CAMHS Reference and Resource File

Transcription

1 @ SURREY COUNTY Hampshire ~ County W Council Surrey and Borders Partnership rll:g:j NHSFoundation Trust CAMHS Reference and Resource File What CAMHS is and how it works The tier system South East and Mid Surrey CAMHS and referral procedure Referral criteria What makes a good referral The CAMHS referral pathway Primary Mental Health Trust referrals The services that work with CAMHS Leaflets of the services that work with CAMHS Information and advice leaflets for young people and parents CAMHS Surrey Child and Adolescent :rvlental Health Services

2 CAMHS Reference and Resource File: What CAMHS is and how it works The tier system South East and Mid Surrey CAMHS and referral procedure Referral criteria What makes a good referral The CAMHS referral pathway Primary Mental Health Trust referrals The services that CAMHS work with Leaflets of the services that work with CAMHS Information and advice leaflets for young people and parents

3 What is CAMHS? CAMHS is the Child and Adolescent Mental Health Service. CAMHS exists to promote emotional well-being and to deliver preventative services and treatment to children and young people with mental health problems. CAMHS is a partnership between Surrey County Council, Surrey's Primary Care Trusts, three NHS delivery trusts for mental health and voluntary organisations. CAMHS in Surrey CAMHS is organized around a tier system: Tier 1 Professionals working with young people. Although these professionals, (e.g. teachers, youth workers, school nurses, health visitors, GP's and social workers)are not directly employed to promote mental health, with appropriate training and support they are ideally placed to offer early intervention strategies as they may already have a collaborative therapeutic relationship with their clients. Tier 2 Primary Mental Health Workers (PMHW). These specialist professionals provide consultation, training and support to young people with a mental health problem, emotional problem, or challenging behaviour. Tier 3 Multi-disciplinary Teams work with young people with complex mental health problems. The teams include psychologists, psychiatrists, therapists, art psychotherapists, play therapists, family therapists, social workers and community nurses. The teams work collaboratively together to help young people with severe mental health problems, their parents and carers. Tier 3 plus service HOPE Service. This service is a CAMHS Outreach service for adolescents with complex needs and challenging behaviour. The service aims to prevent problems escalating and children needing hospital care or a specialist placement. This service provides healthcare, education and social care to young people at a site in Epsom and Guildford. HOPE is accessed by CAMHS Tier 3 and via Area Placement Panels. Placement Stability Service works with looked after children to help prevent a placement breaking down. It offers treatment to young people, and training and support to carers. Tier 4 Specialised care for young people suffering serious mental health problems e.g. inpatient hospital care. Education and health facilities are available on the same site (i.e. Chalk Hill in Haywards Heath West Sussex).

4 ',...-I. -'. The.Fo,ur!ier StrateSJc,l,3'ramewOrk.:.) ~"...,' ~'. Tier Professionals Providing the service include: Tier 1: Aprin?arylevelofcare GP's Health visitors School nurses Teachers Juvenile justice workers Voluntary agencies Social services Tier 2: A service provided by Child and Adolescent Mental health s workers professionals relating to workers in primary care Paediatricians (esp. community) Educational psychologists Child & Adolescent psychiatrists Child & Adolescent psychotherapists Community nurses/nurse specialist Familv therapist Tier 3: A specialised service for more Child & Adolescent psychiatrists severe, complex or persistent Clinical child psychologists disorders. Nurses (community or in-patient) Child psychotherapists Tier 4: Essential tertiary level services such as day units, highly specialised out-patient teems and in-patient units. Occupational therapists _. Speech and language therapists Art, music and drama therapists Family therapist Function/Service CAMHS at this level are provided by professionals working in universal services in a position to: )- Identify mental health problems early in their development )- Offer general advice )- Pursue opportunities for mental health promotion and prevention. CAMHSprofessionals should be able to offer: )- Training and consultation to other professionals (who might be within Tl) ~ Consultation to professionals and families )- Outreach )- Assessment Services offer: )- Assessment and Treatment )- Assessment for referrals to T4 )- Contributions to the services, consultation and training at Tl and 2 ~ Child and Adolescent in-patient units ~ Secure forensic units )- Eating disorders units ~ Specialist teams (e.g. For sexual abuse) )- Specialist teams for neuro-psychiatric problems.

