SPECIALIST CAMHS REFERRAL PROCESSHarrogate District CAMHS

Provided by Tees, Esk and Wear Valleys NHS Foundation Trust

CONTACT ADDRESS

Specialist CAMHSDragon Parade Clinic2 Dragon ParadeHarrogateHG1 5BY Tel: (01423) 726900Fax: (01423) 726910

THE CORE BUSINESS OF SPECIALIST CAMHS

The specialist assessment and treatment of serious mental health issues and associated risks in young people under the age of 18 (to 18th birthday).

All young people may experience distress in reaction to life events, transition or family disharmony but those without a clear mental health component to their presentation can be supported by Universal Services (see information provided in this document).

CONSULTATION SERVICES OFFERED BY SPECIALIST CAMHS

Individual telephone or face to face consultation is offered for practitioners concerned about the mental health of a child/young person with whom they are working. This is usually via the PMHW Team but this may be via the Duty Clinician service, depending upon the level of concern.

Consultation could be offered to professional teams, after a discussion with the CAMHS Team Manager.

CONFIDENTIALITY AND CONSENT

Before discussing a child or young person with a CAMHS practitioner we would ask that you always gain permission from their parent or guardian. If a young person is aged 16 or over you can get permission from them directly, however it is usually advisable that the parent or guardian is made aware.

You can discuss a child or young person with us without giving their name. However before making a formal referral, the referrer should gain the consent of the young person and/or responsible parent/guardian.

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REFERRAL CRITERIA

Children, young people up to their 18 th birthday, (and their families) with Mental Health needs which are substantially impacting upon their lives and cannot be resolved with appropriate intervention by Universal and Targeted Services within Health, Integrated Children’s Services (via the CAF process); Social Care; Education Services and the Voluntary Sector. Presenting problems may include:-

- Severe deliberate self harm and/or risk of suicide- Depression- Psychosis (the Early Intervention Psychosis Team for Young People 14+ may be

more appropriate.)- Anxiety Disorders (life affected day to day)- Eating Disorders- Significant/complex behavioural difficulties that have not improved following

Universal or Targeted Interventions.

Other factors to consider when deciding to refer:-- level of parental concern- duration of problem- level of distress to child/young person- number of areas of child/young persons life which is affected ie home, school,

friendships, interests and hobbies.- other agencies that are involved and how their work is progressing. (NB if the child

or young person is the subject of a Child Protection Plan the lead Social Worker should be the person consulting with specialist CAMHS about the appropriateness of referral and this is best managed by booking a session at the monthly Consultation Sessions.)

Emergency Referrals: are those where a professional has serious concerns about the mental health of a young person requiring an assessment of risk within 24 hours. Such referrals should be directed to the CAMHS Duty Clinician between 9 -5pm or to A&E for the Out of Hours Service.

Urgent/Acute referrals: These referrals will be seen within two to five working days.

(a) Where there is significant deliberate self-harm or a risk or threat of significant deliberate self-harm.

(b) Where the presentation suggests a major psychiatric illness or a risk of major psychiatric illness.

Routine referral: referrals are screened daily. Where a referral is accepted, a phone call or a letter will be sent to the family (for under 16’s) and to the young person (over 16’s) with an appointment in order that they are seen within 28 days.

This includes less serious psychiatric, psychological and emotional problems where there is a significant impact on the child and/or family.

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WHO CAN REFER?

We accept referrals from a range of practitioners working with children, young people and their families including, GPs, Health Visitors, School Nurses, Paediatricians, Social Care staff, Education staff (including Educational Psychologists, SENCOs, Educational Welfare Officers, Parent Support Advisers), Youth Support Service Workers, voluntary sector organisations (including Young Carers, Relateen, Bereavement service).

We also consider self-referrals and this would be reviewed in relation to capacity to consent and the presenting criteria for access to specialist Mental Health Services.

INAPPROPRIATE REFERRALS FOR SPECIALIST CAMHSMay include

- Child/Young People where behaviour issues are the primary concern, but no intervention has taken place by Universal or Targeted Services.

- Children and young people whose difficulties are associated with a normal reaction to recent life events, (e.g. bereavement, parental separation, adjustment to chronic illness), and who would be considered to be experiencing normal adjustment reactions.

- Children and young people whose problems are entirely education based and are best addressed by educational services such as specific learning or behavioural issues within the school environment.

- Children and young people where there is a request for a diagnostic service for Autism without any clear evidence of mental health difficulties.

Please find below services which are available to support children, young people and families with a range of issues which may be impacting upon their psychological wellbeing, but where specialist CAMHS is not indicated as first line management.

ISSUES APPROPRIATE SERVICESIssues which are Primarily about Safeguarding: Child Welfare; Child Protection.

