Download assessment criteria for community and specialist camhs

ELIGIBILITY CRITERIA FOR CORNWALL & ISLES OF SCILLY CHILD AND ADOLESCENT MENTAL
HEALTH SERVICE (AGED 0-18)
Version Control
Version 1
Version 2
Version 3
Version 4
Version 5 -Final Version
Version 6 -Revised Version
Version 7-Cornwall amended
version
Version 8-Comments &
Revisions
Version 9- Updated to
incorporate in revised service
operational policy
Version 10 -New Version to
differentiated between tier 2
and tier 3 CAMHS as
requested by Commissioners
and to reflect update service
specification
Version 11
August 2013
Dr Sheheryar Jovindah
Cate Simmons
Colin Terry and Cate Simmons
Dr Tim Hawkins and Cate Simmons
Agreed in consultation with the Mental
Health and Psychological Well-being
Partnership and Universal Stakeholders.
Helen Ferguson. Updated in line with
service model changes in consultation with
CAMHS Patient Quality and Safety
Committee
Dr Mark Woodgate, Dr Matthew Gilbert,
Sheenah Jones, Linda Bennetts revision
for the Cornwall CAMHS eligibility criteria.
Mark Woodgate, Sheenah Jones &
Matthew Gilbert
Ken Sampson, Angela Taylor, Sheenah
Jones and CAMHS Forum
January 2007
June 2007
September 2007
November 2007
December 2007
Annick Pearce , Ken Sampson & CAMHS
Forum, then Jenny Cove/Carol Green
December 2012
Spring 2013
Ken Sampson & Carol Green CAMHS
input from Jo Lewis, Community
Paediatrician.
Summer/Autumn 2013
February 2010
30 July 2010
23 August 2010
February 2012
These criteria have been developed with the following principles:
1. Partnership Services for Children, Young People & Families (CAMHS) core purpose is to address the Psychiatric and Mental Health needs of children
and young people (under 18) in Cornwall, including the Isles of Scilly. Behavioural disturbance may or may not be driven by mental health disorder.
2. Promote and support emotional and psychological well being in young people. Support universal services and comprehensive CAMHS practitioners
in developing skills and knowledge of how to identify and meet the needs of children and young people who have difficulties with Emotional and
Psychological Well-Being.
3. Support and facilitate the provision of comprehensive CAMHS care packages and targeted interventions where the primary need is not a mental
health difficulty. This may be delivered through consultation that may not lead to a Specialist CAMHS intervention.
Working
formulation
Attention Deficit
Hyperactivity
Disorder
(ADD / ADHD)
School Refusal
Brief Description


September 2013
Pervasive hyperactivity,
impulsivity and
inattention, which is
developmental
inappropriate and
clinically significant,
which has a major
impact on functioning.
Difficulties in attending
school and prolonged
absences.
Initial intervention from other Tier 1 / 2 services
prior to CAMHS involvement

If child is 4 or below refer to Community
Paediatrician for assessment.

In mild cases with educational impairment
suggest behaviour support service or
Education Psychology.

Also parents should initially be advised to
attend ‘Incredible Years’, ‘Take Three’ or
‘Time Out from ADHD’ parenting groups

Initial intervention via Pastoral Support,
Education Welfare Officer or Educational
Psychology
Primary Mental Health
Service – Tier 2

Consultation by Tier 2 to
be provided following
initial intervention by tier
1 where appropriate.

If there are severe and
persistent symptoms Tier
2 consultation or
Specialist Child & Adolescent
Mental Health Service –Tier 3
For children between the
ages of 5-17 (inclusive)

Tier 3 will provide an
assessment & intervention if
there are severe symptoms
with significant psycho-social
disability.

Tier 3 to provide assessment
& intervention where there are
co-morbid mental health
problems
[Assessment & intervention is
compliant with our ADHD care
guidelines which are guided by
‘ADHD’. NICE. CG 72. Sep-08]

Assessment & Intervention of
complex, severe and
persistent symptoms.

