Specialist Child and Adolescent Mental Health Service (CAMHS) May 2012Alison Chisholm, Service Manager

Overview of service

•Secondary/specialist multi-disciplinary mental health service for children and young people from 0 – 18 (19 with additional needs)

•Community Mental Health Teams (Tier 3)

•Inpatient Unit (Tier 4) – Wessex House, Bridgwater •Outreach/home treatment

•Specialist substance misuse service – integrated with community CAMHS

•ND CAMHS – specialist service for Deaf children and young people

•Learning Disabilities/Mental Health - Additional Needs resource

•Links to Youth Offending Team – one seconded CAMHS post

•C0MPASS (Musgrove Park Hospital) – psychological interventions for children and young people with life limiting conditions

Community CAMHS – (1) • Multi-disciplinary teams (psychology, psychiatry,

nurses, social workers, therapists, occupational therapists, primary mental health link workers, managers)

• Mendip: Priory House, Wells

• South Somerset: Balidon Centre, Yeovil

• Taunton Deane: CAMHS West, Foundation House

• Somerset Coast: Taunton

Community CAMHS (2)

• Assessment - formulation/diagnosis

• Care planning – Recovery model

• Collaboratively agreed goals and timescales

• Wide range of direct therapeutic interventions: Brief Solution Focused Therapy, Cognitive Behaviour Therapy, Family Therapy, Creative Therapy, medication

• Advice and consultation • “Signposting” to more appropriate services• Training

Community CAMHS (3)

Referral criteria:

• Mental health = significant impact on function (e.g. inability to attend to school due to severity of anxiety)

• Significant or severe levels of risk of harm to self or

others • Complex problematic substance misuse

Timescales:

• Emergency – within 24 hours/immediate

• Urgent – within 7 day

• Routine – within 3 weeks

Community CAMHS (4): mental health conditions • depression• anxiety • obsessive compulsive disorder • psychosis • significant self harm and/or suicidal ideation • eating disorder • complex emotional and family problems • Attention Deficit Hyperactivity Disorder

(complex, or with additional needs) • post traumatic stress disorder • dual diagnosis (e.g. Autistic Spectrum

Condition/Learning Disability plus any of above)

Substance misuse• Integrated specialist substance misuse treatment

service

• Working with young people with complex and high risk drug and alcohol problems

• Joint working with Community CAMHS for young people with additional mental health needs

• Inter-agency working (YOT, Targeted Youth Service, Turning Point

• 4 whole time specialist substance misuse workers, based in CAMHS community teams across the county

Referral sources: • GPs• Health Visitors• Special Educational Needs Co-ordinators (SENCOs)• School pastoral leads/Heads of Year• School Nurses• Parent and Family Support Advisors (PFSAs)• Children’s Centres*• Children’s Social Care*• Youth Offending Teams and Targeted Youth Support Service*• Educational Psychologists• Somerset Direct• Paediatricians (community and acute)• Acute hospitals children’s ward• Integrated Therapy Service*• Somerset Advocacy Service*• Children and young people discharged from Specialist CAMHS with

an agreed ‘fast track’ route to re-referral as part of an agreed discharge/relapse management plan (“Orange Card”)

*NB The Request for Involvement must be discussed with and agreed by relevant managers within each organisation.

Key principles - and challenges

• Committed to develop an early intervention model - as well as meeting the needs of the most vulnerable children and young people

• Partnership and multi-agency working – across the continuum of education provision

• Information sharing – acknowledging the tensions

• Identifying, achieving and measuring outcomes • Sustaining reduced waiting times

• Ensuring high quality and evidence based practice

Challenges for 2012 and beyond (1)

• Small CAMHS service against national benchmarking: approx 133 wte staff (55 wte Inpatient, 78 wte Community)

• Pressures on overall NHS budgets

• Likelihood of decrease in resources although age range changed from 17 to 18 with new Service Specification

• Steady increase in numbers and complexity of referrals to CAMHS from all sources (305 in March 2012)

• Current caseload: 1800

Challenges for 2012 and beyond (2)

• Impact of known and unknown changes in other agencies (particularly CSC/Local Service Teams/Education)

• Impact of rise in numbers of children and young people subject to Child Protection Plans or becoming LAC

• Responding to statutory framework re Looked After Children (including very complex young people placed in Somerset by external agencies)

• Responding to new commissioning arrangements under Health and Social Care Bill – Clinical Commissioning Group (GPs)

Responses for 2012 and beyond (1)

• Review service delivery model – focus on solution focussed approach (“ready, willing and able” to access treatment)

• Review referral criteria and processes

• Improve access and information e.g. telephone help line web based information (self help, information for

professionals, contact details)

• Ongoing critical review of all posts/reinvestment/redesign/skill mix

• Further develop Recovery Care Programme Approach (personalised care planning) including robust review and timely discharge/transitions

Responses for 2012 and beyond (2)

• Develop integrated training strategy across Children and Young People’s Service – focus on early intervention, sharing skills and building confidence

• Priority training programme for School Nurses

• Develop care pathways across integrated services (e.g. ADHD, ASD, eating disorders, additional needs)

• Pro-active and positive engagement with new commissioners and stakeholders – including education

Examples of additional services and joint agency models

• Evidence based training packages on specialist subject areas, including:

– Making sense of behaviour that is difficult to understand

– Preventative interventions– De-escalation and re-integration strategies

• Direct interventions with family and schools regarding individual young people

• Active planning under way with Educational Psychology and Integrated Therapy Service – working towards a programme building on evidence based TAMHS pilot

And finally…

• Recognising the limits and limitations of a commissioned Specialist Mental Health Service

• Welcoming opportunities to learn more about the challenges facing schools

• Finding creative and collaborative solutions

• Shared goals – improving outcomes for young people

Contact details:Alison ChisholmCAMHS Service [email protected]: 01823 368368

Sue PearsonTeam Manager - CAMHS [email protected] Tel: 01823 368368

Nigel PotterOperational Manager – Mendip and South [email protected]: 01749 836561 or 01935 384140

Maria Gascon-RamosOperational Manager - National Deaf CAMHS (ND CAMHS)[email protected]: 01823 368373 or text: 07798 667966

• Follow links on website to access Information for Professionals and Information for Families leaflets, and Request For Involvement forms

http://www.sompar.nhs.uk/Childrenandyoungpeople.aspx