Things you should know
East Lancashire Hospitals Specialist CAMHS aims to provide a joint agency/multi-disciplinary service to enhance the development of those children with mental health problems and disorders. This will be achieved by:
o Assessment of children who are experiencing mental health disorders and their families.
o Treatment of children who are experiencing mental health disorders and their families.
o Contributing to the development of prevention strategies.
o Supporting the work of other childcare professionals through consultation, training and supervision.
o By acting as a specialist resource to managers and planners and commissioners in the development of services.
o Promotion of the positive mental health of children and adolescents.
o Training and research.
Specialist CAMHS aims to provide a comprehensive service which is able to deal with a range of mental health issues, in collaboration with other agencies to provide the highest quality standards of care and intervention.
Clinical Service Structure
The service covers the whole of East Lancashire across 6 different localities (population circa 520,000). Within each of the localities are specialist CAMHS workers who work primarily with other professionals in primary care. The workers in these localities have direct links into three sector teams. The sector teams consist of Child and Adolescent Psychiatrists, Staff Grade Doctors, Community Mental Health Workers, Community Mental Health Nurses, Social Workers, ADHD Practitioners and Occupational Therapists.
There is also an Intensive Support Team, which the three sector teams can access for referral of cases requiring an intensity of input that cannot be provided in conventional outpatient settings. The Service also benefits from input from the Clinical Child Psychology Department. This is a separate service which is managed by Lancashire Care NHS Trust and provides specialist psychological input on a part-time basis to specialist CAMHS although this is not equated throughout the sectors. There are no inpatient beds within the East Lancashire area. If required, this is accessed through normal commissioning procedures into out of area provision.
Sector Teams (Tier 3)
The sector teams are all based within The Mount, at Accrington
o Burnley and Pendle
o Rossendale, Hyndburn and Ribble Valley
o Blackburn with Darwen
For the Sector Teams most of the work is currently undertaken in the Out-Patient Department. The Out-Patient Departments have specialist facilities such as family therapy and play therapy provision, together with specialist assessment equipment.
Intensive Support Team (Tier 4)
Based at the Mary Burbury Unit at Burnley General Hospital, the Intensive Support Team (IST) undertake a combination of centre based and outreach based activity for children and young people where specialist input is required on a more intensive and frequent basis.
The service is available, through the administrative team, as follows:
The Mount, Accrington - 9.00am to 5.00 pm Monday to Friday
Intensive Support Team - 8.00am to 4.30pm Monday to Friday
Clinical staff work flexibly across these timescales in order to meet the needs of young people and their families/carers. However, the specialist CAMHS service is not commissioned to provide an out of hours full emergency service, there is an answer phone available outside of normal office hours, and other usual health routes should be considered in an emergency, e.g. NHS Direct, PCT services, A&E.
Specialist CAMHS is commissioned to provide a service for children up to their 16th birthday. Referrals for young people over the age of 16 should be sent to the appropriate adult mental health provider
For those young people who reach their 16th birthday while undergoing a course of treatment, this will not be affected should this treatment or intervention be short term. If the long-term prognosis indicates the need for on-going intervention there is a Transition Protocol which will be followed and arrangements made for transfer of care from East Lancashire Hospitals NHS Trust to the appropriate adult mental health provider. In East Lancashire this is likely to be Lancashire Care NHS Trust.
All referrals for specialist CAMHS have one point of entry, through the sector team referral meetings. All referrals should be addressed to the team or the Team Coordinator.
Prior to initial allocation, all referrals are discussed by the multi-disciplinary team.
If the referral is appropriate for the service, children and families will be offered in an initial appointment where they will be seen by a member of the team and a letter sent to the referrer informing them of the outcome.
The case will then be either placed on the waiting list or allocated to member of the team, dependent on the outcome of the initial assessment. Allocation of cases to team members for intervention is decided upon by the team to ensure a child’s needs are best met. Allocation can be to any member of the clinical team.
Cases are regularly discussed at a multi-disciplinary team level to support ongoing intervention or to support referral to a more appropriate agency. During the course of contact with the service a child/family may see many professionals, not necessarily a doctor. Medical responsibility for out patients remains with the GP practice. For this reason it is important that all referrers ensure the GP knows of the referral.
Referrals to the Intensive Support Team are only accepted via the Sector Teams through sector team discussion, following assessment by a CAMHS health professional.
