access beh policy … · web viewbarnet, enfield and haringey nhs trust aims to design and...

Child and Adolescent Mental Health Service

(CAMHS) Access Policy

Version: 2.0

Policy Lead/Author & Position: Andrew SmithProject Manager

Responsible Directorate: Patient Services / CorporateReplacing Document: Local CAMHS Access documentsApproving Committee / Group: Policy Development Monitoring and Review CommitteeDate Approved/Ratified: January 2018 (Pending)Ratified by: Policy Development Monitoring and Review CommitteePrevious Reviewed Dates: Not applicableDate of Current Review: January 2018Date of Next Review: January 2020Relevant NHSLA Standard(s): Not applicableTarget Audience CAMHS Services

CAMHS Access Policy (Version 1.0) 1

EQUALITY STATEMENTBarnet, Enfield and Haringey NHS Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. It takes into account the Equality Act (2010) including the Human Rights Act 1998 and promotes equal opportunities for all. This document has been assessed to ensure that no employee receives less favourable treatment on the protected characteristics of their age, disability, sex (gender), gender reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity.

Members of staff, volunteers or members of the public may request assistance with this policy if they have particular needs. If the member of staff has language difficulties and difficulty in understanding this policy, the use of an interpreter will be considered. Barnet, Enfield and Haringey Mental Health NHS Trust embraces the four staff pledges in the NHS Constitution and this policy is consistent with these pledges. The Trust is also committed to safeguarding and promoting the welfare of children, young people and vulnerable adults and expects all staff and volunteers to share this commitment.

CONSULTATION RECORD OF PROCEDURAL DOCUMENT FORM

Name and Title of Individual Date ConsultedCAMHS Service Project Group Members Nov15, Dec15 , Jan16, Jan 18Contributing Authors: Mark Carter, Dr Nina PatelName of Committee Date of Committee

CAMHS Service Project Group Oct 15, Nov15, Jan16CAMHS Commissioning Group Jan 15, Feb15

Version Control Summary

Version Date Section Author Comments0.2 06.11.15 6, 8, 9, 10 ,11 A Smith Drafted new sections

0.3 23.11.15 3.2, 5.3, 6.1, 8.5, 8.9, 12, 13

A Smith Incorporating comments from Mark Carter and Dr Nina Patel

0.4 02.12.15 04.12.15

8.1-8, 9, 13.9 A Smith Incorporated comments from Dr Stephanie Vergnaud

0.5 07.01.16 Full Review A Smith Dr Nina Patel and Mark Carter Reviewed full policy, appendices, form and leaflets.

0.6 18.01.16 Full Review A Smith Dr Nina Patel and Mark Carter Reviewed full policy, appendices, form and leaflets.

0.7 22.01.16 Full Review A Smith Teams consulted on policy, appendices, form and leaflets.

1.0 26.01.16 Final feedback A Smith Final Changes Added

2.0 01.01.18 Full review CAMHS working group

Document reviewed


Table of Contents Page

1. Policy Statement 4

2. Introduction 4

3. Aims 4

4. Scope and Outcome 5

5. Duties 5

5.1Chief Executive 55.2Clinical Directors / Assistant Directors / Managers 55.3Employees 55.4Referrers 5

6. Equalities 5

7. Child Protection 5

8. Referral Principles 6

8.1 Eligibility 78.2 Consent 78.3 Mental Health Problems 78.4 Severity 78.5 Risk 78.6 Complexity 88.7 Engagement and Re-referral 88.8 Consultations 8

9. Referral Criteria 8

10. Problems appropriate for a CAMHS referral 9

11. Problems where CAMHS can be involved 12

12. Problems CAMHS Cannot Assess 12

13. Problems that do not meet the threshold for Tier 3 CAMHS 13

14. Did Not Attend (DNA) Rules for Service users who fail to attend 13

15. Appendix 1 - CAMHS Referral Form 15

16. Appendix 2 - CAMHS Leaflets 15

Monitoring Compliance and Effectiveness

Equality Impact Assessment and Analysis Form


1. Policy Statement

1.1 All staff should be aware of the Child and Adolescent Mental Health Service (CAMHS) access policy, and how to access the policy for reference.

