Clinical change after the implementation of the Choice and Partnership Approach within an Australian Child and Adolescent Mental Health Service

Abstract

Background: The Choice and Partnership Approach (CAPA) model has been implemented widely into Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom and similar health systems in Australia and New Zealand. This study investigated whether the implementation of the CAPA model was related to changes in client clinical outcomes and response times within a regional Australian CAMHS. Method: Multiple measures of time, clinical diagnosis, contact and outcomes were collected at intake and discharge for 33 clients prior to and 77 following the implementation of CAPA. Results: A two-tailed t-test showed that the significantly reduced waiting time was associated with the timing of CAPA implementation. The Health of the Nation Outcome Scales for Children and Adolescents information subscale showed a significant post-CAPA implementation improvement. A chi-square test for independence showed that the CAPA model group had significantly more initial clinical appointments. Conclusions: After the implementation of CAPA, the flow of young people through the service improved, with children and adolescents being seen in a more timely manner. The findings highlighted that the greater client throughput did not negatively impact upon clinical outcomes. Further prospective research with the completion of multi-informant outcome measures is recommended. Key Practitioner Message• Utilising the CAPA model, CAMHS may improve access to and flow through the service without increasing clinical demands.• The CAPA model may lead to young people being seen significantly faster than previously.• One of the six HoNOSCA measures (Information) demonstrated a larger pre-post change for the CAPA cohort than for the comparison group.

A systematic review of current approaches to managing demand and waitlists for mental health services

“…The partnership approach is explained to new families during the initial Choice appointment and families have the option to participate in services delivered according to this approach or receive mental health care under the traditional model. Most studies (Clark et al , 2018; Naughton et al , 2015, 2018) reported significant reductions in wait time for the first appointment, and Fuggle et al (2016) found a trend of shorter wait times and increase in the overall number of first appointments offered. Wilson et al (2015) found that the eight agencies met demand with available appointments and had no waitlist, despite an increase in demand over the study period.…”

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

“…In our review, only seven evaluations reported clinical outcomes, all reporting positive findings. 14 30 31 36 41 64 66 However, only three measured changes from baseline. 14 31 36 Patient-reported outcome measures, such as the Revised Children’s Anxiety and Depression Scales or Goal Based Outcome Tool, while recommended by healthcare systems internationally and demonstrated to benefit shared decision-making, 91 were not often reported.…”

The impact of a needs‐based model of care on accessibility and quality of care within children's mental health services: A qualitative investigation of the UK i‐THRIVE Programme

“…Yet some viewed it as compromising effectiveness and one service user was demotivated by limited sessions. Although some studies suggest that focused interventions are inappropriate for complex cases, others indicate that goal‐focused systems can improve efficiency without reducing clinical effectiveness or user satisfaction (Fuggle et al, 2016; Naughton et al, 2018; Robotham et al, 2010). Taken together, this highlights the importance of monitoring clinical outcomes and user satisfaction.…”