February 2011 NHS Forth Valley CAMHS REFERRAL CRITERIA Introduction to this Guidance This guidance document is intended to assist those in front line services to know when to refer to NHS Forth Valley CAMHS, as well as offering suggestions for advice or where to go to get more information. The guidance is designed to improve access to CAMHS for those children and young people who need it most, whilst at the same time making sure that other sources of help have been tried where appropriate. Referrals are accepted from GPs, Public Health Nurses, Health Visitors, Paediatricians, Other Hospital Doctors including Dentists, Allied Health Professionals, Educational Psychologists, Social Workers, Reporters to the Children’s Panel etc NHS Forth Valley CAMHS NHS Forth Valley CAMHS provides specialist assessment as part of a tiered system which includes both stepped care (as a problem becomes more severe in nature the type of help that is available becomes more specialised) and matched care (the idea that there should be an accurate and properly informed match of need to provision at the earliest stage of a child or young person’s presentation). A full explanation of our tiered system is attached. Referrals to NHS Forth Valley CAMHS CAMHS accepts referrals from a variety of sources and those wishing to refer should send a written referral – some tips as to what makes a good referral are noted at the end of this document. In deciding how to proceed we will consider whether there is evidence of specific mental health difficulties, whether there is any risk of harm to self or others and also the severity of the symptoms and the degree of impairment. If the CAMHS team feel that the difficulties noted represent mild to moderate mental health issues then the referral is passed to our Primary Mental Health Team, which is the early intervention part of our service. The Primary Mental Health Team operates a CAMHS Early Access Service (described below) within Stirling and Clackmannanshire, which will include Falkirk from 1st March 2011. Those referrals that describe more severe, complex and enduring mental health difficulties will be seen by our specialist CAMHS service. Child and Adolescent Mental Health Services is focussed on children and young people presenting with severe and complex difficulties whereas the Primary Mental Health Team aims to intervene earlier with the milder to moderate cases. The Primary Mental Health Team also have a role to advise and consult with universal services which is done via our Advice Line which is referred to in this document and is available to any professional working with children within Forth Valley. Details of both the Advice Line and CAMHS Early Access are noted below. Additionally referrers should note that a multi disciplinary approach will always be taken by the Service with referrals of children who are looked after or looked after away from home. We find it is best to meet with the responsible Social Worker to discuss and plan how best to ensure the child or young person can access our Service. As a consequence Forth Valley CAMHS have regular arrangements for consultation with colleagues in childrens service across the 3 local authorities. Referrals to our service are considered urgent if there are: a) concerns that a child/young person is suicidal b) concerns that a child/young person has an acute psychosis February 2011 c) NHS Forth Valley CAMHS concerns that a child/young person has life-threatening weight loss or BMI of less than 18 Or occasionally when there is reason to believe that there is significant risk to a child that may be alleviated by the CAMHS becoming involved quickly. In these unusual cases we would often aim to discuss the referral personally with the referrer and suggest that you telephone the team and speak to a Clinician. Referrals of an urgent nature out with normal working hours and at weekends should be directed to A&E. NHS Forth Valley currently provides Child & Adolescent Mental Health Services to children and young people from birth to eighteen years of age. For referrals in those children under the age of five years we find it is best to meet with the Health Visitor, Public Health or School Nurse in the first instance and we offer regular consultation sessions for colleagues in primary care. CAMHS Early Access The aim of CAMHS Early Access is to provide an opportunity to speak with a child mental health professional as early as possible in the development of a problem as this has been linked with better long-term outcomes. Early Access offers a range of treatment options including advice, self-help material, supported self-help, and a range of short-term individual and family based interventions using a stepped care approach. Many of our families are offered self help or supported self help as a first stage. Currently there is no separate referral route to Early Access. All referrals should be directed to the CAMH service who will decide which part of the service is best placed to meet the needs of the child depending on the nature and severity of the difficulties, further details being described within this document. Referrers will receive a copy of the Early Access Session Note providing the family agree to share this information. Details of this service are as follows: DAY TUESDAY THURSDAY TUESDAY THURSDAY LOCATION CLACKMANNANSHIRE COMMUNITY HEALTHCARE