1.2 The overriding duty of care to patients means that should the content or operation of this policy be challenged on any grounds whatsoever then the impact on the past, present or future duty of care to patients will be taken to be a primary factor in deciding the outcome of that challenge.

2. Introduction

2.1 This policy outlines arrangements for access to CAMHS within the boroughs of Barnet, Enfield and Haringey. CAMHS services are available for children and young people under the age of 18 with complex mental health and emotional difficulties.

2.2 The aim of this policy is to ensure that, where appropriate, patients receive an assessment and treatment from services best equipped to meet their mental health, emotional and wellbeing needs.

2.3 CAMHS Access is available within each of the three London boroughs of Barnet, Enfield and Haringey. This is a single point of entry in each borough for all referrals requesting a child and adolescent mental health service.

2.4 CAMHS ACCESS are multi-disciplinary teams made up of representatives from Barnet Enfield and Haringey Mental Health NHS Trust (Lead provider) and other key local agencies (in Barnet and Enfield). Child & Adolescent Mental Health Services provide a variety of mental health services and professionals for children and young people.

2.5 Services are structured according to need.

2.6 As CAMHS is not an emergency service and if a young person or a child is at risk and needs immediate or urgent medical assistance, s/he will need to go to their GP or local hospital Accident and Emergency.

3. Aims

3.1 The aim of this document is to set and standardise practices and expectations in respect to access to CAMHS services across the three boroughs.

3.2 This means standardising best practice across the trust and includes:

A CAMHS Access referral form A CAMHS Access guidance leaflet for referrers/professionals; and Agreed processes for the administration of referrals, which would include

acceptance/non-acceptance, allocation and Did Not Attends (DNA). Criteria for the acceptance of referrals adapted according to the differently

commissioned services in the 3 boroughs


4. Scope and Outcome

4.1 This policy is aimed at all professionals working in Child and Adolescent Mental Health Services and referrers from the local community including GPs, Child Health, Schools, and Social Workers.

4.2 The intended outcome of the CAMHS Access process is to ensure that vulnerable children and young people receive the care and support that is most appropriate to their needs.

4.3 This access policy does not relate to CAMHS inpatients services. For information about specialist acute CAMHS mental health assessment and treatment services at the Beacon Centre go to the Trust website: http://www.beh-mht.nhs.uk/mental-health-service/mh-services/the-beacon-centre-acute-adolescent-unit-original-original.htm

5. Duties

5.1 Chief Executive - Overall responsibility for the strategic and operational management of the Trust which includes ensuring that age appropriate care is provided at all times, and that care is transferred between services smoothly and effectively.

5.2 Clinical Directors / Assistant Directors / Managers - Front line and senior operational managers should ensure that all staff are familiar with this policy, follow the principles and process outlined in the policy and that new staff are informed of this policy as part of their induction.

5.3 Employees - All staff in CAMHS and adult clinical services should be familiar with the principles and process. Clinical staff should monitor the transfer of care between services and ensure a smooth transition and that any delays are minimised and addressed. Staff have a responsibility to raise any delays or issues in the process with their immediate line manager in order to seek prompt resolution.

5.4 Referrers – to provide adequate and clear information of the presenting difficulty and the psycho-social context and risk factors. To complete the referral form in consideration of the leaflet and this policy. CAMHS Access only accepts referrals from professionals working with the child or young person concerned.

6 Equalities

6.1 CAMHS services will implement monitoring systems to measure key equalities data as it relates to each borough. This information will be collated and utilised to address over representation and underrepresentation and to promote access and inclusion.

7 Child Protection7.1 If there is concern that a child is at risk of physical, sexual or emotional abuse or

neglect, they must be referred to Social Care in the first instance, by the referrer who has these concerns, specifying the concerns and following the referrer’s organisation’s child protection guidelines. It would not be appropriate to refer to CAMHS before those concerns have been addressed. Where there are immediate acute mental health


concerns and/or significant risk a referral to CAMHS can be made alongside the referral to social care.

