6. Selecting Partnership Clinician by Skill
Selecting the Partnership clinician by skill i.e. choosing the appropriate clinician for Partnership based on the family/young person’s goals and chosen intervention style.
Traditional CAMHS systems tend to allocate a clinician based on information in the referral letter. The young person and family then sees that person and receives whatever intervention that clinician is able, or prefers, to deliver. The problem with this is that: Referral letters are not good at letting us know what people want The young person and family is not given a choice of intervention The intervention is determined by what the clinician can deliver, not what is wanted or suits the family’s goals.
Choice Appointment
In CAPA, the young person and family are initially seen in a Choice appointment. One of the tasks in Choice is to find out what they want to be different, discuss different ways of achieving this goal and then ensuring they are seen by someone best suited to help them. Booking the young person and family into the next Core Partnership appointment with this clinician thus often means a change from the Choice clinician.
Pull system
In Lean Thinking terms, this aspect of CAPA is a ‘pull’ system i.e. the resources are pulled towards the young person and family rather than them being pushed through a fixed, set way. Push systems are based on the flawed assumption that demand is predictable and that the best way to manage scarce resources is to require them to be used in a specified way. In traditional models we erroneously assume that a referral for a particular problem means a particular intervention is indicated. This is based on a conveyor belt way of thinking that X problem always needs Y. We all know that people aren’t as simple as this! They may not have the problem that the referrer thinks they do, they may not have only one neat problem and they may not want the same goals as the referrer. There may be a wide range of practice based evidence approaches that can help them.
In contrast, pull systems (as in CAPA) mobilise internal and external resources (i.e. those of the young person and family and network and those of your team) as needed. Rather than limit the resources available they help people find relevant options. What is provided is not rigid and fixed but the elements of what is needed are coupled together according to individual need. In CAMHS this means 1) making active use of the strengths and resources of the young person and family and 2) their networks/other agencies and 3) allowing clinicians to identify and mobilise the clinical skills when they are needed.
Because you do not know from the referral letter what the young person and family’s goals are, or their preferred way of meeting these, you cannot predict who may be best suited to them from the team. Thus it is likely that the person they see in Core Partnership is not the same person that they see in Choice - unless they have the right skills and the young person and family wants to stay with them.
What happens if you don’t select Partnership clinician by skill?
The family may not get the intervention they want and the goals and care plan might be vague. Thus motivation, alliance and focus may be reduced. Treatment might be less effective and not directed to the family’s goals. Drop out rates may increase. You may also be working in your team by profession and so not be extending clinical skills, reducing flexibility and perhaps creating bottlenecks.