Transcript CAPA in Child and Adolescent Mental Health Services

National CAMHS Support Service
CAPA in Child and Adolescent Mental
Health Services
An independent evaluation by the Mental
Health Foundation 2009
The Choice and Partnership
Approach
• CAPA is a clinical system that brings together the active involvement of
young people and their families, demand and capacity ideas and a new
approach to clinical skills and job planning
• It was developed in Richmond and East Herts CAMHS by Ann York and
Steve Kingsbury
• It is used in many teams across the UK and in New Zealand, Western
Australia and Belgium
Evaluation
In January 2009 the Department of Health
Commissioned the Mental Health Foundation
to undertake an independent evaluation of the
CAPA to:
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Examine how well CAMHS in England have
adopted the components of CAPA in their practice
Assess the degree to which the intended
outcomes of CAPA are being achieved
Understand the impact of adopting CAPA for
services and families
Enable future decision making
Method
Phase 1
– 1a audit of CAMHS teams in England
– 1b audit of implementation of 11 components
– 1c audit of pre and post CAPA data
Phase 2
– Visiting selected CAMHS teams (n=6)
• Staff
• Children, young people and their families
Findings – Phase 1
Phase 1a (n=213)
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92% had heard of CAPA
97 teams implementing CAPA
Phase 1b (n=53)
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Highest CAPA score = 10.5 out of 11
Lowest CAPA score = 1 out of 11
Mean CAPA score = 6 out of 11 components
implemented
Phase 1c (n=7)
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Difficult to get pre and post CAPA data from teams
Before implementation waits were between 7-108
weeks for a first appointment after implementation
they were between 5-12 weeks.
The 11 Key Components of
CAPA
1. Leadership
2. CAPA language
3. Importance of
handling demand
4. Choice framework
5. Full booking
6. Selecting
appropriate
clinicians
7. Extending clinical
skills
8. Job plans
9. Care planning
10. Peer group
supervision
11. Away days
Findings – Phase 2
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The benefits implementing teams
reported were:
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Reduced waiting times
Reduced demands on the service
More formalised team working
Better planning and greater transparency for
staff and families
Impact on families
• Waiting lists - surprised at how quick they
could get into the service
• Care planning - none explicitly said that
they had been involved at all in a ‘care
plan’; however they knew what care they
were receiving and why and were involved
in deciding about their care
Impact on waiting times
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In services that were high implementers
of CAPA components 92% of families
were seen within 13 weeks
Compared with the rest of CAMH
services in England using CAMHS
mapping data where 78% of families
were seen within 13 weeks
Main benefits of CAPA
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Reduced waiting times
Reduced demands on the service
More formalised team working
Better planning infrastructure
Greater transparency
Main challenges of CAPA
• Internal waits for partnership appointments due
to not implementing full booking
• Confidence in doing choice appointments
• Capacity planning
• Clarity of staff roles within CAPA
• Letting go of more complex cases and
understanding that the aim is to see who needs
to be seen as long as they need it, but not
continuing the see a family when there is no
need for specific work
Strengths and limitations of
evaluation
• Strengths
– Excellent response from staff
– Mixed methods used
• Limitations
– Difficulties in engaging families for their feedback
– Difficulty obtaining tangible CAPA instruments eg.
Capacity plans and before and after data
National recommendations
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An enhanced training package should be developed to
facilitate successful implementation of CAPA. This should
include training on conducting Choice appointments for
clinicians, job planning and capacity planning for managers.
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The training and support package should address
commonly held misunderstandings of the CAPA model,
particularly how the system can be applied to complex
cases. This will help to ensure that the implementation
process becomes more standardised across teams.
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A national online network and directory of CAPA
implementers from a variety of contexts could be developed
allowing professionals to share information and solve
problems.
Local implementer recommendations
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To realise the benefits of CAPA facilitative team
management is crucial. In line with the first component
of CAPA there should be an informed manager, a
clinical lead, and an administrative lead. They should
be well respected within the team, educated and
trained in CAPA prior to implementation.
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Appointing a number of champions to help oversee
and standardise implementation within an area. These
champions should be a mixture of clinicians and
managers with experience of implementing CAPA
already.
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More formalised mechanisms need to be in place to
facilitate effective team-working eg. peer group
supervision.
Local implementer recommendations
Continued
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Children’s Trusts should hold extensive, up-to-date
directories of all local children’s services. CAMHS
teams should use these directories to enable them to
engage in multi-agency work or to signpost families to
appropriate services.
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Monitoring and feedback are integral prior to, during,
and after the implementation phase. Teams should
engage in robust, transparent data collection and
analysis processes that will allow them to monitor the
following; outcomes for families, user experiences of
the service, waiting lists, internal waits, capacity, flow
and discharge.
Next Steps
The Department of Health has asked the
National CAMHS Support Service to
prepare a costed options paper that
considers possible responses to the
findings of the evaluation and the
recommendations made by the Mental
Health Foundation.