Referral Criteria for Berkshire Specialist CAMHs

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1 Referral Criteria for Berkshire Specialist CAMHs Berkshire CAMHs is a specialist child and adolescent mental health service that provides support, advice, guidance and treatment for children and young people with severe or moderate mental health difficulties, whose symptoms are having a significant impact in their day to day lives. Usually these symptoms will have been occurring over several months and will not have responded to interventions from early intervention and children s services. The referral criteria below are designed to help make the decision about whether a child or young person would be best helped by a referral to Berkshire CAMHS. Referrals are accepted from all health, education, and children s services colleagues and should be made on the Berkshire CAMHS referral form (found on professionals page of the CAMHS Website) and sent to CAMHs CPE (information about CPE is found in the Our Service section of the CAMHS website, with a referral form and contact details on the Professionals page). All referrals will be assessed by telephone contact or face to face appointment to ensure that CAMHs is the right service for the child or young person and to evaluate the seriousness of the symptoms and immediacy of risk. Referrals are prioritised as either:. 24 hours. Soon. Routine 24 hour criteria If you are making a referral for a young person who you feel needs to be assessed by CAMHS within 24hrs, please contact CAMHS CPE by telephone on to discuss the referral as well as sending the referral form (either by to: or by fax to ) The types of presentations that might be considered to require a 24 hour response include: People who are actively suicidal Presentation of severe psychotic symptom Presentation of anorexia with severe physical signs (BMI below 15, weakness etc.). Note that this may require an urgent medical response first.

2 Immediate risk of serious harm to self or others.. Soon criteria Referrals will be prioritised for a soon response if there is a high level of risk or concern that if symptoms are left unaddressed they may result in a crisis or emergency referral. As with the 24 hour criteria, please contact CAMHS CPE to discuss the referral as well as sending the referral form. The following are likely to require a soon response: Severe symptoms of depression with or without suicidal thoughts. Suicide attempt and persistent suicidal thoughts or evidence of a plan Symptoms of anorexia (rapid, intentional weight loss) Severe unexplained deterioration in emotional state and behaviour at home and school not thought to be due to drugs, alcohol or physical illness. Referrals prioritised as Soon will be assessed within 5 days. All other referrals would be classified as Routine. We aim to assess all routine referrals within a maximum 6 week waiting time. Not seen as a matter of routine Young people with the following conditions will only be seen if there is evidence of co morbidity (more than one condition) with a serious mental health condition Children and young people presenting with emotional and behavioural difficulties with no associated mental illness such as those described below, are not usually appropriate for Tier 3 Specialist CAMH services. CAMHS CPE are available for consultation and discussion prior to making a referral to consider appropriateness. Enuresis / complex Soiling It is important to rule out any physical cause which may be associated with this condition prior to considering psychological involvement. In the first instance refer to the continence clinic. If there are associated significant relevant mental health needs, contact CAMHs CPE for discussion and consultation to consider if referral is appropriate.

3 Somatoform disorder (Psychosomatic disorders) Includes chronic fatigue Chronic physical illness. Child is experiencing persistent physical symptoms (stomach pains, vomiting) If this is having a significant impact on the child s normal functioning for long periods of time and other causes have been excluded, a referral to CAMHs could be considered. Chronic physical illness would not be a reason for a referral to CAMHs on its own but along with significant psychological distress, a referral may be appropriate. The care of these young people will rest primarily with Paediatrics. CAMHs will provide psychological input (i.e. individual therapy and family therapy) if there are associated significant relevant mental health needs. Contact CAMHs CPE for discussion and consultation to consider if referral is appropriate... Family Relationship Difficulties Children and young people may present with emotional and behavioural difficulties in response to family stress e.g. parental discord, divorce or separation CAMHs teams will not be involved in legal issues in relation to parental separation. If referrers are aware of families difficulties, please encourage parents to make efforts to resolve these matters through access to appropriate relationship counselling services such as Relate or Relateen. Specialist CAMHs will consider referrals where there is a high level of complexity. This might include a combination of multiple risk factors, complex family problems and child protection concerns. Challenging Behavioural/ conduct difficulties Managing children with difficult or challenging behavior can be incredibly difficult. Challenging behaviour is common in children with learning disabilities so if you child is known to LD services and or attending a special school, they may be able to offer support. CAMHS are not commissioned to provide interventions for behavioral difficulties unless there is a significant mental health disorder as described in our Service criteria. Each local authority within Berkshire offers a range of service as part of the local offer, please click on the link to your local services (found at the top of the What is CAMHS? page and towards the bottom of the Professionals page) to find out what s available in your local area. Bereavement/loss Sadness/grief and anger are normal/usual responses to death or loss. These do not in themselves need a referral to CAMHs. Refer to counselling services. If there is a significant concern about the young person s symptoms or if the bereavement is complicated by a traumatic event, contact CAMHS CPE to discuss whether referral may be appropriate.

