Havering Child and Adolescent Mental Health Service (CAMHS) TIER 3 Referral Guidelines The Child and Adolescent Mental Health Service provides services to children and young people who have mental health difficulties, behavioural and / or emotional problems. The service is available to families with children and young people aged from birth to their 18th Birthday. The child or young person must be resident in the borough of Havering.
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Who can refer? Referrals are accepted from professionals in health, education and social services. In the case of referrals from the educational service, consultation should have taken place before the referral is made, with the appropriate professionals from that service e.g. educational psychologists, education welfare officers, school nurses or the behaviour support teams.
Guidelines for referral Havering Child and Adolescent Mental Health Service operates as a multidisciplinary team. Therefore, it is preferred that referrals are made to the team and not to a named professional. On completion of the initial screening / assessment, cases will be allocated, as appropriate, in accordance with the agreed treatment plan.
Consultation We provide consultation to a range of professionals to support them in their work. For example: Social Workers Youth Offending Team Tier 2 Counselling services Health Visitors / School nurses Paediatrics Special Educational Needs Co-ordinators / Educational Psychologists / Education Welfare Officers We are happy to engage in telephone consultation with professionals to discuss the appropriateness of potential referrals.
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Some referrals may be more effectively dealt with by agencies other than CAMHS: If children are at risk of significant harm the London Child Protection procedures must be followed. Education problems that have manifested exclusively within the school setting and have not been through the in-school review should be followed-up initially by the education services. Parental mental illness and emotional distress should be referred to the adult mental health service.
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Severe global learning difficulties or specific learning difficulties should be referred to the community paediatrician or educational psychology services. Situations where children or young people are affected by parental acrimony or separation may initially require the involvement of a mediation service. Tiers 1 and 2 plus voluntary counselling services may also be a more appropriate route for some referrals.
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Referrals considered by CAMHS include requests for the assessment and management of problems suggestive of: Suspected / actual psychosis (if the child is over 14 years old they should be referred to the Early Intervention into Psychosis Team – 01708 796 000) Moderate/severe depression / suicidal ideation Deliberate self-harm Substance abuse Incapacitating physical disturbance due to psychological causes
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emotional / physical / sexual Severe behaviour problems / Conduct Disorder/Oppositional Defiant Disorder School refusal with associated emotional trauma Traumatic life events with evidence of severely disturbed behaviour Severe family dysfunction The severity of a mental health problem is assessed on the basis of the history, symptoms and the following factors: Complexity
Eating disorder
Persistence
Aggressive behaviour as the result of a psychiatric condition, including Learning Difficulty (where skills are available)
Risk to child of further development of mental health issues if situation persists
Incapacitating OCD
Presence or absence of protective factors or risk factors
Incapacitating Anxiety Incapacitating emotional disorders Neuro-developmental difficulties, e.g. ADHD; Autistic Spectrum Disorders; social & communication difficulties Attachment disorders / parentinfant bonding difficulties in under 3’s Trauma following abuse:
Child’s level of development
Presence or absence of stressful social or cultural factors Sudden unexplained onset of symptoms All referrals are screened for urgency as part of standard procedure. Referrers and GP will be advised when the case has been closed by CAMHS services
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TIER 2 REFERRAL GUIDELINES Primary Mental Health Team What is the Primary Mental Health Team? The Primary Mental Health Team (PMHT) is part of the Havering Child and Adolescent Mental Health Services (CAMHS) and is based at Raphael House. We work with children and young people between the ages of 5 and 16 and their families, where the child or young person may have emotional or mental health difficulties. We also work with professionals who are involved with these children.
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How do we differ from TIER 3 services? We may become involved at an earlier stage of intervention with children and young people who do not require the multi-disciplinary input of the Tier 3 team and may consult them on cases. Our work is usually short-term. Referrals considered by PMHT: The PMHT is a Tier 2 service for the treatment and management of children, young people and their families, whose mental health / emotional health issues cannot be managed at Tier 1 (primary care) AND DON’T REQUIRE THE MULTIDISCIPLINARY SERVICES OF TIER 3 Examples of suitable referrals where work at Tier 1 has been unsuccessful could include: Emotional disturbance Anxiety / low self-esteem Attachment / relationship difficulties Moderate behavioural problems
to refer?
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To ensure that the referral is appropriate to our service, we would like you to phone us to discuss the case prior to sending a written referral using the CAMHS referral form. Tel: 01708 796818 Mon to Fri: 9 – 5pm
How we work Once we have accepted a referral we will keep you informed, work closely with you if appropriate and notify you of the outcome of our work. Our work could take one of the following forms: Direct work with the child / young person and their family. Consultation with the referring Professional. Co-work with a professional.
Who do we accept referrals from? In Health: G.Ps Health visitors school nurses In Social Services: Social worker team leaders Early Years Centres In Education: Education psychologists Behaviour support workers
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North East London Mental Health NHS Trust
Child & Adolescent Mental Health Service Raphael House Victoria Centre Pettits Lane Romford RM1 4HP If you require further information regarding these guidelines or would like to speak to us about anything in this document please contact Referral Administration Support on tel: 01708 796 800 fax: 01708 761 893 website: www.nelmht.nhs.uk