CENTRE, SAUCHIE CAMHS OFFICE BASE, 1 RANDOLPH RD, STIRLING CAMHS OFFICE BASE, THE MANOR, BROWN STREET, FALKIRK CAMHS OFFICE BASE, THE MANOR, BROWN STREET, FALKIRK TIME 9.30-4PM 9.30-4PM 9.30-4PM 1.00PM4PM Advice Line The Advice Line is operated by the Primary Mental Health Team which is the early intervention part of CAMHS. The purpose of the Advice Line is to make information on childrens mental health accessible to all those professionals working with children within NHS Forth Valley. The Advice Line accepts calls from ALL child care professionals including, Guidance Teachers, Head Teachers, Public Health Nurses, Family Support Workers, Social Workers, Voluntary Organisations etc. February 2011 NHS Forth Valley CAMHS The Advice line offers advice, guidance and can provide access to our resources gathered to work with children. It is NOT an emergency or crisis line, nor is it there to discuss aspects of child protection. The Advice Line does not accept referrals and is not a referral route or a pathway to referral. The Advice Line operates 9-5 Monday to Thursday and 9-3 on Fridays on 01786 450591. If you leave your name and number someone will phone you back within an hour. Referrals Accepted by Specialist CAMHS When a referral is accepted we write to the child or young person and their family providing information about the service and asking them to contact the team to make an appointment that is convenient for them. A range of appointment times are available. A reminder will be sent if they do not contact us and if we don’t hear anything we will write to the original referrer to advise that we have discharged the child unseen. The initial attendance (Choice appointment) is an opportunity for us to hear more about the problem to assess what would be the best intervention and clinician within the team to continue the work- this is the Partnership part. Choice is designed to assess whether further input is required and, if it is, who would be the most appropriate clinician in the team to provide this. Referrers will be copied into all correspondence assuming the family give consent to do so. The Royal College of Psychiatrists have produced a helpful brochure on what to expect from CAMHS which can be downloaded from http://www.rcpsych.ac.uk/PDF/CAMHS%20inside%20outx.pdf Referral Criteria Problem Description Referral Pathway Anxiety: anxiety disorders are the most common type of mental health disorder in children Anxiety is a normal and common part of childhood. In most cases, anxiety in children is temporary, and may be triggered by a specific stressful event e.g. young child may experience separation anxiety when starting school. In some cases, anxiety in children can be persistent and intense, interfering with a child’s daily routines and activities. Anxiety disorders include phobias, general anxiety, panic or persistent unexplained physical symptoms, e.g. headache or stomach-ache, where physical cause has been excluded. Children who show persistent or severe symptoms of anxiety should be referred to Specialist CAMHS by letter. Those with less severe difficulties may be directed to the CAMHS Early Access Advice Specialist services should be involved: Where the child’s development or level of functioning has been seriously affected or there has been a sudden deterioration Where it appears to be out of proportion to the family circumstances Where there is a significant impact on the parent / carer / child relationship-please describe in referral. You may wish to find out more at www.moodjuice.scot.nhs.uk/anxiety www.shapeofmind www.youngminds.org.uk www.anxietyuk.org.uk www.stressandanxietyinteenagers.com February 2011 Problem Separation Anxiety Disorder/School Refusal NHS Forth Valley CAMHS Description Schools and education departments have their own resources (e.g. inclusion support workers, educational psychologists and behavioural support services) which will need to be exhausted prior to referral. Referral Pathway A summary of school / education department involvement and action will be essential before a referral can be accepted therefore we would normally expect a child to be subject to Staged Intervention. CAMHS will not accept referrals for school truancy only and referrers should consult with education in the first instance. Advice www.handsonscotland.co.uk/topics/anxiety/scho ol_refusal.html You may want to discuss your concern with school first. The Educational Psychologist can refer to CAMHS if required. Bereavement: Grief is the normal response to the loss of a loved one. Childrens response to grief can be varied, dependent on age and cognition. Quite often it can be the subsequent change in circumstances or other family members’ reactions that can prove difficult for the child. Schools can also access the PMHT Advice Line if concerned Discuss with PMHT via the Advice Line or make a referral describing what has been tried and how the difficulties are affecting the childs day to day functioning You may want to consider referral to Specialist services when the loss has had an extreme impact on the child and their functioning, or when the child is experiencing difficulties after bereavement support. If the child is experiencing significant distress and / or difficulties following a bereavement / loss that has occurred in extreme circumstances (e.g. trauma, illness, suicide or accident) you may want to refer to