Traditional Assessment?

The key differences from a more traditional first assessment are that Choice is:

  • Conversational (i.e. less structured)
  • Collaborative
  • Flows with the person’s processes and
  • Reaches a collaborative Choice Point, rather than delivering a prescribed assessment and treatment recommendation.

How does a Choice appointment differ?

The aim is to find out what is going on, identify risks and work out what would help. So we glean as much information as needed to work out an initial formulation with them and what we could do. Enough to allow them to make an informed decision.

We listen a lot, make very active use of information we already know from the referrer etc. (i.e. we don’t get them to repeat things, we may check facts out with them though, and delve deeper). We do not go deeply into things that seem less relevant at the moment.

We are constantly thinking about their motivation to change and may try and enhance this if needed.

This is all set in a background of thinking about risks, diagnoses (if they think it would help to label) etc. as needed – the usual things. We do a mental state if needed (again, not a structured interview – conversational, asking lots of open questions and funnelling down as needed) and risk assessment – at a level appropriate to the situation.

We talk about evidenced based interventions and others that may help and how these apply, or not, in their situation. This involves explaining what our service does, who is in it, what these interventions are like, how appointments are made etc.

The person may be given information (verbal and written, CD-roms, websites, books, leaflets). What is really important is that we work out together what they can do to help themselves, what other resources can help them in the com- munity, other agencies, extended family etc.

They are encouraged to ask questions.

Stance

We think many clinicians work in this way some of the time but it’s the stance and process in CAPA that are different. More traditional models tend to use a structured assessment that is geared to the professional making a diagnosis/formulation (which may not be shared with person at that point), with the service user being the passive recipient (when extreme).

When clinicians have observed a Choice appointment they often say that the Choice clinician gets the same information that they would using their structured interview proforma, but in a conversation that flows. We listen a lot, and it feels more like the client and ourselves are equal players.

CAMHS example

If ADHD or ASD might be relevant we would find out enough to know whether this needed neuro-developmental assessment, share this with the family and help them understand what this assessment would be like, how long it would take etc., and discuss the pros and cons of labelling. We would give them verbal and written information about these things, some rating scales to take away and contact school – so all that would be ready for whoever saw them in Partnership. We would also have explored the systemic issues and considered risk.

Not just Triage!!

The key difference is that after Choice appointments not all people choose to return. This contrasts to triage where not all clients are chosen to return.