7.2 When there is ongoing Social Care involvement with a child/family, the Social Worker needs to be advised of the referral to CAMHS, to ensure inter-agency liaison.

7.3 CAMHS and Social Care should consult regularly, where there are families with a high level of need and who may benefit from both services.

8. Referral Principles (for clinicians undertaking CAMHS Access)

8.1 Eligibility Children and Young People under the age of 18 with a GP address in the relevant borough.

Whilst some referrers may have a specific intervention or service in mind for the young individual they are referring, CAMHS Access will direct the referral to the most appropriate setting, although services will try and accommodate specific relevant needs. Specific requests for needs to be met across boroughs should be directed to the Service Manager for discussion by the clinical team. These requests will be considered on a case by case basis noting the full circumstances of the case and any reasons for exceptionality. The wishes of the family will also be considered in the decision making process.

8.2 Consent The parent(s) / carer(s) are expected to give their consent for the referral on the referral form. For young people 16 years old or over or who are assessed to be Gillick competent (as per Fraser guidelines), we would need their consent recorded in the appropriate slot in the referral forma as well. Young people 13-18 who wish to access the service without parental consent can do so if deemed to be Gillick competent. If they are under 16, parental consent is preferable and advisable, but specific situations will be assessed on a case by case basis.

8.3 Mental Health Problems - A comprehensive list of the mental health problems appropriate for a CAMHS referral is in the following section below (Referral Criteria). The list distinguishes between problems seen in CAMHS and problems that are more appropriately dealt with in other services.

8.4 Severity - Severity is considered in terms of the disturbance in a young person’s functioning. For a referral to be accepted a moderate degree of interference in functioning in most social areas (such as home, school, or social activities) or severe impairment of functioning in one area.

If a young person's functioning is not disturbed to this level, it is not appropriate to refer to Tier 3 CAMHS and other services should be considered by the referrer including CAMHS Tier 1 and Tier 2 services. CAMHS Access may suggest an alternative and appropriate service or redirect.

8.5 Risk - CAMHS seeks to respond appropriately to the perceived level of risk as described on the referral form. All referrals are screened for risk as soon as they are received. CAMHS is not an emergency service, but can offer mental health


assessments very quickly in certain urgent circumstances. Clear information from referrers is essential in order that an appropriate and timely response can be made by CAMHS.

Referrers should clearly state the risk, including indications of severity, history and duration of the concerning issue. Risk can take different forms, including risks to the young person, risks the young person poses to others, and risks the young person poses to themselves or their lives (e.g. risk of school exclusion). The details are important, so for example if self-harm is the risk then alongside the nature of the self-harm the referrer should state the intent of the self-harm, the frequency and intensity of the self-harming behaviour, the likelihood of the self-harming behaviour reoccurring and also the mental state, mood and suicidal ideation of the self-harming young person. These details should also be given in conjunction with other back ground information suggested in this section of this referral criteria.

NB referrers should always fill out the risk assessment part of the referral form (for Enfield – this is included on the Early Help Form).

8.6 Complexity – When processing referrals CAMHS Access clinicians will be considering complexity to more fully comprehend the child or adolescent being referred and the difficulties that they are experiencing. Not only does this enable a greater depth of understanding but also risk issues, appropriateness of prospective service, and what other agencies need to be involved can also be considered. Issues of complexity can be grouped into three areas:

a) Co-morbidity: b) Family and psycho-social factorsc) Life situation/life events

8.7 Engagement and Re-referral - CAMHS Access clinicians will look at any information they have on the past history of the young person and their family's engagement with services and also information on their current situation in order to consider how best to facilitate their engagement with CAMHS. The young person and their family's likely ability to travel to a community clinic is a very important factor in engagement and so the appropriateness of recommended services is considered in this context.