5 SOUTH EAST AND MID SURREY CAMHS We aim to work with, or offer support to others who are working with, children or young people with emotionajfpsychological or mental health difficulties from birth to their 18 th birthday. This help and support will, in the first instance, involve their families. We can usually recognise these children and young people by the behaviours they use. Following a national audit of child mental health services in 1995 (Together We. Stand) CAMHS services were organised into 4 'tiers' to support children and families with emotional, psychological and mental health difficulties, and those professionals who work with them. Tier 1 - 'Universal Services' - any professional or voluntary service working with children/young people. Tier 2 - CAMHS Primary Mental Health Service - mild to moderate Tier 3 - CAMHS Multi-disciplinary team - moderate to severe/chronic/acute Tier 4 - CAMHS inpatient, day-patient or specialist assessment service Referral Any professional or voluntary sector employee can refer a child to CAMHS. We do not accept self-referrals. Discuss with parents and young person before making a referral. We do not see children or young people without the knowledge or consent of their parents/carers. However, we will offer advice/risk assessment. Let us know what has happened, what has been tried, what the family and child want. Name and address of GP When the referral is received by the appropriate CAMHS clinic it will go to a 'Screening Meeting' where it will be allocated to Tier 2 or 3.

6 We will then either contact you direct to offer consultation, advice or joint visit or we will send you a copy of the letter we have sent to the family. Those referrals that are allocated to the Tier 3 team will be prioritised into Emergency/Urgent/Standard and contacted within an appropriate time scale. The Emergency referrals will be contacted the same day. At the moment in Redhill the Standard referrals are offered an assessment appointment in 7/8 weeks. If you would like to discuss a concern you have or a possible referral before you send it you can telephone the appropriate Primary Mental Health Worker: Horley/Reigate RedhilllHorley Tandridge Mole Valley Epsom East Elmbridge Martin Longhurst Graham Pritchard Chandra Atkinson Patricia Allardyce Charlie Fancy/Liz Ephgrave Sue Fraser or Carol Bason Community Development Manager !

7 REFERRAL CRITERIA The service accepts referrals for children and young people up to their 14th birthday if they meet the following criteria: DEPRESSION Where the difficulties are beyond age-appropriate mood variation. Where there is an impact on daily living - e.g. sleeping, eating and/or school attendance. Where there is positive family history of mental illness or suicidal ideation. SELF-HARM Where there is concern about self-harrn in the context of other difficulties.,. Overdose cases should be sent directly to the Southampton General Hospital or local District General,. Hospital for immediate medical care. They should NOT be referred to the Child and Adolescent Mental Health Service. ANXIETY Where it is affecting the child's development or level of functioning. R:. Where it is out of proportion to the family circumstances. Where there is an impact on the parentlcarer/child relationship. T'. Where there is a sudden change or deterioration. OBSESSIONAL-COMPULSIVE DISORDER PJease consider an early referral if the symptoms are interfering with the child's functioning. 1- PSYCHOSIS f}efer immediately to the Child and Adolescent misuse. Mental Health Service, including those secondary to substance EA TlNG DISORDERS Please consider an early referral to the service where there are symptoms of an emerging eating disorder. It is helpful to complete medical investigations (bloods, weightlheight, etc) via the GP prior to referral. COMPLEX DEVELOPMENTAL PROBLEMS Difficulties may include: Impaired social communication. ~... Unusual or very fixed interests. Marked preference for routine and difficulties adapting to change or rigid behaviours. ',' Hyperactivity, impulsivity, inattention in children that is unresponsive to behavioural intervention in the home and school. There is currently no service for children with severe learning disabilities within CAMHS. FAMIL Y DIFFICUL TIES R'. Children and young people may present with emotional and behavioural difficulties in response to family rr' stress - e.g. parental discord or separation. If referrers are aware of these issues, please be aware that parents should be encouraged to make efforts to resolve problems prior to referring the child. CA. The Child and Adolescent Mental Health Service should not be used to support children in situations where problems need to be resolved by parents. More appropriate support can be obtained from other agencies - e.g. Mediation Service and Relate. The service will not be involved in any legal issues in relation to parental separation. Solicitors should commission reports for court from professionals who work on a private basis. 'f}oma TOFORM DISORDER Where a child is experiencing significant impairment of function that may be related to psychological difficulties. (',

