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Referrals to Child and Adolescent Mental Health Services (CAMHS) and Learning Disabilities (LD)

Specialist CAMHS/Learning Disabilities provides evidence-based services for children and adolescents suffering from severe and complex mental health issues which have a significant impact on the child’s development and causes distress to the child and/or

 

DEFINITION OF SEVERE LEARNING DISABILITIES

Individuals with severe disabilities typically have IQ scores in the 20-35 range. (World Health Organisation), may exhibit a wide range of characteristics, which may include:

  • Significant delay in reaching developmental milestones
  • Serious speech or communication problems
  • A severe degree of apathy in relation to the environment
  • Difficulty in basic physical mobility
  • Inability to remember basic skills
  • Inability to generalise skills from one situation to another
  • Dependence on others to satisfy basic needs, e.g., feeding, toileting
  • Inability to live without support throughout life
  • A variety of medical conditions may accompany severe or profound disabilities, such as epilepsy, hydrocephalus and scoliosis.

We do not routinely assess I.Q scores within our team.

'Learning disability' does not include all those who have a 'learning difficulty' (e.g. Dyslexia)". (Valuing People, DOH, 2001).

Age range and Access

  1. Children aged 0-18 years with consent from the person with parental responsibility (Children between 13 years and 16 years (if Gillick competent) can give their own consent but should be accompanied by a caregiver to the first appointment)
  2. Children up to the age of 19 in special circumstances (ADHD, ASD, Complex disability, Special Educational Needs).
  3. Children who are resident in North Somerset
  4. Children registered with a North Somerset GP, even if children are attending a school in another county
  5. Children who attend a Special School in North Somerset
  6. Children 'Looked After' by North Somerset Council, where practically possible
  7. Children 'Looked After' by other Local Authorities but placed in N. Somerset, where medical follow up by local CAMHS/LD is impractical. Information about the Local Authority who has responsibility for the child will need to be included in the referral, otherwise it will not be accepted. An extra-contractual referral agreement may be required.
  8. There are joint adult mental health (AMHS)/CAMHS referral pathways for young people aged 16/17 years who have more serious psychiatric disorder. A referral into either service will be the point of access for obtaining the most appropriate service provision including possible joint AMHS/CAMHS care.

Type of problem

  • Aggression/conduct problems which significantly impacts on everyday functioning.
  • Parent/carer/relationship problems with complex and severe behavioural problems in the child.
  • Depression and mood disorder.
  • Attempted suicide and deliberate self harm that poses a risk to safety which significantly restricts every day functioning.
  • Anxiety and obsessive compulsive disorder which significantly impacts on everyday functioning.
  • Eating disorder
  • Hyperactivity and attention deficit disorders which significantly impairs daily functioning.
  • Post traumatic stress disorder
  • Psychoses
  • Consequences of sexual, physical or emotional abuse following initial therapeutic treatment via social services
  • Complicated bereavement and loss
  • Complex sleeping, eating, toileting or behaviour problems accompanied by a severe learning disability.

Statutory Work

This includes medical advice for Statements of Special Educational Need (SEN).

How to refer

Complete the Single Point of Entry form and send to the address on the form and attach any supporting information which would be of help.

There is always someone available for advice if you are not sure what is appropriate.

Consent

It is expected that informed consent for the referral has been obtained from someone with legal parental responsibility for the child or young person. Young people aged 16 and above can consent to a referral in their own right. Some young people under 16 may consent to a referral and request that their parents are not informed. In this case it is expected that the referrer has decided that he young person has Gillick competency and has considered the risks and benefits of not informing the parents or carers of the referral.

Who can refer

Referrals to the CAMHS Service are accepted from: - Health (GP's, paediatricians, health visitors, school nurses), social workers, educational psychologists, education welfare officers, Youth Offending Team, Head teachers of Special Schools. SENCos at secondary schools who have had attended training on referral to CAMHS

How to decide if a referral is appropriate

Severity

Specialist CAMHS will accept referrals of children and young people whose symptoms or distress and degree of social and/or functional impairment are severe.

Duration

Usually, the duration of these difficulties should be not less than three months.

For severe / life-threatening conditions (see below) and for other conditions where there is severe impairment of functioning, the referral should be made immediately and discussed with a senior member of the CAMHS team.

Severe Mental Health Disorders

Specialist CAMHS will accept referrals where there is a likelihood that the child or young person has a severe mental health disorder.

Case Complexity

Specialist CAMHS will accept referrals where there is a high level of case complexity.

This might include, for example, multiple risk factors, complex family problems, child protection concerns.

Please note that any child protection concerns should already have been reported to the statutory agencies prior to referral.

Timing of the Involvement of Specialist CAMHS Services

Despite the apparent intensity or severity of a problem when it is first identified, an important issue for the child/young person and family is the timing of the involvement of specialist CAMHS services. This should be discussed carefully with the parent(s) and the child/young person because they are best placed to know when they are ready to engage with services which might lead to a programme of treatment that will require their involvement.

How to decide who is not an appropriate referral

  • Learning disability as the primary problem without mental health issues
  • Reaction to external life crises that is likely to resolve with time or with general counselling or advice from other agencies. (e.g. bereavement, divorce)
  • School related problems or educational difficulties where the dynamics are primarily in the school or where the intervention is more appropriately carried out by the education service.
  • Substance abuse unless there is a significant associated mental health problem
  • Mild and Moderate Learning Disability
  • See definition of Severe Learning disability above.

Cases that do not meet the referral criteria may be returned to the referrer. It is also possible that mild to moderate cases may be passed to Primary Mental Health workers for possible consultation, joint working and advice about management.

What work needs to be done before making a referral

Direct assessment

The child or young person needs to have been seen in person and assessed by the referrer prior to making a referral to the service.

Intervention by frontline staff

It is an essential requirement before a referral can be accepted into specialist CAMHS that attempts have been made by frontline staff (e.g. primary health care staff, school staff, school health nurse, CYPS staff) to resolve the child / young person's difficulties or problems before making a referral. Many children/young people can be helped in this way and, generally, it is better if the problems can be resolved without the need to identify the child/young person with mental health services though we are always happy to consult / advise as necessary.

Likelihood of Attendance

If the referrer knows that a family has found it difficult to attend for CAMHS appointments in the past, the referrer will be asked to consider how they can help the family to engage with CAMHS this time before making the referral. We will also need to know from you, the referrer, what we can do to try to ensure the family's engagement.

CYPS Assessments

For referrals from CYPS, a social work Initial or Core Assessment, or a Common Assessment Framework (CAF) assessment needs to have been completed before referral to CAMHS.

ETHNICITY MONITORING

Please note that we have a legal requirement to monitor ethnicity as defined by the child or young person themselves or by a parent with legal parental responsibility in the case of a young child. This means that the ethnicity section on the referral form must be completed please.

What will happen next?

  • All referrals will be acknowledged to the referrer/parents/carers/GP within 7 working days
  • Referrals will be reviewed by the relevant team in CAMHS who will contact the referrer if further information is required or if the referral does not fulfil the referral criteria.P
  • arents/carers/young people will receive a letter giving them information on how to book an initial appointment.