAPA 1 year on data: 3 teams
Quantitative data plus staff views 6 months in. 25 matched pairs pre and
post CAPA
% Redirected at referral reduced from around 25% to 8-16%
Increase in referrals from around 400 (accepted 350 to 400 to460)
Waits:
 Pre:
 Post: 7-9 wks
Choice to Partnership wait:
 6-8 wks
C/P trans rate: 72-62%
DNA: 9-12%
New: FU ratio 5.31- 8.4
Choice Plus: 2%
Clincians views
One team less positive than the other 2.
Felt imposed by management, rigid and hindered creativity
 Did NOT think:
 Added quality (less joint assessment)
 Workload could be sustained

Mixed views on whether
 Was efficient
 My job plan is working

Agreed
 Opportunities for discussion
Compared to pre CAPA:
 More shared understanding
 1 team-Increased job satisfaction and morale (tho some felt worse);
other 2 mixed
Admin staff
2009
Positives:

Prefer CAPA to old system

Clincians now ask them to do more
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Felt well prepared for CAPA
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Tracking clients easier

Easier to do Partnership admin

More efficient than old system

Higher workload
Mixed views:

re Choice admin
2010- all above areas more highly
positive
Negatives:
 Duplication in processes
Ideas to improve
 Reduce time spent chasing
clincians for slots
 Merge systems
User experience
References available from Ann
Youth views on CAPA
Bridget Greaney, Capital & Coast, NZ 2009
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Youth views on CAPA- focus gp after presentation on CAPA
Views of Youth Consumers Advisors
User views
Results:
Youth Focus gp
 Like:
 Talk re goals not just problems
 Match clinician to their needs
 Don’t have to see Choice clinician again if not like them
 The name ‘Choice’
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Dislike:
Choice if really sick, may say no
Word ‘Partnership’ not mean anything
Youth views (2)
Advisor gp:
 Reduced waits
 Choice of appts
 Clear pathway for users
User views:
 12-19 yrs
 N= 53
 66% found Choice useful
 83% given enough info
 100% felt taken seriously
Audit of 100 families.
Steve Kingsbury 2006
Tracking of the first 100 CAPA families in East Herts CAMHS:
CHI-ESQ
CAPA Experience Que
Results
Highly positive on all measures
http://www.camhsnetwork.co.uk/Evaluation/evaluation-east-hertsuser-capa.htm
User and Carer involvement in Service redesign:
New Ways of Working national pilot.
Ann York 2007
Que and direct interviews with children, young people and families
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CHI ESQ:
Children n=7
Young people n=27
Parents/carers n= 35
Direct interviews:
 Children < 11 y n= 3
 Young people 11-18 n = 11
 Parents/carers n= 34
Exeter:
Vikki Barnes, 2009
Ques to Parents who had recently attended a Choice appt.
 Response rate: 42%
 CAPA Experience Que
 CHI-ESQ
Waits:
 Pre CAPA: 6 mths
 Post: 2-4 wks
User views:
 Choice appt was useful
 CHI ESQ positive
User & Carer involvement (2)
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Children, young people and parents/cares all very positive at
interview and on CHI ESQ
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Que feedback from GPs- positive
Full report is 200 pages long
http://www.newwaysofworking.org.uk/component/option,com_doc
man/task,doc_view/gid,247/org.uk/component/option,com_doc
man/task,doc_view/gid,247/
Gloucester CAMHS
9 mths planning
Started July 2006
6 FTE
338 referrals, accepted 267 (5 pw)
WL Blitz: 39 families, took 1 mth
Anna Burhouse, 2006
Gloucs (2)
Results
CAPA-CRS: 97%
Waits:
 Post: 3-4 wks
 4 wks to Partnership
User feedback:
 100% positive
Staff feedback:
 Very positive
 Higher job satisfaction
Richmond CAMHS
Mona Botros & Ann York 2009
Method
 Sept 2008 to Feb 2009: user feedback questionnaires on Choice
 1-5 Likert scale
Results
N= 43
Response rate 25%
 93% found Choice helpful or extremely helpful
 100% felt listened to
 53% got new ideas
 88% given enough info

