Christchurch CAMHS, NZ: 2013
Story provided by Katrina Falconer Beach, Senior Clinical Psychologist, CFSS
Name of service
Child and Family Specialty Service (Green team) in Christchurch NZ.
When started CAPA
We are an outpatient service for children aged between 2 and 13 years with moderate to severe problems. The Green Team has 5.5 full time equivalent staff (7 people, including an admin person, psychiatrist, psychologists, social workers, and psychotherapist). Two of the full time positions (admin and psychiatry) don’t carry a caseload. The team have consults from their Maori health worker (Pukenga Atawhai), speech therapist, ASD team members and OT. The Green Team is one of three teams at our service all equally covering a population of 400,000 people in Christchurch.
We planned to do CAPA over an 8 month period, decided on all processes and paperwork changes and worked through any anxieties we had about making the changes. We then implemented it lock stock and barrel from December 2007 and it has been excellent for the families, we as staff and the referrers have appreciated it too.
We evaluated how things had gone for the first 50 families going through and then we repeated this for the 50 families coming through in the summer of 2009-2010. The families felt respected and listened to in the first meeting, we formed more of a partnership with them in that once they had set goals and we had come up with suggestions together of how those goals could be met, the families were far more likely to do the necessary work (than previous families).
The waiting times to get in have remained much shorter (4 to 6 months shorter than before and internal waits are very short (2-3 weeks rather than months). Staff morale is much higher and team cohesion is greater (our team has lost no staff because of the earthquakes whereas 8 people have left other parts of our service because of stress following the earthquakes). Families report liking our letters that we write and outcome data from questionnaires has been very positive (which was a surprise given the earthquakes).
Evaluating has helped us keep on track but as soon as we started CAPA we knew we would never go back to our old ways because the new ways felt so much better for us and for the families. Our service as a whole has started to value CAPA more in the context of dealing with an increase in referrals following the earthquakes.
What do we like?
The respect that is intrinsic to a partnership model and the far more functional view of what families want to be different rather than solely focusing on diagnoses. Spending time as a team during team away days has been great for increasing trust and work enjoyment.
Having supportive managers and happy team members who are capable of managing life in a healthy manner.
Problems and advice?
Really recently some sectors of our service who did not appear to support CAPA have moved to appreciating it and supporting it, solely because they can now see it is the only way to cope with an increase in demand in a constructive way and they can see that our team, who have been following CAPA processes for five years, are continuing to feel confident and positive about working with families, not burnt out (as they may be). The evaluations have helped demonstrate that it is a sensible process to follow with good outcomes and much lower Did Not Attend rates than experienced by the other teams. So I would recommend for teams where there is not 100% buy in, keep going!
Eventually even the most sceptical will come around, especially if you have a devastating natural disaster!
We currently are more compliant with CAPA than ever before having re-instated our “letting go” meetings (stopped because of room shortages following the earthquakes) and we are informally at least running off a team job plan which involves us all deciding what the families need from us and adapting each team member’s work accordingly. We have reduced the case management role for our psychotherapist (as our whole service currently only has one instead of two) and we are working together in pairs with each per-son working to their strength (e.g. someone does the paperwork, someone does the formulating and intervention work).
And finally 3 tips to get going and keep going:
- Discuss changes that you plan to make and look honestly at the anxiety that might create and look at ways staff can tolerate that
- Communicate openly and helpfully with team members about how you are finding doing the Choice appointments and letters to fine-tune them
- Remember that all of the elements are important and were put in for a reason – keep doing them!
Always thinking about what are the needs of the families coming through keeps us feeling positive and creative about working as opposed to overwhelmed.
CAPA Compliance: 90%