Partnership Process and Admin
Partnership appointments are all the contacts the service user has with the service, after Choice. Partnership work may involve Specific work in addition to Core. This section explains how to set up Core Partnership.
Organising Initial Core Partnership Appointments
Full Booking (CAPA Key Component 5) is essential and so if Core Partnership work is needed and chosen by the client, then an initial Partnership appointment is booked before leaving the Choice session. To be able to do this, there needs to be a team Partnership diary that has vacant first Core Partnership appointments available. This could be a paper diary or an electronic system. If Choice is offered in a range of venues then the diary needs to be held centrally so that the Choice clinician can phone in when they are with the service user and ask when the free appointments are with the clinician they think will suit them.
At the end of the Choice appointment the Choice clinician will have an idea of who has the right skills to help this person reach their goals. They find the diary (or phone up if off-site) and offer the next available appropriate appointments.
These vacant first Core Partnership appointments are generated following team and individual job planning (see the Implementation section) which gives everyone an activity number for first Core Partnerships they must offer in a quarter (3 month period). About 6 weeks before the new quarter, everyone needs to put their vacant appointment slots in the diary.
The initial Core Partnership appointments are offered by a range of multidisciplinary professionals who have extended, multiple, clinical assessment and treatment skills that we describe as the ‘Alphabet’ skills of Assessment, Behavioural, Cognitive, Dynamic and Systemic (ABCD’S). A Core Partnership appointment may be with one or two clinicians depending on the complexity and needs of the family and determined by the outcome of the Choice session.
Core Partnership Clinics?
Initial Partnership appointments can work well when clinicians are part of a core partnership pathway that includes clinical discussion and peer supervision built in. A pathway does not mandate that this is delivered in a ‘clinic’ but simply that the capacity, flow and skills are defined. The first Core Partnership appointment needs to be fixed in a Partnership diary and available for Choice clinicians to book people in to but subsequent appointments can be negotiated between the client and the clinician (as is the case generally in CAMHS). Alternatively, you may prefer to organise all follow-on appointments to be in a diarised Partnership clinic. This may result in reduced choice of times for clients however. But it may make joint working easier to organise for clinicians. This is for you to decide.
Whichever way you decide to organise things, the small peer group supervision of ongoing work from that Partnership clinic needs to be organised in the team diary. This can be stable peer groups within the ‘clinic’ or “clinics”, at another time e.g. when the team is back at base if appointments are offered at a range of venues or by the whole team in more random changing groups in the team meeting or in a specific meeting arranged for this when the whole team can be present.
If you are a lone worker then you need to find others to have small group discussion with- perhaps other lone workers or your local specialist team. This could be by video link/conference call if large distances are involved.
Adding other clinicians
Core Partnership clinicians may feel the need to add in another Core Partnership clinician to aid the work. It can be that these requests are made and discussed in a team meeting or you may have a booking system. Then the Core Partnership clinician that joins can count this as part of their quota of new Partnership onsets for the quarter. Or these requests can be made within the Core Partnership team if you have one defined this way. The Core Partnership clinician may also involve a Specific co-worker. For example, Core Partnership work- with a family where there has been domestic violence may move to include individual trauma focused CBT for the young person who has PTSD. The initial Core Partnership worker retains the family work and key worker role. Ideally, the Specific worker joins the Core work, without the family going onto a waiting list (i.e. the resources are pulled to the family, in Lean Thinking terms!). In Richmond, this has been done by using a next up rota system for a range of Specific Partnership work or a Specific Partnership diary. These both work well as long as the Specific Partnership activity has been calculated using a specific partnership multiplier.
At the end of the first Core Partnership appointment a written communication is sent to the client , referrer and agreed network summarising the Care Plan (and any risk plan) and review date. It will include a review of the goals developed in Choice, amended if needed, and any reformulation. This can be done in a letter (as in East Herts) or a structured Care Plan (as in Richmond). We encourage you to develop your own paper- work and to ensure this fits with any existing frameworks you need to use, such as the Care Programme Approach. But the important thing is that the service user and network get a clear, agreed summary of what is happening and plans made.
Review intervals may depend on the issues or you may decide in the team to have a standard review process (in Richmond CAMHS cases are reviewed after every 6 sessions for Core work, every 6 months for psychodynamic psychotherapy and every 3 months for the segmented eating disorders clinic).
Use of Outcome measures
If you decide to routinely use Outcome measures (generally we think this is a good idea) then the tools and frequency needs to be agreed. The
CAMHS Outcome Research Consortium tools (HoNOSCA, C-GAS, SDQ and CHI-ESQ) are a possibility (www.corc.net.uk), or
Children and Young People’s Improving Access to Psychological Therapies measures (www.iapt.nhs.uk/cyp-iapt/).