Big Idea 2 - Core and Specific work
This idea is about separating the clinical work we do into two segmented work streams: Core and Specific work. This reduces bottlenecks and smoothes flow (for more information see the 7 HELPFUL Habits section).
Core work
In CAPA, Core work is the bulk of what we do most of the time. It is work that uses a range of skills, involving liaison with the system and other psychosocial interventions. It requires clinicians to have extended clinical skills in key areas, at a threshold level of competence. All professions can do Core work if they have a range of threshold level, extended clinical skills (see Chapter 6 for more details). Although Core Partnership work is the bread and butter of the work, it isn’t, and shouldn’t be seen as, the least skilled area. Core clinicians are highly flexible and experienced. This Core work is the clinical domain where good, widely skilled clinicians work.
Specific work
This is when we use a particular assessment or therapy skill in a pure way, to complement Core work. It may be of short duration e.g. psychometric assessment, or longer term, more intensive work e.g. systemic family therapy teams, formal CBT or psychodynamic psychotherapy. Clinicians working in this way may have done higher-level training and would be able to supervise someone else in that skill. A young person or family accesses these Specific skills by the Core worker asking another clinician to join the Core work to add in a specific assessment or therapy skill. It is an adjunct to the Core work.
Why have these two types of work?
The gains of having Core work are:
- Many children and families can be helped by core/threshold level work = fast access to something that will help
- Extended Core skills reduce bottlenecks to specific work = no waits to needed Specific interventions
- Extended Core skills increase clinical flexibility = fewer queues/waiting lists to see a particular clinician
- It allows us to identify AND PROTECT team and individual capacity for Specific work = need for range of specialism's in team is formally recognised.
In other words, it allows young people and families to quickly access help to work on issues that matter to them by seeing clinician(s) with extended Core skills that can help with their problem. It reserves Specific work of many types for those young people who need a more intensive intervention.
What is the challenge of defining Core and Specific work?
Core work
Most of the team are expected to do Core work for some part of their week. This may create anxiety about learning new skills. Of course, this is also a benefit as it creates a learning culture with time.
Specific roles
Initially, in a team that is new to these concepts, there may be some debate about seeming to reduce Specific roles. Some can feel that to be a professional they need to be doing ‘Specific’ work, that they may see as more ‘specialist’. Our view is that the Core Partnership work needs Specific Partnership work to support it. Defining clinicians’ Specific time promotes and preserves it. The shift is that this should come about through transparent team job planning (the 4th Big Idea!) rather than decided by individuals or professional line management.