Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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: