Keeping a Choice client?

There is no hard and fast rule about always transferring a service user to another clinician for Partnership. However, there are good reasons about why the default position should be to do so.

Why Change?

The first is all the factors stated earlier about why the transfer helps, especially in maintaining curiosity. In small teams or lone workers this means doing Choice as if you will not see them again, even though you probably will, helps in reaching a Choice Point.

Secondly, it makes best use of the skills mix of your Core Partnership team.

Why Keep?

OK having thought about the good reasons to keep selecting another clinician in Partnership, what are some to consider not transferring?

1. When the person has revealed something very personal or traumatic that they do not want to have to tell again. Of course, they might be glad of a chance to say this and move on (our audit on the session being a one-off that made adolescents and families feel more open). Giving them the choice about staying with you (if you have the skills for the goal) or someone else might be helpful. The important point is don’t assume their preference - offer a choice.

2. When you, as the Choice clinician, have done a huge amount of work in getting to the Choice Point. Some of this may involve working with the multi-agency system, attending professional meetings and this knowledge might be really important to have in the Partnership work. However, you still need to offer the client the choice of someone else or remaining with you.

3. Service user choice! They may just get on with you, feel confident in the Choice you made together and you might have the next appointment!

Note of Caution about Keeping

If it seems that you or another member of the team could provide the core skills for the desired goals then it is worth thinking about your own skills and attributes relative to the team. If you have a skill or are of a cultural background or gender that is rare in the team then you need to make sure you are available to any client, not just the ones you see in Choice. Keeping your own Choice client to work with in Core Partnership means you are less available to others who may need you more.

A tone of sad regret?

There is no doubt that some clinicians really want to help everyone and struggle to separate from the client in Choice. The session might have gone well, they made a connection or the work looked attractive or meaningful. When this happens, how you have talked about the process of selecting the clinician for Partnership is important.

If your literature said this and you positively describe selecting a clinician with the right skills for their goals in the Choice introduction (families nod in agreement here) it will go well. However, if you forget to mention it and at the end of the Choice appointment say in a tone of sad regret ‘I’m sorry but I have to transfer you…’ – it won’t go well! The family and young person will no doubt feel deprived and less enthusiastic about the receiving Partnership clinician.

Example: you keep the client for some Core Partnership family work. You also have Core Partnership CBT skills and many of your Core Partnership clinicians have family therapy skills but there are fewer with Core level CBT. Keeping the family yourself means reduced access for other families to that less available skill (the CBT). Lots of people in the team could help them systemically (Core family therapy skills). In another situation the gender or cultural mix may be very uneven and ‘keepsies’ allocations may worsen this.