IWK, Nova Scotia, Canada: 2013
Story supplied by Sharon Clark, Registered Psychologist, Clinical Leader MHAA Strategic Plan Implementation Team
IWK Health Centre, Mental Health and Addictions Program (MH&A)
Halifax, Nova Scotia, Canada
When started CAPA
We began to explore the CAPA approach in July 2011, received leadership approval to implement the model in September 2011, and 100 staff participated in the 2-day workshop with Steve and Ann at the end of November, 2011. Our waitlist blitz ran from January to March 2012, with our first quarter of CAPA beginning in April, 2012.
The MH&A program at the IWK provides mental health services for children, youth, and their families who live within Halifax and tertiary level care across the province of Nova Scotia. Halifax is a city of a population of 360,000 within the province of Nova Scotia with a population of 940,000.
CAPA was selected as a model of care because it resonated with our desire to put the needs of families at the centre of the care we provide. It also facilitated meeting many of the goals articulated within our strategic plan recommendations. Focusing on eliminating our waitlist has put a personal face on those who are waiting for care. In asking ourselves what the experience is like for families who access our services, it has guided how we will restructure our services.
Prior to the waitlist blitz we had a waitlist of 1100 children waiting for services for upwards of 20 months before their first contact. At the end of our second quarter of CAPA, the time to Choice appointment varies between outpatient teams – but on average families are waiting 3 months for their Choice appointment. The wait for partnership appointments after Choice ranges from 4 weeks to 5 months.
We have been collecting experience of service data from parents and adolescents since January 2012. To date we have had 114 Adolescents complete the questionnaire and 218 parents/caregivers. Overwhelmingly positive feedback has been received with over 98% responding either all/partly true or pretty/very much true to almost all of the questions.
Adolescents and parents are equally satisfied and clients are reporting they feel listened to; treated well; involved in decision making; and being offered new ideas.
“I felt like I was being listened to and like my opinion mattered” – adolescent client feedback
“The wait time for services was a lot shorter this time and that was great. It made it better. I like this new system.” – parent feedback
Changes over time
CAPA has been implemented within our ambulatory programs – outpatient community mental health teams, forensic services, and addictions programs. The MH&A program provides treatment across a continuum of care, so we have had to work through how to ease the transitions between programs – and this is an area that requires further focus as we implement more broadly.
We understand that CAPA has to become a cultural shift within our system. The 7 Helpful Habits are providing us with a structure and we are adapting our program to meet the philosophy – having to work through those changes has been difficult.
What do we like?
Really understanding the demand for our service and then consider how we match our clinical capacity to that demand has been transformative. CAPA has provided a common language which is facilitating standardised processes between our teams and services. This helps to keep the family experience of using our services in the forefront of what we do.
Guidance from Steve and Ann has been extremely helpful to work through the challenges of implementation. The establishment of a strong clinical leadership team is what will facilitate our move towards full implementation of CAPA processes within our system.
Problems and advice?
We have had a lot of change in a short period of time within our program. Spending more time considering change management principles would have assisted us in avoiding some of the challenges associated with shifting our model of care within a large system.
And finally- 3 tips to get going and keep going
- Set up a leadership and implementation team who understand well how the current system works and its real status – especially understand the demand for your service and your capacity to meet that demand.
- Workshop the key CAPA concepts with staff prior to initiating the waitlist blitz to allow staff focused attention rather than dividing their attention between the blitz and gaining a deeper understanding of CAPA.
- Prior to initiating the waitlist blitz, complete job plans for each clinician and team so full-booking can happen without hitches.
CAPA Compliance: 76%
(amazing given the size of change required and how recent this was: Steve and Ann)