A scoping review of the Choice and Partnership Approach in child and adolescent mental health services

Abstract

Child and adolescent mental health (CAMH) problems are prevalent and inefficient mental health (MH) care systems can contribute to poor outcomes. The Choice and Partnership Approach (CAPA) is a MH care delivery model aiming to provide efficient, high-quality care. Although widely used, no CAPA research review exists. We conducted a scoping review to fill this gap. Medline, Embase, and PsycINFO databases were searched from inception to June 2021. Grey Matters and Google were used to search the grey literature. We identified 5322 records. Removal of duplicates left 4720 documents, which were successively screened and data extracted by pairs of co-authors. The final dataset comprised six published and three non-published studies, conducted primarily at CAMH sites in England, Scotland, Australia, or Canada. Each study had multiple research objectives, which we summarized into seven categories. Positive outcomes were reported for most objectives, but attributing causality to CAPA was hampered by research methodology. Observational designs were used in all studies and approaches to analyzing data varied considerably. Research gaps included the lack of healthcare economics studies of CAPA and no assessment of facilitators and barriers. Current research on CAPA provides intriguing findings meriting further investigation. We suggest strategies to improve future studies.

Keywords

Choice and Partnership Approach CAPA mental health services child adolescent

Introduction

Child and adolescent mental health (CAMH) problems are common sources of pediatric morbidity and mortality worldwide (Polanczyk et al., 2015). Nearly 20% of children and adolescents in the UK (Ford et al., 2018; Parker et al., 2019; Sadler et al., 2018) and other countries such as the US (Whitney and Peterson, 2019) and Canada (Wiens et al., 2020) have a mental health (MH) disorder. Approximately half of these young people develop into adults with persistent symptoms, substance use problems, or occupational, social, criminal, or parenting difficulties (Costello and Maughan, 2015).

The possibilities of such adverse outcomes emphasizes the importance of early intervention in CAMH problems, but this occurs in less than half of affected children and adolescents (Finkelhor et al., 2021; Islam et al., 2020; Merikangas et al., 2010; Sadler et al., 2018; Waddell et al., 2014; Whitney and Peterson, 2019). One reason is long wait times (Edbrooke-Childs and Deighton, 2020; O’Brien et al., 2016; Owens et al., 2002; Sunderland and Findlay, 2013), which are associated with the development of substance use, truancy, and self-harm (Sadler et al., 2018). Moreover, the longer the wait time to an appointment, the less likely a family is to show up, exacerbating system inefficiency and delays in the delivery of care (Schraeder and Reid, 2015; Sherman et al., 2009). Reducing wait times in CAMH services (CAMHS) and finding more efficient ways to use providers’ time and engage patients and families are therefore important goals for governments, agencies, and practitioners.

The Choice and Partnership Approach

The Choice and Partnership Approach (CAPA) (http://www.capa.co.uk/) is a MH service delivery model designed to increase access and efficiently improve quality of care. CAPA is organized around four principles: (1) operations are grounded in Lean health care, demand and capacity models, and queue theory; (2) families and patients (henceforth, referred to as patients) are co-experts in treatment planning; (3) treatments are evidence-based and delivered by appropriately trained staff; and (4) clinics use real-time data about patient demand and flow, provider capacity, and clinical outcomes to respond to changes in patients’ needs.

The CAPA manual describes the clinical procedures and operational instructions, including formulae to calculate patient demand and capacity and flow (York and Kingsbury, 2016). The first face-to-face contact is the Choice appointment, designed to empower the patient as owner of emotional or behavioral change. Choice appointment goals are to define problems from patients’ perspectives, assess risk, identify solutions, help patients decide between treatment options, and for providers to make brief therapeutic interventions. Although a diagnosis may be made at Choice, this is not the main reason for the appointment.

After patient and provider collaboratively make a treatment plan, the patient may decide that the appointment met their needs and no further appointments are scheduled. If more treatment is needed, but not available at the Choice site, the patient is referred elsewhere. If the patient can receive appropriate treatment at the Choice site, the provider books an appointment with a clinician skilled in that modality.