Simple or
Specific
Phobias
Anxiety based
Disorders


Generalised
anxiety, social
anxiety, panic
attacks/disorder

Depression

September 2013
Emotional upset which
may include anxiety,
angry outbursts, or low
mood.

assessment, which
guides intervention.
Initiate a CAF
A fear that must result in 
For 16+ suggest choice of IAPT provider
substantial distress or in
avoidance that impacts
significantly on the
young person’s
everyday life.
Marked and persistent

For 16+ suggest choice of IAPT provider
worries, anxieties are

Universal tier 1 professionals to support guided
not consistently focused
self help.
on any one object or

situation. Typical
worries focus on the
future, on past
behaviour and on
personal competence
and appearance.
Inability to relax, selfconsciousness, need for
frequent reassurance,
somatic complaints.
Symptoms have caused
clinically significant
distress or social
impairment
Depressed mood, loss
 For 16+ suggest choice of IAPT provider
of interest and
 Universal tier 1 professionals to support guided
enjoyment, reduced
self-help eg from KOOTH.com
energy, poor attention
 Mild symptoms - watchful waiting by universal Tier
and concentration, low
1 professionals.
self-esteem and selfconfidence, ideas of guilt
and unworthiness,

[Assessment & intervention is
aware of ‘Social & Emotional
Wellbeing in Primary Education’.
NICE. PH12. Mar-08]

Severe and persistent
symptoms identified through
consultation or following direct
intervention from Tier 2 will be
assessed & treated by Tier 3.


Consultation at Tier 2.
Tier 2 direct CBT based
intervention.

A consultation should be
sought from Tier 2.
Tier 2 direct CBT
foundation level based
intervention.

Tier 2 will provide
consultation, advice and
training where required.
Moderate with low risk
provided consultation or
assessment and
treatment in Tier 2.




If co-morbid disorders
identified.


If significant risk identified
straight to Tier 3.
Severe and persistent
symptoms identified through
consultation or following direct
intervention from Tier 2 will be
assessed & treated by Tier 3
at intermediate / advanced
level.
If symptoms or risk increase
or multi-disciplinary approach
requirement identified straight
to Tier 3.
Tier 3 to provide assessment
& intervention, including
medication, family therapy or
CBT at intermediate

Bi-polar
Affective
Disorder
Deliberate Selfharm


September 2013
pessimistic view of the
future, ideas or acts of
self-harm or suicide,
disturbed sleep and
diminished appetite.
Young children may
present with regression
in milestones,
challenging behaviour or
medically unexplained
physical symptoms.


Symptoms of mania or
hypomania. Irritability
more common than
euphoria. Social
disinhibition, excessive
cheerfulness, high
energy levels, tendency
to tell fantastic and
sometimes grandiose
stories

Self-harm in the form of
taking an overdose, selfmutilation or using any
other method.

GP assessment to exclude medical causes.
Universal/Targeted Services provide support
for Children / Young people who self-harm
short term with limited risk or no co-morbid
difficulty.


Tier 2 consultation.
Tier 2 to provide
supervision, training,
consultation, assessment
and direct work.
/advanced level.
Complex presentations may
receive Child & Adolescent
Psychotherapy.
Medication may be initiated
by a Consultant Child
Psychiatrist, in consultation
with multi-disciplinary team &
GP.
[Assessment & intervention is
compliant with our Childhood
Depression care guidelines which
are guided by ‘The treatment of
depression in children and young
people’. NICE. CG 28. Sep-05]
 If significant indicators of
diagnosis, Tier 3 to provide
assessment & intervention as
appropriate.
[Assessment & intervention is
guided by ‘Bipolar disorder: The
management of bipolar disorder in
adults, children and adolescents,
in primary and secondary care’.
NICE. CG 38. Jul-06]
 Where significant risk of death,
permanent physical damage or
uncertainty straight to Tier 3.
 Any high risk to life self-harm
should be referred to
Emergency Department. The
jointly agreed protocol for the
management of self-harm will
be followed.
 Deliberate self-harm that
requires within 24 hours


