Selecting Core Partnership Clinician
CAPA is all about doing the right things with the right people at the right time and by people with the right skills. So a key part of the CAPA system is selecting the right clinician at the Choice appointment with the right skills for the Core Partnership intervention.
So why select clinician?
…ensures that the person with the right skills will do the Partnership work.
The traditional CAMHS model of service delivery means that there is a rather hit and miss process whereby the clinician that the family first sees is the one they continue with. They usually work with the family in a way in which they feel comfortable. In contrast, choosing the Partnership clinician at the Choice appointment means a good match for the family in terms of skills and, to some extent, personal style. Plus, if it seems complex, two staff can be allocated in Core Partnership. It also gives them a choice if they haven’t got on with us. If we assume continuing is the right choice they may only be able to DNA to let us know they don’t agree! In adult mental health, a transfer from the assessing clinician to another for intervention is a common model.
…facilitates informed choice
We have found that setting up the Choice appointment as a one-off session right from the start facilitates the person’s ability to make an informed choice. It makes the purpose of coming clear, that the pros and cons of all options can be discussed and does not assume that continued input from us is necessarily required. This ensures that a clear plan of action can be made by the end of Choice (the Choice Point).
It makes it an active process for the clinician who has to use their expertise to allow the client to make a truly informed choice. Knowing that this is a one-off meeting frees the clinician up to be more curious about the issues, transparent about their thinking and to reach an initial shared formulation with the person. As clinicians, we know that if we can meet with them again, the easiest thing is to offer another appointment without fully formulating the issues or explaining processes in the way that perhaps we should. It can then be easy to drift into continued contact that is not truly informed or agreed and with no, or only a vague, care plan. Without a clear goal is can be much harder to stop (see Letting go).
Knowing that a colleague is going to take on the ongoing work with the person in Core Partnership puts the onus on the Choice clinician to ensure a Choice Point is reached. We also know from audit that families and young people feel more open in what they can say if they know that this initial session is a one-off with the clinician. (See Evaluation section).
…facilitates the Choice clinician’s curiosity
If the Choice clinician knows that their task is to reach a Choice Point, and that they will pass the client to an appropriate Partnership clinician, they are encouraged to find out, as well as they can, what they want. Knowing that they will not (in general) be doing the follow-up work means they can continue to think with them rather than being distracted by wondering and worrying about how they will help this person – do they have the skills etc?
…frees the clinician up to think
When meeting a person and their family that we are going to see again for ‘treatment’ we can spend our time thinking about what skills will be required, do we have them etc. This thinking and sometimes worrying can distract us from listening and making a choice with them. We are not very likely to suggest an intervention we are not very good at even if the person would prefer it!
…encourages their agency
An important part of Choice is asking the client what they can do to help themselves. This sets the scene very early on in the contact that they have to contribute to any change. The process of reaching a Choice Point with them means they have chosen the path to take and so feel more active and involved. They also have to carry the ideas about change from the Choice to the Partnership session. The Choice clinician can’t carry the ideas for them, as they won’t meet them again.
…facilitates capacity management
Separating Choice and Core Partnership allows the team to plan the Choice activity based on the referral volume, as it doesn’t include the unpredictable amount of follow-up activity. It also easily allows the team to flex the Choice activity in line with the referral demand ebbs and flows. Staff will find it easier to offer an extra Choice appointment if needed at busy periods as it doesn’t tie them in to any follow-up activity. This ability to find extra Choice appointments is very useful (and essential in any waiting list blitz). It also means staff are willing to step into Choice appointments if a member of staff is off sick.
Separating the Choice activity from the Core Partnership also allows the Partnership follow-up work to be incorporated into staff job plans. This ensures the planned activity is reasonable and tailored to the individual. It also makes it easier to demonstrate to managers and commissioners if you truly can’t cope with your demand.
But doesn’t selecting clinician impair the therapeutic relationship?
We all know that a key part in any change process is the relationship between client and the clinician. Having a contact with one person and then immediately making a change to another challenges some of our fundamental beliefs about the importance of engagement. But we have found that the ability to select a clinician that suits the person as well as engaging them in their own change process is more valuable than simple continuity. The focus in Choice is development of the Task Alliance, as we know from research that this has a great impact on outcome. We also know from service user feedback that families (and especially adolescents) find it frees them up to be more open in the Choice appointment if they know it is a one-off. We found that 93% of adolescents felt more open knowing the Choice session was a one-off – see Evaluation section.