Partnership begins with the second appointment and a clinic average of 7–9 sessions is recommended. Most patients begin with Core Partnership, which is an evidence-based first line treatment, for example, cognitive behavior therapy (CBT) for anxiety (Wergeland et al., 2021). If augmentation is needed, a second clinician is brought in for a limited number of sessions to deliver Specific Partnership, for example, psychopharmacotherapy for an anxiety disorder. Core and Specific Partnerships are thus segmented to support a nimble response to patients’ needs.

CAPA has been implemented worldwide, in countries such as England, Scotland, Australia, Norway, Latvia, and Canada, with enthusiastic uptake (http://www.capa.co.uk/homes/servicestories.htm). However, concerns have been raised about the Choice appointment emphasis on patient empowerment and collaborative decision-making instead of diagnostic assessment (Coghill, 2012). Demand and capacity models such as CAPA have also been criticized for creating “internal wait lists” by shifting the wait for the first appointment to the second appointment. Furthermore, providers have complained that they are simply being asked to work harder for the same money (Craighead, 2001) and providers also report that efficiency healthcare delivery improvement strategies in general often increase the burden of work (Ofri, 2019).

Aim

Such differing impressions can be confusing to policy-makers, administrators, and practitioners considering the use of CAPA. In situations such as these, reviews of the research literature are used to determine whether a new system of care should be implemented or not, but to our knowledge, no review of CAPA research exists. Therefore, our aim was to locate and summarize as much information as possible about the use of CAPA to deliver mental health services to children, adolescents, or adults in any type of service delivery setting.

Methods

We conducted a scoping review. These types of reviews are designed to (1) identify studies on a broadly defined topic and map out or describe the research; (2) summarize how the research was conducted and delineate research gaps; (3) identify factors that could have affected the findings; and (4) present implications for future researchers (Munn et al., 2018). We followed scoping review guidelines from Levac and colleagues (Levac et al., 2010) and the Joanna Briggs Institute (Peters et al., 2020). A summary of the location of study components in our paper is in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Reviews (PRISMA-ScR) checklist (Tricco et al., 2018) (see Supplementary File 1).

Research question and study selection

Using the Population-Concept-Context (PCC) structure recommended for formulating scoping review research questions (Peters et al., 2020), we aimed to answer the following question: what is known in any age group with MH problems (population) about implementation of CAPA (concept) in any type of MH care setting (context)? We searched the scientific literature through Medline (1984-April 2017), Embase (1966-April 2017), and PsycINFO (1966-April 2017). Searches were updated in September 2019 and June 2021. Grey literature was searched from January 1990 to June 2021with Grey Matters (Canadian Agency for Drugs and Technologies in Health, 2018) and Google Scholar. Our search strategy was based on the concepts “CAPA” or “Choice and Partnership Approach” with specific search terms varying, depending on the database (see Supplementary File 2 for details).

A study document was included if it (1) focused on CAPA; (2) included quantitative or qualitative information; and (3) was written in English. Studies were not restricted by country, design, patient age, setting, or publication status. Documents meeting any of the following criteria were excluded: (1) limited to a description of how CAPA works; (2) testimonials; (3) patient education materials; or (4) abstracts.

Records were organized using Covidence (Veritas Health Innovation, 2019). Duplicates were removed, followed by a three-step process of blinded assessments by pairs of co-authors. Titles and abstracts were screened and documents still eligible were then subjected to full-text screening. Any documents eligible after that process were subjected to full-text data extraction according to a standardized spreadsheet. Documents meeting criteria after data extraction comprised the final dataset. Disagreements between raters were resolved through consensus. Reference lists for each of the included review papers were also checked for other documents that may have been missed in the searches.

Results

Figure 1 displays our PRISMA diagram. We located 5322 records. After removing duplicates, 4720 remained. Screening of titles and abstracts removed an additional 4635 documents, the most common reason being that documents were not related to CAPA. We did not find any non-English studies focused on CAPA. The remaining 85 documents underwent full-text review and data extraction; 76 were removed at this stage for one of six reasons, the most common being that CAPA was only mentioned in the document, that is, it was not the focus of the study. We did not find missing studies or documents from reference lists.

Figure 1.

PRISMA diagram of record processing.

How many studies of CAPA exist and where were they done?

