Protocol between the Bromley Youth Offending Team and Bromley Tier 3 CAMHS for the provision of specialist CAMHS to young people supervised by the Youth Offending Team

1. Introduction

1.1 The Youth Justice Board requires all Youth Offending Teams (YOT) in England and Wales to establish a written agreement with the Primary Care Trusts (PCT), setting out how Child and Adolescent Mental Health Services (CAMHS) can be accessed for young people known to the Youth Offending Team with assessed mental health needs.

1.2 The information contained within this document represents the protocol between Bromley Tier 3 Child and Adolescent Mental Health Services and the Bromley Youth Offending Team.

1.3 The Bromley Youth Offending Team delivers and co-ordinates youth justice services throughout Bromley to all young people aged 10-17 years who come to the attention of the police or courts for criminal offences. It is a multi-agency team and has a 0.6 WTE mental health nurse to conduct nursing assessments and sign-post young people with mental health needs to the most appropriate service. The post holder is also involved in the direct provision of Tier 2 services and supporting Youth Justice Officers in their work with youth offenders with mental health issues.

1.4 It is Bromley Youth Offending Team’s intention to work in close collaboration with CAMHS to access a range of appropriate services for young people assessed as having a mental health need. We have established a system for monitoring each referral and will regularly report this activity to the YOT Operational Board via line management.

2. Aims and objectives of the mental health protocol

2.1 To establish a joint protocol between Bromley Tier 3 CAMHS and Bromley Youth Offending Team for accessing CAMHS assessments and treatments for young offenders when ASSET or other sources demonstrate them to be advisable.

2.2 Establish a system for monitoring each referral and how effectively we responded to mental health needs as assessed/identified.

2.3 Feedback to the CAMHS Strategy Group in Bromley via line management the nature of referrals on an annual basis to inform future service developments for this client group.

2.4 Work in close collaboration with CAMHS to access a range of suitable services for young people assessed as having mental health problems

3. Content

3.1 This Protocol document aims to establish:

a)  A joint protocol for referral between Bromley Youth Offending Team (Mental Health Professional) and Bromley Tier 3 CAMHS.

b)  Outlines the core roles and responsibilities of the CAMHS Nurse within the Bromley YOT.

c)  Establish eligibility criteria for Mental Health assessments by the CAMHS Nurse within the team.

4. Referral protocol between Bromley Youth Offending Team (YOT) and Specialist Child and Adolescent Mental Health Services (CAMHS).

4.1 The YOT and CAMH services criteria for assessing the priority with which referrals are managed is shown below:

4.2 All young people will be assessed by the YOT workers using ASSET. If a young person scores two or more in the mental health section a Mental Health Screening Questionnaire Interview for Adolescents (SQIFA) will be completed. Where the score is higher than 2 the young person should be referred to the CAMHS Nurse.

4.3 The YOT CAMHS Nurse will carry out a full interview and ‘tier 2 CAMHS’ assessment using the Mental Health Screening Interview for Adolescents

(SIFA) where appropriate within 15 days for a ‘non-acute mental health

difficulty’ or 5 days if an ‘acute mental health difficulty’, of receiving the

referral. This assessment, in consultation with specialist CAMH services as required will identify the young person’s mental health needs and determine a plan for intervention.

4.4 The YOT worker should generally discuss the plan with the CAMHS Nurse and determine whether it is necessary to receive a further tier 2 or ‘tier 3’ CAMHS assessment.

4.5 Should any member of the YOT be concerned that a young person may

require an urgent mental health assessment e.g. the young person is at risk of self harm or suicide, is threatening to harm others or whose behaviour is very unusual or very out of character the young person should where practicable be assessed urgently by the CAMHS Nurse who will decide whether to make an urgent referral for a ‘tier 3’ CAMHS assessment. Tier 3 ‘specialist CAMHS’ should undertake a formal mental health assessment of the young person within 5 days

4.6 Referrals from YOT to CAMHS will usually be directed via the CAMHS Nurse. Where urgency or unavailability prevent this, referral will be directed to the CAMHS Adolescent Team. In cases of conflicting view regarding clinical priority there will be negotiation between the YOT Operational Manager and CAMHS Adolescent Team Leader. In exceptional cases, the decision may be referred to the YOT Manager and CAMHS Service Manager.