For re-referrals, where there has been a history of disengagement and the service user is high risk, an assertive approach may be necessary, If so, then clinicians should look at all available means to engage the service user. These might include home visits, telephoning, and arranging network meetings. Also, in cases where it has proved difficult to engage people with high risk e.g. self-harm or safeguarding issues, the CAMHS team will ensure liaison with Social Services and Schools. CAMHS Access clinicians should consider these issues and gather as much information as necessary to come to decision about the necessary steps to ensure engagement, before accepting the referral and passing on key engagement information to clinicians involved thereafter.

8.8 Consultations - When Social Services are already involved with the referred young person CAMHS Access clinicians may decide that some referrals may benefit from a CAMHS consultation. This consultation would support the network around the young person and to establish whether a CAMHS referral is appropriate, exploring issues around the child’s mental health.


8.9 If CAMHS Access does not think that the referral is appropriate for CAMHS then they will attempt to explain why in their communications to the family and also offer suggestions about that may be the most appropriate way to help the family or suggest another service that may be able to offer support. Local teams should keep an electronic document listing local services and useful websites so that details can be readily cut and pasted into this explanatory letter.

9. Referral criteria

9.1 The core business of CAMHS is: “the assessment and treatment of serious mental health disturbances and associated risks in young people under the age of 18 years”.

9.2 Details of how to refer to CAMHS are outlined in the CAMHS Access Leaflets (see below 13. “Example CAMHS Leaflets). CAMHS Access is the service provided by Barnet CAMHS and Haringey CAMHS clinicians (in Enfield the Team Co-ordinator) where all new referrals are viewed on a daily basis to consider if the referral is appropriate for CAMHS or one of its partner services.

9.3 Most young people with mild emotional or behavioural difficulties are best served by universal services e.g. General Practitioners, schools, health visitors and community groups etc. Before making a referral to CAMHS, these other options should be considered (i.e. Tier 1 and tier 2 services).

9.4 In Barnet a CAF (Common Assessment Framework) may be implemented to gather

observations and views on the child or adolescent from those who know them, in order to initiate supportive services from different agencies including social care and education. The CAF forms are sent to the central CAF panel where requests for services are considered, including a referral to CAMHS if necessary.

9.5 In Enfield, referrals to CAMHS should be via the Early Help form if there is already multiagency involvement sent to the Administrator as part of the Single Point of Entry (SPOE) process. If CAMHS referrals are only single agency (i.e. no other agency apart from CAMHS) then referrals can be passed directly to Enfield CAMHS on the CAMHS Access Referral Form (Enfield CAMHS address is at the top of the form – see page 15).

9.6 In Haringey, the Early Help forms are sent from the Early Help team to the CAMHS Access Administrator, and include an additional CAMHS Annexe that must be completed by the referrer.

9.7 When the difficulties are complex and enduring and there is a significant impact on the young person's functioning, a direct referral to targeted community based services or specialist clinic based mental health services such as CAMHS or social care may be appropriate (see 7.3 above).

9.8 The criteria for acceptance of a referral to CAMHS in terms of severity of the referring problems is gauged by considering the level of disturbance in a young person’s functioning (as described in 7.3 ‘Severity’ above).

9.9 Referrals are screened within 1 working day from receipt by CAMHS Access. Where


sufficient information has been received by CAMHS, referrers, GPs and families will receive a written response advising them of the outcome within 2 weeks from receipt of referral.

9.10 Where insufficient information is provided on the referral, CAMHS Access will attempt to contact the referrer and/or family or appropriate other agencies, to gather further information. If CAMHS Access are unable to make contact or receive a response to their communications, then the referral will be closed, and a letter will be sent to the family and referrer advising of this outcome within 2 weeks.

9.11 If a referral is thought to be inappropriate for CAMHS, the Access team endeavour to explain why and make recommendations for alternative services in their communications back to referrers and families.

9.12 As part of the process of clearly understanding the nature of the CAMHS referral, CAMHS Access clinicians may request further information from the referrer, or the young person or their family, or with permission of the child or young person’s parents or carers, from other involved agencies. This is to ensure that the referral gets sent to the appropriate service as soon as possible, saving time for those being referred and increasing the efficiency of the Access service.