specialist CAMHS Although painful for everyone including professionals, you may wish to give the child & family some time to experience a normal grief process You may wish to consider referral to Strathcarron Hospice where groups are run for children & parents who are bereaved as well as individual work. Families can self refer Tele 01324-826222 www.strathcarronhospice.org www.rd4u.org.uk www.winstonswish.org.uk www.childbereavement.org.uk February 2011 Problem Developmental difficulties These difficulties are nearly always seen within the context of a child’s circumstances, and often present in the form of difficult behaviours. NHS Forth Valley CAMHS Description This would also include worries regarding ASD (Autism Spectrum Disorder) or Aspergers. Difficulties which may impact on daily living and are criteria which could support a referral include: Significant delay in acquiring appropriate social skills Significant difficulties with the child’s peer relationships Unusual or very fixed interests and bizarre or unusual behaviours Marked preference for routine and difficulties in adapting to change Referral Pathway Early intervention with developmental disorders may include monitoring the child or identification of need for further assessment within school. Therefore families with children with developmental (and behavioural) problems should already have received significant advice and intervention from other named professionals Referrers can refer to the Forth Valley Framework for Assessment and Diagnosis of Autism Spectrum Disorders, a multi-disciplinary framework agreed by NHS Forth Valley and the 3 local authorities. Advice Developmental difficulties often come to light when a child gets older i.e. throughout the course of their development. www.incredibleyears,com www.angermgmt.com www.aspergersyndrome.org National Autistic Society offers information and support http://www.autism.org.uk/ A copy of the Framework can be requested from the PMHT Advice Line Tele: 01786-450591 Consider referral to specialist CAMHS as part of staged intervention within school or when difficulties are pervasive. For further advice contact the PMHT Advice Line for consultation/ advice Learning Disabilities: this is also known as Global Learning Disability normally evident from early childhood and defined as significant impairment of intellectual functioning including impaired social functioning, Learning disability on its own is not grounds for referral to CAMHS. For CAMHS to become involved there have to be concerns about a mental health problem in those already identified as having a Global Learning Disability and An associated behavioural or mental health problems, Children and young people with a learning disability can present with any of the mental health problems described in this document but their presentation may be complicated by factors such as CAMHS do not conduct initial diagnostic assessments for global learning disability. Paediatricians and pre school assessment teams assess children for global learning disability. CAMHS has a small specialist team of clinicians who will accept referrals for concerns relating to the mental health of such children up until their 16th birthday Children 16 and over should be referred to adult learning disability services. www.cafamily.org.uk February 2011 NHS Forth Valley CAMHS Problem Description Referral Pathway communication, social skills and daily living skills communication difficulties and sensory sensitivities Given the specialist needs of these children, referrals sent to CAMHS are dealt with slightly differently. ADHD: Attention Deficit Hyperactivity Disorder is characterised by pervasive lack of attention, impulsivity and hyperactivity across situations and settings – at home, school, and in public – which began before 7 years of age. Obsessive Compulsive Disorder (OCD): involves both obsessions and compulsions that take a lot of time and get in the way of activities. Families with children who display difficulties in these categories should have already received significant advice and intervention from other professionals such as paediatricians, health visitors, social workers and educational support services before referral to CAMHS is made. Obsessions (intrusive repetitive thoughts) Compulsions (repetitive, ritualistic, unwanted actions) These will be either distressing or disabling and interfere with the child’s functioning and across settings e.g. school and home. This behaviour can also be as the result of anxiety or a change. Again given the specialist nature of these referrals they are not dealt with by the PMHT or seen within Early Access. Discuss with PMHT via the Advice Line CAMHS would not normally assess a child for ADHD until they have completed at least one term within P1. For children under 5 the normal route to assessment would be via Prefcat/CEAT etc. Referrals within this age group will be offered consultation with health visitor or public health nurse by the PMHT in the first instance. If concerns exist an assessment will be completed if the child has difficulty with hyperactivity, impulsivity, inattention in more than one setting and of severity to require school input equivalent to Stage 3 Intervention within school or has an IEP. This approach has been agreed by Principal Educational Psychologists across Forth Valley Children often experience obsessions and