Psychosis

Adjustment

Reactions to
trauma and
Post Traumatic
Stress Disorder

September 2013
Hallucinations,
delusions, thought
disorder, negative
symptoms with
associated social
dysfunction
Traumatic event is
persistently reexperienced, intrusive
images, traumatic
dreams, and repetitive
re-enactment in play,
distressed at reminders.
Continued avoidance of
stimuli associated with
trauma or numbing of
responsiveness, which
includes avoidance of



Urgently refer all children and young people with
a first presentation of sustained psychotic
symptoms (lasting 4 weeks or more) to a
specialist mental health service,
Watch and wait for four weeks by universal
services.
If related to domestic violence, parental drug or
alcohol misuse, or sexual abuse refer to
appropriate Tier 1 / Tier 2 targeted services. i.e
CLEAR and JIGSAW.


Advice and consultation.
Consultation and
supervision as
appropriate.
response will be seen by Tier
3.
Self-harm that is severe, or
high risk that requires a 5-day
response will be seen by Tier
3.
Tier 3 assessment &
treatment as required.
[Assessment is compliant with our
Self Harm Practice Guidance
which is guided by ‘Self-harm:
short-term treatment and
management’. NICE. CG 16. Jul04]
 If suspicion of psychosis
confirmed straight to Tier 3.
 Tier 3 will assess and treat in
all cases and liaise with Early
Intervention Team as clinically
appropriate for over 14s
[Psychosis and schizophrenia in
children and young people:
recognition and management.
NICE. CG 155. Jan-13]

PTSD suspicion confirmed
straight to Tier 3.

Tier 3 to provide assessment
and intervention as
appropriate in moderate to
severe cases.

Obsessive
Compulsive
Disorder
(including Body
Dysmorphic
Disorder)

September 2013
thoughts, feelings,
locations, situations.
Feeling of being alone or
detached, reduced
interests and restricted
emotional range.
Increased arousal, sleep
disturbance, irritability,
poor concentration,
memory problems,
hyper vigilance, and
alertness to any
perceived danger and
exaggerated startled
response.
Obsessions are
unwanted repetitive
intrusive thoughts.
Most common
obsessions focus on
contamination, disasters
and symmetry.
Compulsions are
unnecessary repetitive
behaviours or mental
activities such as
counting. Common
compulsions may
involve rituals, washing
or cleaning, checking or
repetitive behaviours.


For 16+ suggest to choice of IAPT provider
Universal services to support guided selfhelp


Tier-2 provides
consultation to support
the work of universal or
targeted service.
Tier 2 will respond to
OCD with mild functional
impairment with
assessment and short
focused intervention at
foundation level.
[Assessment & Treatment is
guided by ‘Post-traumatic stress
disorder (PTSD): the management
of PTSD in adults and children in
primary and secondary care’
NICE. CG 26. Mar-05]

Moderate to severe functional
impairment – Tier 3 to provide
assessment and intervention
at intermediate / advanced
level.

Medication as appropriate.
[Assessment & Treatment is
guided by Obsessive-compulsive
disorder: core interventions in the
treatment of obsessive-compulsive
disorder and body dimorphic
disorder’. NICE. CG 31. Nov-05]
Tic Disorders
inclusive of
Tourette’s
Syndrome

Involves chronic motor
or vocal tics (or
combination of the two).

If associated with other Health concerns GP to
provide initial assessment and investigation.
Mild cases and simple Tic disorders of short
duration which are not having a significant impact
on the child or young person, take a watch and
wait approach.

Consultation to be
provided.
Food Refusal,
Restricted Eating or
other developmental
concerns

Universal Services – Health Visitor/ school Nurse
to make assessment and intervene as
appropriate

Tier 2 to provide
consultation, joint
working or assessment &
Brief intervention.

GP to do a physical health check including
height, weight calculation as junior Marsipan
guidelines See below
([email protected]/files/pdfversion/CR168.pdf)


Moderate/severe Tier 3 to
provide assessment and
intervention, including
medication as appropriate.

If suspicion of Anorexia
Nervosa (BMI 18.5 or under)
or Bulimia Nervosa confirmed
straight to Tier 3.
Tier 3 to provide assessment
and intervention as
appropriate, while accessing
Eating Disorder Service via
Clinical Nurse Specialist for
Children & Adolescents with
Eating Disorders or other
specialists as appropriate.
Eating
Difficulties and
Disorders
Developmental
or Emotional
based eating
Difficulties
Anorexia
Nervosa (AN)
Bulimia
Nervosa
(BN)
Eating Disorder
Not Otherwise
Specified
(EDNOS)


September 2013
Anorexia nervosa is
characterised by
deliberate weight loss,
induced and/or
sustained by the patient.
Body weight is
maintained at least 15%
below the expected
(either lost or never
achieved) or a trend of
rapid weight loss with
intent to continue. The
weight loss is selfinduced by avoidance of
adequate food, selfinduced vomiting, selfinduced purging,



Mild Emotional
and
Behavioural
difficulties

September 2013
excessive exercise, use
of appetite suppressants
and/or diuretics. There
is body image distortion
and in post pubertal
females secondary
amenorrhoea.
Bulimia nervosa is
characterised by a
persistent preoccupation with eating
and periods of over
eating in which large
amounts of food are
consumed in short
periods of time.
Associated symptoms
include - self-induced
vomiting, purgative
abuse, alternating
periods of starvation,
and use of drugs such
as appetite
suppressants.
We do not treat Obesity
without co-morbid
mental disorder as
specified.
Childhood emotional
and behavioural
difficulties that are
causing concern or
distress or are impacting
on health, development
and welfare.
[Assessment & Treatment is
compliant with our Children &
Adolescent Eating Disorder care
guidelines which is guided by
‘Core interventions in the
treatment and management of
anorexia nervosa, bulimia nervosa
and related eating disorders’.
NICE. CG 09 Jan-04]

Universal and Targeted Services to offer support
and assessment. Eg, School nurse, Family
Information service.

Tier 2 consultation with
universal professionals if
initial intervention
ineffective.
Moderate –
Severe
disturbance of
mental health
and/or
significantly
challenging
behaviour
associated with
intellectual
impairment,
genetic
conditions or
acquired brain
injury

Sexually
harmful
Behaviour
(SHB)

Autistic
Spectrum
Disorder (ASD)

Learning disability is a
significantly reduced ability to
understand new or complex
information, to learn new
skills (impaired intelligence);
with a reduced ability to cope
independently (impaired
social functioning); which
started before adulthood, with
a lasting effect on
development.
Challenging behaviour
(including self-injurious
behaviour) - culturally
abnormal behaviours of such
intensity, frequency or
duration that the physical
safety of the person or others
is likely to be placed in
serious jeopardy, or
behaviour which is likely to
seriously limit use of, or result
in the person being denied
access to, ordinary
community facilities.

Assessment and intervention
by special/allocated school
nurses.

Persistent sexual behaviour
that infringes the rights of
others.

Consultation to universal and
targeted services from
CAMHS/LD
Refer immediately to the MultiAgency Referral Unit (MARU).

Tier 3 assessment & treatment as
appropriate.

No co-morbid condition refer to
Gweres Kernow service who
specialise in SHB
If co-morbid may joint work with
specialist clinical psychologists from
Gweres Kernow.
Initial assessment from Tier 3
CAMHS as appropriate.
Specialist assessment from ASD
assessment team.