8 I.. RESPONSE TO BEREA VEMENT You may want to consider referral when the child is experiencing significant distress following a death that has occurred within traumatic circumstances (e.g. suicide), or an abnormal grief reaction. In these cases we may choose to meet carers without the child to offer them advice and support. It is not appropriate to refer when this '~R'normal grief. 'v ~ POST- TRAUMA TIC STRESS DISORDER Where a child continues to demonstrate hyper-vigilance, avoidance, flashbacks, or a marked increase in ~nexplained temper tantrums or episodes of other distress. SCHOOL REFUSAL It would be most appropriate to refer a child in the first instance to the Education Welfare Service, however, refer to CAMHS when the following conditions apply: When there is severe difficulty in the child attending school, often amounting to prolonged absence and where the child is experiencing severe emotional upset on being faced with the prospect of attending school. This may be demonstrated by excessive fearfulness, anxiety, temper, misery and complaints of feeling unwell without obvious cause. COMPLEX ENURESIS OR SOILING '(. In the first instance the specialist community constipation clinic or paediatrician should see these oc children. c. We recommend referrals to come from the specialist within these clinics..) It is NOT appropriate to refer:,.; Children and young people whose problems are primarily school-based (refer to school concerned). v~ Children and young people where the behaviour, although challenging, is age-appropriate. r-.... ), With acknowledgement to: The Battenburg Clinic, Portsmouth Primary Care Trust. ",.. t' T

9 CHILD AND ADOLESCENT MENTAL HEALTH SERVICE SPECIALIST CAMHS This example of what makes a good referral was taken from Cooper et al (2005) Child and Adolescent Mental Health Theory and Practice. Edward Arnold, London. It shows the sort of information that a Tier 3 CAMHS would consider makes a good referral and lists referral criteria. It was used by Ashurst Hospital Tier 3 Service who provide a CAMHS service for children aged 0-14 years of age (and their families and carers), who have highly complex or severe mental health problems. WHAT MAKES A GOOD REFERRAL? General Considerations It is important that you have met with the parent(s)/carer(s) and the referred child/children. It is essential that the referral to our service has been discussed with the parent(s)/carer(s) and the referred child/children and they are in agreement with the referral being made. Basic Information Name and date of birth of referred child/children. ( Address and telephone number. Who has parental responsibility? c, Surnames if different to child's C GP details i-'{r; ~fi!ason for referral ",vi'. What are the specific difficulties that you want our service to address? h'. How long has this been a problem and why is the family seeking help now? Your understanding of the problem / issues involved. X;;rther helpful information r- Who else is living at home and details of separated parents if appropriate.,~ Name of school. Who else has been or is professionally involved and in what capacity? Has there been any previous contact with our service and what was the outcome? Any relevant history, i.e. family, life events and/or developmental factors. h. Is the child 'Looked After' by the Local Authority? Is the child on the Child Protection Register? 1{~yOU have any queries regarding referral to the service please contact the team. 8mLD PROTECTION. If-you are concerned that a child is at risk of harm from physical, sexual or emotional abuse, you must refer to Social Services in the first instance, specifying your concerns. All referrals to Social Services should be made in writing, or if made by telephone, should be followed up in writlng. \-' {-,,> " C" J _ 11.~ Co' v.,

10 Consultation 1-- I Meetings I School! home vsits I-- CAMHS Paper Referral Form (e.g. from teacher, school nurse et c) TIER 1 Primary Mental I... 1 CAMHS Referral Health Team TIER2.---_----"~L , Meeting ~ ~ Not taken up Refer on to other Agencies CAMHS Referral Pathway Clinic Specialist Team TIER3 Emerging mild! moderate. Less than 18 months duration I Complex! Serious! Chronic Simple Phobias Anxiety Emotional! Behavioural problems School issues! refusal Mild Self-harm Loss Mild! Moderate eating disorder Attachment disorders ADHD Severe depression Major trauma Risk of suicide! high risk DSH Suspicion of psychotic disorder Moderate! severe eating disorder Complex emotional! behavioural problem Consultation, Short term work (max 6 sessions), Joint - work (Multi-professional), Group! family work 1 Review, Closure or Transfer to Tier 3 Consultation, Individual, Specialist (e.g. psychiatrist), Group! family work. Review, Closure or Transfer to TIER 4

