CAPA and CYP-IAPT
An Odd Couple or
a Marriage Made in Heaven?
Complimentary, continuing or
completing?
Ann York and
Steve Kingsbury
1
What is CAPA?
…the Choice and Partnership Approach
Began with conversations between us many years ago…
a clinical system that evolved in Richmond CAMHS from
2000
developed and implemented wholesale in East Herts.
CAMHS 2005 and
now being used in many CAMH teams across the world
Increasingly used in adult mental health
5000 staff in around 500 teams have had CAPA training
2
CAPA is a Service Transformation Model
Collaboration
Skill
layering
Demand &
Capacity
Leadership
Slide 3
Values of CAPA
Users are at the heart of the process
“Led by them and guided by us”
Shift in clinician stance to
Facilitator with expertise rather than expert with
power
Everything we do must add value to the user
“Just the right amount”
Is this working for this young person?
4
Traditional CAMHS…
Referral
Triage / assessment
process – often lengthy
Initial ASSESSMENT
Specialist Referral
Standard treatment by
SAME clinician
Waiting List = long delay
Slide 5
The CAPA system…
6
The 11 Components
Foundation
Choice
Transfer
Partnership
Letting Go
7
What CAPA is…
It is about
Doing the right things = on the right goals
With the right people = with the right skills
At the right time = with no waits
8
5 Big Ideas that make CAPA different
1. Choice
2. Selecting clinician for Partnership
3. Core and Specific work
4. Team Job Planning
5. Peer group discussion
9
1: Choice
It is a STANCE in EVERY contact and the name of the FIRST
appointment
Aims of Choice:
Find out what they want
Use our knowledge to jointly form an understanding
Goals and Outcomes
Together choose what will be helpful: Shared Decision
Making
NOT…
Assessing a passive young person and family
Handing down a diagnosis and treatment plan
10
2: Selecting Partnership Clinician
This is
At the end of the Choice appointment
With the young person’s and family’s goals in mind
Selecting a clinician in Partnership who has the
Skills to work towards those goals and (maybe)
A personality that matches the young person and family
Fully booking them in using the Core Partnership diary
11
3: Skill Mix Layering
This means describing the whole range of skills of the
service into two layers:
Core
Specific
This allows
Lower complexity skills to be privileged
Reserves and protects “specialist” skills
Allows job planning and capacity management
Smoothes flow through the system
Enables a “light” touch
12
4: Job Planning
Each individual has a job plan that describes their
work in various ways including
Core and Specific Capacity
Combined to form a team job plan
Useful to managers and clinicians as describes
predicted activity
Can show effects of losses
Contains activity for clinicians
Based on “do-able”numbers
13
5: Peer group supervision
Meeting weekly in small groups to talk
about ongoing work
About 1 to 1.5 hours
3 to 5 people
Not single discipline
Stable or random groups
Pro’s and con’s to both
Aim for everyone to present each week
Slide 14
CAPA is used all over the world
UK
Ireland
New Zealand
Parts of Australia
Nova Scotia, Canada
Belgium
Eindhoven
Slide 15
CAPA is used in
CAMHS
Adult mental health (NZ)
CAMHS Learning disability
Adult learning disability
Being extended into adult addictions
and services for the elderly (Canada)
Paediatrics (NZ) and pain management
services are working towards it
Slide 16
CAPA and CYP-IAPT
Share the same values and philosophy:
service user at the centre of everything we
do
Collaborative practice
Focus on goals and outcomes
Focus on skills and matching these to the
goals of the service user
Smooth processes and easily accessible
services
Slide 17
CAPA also
Uses demand and capacity techniques
to increase capacity and efficiency
Team culture of flexibility and
continuous service improvement
Promotes development of extending
skills in staff
Slide 18
CYP-IAPT curriculum
CAPA is an example of service
improvement that may be chosen to
facilitate CYP-IAPT implementation
Slide 19
CAPA & IAPT Venn diagram
Slide 20
CAPA spread - why?
It brings clarity
It is collaborative at its heart
It is efficient
It has a language that allows service to
describe themselves
It fits with people’s values
It works!
