The Werry Centre, NZ: 2013

The werry centre map

Story provided by Tania Wilson, Senior Advisor, Clinical Psychologist

Name of Service

The Werry Centre for Child and Adolescent Mental Health (workforce development programme), University of Auckland, New Zealand.

When started

The Werry Centre has held a contract with the Ministry of Health for child and adolescent mental health workforce development since 2001. We have been supporting Child & Adolescent Mental Health Services (CAMHS) to implement CAPA/7HH by providing workshops and advice since 2007.

Service description

The aim of the Werry Centre Workforce Development Programme is to improve the mental health of infants, children and adolescents in New Zealand by working with the CAMHS sector.

The CAPA Experience

In working with CAMHS across the country common challenges have been identified by services. These have included:

  • Relentless demands on our services
  • Assessment rather than treatment focused
  • Target pressures
  • Lack of time
  • Staff recruitment, retention/turnover issues
  • Shortage of Supervisors/supervision
  • Insufficient resources
  • Insufficient psychiatric cover
  • Lack of cultural support
  • Access issues – poor access to in-patient facilities
  • Reduced funding
  • Rising referral rates
  • Managing waiting lists
  • Trial and error approach to problems

These challenges have prompted services to seek out new solutions. The successful implementation of CAPA in some services has definitely increased confidence of other services that CAPA may be a solution for them as well.

Implementing the CAPA model, like bringing any change into a service which has well established systems and ways of doing things has required strong service leadership, good staff “buy-in”, significant planning, adjustment to meet local challenges and general perseverance. The services that the Werry team have worked with have generally found that it may take as long as 12 – 18 months for services to embrace the model with on-going adjustment to accommodate fluctuations in staffing levels (particularly in the smaller services), changes in management, letting go of old ways, and for CAPA champions to become more confident with how to operationalize the CAPA system.

Impact

  • As of 30 June 2012 the CAPA has been implemented in 15 of the 20 District Health Board CAMHS’s across the country. The common benefits reported by those services who have introduced CAPA are:
  • waiting lists have gone
  • reduced waiting times for entry to the service
  • reduced DNS rates
  • client satisfaction
  • team moral improvements.
  • enjoying the Choice appointment process
  • working in the spirit of partnership
  • more focused clinical practice
  • clearer outcomes agreed with young people and families.

The data collected from services confirm that CAPA results in improvements in service delivery such as reduced waiting times for first appointment, improved flow of referrals through the service, improved satisfaction reported by families, improved use of existing resources to meet referral demand, and improved use treatment goals and planning processes. The benefits reported by services have been so encouraging that Services within the Adult Mental Health Sector are now considering implementing CAPA.

Changes over time

Ensuring the model is relevant and acknowledges “tangata whenua” (the indigenous people of the land) is a priority in the New Zealand CAMHS sector. Under the guidance of our Werry Centre Kaumatua, Rawiri Wharemate, we have found that CAPA’s ideas, principles and values align well to the Treaty of Waitangi and Maori models of care. Keeping the service user at the heart of the process fits well with the principles of “whanau ora” and other Maori models of care which places the client and their family pivotal to the success of service engagement and positive outcomes.

The essence of CAPA and service delivery has been captured in the following whakatauki (proverb) …

“Anake, kihai e peka i runga te waka
Ki te mahia te neketanga o te moana,
he maha nga Kaihoe.”

“You do not go on the waka alone;
It takes many paddlers to make the waters shift”

Sustaining CAPA

We have learned from the CAMHS who have implemented CAPA that there will be challenges in implementing a new clinical system and so there needs to be a high level of commitment by CAPA champions to drive implementation and maintain the new system until it is established. It is clear that considerable planning is needed to prepare a service for implementation and a robust continuous improvement approach is needed to support the implementation process, address the challenges but also celebrate the benefits of the CAPA system. In the face of fiscal restraints every effort must be made to preserve Team Away Days.

3 Tips…

And finally – 3 tips to get going and keep going

  1. Take a strengths based approach. CAPA allows you to build on the strengths your service already has
  2. Don’t give up – the benefits outweigh the challenges encountered in making changes
  3. For the young people and their families, CAPA works !

One of the key elements in Te Āo Māori (Māori Worldview) is embodied in our whakatauki (proverb):

“He aha te mea nui o te Ao? He tangata, he tangata, he tangata.”
(What is the greatest thing in the world? It is people, it is people, it is people).

Putting “people” in this case, the service user/family/whānau at the centre of a service and/or therapeutic process will reflect an understanding of this principle. “People” and clinicians need to work together in partnership to maximise the strengths of both the service and the “people”. In this way mauri ora (achievement of a life balance) can be accomplished over time. The practise of CAPA principles is able to successfully align with the Maori worldview and negotiate a pathway towards wellness.

Rawiri Wharemate: Kamutua, Werry Centre

Team photo