Download July 2015 NHS Highland CAMHS Tier 2 CAMHS Referral Requests

July 2015
NHS Highland CAMHS
CAMHS REFERRAL GUIDANCE AND CRITERIA
Tier 2 CAMHS Referral
Requests for service from the Primary Mental Health Worker Service are considered through consultation. Where focused targeted therapeutic
intervention at an early stage is likely to have long term benefit to the well being of the young person and their family.
Tier 3 CAMHS Referral
If there are concerns regarding a child or young person who might need an urgent mental health assessment (e.g. evidence of early psychosis;
risk of suicide with specific plans and preparation i.e. gathering of medication; severe depression; severe eating disorder with significant weight
loss over a short period. We would suggest if possible these referrals are discussed with a CAMHS clinician prior to referral submission.
Referrals of an urgent nature out with normal working hours and at weekends should be directed to A&E.
All other referrals would be considered for routine appointments.
Tier 4 CAMHS Referral
Young people with mental health difficulties and one or more of;
 Too high risk to attempt to treat with usual out-patient resources for example suicidal, psychotic with disorganisation, self harm or violent
behaviour.
 Need intensive assessment or treatment (equivalent to more than weekly out-patient contact and more than one CAMHS professional)
 Not responding to usual out-patient treatment – which may be because they need re-assessment or more intensive input.
July 2015
NHS Highland CAMHS
CAMHS REFERRAL GUIDANCE
Introduction to this Guidance
This guidance document is intended to assist those in front line services to know when to refer to NHS Highland CAMHS, as well as offering
suggestions for advice or where to go to get more information. The guidance is designed to improve access to CAMHS for those children and
young people who need it most, whilst at the same time making sure that other sources of help have been tried where appropriate. Referrals are
accepted from GPs, Public Health Nurses, Health Visitors, Paediatricians, Other Hospital Doctors, including Dentists, Allied Health
Professionals, Educational Psychologists, Social Workers, Reporters to the Children’s Panel etc
NHS Highland CAMHS
NHS Highland CAMHS provides specialist assessment as part of a tiered system which includes both stepped care (as a problem becomes
more severe in nature the type of help that is available becomes more specialised) and matched care (the idea that there should be an accurate
and properly informed match of need to provision at the earliest stage of a child or young person’s presentation).
CAMHS 4 Tier Model of service delivery
Specialist
inpatient &
Intensive
Community outreach
CAMHS operates within the Getting it right for every child principles using a tiered model of intervention that
includes the established staged approach which ensures that children receive both a stepped care approach (the
idea that as a problem becomes more sever in nature the type of help that is available becomes more specialised)
and matched care approach (the idea that there should be an accurate and properly informed match of need to
provision at the earliest stage of a child or young person’s presentation).
Tier 1: Also referred to as universal level the child’s needs are addressed through normal class room/nursery
management/by public mental health nurse, school nurse, health visitor, social worker, children’s service
worker. CAMHS has no direct involvement at Tier 1 but remains committed to building capacity and
confidence within universal services via training and consultation.
Tier 4
Specialist CAMHS
Team
Tier 2: Also referred to single agency when concerns continue. My World Assessment undertaken and
need/risk analysed and detailed within a child’s plan. Other staff may be involved; children may be receiving
some specific support i.e. children’s service worker, family social work, health visitor etc. request for service to
Tier 2 CAMHS may be accepted at this stage, via consultation.
Tier 3
PMHW – Training/consultation
to increase capacity & confidence.
Consultation & direct work with children
& young people
Universal services who all have a role to promote
Children emotional health consisting of all primary
care agencies including GP’s, school nursing, health
visitors, children’s service workers and schools
Tier 3: Also referred to as single agency where concerns continue but targeted support is requested. Advice, plus
recommendations sought perhaps from special educational services (e.g. Educational Psychologists) Children
may have Individualised Education Programmes (IEP). At times PMHW’s offer a bridge into specialist
CAMHS and could be both involved at this tier.