4 School / College refusal School refusal/truancy in itself does not need input from CAMHs. Schools and education departments have their own resources which will need to be involved prior to referral to CAMHs. Refer to education services in the first instance If associated with either significant mood/anxiety disorder or other significant mental health problems, contact CAMHS CPE for advice. Substance misuse Substance misuse in itself does not indicate that a referral to CAMHS is necessary. In the absence of significant co-morbidity (e.g. anxiety/depression) refer to specialist substance misuse services. Tier 3 Specialist CAMHs will see individuals who present with co-morbidity relating to drug and alcohol problems, working alongside specialist substance misuse service. Other issues not seen as a matter of routine: Attachment difficulties/disorders: A persistent pattern of abnormal functioning in interpersonal relationships. Obesity. Problems for which support is offered within CAMHS Problem Brief Description Action

5 Anxiety Generalised anxiety disorder (GAD) - excessive and pervasive anxiety which is not specific to a particular thing or situation a Common symptoms may include restlessness, nervousness, difficulties with concentration, sleep disturbances and fatigue. Any anxiety disorder which causes persistent and significant impairment: refer to CAMHS Separation anxiety disorder - worrying out of proportion to the situation of temporarily leaving home or otherwise separating from loved ones Panic attacks / panic disorder. Specific phobias extreme or irrational fear of an object, place or situation. Social anxiety disorder (social phobia) is a persistent fear about social situations (talking in groups or starting conversations, speaking on the telephone, eating or drinking with company). Complex Neurodevelopment disorder - ADHD The symptoms of attention deficit hyperactivity disorder (ADHD) Inattentiveness having a short attention span, being easily distracted, and making careless mistakes in schoolwork. Appearing forgetful or losing things. Being unable to stick at tasks that are tedious or time-consuming, constantly changing activities. Appearing to be unable to listen to or carry out instructions. Having difficulty organising tasks. Hyperactivity and impulsiveness - being unable to sit still, constantly fidgeting. Being unable to concentrate on tasks. Excessive talking, interrupting conversations. Act without thinking, little or no sense of danger. The nature of these features should be of a severity that impacts on the ability to engage in education and social activities. It is essential that behavioural interventions involving education and other statutory services have been tried and that parents have undertaken an appropriate, evidence-based parenting programme. Refer to CAMHS if ADHD is suspected, the core difficulties in hyperactivity, inattention and impulsivity are evident and persistent in two or more domains of the child s life (e.g. school and home) and have been unresponsive to behavioural intervention in the home and school. Ideally school SENco should make direct referral to the CAMHS (ADHD Pathway) via CAMHS CPE.

6 Depression Symptoms of depression in children and young people can vary, and may be masked by other difficulties. Common characteristics can include Persistent depressed or irritable mood over 2 weeks. Marked loss of interest in or ability to enjoy activities that were previously pleasurable. Loss of confidence, self-esteem and feelings of hopelessness. Recurrent Suicidal thoughts or intention Persistent sleep problems or alterations in sleep pattern Changes of appetite (decrease or increase), with the corresponding weight change. For all children and young people it is important to consider the extent to which symptoms interfere with daily functioning - i.e. family relationships, school performance, peer relationships, risk taking behaviour and self-harm. Explore and address potential triggers and contributing factors e.g. family context bereavement bullying Explore impact these triggers have to determine if treatment by specialist CAMHS For moderate to severe depression, where symptoms are having a significant impact in their day to day lives refer to CAMHS. If there is no significant impact to daily functioning, recommendations are increase physical activity, healthy diet engaging in meaningful activities and encourage to make supportive relationships Access website for links to other services in the area. Eating Disorders Anorexia (at least 10-15% deficit from ideal weight) Bulimia (engaging in binge and purge behaviour). Severely restricting food intake. To be considered by CAMHS the above criteria needs to be met. Some young people s eating is impacting by other conditions such as anxiety. If this is the case please crossreference with the CAMHS criteria for Anxiety or other conditions seen as routine by CAMHS. GP to monitor weight and physical health Refer directly to CAMHs. The young person may be eligible for the eating disorder day programme (BAU). Gender Identity There is usually a long standing history (from childhood) of the young person s distress regarding their physical gender. Significant emotional and psychological distress. This is not about the young person s sexual orientation. Refer to Specialist CAMHS. Young people presenting with issues relating to gender identity are routinely referred on by CAMHS to the national specialist clinic at the Tavistock and Portman NHS Foundation Trust. These young people will also remain open to Specialist CAMHS during their referral.

