* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download assessment criteria for community and specialist camhs
Spectrum disorder wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Autism spectrum wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Gender dysphoria in children wikipedia , lookup
Psychological trauma wikipedia , lookup
Eating disorder wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Discrete trial training wikipedia , lookup
Conduct disorder wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Conversion disorder wikipedia , lookup
Asperger syndrome wikipedia , lookup
Mental disorder wikipedia , lookup
Depression in childhood and adolescence wikipedia , lookup
Factitious disorder imposed on another wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Intervention (TV series) wikipedia , lookup
Child psychopathology wikipedia , lookup
Diagnosis of Asperger syndrome wikipedia , lookup
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