Tier 2
Tier 1
Tier 4: Also referred to as mutli-agency plan or stage 4 interventions. Significant support from one or more
agencies is required and the child may require a Co-ordinated support plan (CSP). A small minority if children
may enter at this tier if their mental health deteriorates and are likely to receive inpatient care & may also
require a multi agency response. Specialist CAMHS are nearly always involved at this stage.
July 2015
NHS Highland CAMHS
Referrals to NHS Highland CAMHS
CAMHS accepts referrals from a variety of sources – some tips as to what makes a good referral can be found here. In deciding how to
proceed we will consider whether there is evidence of specific mental health difficulties, whether there is any risk of harm to self or others and
also the severity of the symptoms and the degree of impairment. If the CAMHS team assess that the difficulties noted represent mild to
moderate mental health issues then the referral is passed to our Tier 2 Primary Mental Health Worker Service, via consultation.
Those referrals that describe more severe, complex and enduring mental health difficulties will be seen by our Tier 3 CAMHS service. Child and
Adolescent Mental Health Services are focussed on children and young people presenting with severe and complex difficulties whereas the
Primary Mental Health Team aims to intervene earlier with the milder to moderate cases. Referrers should note that a multi disciplinary
approach will always be taken by the Service with referrals of children who are looked after or looked after away from home. We find it is best to
meet with the responsible Social Worker to discuss and plan how best to ensure the child or young person can access our Service.
Referrals to our service are considered urgent if there are:
a)
concerns that a child/young person is suicidal
b)
concerns that a child/young person has an acute psychosis
c)
concerns that a child/young person has life-threatening weight loss or BMI of less than 18
Or occasionally when there is reason to believe that there is significant risk to a child that may be alleviated by the CAMHS becoming involved
quickly. In these unusual cases we would often aim to discuss the referral personally with the referrer and suggest that you telephone the team
and speak to a Clinician. Referrals of an urgent nature out with normal working hours and at weekends should be directed to A&E.
All other referrals would be considered for routine appointments.
NHS Highland currently provides Child & Adolescent Mental Health Services to children and young people from birth to eighteen years of age if
in full time school OR sixteen years of age. For referrals in those children under the age of five years we find it is best to meet with the Health
Visitor, Public Health or School Nurse in the first instance. PMHW can provide consultation for this age group.
PMHW Service
Consultation by the Primary Mental Health Team is the early intervention part of CAMHS. The purpose of consultation is to make information on
childrens mental health accessible to all those professionals working with children within Highland. Consultation is accepted from ALL child care
professionals including, Guidance Teachers, Head Teachers, Public Health Nurses, Family Support Workers, Social Workers, Voluntary
Organisations etc. During consultation the PMHW may accept a direct request for service. The PMHW Service offers a range of treatment
options including advice, self-help material, supported self-help, and a range of short-term individual and family based interventions using a
stepped care approach. (hyper link to PMHW guidance)
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NHS Highland CAMHS
Consultation offers advice, guidance and can provide access to our resources gathered to work with children. It is NOT an emergency or crisis
service.
Referrals Accepted by Tier 3 CAMHS
Referral to the Tier 3 CAMH Service should be by the referral form (link). There is specific information that must be included within the referral
to ensure that the correct intervention can be targeted to the right child/young person. If a referrer is not sure what to include, s/he might want
to phone the Tier 3 service and discuss the referral. If a referral is accepted we write to the child or young person and their family providing
information about the service. If from the referral information it is not clear which intervention would be helpful then an assessment appointment
may be offered.
The Royal College of Psychiatrists have produced a helpful brochure on what to expect from CAMHS which can be downloaded from
http://www.rcpsych.ac.uk/PDF/CAMHS%20inside%20outx.pdf
Referral Criteria
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NHS Highland CAMHS
Problem
Description
Referral Pathway
Anxiety: anxiety
disorders are the
most common type
of mental health
disorder in children
Anxiety is a normal and common part of
childhood. In most cases, anxiety in
children is temporary, and may be
triggered by a specific stressful event e.g.
young child may experience separation
anxiety when starting school.
In some cases, anxiety in children can be
persistent and intense, interfering with a
child’s daily routines and activities.
Anxiety disorders include phobias,
general anxiety, panic or persistent
unexplained physical symptoms, e.g.
headache or stomach-ache, where
physical cause has been excluded.