September 2013
Social impairment which
includes; qualitative
impairments in reciprocal
social interaction, inadequate
appreciation of socioemotional cues, lack of


If child is 4 or below refer to
Community Paediatrician for
assessment.
If the young person is 16 or
above refer to Out Look South
West

Tier 2 consultation as
appropriate





September 2013
responses to other peoples
emotions, lack of modulation
of behaviour according to
social context, poor use of
social signals and lack of
social emotional reciprocity.
Communication impairment
which includes; lack of social
usage of language skills,
impairment in make-belief
and social imitative play, lack
of reciprocity in
conversational interchange,
poor flexibility in language
expression, lack of creativity
and fantasy and thought
processes.
Restricted and repetitive
activities and interests, which
include; resistance to change,
insistence on routines and
rituals, hand flapping and
other stereotypy’s, ordering
play, attachment to unusual
objects, fascination with
unusual aspects of the world
and consuming
preoccupations with restricted
subjects.
Children and Young People
with ASD only where there is
a suspicion of mental disorder
(separate from the features of
ASD)
Criteria – the conditions below would also need to have a co-morbid mental health problem
Working
formulation
Brief Description
Oppositional
Defiant
Disorder
& Conduct
Disorder

Enuresis and
Faecal soiling


September 2013
Often looses temper, argues
with adults, defies adult
requests, deliberately annoys
others, shifts blame to others,
touchy, easily annoyed,
angry, resentful, spiteful or
vindictive.
Enuresis: A disorder
characterised by voiding of
urine, by day and/or by night,
which is abnormal in relation
to the individual’s
developmental stage and
which is not a consequence of
a neurological disorder,
epileptic attacks or to
structural abnormality of the
urinary tract. In primary
enuresis children have never
acquired normal bladder
control, whereas a child who
acquires bladder control for at
least 6 months and then loses
it again is said to have
secondary enuresis.
Faecal soiling: Repeated
voluntary or involuntary
passage of faeces, in places
not appropriate for that
purpose in the child’s own
social cultural setting. Soiling
Initial intervention from other
Tier 1 / 2 services prior to
CAMHS involvement

Initial assessment from
universal professionals

Take 3 parenting course


Initial physical screen by GP,
Early stage of presentation
should be signposted to
Health Visitor or School
Nurse for intervention
Referral to the continence
advisors
Primary Mental Health Service –
Tier 2


In complex cases consultation
can be sought from a Tier 2 to
determine whether the client
meets criteria for co-morbid
mental health problem (as
above).
In complex cases with a comorbid psychological or family
disturbance consultation can be
sought from a Tier 2 to determine
whether the client meets criteria
for co-morbid mental health
problem (as above)
Specialist Child & Adolescent
Mental Health Service –Tier 3
[See ‘Conduct disorder in children parent-training/education
programmes: guidance. NICE.
TA102. Jul-06]
more than once a month after
the age of 4 is generally
regarded as an elimination
disorder.
 An onset of unexplained,
persistent fatigue
unrelated to exertion and
not substantially relieved
by rest that causes a
significant reduction in
previous activity levels.
Chronic
Fatigue
Syndrome (or
ME)
Substance
Misuse

Problematic drug and alcohol
use.
 All suspected cases of CSF
initially to be referred to
General Paediatrics for
medical physical assessment.


Palliative care

Emotional or psychological
disturbance in response to a
life limiting/life threatening
condition in a child/young
person.


September 2013
Young people presenting with
drug or alcohol intoxication
(refer to substance misuse
specialist).
Where the substance misuse
is problematic but a mental
health or psychological wellbeing difficulty is not identified
on referral, refer to YZUP
where the C&YP meets their
eligibility criteria.
Referred to Paediatric Liaison
Services at Royal Cornwall
Hospital, Derriford or North
Devon District Hospital
respectively from the
child/young person’s
Paediatrician.
Consider Penhaligon’s
Friends.
[See ‘Constipation in children and
young people: diagnosis and
management of idiopathic childhood
constipation in primary and
secondary care’. NICE. CG 99.
May-10]

Tier 3 will assess & treatment
co-morbid conditions.
[See ‘Chronic Fatigue Syndrome /
Myagic encephalomyelitis. NICE.
CG 53. Aug-07]

If the substance misuse is comorbid with possible mental
health diagnostic criteria. Tier
3 to provide assessment and
intervention as appropriate.
Emotional

Distress around
parental
separation &
Divorce
Bereavement

Emotional and behavioural
disturbance around parental
disharmony, separation and
divorce – over several years

Universal Services will
provide support.

