Guidelines for School Nurse Role in the. Management of Depression in Children and. Young People

Transcription

1 Guidelines for School Nurse Role in the Management of Depression in Children and Young People Reference No: G_CS_45 Version 1.2 Ratified by: LCHS Trust Board Date ratified: 26 th August 2014 Name of originator / author: Sarah Packwood, School Nurse CPT Name of responsible committee / Individual Quality Scrutiny Group Date issued: November 2016 Review date: March 2017 Target audience: School Nurses Bands 5-7 Distributed via Website 1

2 Guidelines for the School Nurse Role in the Management of Depression in Children and Young People Version Control Sheet Version Section / Para / Appendix Version / Description of Date Author / Amended by Amendments 1 27/05/14 Sarah Packwood Extension agreed Extension agreed May 2016 May 2016 Audit Committee Corporate Assurance Team Copyright 2015 Lincolnshire Community Health Services NHS Trust, All Rights Reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. 2

3 Guidelines for School Nurse Role in the Management of Depression in Children and Young People Contents i. Version control sheet ii. Contents iii. Policy Statement Section Page 1 Background and definition 6 2 Stepped care model 6 3 CAMHS 4 tier model 7 4 Step 1: Detection, risk profiling and referral Step 3: Mild depression 8 6 Flowchart for school nurse role in the identification and management of depression in children and young people 9 7 Gener a l a d vic e f or s chool n urses working wit h young people who may b e at r isk of de pression Other agencie s c ommissioned t o provide Tier 1/ 2 CAHMS in the c ommunit y Resources recommended f or young people wh o may b e at r isk of de pression Com petencies Ref erences

4 Guidelines for School Nurse Role in the Management of Depression in Children and Young People Procedural Document Statement Background School Nurses in Lincolnshire are commissioned to provide Tier 1 CAMHS support to children and young people as defined in The Service Specification for School Nursing (Lincolnshire Community Health services 2014) The National Service Framework for Children, Young People and Maternity Services: The Mental Health and Psychological Well-being of Children and Young People (DH, DfES 2004) defines Tier 1 as CAMHS provided by professionals working in universal services who are in a position to: Identify mental health problems early in their development Offer general advice Pursue opportunities for mental health promotion and prevention. The purpose of these guidelines is to implement a coordinated and uniform approach to the school nurse role in the management of children and young people who present with suspected depression or low mood, based on best available evidence. It should be used in conjunction with the Procedural Document for School Nurse Role in the Management of Self-harm and the Procedural Document for School Nurse Role in the Management of Anxiety and Stress in Children and Young People. Statement Lincolnshire Community Health Services will develop policies to fulfill all statutory and organisational requirements. These will be comprehensive, formally approved and ratified, disseminated through approved channels and implemented. Responsibilities Staff undertaking have a responsibility to read and comply with this guideline. Authors of policies are responsible for undertaking appropriate consultation during the development of any policy. The guidance will be agreed and ratified by the Clinical Effectiveness and Risk Committee. Training Staff carrying Tier 1 CAMHS role will receive training provided by a School Nurse Practice Teacher with support and advice from a Primary Mental Health Worker (PMHW). This is booked via ESR. 4

5 Dissemination School Nurse Professional leads will be responsible for ensuring that all School Nursing staff are made aware of and have access to this guideline. All staff will have access to this document via the LCHS website. Consultation This guideline has been produced in consultation with School Nurse Specialist practitioners and a PMHW. 5

6 Guidelines for School Nurse Management of Depression in Children and Young People 1.0 Background and definition This procedural document is based on the recommendations of NICE Clinical Guideline 28, Depression in children and young people: identification and management in primary, community and secondary care (September 2005). 1.1 The definition of depression is broad and focuses around depressed mood or loss of pleasure in most activities. The ICD-10 Classification of Mental and Behavioural Disorders (World Health Organization, 1992) uses an agreed list of 10 depressive symptoms, and divides the common form of major depressive episode into four groups: not depressed (fewer than four symptoms), mild depression (four symptoms), moderate depression (five to six symptoms), and severe depression (seven or more symptoms, with or without psychotic symptoms). Symptoms should be present for at least 2 weeks and every symptom should be present for most of the day (see Appendix E (NICE 2005) for list of symptoms). 1.2 The treatment and management of depression have been divided into the following descriptions: mild depression moderate and severe depression severe depression with psychotic symptoms. 2.0 The stepped-care model The NICE Guidance advocates a stepped care model (see table below) Focus Action Responsibility 1.Detection Risk profiling and referral Tier 1 2.Recognition Identification in presenting children or young people Tiers Mild depression (including dysthymia) 4.Moderate to severe depression Watchful waiting Non-directive supportive therapy/group cognitive behavioural therapy/guided self-help Brief psychological therapy +/ fluoxetine Tier 1 Tier 1 or 2 Tier 2 or 3 6

7 5.Depression unresponsive to treatment/recurrent depression/psychotic depression Intensive psychological therapy +/ fluoxetine, sertraline, citalopram, augmentation with an antipsychotic Tier 3 or CAMHS 4 Tier model School nurses are identified as Tier 1 workers in the 4 tier model of a comprehensive CAMHS provision (National Service Framework 2004). School nurses are thereby involved in the detection of symptoms of depression and the treatment of mild depression. Insert 4 tier model 4.0 Step 1: Detection, risk profiling and referral The NICE guidance suggests that healthcare professionals in primary care, schools and other relevant community settings should be trained to detect symptoms of depression, and to assess children and young people who may be at risk of depression. 4.1 Risk profiling should include the evaluation of recent and past risk factors, eg age, gender, family discord, bullying, physical, sexual or emotional abuse, drug and alcohol use, history of parental depression, history of single loss events ethnic and cultural factors factors known to be associated with a high risk of depression and other health problems, such as homelessness, refugee status and living in institutional settings School Nurses need training to assess the risk of depression, to provide emotional support and know when to refer, especially when a child or young person has experienced an undesirable life event. School Nurses should be trained in communications skills such as active listening so that they can deal confidently with acute sadness and distress that may be encountered in children and young people following recent undesirable events. 4.3 In the assessment of a child or young person at risk of depression, school nurses should be able to give advice about self-help materials or other methods used or considered potentially helpful by the patient or their parent(s) or carer(s). This may include educational leaflets, helplines, self-diagnosis tools, peer, social and family support groups, complementary therapies, and religious and spiritual groups. These should only be recommended as part of a supported and planned package of care. NB the use of St John s Wort is NOT advocated in the treatment of depression in children 7

8 and young people (NICE 2005). 4.4 In the assessment and treatment of children and young people at risk of depression, special attention should be paid to the issues of confidentiality the young person s consent (including Fraser competence) parental consent child protection 5.0 Step 3: Mild depression Some children and young people diagnosed with mild depression may not need or want a specific intervention, but they need to be monitored and followed up, especially if they miss appointments. 5.1 Watchful waiting For children and young people with diagnosed mild depression who do not want an intervention or who, in the opinion of the healthcare professional, may recover with no intervention, a further assessment should be arranged, normally within 2 weeks ( watchful waiting ). A child or young person with depression should be offered advice on the benefits of regular exercise. A child or young person with depression should be offered advice about sleep hygiene and anxiety management. A child or young person with depression should be offered advice about nutrition and the benefits of a balanced diet. 5.2 St John's Wort should not be prescribed for the treatment of depression in children and young people. Children and young people with a chronic subclinical version of depression that has persisted for over a year known as dysthymia should be treated as for mild depression. 5.3 After up to 4 weeks of watchful waiting, children and young people with continuing mild depression should be referred to Tier 2 or 3 CAMHS. 8

9 6.0 Flowchart for identification and management by school nurses of depression in children and young people. Young person presents to school nurse with history of low mood Assessment of risk of depression. Consider past and present risk factors Consider confidentiality, consent and child protection issues, complete Fraser guidelines template Seek advice from PMHW (Tier 2) Consider TAC Open individual offer referral If risk low, give general advice and watchful waiting. Give written information. Offer support for selfesteem/stress/anxiety. Reassess 2 and 4 weeks later Seek advice from PMHW Inform GP Consider TAC Record on S1 If assessed by Tier 2/3 as low risk and referred back to school nurse If risk of depression high, Refer to Tier 2 CAMHS for assessment and inform GP or Refer to Tier3 CAMHS via GP. Continue to support young person until referral accepted. Close to individual offer once young person has been referred to Tier 2/3 service. If improved after 4 weeks If no improvement after 4 weeks or if symptoms worse Close to individual offer referral. Advise young person to come back to drop-in should further issues arise. 9