Children who show persistent or severe
symptoms of anxiety should be referred
to Tier 3 CAMHS by letter and/or with a
Child’s Plan.
Schools and education departments have
their own resources (e.g. inclusion
support workers, educational
psychologists and behavioural support
services) which should to be exhausted
prior to referral.
A summary of school / education
department involvement and action will
be essential before a referral can be
accepted therefore we would normally
expect a child to be subject to Staged
Intervention.
CAMHS will not accept referrals for
school truancy only and referrers should
consult with other Children’s Services
and/or the Highland Council
Educational Psychology Service in the
first instance.
Separation
Anxiety
Disorder/School
Refusal
Those with less severe difficulties may
be directed to the PMHW Service after
consultation with the PMHW.
You may want to discuss your concern
with school first. The Educational
Psychologist can refer to CAMHS if
required.
Schools can also access the PMHW
Service for consultation.
Advice
The Tier 3 service should be involved:
 Where the child’s development or level of
functioning has been seriously affected or
there has been a sudden deterioration
 Where it appears to be out of proportion
to the family circumstances
 Where there is a significant impact on the
parent / carer / child relationship-please
describe in referral.
You may wish to find out more at
www.moodjuice.scot.nhs.uk/anxiety
www.shapeofmind
www.youngminds.org.uk
www.anxietyuk.org.uk
www.stressandanxietyinteenagers.com
www.handsonscotland.co.uk/topics/anxiety/scho
ol_refusal.html
July 2015
Bereavement:
Grief is the normal
response to the
loss of a loved
one.
NHS Highland CAMHS
Childrens response to grief can be varied,
dependent on age, cognition and
developmental stage. Quite often it can
be the subsequent change in
circumstances or other family members’
reactions that can prove difficult for the
child.
Consult with PMHW in the first instance
describing what has been tried and how
the difficulties are affecting the childs
day to day functioning. The PMHW may
work directly with the child/young
person or may signpost other services
that can provide bereavement support.
You may want to consider referral to
Tier 3 service when the loss has had an
extreme impact on the child and their
functioning, or when the child is
experiencing difficulties after
bereavement support.
Learning
Disabilities: this
is also known as
Global Learning
Disability normally
evident from early
childhood and
defined as
significant
impairment of
intellectual
functioning
including impaired
social functioning,
If the child is experiencing significant
distress and / or difficulties following a
bereavement / loss that has occurred in
extreme circumstances (e.g. trauma,
illness, suicide or accident) you may
want to refer to Tier 3 CAMHS
Learning disability on its own is not
CAMHS do not conduct initial diagnostic
grounds for referral to Tier 3 CAMHS. For assessments for global learning
CAMHS to become involved there have to disability. Paediatricians, Educational
be concerns about a mental health
Psychologists and pre school special
problem in those already identified as
teachers assess children for global
having a Global Learning Disability and
learning disability.
associated behavioural or mental health
problems.
Professionals concerned about a
child/young person with ASD can refer
to the Highland Framework for
This group may also include worries
Assessment and Diagnosis of
regarding ASD (Autism Spectrum
Autism Spectrum Disorders, a multiDisorder) or Aspergers. Difficulties which
may impact on daily living and are criteria disciplinary framework agreed by in
which could support a referral include:
Highland.
 Significant delay in acquiring
Young people aged 18 and over should
appropriate social skills
be referred to adult learning disability
 Significant difficulties with the
services.
child’s peer relationships
Although painful for everyone including
professionals, you may wish to give the child &
family some time to experience a normal grief
process
You may wish to consider referral to CHAS at
Home (the Highland outreach service for the
Children’s Hospice Association of Scotland)
Where support is provided for children & parents
who are bereaved as well as individual work.
www.chas.org
www.rd4u.org.uk
www.winstonswish.org.uk
www.childbereavement.org.uk
www.cafamily.org.uk
Developmental difficulties often come to light
when a child gets older i.e. throughout the course
of their development.
www.incredibleyears,com
www.angermgmt.com
www.aspergersyndrome.org
National Autistic Society offers information and
support
http://www.autism.org.uk/
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NHS Highland CAMHS
Children and young people with a
learning disability can present with any of
the mental health problems described in
this document but their presentation may
be complicated by factors such as
communication difficulties and sensory
sensitivities
ADHD: Attention
Deficit Hyperactivity Disorder is
characterised by
pervasive lack of
attention,
impulsivity and
hyperactivity
across situations
and settings – at
home, school, and
in public – which
began before 7
years of age.
