Implementation!

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!!

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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

CAPA-ccino and other beverages…

We visit and hear about lots of teams who say they are doing CAPA but when we look closely they are doing some but nowhere near all of the 11 CAPA components. Our experience is that this CAPA-lite model really doesn’t work very well! In fact this was a key finding of the Mental Health Foundation of English CAMHS and CAPA, that there were many partial implementations often due to myths about CAPA (MHF report).

At a recent conference a delegate suggested that we should call such a service not CAPA-lite but CAPA-ccino! It has less coffee, is covered with a frothy top and suggests it is more substantial than it is.

More extreme even was when we came across a service that said they were dong CAPA and had merely converted their first appointment into triage, called it Choice and nothing else! As another delegate suggested this should be CAPA Zero.

So if you think your service is meant to be doing CAPA but it isn’t a full and satisfying double espresso, check out the self rating scale…
Steve

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.

Ann

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.

Steve