5. CAMHS Nurse: roles and responsibilities

Service Provision

The CAMHS Nurse role within the Youth Offending Team is:

5.1 To provide a mental health assessment/referral service for young people aged between 10-17 who are presenting with mental health problems throughout Bromley, who are referred to Bromley Youth Offending Team via the police and courts.

5.2 The CAMHS Nurse provides Tier 2 services acting as Filter between Tier 1 (GP, Health Visitors, School Nurses, and Midwives) and Tier 3 specialist health services (CAMHS).

5.3 Initial identification of emotional mental health issues will be done by YOT professionals using YOT ASSET tool. The CAMHS Nurse will clarify mental health issues, and where necessary prepare nursing reports for Youth Courts, as addendums to Pre Sentence Reports.

5.4 Where mental health has been identified through ASSET as the primary reason for offending the CAMHS Nurse will be working along side the YOT worker for support and specialist interventions. The YOT worker will remain case responsible officer for the case.

5.5 Cases identified under the Youth Rehabilitation Order, Mental Health Requirement will be jointly worked by the CAMHS Nurse and a representative from the Court and Community team.

5.6 Brief Focused Interventions with child/family to address identified low - moderate mental health need where they can be contained within Tier 2 provision

5.7 Liaison and networking - Referrals to CAMHS/specialist services for further assessment and services.

5.8 Consultation regarding Mental Health needs (Within the YOT and with other external agencies)

5.9 Joint work by CAMHS Nurse with clients identified at risk of offending combined with severe mental health issues, in partnership with appropriate services (YOT/CAMHS/Children and Young People Services/Voluntary Sector).

5.10 Support and Advice to young people, families or main carers with identified mental health needs.

5.11 Training and Education (internal/external agencies) as jointly agreed within the context of available resources.

5.12 Evaluation and auditing of service provision

Areas which fall outside the CAMHS Nurse role:

5.13 Psychiatric assessment/reports

5.14 Psychological assessment/reports

5.15 Prescription or administration of medication

5.16 Definitive diagnosis of mental illness

5.17 Out of hours Emergency assessments, such requests would be redirected to A&E for assessment by the duty team.

6. Information Sharing

6.1 The Crime and Disorder Act 1998 states that information should be shared between agencies if it contributes to the reduction or prevention of offending. This is the measure that should be used on a case by case basis when the YOT and CAMHS share information.

6.2 This definition is appropriately interpreted to include the sharing of information To Whom It May Concern: protect children and staff. The sharing of relevant information is recognised as crucial for assessment, planning and intervention.

7. Activity/performance monitoring

7.1 Performance data will be collected, this will be monitored quarterly at YOT/CAMHS management meetings to ensure compliance with required performance standards.

7.2 The views of service users should inform service planning and development.

7.3 Reports on mental issues should be made to the local CAMHS Strategy Group and the YOT Operational Board as required.

7.4 Clinical audit will be undertaken and inform service developments

8. Supervision arrangements

8.1 Clinical supervision will be given by CAMHS and YOT Operational supervision will be given by the YOT Operational Manager. Three-way supervision will be conducted between CAMHS, YOT and CAMHS Nurse will take place on a quarterly basis and YOT will provide input into PADS on an annual basis.

9. Contingency Arrangements

9.1 In the absence of the CAMHS Nurse and urgent advice is needed the YOT Operational Manager should liaise with the CAMHS Adolescent Team Leader. In these cases there is no requirement to complete the screening pathway before making a referral. The best possible alternative support package which should have already been considered, should be put in place while waiting for access to specialist CAMHS.

10. Review of protocol

10.1 This will take place on an annual basis and be undertaken jointly by the YOT Manager and CAMHS Service Manager.

Signed on Behalf of CAMHS

…………………………

Mick Russell

Service Manager

Bromley Tier 3 CAMHS

Date:

Signed on behalf of the YOT ………………………….

Elayne Stewart

YOT Manager

Date: May 2011

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