compulsions as part of normal childhood behaviour and they can often disappear without intervention. Therefore when considering specialist referral the situation has to be distressing, disabling and interfere with the childs day to day functioning. If pervasive and evident across settings then refer to CAMHS Phone PMHT Advice line for more information or to discuss. Advice www.adhdtraining.co.uk/ www.boxofideas.org/ This behaviour can often be due to a change therefore establishing normal routines may affect a positive change www.ocdyouth.ipo.kcl.ac.uk Info site run by Royal Maudsley Hospital on OCD www.ocduk.org Includes Information and Guide for parents of young children www.ocduk.org/pdf/children.pdf www.ocduk.org/pdf/youngpeople.pdf : www.ocduk.org/pdf/ParentsOCDGuide.pdf : Information and guide for parents of children worried about OCD February 2011 NHS Forth Valley CAMHS Problem Depression: disturbances of mood, sleeping, irritability, decrease in energy, social isolation, school performance is affected and thoughts of selfharm have been expressed Description Referral Pathway Advice Low mood is a normal part of childhood and in most cases is temporary and might well resolve on its own. Discuss with PMHT via the Advice Line For more info: www.moodjuice.scot.nhs.uk/depression.asp www.shapeofmind.scot.nhs.uk www.depressioninteenagers.com www,beatingtheblues.co.uk www.breathingspacescotland.co.uk Post Traumatic Stress Disorder / Acute stress disorder; due to PTSD is linked with an extreme traumatic stress involving direct personal experience of an event that involves actual or threatened death or serious injury. The event is re-experienced in one or more of the following ways: flashbacks, nightmares related to the event, reenactment through play, intense emotional arousal, numbness around memories and physical symptoms such as tummy aches and headaches. exposure to one or more traumatic often life threatening events Psychosis: Rare in children and adolescents but may involve transient states or short episodes of delusions, hallucinations, disorganised speech or behaviour In order for referral to CAMHS to be appropriate difficulties should be more than age appropriate variation of mood. There should be a significant change from previous levels of functioning and an impact on daily living. Bipolar disorder is rare in children and relatively uncommon in adolescents. As manifested in thought disorder, delusions, perceptual disturbances, hallucinations GPs may advise and review prior to referral as often difficulties can resolve without intervention For persistent symptoms, or if concerns exist regarding suicidal thoughts then refer to CAMHS who will make a decision whether the PMHT undertake some assessment (early intervention) or this is passed directly to specialist CAMHS. . It is important to know whether there are legal proceedings pending and to establish who wishes to establish the severity of the symptoms. For example is someone asking for help or is the main concern a wish to support some legal case Where children and young people are currently experiencing trauma such as domestic violence a referral to other agencies such as Social Work or the CEDAR project is likely to be appropriate. Psychological intervention is unlikely to be possible where the child's living situation continues to be insecure and traumatic. For information and advice contact PMHT Advice Line. Or, refer to CAMHS www.cedarfv.org.uk/ Referral to specialist CAMHS is indicated. If urgent, contact CAMHS within normal working hours. Outside this time contact out of hours mental health services if emergency assessment is required. www.rcpsych.ac.uk/mentalhealthinfo/mentalhealt handgrowingup/psychoticillnessyoungpeople.asp x February 2011 Problem Self Harm : overdoses & other serious self harm. This is rare in children under 12 years of age. NHS Forth Valley CAMHS Description Referral Pathway Advice Deliberate self harm without suicidal intent takes many forms and can be seen as a way of dealing with difficult feelings that build up. Self harm here would have the absence of suicidal intent. . You can contact the Advice Line for more information. Self harm at this level can be very anxiety provoking for professionals. PMHT are committed to providing training and development opportunities to Tier 1 professionals to assist them to deal with things like self harm If you feel concerned that the self harming behaviour is indicative of a disturbance of emotional and psychological well-being then you should refer to CAMHS. www.selfharm.uk.org www.harmless.org.uk/downloads NHS FV also offer free training e.g. ASSIST & MH First Aid (contact NHS Health Promotions) Deliberate self harm with suicidal intent should always be taken seriously. However the decision to attempt suicide is often a hasty one – following arguments with family, friends and partner. Therefore it is important to establish if the intent was to end one’s life. Eating Disorders Anorexia: is characterised by a refusal to maintain a minimally normal body weight or an intense fear of gaining weight. Bulimia: is characterised by binge-eating and purging and maintaining adequate body weight. Where there is concern in relation to an eating disorder it is advisable to discuss with GP in the first instance to think about medical investigations (blood, weight, height BMI etc) prior to referral. Sometimes