Referral Criteriaand Process For
Referral criteriaand process for
Oxfordshire CAMHS community services
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Summary
This document provides an overview of the referral criteria and process for the child and adolescent mental service that will be screened through the Single Point of Access (SPA) in Oxfordshire.
These include:
•PCAMHS (Primary Child and Adolescent Mental Health Service)
•CAMHS Community service (Child and Adolescent Mental Health Service)
•CAMHS Outreach Service (OSCA)
•CAMHS Learning Disability Service
•How to refer
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Primary CAMHS (PCAMHS)
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What is PCAMHS?
Children & Adolescents Primary Mental Health (PCAMHS) is part of the integrated CAMH service for children and young people aged 0-18 and their families / carers. The function of PCAMHS (also referred to as Tier 2) is to ensure that the emotional and mental health needs of children and young people are appropriately met at theearliest opportunity with the aim of reducing the likelihoodof long-term mental health problems. The service is delivered by a multi-disciplinary team whoare able to deliver a range of evidence-based therapeuticinterventions.
What does PCAMHS do?
PCAMHS offer short-term interventions that areindividually tailored to the needs of each child, youngperson or family. These evidence-based earlyinterventions can be carried out on an individual, group orfamily basis. As a service we will aim to work in familiar settings that are easily accessible such as schools,children’s centres, youth centres, home settings and GPpractices. PCAMHS will also offer consultation andtraining to universal services to help support the work theydo with young people.
Who is the service for?
We work with children and young people with emotionaland mental health needs where appropriate first-lineinterventions have been put in place and have not had asuccessful impact, or where there is not the relevantexpertise or skills to pick this up by those services whocurrently know the child.
•Persistent difficulties in making and maintainingrelationships with family and peers, including insecureattachments
•Parents/carers who would benefit from time limitedparenting support to help understand their child’schallenging behaviour including help with routines andboundary setting
•Children and young people whose impaired mentalwellbeing interferes with social and educationalperformance
•Children and young people exhibiting symptoms of lowmood, anxiety, anger or emotional distress including self-harm
•Children and young people reacting to issues ofbereavement, trauma and loss
•Children and young people affected by parental mentalill health
•Children and young people where there are concernsabout a developing mental illness e.g. eating disorder,distorted body image, compulsive and obsessivebehaviour patterns, gender identity
•Children and young people where their emotional andmental health is impacting on their development
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CAMHS Community service
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The core business of CAMHS Community service is:
The specialist assessment and treatment of serious mentalhealth disturbances and associated risks in young peopleunder the age of 18 years.
Emergency criteria
To be discussed with the Duty Clinician for the CommunityCAMHS team and assessment arranged as is clinicallyindicated and as a maximum within 24 hours.
•Presentation of symptoms of severe depression andsuicidal ideas /thoughts
•Presentation of severe psychotic symptoms
•Presentation of anorexia with severe physical risk
•Significant risk of harm to self or others
Urgent criteria
To be discussed with the Duty Clinician for the CommunityCAMHS team and assessment arranged as is clinicallyindicated and as a maximum within 7 days
•Severe symptoms of depression with or without suicidalideas/thoughts
•Symptoms of anorexia with over 20% deficit from idealweight and/or significant physical risk
•Severe unexplained deterioration in emotional state andbehaviour at home and school not thought to be due todrugs, alcohol or physical illness
•Assessment following deliberate self-harm andpresentation at accident and emergency services. The referrer needs to identify the level of urgency of thecase. If in doubt the referrer should contact theCommunity CAMHS Duty Clinician.
Standard criteria
There will be an emphasis on the need for assessment toascertain presence or not of severe mental ill health andCommunity CAMHS contribution to management ofcomplex cases. Factors to consider include: severity,complexity, enduring difficulties over time, difficulties inone or more domain, impairment of function at home,school or socially.