Cases that do not meet the referral criteria will be returned to the referrer with suggestions when possible as regards alternative courses of action. It should be noted that all referrals are accepted for assessment only in the first instance.
It is recognized that it can be difficult for referrers to know which of the distressed children and families they see should be referred to this department and the following guidance on the types of cases that should be referred should be used as a guide.
It is important to define CAMHS priority levels. Priority is given to those cases where CAMHS would be seen to take the lead in assessment and treatment.
Low priority is defined as those cases where there are other agencies/services available to support the young person and family and where CAMHS may be required to play a component part.
Sector teams predominantly accept referrals for assessment and intervention from GPs, Social Workers, Clinical and Educational Psychology, other CAMHS professionals and Paediatricians. All referrals from other sources should be via the CAF process.
Problems and Disorders regarded as a priority for Specialist CAMHS
o Children or adolescents who attempt to harm themselves
o Psychotic Disorder (including early on-set Schizophrenia).
o Developmental Disorder including diagnosis of autistic spectrum disorder, complex ADHD, Tourette’s syndrome etc
o Depressive Disorders.
o Anxiety Disorders.
o Eating Disorders.
o Family relationship difficulties that appear associated with severe abnormal behaviour in a child or adolescent.
o Severe and prolonged adjustment difficulties e.g. abnormal grief reactions, severe post traumatic stress disorder, dissociative and somatic conversion disorders
o Severe attachment difficulties
Problems and Disorders suitable for collaborative intervention
The following is a list of problems and disorders that are not regarded as first line work for CAMHS. There are some circumstances where CAMHS would be involved but these referrals should only be made when despite the involvement of other professionals and agencies there still appears to be a need for mental health involvement. Referrals in these cases will come from other professionals or agencies who would be expected to continue their involvement.
o Physical disorder with possible psychological cause.
o School non-attendance due to mental health difficulties
o LAC with complex social/psychological/emotional presentations
o Child Protection.
o Children with mild learning disabilities also showing evidence of mental health disorder
Problems and Disorders regarded as low priority for Specialist CAMHS
The following is a list of problems and disorders that, in isolation, are not considered suitable for referral to specialist CAMHS. Whilst the team would be happy to offer advice and guidance on these problems they are generally not regarded as suitable to be taken on to a specialist CAMHS caseload.
o Offending and antisocial behaviour.
o Substance misuse.
o Normal reactions to stress.
o Difficulties presenting in a school setting.
o Child Protection issues when there is no evidence of mental health disorder.
o Specific or global developmental delay, severe/moderate learning difficulties
o Cases where parents and/or child when competent to give consent have not given informed consent to the referral.
If there are doubts about the referral criteria in addition to those mentioned above, the following are 5 key principles which referrers should take into account and which we refer to when considering the appropriateness of a referral.
Severity – The severity of symptoms or distress of the child and family and the degree of social and functional impairment that that child or adolescent is showing.
Duration – The duration of these difficulties needs to be significant and it is not a self- limiting problem.
Responsiveness to Treatment – If it is likely that therapeutic intervention will result in significant improvement this very much strengthens the case for mental health involvement.
Case Complexity – Involvement of the specialist Child and Adolescent Mental Health Service in providing assessment and treatment for cases is sometimes most helpful when the factors contributing to the development and maintenance of the child’s difficulties are complex.
Likelihood to Engage - Even if the difficulties of a child or adolescent would otherwise merit referral there may be little point in making one if there is little likelihood of the members of the family engaging with us. In order to maximize the service offered, the team prioritise into 3 categories:
(a) High priority where specialist CAMHS skills are definitely needed.
(b) Routine priority where specialist CAMHS has a role.
(c) Low priority where specialist CAMHS is not necessarily needed and other services may be more appropriate.
The Team also considers the likely effect on the child if untreated together with the effect on others. Good practice included in government directives involves a multi agency approach to the CAMHS problems and referrers may be asked to contribute to either multi-professional meetings or TAC meetings.
Dr Malcolm Bourne
Blackburn with Darwen Sector Team
Tel: 01254 226281
Dr Tim Morris
Burnley & Pendle Sector Team
Tel: 01254 226334
Dr Shahid Ahmad
Hyndburn, Ribble Valley and Rossendale Sector Team
Tel: 01254 226280
Dr Monica Nangia
Intensive Support Team
Mary Burbury Unit
Burnley General Hospital
Tel: 01282 804804
Clinical Director: Dr Tim Morris
Business Manager: Mrs Jo Weller