10: Peer Group Discussion

The service has systems for weekly small group multi-disciplinary discussion (no more than 4 staff) to consider on-going work. This is a “letting go” task as well as developing a learning culture across many clinical competencies. This is NOT the MDT or individual supervision, but may be in addition to these.

Small groups not whole team

This peer group supervision needs to be in small groups of no more than five, to allow time to talk. How you organise this is up to you. All CAPA needs is for it to be happening. Some teams prefer to go into random groupings each week to talk; others prefer keeping with the same group of people. There are pros and cons of each – if random it may be easier to be innovative or be quietly challenging; stable groups get to know each other well and so information on cases does not need repeating, but they develop their own culture. Work out what is best for you (Richmond uses stable groups and East Herts random ones).

Ongoing work

The focus is on ongoing work and in the hour slot each member of the group should present one family. Often this is a ‘stuck’ case but can be things going well etc. This is a Letting Go task (one of the 7 HELPFUL Habits of Effective CAMHS) as well as developing a learning culture across many clinical competencies. This is NOT whole team discussion or individual supervision. It is in addition to these.

CAPA involves lots of clinical case discussion. As a minimum there must be discussion of Choice work and Partnership work in addition to individual clinical supervision. This ensures work is safe and on track, supports clinicians, and increases learning in staff. It reduces variation in practice, allows sharing of new ideas and formulations and staff enjoy it!

What will happen if you don’t have peer group supervision?

It partly depends on why – it may come from an avoidance of talking about clinical material and an anxiety about the transparency it facilitates. If so there might be wider cultural problems to address.

Small group multidisciplinary discussion is more challenging to organise than within-profession discussion. Whole team discussion can be intellectually stimulating but it is much harder to be focused in a large group, or for enough cases to be adequately discussed. It can also turn into a com- petition for whose ideas are best and the clinician may not always feel supported. If supervision is only focused along professional lines, opportunities for learning and the challenge that comes from other professional perspectives is lost.

Without multidisciplinary small group discussion clinicians will be stuck more often.