Attention Deficit Hyperactivity Disorder (ADSHD) & AutisticSpectrum Disorder (ASD)
•Complex Attention Deficit Hyperactivity Disorder& Autistic Spectrum Disorder cases withco-morbid mental health issues which meet CommunityCAMHS criteria
Eating Disorders
•Anorexia: at least 15% deficit from ideal weight withassociated psychopathology
•Bulimia: engaging in binge and purge behaviours
•Eating Disorders Not Otherwise Specified (EDNOS) withfunctional impairment or physical risk
Psychotic Illness
•Positive symptoms – Paranoia, delusional beliefs,abnormal perceptions (hallucinations on all sensorymodalities)
•Negative, symptoms – deterioration in self-care anddaily personal, social and family functioning
•Disinhibited behaviour, over-activity, risk taking, withpressure of speech and agitation
•Severe depression with psychomotor retardation, socialwithdrawal, suicidal ideas/thoughts
Anxiety Disorders
•Anxiety panic attacks
•Separation anxiety
•Phobias including phobic anxiety related to school
Depression
•Physical symptoms: poor sleep/appetite/ libido
•Cognitive symptoms: negative thoughts aboutself /others /world
•Suicidal ideas/thoughts: such as level of intent, currentthought
•Co-morbidity: depression often occurs concurrentlywith other presenting mental health problems
Post Traumatic Stress Disorder
•Symptoms occurring more than 1 month after arecognised traumatic event
•Intrusion and avoidance of thoughts and memoriesabout the trauma
•Hyper-vigilance, hyper-arousal and emotional numbing
Obsessive Compulsive Disorder & Tourettes
•Obsessions and/or compulsions with functionalimpairment
•Tourettes Syndrome with complex motor and vocal tics,particularly with co-morbidity with OCD and rage
Deliberate Self Harm
•If accompanied by significant suicidal ideas/thoughts
•If presenting with a pattern of emotional disregulation,interpersonal difficulty and maladaptive copingstrategies
Attachment Disorders
•If presenting with a persistent pattern of abnormalfunctioning in interpersonal relationships
Community CAMHS will also see individuals with thefollowing presentations if there is evidence of comorbiditywith a serious mental health condition
•Drug and alcohol problems
•Conduct disorder
•Children with learning disabilities
•Obesity
•Enuresis/Encopresis
•Chronic fatigue /somatisation syndrome
Consultation will be provided by specialist CAMHS to:
•Help support cases that do not meet the criteria withinuniversal services
•Advise referrers on the most appropriate service for thechild/young person
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CAMHS Outreach service (OSCA)
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Overview
The primary role of the CAMHS Outreach Service for Children & Adolescents (OSCA) is to work intensively withchildren, young people and those in emerging adulthood (18-25) who are experiencing a complex range ofbehavioural, emotional and mental health needs to preventescalation of at-risk behaviours, and to work towardsachieving identified goals using focused interventions.
The key objectives are to:
•Support children/young people in stable placements,either at home or in care
•Reduce the numbers of children requiring to beaccommodated by the local authority
•Reduce the need for out of county placements
OSCA work extended hours 8am-8pm Monday to Fridayand 9am-5pm weekends and Bank Holidays providing aresponsive and flexible approach to meeting the needs ofchildren, young people & families.
OSCA will deliver a number of therapeutic interventions including high intensity Dialectal Behavioural Therapy(DBT), family work, Cognitive Behavioural Therapy (CBT),solution focused therapy, parenting support, and engagement work, to the following groups of children:
Children and young people with a clear mentalhealth diagnosis
OSCA will offer care to children and young people who havealready met specialist CAMHS criteria, (i.e. have beendiagnosed with a serious mental health disorder) where;
•The child/ young person is at risk of placementbreakdown and failed to engage with or disengagedfrom specialist CAMHS services
•Where the intensity of an intervention required tosupport a child in placement is greater than theresources available within specialist CAMHS (more thanone visit per week required), and there is a history of thechild and young person failing to engage with these services on a regular basis
Where a mental health diagnosis is less clear
OSCA will care coordinate complex cases that meets at leastone of the following criteria:
•The child/ young person is looked after, adopted orunder a child protection plan
•The young person is significantly involved in the criminaljustice system / or has major substance misuse issues
•The young person has an Education, Health and Care Plan (EHCP), and is educated withinspecialist educational provision
And where:
•Significant emotional, behavioural, or mental healthconcerns that have been identified through the Youth Offending Service (YOS) Asset assessment, Education, Health and Care Plan (EHCP),Family Star assessment, or Department of Health Framework for Assessment
And where a minimum of two of the following criteriaapply:
•The child or young person is at risk of placementbreakdown (either home or a care placement)
•The child and young person’s needs cannot be met by therange of professionals currently involved with the case
•A standard primary mental health intervention isCLEARLYnot sufficient to meet the child’s needs
•A range of other primary mental health interventionshave already been tried and have proved unsuccessful/or there is a history of failure to engage
Consultation and support to frontlineprofessionals
OSCA will provide named workers tosupport the following agencies:
•Looked after children’s services
•Youth offending and substance misuse services
•Special schools for children with emotional difficulties
OSCA will provide support, advice and consultation tofrontline children services to ensure that children andyoung people are:
•Appropriately supported at the right level of care
•Ensure timely access into additional services whenrequired
Crisis Interventions
The OSCA team will provideCrisis support which involves intensive community-orientedtreatment to children and young people in the acute / crisisphase of mental illness, which, in the absence of the Crisisintervention, would be at risk of inpatient admission.