10 7.0 General advice for School Nurses working with young people who may be at risk of depression Consider the possibility of eating disorder and self-harm and be prepared to inquire further in an empathic and non-judgmental manner. Health care professionals assessing children and adolescents showing signs of emotional and behavioural problems should be alert to indicators of abuse (emotional, physical and sexual, including CSE) and should remain so throughout all contacts The right to confidentiality of children and adolescents showing signs of emotional and behavioural problems should be respected in line with national and local policy. The role of the school nurse in management of young people with suspected depression is detection, risk profiling, referral and treatment of mild depression. School nurses should always seek supervision from their line manager and/or PMHW when dealing with cases.. School Nurses have access to PMHW in all areas for consultation, advice and referral 8.0 Other agencies commissioned to provide Tier 1/2 CAMHS in the community. Kooth.com: online counselling and advice service supported by a rapid referral team. The counselling sessions take place on the website in secure chat rooms and via a private messaging system. Kooth.com also has message boards, online diaries for young people to complete and a magazine section where youngsters can find out about local services, events and news that affects them. This service has been commissioned by the Local Authority. Relate Counselling Services Lincoln Centre for Grief and Loss Tel: Countywide service for children and young people aged 8 and above who are coping with issues of grief and loss, including parental separation and family breakdown. Counselling usually takes place in school, up to 8 sessions. Targeted Youth Workers provide 1:1 and group sessions to build self-esteem and resilience in identified young people. Referrals can be made for single agency support using TAC form. 9.0 Resources recommended for young people and their families to promote emotional health and wellbeing and provide information/support. Young Minds Downloadable leaflets for young people and parents on a variety of common mental health problems Royal College of Psychiatrists (downloadable factsheets for children, young people and carers) 10

11 10.0 Competencies Procedure/ action Rationale Skill Knowledge Behaviour Comp. met and signed Assessing children and young people at risk of depression, selfharm, eating disorders and other emotional/behav ioural issues To detect early indications of emotional problems. To promote emotional health and wellbeing in children and young people. Communication skills, especially active listening, open questions, summarising reflecting, affirmation. Motivational interviewing techniques. Observation skills Record keeping skills Attend emotional health and wellbeing training for school nurses. child and adolescent development. child and adolescent mental health problems. child protection policies and procedures Fraser guidelines, confidentiality and consent issues. NICE Guidance 28: Depression in Empathetic, nonjudgemental approach. Professional behaviours Always affords dignity and respect to all clients Maintains confidentiality in line with national and local guidelines Always assesses capacity to consent using Fraser guidelines Selfawareness Emotional intelligence Seeks support and supervision for 11

12 children and young people, identification and management in primary, community and secondary care.(2005) self Reflective practitioner NICE clinical guideline 16, Short term physical and psychological management and secondary prevention of self-harm in primary and secondary care (2004). Draft NICE guideline, Self-harm, longer term management. NICE clinical guideline 9, Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating 12

13 . disorders (January 2004). Advice, signposting and referral to other agencies To ensure that young people receive appropriate support for emotional health issues Communication skills. As above local CAMHS and referral criteria. Awareness of role of and how to contact Primary Mental Health Worker. available local agencies and of referral criteria and pathways. sources of information and support. TAC process Evaluating interventions To monitor appropriaten ess and acceptability of intervention. Communication skills Record keeping skills.as above outcome measures, eg Likert scales, client satisfaction surveys (school nurse survey/your opinion counts Should be culturally appropriate. Should be accessible to people with additional needs such as physical, sensory or learning disabilities and to people who do not speak or read 13

14 English. ALL COMPETENCIES MET AND ACHIEVED: Name of Nurse Signature of Nurse. Date Name of Assessor... Signature of Assessor Date Training record and associated competencies to be recorded within the electronic staff record. Competencies to be viewed by line manager and copy sent to e-workforce to be entered onto ESR References Department of Health, Department for education and Skills: The National Service Framework for Children, Young People and Maternity Services: The Mental Health and Psychological Well-being of Children and Young People ( 2004) NICE Clinical Guideline 28, Depression in children and young people: identification and management in primary, community and secondary care (September 2005). World Health Organization The ICD-10 Classification of Mental and Behavioural Disorders (1992) 14

15 Monitoring Template Minimum requirement to be monitored Process for monitoring e.g. audit Responsible individuals/ group/ committee Frequency of monitoring/audit Responsible individuals/ group/ committee (multidisciplinary) for review of results Responsible individuals/ group/ committee for development of action plan Responsible individuals/ group/ committee for monitoring of action plan As policy. per Audit tool in organizational wide policy for development and management of policies and procedural documents. School Nurses. School Nurse Development Group. Operational leads. Clinical Governance and Scrutiny Group. 2 Yearly All staff using the policy. School Nurses Development Group School Nurse Practice Teachers Clinical Governance and Scrutiny Group School Nurses Development Group School Nurse Practice Teachers School Nurses Development Group School Nurse Practice Teachers 15

16 Equality Analysis Name of Policy/Procedure/Function* Guidelines for School Nurse Role in the Management of Children and Young People with Depression. Equality Analysis Carried out by: Sarah Packwood Date: 10/06/14 Equality & Human rights Lead: Rachel Higgins Director\General Manager: Nikki Silver *In this template the term policy\service is used as shorthand for what needs to be analysed. Policy\Service needs to be understood broadly to embrace the full range of policies, practices, activities and decisions: essentially everything we do, whether it is formally written down or whether it is informal custom and practice. This includes existing policies and any new policies under development. 16

