Continuous Improvement in 2014

Happy New year! 

The New Year has made me reflect on how things have changed with CAPA over the years. It has brought home to me how the essence of CAPA is one of continuous service improvement with the client at the centre of everything we do. It has evolved, and continues to do so, within the 11 key components. 

Our experience of working with so many wonderful services in so many countries is greater understanding of how to help people adapt the components to work in their setting.  This doesn’t mean doing CAPA-lite however- which we know doesn’t work and causes more problems ! But really understanding the philosophy behind all the components helps us evolve to whatever the climate is. 

When myths appear- such as ‘CAPA won’t work for us because our session average is more/ we work in people’s homes/ we have a very vulnerable client group/ we do long term interventions’ it makes me realise that perhaps we have not emphasised the continuous service improvement philosophy enough. None of these things mean CAPA can’t be implemented- you may just need to adjust the maths.

 I think we all wish for ‘the answer’ that can easily be put in place and require minimal effort- whether it’s our New Year’s resolution of going to the gym, eating better or giving up smoking. But deep down we know that to change takes resolve and adaptation- and increases if the going gets tough. But then it just becomes something you do and you can’t imagine life any other way.

 CAPA gives us a framework and tools to continuously improve and so will continue to evolve in 2014! Watch this space.

 Happy New Year!



Phew! After 10 days of weird struggling with the server I have finally uploaded the new website! Hope everyone likes it.



Just got back from presenting on the 2nd day (as well as a workshop) of a launch conference for the Scottish HEAT strategy. This is about incr4easing efficiency and access across all mental health. It was interesting to hear that CAPA is in play effectively in some service and others are just about to start. Lots of change…

However the really exciting thing was that we got to hear Karen Blase talk. She is leading researcher on implementation science in the real world ie what actually helps change and new programs work. Not only was she a great speaker, relaxed, knowledgeable and funny but said really good stuff. I was reassured that lots of the CAPA stuff we do is in line with the science – we’ve just learnt this from the 500+ teams we’ve worked with but there was also stuff to learn.

I think the sound bite knowledge was that you needed 1. Values ( as everything inst on a flow chart and you need to know how you decide), 2. a clear set of practices [eg the CAPA CRS], 3. these practices operationalised ie what you have to actually do and 4. direct feedback and coaching on those practices. It came to me that we need to talk more about teams doing this re Choice if their implementation is going to go well.

She also talked about values based management – i dream of this!!

HwattFinally it was neat to be @ Herriot Watt university as the first small talk Ann and I did on all this was there just over 9 years ago!!

Nova Scotia in the Fall


[Chocolate lake outside Chocolate Lake Hotel in Halifax – a workshop venue]

Well we’ve been back a week now and i think I’ve recovered enough to reflect on our recent trip: one week across Nova Scotia. It wsa pretty full on: 2 introductory workshops in Sydney (yes there is a smaller one!) and Truro. 100 and 143 people. Very full and full  of energy, 2 master class level 2 workshops in Halifax (110 each time), 2 regional tele-health conferences and 9 individual team coaching sessions.

It was really exciting for us to hear about the positive changes (and challenges) that had occurred across Nova Scotia in all types of mental health services. Also to hear the developing history of Halifax, the first site in 2011, the second wave of the Valley and Cumberland and the services just beginning everywhere. Its very moving to hear of the commitment of staff in taking risks with a  new system and their appreciation.

We noticed this last time we were in Nova Scotia and it happened again – talking about CAPA for five days draws us into thinking about issues a little deeper and from different perspectives. And this time we found ourselves reflecting on the importance of formulation in the Choice process. Without good formulation someones goals are really just wishes. And good goals need a formulation to evolve from.

So we a section of the masterclass PowerPoint around this. It was quite thought provoking and we shall add more content to this soon. In a week or so the new site will be uploaded and this presentation will be there.

Finally thanks to all for making us so welcome: Sharon in particular, Laura for her logistic support and Dana and John for a night out with old friends! Plus we got see and ice hockey game! Heaven.

Visitors from Nova Scotia

We’ve had our wonderful colleagues from IWK ( Nova Scotia visiting our teams and finding out about CAPA and CAMHS in England. Sharon, Kathi and Ruth spent 2 days with Steve and his team and 2 days with mine last week. They also visited the CYP-IAPT Accreditation Council, QNCC and CORC.

They have been implementing CAPA for the last few years and wanted to see how things work here. So they sat in on Choice and Partnership appointments, saw the team diaries and job plans and how we are integrating CYP-IAPT.

They had lots of other experiences of general CAMHS too such as inpatient, outreach and Deaf services in my organisation and Children Looked After and YOT in Richmond.

A jam packed week!

Their reflections on CAMHS in England, the NHS  and the things they saw were really helpful. One thing they commented on was how they felt they benefit from providing all services whereas we have to work with non-health organisations that provide CAMHS and they felt the embedded workers  in my team were a great way of doing this. We think so too!

We are going over there for a week soon to support the province in their CAPA implementation- their further reflections will be really interesting with a week’s hindsight!



Book finished!

Well haven’t posted here in a while and there seems to have been so much happening.

Mostly Ann and i have been working flat out to finish the new book. We have written it in system free language so we feel any service can pick it up and find useful. Its at the printers today for proofs and if they are OK then will be printer at end of next week hopefully. The whole process has not been helped by deciding in Nov we needed to completely rewrite the structure and a lot of the content as then more recently my laptop crashing on multiple occasions!

Has also been interesting the increasing synergy between the aim of CYP-IAPT, shared decision making and CAPA. From our point of view these all come together in the Choice appointment and we’ve been playing with a more detailed review measure of this appointment that the clinician, the young person and the family can fill out. Scary but surprisingly satisfying too.

Finally i have been helping some local teams implement. This has been much more hands on than I’ve experienced before (usually its via supporting team managers etc) and this has helped me how to say things more clearly as well as develop some tools to help. These will be on the new website – currently in development.

See you soon – Steve


Ann and I visited Guernsey on Friday. Another country – sort of! Smaller island than i realised and facing the many challenges that all CAMHS teams do especially not having clear process so unable to solve issues clearly. This was just a “Window Shopping” workshop so they could decide if they wanted to do CAPA or not. The interesting challenge there amongst everything is that it costs a fair amount of money to go and see the GP (maybe £40) and so “letting families go” back to primary care is a challenge as they really don’t want to go!