Choice and Partnership Approach to community mental health and addiction services: a realist-informed scoping review

Abstract

ObjectivesThe Choice and Partnership Approach (CAPA) was developed to create an accessible, child-centred and family-centred model of child and adolescent mental health service delivery that is adaptable to different settings. We sought to describe the state of evidence regarding the extent, outcomes and contextual considerations of CAPA implementation in community mental health services.DesignScoping review.Data sourcesPublished and grey literature were searched using MEDLINE, Embase, CINAHL, PsycINFO, Scopus and Google to 13 and 20 July 2022, respectively.Eligibility criteriaWe included reports focused on the implementation, outcomes (clinical, programme or system) or a discussion of contextual factors that may impact CAPA implementation in either child and adolescent or adult mental health services.Data extraction and synthesisData were extracted using a codebook that reflected the five domains of the Consolidated Framework for Implementation Research (CFIR) and reviewed for agreement and accuracy. Data were synthesised according to the five CFIR domains.ResultsForty-eight reports describing 36 unique evaluations were included. Evaluations were observational in nature; 10 employed pre–post designs. CAPA implementation, regardless of setting, was largely motivated by long wait times. Characteristics of individuals (eg, staff buy-in or skills) were not reported. Processes of implementation included facilitative leadership, data-informed planning and monitoring and CAPA training. Fidelity to CAPA was infrequently measured (n=9/36) despite available tools. Health system outcomes were most frequently reported (n=28/36); few evaluations (n=7/36) reported clinical outcomes, with only three reporting pre/post CAPA changes.ConclusionsGaps in evidence preclude a systematic review and meta-analysis of CAPA implementation. Measurement of clinical outcomes represents an area for significant improvement in evaluation. Consistent measurement of model fidelity is essential for ensuring the accuracy of outcomes attributed to its implementation. An understanding of the change processes necessary to support implementation would be strengthened by more comprehensive consideration of contextual factors.

“I needed the help. They weren’t giving it”: Experiences of young people in tertiary education on waitlists for mental health services in Aotearoa

“…For some, this contributed to engaging in harmful behaviours, such as self-harming and substance abuse. These findings contrast slightly with those of Punton et al (2022) and MacDonald et al (2022) who found that some young people engaged in harmful behaviours in an attempt to be taken seriously by service providers and seen sooner. While any escalation in destructive behaviours is concerning, there is evidence to suggest that young people presenting with severe mental distress, such as self-harming, are more likely to experience shorter wait times than those with less urgent symptoms (Edbrooke-Childs & Deighton, 2020).…”

“…Experiencing long waits between the first and second appointments may reflect the use of specific service models. Within Aotearoa and internationally, many community mental health services implement the Choice and Partnership Approach (CAPA) (Campbell et al, 2022), which is a service improvement model designed to centre the unique needs of each young person seeking help while also effectively managing capacity and demand (Robotham et al, 2010). This usually involves an initial 'choice appointment' to reach a shared understanding of the challenges the young person may be experiencing and to collaboratively explore possible treatment options (Robotham et al, 2010).…”

“…The widespread uptake of the CAPA model has primarily been motivated by a need to reduce long waiting times (Campbell et al, 2022), and there is some research to suggest the implementation of the CAPA model has been successful in reducing waits to initial choice appointments (Pajer et al, 2022). However, there is concern that this is at the expense of wait times for the second appointment (Campbell et al, 2022). Service providers implementing the CAPA model in Canada have reported clients waiting months to receive a partnership appointment (Brown et al, 2022).…”