National Evaluation in England

In January 2009 the Department of Health commissioned the Mental Health Foundation to undertake an independent evaluation of CAPA in England (NCSS/Mental Health Foundation 2009). The purpose was to examine how well CAMHS adopted the components of CAPA and understand the impact of adopting CAPA for services and families.

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What did they find?

Phase 1

442 teams were sent a questionnaire. 213 staff replied. 92% had heard of CAPA and 97 teams stated they were implementing CAPA. 53 of these 97 teams then completed a more detailed survey and, on average, were implementing 6 out of the 11 CAPA key components (range 1 to 10.5).

Seven teams were able to supply audit data pre and post-CAPA implementation. This showed that waits for a first appointment dropped from 7-108 weeks before implementation to 5-12 weeks after.

Phase 2

Benefits reported by CAPA teams were:

• Reduced waiting times: 92% of families were seen within 13 weeks compared with the national average of 78% (CAMHS mapping).
• Families were pleasantly surprised at how quickly they could get into the service
• Reduced demands on the service
• More formalised team working and better planning infrastructure
• Greater transparency for staff and families

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Challenges

Few teams were implementing job plans or full booking systems, which resulted in internal waits to Partnership, and few were handling demand in the way recommended by CAPA. However, most were conducting Choice appointments within an appropriate framework. Teams felt the need for more information and support on how to apply CAPA to complex and long-term cases.

The report made two types of recommendations:

National recommendations

1. CAPA should be rolled out gradually, for teams to opt-in
2. A national support framework for CAPA should be established
3. An enhanced training package should be available
4. A national online network and directory of CAPA implementers could be developed
5. The CAPA implementation training and support package needs to address the commonly held CAPA Myths
6. Case studies to illustrate how the system can work in different types of services

Local Implementer recommendations

1. Facilitative team management is crucial- an informed manager, a clinical lead, and an administrative lead (CAPA Key Component)
2. CAMHS teams implementing CAPA need mechanisms to facilitate effective team working: peer group supervision and regular away days (CAPA Key Components 10 and 11)
3. Children’s Trust directories should be used to promote multi-agency work or to signpost families
4. Successful implementation of CAPA should involve staff from a variety of roles within the CAMHS
5. Monitoring and feedback are integral prior to, during, and after the implementation phase
6. Local regional support systems should appoint a number of local CAPA champions

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What happened as a result?

The Department of Health (England) asked the National CAMHS Support Service to prepare a costed options paper that considers possible responses to the report recommendations. How- ever, due to a change of Government, discontinuation of the NCSS and financial recession the recommendations were never pursued. However, knowledge of CAPA as a positive service transformation model is included in the English Children and Young People’s Increasing Access to Psychological Therapies curriculum (http://www.iapt. nhs.uk/cyp-iapt/).

This national evaluation supports our experiences of the impact of CAPA on teams and families, including our own survey in 2007. The study also found that there are many misunderstandings of CAPA- hence our writings in the book and on the website about the CAPA myths! We know from many teams who have done service audits (some reported in the book and on the website) that families feel engaged, access is improved and teams function more efficiently and effectively. But planning and ongoing monitoring are key!