9.13 If there are high levels of risk or urgency indicated in the referral a timely response from CAMHS Access is essential to ensure patient safety. Such a response depends upon clear risk information being provided by the referrer.

9.14 A re-referral is deemed as a CYP who has been seen by the service within the last year. Latest details of the presenting needs are required. The re-referral will be received by CAMHS Access, and wherever possible or appropriate directed to their original clinician.

10. Problems appropriate for a CAMHS referral

10.1 Depression or Mood Disorder: When the young person has persistent moderate to severe low mood, or mood lability, of at least 2-3 weeks duration, unless an urgent presentation /suicidal ideation. Activities of daily living or social functioning in general are affected – e.g. loss of interest, in friends, school work, disturbances of sleeping or eating.

10.2 Self-Harm: Risks need to be clearly described: If there is an acute risk of self-harm or suicide, families should be sent directly to an Accident & Emergency Department for immediate medical care. For attendances at the North Middlesex Hospital and Barnet General Hospital the protocol for management by A&E / Paediatricians / CAMHS is then followed. If there is not acute risk of self-harm or suicide then a direct referral to CAMHS should be made and the CAMHS team will look at prioritising this referral according to risk.

10.3 Psychosis: Hearing voices, holding delusion or behaving in an unusual manner. Sudden changes in behaviour can be significant.

10.4 Anxiety: Significant anxiety which is persistent and affects day to day functioning.


Examples might include: somatic symptoms, phobias, school refusal, and frequent ruminations.

10.5 Somatisation Disorders, Hypochondriasis, Dissociative Disorders, Pain Syndromes & Chronic Fatigue Syndromes: CAMHS will work in close liaison with Paediatric services. Refer to Paediatrics in the first instance to rule out organic causes.

10.6 School Refusal: Refer to education welfare services in the first instance.. Refer to CAMHS if there is evidence of mental health concerns, e.g. where the child has severe emotional distress linked to attending school.

10.7 Eating problems for children aged 5 and under: For less severe cases of selective eating and fears about food in young children, ask for support from the Health Visitor in the first instance and refer to CAMHS if this has not helped).

10.8 Eating Disorders (Anorexia and Bulimia): Referrals regarding eating disorders are passed on to the Royal Free Hospital. GPs can make a direct referral. The referral should include the young person’s height and weight. GPs should assess the young person’s physical and mental state and refer as necessary. If any of these requirements have been difficult to obtain but a professional remains concerned, then please call The Royal Free to discuss further. However, children with mild Bulimia may be seen locally.

10.9 Post-Traumatic Stress Disorder: Refer for Post-Traumatic Stress (severe distress occurring after a traumatic incident) after symptoms persist for four or more weeks duration after the traumatic event. Symptoms can include: nightmares, flashbacks, insomnia, feelings of guilt, poor concentration, feelings of isolation, avoidance of reminders of the event etc.

10.10 Obsessive Compulsive Disorder: Compulsions and rituals such as checking repetitive hand-washing, in response to upsetting thoughts and feelings.

10.11 Tourette’s Syndrome and Complex Tic Disorders: Neurological assessment first through Paediatrics and then CAMHS for assessment and treatment for Tourettes and for co-morbid mental health disorders.

10.12 Autistic Spectrum Disorders: Possible presentations include: difficulties in relating to parents/carers and other family members; significant difficulties with the child’s peer group relationships/social interactions with others; unusual or very fixed interests; marked preference for routine and difficulty managing change; bizarre, ritualistic or unusual behaviours.

In Barnet, if the child is under 7 then the CDC will carry out the assessment and if under 7 then the CAMHS team.

In Enfield, if under 6, the Child Development Team (CDT) will carry out the assessment and over 6 then CAMHS.