23% felt seen too quickly
 44% felt seen very quickly
 5 % felt waited too long
 Free comments: 8 positive, 1 negative (parent demanding meds that
were refused)
Richmond CAMHS (2)
Vanishri Yadav, 2010
Hannah Thorpe
Method:
March 2009- Feb 2010
Choice feedback forms completed by users
Results:
N=132
On Likert scale 1 to 5, scores of 4 and 5:
84% found the Choice appointment helpful/extremely helpful;
96% felt listened to
57% felt got new ideas
86% got enough info on the service
14% felt seen too quickly
39% felt wait was fine (waits were 4 weeks). Rest scored 3,2 or 1
(45% in total, mainly scores of 3)
Staff experience
References available from Ann
Staff views on implementation Kingsbury & York 2006
Method
 Focus group of clincians, transcribed by assistant psychologist and
analysed by Steve and Ann
Results
Before started: worry re
 May not work
 Adapting to new way of working
What helped:
 Vision
 Leadership
 Commitment
 Planning
What think like for families?
 Focus on what they want
 Easier to ensure CAMHS right service
Staff views (2)
How change practice?
 More focussed
 Think more clearly
 More collaborative
 Shared language
Problems:
 Sense of missing something if not done Choice
What helped transfer?
 Clear formulation
 Right skills
 Iterative process
 Flexibility re co-working
Staff views (3)
Liked:
 Pride in no waiting list
 Referrers pleased
How to make it work well:
 Monitoring processes
 Formulation with family
 Team discussion
 Trust in team
Other tips
 Get resource file
 Adapt it
Staff views
Caroline Fell Southmead CAMHS, Bristol, 2009
Method
 3month collection period
 Que to all Choice clinicians
 n= 17
Results
 Majority of users waited 1 to 4 weeks for Partnership
Majority of staff felt:
 Intervention been discussed at Choice
 Matching of skills/personality
N Somerset CAMHS
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Narrative of implementation experience- semi structured interviews
with clinicians
4.7 FTE
Received 342 refs, Accepted 307
5% DNA Choice
Transfer to Partnership rate: 70%
Staff views:
 All positive
 Felt user friendly service
 Value team working
 More focussed
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Emma Stapley, 2007
Challenges:
Not enough Partnerships
Pressure to discharge
Managing variation in demand
Bottlenecks to some specialists
Stockton CAMHS
Tracey Splevins and Roger Williams, 2007
New Ways of Working national project
28 FTE
750 refs pa (14 pw)
Staff ques and semi structured interviews
Results:
70% of users seen within 4 weeks
CAPA –CRS: 86% full compliance
 Some staff felt threatened and suspicious that would cut costs and
erode professional expertise
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Clear mechanisms to collect data
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Skills valued and respected
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Morale improved
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Team functioning improved
http://www.
newwaysofworkinghttp://www.newwaysofworking.org.uk/component/option,com_docman/task,doc_view/
gid,241/Itemid,412/.org.uk/component/option,com_docman/task,doc_view/gid,241/Itemid,412/
Stockport CAMHS, 2008
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27 FTE
Planning took 5 mths
Care Bundles
Specific clinics
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Sought staff experiences
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Waits:
Pre CAPA: 28 wks
Post: 5 wks
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CAPA-CRS: 97%
Staff:
 Like Choice
 Streamlined paperwork
 Partnership working enhanced
Adult Mental Health
References available from Ann
Adult Mental Health, NZ
Tony Littlejohns, Capital & Coast 2009
Service audit of CAPA implementation in 4 GAMHS Mar- Oct 2009:
 Introduced:
 Single point of entry
 Fully booked Choice appts
Results
 Waits to Choice Per CAPA 58 days
 Post: 30
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DNA; approx
Pre: 3%
Post 2.8%
11% increase in refs
16% increase in pts seen