Tier 2 will provide consultation
advice or signpost to appropriate
services.
Abnormal or prolonged grief
that has not responded to
targeted interventions (severe
and complex presentations).

Targeted Services to provide
support and intervention.
Eg CRUISE, Penhaligons
Friends.

Tier 2 will provide consultation
Targeted services to guide their
care of the C&YP, if there are
concerns about co-morbid
disorders.
Consultation available to
universal services from Tier 2 for
management in primary care

Response by Tier 3 for
assessment and treatment of
co-morbid mental health
problem, as specified, and/or
therapy for complex cases.
Somatoform
Disorder

Physical symptoms that may
be related to a psychological
contribution or a degree of
uncertainty and which have
an impact on the child’s
normal
functioning/development.

Paediatric Liaison via Acute
General Paediatrics

Safeguarding
Concerns

Where there is a suspicion of
actual or potential
safeguarding concern
(around neglect or emotional,
physical or sexual abuse)

Refer immediately to the
Multi-Agency Referral Unit
(MARU).

Refer immediately to the MultiAgency Referral Unit (MARU)

Refer immediately to the MultiAgency Referral Unit (MARU)
Is characterised by persistent
abnormalities in the child’s
pattern of social relationships,
which are associated with
emotional disturbance and
reactive to changes in
environmental circumstances.
Fearfulness and hypervigilance that do not respond
to comforting are
characteristic, poor social
interaction with peers is

Refer to Child in Care
Psychology Team if CIC if
appropriate.
Universal services to work
with the family using the
Solihull approach
Consider initiating a CAF

Provide consultation, using the
Solihull approach, to Universal or
Targeted Services from Tier 2 if
child is under 5
Will contribute to multi-agency
assessment.
Contribute to multi-agency
package of support or care, via
Common Assessment
Framework.

Response by Tier 3 following
consultation and initial
assessment as appropriate if
co-morbid mental health
difficulties exist.
Attachment
Difficulties
September 2013





Emerging
borderline
personality
disorder

typical. Aggression towards to
self and others is very
frequent, misery is usual. The
disorder occurs as a direct
result of severe parental
neglect, abuse, or serious
mishandling. These children
show strong contradictory or
ambivalent social responses
that may be most evident at
times of partings and
reunions. In disinhibited
attachment disorder children
show an unusual degree of
diffuseness in selective
attachments during the first
five years and this is
associated with generally
clinging behaviour in infancy
and/or indiscriminately
friendly, attention seeking
behaviour in early or middle
childhood.
Borderline personality disorder
is characterised by significant
instability of interpersonal
relationships, self-image and
mood, and impulsive
behaviour.
No specific Attachment Disorder
Intervention pathway currently
exists at Tier 2 or Tier 3.

Common Assessment
Framework to be in place.


Consultation from Tier 2 as part of 
multi-agency approach
Will contribute to multi-agency
assessment.
Tier
3
assessment
and
treatment
of
co-morbid
disorders or where there is
significant risk to life or others.
No specific Emerging Borderline
Personality Disorder Intervention
pathway currently exists at Tier 2 or
Tier 3.
[Assessment & management is
guided by ‘Borderline personality
disorder: treatment and
management’ NICE. CG 78 Jan-09]
September 2013
Notes

Response for Children in Care (CIC) or those known to Youth Offending Service (YOS) will be different to the above as they have a specially
commissioned a fast track service. A child or young person in care may be referred to the local CAMHS Team, but unless they require an urgent or
high priority response, the referral should be redirected via the Children in Care Psychology Team.

Whilst all members of clinical staff provide consultation, the Primary Mental Health Workers in the team provide the majority of consultation to
Universal Services where a child or young person is not known to CAMHS. Information, advice and guidance are always available by contacting the
Child & Adolescent Mental Health Service.
September 2013