Community Child and Adolescent Mental Health (CAMHS) is one of the four workstreams of the Mental Health and Addiction Change Programme, with a key area of focus being the implementation or refresh of teams’ use of the Choice and Partnership Approach (CAPA).
CAPA is a service improvement model that, when used to its full potential, offers responsive and consistent services for tāngata whaiora and whānau. Benefits include more effective service delivery, and improved demand and capacity management.
“CAPA is all about working collaboratively with young people and their whānau, and actively involving them in their treatment and decision-making,” says Clarissa Ventress, Operations Manager for the MHAIDS Younger Persons Service.
Spotlight on Wairarapa CAMHS
A small team covering a large area, Wairarapa CAMHS (pictured above) consists of Registered Nurses, Social Workers, Clinical Psychologists, Consultant Psychiatrists, a Kaumatua, a Kaituruki/Cultural Support Worker, a Community Support Worker, a Co-Existing Problems (CEP) Clinician and an administration team.
Distance is a big consideration in the Wairarapa, with the team covering the area from Eketahuna to Castlepoint, and from Lake Ferry to Cape Palliser, with little in the way of public transport. This can result in travel time of up to two hours when seeing young people in the community – meaning less time available to deliver direct care. At the same time, there are fewer community resources - no ‘One Stop Shop’ – meaning there is more pressure on the MHAIDS team to deliver services.
Despite not having used CAPA previously, the team took up the challenge with enthusiasm, and worked together to pilot an approach.
The CAPA process begins with an initial ‘choice appointment’. These appointments help develop a shared understanding of the issues the young person and their whānau may be experiencing, as well as possible treatment pathways.
Under the pilot, team members had dedicated slots for choice appointments with whānau given choice around when they are seen. Following these appointments, the team started holding mini-multi-disciplinary team (MDT) meetings, at which they would discuss their provisional decision-making and get other perspectives. A plan for whaiora treatment would then be finalised that same day in conjunction with the whānau.
The pilot worked so well that after a three-month trial, it was adopted as standard procedure.
“This approach is more seamless for the team, as it means the initial choice assessment process is wrapped up the same day,” says Dawn Badco, Team Leader of Wairarapa CAMHS.
“The MDT discussion means young people and their whānau can move to the next steps in their treatment sooner, by ensuring good communication and collaboration between the whānau and CAMHS.”
At the same time, wait times have decreased, which Dawn attributes to more clinicians on the team offering choice appointments. While CAPA implementation is in its early days, she is encouraged by the benefits so far.
"CAPA has supported us by providing a framework," she says. “It ensures we understand the concerns and goals of the young person and their family, are able to undertake a risk assessment, and offer options to, and shared decision-making with, the young person and their family.”
Other changes undertaken by the team focus on improved communication with the community services that they work with. In the past, community expectations of the team’s role were not entirely correct, leading to confusion and delays for young people trying to access services.
“Better communication about our service and the treatment offered at CAMHS has improved our relationships, as it is now clear what CAMHS can and cannot provide," says Dawn.
Sharing ideas at service-wide hui
Wairarapa is one of the CAMHS teams from across MHAIDS that have come together to share ideas and knowledge at CAPA days over the last few months.
“CAPA is about collaboration and a culture of shared learning and development,” says Clarissa.
“The CAPA days have orientated CAMHS staff to the possibility of working differently, familiarising them with the CAPA model and language, and giving them a rationale as to why we need to change the way we’ve been working. The days provide the opportunity for the staff to share and learn from each other.
“There are seven teams and a vast range of experience across the sector. These days offer opportunities for staff with knowledge and experience of the model, to share with others who are newer to the model.”