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6.7 CAMHS Referrals

For emergency referrals please see CAMHS Emergency Protocol and Escalation Arrangements.


Contents

  1. Introduction           
  2. Preliminary Thinking Prior to making a Referral
  3. What Problems? Which Cases?  
  4. Mental Health Problems which have Specific Treatment Possibilities                
  5. Treatment Approaches Available     
  6. Requests for Consultation    
  7. Referral Procedure           
  8. Which Service?         


1. Introduction

This chapter is intended to assist social workers in making referrals to CAMHS. For emergency referrals please see CAMHS Emergency Protocol and Escalation Arrangements.

This exercise in defining an approach to referrals has arisen for a number of reasons, not least of which is the recognition that all services have finite resources. While some care needs to be exercised in deciding which cases to refer, referrals are welcomed.

The task is complicated by the fact that there is clearly an overlap between a “Social Services case” and a “Child Mental Health case”. There are likely to be concerns about the mental health of most children in contact with Specialist Children’s Services and Safeguarding but by no means all such children will need to be referred to CAMHS.

It is hoped that defining the problem and producing a set of guidelines will make the referral process easier.


2. Preliminary Thinking Prior to making a Referral

Note. If the child is subject to legal proceedings, the leave of the Court must be obtained before a referral is made, as well as discussing with CAMHS whether they are able to accept the referral.

Firstly, the thoughts behind a request for a psychiatric assessment and/or request for treatment need to be defined clearly. Perhaps most helpfully this can be tackled by posing the following questions:

  1. What is the nature of the problem causing concern?
  2. What is the origin of the child’s or the family’s difficulties? If there is doubt, what information is missing? Is further exploration necessary and, more particularly, will a psychiatric/psychological assessment be able to shed light on the problem?
  3. What is the “meaning” of the child’s or the family’s behaviour? Is the “meaning” unclear and will greater understanding focus the work undertaken more effectively?
  4. Have all the resources within Specialist Children’s Services and Safeguarding or elsewhere been explored to help address a, b and c, for example Family Resource Teams, Care Link, the Intensive Parenting Service or voluntary sector agencies?
  5. What can CAMHS offer that Specialist Children’s Services and Safeguarding or other agencies cannot?
  6. Does the child or family wish to attend CAMHS? Has consent been obtained? If not, the referral cannot usually proceed so how can consent best be facilitated?
  7. Should the case be discussed first with the CAMHS Social Work Team Manager or Practice Supervisor before making the referral?
  8. Is the request for an “assessment” only, or a consultation or are there hopes for treatment?
  9. If an assessment is required, what type of assessment? Who should be seen and why?
  10. Is a Child Psychiatrist or other CAMHS professional required to attend Court to give an opinion? If so, this should be stated clearly at the outset as this may affect who can take on the referral.
  11. Will an additional service involved in the case add to or detract from the work already being undertaken?

Once the above questions have been considered, the focus of a potential intervention can be made more relevant. In addition, the following need to be considered:  

  1. If an opinion for Court is required, the family will need to be fully informed that information given to a Psychiatrist by them may be presented to the Court.
  2. If individual counselling of a Looked After Child is requested, clarification about who holds Parental Responsibility needs to be made clear, along with how confidentiality is to be managed between the child, her/his carers and the Social Worker.
  3. If a consultation is requested, then the relevant Practice Supervisor or manager with responsibility for the worker should be involved in the consultation where possible.


3. What Problems? Which Cases?

The Social Worker should consider which of the following assessments is appropriate:

a. For diagnosis of a specific psychiatric disorder/illness.
b. For the relevance and appropriateness of specific psychiatric/psychological treatments
c.

For treatment of more general mental health problems affecting children, including:

  1. Where there is severe Physical Abuse/Emotional Abuse/Sexual Abuse
  2. A child with serious behavioural disturbance such as violence, persistent aggression or unmanageable and challenging behaviours.
  3. Family and individual trauma - significant loss or bereavement complications.
d.

For Court, including:

  1. A young person involved in serious or persistent criminal activity.
  2. Parents/family/child where a Care Order is thought a possibility,where there is doubt about the correct course of action and/or where it is felt treatment might be useful.
  3. Parents/family/child where the child is Looked After and rehabilitation is being considered.
  4. A young person who may require a Secure Accommodation Order.
  5. A child/family where there are doubts about the degree of risk the child may be subject to or where there are uncertainties about whether a treatment programme would be helpful.
e.

For placement, including:

  1. A Looked After Child who is thought to require a specialised placement and where a psychiatric opinion is required;
  2. With regard to the suitability and desirability of a permanent placement, such as fostering or adoption for the child.
f.

For admission to an in-patient unit:

  1. Snowsfield Adolescent Unit, Guy’s Hospital;
  2. Bethlem Adolescent Unit, or;
  3. Acorn Lodge, Bethlem Royal Hospital (for a child under 12 years of age). 

In-patient services are reserved for those children where the needs are complex, the level of disturbance is severe and/or specific treatments are required. A child admitted to an adolescent in-patient unit may require an assessment under the Mental Health Act by an Approved mental Health Practitioner. A social worker might require an opinion as to whether a child fulfils the criteria to be detained under the Mental Health Act 1983, and CAMHS should be approached for all young people under 18 years old where an admission is possible.


