Referral to CNWL Child and Adolescent Mental Health Service (CAMHS) Eating Disorder Team

Referral to CNWL Child and Adolescent Mental Health Service (CAMHS) Eating Disorder Team

Please complete all sections as fully as possible. We are required to register the full postcode, GP details and NHS number of all referrals. Please include this information in your referral.

Please complete this form and email to posted referrals will also be accepted.

Eating Disorders Team (Brent, Harrow, Hillingdon, Kensington and Chelsea, Westminster)
Address:
South Kensington and Chelsea Mental Health Centre
1 Nightingale Place
London,SW10 9NG
United Kingdom
Email:
Fax: 020 3315 3363
Tel:020 3315 3369
Urgent referrals should be emailed or faxed. / Risk section (Health Professionals only)
One or more ticked boxes indicates urgent assessment required
HR< 50bpm (<40bpm – admit paediatric/medical ward)
Symptomatic postural tachycardia (admit if increase >30bpm)
ECG – prolonged QT, arrhythmia (not sinus) – admit
BP below 0.4th centile for age
BP postural drop >15mmHg (admit if >20mmHg)
Temperature <36oC (admit if <35.5 oC)
Hypokalaemia [If <3mmol, admit paediatric / medical ward]
Hyponatraemia [If<130mmol, admit paediatric / medical ward]
Hypernatraemia
Rapid weight loss
Signs of significant dehydration or malnutrition
Suicidality / significant mental health concerns
Date of referral / Priority: / Routine / Urgent
Details
Dates to avoid / i.e. any dates to avoid as patient may be away/unavailable:

Child/young person’s details

Full name / Address
Date of birth
NHS No. / Telephone no.
Gender / Mobile no.
Ethnicity / Email
Language / Interpreter required?
Yes No
Details: / Main spoken language at home
Disabilities Physical/Communication impairments, especially if requires assistance with arranging appointments? / Yes No
Details:
Maritalstatus
Single
Married/Civil Partnership
Divorced
Widowed / Livingarrangements
Living with family/friends
Supported accommodation
Other (please state below)
______

Referrer details

Name / Telephone
GMC / Address
Organisation / Fax
Organisation code
(if applicable) / Email (NHS)

GP details

Only required if the referrer is not the patient’s GP

Name / Telephone
Job title / Fax
Address / Email

Family details

Name of parents/carers
(whom patient lives with) / Relationship to child
Telephone no. / Email
Who holds parental responsibility? (parent/carer/Local Authority (LAC)
Please give contact details if not already shown above.
Name / Telephone no.
Address / Email
Who else lives in the referred child’s/young person’s household? Please list.
Name and relationship to child/young person / Age / School/Occupation

Patient’s school/college/workplace

Name of school/college
/workplace / Telephone
Address

Reason for current referral

(Continue on separate sheet if required)

Please indicate what is required from our service.
Please provide details of significant history, concerns and any risks.
Past Medical History -- Include only relevant medical history:
Problems:
Summary:
Any other agencies currently involved/involved in the past with the child/young person/family; and any services for which they are on a waiting list, and attach any relevant reports.

Physical health assessment

Date of physical health assessment / Weight (kg)
Allergies / Height (metres)
Please attach Blood Investigation and ECG results.

Change in Weight Over the past Three Months

Date Weighed / Weight

Medication

Current acute medication in the last 1 month

Name of medication / Dose / Prescribed by / obtained from / Duration

Further information

Do the parents/carers (who have parental responsibility) consent to this referral?
Yes No
If 16 or over, has consent been given by the young person?
Yes No
Has the child/ young person/family had previous involvement with this or any other CAMHS?
Yes No Unsure
If Yes: Date: Reason:
Has the child/young person ever had a Child Protection Plan?
Yes No Unsure
If Yes: Date: Reason:
Is the child/young person/family currently involved in Legal Proceedings relating to the child/young person?
Yes No
If Yes, please give brief details:
Are you aware of any domestic violence issues in this family?
Yes No
If Yes, please give brief details:
Are there any other matters, such as culture, language, illness, religion, or disability that we may need to consider when getting in touch with the family?
Referrer’s signature / Job title / Date

Client Name:DoB:Date of Referral:

Reason for Referral, please give a brief description of mental health concerns. (Provide physical health screening Information where possible)
Lower Risk / Moderate Risk / Alert to High Concern / High Risk / Factor / BRIEF DETAILS
Percentage median BMI
80–85% (approx.
9th–2nd BMI centile) / Percentage median BMI
80–85% (approx.
9th–2nd BMI centile) / Percentage median BMI
70–80% (approx. between 2nd and 0.4th BMI centile) / Percentage median
BMI<70% (approx.
below 0.4th BMI centile) / 1. BMI
No weight loss
over past 2 weeks / Recent weight loss of up to
500 g/week for 2 consecutive weeks / Recent loss of weight of 500– 999 g/week for 2
consecutive weeks / Recent loss of weight of 1 kg or more/week for 2
consecutive weeks / 2. Weight Loss
Heart rate (awake) >60bpm / Heart rate (awake) 50–60bpm / Heart rate (awake) 40–50bpm / Heart rate (awake)<40bpma / 3. Heart Rate
Normal sitting blood pressure for age and gender with reference to centile chartsa / Sitting blood pressure: systolic <2nd centile (98–105mmHg depending on age and gendera); diastolic
<2nd centile (40–45mmHg
depending on age and gendera) / Sitting blood pressure: systolic <0.4th centile (84–98mmHg depending on age and genderb); diastolic <0.4th centile (35–40mmHg depending on age and gendera) / 4. Blood Pressure
Normal orthostatic cardiovascular changes / Pre-syncopal symptoms but normal orthostatic cardiovascular changes / Occasional syncope; moderate orthostatic cardiovascular changes (fall in systolic blood pressure of 15mmHg or more, or diastolic blood pressure fall of 10 mmHg or more within 3min standing, or increase in heart rate of up to 30bpm) / History of recurrent syncope; marked orthostatic changes (fall in systolic blood pressure of 20 mmHg or more, or below 0.4th– 2nd centiles for age, or increase in heart rate of >30bpm) / 5. Syncope
Normal heart rhythm / Irregular heart rhythm (does not include sinus
arrhythmia) / 6. Heart Rhythm
Cool peripheries;
prolonged peripheral capillary refill time (normal central capillary refill time)
QTc<460ms (girls) or 400 ms (boys) / QTc<460ms (girls) or 400 ms (boys) and taking Medication known to prolong QTc interval, family history of prolonged QTc or sensorineural deafness / QTc>460ms (girls) or 400 ms (boys) / QTc>460ms (girls) or 400 ms (boys) with evidence of bradyarrhythmia or tachyarrhythmia (excludes sinus bradycardia and sinus arrhythmia); ECG evidence of biochemical
Abnormality / 7. ECG abnormalities
Not clinically dehydrated / Fluid restriction Mild dehydration (<5%): may have dry mouth or not
clinically dehydrated but with concerns about risk of dehydration with negative fluid balance / Severe fluid restriction
Moderate dehydration (5–10%): reduced urine output, dry mouth, normal skin turgor, some tachypnoea,
some tachycardia,c
peripheral oedema / Fluid refusal Severe dehydration (10%): reduced urine output, dry
mouth, decreased skin turgor, sunken eyes, tachypnoea, tachycardiac / 8. Hydration status
<36°C / <35.5°C tympanic
or 35.0°C axillary / 9. Temperature
Hypophosphataemia,
hypokalaemia,
hyponatraemia,
hypocalcaemia / Hypophosphataemia,
hypokalaemia,
hypoalbuminaemia,
hypoglycaemia,
hyponatraemia,
hypocalcaemia / 10. Biochemical abnormalities
Moderate restriction, bingeing / Severe restriction (less than 50% of required intake),
vomiting, purging with laxatives / Acute food refusal
or estimated calorie intake 400–600kcal per day / 11. Disordered eating behaviours
Some insight into eating problems, motivated to
tackle eating problems,
ambivalence towards changes required to
gain weight not apparent in behavior / Some insight into eating problems, some motivation
to tackle eating problems,
ambivalent towards changes required to gain weight but not actively resisting / Poor insight into eating problems, lacks motivation to tackle eating problems, resistance to changes required to gain weight,
parents unable to implement meal plan advice given by healthcare providers / Violent when parents try to limit behaviour or encourage food/fluid intake, parental violence
in relation to feeding (hitting, force feeding) / 12. Engagement with management plan
No uncontrolled exercise / Mild levels of uncontrolled
exercise in the context of
malnutrition (<1h/day) / Moderate levels
of uncontrolled
exercise in the context of malnutrition (>1h/day) / High levels of uncontrolled exercise in
the context of malnutrition (>2h/day) / 13. Activity and
Exercise
Cutting or similar
behaviours, suicidal ideas with low risk of
completed suicide / Self-poisoning,
suicidal ideas with
moderate to high risk of completed suicide / 14. Self-harm and
Suicide
Other major psychiatric co-diagnosis, e.g. OCD, psychosis, depression / 15. Other mental
health diagnoses
Sits up from lying flat without any difficulty (score 3) / Unable to sit up without noticeable difficulty
(score 2) / Unable to sit up without using upper limbs (score 1) / Unable to sit up at all from lying flat (score 0) / 16. Muscular
weakness – SUSS Test:
Sit Up from lying
Flat
Stands up from squat without any difficulty (score 3) / Unable to get up without noticeable difficulty
(score 2) / Unable to get up without using upper limbs (score 1) / Unable to get up at all from squatting (score 0) / Stand up from
Squat
Poor attention and
concentration / Mallory–Weiss tear, gastro-oesophageal reflux or gastritis,
pressure sores / Confusion and delirium, acute pancreatitis, gastric or oesophageal
Rupture / Other
NOTES: DETERMINING REFERRAL RISK PRIORITY STATUS (see more detailed guidance)
Assessing risk is judgement-based and to a degree necessarily subjective. A referral should, in general terms, always be regarded as:

EMERGENCY where the risks in relation to the above factors are so great that you feel unable to leave the patient for safety reasons and/or they are at risk of needing an admission if home assessment and treatment is not provided.
URGENT where there is risk present in relation to 1 & 2, above, or an imminent threat in 3 – 10 is evident during your discussion and routine assessment would be inadequate in terms of timely intervention.
ROUTINE for all other referrals to secondary care, or to the local Primary Care Mental Health Service in the first instance, for steps 1 - 3.

Suspected or Diagnosed Eating Disorder –Referral Guide for General Practitioners

Due to the complex medical and mental health presentation of eating disorders, the young person does require an assessment by a GP as part of the initial referral pathway to the Community Eating Disorders Service for Children and Young People.

This will:

•Assist with the prioritisation of the referral

•Assess whether a more immediate paediatric obtained intervention is necessary

•Ensure that the young person is responded to following the appropriate pathway.

Clinicians can find more information on the MaRSiPAN website:

Prior to a referral to Community Eating Disorders Service for Children and Young People the information listed below should be obtained and sent with the referral or as soon as the results are received:

•Weight and height (no shoes)

•Information of history of weight loss – amount lost, rapidity and intention

•Blood pressure and pulse sitting and standing

•Temperature

•ECG if clinically indicated

•History of excessive exercising, vomiting, abuse of laxatives or other diet pills

•Menstruation history in females

•Bloods to include blood glucose, FBC, U+E, LFT, TFT, magnesium, calcium, albumin, creatine kinase, ESR and phosphate

When to be concerned:

•Heart rate- less than 50bpm, symptomatic postural tachycardia - ECG indicated

•ECG-prolonged QT, heart rate < 50bpm, arrhythmia associated with malnutrition and/or electrolyte disturbance

•Blood pressure-systolic, diastolic or mean arterial pressure below the 0.4th centile for age/gender and/or postural drop of more than 15mmHg

•Signs of significant dehydration and malnutrition

•Temperature < 36 degrees

•Evidence of Purging –hypokalaemia, uncontrolled vomiting with risk of oesophageal and other visceral tears

•Hypokalaemia - <3mmol/l –admit under paediatrics

•Hyponatraemia or Hypernatremia- related to dehydration or water loading- <130mmol/l admit under paediatrics

•Rapidity of weight loss, even when seemingly a healthy weight range

Psychiatric/Mental health risk

Suicidality
Evidence of self-harm
Young Person not coping
Family not coping

We recommend that whilst awaiting referral to CAMHS the referring GP continues to monitor the young person regularly taking into account the above information.

Safeguarding Risk

Child/young person identified as child in need
Child/young person lacking support and or identified as being at risk of abuse and harm

Helpline and Resources

Website:
Helpline: 0345 634 1414 open Monday to Friday
10.30am–8.30pm; Saturdays 1.00–4.30pm
Email: / For young people aged 25 and under
B-eat Youthline: 0345 634 7650 open Monday to
Friday: 4.30–8.30pm Saturdays: 1.00–4.30pm
Email: TXT 07786 201820
F.E.A.S.T Families Empowered and Supporting
Treatment of Eating Disorders
/ Around the Dinner Table

CAMHS three-borough eating disorder service

Referrals: information and guidance

Who we are and Who do we treat?

