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Specialist Child and Adolescent Mental Health Service (CAMHS) May 2012Alison Chisholm, Service Manager
Overview of service
•Secondary/specialist multi-disciplinary mental health service for children and young people from 0 – 18 (19 with additional needs)
•Community Mental Health Teams (Tier 3)
•Inpatient Unit (Tier 4) – Wessex House, Bridgwater •Outreach/home treatment
•Specialist substance misuse service – integrated with community CAMHS
•ND CAMHS – specialist service for Deaf children and young people
•Learning Disabilities/Mental Health - Additional Needs resource
•Links to Youth Offending Team – one seconded CAMHS post
•C0MPASS (Musgrove Park Hospital) – psychological interventions for children and young people with life limiting conditions
Community CAMHS – (1) • Multi-disciplinary teams (psychology, psychiatry,
nurses, social workers, therapists, occupational therapists, primary mental health link workers, managers)
• Mendip: Priory House, Wells
• South Somerset: Balidon Centre, Yeovil
• Taunton Deane: CAMHS West, Foundation House
• Somerset Coast: Taunton
Community CAMHS (2)
• Assessment - formulation/diagnosis
• Care planning – Recovery model
• Collaboratively agreed goals and timescales
• Wide range of direct therapeutic interventions: Brief Solution Focused Therapy, Cognitive Behaviour Therapy, Family Therapy, Creative Therapy, medication
• Advice and consultation • “Signposting” to more appropriate services• Training
Community CAMHS (3)
Referral criteria:
• Mental health = significant impact on function (e.g. inability to attend to school due to severity of anxiety)
• Significant or severe levels of risk of harm to self or
others • Complex problematic substance misuse
Timescales:
• Emergency – within 24 hours/immediate
• Urgent – within 7 day
• Routine – within 3 weeks
Community CAMHS (4): mental health conditions • depression• anxiety • obsessive compulsive disorder • psychosis • significant self harm and/or suicidal ideation • eating disorder • complex emotional and family problems • Attention Deficit Hyperactivity Disorder
(complex, or with additional needs) • post traumatic stress disorder • dual diagnosis (e.g. Autistic Spectrum
Condition/Learning Disability plus any of above)
Substance misuse• Integrated specialist substance misuse treatment
service
• Working with young people with complex and high risk drug and alcohol problems
• Joint working with Community CAMHS for young people with additional mental health needs
• Inter-agency working (YOT, Targeted Youth Service, Turning Point
• 4 whole time specialist substance misuse workers, based in CAMHS community teams across the county
Referral sources: • GPs• Health Visitors• Special Educational Needs Co-ordinators (SENCOs)• School pastoral leads/Heads of Year• School Nurses• Parent and Family Support Advisors (PFSAs)• Children’s Centres*• Children’s Social Care*• Youth Offending Teams and Targeted Youth Support Service*• Educational Psychologists• Somerset Direct• Paediatricians (community and acute)• Acute hospitals children’s ward• Integrated Therapy Service*• Somerset Advocacy Service*• Children and young people discharged from Specialist CAMHS with
an agreed ‘fast track’ route to re-referral as part of an agreed discharge/relapse management plan (“Orange Card”)
*NB The Request for Involvement must be discussed with and agreed by relevant managers within each organisation.
Key principles - and challenges
• Committed to develop an early intervention model - as well as meeting the needs of the most vulnerable children and young people
• Partnership and multi-agency working – across the continuum of education provision
• Information sharing – acknowledging the tensions
• Identifying, achieving and measuring outcomes • Sustaining reduced waiting times
• Ensuring high quality and evidence based practice
Challenges for 2012 and beyond (1)
• Small CAMHS service against national benchmarking: approx 133 wte staff (55 wte Inpatient, 78 wte Community)
• Pressures on overall NHS budgets
• Likelihood of decrease in resources although age range changed from 17 to 18 with new Service Specification
• Steady increase in numbers and complexity of referrals to CAMHS from all sources (305 in March 2012)
• Current caseload: 1800
Challenges for 2012 and beyond (2)
• Impact of known and unknown changes in other agencies (particularly CSC/Local Service Teams/Education)
• Impact of rise in numbers of children and young people subject to Child Protection Plans or becoming LAC
• Responding to statutory framework re Looked After Children (including very complex young people placed in Somerset by external agencies)
• Responding to new commissioning arrangements under Health and Social Care Bill – Clinical Commissioning Group (GPs)
Responses for 2012 and beyond (1)
• Review service delivery model – focus on solution focussed approach (“ready, willing and able” to access treatment)
• Review referral criteria and processes
• Improve access and information e.g. telephone help line web based information (self help, information for
professionals, contact details)
• Ongoing critical review of all posts/reinvestment/redesign/skill mix
• Further develop Recovery Care Programme Approach (personalised care planning) including robust review and timely discharge/transitions
Responses for 2012 and beyond (2)
• Develop integrated training strategy across Children and Young People’s Service – focus on early intervention, sharing skills and building confidence
• Priority training programme for School Nurses
• Develop care pathways across integrated services (e.g. ADHD, ASD, eating disorders, additional needs)
• Pro-active and positive engagement with new commissioners and stakeholders – including education
Examples of additional services and joint agency models
• Evidence based training packages on specialist subject areas, including:
– Making sense of behaviour that is difficult to understand
– Preventative interventions– De-escalation and re-integration strategies
• Direct interventions with family and schools regarding individual young people
• Active planning under way with Educational Psychology and Integrated Therapy Service – working towards a programme building on evidence based TAMHS pilot
And finally…
• Recognising the limits and limitations of a commissioned Specialist Mental Health Service
• Welcoming opportunities to learn more about the challenges facing schools
• Finding creative and collaborative solutions
• Shared goals – improving outcomes for young people
Contact details:Alison ChisholmCAMHS Service [email protected]: 01823 368368
Sue PearsonTeam Manager - CAMHS [email protected] Tel: 01823 368368
Nigel PotterOperational Manager – Mendip and South [email protected]: 01749 836561 or 01935 384140
Maria Gascon-RamosOperational Manager - National Deaf CAMHS (ND CAMHS)[email protected]: 01823 368373 or text: 07798 667966
• Follow links on website to access Information for Professionals and Information for Families leaflets, and Request For Involvement forms
http://www.sompar.nhs.uk/Childrenandyoungpeople.aspx