CAPA is focused on the service user and their family. The stance is collaborative and provides choices. For the clinician there is a shift in position from an ‘expert with power’ to a ‘facilitator with expertise’. There are 11 key components, including a change in language, team job planning, goal setting, care planning and peer supervision.
The service needs to apply eligibility criteria for access. However, the threshold of acceptance needs to be low if information in referral letters is lacking. The aim is to find out from the client and people important to them whether the service has anything to offer, rather than try to guess this from a letter.
The Choice appointment
When their referral is accepted, the client is given the opportunity to book an appointment at a time (and ideally place) to suit them. This may be by phoning the service. For more vulnerable people the referrer may facilitate this. The first clinical contact is in a Choice appointment. During the Choice appointment they may choose:
- That they can get back on track and do not need to return or
- To be put in contact with a different agency more suited to help or
- To return to the service.
If they decide to return they will be able to choose an appointment with a clinician who has the right skills to help them. This next appointment will be the start of Core Partnership work with one or more clinicians with extended clinical skills. Most people will find this is enough to achieve their goals. For some, more specific partnership work may be added to the core work.
The Key tasks in Choice are:
- Curiosity about the person’s view as well as
- Reflecting our opinion; evolving a
- Joint Formulation followed by a
- Discussion of Alternatives (not all involving services) ending in
- The Choice Point
- Maximised by their engagement tasks.
Choice appointments can take as long as are needed to reach a Choice Point. This is where a decision can be made about what is going on and what will help. More than one Choice appointment may be needed (Choice Plus) e.g. if a father is not present, or the teenager. Choice Plus may be done with the referrer or someone from an- other agency.
Choice appointments aim to combine:
- Motivational enhancement
- Goal setting
- Things to try at home/ ‘homework’ or Pre-Partnership work.
The style is conversational, collaborative and strengths based. More details about Choice appointments are in
the Choice section of the site.
The Core Partnership pathway is where the majority of intervention work occurs. It can be done by most clinicians who have extended clinical skills. Extended clinical skills means having a core level of competency to deliver a range of common assessments and interventions. Core Partnership work involves integrative, multimodal work or a single therapy model at core level to help the service user meet their agreed goals. The Core Partnership worker generally remains the Key Worker during the pathway.
Assessment and reformulation continue through- out contact with the client, in the normal way. Some people will need an additional Specific Partnership pathway, alongside the Core path- way. This type of work may be delivered at higher intensity than at core level or it may just take longer. Examples could be individual psychodynamic psychotherapy in conjunction with Core family work, systemic therapy using a one way screen alongside core individual work or additional Specific assessments e.g. psychometry or autism assessment.
Partnership work can be as many or as few appointments as are needed. It must be regularly reviewed against clear goals, through the use of care planning. Contact with the client ends when a review concludes that goals have been met.