Slide 21
National Evaluation: England 2009
Mental Health Foundation
Findings
Few teams were implementing
Job plans (Key component 8)
• 97 teams implementing
• Av 6 out of 11 Key Components
• waits to a first appointment dropped
•
•
•
•
from 7-108 weeks before to 5-12 weeks
after CAPA
Families satisfied
Reduced demands on the service
More formalised team working and
better planning infrastructure
Greater transparency for staff and
families
Full booking systems (K c 5)
Handling demand ( K c 3)
Recommendations: including
CAPA should be rolled out
gradually, for teams to opt-in
A national support framework
for CAPA should be established
National recommendations
1.
2.
3.
4.
5.
6.
CAPA should be rolled out gradually, for teams to opt-in
A national support framework for CAPA should be established
An enhanced training package should be available
A national online network and directory of CAPA implementers
could be developed
The CAPA implementation training and support package needs
to address the commonly held CAPA Myths
Case studies to illustrate how the system can work in different
types of services
Local Implementer recommendations
1. Facilitative team management is crucial- an informed manager, a
2.
3.
4.
5.
6.
clinical lead, and an administrative lead (CAPA Key Component 1)
CAMHS teams implementing CAPA need mechanisms to facilitate
effective team working: peer group supervision and regular away
days (CAPA Key Components 10 and 11)
Children’s Trust directories should be used to promote multi-agency
work or to signpost families
Successful implementation of CAPA should involve staff from a
variety of roles within the CAMHS
Monitoring and feedback are integral prior to, during, and after the
implementation phase
Local regional support systems should appoint a number of local
CAPA champions
CAPA Myths
There are lots of myths!
The Mental Health Foundation report these…
Choice means they can choose anything
Partnership is limited to 6 - 7 sessions
Only allowed one Choice appt and for 1 hour
Choice does no assessment
Complex cases don’t fit into CAPA
Not allowed to do specialist work
Job plans are inflexible
No long term work
25
New Zealand Update
14 CAMH services using CAPA
2 CAMH services using aspects of CAPA
1 DHB with adult services using CAPA
5 DHBs considering how CAPA could work for
their adult services.
All in all, it has been a good response to the
model and each service is ensuring that
CAPA accommodates their local needs.
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.”
Our findings to date….
CAPA results in improvements in service
delivery…..
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
improved use treatment goals and planning
processes
Benefits…..services reports
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.
CAPA - lite
Many teams struggle to implement all of CAPA…
Formal details
Full booking from Choice to Partnership
Team Job Planning
Values
Working in a Choice framework
Adding value to user vs. organisational targets
Changing language
Practical things
Monitoring of Partnership Activity
Regular away days
Small peer group weekly IntraVision
However they do manage to call it CAPA!
Slide 30
CAPA-ccino
Has less coffee in it
A frothy top that
Belies the lack of substance inside!
Slide 31
The Challenge to change
Implementation Gap…
What is adopted is not used with fidelity
and good outcomes for consumers.
What is used with fidelity is not sustained
for a useful period of time.
What is used with fidelity is not used on a
scale sufficient to impact social problems
Dean L. Fixsen and Karen A. Blase, 2012.
Stages of the Implementation Process
1.
2.
3.
4.
5.
6.
Exploration and Adoption
Program Installation
Initial Implementation
Full Operation
Innovation
Sustainability
Fixsen et al 2005
Implementation Teams
Minimum of three people (ideally four or five)
Expertise to promote effective, efficient, and
sustainable implementation, organization
change, and system transformation work
Implementation teams are sustainable even
when the players come and go
Higgins, Weiner, & Young, 2012; Klest & Patras,
2011
Transformation of services is achieved by:
Program-centred or practice-centred
rather than practitioner-centred
Programmes implemented with fidelity
High level of involvement by program
developers on a continuing basis
Fixsen at al 2005
Slide 35
The Challenge
Both CAPA and CYP-IAPT are
programme centred
CAPA fidelity can be monitored- should
we enhance that for CYP-IAPT?
CAPA programme developers intensely
involved in ongoing development and
support - how will this happen for CYPIAPT when the programme ends?
Slide 36
Support tools
Book The Choice and Partnership Approach- a
service transformation model (2013)
Website www.capa.co.uk
Training workshops Introductory
Implementation
Refresh and Troubleshoot
Ongoing support- email/Skype
Self evaluation: CAPA-CRS (paper and online)
Fidelity tool: CAPA-FACE
Are we busy doing lots of work...
…but not the right things?
Conclusion
A Marriage made in Heaven!!
Slide 39