7 Obsessive Compulsive Disorder Obsessions and/or compulsions with significant social and functional impairment. For example ability to attend school Obsessions are unwanted thoughts, pictures or urges that come into the mind repeatedly and are unpleasant and cause distress. Compulsions are actions that are repeatedly carried out in response to the obsessions. Compulsions may be seen by others e.g. hand washing or hided e.g. counting rituals. In Obsessive Compulsive Disorder, obsessions and compulsions take up a significant amount of time in the young person's day (over 1 hour) and cause difficulties in everyday functioning and/or significant distress. OCD rituals that are having a serious impact on the child/ young person s life direct referral to CAMHS CPE. Post-traumatic stress disorder (PTSD) PTSD is a delayed or protracted response to a traumatic event. The child or young person experiences symptoms of reliving the trauma through nightmares and/ or flashbacks. Other symptoms include, emotional numbness, hypervigilance, avoiding triggers of memories of the trauma, extreme agitation and insomnia. It may present in less characteristic ways in young children and advice should be sought from CAMHS in this age group. It can start weeks or months after the traumatic event If presenting with symptoms of PTSD and other associated mental health difficulties such as persistent low mood and self-harm refer to CAMHS For Post abuse work without accompanying symptoms of PTSD, referral should be made to community counselling services or agencies specialising in this area. People who experience trauma may not develop PTSD. However they may find counselling useful (link). Psychosis Manifested as episodes with the following symptoms: Positive symptoms Paranoia, delusional beliefs. Perceptual disturbances (i.e. hallucinations, hearing voices). Negative symptoms deterioration in self- care, school performance, social and family relationships Disinhibited behaviour, over activity, risk taking. Urgent referral to CAMHs to assess co-morbidity with other presentations.

8 Self-Harm Intentional Self-harm can take many different forms e.g.: Cutting Scratching Overdose Poisoning Ligatures (e.g. tying a rope round one s neck) Threat to life Burning Head banging Any overdose requires medical assessment (By GP or A&E). Significant overdose and serious self-harm requiring medical attention should be referred directly to the Accident & Emergency Department. Patients attending A+E following self-harm will receive a mental assessment prior to discharge as part of an established deliberate self-harm care pathway. Support can be provided through local services and professionals via counselling and other support methods. Concerns about significant self-harm, in the context of other mental health / psychological difficulties, telephone CAMHS CPE for advice. Tics and Tourette s Tourette s syndrome with complex motor and vocal tics, particularly with co-morbidity. Children with Tourettes often have other neurodevelopmental difficulties such as ADHD and OCD Refer to CAMHS Diagnostic assessment only Complex neurodevelopmental disorder ASD (Autistic Spectrum Disorder) ASSESSMENT ONLY Complexities with social interaction and communication including difficulties understanding and being aware of other people's emotions and feelings, impaired language development and an inability to start conversations or take part in them appropriately. Restricted and repetitive patterns of thought, interests and physical behaviours including making repetitive physical movements, such as hand tapping or twisting, It is essential that behavioural interventions involving education and other statutory services including parenting and social skills programmes have been tried. If ASD is suspected, refer to CAMHS, ensuring that there is comprehensive early years & school information giving evidence of the presence and complexity of the difficulties which require CAMHS assessment We recommend that a SENco, SLT or paediatrician are best placed to make a referral to CAMHS via CPE BHFT offer a diagnostic service only

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