The CNWL Community Eating Disorders Service is a specialist community multi-disciplinary Eating Disorders service. We provide assessment and treatment for children and adolescents with eating disorders such, including anorexia nervosa, bulimia nervosa and binge eating disorder. These can be suspected or confirmed eating disorders. Patients can be of any weight and there is no BMI or weight criterion. The service accepts referrals for young people registered with a GP in the boroughs of Brent, Harrow, Hillingdon, Kensington and Chelsea and Westminster up to their 18th birthday.

Where to find us

We are based at South Kensington and Chelsea Mental Health Centre
1 Nightingale Place and also offer appointments at Northwick Park Hospital

Transport information to South Kensington and Chelsea Mental Health Centre 1 Nightingale Place

Bus: C3, 11, 14, 22, 212, 320, 414

Tube: Fulham Broadway (District Line), Earl's Court (Piccadilly and District lines), South Kensington (Piccadilly Line) and Gloucester Road (Piccadilly Line), are all within 15 minutes' walk.

Rail: Paddington 31 minutes, Victoria 25 minutes, King's Cross St Pancras 47 minutes, and Euston 40 minutes

Who can refer?

We accept self-referrals (parents and young people), referrals from GPs and other health professionals, education and social services professionals working with children.

Consent to the referral is required. Parents are an integral part of the treatment programme and so we always recommend the referrer informs the parent of the referral here, unless there are exceptional circumstances.

How to refer

Professionals working with children can refer using our referral form (attached). If you are not the GP, we recommend the young person is seen by the GP to exclude a physical cause for their symptoms and to help the team assess the urgency of the referral, but we can accept the referral alongside this.

You can also call the service between 9am–5pm Monday to Friday on 020 3315 3369 and ask to speak to the Duty Eating Disorders clinician if you are unsure if the referral is appropriate or if you have other questions.

If you are a parent or young person, you can call the service between 9am-5pm Monday to Friday on 020 3315 3369and ask to speak to the Duty Eating Disorders clinician who will discuss your concerns with you.

Occasionally, the underlying issue may not be an eating disorder – in this instance the team will recommend a more appropriate team or service.

How soon will the first appointment be?

The team use the referral information to make a decision on urgency. We aim to see urgent cases within five working days of the receipt of the referral and routine cases within 15 working days. High risk/ Emergency cases will be seen within 24 hours. Very unwell young people may need to be referred to the paediatric/medical team or A&E in an emergency.

Guidance for referrers

Is this an eating disorder?

Eating disorders are classified as Anorexia Nervosa, Bulimia nervosa, Binge Eating Disorder, and variants of these. In anorexia and bulimia, there is an overwhelming preoccupation with weight and shape with attempts to lose weight. In anorexia there is restriction of food with consequent significant weight loss whilst in bulimia nervosa frequent episodes of bingeing occur followed by attempts to get rid of the food or calories consumed, e.g., by vomiting or using laxatives. In Binge Eating Disorder, there are episodes of intense bingeing of food with a sense of loss of control which occurs at least twice a week over six months. Eating disorders such as anorexia and bulimia are relatively uncommon in younger children but often start in adolescence.

Dissatisfaction with weight and shape is very common and young people will often try and diet or may skip meals to try to lose weight or prevent weight gain. If they are not losing weight and the behaviours are only of a few days or weeks duration, it is unlikely that they have an eating disorder but they may benefit from advice on regular healthy eating and the behaviours monitored to ensure they are not worsening.

Young people who need a referral to our service will have clinically significant symptoms and behaviours. For those whose eating disorder is of the anorexia nervosa type, there will be a significant reduction of food intake over a period of weeks or more with consequent weight loss. There will also be effects on their physical health and mental health. There may be thinning of the hair and skin dryness. The young person may look pale and they may appear tired and fatigued (although this may be masked in some who over-exercise); they may appear low in mood, more anxious or may lack concentration. They may miss school lunch or eat very little. The young person may complain of feeling dizzy or faint; girls may report their periods have become less frequent or have stopped altogether. Medical examination by the GP or school nurse may show effects on the heart rate and blood pressure. Some young people may neglect their general hygiene.

Bulimia nervosa is often harder to identify as it can remain “hidden” for months or years. The young person may disclose that they are overeating (bingeing) several times per week, with consequent attempts to get rid of the food by purging, e.g., by vomiting or using laxatives, or excessively exercising.