In Haringey a referral to the Child Development Centre (CDC) can be made for a diagnosis if the child is younger than 12 years-old. If the young person is 12 or older, but still younger than 18 then refer to CAMHS for an initial screening appointment,


after which the diagnosis is made at Great Ormond Street Hospital.

Treatment will be provided by CAMHS for co-morbid moderate to severe mental health disorders, which for example may include severe challenging behaviours.

10.13 ADHD/ ADD symptoms: When a child or adolescent appears to be hyperactive/restless , has difficulty concentrating or is impulsive, then ADHD may be suspected if this is a generalised problem across two or more off the different areas of the young person's life (such as: home, school and other social activities). Other indicators of ADHD may include early onset of the behaviours, the difficulties have been on-going for more than six months and the problems have been unresponsive to behavioural interventions in school.

CAMHS will diagnose this difficulty, although we request that schools discuss the child with the Educational Psychologist allocated to their school and that the school implement any school based assessments or interventions that the Educational Psychologist recommends, as a first step. A referral to CAMHS for this diagnosis will not be accepted until this has been done.

For Barnet pre-school children, CAMHS will request a preliminary paediatric assessment. In Enfield the Child Development Team assesses children under 6. Haringey will assess diagnose and treat.

10.14 Behaviour problems and Conduct Disorders: If there are severe behavioural difficulties or significant antisocial disorders e.g. truancy, stealing, destructiveness in multiple settings.

10.15 Sleep difficulties: Sleep difficulties should be co-morbid with other difficulties, or of such a nature that they affect functioning to such an extent that they fit the criteria for severity described above. Otherwise universal services are more applicable.

10.16 Looked after Children (LAC) and adopted children: The referral criteria for children in Looked After and Adopted families are a lower threshold for acceptance as we are aware that these children experience difficulties with the nature of their social circumstances. However these arrangements vary between the three boroughs. Liaison with social care is essential.

Haringey: 'First Step' delivered by the Tavistock and Portman NHS Foundation Trust provides mental health screening via the Strengths & Difficulties Questionnaire (SDQ) for all Haringey looked after children upon entering care and annually thereafter. The service provides advice, assessment / brief intervention where the SDQ indicates concern or if a social worker is concerned about a child's wellbeing. The team encourage social workers to contact them at any time if they have concerns, and they will discuss the child's needs and recommend an initial First Step assessment / brief intervention and / or a referral to CAMHS or other agencies for longer-term treatment as indicated. For looked after children registered with a Haringey GP they would access provision in line with the stipulated criteria for the service. For some young people the presenting issues may be more appropriate for the Tavistock and Portman Fostering, Adoption and Kinship Care (FAKCT) service or for other providers within the CAMHS network, and in that case the referral would be passed by CAMHS Access to the relevant agency.


In Barnet, for those children resident and under Barnet Social Services, the Barnet CAMHS LAC team will provide a service supporting mental health disorders for these children and young people. A specialist service can be accessed through the Tavistock and Portman NHS Trust when needed and referred by local services.

In Enfield, for those children resident and under Enfield Social Services team CAMHS will provide a service supporting mental health disorders for these children and young people through their HEART team. A specialist service can be accessed through the Tavistock and Portman NHS Trust when needed and referred by local services.

11 Problems where CAMHS can be involved (where there is a significant mental health impact)

11.1 Delays in development: Developmental delays /disabilities should be referred in the first instance to Community Paediatrics, who may refer on to CAMHS for management of associated mental health / behavioural difficulties after their own assessment/treatment.

11.2 Significant learning disability with co–morbidity: of enduring, severe challenging behaviour or mental health problems.

11.3 Medical Conditions and Physical Disabilities: where there are co-morbid with mental health problems

11.4 Enuresis or Soiling-refer to CAMHS: if this is secondary in origin and primary causes are ruled out.

11.5 When a compensation claim is outstanding, such as in relation to the trauma experienced due to a Road Traffic Accident: the young person can be referred to CAMHS once the legal matters have been resolved if suffering from psychological distress. However, if the child’s difficulties are severe or high risk then a CAMHS referral should take precedent over legal matters.

