Download Appendix 2: Bromley CAMHS specialist mental health LAC team

Appendix 2 Bromley CAMHS specialist mental health LAC team
Bromley CAMHS
Looked After Children’s
Specialist Mental Health Team
Who we are:
 Bromley’s only specialist mental health team for Looked After Children
 A multi-disciplinary team comprising Nursing, Systemic Psychotherapy, Child Psychotherapy
and Psychology, equivalent to 2.4 full time posts:
o
Offering a range of evidence-based interventions to children with complex needs
and histories
o
Offering tailored support to foster carers and the professional network
o
Working with children and young people aged up to the age of 18
o
Working with children and young people both during and after care proceedings
o
Providing a quick response service
What we do:
Our service aims to assess, identify and treat the mental health needs of Looked After Children,
working directly with children and young people, as well as with their carers and professional
network to ensure the best outcomes for Looked After Children and Young People.
Such work:
 Supports transition to new placement processes
 Improves placement stability
 Improves foster carer confidence and their understanding of the foster child
 Supports the network’s decision making processes
 Improves the child / young person’s attachment patterns and relationships
 Improves the child / young person’s mental health and emotional well being
 Improves educational achievement
“We give her
everything, why does
she keep stealing?”
“He argues with his
sister all the time, I don’t
know what to do”
“I can’t keep him if
this behaviour
continues”
“I feel on my own
with this”
“He keeps soiling
after contact –
what should I do?”
“Why do I feel like
she hates me?”
Foster Carer
COMMON DIFFICULTIES
Child
“All the pain makes
me go out and do
stupid things”
“The only way to
manage the pain is
to cut myself”
“There’s no point
trying at school
because I don’t
understand”
“I feel rejected again
now I have to move
placements and I don’t
know how to cope”
“I just want to be
with my real mum
and dad”
“I just can’t keep
any friends”
What we offer:
The range of treatment modalities ensures that the most appropriate treatment for a particular child
/ young person is given. Interventions include:
 Specialist assessments
(cognitive / neuropsychological, state of mind, adaptive functioning)
 Individual psychological therapies
(including: Psychoanalytic Child Psychotherapy, Cognitive Behaviour Therapy, attachment
and trauma focused intervention)
 Systemic psychotherapy
 Sibling therapy
 Group Therapy, including NVR
 Therapeutic Placement Intervention
 Consultation to the network
 Consultation to the social worker
Bromley
CAMHS
Pathway
Referral received
andLAC
discussed
at
team meeting
Declined:
Alternative services
recommended
Within 8 weeks
Accepted
Systemic Assessment
Consultation
Including foster carer, child, school, social worker
Within 6 weeks
Assessment Report
Including formulation, diagnosis if appropriate,
recommendations and treatment plan
Within 10-12
weeks
Specialist
Assessment:
Cognitive
State of Mind
Extended
Psychological Therapy:
On-going Network
Consultation
- individual / group
- brief / long term
Therapeutic Placement
Intervention
With foster carer
With foster carer & child
Child Focused:
Carer Focused:
CBT
Psychoanalytic psychotherapy
Trauma / attachment
focused
Sibling groups
Systemic psychotherapy
NVR
Systemic Psychotherapy
Review
Further CAMHS
intervention
Discharge &
Report
Bromley CAMHS LAC Audit
In April 2013 an audit of 40% of the Bromley CAMHS LAC team’s current case load was carried out.
The audit indicated that all referrals had come from Social Workers, and that 58% of those referred
were boys. In addition, the audit indicated that 5-12 year olds were the largest age group referred.
Bromley CAMHS LAC population experiences a level of co-morbidity: there were on average 3
referral concerns per child / young person.
Bromley CAMHS LAC population have suffered multiple factors of abusive and damaging
experiences: on average 3 factors given in each referral.
Specialist assessment, consultation, Therapeutic Placement Intervention and individual therapy were
the most commonly provided interventions.
Evidence-based interventions offered:
Cognitive Behaviour Therapy (CBT)
Cognitive Behaviour Therapy (CBT) has an extensive evidence base and is recommended by NICE
(the National Institute for Clinical Excellence) as a first line treatment for children and adolescents
who suffer from:




anxiety disorders
obsessive-compulsive disorder (OCD)
depression
post-traumatic stress disorder (PTSD).
There is also an evidence base for CBT to be used with children and adolescents with other mental
health presentations, such as self-harming and eating disorders.
CBT can be offered on an individual basis or with other members of the child or young person’s
system. It aims to help them to notice and change their negative thinking patterns which have a
negative impact on their feelings and their behaviour. The results can lead to children becoming
aware of vicious cycles they get into and feeling more skilled in being able to adapt their thoughts
and behaviours.
Psychoanalytic Child Psychotherapy
Psychoanalytic Child Psychotherapy helps children with severe and long-lasting problems who have
become stuck in their development explore underlying anxieties, recover their capacities, improve
their relationships and achieve their potential. Difficulties that Psychoanalytic Child Psychotherapy
can help with include:









depression – moderate and severe with suicidal ideation
loss & bereavement
anxiety
trauma
emotional regulation difficulties
attachment difficulties
attention difficulties and conduct disorders
mind-body disturbances
underlying internal states in children and adolescents exhibiting
challenging behaviour
This is achieved by supporting the development of secure attachment patterns, working with
feelings which the child or adolescent is not aware of or cannot articulate, alleviating the effects of
early trauma / pre verbal trauma and helping children make sense of their experiences.
Child Psychotherapists work individually with children on a regular basis using play and art therapy
techniques as well as talking. Work can be brief or longer term, and includes regular reviews with
the Social Worker and Foster Carers.
Therapeutic Placement Intervention (TPI)
This intervention aims to:
 stabilise placements
 develop good attachment patterns between foster carer and child
Our work focuses on the unique relationship between carer and child enabling carers to understand
their foster child’s emotions and behaviour. Through this carers develop their own way to meet their
particular child’s needs and manage behaviour more effectively.
The intervention takes place through regular individual meetings with the foster carer or the foster
carer and child. Our approach allows for specific problems to be addressed as they arise.
Attachment Focused Therapy
This intervention aims to:


address a child's attachment difficulties and trauma history
enable the child to form more secure attachment relationships with their primary
caregivers
Attachment Focused Therapy usually involves working with the child and their foster carers and the
work typically integrates theory and principles of Theraplay, Dyadic Developmental Psychotherapy
(DDP) and Eye Movement Desensitisation and Reprocessing (EMDR).
Consultation
This intervention aims to:

deepen the Social Worker’s and professional network’s understanding of the emotional
factors underpinning a child’s difficult or troubling behaviours
 enable the network to make the best decisions for a child’s care
 stabilise foster placements
 stabilise school placements
Specialist consultation makes use of a range of therapeutic models and a deep understanding of
emotional and developmental processes in order to further the corporate parent’s understanding of
the child’s needs. In addition, the therapists’ understanding of group processes enables them to
engage directly with the impact of the child on the network as it is enacted within the consultation
process.
Consultation can be a one-off meeting or several meetings with the Social Worker and significant
members of the corporate network and can include the child’s Social Worker, the supervising Social
Worker, foster carers, school representatives, members of other statutory or voluntary services
involved with the child or young person.
Non Violent Resistance (NVR)
This intervention aims to:


address violent, destructive and harmful behaviours in children and adolescents
help developing a support network that will stop violent and destructive behaviours both
in and out of the home.
 improve relationships between family members and the outside world
The NVR Parenting Programme is recommended by NICE as one of the parenting programmes
recommended treatments for Children and Young People with behavioural difficulties.
Specialist Assessments
We offer several specialist assessments:
State-of-mind Assessment:
This is offered by a Child and Adolescent Psychotherapist. The aim is to gain an in-depth
understanding of the child’s inner world and their capacity to form and maintain relationships with
others. It is often offered when we require a fuller understanding of the child or young person.
Cognitive / Neuropsychological Assessment:
This is offered by a Clinical Psychologist. These assessments are often offered when there is a
concern regarding a child or young person’s cognitive functioning. A range of assessment tools can
be utilised depending on the concerns.
Extended Assessment:
This is where it is felt that the child or young person requires a more in-depth assessment which
aims to further understand the young person and the difficulties they may be facing. This may
involve:
 school observation
 adaptive functioning assessments
 liaising with other people in their system, such as school teachers, other health
professionals
Systemic Psychotherapy / Family Therapy
Family & Systemic Psychotherapy, often called Family Therapy, helps people in close relationships to
help each other and focuses on the immediate and wider context of the client/family/system.
By focusing on what is happening between individuals in terms of patterns of relationships, it
enables family members to:





