THE CHILD AND FAMILY PSYCHOLOGICAL HEALTH DIRECTORATE (Specialist CAMHS) (Family and Therapies Division) Service Information Booklet for Referrers Comments on this booklet are welcome; please send to Ty-Bryn Unit, St. Cadoc s, Lodge Road, Caerleon, Newport, NP18 3XQ Version printed March 2011 Aneurin Bevan Health Board is the operational name of Aneurin Bevan Local Health Board
The Child and Family Psychological Health Directorate (Specialist CAMHS) The Child and Family Psychological Health Directorate is home to a range of professionals including Child Psychiatrists, Child Psychologists, Community Psychiatric Nurses, Family Therapists, Occupational Therapists, Physiotherapists, Speech and Language Therapists and Dietitians. All have expertise in working with children, families and young people (up to 18 if in full-time education) 1, where there are developmental, emotional and/or behavioural difficulties. Please turn to the back of this booklet for information about our Directorate Senior Management Team. Within the Tier 2 Specialist Service there are 3 Community Multidisciplinary Teams across Gwent (Caerphilly, Newport/Torfaen and Monmouthshire/Blaenau Gwent). The key elements of service provision are: 1. Consultation, Liaison and Health Promotion 2. Urgent Mental Health Assessment 3. Psychological Therapy 4. Diagnostic Assessment/Intervention 5. Specialist Services This booklet outlines a brief summary of each element and how they relate to one another. It provides information to professionals about the consultation services that are available, including Primary Mental Health Teams (PMHTs) which are managed by the Directorate. There is a step by step guide to Making a Referral and information about what professionals and families can expect following a referral. Finally, there is a section that briefly describes Specialist Services within the Directorate (eg. Substance Misuse, Child and Adolescent Learning Disabilities Service, Ty Bryn and Pollard s Well Day Service, Portage etc.) 1 WAG policy to provide services to all young people up to the age of 18 by April 2012 2
Consultation, Liaison and Health Promotion Emotional and behavioural difficulties in children and young people are very common. They are most appropriately managed in Primary Care. Only a small percentage will need to access specialist services (Tier 2/3). This avoids the stigma and time consuming appointments for the family. The Child and Family Psychological Health Directorate seek to support Primary Care to do this work in the following ways. Primary Mental Health Teams (PMHTs): have a key role in supporting Primary Care in this work. They hold information about local services and provide guidance on when and how to access more specialist services. You can find further information at the back of this booklet about how they are organised in each borough. 1 Telephone Advice Line: is available to all child care professionals working in Gwent to seek advice on children they are working with regarding psychological/emotional issues and discuss an appropriate course of action. 01633 436995/6996 Tuesday 9.00 am 11.30 am Group Consultation Meetings: Health Visitors/School Health Nurses/Social Workers. These are arranged in each borough by a member of the Child and Family Psychological Health Directorate. Individual Consultations: Provided to childcare professionals on request. Information Booklets: Advice on a range of commonly experienced difficulties. These are available on the Aneurin Bevan Health Board website (www.aneurinbevanhb.wales.nhs.uk) or on request by ringing the administrative base. Bibliotherapy Scheme: This is a Gwent wide scheme. A professional pack has been provided to each G.P. practice and to other child care professionals. Books on common childhood difficulties are recommended and available to parents/carers in all local libraries. Please consult your Bibliotherapy pack. When resources at Tier 1 have been exhausted, a written referral to the Child and Family Psychological Health Directorate (Specialist CAMHS) Tier 2 Community Multidisciplinary Teams may be appropriate (please see referral form). The following information will take you step by step through this process. A referral form is available on the intranet (www.aneurinbevanhb.wales.nhs.uk). 3
Making a Referral To The Child and Family Psychological Health Directorate (Specialist CAMHS) Tier 2 Community Teams Referral Criteria We provide a specialist assessment and intervention service in Community and Day Services (Tier 3) for children with complex, persistent and severe mental health problems. These may manifest themselves as: Presenting problems: aggressive/destructive behaviour, anxiety (fears and phobias), obsessive compulsive disorder, dangerous to self and others, including deliberate self harm and attempted suicide, encopresis enuresis toileting, eating disorders, identity issues/self-esteem, non-compliant/defiant behaviour, offending/anti-social behaviour, relationship problems, sleeping problems, somatic problems, unhappiness and low mood, depressive illness and withdrawal. We also work with young people with poor concentration and impulsive behaviour. Making A Referral In addition, there are a range of circumstances that put children and young people at particular risk, including: Post Abuse: physical abuse, emotional abuse, sexual abuse, neglect. Developmental Problems: adjustment to chronic illness, adjustment to disability/acquired injury. Adverse Social Circumstances: parental drug/alcohol misuse, domestic violence, adult mental health problems, young carers. Life Events: family change and disruption, reaction to trauma/ significant life events, bereavement. Together with colleagues from Paediatrics, Therapies and Educational services we contribute to the assessment and treatment of children with ADHD and Autistic Spectrum Disorders. We aim to work in partnership with other agencies and disciplines in health, social and education services and voluntary agencies so encourage discussion prior to referral to ensure our service can provide appropriate interventions for children and families. Continued on next page 4