the school nurse is also a good source of support in helping to weigh a child you suspect may be of low weight. It is important that a young person has a physical check with their GP or School Nurse. This not only gives us some ideas re BMI but assists with prioritisation as we would want to prioritise those children with low BMI. Overdoses and other serious self-harm should be sent directly to A&E in the first instance. The ward or hospital will then refer on to CAMHS Referrals from hospital will be prioritised & referral protocols are already in place. Please let us know if there are any difficulties in getting the young person to attend follow up appointments If BMI below 18 or recent rapid weight loss with no physical cause, request urgent CAMHS appointment If there is some concern that a young person has some distorted thinking or body image then you may still refer but this might be dealt with by our CAMHS Early Access. Phone PMHT Advice Line for more information This is an example of the sort of screening questions that can be helpful however any decision on referral will be based on relevant history and clinical presentation Do you make yourself sick because you feel uncomfortably full? Do you worry you have lost control over how much you eat? Have you recently lost more than 1 stone in a 3 month period? Do you believe yourself to be Fat when others say you are too thin? Would you say food dominates your life? If the young person answers yes to 2 of these questions consider referral. www.b-eat.co.uk February 2011 NHS Forth Valley CAMHS Problem Description Referral Pathway Feeding and Faltering Growth:this is where growth has been affected by feeding difficulties (also known as non organic failure to thrive) Faltering growth is a common occurrence and health visitors play a key role. Most children with faltering growth will be detected by the primary health care team and supported within the community. Consult Health Visitor/Public Health Nurse in the first instance. Refer on to paediatrician as necessary. Feeding problems include: children with behavioural feeding problems in the context of chronic illness/medical problems; severe and chronic selective eaters; Enuresis and Encopresis or complex soiling: Both are categorised as elimination disorders and is the inability to control urination or soiling in those deemed old enough to exercise control Advice You may wish to look at www.childrenfirst.nhs.uk/families/features/behavi our/fussy_eaters.html Initial screening and treatment should be undertaken by the paediatric team (who have a team with specialist interest in feeding difficulties) therefore referrals normally come to CAMHS via this route. The PMHT offer consultation on a monthly basis to Health Visitors/ Public infant feeding problems and failure Health Nurses. Slots can be booked by phoning our normal office number to thrive; Discuss with PMHT via the Advice Line emotional eating difficulties (e.g. food phobias) or in the context of somatic problems such as chronic fatigue syndrome. Initial screening and treatment should be undertaken by paediatrician to rule out physical causes. Refer to paediatrician in the first instance. Referrals to CAMHS will only be accepted from this specialist or the Continence Nurse You may wish to find out more information from www.eric.org.uk which includes a free downloadable toolkit for parents and professionals February 2011 Problem Psychosomatic Difficulties: children experiencing emotional distress in the form of physical symptoms with no physical illness and also children with real physical illness where the presentation is complicated by mental health difficulties NHS Forth Valley CAMHS Description Referral Pathway Physical complaints with no apparent medical basis may be a reflection of a stress, such as nervousness in a social situation, a demanding school setting, separation from parents, or other stressful situation. . Referral should be considered only when this is having significant impact on the child’s normal functioning e.g. absence from school for long periods Where a child is experiencing physical symptoms initial referral to a paediatrician is recommended Initial referral to a paediatrician is often useful especially where there are unexplained physical symptoms in the absence of obvious mental health difficulties It is therefore useful that children have completed physical investigations prior to referral to rule out any organic cause so that the child and family will accept the idea some psychological cause for the difficulties. Better outcomes can be achieved by preparing the family in this way. CAMHS liaise closely with colleagues in Paediatrics and have protocols for liaison etc. Refer to specialist CAMHS. Advice www.there4me.com Website for children and young people (12-16) who have got fears and worries. Run by NSSPCC www.rcpsych.ac.uk/mentalhealthinformation/men talhealthproblems/physicalillness/unexplainedphy sicalsymptoms Royal College of Psychiatrists Website February 2011 Problem Children / young people Looked After or Looked After Away from Home: those known to social services, LAC, LAAH, or families with longstanding problems and a poor history of engagement NHS Forth Valley CAMHS Description Referral Pathway Advice Children are looked after and looked after away from home for many varied reasons. Their legal situations are also very varied