11 Appropriate Primary Mental Heath Trust Referrals Cases appropriate for intervention from PMHT: Less complex mental health problems, e.g. o o o o o o Mild anxiety Moderate self-esteem issues Mild depression Adjustment problems following divorce 1 loss 1 bereavement. Early signs of Phobia, QCD, PTSD. Disruptive behaviour in school 1 other setting where neurodevelopmental issues are not apparent at assessment. Where time-limited intervention appears appropriate. Where referrer is not the GP or where the family identify a front-line professional who is already closely supporting the family (PMHT can then provide consultation to the professional concerned). Where a network meeting is the most helpful way of supporting the child 1 young person and where substantial additional input is not needed for the child or family. Other services PM HT can offer: Information to professionals (e.g. assessment clinicians about local services available in the locality - alongside resource files that are being assembled at present). Home visits and appointments in the locality (at schools 1 at health centres etc). Consultation to professionals already involved with the family. Training to tier 1 staff. Points to consider: It is not appropriate to give the PMHT telephone number to families who may need additional advice following the initial assessment appointment. If it is unclear whether people will need additional support, please use the "leave the case open for 3 months" option and ask the family to contact the CAMHS team if they need further input.

12 PM HT have more flexibility to offer home visits and attend network meetings. This does not mean that they are the only clinicians able to do this and PMHT involvement should be about early, brief intervention and level of mental health need, rather than treatment modality / location.

13 CAMHS work with: Action for Carers provide support for and training for carers in Surrey. Tel: They run the Surrey Young Carers Project, Tel: Attention Deficit Hyperactivity Disorder (ADHD) parent support groups. CAMHS assists parents in who have children with ADHD Childline is a free confidential support service for children. It provides leaflets and advice. Tel: Connexions. The Surrey Peer Support Project is an example of CAMHS work with Connexions. The Project provides an early intervention service for young people in secondary school education based around peer support. The Surrey Peer Support Project, Tel: Cruise Bereavement Care is a charity providing support for carers and children who have experienced bereavement. Tel: helpline@cruse.org.uk. Young persons free phone: Drug and Alcohol Action Teams. Surrey Young People's Services (SYPS) is Surrey's drug and alcohol intervention team. They provide drug advice, counseling, drug therapies and aftercare packages for young people aged under 19. They also run music graffiti and design workshops. Tel: They have a staff member dedicated to CAMHS work. East Surrey Domestic Violence Forum is an outreach service who offers confidential listening, practical advice and support for those suffering domestic violence. Tel: es.dvf@virgin.net. Family Information Service is an internet, telephone and outreach service giving parents and prospective parents information about all services for children aged 0-19 years (up to 25 years for children with special needs). Tel: Family Line provides a one-to-one telephone service for anyone with family concerns. Tel: , Helpline: Gingerbread provides help and advice for lone parents and their children. TEL: Heads Together offers a professional counseling service for young people aged Tel: HEADSTOG@ymcaredhill.com Healthy schools. This whole school improvement programme promotes the health and well being of pupils and staff; through the development of personal,

14 social, health education, healthy eating, physical activity and emotional health and well-being (including bullying) The Hideout is a website offering support to young people living with domestic abuse. Home Start offer support and friendship for parents through home visiting, family and specialist groups and social events. Tel: It's not your fault is a website for young people who are worried about their parents splitting up. Jigsaw Bereavement Service offers training advice and support for families and clinicians. Tel: Kidscape helpline for parents and relatives of bullied children. Tel: Mental health work in youth offending. There are two dedicated mental health workers in this team National Autistic Society (NAS) EarlyBird Programme is for parents of children under five with a diagnosis of autistic spectrum disorder. It is times a three month programme, one day a week working with six families at a time. Tel: National Children's Home's Family First Service works with children and young people with services for children with disabilities, family and community services work with young people leaving care and rural children's services. CAMHS has a mental health worker in this team NSPCC After Sexual Abuse Project (ASAP) offers a therapeutic service to help children and young people who have experienced sexual abuse. Tel: surreycw@nspcc.org.uk National Youth Advocacy Service (NYAS) provides a voice for young people who use CAMHS Parenting education and support offers a range of educational and supportive measures to help parents understand their children's health and development needs. Parentline Plus Tel: Partnership with parents provides support for parents of children with suspected or diagnosed special educational needs. Tel: pwp@surreycc.gov.uk. Rainer 16 plus offers support to young people who are leaving care. CAMHS has a mental health worker in the team