Express and explore difficult thoughts and emotions safely
To understand each other’s experiences
Appreciate each other’s needs
Build on family strengths and make useful changes in their relationships and their lives
Change relational patterns
Research shows that Family Therapy is useful for children and young people experiencing a wide
range of difficulties such as:
 family communication problems
 child and adolescent behaviour difficulties
 domestic violence
 self harm
 eating disorders
 trauma
Complex cases can sometimes be seen in the weekly family therapy clinic here at Bromley CAMHS,
where there is a lead family therapist and a team. The team is there to support children and families
in finding ways of doing things differently by giving additional ideas and views which help the
therapist and the family.
Psychology
Psychology is able to offer short, medium or longer term interventions across a range of therapy
models such as cognitive behaviour-, systemic-, psychodynamic- and trauma/attachment focussed
interventions, these often involve play and art. Psychology also offers specialist assessments such as
cognitive and neuropsychological assessments in order to gain a better understanding of a child's
complex needs.
LAC REFERRAL FORM
Bromley CAMHS Referral Form (FOR LOOKED AFTER CHILDREN)
Bromley CAMHS, 2 Newman Road, Bromley, BR1 1RJ
Telephone: 0208 315 4430 Fax: 0208 466 5645, Email to [email protected]
Is this a LAC Child □yes
Care status:
Section 20□
▫no
Interim Care Order □
Care Order □
Name of Child/Young
Person:
M/F
Dob:
NHS No:
Address:
Postcode:
Email Address:
Telephone No:
Foster Carer’s Name:
Mobile No:
Telephone No:
Mobile No:
Postcode:
Name of Referrer (Professional relationship to child or Clinical Team):
Address:
Postcode:
Email Address:
Telephone No:
Please provide the following:
1.
2.
3.
4.
5.
A Brief Chronology
A copy of Care Plan
Most recent IRO LAC Review Minutes
Current contact arrangements
A commitment by the Social Worker to attend important CAMHS consultation
and network meetings
Name of GP:
Address:
Postcode:
Telephone No:
Name of School/Pre-School:
Contact Name:
SENCO
Telephone No:
Code of Practice stage (if known):
Does Child have a statement of S.E.N?
Yes  No 
Family Members
Family Name
Forename
Relationship to Child
DOB
Family Name
Forename
Relationship to Child
DOB
Birth Family Members
Siblings of birth family
Foster Carer’s Family Name
Siblings of Foster Carer
Have those with parental responsibility given consent to this referral being made:
Yes  No 
Presenting Problem/
Reason for referral:
What is the current main
concern:
………………………………………………………………………………………………………………………………………………………………………..
What are you requesting:
Assessment
□
Treatment
□
Brief History of Problem:
Any Medical/Development concerns:
Any Special needs with regard to language/culture/ethnicity/disability:
Consultation
□
Other Professionals/Agencies Currently Involved e.g. YOT, Bromley Y & Paediatricians
Name
Signature of Referrer
Address
Date
Please use separate sheet for any additional information
(Please feel free to contact the service if you have any queries regarding this referral)
Reason for referral:
Attachment disorder/relationship difficulties 
Aggressive behaviour/anger 
Special Education Needs 
Sexualised behaviour 
Encopresis/enuresis 
Depression/low self-esteem 
Risk-taking behaviour/self-harm 
Traumatised 
Extreme neglect 
Physical abuse 
Sexual abuse 
Domestic violence 
Please expand: