The service has changed its language and no longer refers to assessment, treatment or triage but either describes it to the service user (verbally and written) as Choice and Partnership or another collaborative local name. When considering clinical skills the service refers to a clinical competency not a particular discipline.
We all know, without needing much explanation, the power and meaning of words. Words and descriptions become labels, they define some possibilities and they exclude others. Words are the building blocks of narratives that we live out and enact.
In CAPA we knew we wanted to fundamentally redefine our relationship with the people we see. And so we decided to call the first contact Choice, rather than assessment and the intervention as Partnership, not treatment.
Assessment and Treatment
Why did we want to change from ‘assessment’? Well, as you read this, pause for a moment and think about what thoughts or images come to your mind when you think about ‘doing’ an ‘assessment’. For us, images of clipboards, semi- structured rating scales, presenting findings to colleagues and the client, and the words ‘full’ and ‘complete’ come to mind. We felt that these ideas took us away from the concerns and choices of the people we are seeing. They led us into doing more and more assessing and less and less listening. And it defined us as the experts.
We wanted to use a word that made us think about client’s concerns, being collaborative and using our expertise to facilitate their choices. So ‘Choice’ was born.
The same applied to ‘Partnership’ in contrast to ‘treatment’. Treatment is fairly one-way. It’s something we do to people. Not something we do together.
Professions or Skills
We also wanted to shift from the position of certain skills being the province of certain professions (a classic one is of CBT being seen as the domain of psychologists). CAPA is about widening people’s skills so that you have a flexible, multi-skilled workforce. Think skills not profession. We noticed that CAMHS teams using traditional ways of working recommended a family saw a particular profession, rather than thinking about what skill they needed. This shift is reflected in New Ways of Working (see Appendix) and the emerging competencies frameworks in the NHS.
What happens if you don’t change your language?
We have noticed that teams who continue to use ‘assessment’ and ‘treatment’ find it harder to think about clients’ goals. The tendency is to identify pathology (which we can find anywhere if we look hard enough!) rather than focus on strengths as well as difficulties. We know from published young person and family feedback that families say they get too much assessment and no-one helps them enough. The National CAMHS Review in England (2008) and that by Young Minds for CYP-IAPT (2011) found that young people said they wanted services that treated them as individuals and to be spoken to in a straighorward way, with no technical jargon. We find this is easier to do if you change your language.