and complex. Children who are looked after or looked after away from home are not suitable for PMHT. PMHT offer training and consultation to foster parents to support them in partnership with the local authorities. Referrals to specialist CAHMS are best made by the responsible social worker. On receipt of a referral CAMHS will meet with social work colleagues in the first instance to collaborate and plan for intervention. We find that this assists to match the best need to provision ensuring children most affected get appropriate help fast. If concerns exist they will have been discussed in multi agency groups. Local authority and CAMHS aim to work together to provide a common, coordinated framework across all agencies that support the delivery of appropriate, proportionate and timely help to all children as they need it. This includes not subjecting children to multiple assessments or to repeat information that other agencies hold. Therefore it is important that information is shared and accessed e.g. the Integrated Assessment Framework, or Staged Intervention process and Child Protection processes. Given these principles (called GIRFEC) its is important that professionals who are concerned about children utilise their existing referral protocols into our Service rather than suggest to the family that they attend their GP. Referrals for children in this category need to identify whether a child or young person has a mental disorder or other condition that results in persistent symptoms of psychological distress, as well as an associated serious and persistent impairment of their day to day social functioning. OR, an associated risk that the child/young person may cause serious harm to themselves or others Difficult or complex behaviour is not always a sign of mental health disorder. CAMHS national priority criteria indicates that those referring children who are looked after should first consult with CAMHS teams. Our usual first step on receiving a referral for a looked after and/or accommodated young person is to discuss the situation with the Social Worker in order to ensure a co-ordinated approach as well as not subject the child to unnecessary further assessment. It helps us to plan together how to help difficult to engage families to access our services as well as confirm who has parental responsibilities etc. This guidance is in line with national policy drivers e.g. Getting it Right for Every Child (GIRFEC) and the local authorities Integrated Assessment Framework. We would need to know how the child is affected by their symptoms i.e. how is their day to day functioning affected. February 2011 Problem Early Years: Significant emotional or behavioural difficulties 0 – 5 years NHS Forth Valley CAMHS Description Referral Pathway Advice With this age group it is unusual for CAMHS to directly intervene. The normal referral route being from CEAT, Prefcat etc which are community pre school assessment teams. This route is coordinated and multi disciplinary. Refer to health visitor or to Paediatrician PMHT is committed to a programme of training and development for Tier 1 professionals Problems within this age range can take many forms : • Parent/child relationship • Factors affecting capacity to parent • Developmental concerns or illness Phone PMHT Advice line for information or to request consultation or pre-referral enquiry. CAMHS involvement with this age range should be secondary not primary. Consequently, families with young children with development and/or behavioural problems should have already received significant advice and intervention from other named professionals such as paediatricians, health visitors, social workers and educational support services including within Nursery. Often with these types of difficulties the relationship between the parent and child is the actual patient; therefore it is useful to know what has already been attempted. Therefore referrals should include information on what has been attempted and who is involved. Inappropriate Referrals to CAMHS In order to improve accessibility for children and young people, we also need to clarify which types of problem it is not appropriate to refer to specialist CAMHS. (a) Children/Young People with Behavioural Difficulties as a Response to Normal Life Events These are sometimes called “normal adjustment reactions”. Unfortunately, we are unable to provide a service to children and young people whose behaviours are associated with a normal reaction to recent life events (e.g. bereavement, parental separation). Although challenging these are often within developmental and cultural norms. Some indication of mental health disorder needs to be evident in the behaviour for a referral to be appropriate. It is also important that CAMHS is a secondary or specialist route of referral when behaviour is being considered as the primary route should always be universal and primary care services who can support families within their own home. (b) Children/Young People Whose Difficulties Occur only at School Please note that specialist CAMHS does not provide a service for children and young people whose problems are solely related to specific learning or behavioural difficulties within the classroom. Schools have February 2011 NHS Forth Valley CAMHS their own referral route and protocols for supporting such children. For these children/young people it is