Question 1

What happens in the situation below?

Specialist skills

In this team there are eight clinicians: one has skills at advanced level and the other seven have no advanced or core level skills in this skill domain. Think about this for moment before you read the text after the diagram.

This is a fairly straightforward question as we often come across this situation. There will be a wait for the clinician with the advanced skills. This person will no doubt feel very stressed and there may be a sense in the team that they need more of this advanced skill due to the bottleneck. The bottleneck (waiting list) will mean that fewer clients receive any of the clinical skill they require, some will receive the right intervention and some who would have been treated and helped with the lower intensity intervention will have received more than they required which might actually not even be helpful in their own personal outcome.

Question 2

What happens in the situation that is shown below?

Core skills

In the situation shown below there is another team of eight clinicians. Five have core level skills in a particular skill domain and three have none. There is no one in the team with any advanced level skills. What you think will happen now?

This is a little harder, so once again have a think before you look at the text after the diagram.

In this situation the majority of clients probably who need that particular skill will get an appropriate intervention as there are several clinicians with core skills available. Those clients who needed a more advanced, higher intensity intervention will not be able to receive it. The consequences of this may be that there are more critical incidents and more escalations to a higher intensity service such as an admission.


The diagram below shows our view of a CAPA team skills distribution. It has both a number of staff with core skills and a smaller number, of staff with advanced skills (in this diagram it is a single clinician). This will allow the appropriate allocation of service users to the skill set and intensity that they need as well as maximising flexibility and flow through the service.

Skill mix layering