Download Referral Criteria for Specialist CAMHS What we do The core

Referral Criteria for Specialist CAMHS
What we do
The core business of Specialist CAMHS is the specialist assessment and treatment of
complex mental health difficulties and associated risks in young people under the age of
18 years.
In line with the Trust’s transition policy we will only accept new referrals for young people
under the age of 17 years and 6 months. Beyond this age, new referrals should be sent
directly to adult mental health services.
We see children and young people with serious mental health difficulties regardless of
their level of learning disability, co-morbid health issues, neurodevelopmental difficulties,
looked after status, ethnic origin, gender, sexuality or creed
Access
Any level of CAMHS can be accessed via the CAMHS Single Point of Access (SPA)
Emergency and Urgent cases can be discussed with a duty clinician at SPA.
Specialist (Tier 3) CAMHS will see:
1.
2.
3.
4.
5.
6.
7.
Psychosis (in under 16 year olds)
Mood Disorders
Eating Disorders
Self Harm
Significantly impairing Anxiety Disorders of a diagnosable level (e.g. OCD, PTSD)
Complex ADHD/ASD/Tourettes (Tic Disorders) (i.e. comorbid/ with MH problems)
Looked after children and adopted children with significant behavioural and/or
mental health difficulties
8. Under 5’s with significant behavioural, social or emotional difficulties (see
attached criteria for more detail)
9. Children with Learning Disabilities who have mental health and/or significant
behavioural difficulties (see attached criteria for more detail)
Where there is no mental health difficulty, the following are not seen in CAMHS
1. ASD/ADHD/Tic Disorder assessments will go to the neurodevelopmental
pathway in the first instance
2. Substance misuse- SPACE
3. Behaviour problems (except for children with a learning disability, who are looked
after and adopted and are Under 5’s. See above) - Parents Matter
4. Family problems- Relate
5. Response to bereavement and/or loss
6. Soiling and Enuresis - Should be screened by a Community Paediatrician, School
Nurse or Health Visitor
20120705 Draft Version 3.0
7. Somatoform disorder – A Community Paediatrician/ GP should screen these
referrals first to rule out medical explanations. Only then can we consider
referrals for CAMHS.
8. School refusal- Education Welfare Officer
9. School-based problems- Educational Psychology Service and/or School Nurse
10. Sexual health related referrals- Sexual Health Teams
If you are concerned that a child may need an appointment with CAMHS please contact
the duty clinician on the CAMHS Single point of Access and discuss whether a case is
appropriate.
There will be an emphasis on the need for assessment to ascertain presence or not of
severe mental ill health and Specialist CAMHS contribution to management of complex
cases. Factors to consider include: severity, complexity, enduring difficulties over time,
difficulties in one or more domain, impairment of function at home, school or socially.
Detailed criteria (This will be set up so they are linked with above with a ‘click on’
facility)
Psychosis
• Positive symptoms – Paranoia, delusional beliefs, abnormal perceptions (hallucinations
on all sensory modalities)
• Negative, symptoms – deterioration in self care and daily personal, social and family
functioning
• Disinhibited behaviour, overactivity, risk taking, with pressure of speech and agitation
• Severe depression with psychomotor retardation, social withdrawal, suicidal ideation
Mood Disorders
(needs writing before Sept)
Eating Disorders
• Anorexia
• Bulimia – Engaging in binge and purge behaviour
• Eating Disorders – Other difficulties around food and eating
Attention Deficit Hyperactivity Disorder (ADHD) & Autistic Spectrum Disorder(ASD) and
Tourettes
• For initial assessment and diagnosis, follow the local multi-agency protocol
• Complex ADHD cases with co-morbidity should be referred to Specialist CAMHS
• Tourettes Syndrome with complex motor and vocal tics, particularly with co-morbidity
with OCD and rage
Significantly impairing Anxiety Disorders of a diagnosable level (e.g. OCD, PTSD)
• Severe or debilitating Anxiety panic attacks
• Separation anxiety which severely impacts on the child’s functioning
• Phobias including phobic anxiety Depression
• Physical symptoms – poor sleep/appetite/ libido
• Cognitive symptoms – negative thoughts about self /others /world
• Suicidal ideation – level of intent, current thought, etc
• Co-morbidity – depression often occurs concurrently with other presenting mental
health problems
Post Traumatic Stress Disorder
 Symptoms occurring more than 3 months after a recognised traumatic event
 Intrusion and avoidance of thoughts and memories about the trauma
 Hyper-vigilance, hyper-arousal and emotional numbing
Obsessive Compulsive Disorder
 Obsessions and/or compulsions with functional impairment
Deliberate Self Harm
 most commonly skin-cutting but might include burning, scratching, banging or hitting
body parts, interfering with wound healing, hair-pulling (trichotillomania) and the
ingestion of toxic substances or objects.
 may be associated with suicidal ideation and intent and/or a pattern of emotional
disregulation, interpersonal difficulty and maladaptive coping strategies
Under 5’s
 Age –Children from 0 to 5 year olds including infants
 Presenting symptoms This is not an exhaustive list but the following examples are a
guideline of appropriate referrals
 Behavioural: sleeping, eating difficulties, toileting, aggression, selective mutism
etc.
 Emotional/social: attachment/bonding difficulties, trauma, abuse, quality of
family relationship, carers mental health issues, birth trauma/ separation anxiety
 There needs to be some evidence or indication that the presenting difficulties have not
been alleviated by Tier 2 Interventions.
Developmental Trauma
(Before September)
LAC
(Before September)
LD
(Before September)