17 Section 1 to be completed for all policies A. B. C. D. Briefly give an outline of the key objectives of the policy; what it s intended outcome is and who the intended beneficiaries are expected to be Does the policy have an impact on patients, carers or staff, or the wider community that we have links with? Please give details Is there is any evidence that the policy\service relates to an area with known inequalities? Please give details Will/Does the implementation of the policy\service result in different impacts for protected characteristics? The purpose of these guidelines is to implement a coordinated and uniform approach to the school nurse role in the management of children and young people who present with suspected eating depression, based on best available evidence. The policy will have an impact on service users by ensuring them best practice in relation to management of depression in children and young people. No Disability Sexual Orientation Sex Gender Reassignment Race Marriage/Civil Partnership Maternity/Pregnancy Age Religion or Belief Carers Yes If you have answered Yes to any of the questions then you are required to carry out a full Equality Analysis which should be approved by the Equality and Human Rights Lead please go to section 2 No X X X X X X X X X X The above named policy has been considered and does not require a full equality analysis Equality Analysis Carried out by: Sarah Packwood Date: 12/06/14 17

18 Section 2 Equality analysis Title: Guidelines for School Nurse Role in the Management of Children and Young people with Depression Relevant line in: What are the intended outcomes of this work? The purpose of these guidelines is to implement a coordinated and uniform approach to the school nurse role in the management of children and young people who present with suspected depression, based on best available evidence. Who will be affected? e.g. staff, patients, service users etc The policy will have an impact on service users by ensuring them best practice in relation to early detection and management of depression in children and young people. Evidence The Government s commitment to transparency requires public bodies to be open about the information on which they base their decisions and the results. You must understand your responsibilities under the transparency agenda before completing this section of the assessment. What evidence have you considered? Department of Health Healthy Child Programme (2009) Department of Health, Department for Education and Skills : The National Service Framework for Children, Young People and Maternity Services: The Mental Health and Psychological Well-being of Children and Young People ( 2004) Lincolnshire Community Health Services Service Specification for School Nurses (2014) NICE Clinical Guideline 28, Depression in children and young people: identification and management in primary, community and secondary care (September 2005). Disability The policy would be available in different formats on request for staff requiring additional support Sex The policy is designed to meet the diverse needs of our service users and workforce ensuring that no one is placed at a disadvantage over others Race The policy is designed to meet the diverse needs of our service users and workforce ensuring that no one is placed at a disadvantage over others Age 18

19 The policy is designed to meet the diverse needs of our service users and workforce ensuring that no one is placed at a disadvantage over others Gender reassignment (including transgender) The policy is designed to meet the diverse needs of our service users and workforce ensuring that no one is placed at a disadvantage over others Sexual orientation The policy is designed to meet the diverse needs of our service users and workforce ensuring that no one is placed at a disadvantage over others Religion or belief The policy is designed to meet the diverse needs of our service users and workforce ensuring that no one is placed at a disadvantage over others Pregnancy and maternity The policy is designed to meet the diverse needs of our service users and workforce ensuring that no one is placed at a disadvantage over others There is a HR policy in relation to pregnant staff members. Carers The policy is designed to meet the diverse needs of our service users and workforce ensuring that no one is placed at a disadvantage over others There is a HR policy in relation to staff members who have caring responsibilities for others. Other identified groups The policy is designed to meet the diverse needs of our service users and workforce ensuring that no one is placed at a disadvantage over others Engagement and involvement Was this work subject to the requirements of the Equality Act and the NHS Act 2006 (Duty to involve)? (Y/N) No How have you engaged stakeholders in gathering evidence or testing the evidence available? School Nurse Development Group Primary Mental Health Worker Ratification process How have you engaged stakeholders in testing the policy or programme proposals? Ratification process For each engagement activity, please state who was involved, how and when they were engaged, and the key outputs: School Nurse Development Group Primary Mental health Worker Summary of Analysis Adherence to all HR related policies regarding LCHS NHS Trust Staff in terms of discrimination, equality and diversity 19

20 Eliminate discrimination, harassment and victimisation NA Advance equality of opportunity NA Promote good relations between groups NA What is the overall impact? NA Addressing the impact on equalities NA Action planning for improvement To review equality analysis in conjunction with national/local changes in programme for school nursing core offer and updates to NICE guidance.. Continue to engage with school nurse development group and speech therapist with special interest Training for staff Ensure policy is updated as the service needs change. For the record Name of person who carried out this assessment: Sarah Packwood Date assessment completed: 12/06/14 Name of responsible Director/ General Manager: Nikki Silver Date assessment was signed: 20