15 Rethink - At Ease provide information about mental health problems. Tel: at-ease@rethink.org. Rape and Sexual Abuse Support Centre (RASASC) provides counselling for young people who have experienced rape or sexual abuse. Tel: RU OK? is a self-help website for teenagers, parents and carers and professionals. Samaritans is a 24 hour service offering confidential emotional support to anyone who is in crisis. Helpline: Social Services. Tel: weekends): Emergency duty team (after 5pm or Studio Centre support for children and parents living with a child with ADHD.Tel: Surrey Drug Care provides drugs information for parents and carers. Tel: Surrey Family Mediation Service is a child counseling programme for children faced with parental separation I divorce. Tel: childcouncelling@surreymediation.co.uk Surrey Young Peoples Service provides drug advice and care packages for under 19's. Tel: Teenage Health Freak is a website with information, stories and advice for teenagers on health issues. There 4 Me gives 12 to 14 year olds advice about bullying, relationships, exams, drugs and difficulties at home. West Surrey Youth Counselling Service provides free and confidential counselling for people ages 12 to 24 years. Tel: Winston's Wish supports bereaved children and young people through home visits, residential weekends, social activities and support programmes. Tel: info@winstonwish.org.uk Young Minds provides leaflets and help for parents and young people concerned about mental health issues. Tel: Youth Access puts young people in touch with local contacts for counselling, advice and information. Tel: wwww.youthaccess.org.uk.

16 Youth Counselling Service. This service offers free and confidential one-to-one counseling for people aged 12 to 24 years, on a short-term basis to address a broad range of issues. Young people can self refer to this service. This service operates across West Surrey. Tel: The voluntary organisation Heads Together operates a similar service in East Surrey. Tel: Youth in Mind is a website with information for young people on stress, emotional and mental health. It has a good booklist. YMCA offer exclusive playschemes (Yippee) for young people aged 5-15 with complex special needs or disabilities: Tel: children@ymcaredhill.com. At Guildford YMCA there is also an open house counselling service for young people

17 Leaflets of the services that work with CAHMS Please help yourself to the photocopies of the leaflets Useful contacts What is CAMHS? Action for Carers (support and training for carers in Surrey) Surrey Young Carers (support for young carers in Surrey) Connexions (advice for young people on education, employment, training and choices) Cruise Bereavement Care (support for young people who have experienced bereavement) East Surrey Domestic Violence Forum (listening, support and advice for those suffering bereavement) Family Line (one-to-one telephone line for family concerns) Heads Together (counselling service for year olds) Home Start (support and friendship for parents) Jigsaw (bereavement support) NAS EarlyBird programme (support for parents of autistic children under five).partnership with parents (support for parents of children with special needs) RASASC (Rape and sexual abuse support) Surrey Family Mediation Service (child counselling) Surrey Young Peoples Service (drug advice and care packages) Winstons Wish (support for bereaved children) Yippee exclusive playscheme (for children aged 5-15 with complex special needs or disability) YMCA (Summer playschemes and counselling services)

18 If you would like further copies of any leaflets in this file please contact Graham Pritchard at Redhill CAMHS: Tel: Kingsfield Centre Philanthropic Road Redhill Surrey RH14DP

19 USEFUL CONTACTS SINGLE PARENT FAMILY SUPPORT offers support and advice to single parents. They also have a phone helpline Single Parent Action Network (SPAN) aims to put single parents in touch with each other via the social networking area on its website ( and offers its parenting service at SUPPORT FOR DADS OadTalk is an online community encouraging all fathers, especially those with teenagers, to do just that, w'/w.dadtalk..co.uk specifically targets separated fathers, and provides an online space where they can stay in closer touch with their children. SUPPORT FOR MUMS The Netmum's organisation puts mothers in touch with other mums in their locality, and also with health visitors, who can help with post-natal problems and issues linked to childcare. CHJLDREN'S MENTAL HEALTH Young minds vlww.youngmindsora.uk offers a free service to anyone concerned about the mental health of a young person, whether caused by bereavement, depression, eating disorders, self-harming or a diagnosed mental health problem. Tel TEENAGE ISSUES aims to recreate the "school gate" community thal parents lose when their children move on from primary school. DISABILITIES has lots of information for the parents of disabled children, and links them up with other rnums and dads who are in the same position. SCHOOL RELATED PROBLEMS The Advisory Centre for Education will offer independent advice to parents on all aspects of the education system, such as admissions, bullying and discrimination. Call Stress between parents can easily impact on progress at school. Relate has launched two new initiatives - one online and the other using text messaging to allow parents to get help quickly w\a/w.relateforparents.org.uk The One Plus One organisation offers parents online relationship support at