11.6 Response to negative life events (e.g. bereavement, persistent bullying, family breakdown or family discord): These are life events that can be managed in the family setting, and sometimes support from other agencies can help families. However if these life events are having a significant and/or enduring impact on the young person's life and functioning sufficient to meet threshold criteria, then a referral to CAMHS is appropriate.

12 Problems CAMHS Cannot Assess

12.1 Custody, Contact Issues, Legal Care, Divorce: CAMHS do not prepare reports or assessments for divorce / family proceedings.

12.2 Reports for court should be commissioned from professionals who work on a private basis.


12.3 Substance Misuse Problems: If substance misuse is the main presenting problem CAMHS Access will send or advise the referral to the appropriate local agency.

12.4 Dyspraxia: Useful website - Dyspraxia foundation

http://www.dyspraxiafoundation.org.uk/

12.5 Learning difficulties and learning disability without comorbid mental health problems: Needs to be addressed within the educational system. Parents should discuss with their child's school, particularly the school's Special Educational Needs coordinator. Useful website - Dyslexia Action: http://www.dyslexiaaction.org.uk/

12.6 Cognitive assessments: CAMHS does not accept referrals for cognitive assessments or educational psychology assessments.

13 Problems that do not meet the threshold for Tier 3 CAMHS referrals

13.1 CAMHS Access clinicians can redirect these referrals to appropriate services, or referring professionals can refer direct.

13.2 Mild Adjustment Reaction: Children and young people may present with milder transient emotional and behavioural difficulties, in response to stressful life events e.g. exam stress, educational transition, peer difficulties/bullying, parental discord, divorce or separation, life adjustment difficulties and parenting problems, and develop no associated mental illness. Such referrals are not appropriate for specialist mental health services, and referral to other agencies should be considered.

13.3 Behaviour problems mainly within the school setting: If school staff are concerned about a child’s behaviour in school, the SENCO should consider referring to other agencies such as the Behaviour Support Service via a CAF or Early Help form. If there are associated learning difficulties, then they can consult their Educational Psychologist. If the problem relates to school attendance, referrals should be made to the Targeted Youth Support Service or Educational Welfare Officer in the first instance. In other cases, prior to referral to CAMHS, an attempt should have been made to resolve the difficulties with the help of universal or targeted services.

13.4 Mild Difficulties in Children Under 5 (e.g. feeding, sleeping difficulties or tantrums for example): Parents should initially contact their Health Visitor or Children’s Centres.

14 Did Not Attend (DNA) Rules for CAMHS Service users who fail to attend

14.1 CAMHS Access staff should ensure they are aware of the requirements of the ‘Safeguarding Children who Did Not Attend (DNA) Hospital Appointments or Were Not Brought In (WNBI) by their carers Policy’ (available via BEHMHT Intranet)


http://www.dyslexiaaction.org.uk/

14.2 A DNA is defined as the situation where a child fails to present / be presented for a service where a referral for specialist assessment or intervention has been requested. It can also encompass situations where parents/ carers fail to arrange appointments for their child following an invitation letter or where young people also do this.

14.3 Teams should be aware of how to best manage the ‘Barriers to Engagement’ as outlined in the ‘Safeguarding Children who Did Not Attend (DNA) Hospital Appointments or Were Not Brought In (WNBI) by their carers Policy’

14.4 DNA of first appointment – check address with referrer. Failure to attend an appointment by a service user should always be communicated to the referrer and/or the General Practitioner.

14.5 It is for the individual practitioner to make a professional judgement based on available information to decide how to respond to a failure to attend. Options include offering a further appointment, in writing or by telephone; involvement of the referrer or other appropriate professional; and discharge from care.

14.6 Following DNA of a booked appointment if the child is known to social care the social worker must be informed immediately if there is deemed to be high risk or if there is an ongoing pattern of non-attendance. If they are not known to social care a discussion should take place with the referrer to assess the degree of risk or the progress notes should be reviewed

14.7 Where there are sufficient concerns around non-attendance and the wellbeing of the child a referral to Children’s Social Care should be made and details recorded in the child’s record including any feedback to the referrer and GP on actions taken.