Making a Referral The simplest way to ensure that all the information required to make a referral is by completing a Referral Form. This is available on the intranet (www.aneurinbevanhb.wales.nhs.uk) or on request by calling 01633 436831 (e-mail, fax or post). When the cases are complex or the primary concerns are behavioural in nature, consultation using the Telephone Advice Line and Primary Mental Health Teams (PMHTs) should precede the referral to ensure our services are used in the most appropriate way for the benefit of the child and family. Child care professionals with knowledge of the child and family can refer to our service. You may make your referral in the form of a letter, if you prefer to do so. If so, please ensure that your letter contains the information that is requested in this form, which you can use as a reminder of the contents that are particularly helpful to us. Medical Health responsibility resides with the child's General Practitioner (GP) and should be the first point of contact if there are physical health concerns or in mental health crises. It is good practice to inform the GP when a referral has been made or send the GP a copy of the referral. You may fill in this form electronically and enlarge or shorten the boxes to fit the volume of the content. Ordinarily and unless there has been prior discussion and agreement with us to vary this position, this service is unable to accept referrals if referrers are proposing to, or are considering closing the child s or young person s case. Each referral is discussed in a multidisciplinary forum that meets weekly. You will receive a response shortly after the meeting of the team at which your referral is discussed to say whether or not the service can accept your referral, or if further information from you is required before our service can decide how best to respond. Once the referral has been accepted, the family will be sent a questionnaire to establish their views. Telephone the Advice Line if you have concerns about literacy, or the family s ability to respond to a questionnaire. Is there an element of mental health risk that needs to be assessed urgently? Does the family/young person want to engage in psychological therapy and are able to make the commitment that this requires? Are the symptoms suggestive of a psychiatric disorder that needs to be assessed? Are there issues that need to be assessed by one of the specialist services? 5
Please address all referrals to: Child and Family Psychological Health Directorate Ty-Bryn Unit, St. Cadoc s Hospital, Lodge Road, Caerleon, Newport, NP18 3XQ 6
Urgent, Emergency & Severe Ongoing Risks Children, young people and families using specialist CAMH Services often present risks to both theirs and others well being, including those related to mental health issues. The aim is to respond well to these mental health risks, in order that they are minimised as appropriate and the safety and well-being of children, young people, families, the community and service staff are maximised. Criteria which indicate that the Urgent, Emergency and Severe Ongoing Risks Service should be accessed include: When there are immediate concerns about the mental health/state of a child or young person and the risks to their well-being are such that inpatient hospital care should be considered. 2 When there are urgent and significant concerns about the risks of a child or young person harming themselves; when these concerns have been initially assessed by an appropriate tier 1 professional (e.g. GP) and a specialist opinion about the degree of risk and necessary response/intervention is thought to be necessary by the Tier 1 professional. Where there is a severe/significant level of risk posed by or to the child or young person, which is ongoing and its severity and longevity necessitates that risk assessment and management is a primary focus of the clinical work (for example young people with a low mood of 6 weeks duration). Assessment of risk following an episode of self harm, resulting in admission to hospital. Referrals are defined depending on their expected speed of response which in turn relates to the severity of risk. This is stated in terms of Emergency, Urgent and Routine referrals. Emergency and out of hours consultation is available 24/7, to help establish this (see below). Emergencies require a very rapid response which should be within 24 hours. Defining what meets emergency criteria is a clinically based decision following discussions with specialist CAMHS professionals. Urgent referrals are where the conditions may deteriorate into emergencies without a quick response. Decisions as to what is viewed as urgent are clinical decisions based on discussions with referring agents. However, 2-4 weeks is the generally considered time frame to see urgent referrals. These are: On call Mon Fri Out of hours 7