Nine studies met the eligibility criteria and comprised the final review dataset. The documents were completed over a 9-year period from 2009–2018. We located 6/9 (67%) in the peer-reviewed literature (67%) and 3/9 (33%) in the grey literature (an audit report, a study in a local physician publication, and a Master’s thesis). Three studies were from England, two from Scotland, two from Australia, and two from Canada.

What are the characteristics of this body of research and the findings?

Study characteristics are summarized in Supplementary File 3, which is organized first by study design and then chronological order of publication or completion date (for non-peer-reviewed documents) within each design type.

All studies used non-controlled observational designs. There were no randomized controlled trials (RCTs). A non-controlled pre-post intervention design was used in 4/9 (44%) of the studies (Clark et al., 2018; Fuggle et al., 2016; Naughton et al., 2015, 2018), a cross-sectional design in another 44% (Robotham and James, 2009; Robotham et al., 2010; Taylor and Duffy, 2010; Wilson et al., 2015), and one study used a prospective evaluation design (Quintana, 2017). The majority of investigations (6/9 or 67%) conducted their studies with mixed methods, but 3/9 (33%) used only quantitative methods.

This corpus of research was primarily done in CAMHS settings, except for one study conducted in an adult tertiary care mental health outpatient clinic (Quintana, 2017). Although there are nine studies, this represents only seven samples because Robotham and colleagues (Robotham and James, 2009; Robotham et al., 2010) and Naughton’s group (Naughton et al., 2015, 2018) analyzed different aspects of the same samples for two studies each. Most studies used samples of convenience, but two collected data using census methods for part of the study (Robotham and James, 2009) or for the entire study (Taylor and Duffy, 2010). Sample size estimates were not provided in either peer-reviewed publications nor in non-published documents.

Study protocols used standardized instruments for clinical outcomes in only 2/9 (22%) of the investigations (Fuggle et al., 2016; Naughton et al., 2018) and for patient experience in only 3/9 (33%) of studies (Clark et al., 2018; Fuggle et al., 2016; Taylor and Duffy, 2010). Otherwise, data were collected with investigator-derived instruments. Where administrative data were used, there were no descriptions of clinical record data validation.

Protocols for qualitative data collection, for example, how focus groups were selected or details on how administrative meeting notes were used were often described in ways that would make replication of the study difficult. The analysis of qualitative data frequently lacked specificity as to the theoretical approach or how it was conducted. Data analytic approaches for quantitative data were described in 3/9 (33%) of the studies (Clark et al., 2018; Fuggle et al., 2016; Naughton et al., 2018).

The studies had multiple aims which we categorized into seven types of research objectives: (1) wait time to first appointment; (2) wait time to second appointment; (3) patient flow; (4) quality of care; (5) patient experience; (6) provider experience; and (7) fidelity to the CAPA model. Table 1 displays the objectives by individual studies, organized in the same way as the table in Supplementary File 3. We did not find any cost-benefit, cost-utility, cost-effectiveness, or cost-minimization studies. The four most frequently studied objectives were wait time to first appointment, patient flow, patient experience, and fidelity to CAPA.

Table 1.

Choice and Partnership Approach review: Research objectives by study.

Studies	Time to first visit	Time to second visit	Patient flow	Quality of care	Patient experience	Provider experience	Fidelity to CAPA
Naughton et al. (2015)	X						X
Fuggle et al. (2016)	X		X	X	X	X
Naughton et al. (2018)	X		X	X
Clark et al. (2018)	X	X	X		X
Robotham and James (2009)	X		X		X	X	X
Robotham et al. (2010)						X
Wilson et al. (2015)							X
Taylor and Duffy (2010)					X
Quintana (2017)							X
Total n/N (%)	5/9 (57%)	1/9 (11%)	4/9 (44%)	2/9 (22%)	4/9 (44%)	3/9 (33%)	4/9 (44%)

Wait time to first appointment

Wait time to first appointment was investigated in 5/9 (57%) of the studies. Most of these used quantitative administrative data (Clark et al., 2018; Fuggle et al., 2016; Naughton et al., 2015, 2018) with one using a CAMHS agency questionnaire and interview data (Robotham and James, 2009). The only group to define wait time to the first appointment was Clark et al. (2018).

All studies compared pre-post-CAPA wait time, the most common time frames being 6 months before and after CAPA implementation, with a range of nine to 18 months in four of the papers (Clark et al., 2018; Fuggle et al., 2016; Naughton et al., 2015, 2018). Pre-to post-CAPA interval was not described in one of the studies (Robotham and James, 2009).

All studies investigating this objective reported decreases in pre-to post-CAPA wait times, but the change was not statistically significant in one study (Fuggle et al., 2016) and statistical analyses were not reported in two of the studies (Naughton et al., 2015; Robotham and James, 2009).

Wait time to second appointment

Only one study examined wait time to second appointment, reporting that it decreased significantly after CAPA implementation (Clark et al., 2018).

Patient Flow

This research objective comprised the following study aims: pre-post-CAPA change in referrals, percentage of referred patients assigned to a first appointment, percentage of patients receiving second appointments, total number of Partnership appointments, number of discharges, and provider productivity. Four of nine studies (44%) (see Table 1) investigated one or more of these variables (Clark et al., 2018; Fuggle et al., 2016; Naughton et al., 2018; Robotham and James, 2009).

Referrals increased in two studies (Clark et al., 2018; Naughton et al., 2018), but audit information reported a decrease (Robotham and James, 2009). The audit had a very low response rate to this question. None of the studies presented statistical analyses.

Two studies discovered the percentage of patients receiving first appointments was significantly higher with CAPA (Clark et al., 2018; Naughton et al., 2018). One reported that the percentage of referrals for second appointments was also higher, but the difference was not statistically significant (Clark et al., 2018), while the other reported a significant decrease in percentage of second appointments (Naughton et al., 2018). Fuggle et al. (2016) stated that the number of first appointments increased with CAPA, but neither referral totals nor statistical analyses were presented.

Only one group investigated post-CAPA changes in number of treatment sessions and reported no significant difference (Naughton et al., 2018).

Discharge rates were addressed in the CAPA audit (Robotham and James, 2009), but information was from only two agencies, one describing an increase and the other a decrease. No sample sizes or statistical analyses were given.

Change in provider productivity, defined as the annual number of first appointments per clinician FTE, was only studied by Clark et al. (2018). They reported increases in productivity, without any statistical analysis shown.

Quality of care

Two studies investigated CAPA-associated changes in quality of care (Fuggle et al., 2016; Naughton et al., 2018). Fuggle and colleagues reported that achievement of patient goals was significantly higher in CAPA, as were provider ratings of clinical improvement in patients. The other study (Naughton et al., 2018) reported no significant difference in clinical improvement between pre- and post-CAPA groups.

Patient experience

Patient experience with Choice or CAPA in its entirety, was measured in 4/9 (44%) studies (Clark et al., 2018; Fuggle et al., 2016; Robotham and James, 2009; Taylor and Duffy, 2010) All collected information from parents and young people. Three used quantitative data from standardized questionnaires (Clark et al., 2018; Fuggle et al., 2016; Taylor and Duffy, 2010) and two used qualitative information (Robotham and James, 2009; Taylor and Duffy, 2010). No pre-CAPA patient experience data were presented.

Choice experiences as assessed by questionnaire, were generally positive for parents and youth (Clark et al., 2018; Fuggle et al., 2016; Taylor and Duffy, 2010). Selection of parents and youth for these questionnaires was described in two of the three studies (Fuggle et al., 2016; Taylor and Duffy, 2010), but response rate was only described in one (Taylor and Duffy, 2010). Parents’ experiences with both Choice and Partnership were similarly positive when measured with a standardized questionnaire (Fuggle et al., 2016).

Qualitative data collected from open-ended survey questions revealed concerns with wait times, too few treatment sessions, and complaints about physical environment at CAMHS sites (Taylor and Duffy, 2010). Focus group information from parents and young people showed that they understood their CAPA agency services, but could not describe their individual treatment plans (Robotham and James, 2009). Response rates for this focus group participation were very low.

Provider experience

Provider experiences with CAPA were assessed in 3/9 (33%) studies using focus groups and individual interviews (Fuggle et al., 2016; Robotham and James, 2009; Robotham et al., 2010), some of which used the 11 Key Components of CAPA (http://www.camhsnetwork.co.uk/Intro/the11keycomponents.html) to organize data collection. Positive experiences included (1) enhanced collaboration with patients; (2) increased staff-patient transparency; and (3) awareness of the relationship between closing cases and reducing wait times. Providers did express anxiety about insufficient time for administrative tasks (Fuggle et al., 2016). Audit data showed that most sites had not fully implemented CAPA, a situation associated with a negative work environment (Robotham and James, 2009). Sites having strong leadership and administrative support, coupled with adherence to the 11 Key Components, reported that wait times were reduced, workload was more efficient, and provider experiences were positive (Robotham et al., 2010).

Fidelity to the Choice and Partnership Approach model

Fidelity to the CAPA model was investigated in 4/9 (44%) of the studies, using either the 11 Key Components or the CAPA mathematical formulae for managing demand and capacity (Naughton et al., 2015; Quintana, 2017; Robotham and James, 2009; Wilson et al., 2015). Fidelity to CAPA was described as challenging in two of the studies using qualitative data, with only some of the 11 Key Components being used (Naughton et al., 2015; Robotham and James, 2009). Wilson, et al. (2015) compared administrative data from all their clinics to the 11 Key Components and reported that the clinics were generally operating within the guidelines suggested for achieving CAPA success.

A Master’s thesis sought to improve CAPA’s operational mathematical formulae in a prospective evaluation study planning for CAPA implementation in an adult MH clinic (Quintana, 2017). Using clinic administrative data and CAPA guidelines, Quintana conducted simulations to determine CAPA implementation feasibility for the specific setting. The adaptations suggested and the modified formulae may be useful to other sites.

Are there facilitators or barriers to choice and partnership approach’s success?

Identifying factors influencing CAPA’s success was not a formal aim in any study. However, four studies addressed facilitators or barriers in their Discussion or Recommendations sections (Naughton et al., 2015; Robotham and James, 2009; Robotham et al., 2010; Taylor and Duffy, 2010). All used qualitative information collected while studying patient or provider experiences or CAPA fidelity. Possible facilitators suggested adherence to the 11 Key Components and having strong, facilitative leaders with a commitment to CAPA (Naughton et al., 2015; Robotham and James, 2009). Potential barriers to success were partial CAPA implementation, lack of provider involvement in planning, and inadequate staff and provider CAPA training (Naughton et al., 2015; Robotham and James, 2009; Robotham et al., 2010; Taylor and Duffy, 2010).

Discussion

This is the first study to comprehensively review the research on CAPA. It fills a gap in the literature by identifying CAPA studies and presenting characteristics of this corpus of research. Despite the worldwide increase in use of CAPA since 2005, we only discovered nine studies (six peer-reviewed publications and three non-published documents) conducted in just four countries: England, Scotland, Australia, and Canada.

Every study had multiple aims, which we categorized into seven types of research objectives. CAPA was associated with decreased wait time to the first appointment in each of the five studies examining this variable (Clark et al., 2018; Fuggle et al., 2016; Naughton et al., 2015, 2018; Robotham and James, 2009), but statistical analyses were only presented in three (Clark et al., 2018; Fuggle et al., 2016; Naughton et al., 2018). A single study reported that wait time to the second appointment was also significantly decreased (Clark et al., 2018). Some aspects of patient flow improved (number of referrals, percentage of referrals receiving first or second appointments, and provider productivity) (Clark et al., 2018; Fuggle et al., 2016; Naughton et al., 2018), while there was no difference in number of treatment sessions (Naughton et al., 2018). Both increased and decreased discharge rates were reported (Robotham and James, 2009). Quality of care was not compromised by CAPA, although the total number of patients studied was less than 150 (Fuggle et al., 2016; Naughton et al., 2018). Patient experience with Choice or CAPA was generally positive (Clark et al., 2018; Fuggle et al., 2016; Robotham and James, 2009; Taylor and Duffy, 2010). Provider experience with CAPA was mixed, with some sites reporting positive (Fuggle et al., 2016; Robotham et al., 2010) and others reporting negative experiences (Fuggle et al., 2016; Robotham and James, 2009). Fidelity to CAPA varied widely (Naughton et al., 2015; Quintana, 2017; Robotham and James, 2009; Wilson et al., 2015). Informal reports of facilitators for CAPA’s success highlighted the importance of full adherence to the 11 Key Components and the need for strong leadership (Naughton et al., 2015; Robotham and James, 2009). Possible barriers were incomplete implementation of CAPA, lack of provider engagement in planning CAPA, and inadequate training of staff and providers (Naughton et al., 2015; Robotham and James, 2009; Robotham et al., 2010; Taylor and Duffy, 2010).