- Social Care- Access and Impact Teams

- Customer Services:Tel. 0845 034 9410

- Emergency Duty Team:Tel. 0845 034 9417

Social issues which do not reach thresholds for Child Protection or Child in Need (see Vulnerability Checklist)

- Common Assessment Framework (CAF) Process CAF Admin Team

- Integrated Services - Office details:Starbeck Children’s CentreTel. (01609) 533446

School based issues i.e. learning difficulties; behaviour issues.

- Head of Year or SENCO of school attended.Each school has a named Educational Psychologist. Private schools need to pay for an Educational Psychologist, which can be discussed via the Local

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School Attendance Issues

Education Authority at County Hall, NorthallertonTel. 0845 034 9444

- Education Welfare ServiceJesmond House, Victoria Avenue, HarrogateTel. 0845 0349 467

Generalised health related issues including low level anxiety; simple phobias, anger issues, behavioural issues including risk taking etc.

Children age 0-6 with developmental problems (including autism diagnosis)

- Healthy Child Programme Team(including Health Visitors and School Nurse Teams)

- School Nurse ‘Drop In Clinics’ held in various Secondary Schools.

- Young People aged 11 - 19 years old (25 years old if the young person has learning difficulties) can also be referred to the Targeted Youth Support Service via TRAXTel. 0845 034 9573

- Health Visitor- Child Development Centres- Children’s Centre- Parenting Groups

Bereavement Issues JUST B Service via St Michaels Hospice, HarrogateTel. (01423) 856790

Family Relationships(separation issues)

Young Person’s Counselling Service at RelateTel. (01423) 502173

CAFCASS (Harrogate/York)37 FishergateYorkYO10 4APTel. (01904 641448)

CAFCASS (Leeds)1 Park Cross MewsPark Cross StreetLeedsLS1 2QHTel. 0113 394 7400

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Emerging psychosis Early Intervention in Psychosis Team (EIP)Contact via the Valley Gardens Resource Centre, Windsor House, HarrogateTel. (01423) 852000

Parenting Issues - Parenting Programmes – via local Children’s Centres- Parent Support Advisors working as part of the Education Welfare ServiceJesmond House, HarrogateTel. 0845 034 9467

- National Numbers and websites:- Parentline Tel. 0808 800 2222 (24hrs) Website: www.parentlineplus.org.uk- Childline: Tel. 0800 11 11 Website: www.childline.org.uk- Young Minds Parent Support Tel. 0808 802 5544 Website: www.youngminds.org.uk

Substance Misuse Issues TRAXYouth Support ServicesTRAX15/17 Station BridgeHarrogateHG1 1SPTel. 0845 034 9573

Parental/Family IllnessWere children may have responsibilities to care for adults or other young people in their family

Young CarersTel. (01423) 500555

Sexuality Issues MESMACTel.(01904) 721173

Disability related issues (including Learning Disabilities)

- Social CareDisabled Children’s ServiceKnaresborough Children’s CentreManor Road, Knaresborough Tel. (01609) 535217

- Children with Learning DisabilitiesNurse – Mel WaudTel. (01423) 812848

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Issues relating to Homelessness -Youthbase (supported lodgings)Referrals only received via Social Care or the Housing Office. Tel. (01423) 500600

Issues with Adoption After Adoption Yorkshire 31 Moor Road, Headingly, LeedsTel. 0113 230 2100

Local Authority Adoption TeamTel. 0845 034 9590

Please note this list is not an exhaustive list and the services may be subject to change.

Harrogate and District Specialist CAMHS is also commissioned to offer services to the Wetherby area. The same criteria, (as outlined in this document), also applies to referrals in the Wetherby area. However, it is acknowledged that access to Universal and targeted services will differ due to the geographical location.

Please find below a list of such services for Wetherby area. (please note this list is not exhaustive.

Issues Appropriate ServicesChild Welfare/Child Protection Social Care Customer Relations

Tel. 0113 2224 403

Common Assessment Framework Team (CAF)Tel. 0113 247 6830

Problems which are primarily education based.

School: ie SENCO or Pastoral SupportEducational Psychology ) EducationEducation Welfare Officers) LeedsTel. 0113 395 1039

Parental Separation and family issues Young Person’s Counselling Service at RelateTel. (01423) 502173

CAFCASS1 Park Cross MewsPark Cross StreetLeedsLS1 2QHTel. 0113 394 7400

Behavioural Issues Tier 1 mental Health Services- Parent support groups- School Nurse- Health Visitor Service- Parent Support Advisors

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Children aged 0-6 with developmental issues

- Health Visitor- Child Development Centre- Children’s Centres- Parenting groups

Bereavement St Gemma’s HospiceYoung Person’s Bereavement ServicesTel. 0113 218 5500Please telephone for a discussion before referring.

