a udit p roject c hild and a dolescent p sychiatry s outhmead camhs “choice to partnership...
TRANSCRIPT
AUDIT PROJECT
CHILD AND ADOLESCENT PSYCHIATRYSOUTHMEAD CAMHS
“Choice to Partnership transition in CAPA process”
Caroline Fell27th January 2010
“CHOICE & PARTNERSHIP APPROACH”BACKGROUND INFORMATION
1st evolved in Richmond CAMHS, later developed and implemented in East Herts CAMHS
Now used in many CAMHS across the UK North west Bristol CAMHS for **yrs
CAPA This is a whole clinical system from the
beginning of the family’s journey to the end Referral choice partnership + specialist
Choice Children and families making informed choices
about what services & interventions may be useful to them
Focus on engagement We should facilitate this using our expertise
We should facilitate conversational curiosity that draws on their strengths
How can the family and young person help themselves between choice and partnership appointments
Reach a “choice point” Partnership appointment booked at the end of the
choice appointment with a clinician/s with the best skills to help
Important aspect to CAPA is choosing the partnership clinician
1. It affects the family and therapist position to the Choice by facilitating choice completion, engagement with “change not clinician” and gives family autonomy in their choice2. It affects the Partnership Appointment by starting with the “right” therapist with the “right” skills3. It helps plan and manage your teams capacity
Core treatment skills of partnership clinicians (ABCDS) Assessment Behavioural Cognitive Dynamic Systemic
COHORT
Questionnaire to all choice clinicians 3/12 period Those progressing to partnership
Total 17 completed 2 straight to specialist work
THE QUESTIONS......
1. Has the work or intervention that you feel to be necessary for this YP/family been discussed with them at the choice appointment?
2. Was the YP/family asked what skills or “personality traits” they would like in their partnership clinician?
3. Does your YP/family know of the change in clinician for their partnership appointment at the end of today’s meeting?
4. Why did you choose the specific clinician that you have assigned for partnership work with this YP/family?
5. Are you aware of the core work and specialist work that this specific clinician can offer? Please specify a) core skills b) specialist skills
6. How quickly will your YP/family be seen in a partnership appointment?
7. Is there anything that you wish was different to ease the transfer of the YP/family from choice to partnership?
RESULTS
1. Has the work or intervention that you feel to be necessary for this YP/family been discussed with them at the choice appointment?
15 out of 17 “yes” 2 were “briefly” i.e. Introduced to some ideas
and possibilities 1 was “no”
Needed to discuss at team meeting before decision could be made
? Group supervision at choice clinics
2. Was the YP/family asked what skills or “personality traits” they would like in their partnership clinician?
9 out of 17 “yes” 8 out of 17 “no”
“based on clinical needs” “not relevant” 2 were put straight into specialist work
3. Does your YP/family know of the change in clinician for their partnership appointment at the end of today’s meeting?
13 out of 17 “yes” 2 that were “no” went straight from choice
clinician to specialist work with same clinician
1 other kept same clinician as had seen child in school previously
1 other had been completing a joint choice, and continued the work in partnership
4. Why did you choose the specific clinician that you have assigned for partnership work with this YP/family?
14 out of 17 stated clinical skills 3 out of 17 stated availability 1 out of 17 stated sex of clinician 1 out of 17 was due to working with clinician
before 2 out of 17 gave no reason
5. Are you aware of the core work and specialist work that this specific clinician can offer? Please specify a) core skills b) specialist skills
Core skills “all” A 9, B6, C6, D7, S6 4 “no/ unknown” or left out as went straight to
specialist Specialist skills
All appropriate
7. Is there anything that you wish was different to ease the transfer of the YP/family from choice to partnership?
“sooner appointments in partnership” “more partnership appointments” “partnership appointments in the diary”
AUDIT CYCLE
Set standardsmeasure practice
compare against practiceidentify improvements?
suggest &implement changes
(to improve clinical care)
evaluate and review those
changesre-audit
COMPARISONS & IMPROVEMENTS
- Ethos of choice partnership preserved
- Facilitation of informed choice re. needs and not “prescribing”
- Change clinician
- Core skills of partnership clinician
- Specialist skills seemed appropriate when stated
- Majority seen in partnership within 4 weeks
- Time- Lack of partnerships in diary- Sooner appointments
- Skills of clinicians ??- 2 questionnaires stated did
not know one or other of core & specialist skills
- 3 chose the partnership clinician due to availablity (2 stated nothing) ? Correct match of clinical skills for that family
- Asking what skills the family would want (informed choice if they agree on clinical need?)
IMPROVEMENTS
VERY LITTLE!
Partnership appointments in advance for all team members Time (?!) Updated quarterly and then can opt out?
Information re. team members skills “skill profile” may help and improve discussion
of clinicians skills to families/ young people at choice
ABCDS ? Attached to partnership diary
CHANGES TO RE-AUDIT
Team to have partnership appointments for the next quarter put in the diary by administrative staff. Clinicians responsibility to change them if necessary
Team “skill profile” to be created and knowledge of all clinicians A,B,C,D and S to be understood
Educate entire team re. general principles of CAPA and findings of the audit