Families with children who display
difficulties in these categories should
have already received significant advice
and intervention from other professionals
such as paediatricians, health visitors,
social workers and educational support
services before referral to CAMHS is
made.
www.adhdtraining.co.uk/
www.boxofideas.org/
The PMHW Service may offer
consultation to those adults supporting
the child/young person where their
behavioural needs are causing concern.
involves
both obsessions
and compulsions
that take a lot of
time and get in the
way of activities.
Obsessions (intrusive repetitive thoughts)
Compulsions (repetitive, ritualistic,
unwanted actions)
These will be either distressing or
disabling and interfere with the child’s
functioning and across settings e.g.
school and home. This behaviour can
also be as the result of anxiety or a
change.
Depression:
Low mood is a normal part of childhood
Obsessive
Compulsive
Disorder (OCD):
CAMHS would not normally assess a
child for ADHD until they have
completed at least one term within P1.
For children all children the normal
route to assessment would through
referral to Community Paediatrics. If
the outcome is unclear or severe
presentation a referral to Tier 3 CAMHS
may be considered,
Children often experience obsessions
and compulsions as part of normal
childhood behaviour and they can often
disappear without intervention.
Therefore when considering specialist
referral the situation has to be
distressing, disabling and interfere with
the childs day to day functioning.
If pervasive and evident across settings
then a referral to the Tier 3 CAMH
Service may be considered.
GPs may advise and review prior to
This behaviour can often be due to a change
therefore establishing normal routines may affect
a positive change
www.ocdyouth.ipo.kcl.ac.uk
Info site run by Royal Maudsley Hospital on OCD
www.ocduk.org
Includes Information and Guide for parents of
young children
www.ocduk.org/pdf/children.pdf
www.ocduk.org/pdf/youngpeople.pdf :
www.ocduk.org/pdf/ParentsOCDGuide.pdf :
Information and guide for parents of children
worried about OCD
For more info:
July 2015
NHS Highland CAMHS
disturbances of
mood, sleeping,
irritability,
decrease in
energy, social
isolation, school
performance is
affected and
thoughts of selfharm have been
expressed
and in most cases is temporary and might
well resolve on its own.
referral as often difficulties can resolve
without intervention.
In order for referral to CAMHS to be
appropriate difficulties should be more
than age appropriate variation of mood.
There should be a significant change from
previous levels of functioning and an
impact on daily living.
Where symptoms are mild or moderate
in nature, a consultation with a PMHW
will help clarify what support may be
appropriate and whether they should
provide some direct intervention to the
child/young person.
Bipolar disorder is rare in children and
relatively uncommon in adolescents.
For persistent and severe symptoms, or
if concerns exist regarding suicidal
thoughts then refer to Tier 3 CAMHS
may be appropriate.
Post Traumatic
Stress Disorder
/ Acute stress
disorder; due to
PTSD is linked with an extreme traumatic
stress involving direct personal
experience of an event that involves
actual or threatened death or serious
injury. The event is re-experienced in one
or more of the following ways: flashbacks,
nightmares related to the event, reenactment through play, intense
emotional arousal, numbness around
memories and physical symptoms such
as tummy aches and headaches.
It is important to know whether there
are legal proceedings pending and to
establish who wishes to establish the
severity of the symptoms. For example
is someone asking for help or is the
main concern a wish to support some
legal case
exposure to one or
more traumatic,
often life
threatening events
www.moodjuice.scot.nhs.uk/depression.asp
www.shapeofmind.scot.nhs.uk
www.depressioninteenagers.com
www,beatingtheblues.co.uk
www.breathingspacescotland.co.uk
Where children and young people are currently
experiencing trauma such as domestic violence a
referral to the Family Team is likely to be
appropriate. Psychological intervention is unlikely
to be possible where the child's living situation
continues to be insecure and traumatic.
www.cedarfv.org.uk/
Where symptoms are mild or moderate
in nature, a consultation with a PMHW
will help clarify what support may be
appropriate and whether they should
provide some direct intervention to the
child/young person.