Young Carers The Willow ProjectLeedsTel. 0113 377 3010

A range of services for young people aged 13 - 25

The Market Place28 Kirkgate, Leeds City CentreTel. 0113 246 1659

The BeckUnit 2, Killingbeck Court,Killingbeck Office VillageLeeds LS14 6FDTel. 0113 240 2929

The Salvation ArmyThe Sanctuary, Wetherby High School,Hallfield Lane, Wetherby LS22 6JSTel. (01937) 588794

Please note this list is not an exhaustive list and the services may be subject to change.

Where possible written referrals should be made using the standard Referral Form (see appendix A) and all sections must be completed. We can send an electronic copy to enable email of referral over secure networks i.e. NHS Mail etc.

We realise this document is lengthy but the intention is to help all referrers as much as possible, both with their CAMHS referrals and also with other information that may be of help when considering if CAMHS is the correct service for their patient/client.

If you have any questions regarding the contents of the document please contact;

Heather DaviesHarrogate District CAMHS Team Manager (01423) 726900

To be reviewed April 2015 (Harrogate Version)

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Please complete this form in full. Failure to do so may result in return of the form and delay in accessing the service

Specialist CAMHS Referral FormSpecialist CAMHSDragon Parade Clinic2 Dragon ParadeHarrogateHG1 5BY

For emergency or urgent referrals you will need to contact the Duty Clinician (Monday – Friday 9.00am – 5.00pm):Tel: (01423) 726900Fax: (01423) 726910Email: TEWV.dpcadmin@nhs.net

Telephone ConsultationYou may wish to telephone CAMHS for a consultation with a Primary Mental Health Worker before making a referral.

To be completed by office personnelPerson(s) screening case:      Decision made:      Date:      Comments:     

Section 1: Child/young person and family details1(a) About the child/young personForename

      School/Current educational setting name and address (if not referrer)

Statement of Educational Need

Learning Disability

Child Protection Plan

     

Yes/ No      

Yes/ No      

Yes/ No      

Surname      Also known as

     

Date of Birth

     

Age       Telephone or contact details

     Gender Male/ Female      Ethnicity       Current General

Practitioner name and address (if not referrer)

     First language

     

Home address (including postcode)

     

Postcode       Telephone or contact details

     

Telephone or contact details

      NHS no:      

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Allergies or significant medical history

      Child/young person aware of the referral?

Yes/ No      

Child/young person consent for this referral?

Yes/ No      

1(b) About the principle parents/main carersName Relationshi

pContact details Parental

Responsibility?

                  Yes/ No      

                  Yes/ No      

Section 2: Mental Health Issues Pertinent to CAMHS (please include duration):Please include relevant presenting mental health concerns and duration, and/or relevant educational information:

     

Section 3: Current Risks:Include: details of self-harm, suicidal ideation, eating problems (including BMI) or sleep problems:     

S risk to Self:      E risk from Environment:      

N risk from Neglect:      

O risk to/from Others:      

C risk to Children:      

Section 4: Previous Interventions and Outcomes:Including: significant past family history or developmental progress; mental health issues; life events; family history

     

Section 5: Other agencies involved3 Please give details of others working with/ have worked with child/young person/familyNursery/Pre School:      

School Nurse/LD’s Nurse     

Connexions PA     

Health Visitor     

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Home-school Link worker     

Youth Offending Team     

Education Psychologist     

Social Worker     

Inclusion/Learning Support     

Educational Welfare Officer     

Behaviour Support Services      

Safeguarding/ Child Protection:     

Other please state      

Section 6: Family Structure:Including: is the young person a parent or carer? Does the child have a close responsible adult? Opinion as to the quality of significant family relationships?

     

Section 7: Referrer’s detailsName      Job title      Agency      Address      

Postcode      Contact details      Signature      Date of referral      Copied to parents/ carerYes or No

     

This form can be saved electronically and filled in electronically with the boxes expanding as required.

Alternatively, if completing by hand, please first expand the relevant boxes by using the “return” button to create enough space in which to write.

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APPENDIX BPathway for Managing Written Referrals received into Specialist CAMHS Team

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Written Referral Received by Post or Fax

Marked by Referrer asURGENT

Information assessed by designated Duty Clinician and judgement regarding

priority made

Marked by Referrer asROUTINE

Information discussed every day by PMHW &

Duty Worker

ROUTINE

EMERGENCY= see within 24 hours

by Duty ClinicianTier 3 Team assessment completed

URGENT= see within 2- 5 working days by Duty Clinician or another Tier 3 Clinician

allocated via MDT

Appropriate Referral for CAMHS Allocate to CAMHS Practitioner for assessment Patient contacted with an appointment phone/ letter

within 48 hrs of referral sent to Parent/Carer or Young Person if 16+

First appointment completed within 28 days of receipt of the referral, assessment recorded on PARIS.

