Choice Components

2. Language [DEMAND ITEM]

The service has changed its language and no longer refers to assessment, treatment or triage but either describes it to the service user (verbally and written) as Choice and Partnership or another collaborative local name. When considering clinical skills the service refers to a clinical competency not a particular discipline.

The words we use lead us into certain ideas. ‘Assessment’ and ‘treatment’ are things we do to people and may distract us from working collaboratively. Using ‘Choice’ and ‘Partnership’ or other locally chosen words can help re-position us with clients as ‘facilitators with expertise’ rather than ‘experts with power’.

This item is a DEMAND item as using the old language of ‘assessment’ especially is likely to transfer more service users from Choice to Partnership. It tends to make the Choice appointment a passive, problem - orientated experience for the client. If we stay with their choices and access their strengths then it can be easier to notice solutions outside the service. This will ensure the percentage transfer rate to Partnership is appropriate.

Stop here and review the team position. You may want to discuss the ideas in the article ‘Choice vs. a traditional assessment’ in Chapter 4: Choice.

3. Handle Demand [DEMAND ITEM]

The service ensures that referrals are appropriate e.g. using published eligibility and redirection criteria. Service users can chose an initial Choice appointment when their referral is accepted i.e. full-booking. The service flexes Choice capacity in line with referral demand to prevent a waiting list.

The first sub component (eligibility) has a strong impact on DEMAND - are you accepting referrals that are appropriate? There is a key difference between accepting any referral that your service could help (in other words, virtually anyone!) rather than those we should help.

Are other services appropriately involved? Is the problem better suited to them or us? Think about your screening process - is there a culture of what ‘should’ we do, rather than what we ‘could’? Is there wide variation between clinicians over what is accepted and not? If there is, how you can help reduce this variation? Team discussion? A check- list? Does the manager need to be present? Take a vote? Have a small screening team? What are your ideas?

4. Choice Framework [DEMAND ITEM]

At the beginning of the Choice appointment, all clinicians ensure that service users are informed about what will happen. All clinicians work in a Choice framework. Clinicians complete appropriate tasks for clinical governance and risk management.

This will probably result in not all service users choosing to return for Partnership. Your transfer percentage from Choice to Partnership is a guide to this. Much more than 75% and you probably aren’t engaging their strengths enough or are inadvertently being too problem/pathology focused.

This DEMAND item is closely linked to Key Do- main 2: Language. If Choice is not done well or robustly a number of people will progress to Choice who really don’t need to (and probably didn’t really want to!). The percentage increase may be small say 80% vs. 70% but they can all add up.

• Do you know if there is a wide variation in transfer percentage?

• What is the range of team views over when someone should be offered an intervention?

• Diverting clients to other local resources needs a good knowledge of what is available – so how is your resource file? Is it available and up to date? Is this anyone’s job?

Do a team workshop on when to offer an intervention in your next team away day.