For persistent and severe symptoms,
referral to Tier 3 CAMHS may be
appropriate.
Psychosis: Rare
in children and
adolescents but
may involve
transient states or
short episodes of
As manifested in thought disorder,
delusions, perceptual disturbances,
hallucinations
Referral to Tier 3 CAMHS is indicated.
If urgent, contact CAMHS within normal
working hours. Outside this time contact
Accident and Emergency if emergency
assessment is required.
www.rcpsych.ac.uk/mentalhealthinfo/mentalhealt
handgrowingup/psychoticillnessyoungpeople.asp
x
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NHS Highland CAMHS
delusions,
hallucinations,
disorganised
speech or
behaviour
Self Harm :
overdoses & other
serious self harm.
This is rare in
children under 12
years of age.
Deliberate self harm without suicidal
intent takes many forms and can be seen
as a way of dealing with difficult feelings
that build up.
Self harm here would have the absence
of suicidal intent.
If you feel concerned that the self
harming behaviour is indicative of a
disturbance of emotional and
psychological well-being then you
should refer to CAMHS.
Where symptoms are mild or moderate
in nature or appear to be due to a
specific and recent incident or event, a
consultation with a PMHW will help
clarify what support may be appropriate
and whether they should provide some
direct intervention to the child/young
person.
Self harm at this level can be very anxiety
provoking for professionals.
PMHWs are committed to providing training and
development opportunities to Tier 1 professionals
to assist them to deal with things like self harm.
They can provide or signpost towards training in
Mental Health Awareness (Scottish Mental
Health First Aid for Young People) and suicide
prevention (ASSIST).
www.selfharm.uk.org
www.harmless.org.uk/downloads
For persistent and severe symptoms,
referral to Tier 3 CAMHS may be
appropriate.
Eating Disorders
Anorexia: is
characterised by a
refusal to maintain
Deliberate self harm with suicidal
intent should always be taken seriously.
However the decision to attempt suicide
is often a hasty one – following
arguments with family, friends and
partner. Therefore it is important to
establish if the intent was to end one’s
life.
Overdoses and other serious self-harm
should be sent directly to A&E in the
first instance. The ward or hospital will
then refer on to CAMHS.
Where there is concern in relation to an
eating disorder it is advisable to discuss
with GP in the first instance to think about
medical investigations (blood, weight,
height BMI etc) prior to referral.
If there has been a recent rapid weight
loss (1kg+ per week with ED cognitions
present) with no physical cause,
request urgent Tier 3 CAMHS
appointment
Referrals from hospital will be prioritised
& referral protocols are already in place.
A follow-up appointment from the Tier 3
service should always be arranged.
This is an example of the sort of screening
questions that can be helpful however any
decision on referral will be based on relevant
history and clinical presentation

Do you make yourself sick because you feel
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NHS Highland CAMHS
uncomfortably full?
a minimally normal
body weight or an
intense fear of
gaining weight.
Bulimia: is
characterised by
binge-eating and
purging and
maintaining
adequate body
weight.
Sometimes the school nurse is also a
good source of support in helping to
weigh a child you suspect may be of low
weight.
It is important that a young person has a
physical check with their GP or School
Nurse. This not only gives us some ideas
re BMI but assists with prioritisation as we
would want to prioritise those children
with low BMI.
Feeding and
Faltering Growth:
this is where
growth has been
affected by feeding
difficulties (also
known as non
organic failure to
thrive)
Faltering growth is a common occurrence
and health visitors play a key role. Most
children with faltering growth will be
detected by the primary health care team
and supported within the community.
Feeding problems include:
 children with behavioural feeding
problems in the context of chronic
illness/medical problems;
 severe and chronic selective
eaters;
 infant feeding problems and failure
to thrive;
 emotional eating difficulties (e.g.
food phobias) or in the context of
somatic problems such as chronic
fatigue syndrome.