At first glance, our review seems to support the numerous positive anecdotal reports in the grey literature. However, methodologic weaknesses in this body of work prevent such a conclusion or generalizing these findings to other CAPA sites. One problem is that all studies used pre-experimental designs. We cannot be confident that changes were due to CAPA because studies lacked control groups, random assignment of patients or clinics to CAPA, adequate sample sizes, or blinding of data collection. In addition, there were no pre-CAPA data for comparison when exploring patient or provider experiences. Therefore, the findings described can only be interpreted as weak signals that CAPA may be able to accomplish its over-arching goals.

Another concern is inter-study heterogeneity in how samples were constructed, protocols were developed, and results were reported. For example, some studies did not fully describe sample sizes or provide statistical analyses of quantitative data. Qualitative sub-studies often did not specify the qualitative approach, acquisition of focus group participants, or methods of analysis. This multiformity in methods makes it difficult to compare or synthesize results across investigations. In addition, there were two gaps in the research objectives investigated. There were no data on the economics of CAPA, for example, no cost-effectiveness studies and no formal studies of facilitators and barriers.

A core tenet of CAPA is the continuous use of administrative, clinical, and patient/provider data to inform clinic operations. Moreover, the 11 Key Components provide an ideal structure for implementation or evaluation. Therefore, we were surprised that there were only nine studies. Why are not more clinics or agencies publishing studies about their CAPA work? One reason may be that administrators or clinicians are unlikely to have the skills or time to do this type of work. We speculate that clinical sites may be funded to make improvements such as CAPA, but are not funded to hire experts to study the impact. Administrators and clinicians may also suffer from change overload or fear of reprisal if results are made public and are not positive (Wilkinson et al., 2011).

Limitations of our review

To minimize selection bias, we used an extensive search strategy, included scientific and grey literature, and used eligibility criteria broad enough to identify any document with quantitative or qualitative data. However, one limitation in our study was the exclusion of documents not written in English. Another limitation is that we did not write to CAPA sites seeking unpublished documents because there is no list of agencies or institutions using this model. Therefore, we may have missed some studies. A third limitation is that we did not conduct a formal analysis of bias in the studies, as this is not usually done in scoping reviews, but may have further specified methodological issues.

Implications for practice and research

Although CAPA research to date has produced provocative results, more studies of different types are needed to understand CAPA’s effects on MH care delivery systems, patients, and providers. At the local practice level, CAPA’s use of real-time clinic data creates an environment ideally suited for continuous quality improvement (CQI) studies. CQI studies differ from research, but adherence to a CQI model can lead to ideas for local improvements in CAPA (Backhouse and Ogunlayi, 2020). The most common CQI models are Lean, Six Sigma, Experience-Based Co-Design, and Model for Improvement (Ham et al., 2016; Stafford et al., 2020) and we suggest that clinical sites use one of these to improve their local use of CAPA. Furthermore, we suggest the use of Standards for QUality Improvement Reporting Excellence (SQUIRE) (Davidoff et al., 2008) guidelines to standardize external reporting of clinics’ CQI projects. Dissemination of these findings can help advance knowledge throughout the international CAPA community and help researchers understand the practical issues in running a CAPA program. This will, in turn, inform the development of scientific studies that are clinically meaningful.

Scientific research on CAPA can be improved in several ways. Causal studies should use experimental designs such as RCTs. However, we recommend that researchers consider using pragmatic RCTs and methods, for example, parallel cluster or stepped wedge cluster RCTs (Hemming et al., 2015; Jeong et al., 2020). Pragmatic studies, conducted in real-world clinical settings, attempt to balance the need to rigidly control experimental bias with the need to produce findings generalizable to real patients (Hemming et al., 2015; Jeong et al., 2020).