usually more appropriate for educational services to become involved to address the difficulties. If a referral to CAMHS is appropriate it is best made by the Educational Psychologist in these circumstances. (c) Children/Young People Whose Parents are in Dispute within Legal Proceedings Children of separated / divorced parents who are in legal dispute about residence and /or contact arrangements or other issues are not specifically excluded in these guidelines though the decision to refer needs to be carefully considered on a case by case basis. If there are ongoing legal proceedings then it is usually better to consider a referral after the legal proceedings have been concluded and legal agreements or Order(s) have been made regarding the matters which are in dispute. Please note that it is for the Courts to order independent reports on the child, not the separate parties to the proceedings, and these reports cannot be obtained via a referral to the specialist child mental health services. Please note that specialist CAMHS does not mediate residence and contact arrangements for the child/young person. The parent(s) could instead be advised to approach the Family Mediation Service or discuss with their solicitor, as appropriate. (d) Children/Young People Whose Primary Difficulty is Substance Misuse AND (e) Children/Young People Whose Difficulty is Described as Offending Behaviour In both of these circumstances it is important that a coordinated integrated assessment to the child or young persons situation is undertaken. This is the responsibility of the local authority social work department in the first instance. What Makes a Good Referral It is important that those referring have met with the parent(s)/carer(s) and the referred child/children. It is essential that that the referral to our service has been discussed with the parent(s)/carer(s) and the referred child/children and that they are in agreement with the referral being made. Referrals should include basic information such as the name and date of birth of the referred child, address and telephone number and perhaps note surnames if different to the child’s. Referrers should also consider who has parental responsibility for the child. In terms of more specific information, you might wish to specify what difficulties you want our service to address, how long this had been a problem and perhaps why the family is seeking help now. Referrals should be in writing and be sent to the following: Chair of Allocation NHS Forth Valley CAMHS 1 Randolph Road Stirling FK8 2AU Chair of Allocation NHS Forth Valley CAMHS The Manor Brown Street, Falkirk F1 4PX Tel 01786 450471 Serves Stirling Council and Clackmannanshire Council areas Tel 01324 610846 Serves Falkirk and District Council area February 2011 NHS Forth Valley CAMHS CAMHS TIERED MODEL CAMHS 4 tier Model of Service 4 tier model of provision for Child and Adolescent Mental Health Specialist Units Tier 4 Specialist CAMHS Tier 3 Team PMHWs – training/consultation to increase capacity & confidence/PMHT Advice Line & direct work with ch/yp up to 8 sessions Tier 2 Universal services who all have a role to promote childrens emotional health and wellbeing e.g. CfE, IAF. These are professionals not primarily employed to deal with child mental health Tier 1 CAMHS operates within Getting it right for every child principles using a tiered model of intervention that includes the established staged approach which ensures that children receive both a stepped care approach (the idea that as a problem becomes more severe in nature the type of help that is available becomes more specialised) and matched care approach (the idea that there should be an accurate and properly informed match of need to provision at the earliest stage of a child or young person’s presentation). Tier 1. Also referred to as “universal level” or (Level 1 of GIRFEC) the child’s needs are addressed through normal classroom/ nursery management/by Public Health Nurse, School Nurse, Health Visitor, social worker. CAMHS has no direct involvement at Tier 1 but remains committed to building capacity and confidence within universal services via training. Tier 2: Also referred to single agency (Level 2 of GIRFEC) Concerns continue. My World Assessment undertaken and need/risk analysed. Other staff may be involved: child may be receiving some specific support e.g. ISW, FSW, involved with HV or PNH. Referrals to CAMHS may be accepted at this stage. Training and consultation to professionals are offered. PMHT Tier 3: Also referred to as single agency (Level 2 of GIRFEC) Concerns continue but targeted support is requested. Advice, plus recommendations sought perhaps from specialist education services outwith school (e.g. Ed Psychologist,) Children may have Individualised Educational Programme (IEP). Often PMHT offer a bridge into specialist CAMHS however both may be involved at this tier. Tier 4 : Also referred to as multi agency plan or Stage 4 intervention (Level 3 of GIRFEC). Significant support from one or more agencies is required and the child may require a Co-ordinated Support Plan (CSP). A small minority of children may enter at this tier if their mental health deteriorates and are likely to receive inpatient care & may also require a multi agency response. Specialist CAMHS are nearly always involved at this stage, if PMHT previously involved this will be transferred.