Consult Health Visitor/Public Health
Nurse in the first instance. Refer on to
paediatrician as necessary.
Enuresis and
Encopresis or
complex
soiling:
Initial screening and treatment should be
undertaken by paediatrician to rule out
physical causes.
Refer to paediatrician in the first
instance who will then refer to other
specialist services if appropriate.
Both are
categorised as
elimination
If the symptoms are less severe but
there is some concern that a young
person has some distorted thinking or
body image, consult with PMHW in the
first instance. The PMHW may work
directly with the child/young person or
may signpost other services that can
provide support.

Do you worry you have lost control over how
much you eat?

Have you recently lost more than 1 stone in a 3
month period?

Do you believe yourself to be Fat when others
say you are too thin?

Would you say food dominates your life?
If the young person answers yes to 2 of these
questions consider referral.
www.b-eat.co.uk
You may wish to look at
www.childrenfirst.nhs.uk/families/features/behavi
our/fussy_eaters.html
Initial screening and treatment should
be undertaken by the paediatric team
CAMHS referrals often come via this
route.
The PMHW can offer consultation to
Health Visitors/ Public Health Nurses.
You may wish to find out more information from
www.eric.org.uk which includes a free
downloadable toolkit for parents and
professionals
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NHS Highland CAMHS
disorders and is
the inability to
control urination or
soiling in those
deemed old
enough to exercise
control
Psychosomatic
Difficulties:
children
experiencing
emotional distress
in the form of
physical symptoms
with no physical
illness and also
children with real
physical illness
where the
presentation is
complicated by
mental health
difficulties
Physical complaints with no apparent
medical basis may be a reflection of a
stress, such as nervousness in a social
situation, a demanding school setting,
separation from parents, or other stressful
situation.
Referral should be considered only when
this is having significant impact on the
child’s normal functioning e.g. absence
from school for long periods
Initial referral to a paediatrician is often
useful especially where there are
unexplained physical symptoms in the
absence of obvious mental
health difficulties
Where a child is experiencing physical
symptoms initial referral to a
paediatrician is recommended.
Where symptoms are mild or moderate
in nature a consultation with a PMHW
will help clarify what support may be
appropriate and whether they should
provide some direct intervention to the
child/young person.
www.there4me.com
Website for children and young people (12-16)
who have got fears and worries. Run by
NSSPCC
www.rcpsych.ac.uk/mentalhealthinformation/men
talhealthproblems/physicalillness/unexplainedphy
sicalsymptoms
Royal College of Psychiatrists Website
For persistent and severe symptoms,
referral to Tier 3 CAMHS may be
appropriate.
It is therefore useful that children have
completed physical investigations prior to
referral to rule out any organic cause so
that the child and family will accept the
idea some psychological cause for the
difficulties. Better outcomes can be
achieved by preparing the family in this
way.
Children /
young people
Looked After or
Looked After
Children are looked after and looked after
away from home for many varied
reasons. Their legal situations are also
very varied and complex.
Referrals to specialist CAHMS are best
made by the responsible social worker.
PMHWs offer training and consultation to foster
parents to support them.
LAC and LAAC can present with mental
If concerns exist they will have been discussed in
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Away from
Home: those
known to social
services, LAC,
LAAC, or families
with longstanding
problems and a
poor history of
engagement
NHS Highland CAMHS
health needs of varying nature.
Referrals for children in this category
need to identify whether a child or young
person has a mental health difficulty or
other condition that results in persistent
symptoms of psychological distress, as
well as an associated serious and
persistent impairment of their day to day
social functioning. OR, an associated risk
that the child/young person may cause
serious harm to themselves or others.
Where symptoms are mild or moderate
in nature a consultation with a PMHW
will help clarify what support may be
appropriate and whether they should
provide some direct intervention to the
child/young person.
For persistent and severe symptoms,
referral to Tier 3 CAMHS may be
appropriate.
multi agency groups. Local authority and CAMHS
aim to work together to provide a common,
coordinated framework across all agencies that
support the delivery of appropriate, proportionate
and timely help to all children as they need it.