Risk Assessment and Care Plan as in step above. 2nd appointment offered within maximum of 8 weeks

from referral. Formulation shared with patient/ family sent to referrer.

Inappropriate Referral for CAMHS

Assessed as inappropriate from the information provided by referrer

Letter to Parent/Carer/ Young Person signposting to an alternative service (see attached list)

Copy of letter to referrer + GP if not the referrer

No further CAMHS action

Information discussed and assessed at daily referral meeting

Referrals entered onto PARIS until decision made re appropriate or not. Decision recorded on checklist. Case remains open on PARIS if accepted, closed if not accepted

Risk Assessments and Care Plan formulated , recorded and shared with client/family and referrer within 72 hours. Case discussed at next available MDT. Follow up arranged for within 8 weeks of referral depending on needs

APPENDIX C

PRESENTING PROBLEMS TO SPECIALIST CAMHS

Please note that diagnosis may be made following an assessment with specialist CAMHS

Attention Deficit Hyperactivity Disorder. For initial assessment and diagnosis, follow NICE guidelines Complex ADHD cases with co-morbidity should be referred to Specialist CAMHS

Eating Disorders Anorexia – low weight/ weight loss/ food restriction/ exercising excessively Bulimia – Engaging in binge and purge behaviour

Psychotic Illness Positive symptoms – Paranoia, delusional beliefs, abnormal perceptions

(hallucinations on all sensory modalities) Negative symptoms – deterioration in self care and daily personal, social and family

functioning Disinhibited behaviour, overactivity, risk taking, with pressure of speech and

agitation Severe depression with psychomotor retardation, social withdrawal, suicidal

ideation

Anxiety Disorders Anxiety panic attacks Separation anxiety Phobias including phobic anxiety related to school

Depression Physical symptoms – poor sleep/appetite/libido Cognitive symptoms – negative thoughts about self/others/world Suicidal ideation – level of intent, current thought, etc Co-morbidity – depression often occurs concurrently with other presenting mental

health problems

Post Traumatic Stress Disorder Symptoms occurring more than 3 months after a recognised traumatic event Intrusion and avoidance of thoughts and memories about the trauma Hyper-vigilance, hyper-arousal and emotional numbing

Obsessive Compulsive Disorder & Tourettes Obsessions and/compulsions with functional impairment Tourettes Syndrome with complex motor and vocal tics, particularly with co-

morbidity with OCD and rage

Deliberate Self Harm If accompanied by significant suicidal ideation If presenting with a pattern of emotional disregulation, interpersonal difficulty and

maladaptive coping strategies

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Attachment Disorders If presenting with a persistent pattern of abnormal functioning in interpersonal

relationships

Specialist CAMHS will also see individuals with the following presentations if there is evidence of co-morbidity with a serious mental health condition

Autism Drug and alcohol problems Conduct disorder Children with learning disabilities Obesity Enuresis/Encopresis Chronic fatigue/somatisation syndrome

URGENT CASE CRITERIA1) Suspected emerging psychosis (e.g. perceptual disturbance, delusional

beliefs, withdrawal from socialising, apparent personality change).2) Suspected Anorexia Nervosa with BMI of less than 17 or rapid weight loss in

recent weeks.3) Suicidal ideation or repeated severe deliberate self harm in the context of a

significant mental health problem.4) Severe and disabling anxiety (e.g. severe OCD) that is impacting significantly

on the child or young person’s functioning.5) Should the case be of a complex nature creating urgency but not necessarily

of a complex mental health nature and expertise from CAMHS would be useful in the context of Multi Agency working we would recommend calling a CAF (Common Assessment Framework meeting and including CAMHS on the invitation list. At this meeting we can agree which agency and therefore which professional should be lead and plan care accordingly. A link to the referral form is included here www.everychildmatters.gov.uk/resources-and-practice/TP00004

Other points to consider prior to considering CAMHS is:

If there is a Safeguarding issue then Social Care should be consulted. If the child has a learning disability, (LD) refer to the LD pathway / LD Nursing team. If the issue is related to family separation has the family been offered information

regarding Relate /Relateen or some other mediation service for parents in conflict. Has a less specialist approach been tried first i.e., Health Visitor, School Nurse,

School Mentor Counselling, Young Carers Service? The PMHW team welcome telephone consultation prior to referral Does the family want referral to a mental health service? Has the referral been discussed with the family, child or young person?

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