OSCA team will:
•Facilitate timely discharge from hospital where hospitaladmission has been necessary
•Deliver intensive support for children, young people andtheir families and within the optimal therapeuticenvironment, by supporting and engaging them andtheir families by means of individualised home and community treatment packages
•Work with colleagues in Community CAMHS teams in theintegrated model of care and other agencies to ensureappropriate follow-up care for the client once the acutephase of mental illness has passed and intensive hometreatment is no longer necessary
Out of Hours
Out of Hours the OSCA team willprovide a first response for all emergency clinical enquiries;they will provide consultation and advice and/or coordinatea psychiatric assessment if clinically indicatedwithin 24 hours as a maximum.
•Significant risk of harm to self or others with mental health identified as the key contributing factor
•Presentation of severe psychotic symptoms
•Presentation of anorexia with serious physical side effectsand/or rapid weight loss (e.g. BMI below 15, pulse rate 45and below with low blood pressure) or co-morbidity withlow mood/depression/ suicidal ideas / thoughts
Please note: consideration should initially be given to referral to paediatric or medical teams in the first instance if there isserious concern about the physical state
•Presentation of symptoms of severe depression withsuicidal ideas /thoughts
•Presenting with significant self-harm by overdose orsignificant self-injury
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CAMHS Learning Disability service
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Referral criteria
We will offer an assessment to children and young peoplewho meet the following criteria:
•Have an identified emotional, mental health orbehavioural difficulty
•Have a diagnosed learning disability or significantimpairment of intellectual and social adaptive functioning
•Assessment indicates that other services involved withthe child are not able to meet the current need if thereare not the skills or competence available
Children with Learning Disabilities often presentmental health differently from that of children without Learning Disabilities.
Therefore, in addition to the criteria for mental healthlisted this service will also address the following:
•Challenging behaviours of sufficient severity to destabilise placements, including physical and verbal aggression and self-injurious behaviours
•Severe disturbance in eating, self-care, toileting, relationships
•The capacity of families and schools to contain and manage these behaviours
Strengthening Care Pathways
The CAMHS Learning Disability Team will offer thefollowing types of support to other agencies:
•Telephone consultation
•Supervision and joint working
•Joint assessment
•Group supervision
•Single and multi-agency training
Our aim is to ensure that children, young people andfamilies are supported at the correct point of the pathwayby the most appropriate resource available.
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How to refer
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There is a range of ways in which you can make referrals to the range of CAMHS services:
Emergency referrals
Wherea child poses an immediate danger to themselves or others, these are dealt with within 24 hours of receipt.
If in hours, Monday-Friday, 09.00-17.00, please call us straight away on
01865 904105 (North Oxfordshire),
01865 902720 (Central Oxfordshire), or 01865 904700 (South Oxfordshire).
If out of hours, please call 01865 901 000 and ask for CAMHS crisis on call.
Urgent referrals
These are seen within7 days. We triage all referrals, but if you have particular concerns about a case or are not sure of its clinical priority, we urge you to call us on 01865 904105 (North Oxfordshire),
01865 902720 (Central Oxfordshire), or 01865 904700 (South Oxfordshire).
Version: 2.2
Date: 24/02/15
Author:Lucien Champion
Standard referrals
GPs please use the referral form on your GP system.
Other professionals are asked tocomplete anOxfordshire CAMHS Comprehensive Referral formandemail it to us at ,
, s appropriate.
Please ensure that thiscontains sufficient information for us to screen the referral appropriately, and that the child, young person and family or carers have given their consent to opt into treatment and to share their personal information.
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