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!

Talking about Choice

Was doing some supervision today and talking about a case of a very anxious mum who seemed over involved with a dependent and anxious child with a diagnosis of Aspergers.  What she wanted – for any “help” – didn’t seem to match well our understanding that her relationship with the child was a part of the issues that we’d like to think about.

This raised a challenge of how do you get to a Choice point if your mutual understandings are miles apart. The clinician I was talking to had actually booked the family into a partnership as they “clearly needed help” (i agree) but not with any mutually agreed goal.

I think the “honest opinion” step of Choice maybe should have been used a bit more. Comments on how close they seemed. What did she think of that? Asking whether mum thought how she felt affected how the child felt or maybe what was her view of successful development or separation. Do you have any thoughts? I think this is trying to get at mums formulation of the situation rather that her experience of the situation…

Just goes to show that although CAPA definitely helps (we think) it doesn’t always make every situation easy!

Exciting times

Well since I last posted we have been to Holland and Wales! And next is to an international conference in Paris to jointly present a workshop with Folk from the Werry Centre, New Zealand.

But the exciting bit is that Ann and I are just piloting a new measure the CAPA FACE.  This is a more detailed evaluation tool for us and services to get a close look ay how near to full CAPA they are and what steps they need to take to get there. The neat bit is that it is an interactive PDF so you can just click the boxes and it works out all the scores for you. We hope to have it available to all through the website soon.

We are also steaming ahead with the new book. It will have some extended and revised content and we want it to be available in September. Phew!


Our tour down under!

Ann and I have been very privileged recently to do a couple of weeks work in New Zealand and Australia around CAPA. We spent three days in Auckland working with the Werry Center (NZ’s excellent CAMHS change organization) including one day’s masterclass with CAPA champions from cross the country. Then we flew to Wellington, met with the local Adult mental health team in their service (great to visit actual buildings and staff) followed by a CAPA conference for the whole DHB (organization). After that we flew to Sydney briefly and on to Orange (160 miles west and inland of Sydney) doing two workshops there – one for staff and another for clinical leads, planners, clinical directors etc. After flying back to Sydney we had a day off on the Wednesday and then two metropolitan conferences in the city.

So much to talk about but for me the highlights were:

  • the positive feedback from the Christchurch team about how CAPA had increased their team cohesion so they had been able to provide a service through the difficulties and been able to flex choice capacity in responses to waves of referral demand. Humbling experience to hear about them, their situation and their efforts.
  • the discussions with adult consumer advisers (service users) about what they would like the initial appointment to be called. They said they really did not like “First Assessment” as they did not want to be “Assessed” not did they like that the service was counting already! The loved “Choice” as “we wold love to be really able to feel that we had a choice”
  • turning up to Wellington airport to discover our booked flight to Sydney did not exist!
  • the size of some of the patches in the Orange area and especially so further inland, The size of Germany with only 100K people in them. And the challenges of the lone workers in these patches were enormous and their resilience was extraordinary.
  • cycling round the Manly dam cycle track on a hire mountain bike. This was not for beginners to advanced as advertised. Very scary for me anyway!
  • the energy of the Sydney metro conferences
  • and finally arriving at Sydney to come home to discover that our return flights had been unbooked by the airline as we had missed the non-existent plane!

We plan to be back in a year maybe. Thanks to all and to Ann for sharing it all with me.