4. Mental Health Problems which have Specific Treatment Possibilities     

  1. Psychoses, e.g. schizophrenia, bipolar affective disorder
  2. Developmental disorders e.g. infantile autism, pervasive developmental disorder, specific learning disorders
  3. Emotional disorders, phobic anxiety, depression, including self-destructive behaviour and attempted suicide, obsessive compulsive disorder illness behaviour
  4. Obsessional disorders
  5. Attention Deficit Hyperactivity Disorder (ADHD)
  6. Anorexia Nervosa and other eating disorders
  7. Enuresis and Encopresis
  8. Sleeping Disorders
  9. Post Traumatic Stress Syndrome
  10. Family Relationship Problems
  11. Bereavement
  12. Consequences of abuse and sexual abuse

Behaviour problems have not been included in this list although many children with such disorders are treated by CAMHS. The treatments, however, are not usually specific to the disorder. In addition, children who are victims of abuse or are engaged in abusive behaviours, and/or the families of such children, may be helped by a variety of therapeutic approaches depending on need and circumstances.


5. Treatment Approaches Available

This list is intended to give an idea of the range of therapeutic interventions offered. Sometimes more than one approach may be used either concurrently or serially. A vital factor in any successful treatment programme is whether the child or family are able to use the treatment and that his/her circumstances are conducive to treatment being offered. The importance of the network surrounding the child cannot be stressed enough. Therapy may result in the child exhibiting more challenging behaviour to begin with and the network should be strong enough to contain this.

The therapeutic interventions are as follows:

  1. Individual psychotherapy and counselling. Except in the case of an older child, there is usually parallel work undertaken with parents and/or carers. Theoretical models used will vary according to needs of the child and include psychotherapy, cognitive behavioural therapy, supportive counselling and behaviour therapy.
  2. Family therapy.
  3. Pharmacological treatment, especially for psychosis, hyperkinetic syndrome and attention deficit disorder (ADHD) and occasionally for depression and severe behavioural disturbance.
  4. Behaviour therapy and cognitive behavioural therapy are particularly indicated in disorders such as encopresis, obsessive compulsive disorder, depression and behaviour difficulties in a younger child.
  5. Art Therapy.
  6. Parenting Training.


6. Requests for Consultation

  1. A preliminary consultation is often a useful starting point for referrals that are complex, where there is uncertainty about the appropriateness of the referral or where there is doubt regarding compliance by the child or the family.
  2. Consultation may be useful when the social worker is seeking further advice about the Care Plan for the child, or wishes to discuss concerns regarding behaviour or mental state.


7. Referral Procedure

The social worker should discuss the case in detail with a Practice Supervisor. 

The questions posed in Section 2, Preliminary Thinking Prior to making a Referral should be explored. The answers or further questions that may emerge can be of great help.

If doubt still exists telephone the CAMHS Social Work Team Manager or the Practice Supervisor in the CAMHS Social Work Team who will often clarify the best approach.

While a consultation or planning meeting may sometimes delay the process, it can nevertheless make the intervention more relevant. Do not hesitate to ask for such a meeting if you think it would be useful.

When a referral is made, the following information is essential:

  1. The reason for the referral, the questions that need to be explored.
  2. Composition of the family, ages, addresses, first and second names.
  3. Agreement of the person with Parental Responsibility.
  4. The nature of any Court Order or status with regard to whether the child has a Child Protection Plan. Include any time constraints, for example the date of a Court Hearing.
  5. If the child is subject to a Court order or the subject of Court proceedings, has the Court given permission? A copy of the written permission or request must be sent with the written referral.
  6. How willing is the child/family to attend and amount of preparation work put in by the referring social worker.
  7. Relevant history that is already known, for example the parents’ history, child’s developmental history, childcare history, educational progress, recent events and agencies involved.
  8. What is hoped for from the referral? The referral should include if relevant and appropriate the Sinlge Assessment, Care Plan, Child Protection Plan, Child Protection Conference minutes and past reports for Court. (N.B. Court reports can only be included with the agreement of the Court, could delay treatment and may not always be relevant).
  9. Future role of the social worker in Specialist Children's Services with the child.

If a request for an assessment for Court is required, the Social Worker should send the necessary documentation to clarify the Court’s expectations, (for example any Court Directions). This should only occur after prior discussion and acceptance of the referral by the named child mental health professional required.


8. Which Service?

Referrals should be sent to Southwark CAMHS Social Work Team:     

Referrals should be sent on the Southwark CAMHS Referral Form or in a letter with the information suggested above.

If the child or family requires a more specialist service, such as in-patient admission, the Sexual Abuse Treatment Service, ‘the keep safe service,’ or where the child has learning disabilities or developmental difficulties, or where intervention by the community child mental health services is required, the referral will be passed to the relevant child and adolescent service within CAMHS.

If the Social Worker is in doubt where to refer, s/he should contact the CAMHS Social Work Team Manager or the Child Mental Health Social Work Practice Supervisor for advice at the Camberwell Child and Adolescent Centre.

End