Service Story CGG Noord-West-Vlaanderen, Belgium

Service story provided by Veerle Louwage (care coordinator) and Frederik Gevaert (clinical psychologist)

CAPA experience

Impact

Individual clinician caseloads prior to the waiting list blitz led to long waits (avg. 6 months) before treatment started. Now reduced to 6-8 weeks wait for the first partnership appointment and less drop out. The time to a Choice appointment varies between a week and a month after the first contact.

Sustaining CAPA

We have an internal task force with representatives of the different teams and disciplines (management, psychiatrists, therapists, administration) overseeing the process and watching over the philosophy.

A biennial Team Away day with discussion groups and workshops (e.g. letting go, getting context involved) helps to evaluate, detect needs and gets everyone involved.

What do we like?

• The model helped us match service demand and capacity.
• The philosophy of ‘collaborative practice’ matches our contemporary view on mental health care where we see our patients as active and equally involved from the beginning of the treatment.
• Choice results in a more dynamic organisation model than the previous intake format. It led to more active client involvement from the start, clearer goal setting and eligibility criteria. Next to that, it fostered the ‘common language’ we speak in the multidisciplinary teams.
• Matching the client with the clinician who is most suited for the partnership. Full booking gives clients a clear perspective. It’s easier to actively bridge the gap between Choice and partnership.
• Flexing to make sure that Choice appointment takes place within four weeks after the first contact.
• Increased staff involvement with the vision and mission of the organisation and with managing capacity. Our staff is nowadays very involved with our social assignment.

What helped?

• Informing (teamdays, presentation Eric Schoentjes Ghent CAMHS) and training (Masterclass CAPA) staff helped to create support. Using appraisals to develop staff profiles, jobplanning and explore training needs.
• Full management support to thoroughly implement the model.
• A broader change oriented culture with open minded, positive and engaged care workers. Open communication is necessary to make this work.
• An effective internal task force with members that have a mandate to further implement the model and to do what is needed.
• Participating in the international CAPA network meetings.
• CAPA workbook and website.

Problems and advice?

You don’t start with a clean slate. Transition from the previous system to CAPA involved a massive shift in the way we think (e.g. less control over caseload, transparency)  and blitzing a significant waiting list.

• Create staff support by team meetings focused on understanding the CAPA-philosophy. Having someone who already works with CAPA share experiences was a plus. Using appraisals and team meetings to probe for worries and develop job planning. It helped to get the administration teams aboard from the start, as their support is key.

• Letting go is an ongoing challenge. Discussing letting go from the start, clear goal setting/monitoring and (letting go) team discussion proved important in preventing bottlenecks. Discussing concerns on ending the partnership and anticipating them helps clients to let go. Clients can come back if necessary. This however, requires a flow through the system.

• As an organisation you need to be aware off the high demands the CAPA model brings: care workers need to
  • limit their goals when faced with complex stories, 
  • actively involve the context in the process (e.g. joint formulation: use them as a resource),
  • discuss their cases thoroughly with their colleagues.

It helps to support the care workers by creating a value driven culture where they can lean on each other, where it’s okay ‘not to know’, where authenticity is appreciated.

• Being transparent on job planning. Ensuring that job planning has a manageable caseload and takes in account sufficient time for admin, team meetings, training, etc.