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
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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.