CAPA research could also be improved by using methods from implementation science and evaluation research. We suggest that incorporating implementation studies into pragmatic experimental research may further enhance CAPA research (Bauer et al., 2015). Evaluation research methods test whether a health care intervention was successful in accomplishing certain goals and a wide range of designs and methods are available, including natural experiments, traditional RCTs, cluster RCTs, and controlled pre-post interventions. The key issue to improving CAPA research is for future researchers to adopt a structured approach, whether process, impact, outcome or summative evaluation studies are conducted (Bauman and Nutbeam, 2013).

Combining methods from experimental, implementation, and evaluation research can capitalize on the strengths of each, particularly in planning for integrated research on complex system interventions such as CAPA (O’Cathain et al., 2019). We propose that guidelines such as those described by O’Cathain and colleagues could be used to create an international roadmap for research on CAPA.

Future CAPA research would be significantly improved if researchers used standardized reporting formats based on the type of study they are conducting, for example, experimental, evaluation, implementation, healthcare economics, or CQI. These can be found at the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network (Moher et al., 2008).

It is important to acknowledge that most clinical sites will not have expertise in these research designs or methods. We suggest that they partner with academic or government research experts when planning an implementation of CAPA or evaluation of an existing application. In addition, creating an international clinical research network comprising administrators, providers, and researchers could increase opportunities for research funding, collaboration, and multi-site studies.

Conclusion

This scoping review presents a summary of the most recent research on CAPA for use by policy-makers, MH system administrators, and clinicians considering implementation or evaluation of CAPA, as well as researchers wanting to examine causal relationships. The review indicates that CAPA may reduce wait times without compromising quality of care, but these findings must be viewed cautiously because of concerns about the methodology used in the studies. Our suggestions to improve CAPA research should facilitate the development of a new body of work to advance knowledge about this innovative MH care delivery system.

Supplemental Material

sj-pdf-1-chc-10.1177_13674935221076215 – Supplemental Material for A scoping review of the Choice and Partnership Approach in child and adolescent mental health services

Supplemental Material, sj-pdf-1-chc-10.1177_13674935221076215 for A scoping review of the Choice and Partnership Approach in child and adolescent mental health services by Kathleen Pajer, Carlos Pastrana, William Gardner, Aditi Sivakumar and Ann York in Journal of Child Health Care

Supplemental Material

sj-pdf-2-chc-10.1177_13674935221076215 – Supplemental Material for A scoping review of the Choice and Partnership Approach in child and adolescent mental health services

Supplemental Material, sj-pdf-2-chc-10.1177_13674935221076215 for A scoping review of the Choice and Partnership Approach in child and adolescent mental health services by Kathleen Pajer, Carlos Pastrana, William Gardner, Aditi Sivakumar and Ann York in Journal of Child Health Care

Supplemental Material

sj-pdf-3-chc-10.1177_13674935221076215 – Supplemental Material for A scoping review of the Choice and Partnership Approach in child and adolescent mental health services

Supplemental Material, sj-pdf-3-chc-10.1177_13674935221076215 for A scoping review of the Choice and Partnership Approach in child and adolescent mental health services by Kathleen Pajer, Carlos Pastrana, William Gardner, Aditi Sivakumar and Ann York in Journal of Child Health Care

Footnotes

Author contributions

The study was conceptualized, designed, and outlined by WG and KP, with advice from AY. WG and KP created the figures, tables, and supplements. Searching was conducted by CP and KP. Screening and extraction were done by CP, AS, and KP. Article versions were written by KP, CP, and AS and edited by all co-authors.

Declaration of conflicting interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AY is co-founder of CAPA, which is available in the public domain. Training in CAPA is provided free by AY. AY receives funds through AHT, Ltd. From sale of the CAPA manual.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: WG received an unrestricted grant from the Ontario Centre of Excellence for Child and Youth Mental Health. All work was done independent from influence of the funder.

ORCID iDs

Kathleen Pajer

Carlos Pastrana

Supplemental material

Supplemental material for this article is available online.

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