Psychological Therapies This element of the dimension of the service provides a range of psychological therapies and approaches including: Family Therapy, Cognitive Behaviour Therapy, Solution Focused Therapy, Individual Psychotherapy and Behaviour Therapy, Psychodynamic Psychotherapy, couple work, multi-systemic interventions, Integrative psychotherapy, Narrative therapy and group work, parent skills training, attachment theory, developmental/normative models. Presenting problems that can benefit from psychological therapies include: Aggression/ destruction, anger, anxiety, fears and phobias, enuresis/encopresis, feeding difficulties, identity/self esteem issues, noncompliant/defiant, anti-social behaviours, relationship difficulties, school refusal, sleeping problems, somatic concerns, unhappiness/low mood, withdrawal, obsessions, rituals, anger, sexualised behaviours and selective mutism. This list is not exhaustive and children present their distress in a variety of ways, so do telephone the Advice Line to discuss concerns about an individual child or young person. For clinic based psychological interventions to be effective, it is important that families are open to alternative ways of understanding their child s difficulties and can commit to a therapeutic relationship. Please explore this with them first. 3 Children and young people often exhibit distress when faced with extraordinary life events or difficult circumstances, for example, abuse (sexual, emotional, physical and neglect), family change and disruption, reactions to trauma/life events and bereavement. This distress is a normal reaction to abnormal circumstances and therapy is not necessarily appropriate. Telephone the Advice Line about the timing of a referral for a child in these circumstances and how else they might be supported. Sometimes referrals may be redirected for Consultation for this reason. 8
Diagnostic Assessment and Intervention/Therapy In a small number of cases a specific diagnostic assessment is useful for the child and family, support agencies (e.g. Education/Social Services) and for us as mental health professionals, to help us understand and manage presenting difficulties. Psychiatric Diagnosis fall into three broad categories: developmental disorders, anxiety/mood disorders and eating disorders. Accurate diagnosis depends on detailed information from a number of sources. If you feel that a child or young person would benefit from a diagnostic assessment then we require the following supporting information: Developmental Disorders (e.g. ADHD, Autistic Spectrum Disorders) - Global Developmental Assessment - Confirmation of no physical concerns - Reports from Tier 1 (e.g. parenting) - School report (2 IEPs completed) - Referral has been made to specialist education services Anxiety/Mood Disorders (e.g. Clinical Depression, Obsessive Compulsive Disorder) - Exclusion of physical cause if somatic symptoms - Confirmation of difficulties in multiple contexts over a period of time (at least 6 weeks) - Impairment of daily functioning - Information regarding interventions at Tier 1 Eating Disorders (e.g. Anorexia, Bulimia, Obesity) - Current diet - Height and weight (preferably serial measurements) - Blood tests - Blood pressure - Co-morbid mood or anxiety symptoms - Current levels of activity 4 9
SPECIALIST SERVICES Substance Misuse The principal focus of the Young Persons Specialist Substance Misuse Service is the provision of assessment, treatment and therapeutic intervention of young people with drug and/or alcohol problem with additional needs. The service provides a Tier 3 specialist service which works with young people under 18 years of age, with a variety of complex needs in addition to their substance misuse. At present, the service accepts referrals for young people under the age of 18 who are resident in the areas of Newport and Caerphilly 2, who have a drug and/or alcohol problem with any of the following: Child Protection Issues Mental Health Problems (Diagnosed or Undiagnosed) Examples: Deliberate Self-harm, Eating Disorder, Depression, Anxiety, Psychosis, etc. Offending Behaviour Physical Health Problems Emotional Problems Family Difficulties Problems with Education Risk taking behaviour Pregnancy Homelessness Multi-Agency Involvement Looked After Children Care Leavers We operate an open referral policy. Young people may refer themselves or be referred by family members, GP s, Statutory or non-statutory agencies, for example Health, Social Services, Education, Youth Services, Youth Offending Team and Voluntary Services. 5 Referral forms are available by contacting the service on 01633 436893 or reception (01633 436833). 2 Please check areas currently available as subject to change 10
Child and Adolescent Learning Disabilities Service (CALDS) CALDS is a specialist tertiary service. It is currently composed of 2 Community Learning Disability Nurses (1.8WTE), Consultant Psychiatrist (0.2WTE) and a Consultant Child Psychologist (0.8WTE). CALDS offers a range of services for children and adolescents with a learning disability, from assessment and interventions to consultation, advice and training to other agencies. It also offers a tertiary diagnostic service for Autism Spectrum Disorders. Who Can Refer? The following Health professionals can refer: - Paediatricians and Specialist CAMHS MDT. If you are unsure about the referral, please contact a member of the team on 01633 436831. Referrals should be addressed to CALDS, c/o Ty-Bryn Unit, St. Cadoc s Hospital, Lodge Road, Caerleon, Newport, NP18 3XQ. To allow effective processing of referrals CALDS needs appropriate information (see below who can be referred). Referrals are discussed at the Team Meeting twice monthly. Who can be Referred? Children and adolescents with a learning disability from the age of four up to their eighteenth birthday. Children under the age of four will normally be managed by CDT and/or Child Development Advisory Service (Portage). If the young person is approaching their 18 th birthday, please discuss this with the local Community Adult Learning Disability Team. Referrals will only be accepted for children and adolescents with a moderate to severe learning disability in association with complex mental health issues, challenging behaviour with or without a diagnosis of Autism Spectrum Disorder. The service also provides a specialist, Tier III Autism Spectrum Disorder Assessment where clarity is needed. Prior to referral to this service, the child or adolescent must have had an assessment by local secondary health services. For those who do not meet the eligibility criteria, further team consultation and signposting may be offered to the referrer. Summary Eligibility Criteria Age range 4 17 (inclusive) Moderate to severe learning disability, with complex, mental health issues, challenging behaviour with or without Autism Spectrum Disorder Tertiary diagnostic assessment for Autism Spectrum Disorder Assessed by local secondary services 11
What Information do we need? We will not be able to process referrals without adequate information. Please see referral form for information required. Assessment and information on the nature of the Learning Disability is essential i.e. nature of intellectual impairment and details of social and adaptive functioning Details on current and previous interventions and their effectiveness Description of current difficulties i.e. presenting problem/issues Description of current functioning in home and school Description of current family/carer composition Copies of other available assessments, e.g. Speech and Language Therapy, Educational Psychology. Contact details for all relevant professionals should be given Identification of any known risks, i.e. home visits Contact details for GP Children whose mental health requires psychotropic medication (antipsychotics and antidepressants) will continue to be monitored by the team. Any other medications will be monitored through mutual shared care agreement. The referrer should indicate what intervention they are seeking. If they are not sure, please contact the Team for further discussion and clarification. 12
Tier 3 Day Service, Ty Bryn Adolescent Ty-Bryn Adolescent Day Unit offers assessment, Risk Management, interventions and therapies for Young People aged 11-16 years, (18 if in full time school education) 3 and their families who are experiencing significant Mental Health difficulties. Typically we see young people with Eating Disorders, early on-set Psychosis, Obsessive Compulsive Disorders, Mood and Anxiety presentations and general complex presentations or emotional and or Developmental Difficulties. Our team consists primarily of Nurses, Occupational Therapists, 2 sessions of a Child Psychiatrist, 4 sessions of a Clinical Psychologist and access to the S-CAMHS Dietetics services. Our programme is delivered from a Monday Friday between 8am 4pm and our week typically consists of individual and group work incorporating therapies such as CBT, motivational interviewing, systemic work, problem solving as well as social skills development, anxiety management, self-esteem work, family therapy etc. All young people are allocated a Nurse Key Worker who co-ordinates their admission, multi-disciplinary care plans and discharge. All young people are regularly reviewed with Tier 2 teams and reports distributed to relevant professionals as well as the young person and their family. Tier 3 Day Service, Pollard s Well Child and Family Service Pollard s Well Child and Family Service is a multi-disciplinary day service working with children and families whose ability to function as a family within their own and their wider environment has become impaired by a range of emotional, functional and psychiatric difficulties. It is our role to work with families and other professionals/agencies in order to assess and clarify difficulties and areas of need. Once these areas have been agreed upon, we can offer specific interventions designed to address some of these needs. These interventions are led by a range of disciplines including Occupational Therapy, Nursing, Psychiatry and Psychology. We also have skilled and experienced support workers. Interventions include social skills training, anxiety management, family therapy, specialist family work carried out by our psychologist, individual work, systemic family work and joint work with Community Mental Health teams. Children do not normally attend for more than one day per week, helping to preserve their identity in other areas of their life, although we are able to respond to more complex difficulties when required. 3 WAG policy to provide services to all young people up to the age of 18 by April 2012 13
Child Development Advisory Service (Portage) In Gwent, Portage is known as the Child Development Advisory Service and is part of the Child and Family Psychology Service. This Service is a home based service for pre-school children with developmental delay. The Child Development Advisory Service will accept referrals for children with a recognised developmental disability or who are developmentally delayed in two or more areas. Most referrals to the Child Development Advisory Service are from Health Visitors and Paediatricians but can come from other health and social services professionals. This service is Gwent Wide (Aneurin Bevan Health Board). The Child Development Advisors (CDAs) work in all of the five local authority areas (Blaenau Gwent, Caerphilly, Monmouthshire, Newport, Torfaen). The CDAs are based at three centres- Caerphilly Children s Centre, Nevill Hall Children s Centre with the central base at Llwyn Onn, Child and Family Psychology, St Cadoc s Hospital, Caerleon. 1. CAERPHILLY Caerphilly Children s Centre 02920 867447 2. NEWPORT AND TORFAEN Llwyn Onn, St Cadoc`s Hospital 01633 436996 3. MONMOUTHSHIRE AND BLAENAU GWENT Nevill Hall children s Centre 01873 732713 For more information, or pre-referral discussion, please contact: The CDA Consultant Child Psychologist Telephone: 01633 436831 / 01633 436996 Or contact the CDA in your local area 14
Youth Offending Service Each of the Youth Offending Services operating across the ABHB geographical area (Newport, Caerphilly/Blaenau Gwent and Monmouthshire/Torfaen) has a Clinical Nurse Specialist (CNS) attached to the multi-agency team. The nurse is able to offer a specialised understanding of the way that a young person s emotional and mental health status affects their behaviour. This understanding can be of crucial importance in devising intervention plans that reduce the risk of a young person engaging in offending behaviour. There are three Youth Offending Services (YOS) operating within the ABHB geographical area. The Nurse Specialists work with young people known to the relevant Youth Offending Services and referrals are accepted from the member of the YOS team, designated as having case responsibility. The CNS supports the work of the YOS which is primarily aimed at preventing young people offending or re-offending. The CNS will have direct contact with young people, they will consult with the staff of Youth Offending Services, liaise with outside agencies including social services, housing and education and provide specialist training relevant to the links between emotional/mental health and offending behaviour. The CNS will refer, if indicated into other services, including the locality Tier 2 Community Teams (CFPHD - Specialist CAMHS) and Adult Mental Health Teams. The CNS will also have very close links with Child and Adolescent Forensic Services operating at both a local and national level. 15
Primary Mental Health Teams The PMHTs are a limited resource multi-agency team with membership across each of the five boroughs. Generally their aim is to support Tier 1 in promoting children s emotional and psychological well being. They provide four key functions: Collating and co-ordinating information on all community services relevant to Children and Young people s emotional and psychological well-being Sign-posting professionals to the most appropriate services, either in the community or at tier two in its broadest sense (e.g. Psychological Health, Community Paediatrics, Social Services, Education Support Services). Providing consultation, liaison and training to professionals at Tier 1 on developmental, emotional and behavioural difficulties in children and young people. Undertaking joint assessments with professionals at Tier 1 when, following consultation, further clarification is required about the next step. The Team does not accept referrals. Addresses 4 : Caerphilly Newport Torfaen Blaenau Gwent / Monmouthshire PMHT Lead Julian Edwards The Health Centre William Street Trethomas Caerphilly CF83 8FX Telephone : 02920 888904/889617 PMHT Lead Veronica Board Pollards Well St Cadoc s Hospital Lodge Road Caerleon Newport NP18 3XQ Telephone : 01633 436831 PMHT Lead Sue Gwynllyw Serennu Children s Centre Off Cwrt Camlas High Cross Road Rogerstone NP10 9LY Telephone: 01633 748023 PMHT Lead Sue Gwynllyw C/o The Access Team Ash House Llancayo Court Usk Monmouthshire NP15 1HY Telephone: 01291 673018 PMHTs 4 Future addresses may change. Please check with our reception to get the updated address 01633 436831 16
Out of County Referrals Any Out of County referrals can only be accepted if agreement has been confirmed that costs will be funded by the Local Health Board in which the GP Practice resides. Such referrals can only be accepted if capacity within the Team is available and the Teams are able to respond in favour. Out of County 17
THE CHILD AND FAMILY PSYCHOLOGICAL HEALTH DIRECTORATE The Senior Management Team Barbara Cannito Directorate Manager (01633 436831) Dr Liz Gregory, Joint Head of Child Psychology (01633 436995/6) Dr Dave Williams, Clinical Director, Child Psychiatry (01633 436831) Dr Rachel Williams, Joint Head of Child Psychology (01633 436995/6) John O Sullivan, Mental Health Advisor to Gwent Youth Offending Services (01633 436831) Dave Powell, Senior Nurse (01633 436831) Mervyn Townley, Consultant Nurse (01633 436831) 18 Senior Management Team