CAPA implementation and leadership

Question: The issue of who should lead CAPA within our teams is currently being discussed as is the issue of what the tasks of a CAPA lead actually are in the first year. We are uncertain whether our leadership model should be based on one person or indeed whether carefully differentiated tasks should be delegated to a small number of people within each team. We do not have an overarching team leader and this is not something that is currently up for debate. Moreover, we need to ensure we have the appropriate CAPA leads to take us through this first year

Steve and I advise that teams have a CAPA leadership team of manager, CAPA clinical lead and Admin lead. The main tasks in the first year are to keep things on track – and this means monitoring what is going on, checking Away days have supportive content, reviewing job plans, co-ordinating any service audit that is happening etc.

The clinical lead role can rotate of course, and this can be helpful so that the ownership is not located within one person. The skills and knowledge needed are enthusiasm and knowledge about CAPA and ability to work with others to take it forward. All the actual work – such as job planning, audit can be delegated within the team.


Adult Eating Disorders: new steps…

I met with the manager of the my trust adult eating disorders team yesterday. They are joining two local teams and were looking for a service model to bring the services together. She had heard of CAPA in CAMHS in my trust and wanted to know if it might help.

Initially we talked about the numbers and how to work out treatment (Partnership) activity. As that maths is simply based on the number of contacts a clinician can do if a half day and the average treatment duration, finding the right multiplier for her service would be fine

She could see that the collaborative stance with patients, the peer group discussion and layering skills in her particular service into the specific specialist skills and extended core versions of these would really make a transparent, open service. It’s really exciting to work with a new team and service area and to work more on not translating CAPA into adult mental health but thinking about the principles of CAPA and how they work in a wide range of services – system free CAPA!

I’m going to go to the next team meeting to talk with everyone as a taster.



FAQ: how long does it take to do a Choice appointment?

Q: Hi- I am wondering how long it takes to do a Choice appointment?  I have heard that sometimes it takes 20 minutes and sometimes several hours! Which is right? I am worried someone will tell me I have to do them in 20 mins.


Both! The aim of the Choice appointment is to reach a Choice Point ie to have a joint understanding with the family/service user about what is going on, what goals and outcomes are being sought and how these can best be met.

If the family is well known to CAMHS e.g have been before and lots is known AND the goals are clear, then it may take only 20 minutes to work out what is needed together. E.g. a family who move back into the area bring their child who has previously been on medication for ADHD. They want to restart. All the assessment and background is known from before so what is needed is an update- what is going on now? What do they need help with and how can this be done? Any risks?  The intervention in Partnership may then be rapidly agreed.

Similarly, someone coming back with another bout of OCD- the focus may be on what are the symptoms now and how can they restart all the things they learned previously plus an update about circumstances, including any risks.

For brand new service users, the conversation will take longer- getting to know them, what they want, how they see things. If someone key in their system is not at the Choice appointment (e.g. the adolescent did not come, only parents, or dad needs to be included, or the social worker) then a Choice Plus appointment needs to happen to reach the Choice Point.

Timetabling in CAPA generally allows of 2 appointments in a clinical half day so you can spend 90 minutes if needed.

Of course, how many Choice appointments you can do in a half day depends on your admin system. If quick and easy it may only take 30 mins. Since moving to an Electronic Care Record the team I am in need 2 hours to complete the admin in addition to the 1 hour admin staff need.



FAQ: Do Choice numbers factor in leave?

Question: Hi! I wonder if you would kindly answer a question about the CAPA model that is causing some confusion here. The confusion surrounds a practitioner’s choice and partnership in the quarter when they are on holiday.

 Q: If a practitioner has 15 choices to undertake in a quarter and they go on holiday, do they still have to do all 15 choices in that quarter? If they still have to do all 15 Choices, should they be made up in that quarter or the next?

 Hope this makes sense!

 Answer: Hi! OK first to answer a question you didn’t ask (!). The partnership numbers are based on job plan and the multiplier of 3 already accounts for holidays so whatever their number is, that is what clinicians need to do.

 However this isn’t the case for choice. Choice can be organised however suits the team and is reasonable and doable.

 The top rule is that total number of choice offered must equal what is required for the whole team. This total number can be divided up amongst the team in a number of ways:

  •  A quota per person – either prorata, based on FTE, or same number each (or another way!). E.g. a team needs 100 Choice and has 10 FTE. This equals 10 per FTE per quarter. So a 0.5 FTE would need to offer 5 in the quarter (next 3 months).
    The number that this produces then is job planned. E.g. if 10 per Q and each choice takes say 2 hrs including admin then 10 x 2 = 20 hours / 13 weeks = about 1.5 hours per week in job plan.
  • A fixed weekly rota e.g. 1 every week there (= 11.5 per Q – accounting for leave). This does factor in leave as there would not be an expectation to do choice when on leave or to make up when back.

It’s whatever suits the team and delivers the right number so leave doesn’t come into it directly.



FAQ: How to manage ASD?

Question: My clinic started CAPA in July 2010. CAPA has helped to reduce waiting list and time to be seen. However, many of our referral and choice seen came out with the possibility of ASD. How to run CAPA with many potential cases are ASD? We don’t have neurodevelopmental team available.

Answer: Hi. You sound like the service I am in- we have a lot of neurodevelopmental in Choice.

We manage this in the team I am in by having a neurodevelopmental Partnership clinic. So if this type of assessment is needed they are booked in from Choice – screening is done in Choice. We don’t just assume such an assessment is needed from the referral. So that means those doing Choice need neuro screening skills. The Partnership multiplier we use in the neuro clinic is still 3 as we have found the session average is still around 7.

We have trained up clinicians to do Neurodevelopmental assessments – and so we have a subteam made up of a range of professional backgrounds. We don’t have SLT or OT in the service so these assessments are not included in our ND assessment. However, if they are indicated as a result of our assessment then we refer to the relevant service locally. We used to have SLT who joined us but this has been withdrawn due to cuts a few years ago.

Everyone doing the assessments is able to do basic social communication assessment with the child – we have been given help from the SLT who used to work with us to do this- i.e. have extended our skills in this area. However, if they need a CELF or such like then we could not do this.

So you have various options: Your SLT and OT could be in Partnership, joining the assessments for Specific Partnership work and you could ask them to help extend your skills so you can do some assessments, bringing them in for the more complex ones- probably a more efficient option

A final thought is also not to assume what ASD referrals want. Often we feel they need a thorough assessment (whatever that is). They may be more pragmatic.

Ann (and Steve)