This includes not subjecting children to multiple
assessments or to repeat information that other
agencies hold. Therefore it is important that
information is shared and accessed e.g. the
Integrated Assessment Framework, or Staged
Intervention process and Child Protection
processes. Given these principles (called
GIRFEC) its is important that professionals who
are concerned about children utilise their existing
referral protocols into our Service rather than
suggest to the family that they attend their GP.
We would need to know how the child/family is
affected by their symptoms i.e. how is their day to
day functioning affected.
Early Years:
Significant
emotional or
behavioural
difficulties 0 – 5
years
With this age group it is unusual for
CAMHS to directly intervene. The normal
referral route being from Health Visitors.
Problems within this age range can take
many forms :
• Parent/child relationship
• Factors affecting capacity to parent
• Developmental concerns or illness
Refer to health visitor or to Paediatrician
CAMHS involvement with this age
range should be secondary not primary.
Consequently, families with young
children with development and/or
behavioural problems should have
already received significant advice and
intervention from other named
PMHWs are committed to a programme of
training and development for Tier 1 professionals
and may be involved in direct work to support
parents where issues arise eg Video Interaction
Guidance.
Often with these types of difficulties the
relationship between the parent and child is the
actual patient; therefore it is useful to know what
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NHS Highland CAMHS
Specialist consultation is offered to,
SCUB/Paediatricians, Tier 3 to network
as part of care planning when
accommodated.
Dyadic interventions
professionals such as paediatricians,
health visitors, social workers and
educational support services including
within Nursery.
has already been attempted.
Therefore referrals should include
information on what has been
attempted and who is involved.
Inappropriate Referrals to CAMHS
In order to improve accessibility for children and young people, we also need to clarify which types of problem it is not appropriate to refer to
specialist CAMHS.
(a) Children/Young People with Behavioural Difficulties as a Response to Normal Life Events These are sometimes called “normal
adjustment reactions”. Unfortunately, we are unable to provide a service to children and young people whose behaviours are associated with a
normal reaction to recent life events (e.g. bereavement, parental separation). Although challenging these are often within developmental and
cultural norms. Some indication of mental health disorder needs to be evident in the behaviour for a referral to be appropriate. It is also
important that CAMHS is a secondary or specialist route of referral when behaviour is being considered as the primary route should always be
universal and primary care services who can support families within their own home.
(b) Children/Young People Whose Difficulties Occur only at School Please note that specialist CAMHS does not provide a service for
children and young people whose problems are solely related to specific learning or behavioural difficulties within the classroom. Schools have
their own referral route and protocols for supporting such children. For these children/young people it is usually more appropriate for educational
services to become involved to address the difficulties. If a referral to CAMHS is appropriate it is best made through the child’s plan.
(c) Children/Young People Whose Parents are in Dispute within Legal Proceedings
Children of separated / divorced parents who are in legal dispute about residence and /or contact arrangements or other issues are not
specifically excluded in these guidelines though the decision to refer needs to be carefully considered on a case by case basis.
If there are ongoing legal proceedings then it is usually better to consider a referral after the legal proceedings have been concluded and legal
agreements or Order(s) have been made regarding the matters which are in dispute. Please note that it is for the Courts to order independent
reports on the child, not the separate parties to the proceedings, and these reports cannot be obtained via a referral to the specialist child
mental health services. Please note that specialist CAMHS does not mediate residence and contact arrangements for the child/young person.
The parent(s) could instead be advised to approach the Family Mediation Service or discuss with their solicitor, as appropriate.
(d) Children/Young People Whose Primary Difficulty is Substance Misuse
July 2015
NHS Highland CAMHS
AND
(e) Children/Young People Whose Difficulty is Described as Offending Behaviour In both of these circumstances it is important that a
coordinated integrated assessment to the child or young persons situation is undertaken. This is the responsibility of the local authority youth
action team and or the child forensic psychology service.
What Makes a Good Referral
It is important that those referring have met with the parent(s)/carer(s) and the referred child/children. It is essential that the referral to CAMH
service is made containing the information requested as per referral form.
Child and Adolescent Mental Health Service
Phoenix Centre
Raigmore Hospital
Inverness
IV2 3UJ