14.8 A single DNA of first appointment is likely to result in discharge if the patient does not respond to a further follow up letter and telephone/communications and referrer informed.

14.9 In accordance with the Trust policy discharge from care should only occur after careful consideration and in the context of a review of the care plan. In all cases the GP and referrer must be informed of decision to close the case.

14.10 In the case of referrals that have been flagged the referrer will be written to. The referrer may be asked to make a further referral to social care in the first instance, if social care are already aware of the case, they should be notified.

14.11 All decisions to close a case should be entered into the case-notes; admin must also be informed to ensure closure on the appropriate IT system.

14.12 The General Practitioner and patient should be informed of the decision to close in writing, with a plan for future engagement of the patient as appropriate. As a matter of good practice correspondence should be copied to other professionals involved in the service user’s care.

14.13 Standard practice following two sequential DNA follow up appointments is that patients are liable for discharge and the referrer is also informed. This may be reconsidered by the clinician concerned subject to circumstance.


14.14 If patients have expressed concerns in respect of the DNA, clinicians may reconsider the situation and the need for further appointments. This should be recorded for future reference. NB the service will take into account any previous poor attendance history when making that decision.

15 Appendix 1 CAMHS Referral Form (pages 21-25)

15.1 The CAMHS Referral Form is provided below for reference. However to download Microsoft word copies of this form go to the BEH-MHT website:

http://www.beh-mht.nhs.uk/gps-and-referrers/making-referrals.htm and click on ‘CAMHS Access Referrals’ Page.

16 Appendix 2 CAMHS Leaflets (pages 26-62)

16.1 Printed and PDF versions of the CAMHS Access Leaflets prepared by BEHMHT Communications will be available via CAMHS services and to download from http://www.beh-mht.nhs.uk/gps-and-referrers/making-referrals.htm (click on ‘CAMHS Access Referrals’ Page).

16.2 The content of each of the leaflets which differs by borough - Barnet, Enfield or Haringey – see appendix for reference.


Monitoring Compliance and Effectiveness

MONITORING COMPLIANCE WITH AND EFFECTIVENESS OF PROCEDURAL DOCUMENTS FORM

1. How will the document be monitored?(please circle as appropriate)

Audit ReviewOther, please specify;

Methodology: Monitoring through clinical network and local operational management groups.

2. What is the process for reviewing results of monitoring?

For results to be discussed/disseminated and changes to be implemented if indicated

3 Report to: Policy Review Group4. Who is responsible for

conducting the monitoring?(please circle as appropriate)

Group / Committee Individual

Name / Title (also include position of individuals):Local CAMHS Manager’s in each Borough

5. How often will the document be monitored?(please circle as appropriate)

Monthly 6 Monthly Yearly

Other, please specify;

Comments:

6 Responsibility for action planning after review

Collective group responsibility of the 3 Borough CAMHS Managers


10. Equality Impact Assessment and Analysis Form

EQUALITY IMPACT ASSESSMENT AND ANALYSIS FORM

1. Please indicate the expected impact of your proposal on people with protected characteristicsCharacteristics(where relevant)

Significant +ve

Some +ve Neutral Some -ve Significant -ve

Age: XDisability: XEthnicity: XGender re-assignment: XReligion/Belief: XSex (male or female) XSexual Orientation: XMarriage and civil partnership

X

Pregnancy and maternity XThe Trust is also concerned about key disadvantaged groups event though they are not protected by lawSubstance mis-users XThe homeless XThe unemployed XPart-time staff XPlease remember just because a policy or initiative applies to all, does not mean it will have an equal impact on all.2. Consideration of available data, research and information. (delete grey guidance text once read)Please list any monitoring, demographic or service data or other information you have used to help you analyse whether you are delivering a fair and equitable service. Social factors are significant determinants of health or employment outcomes. Monitoring data and other information should be used to help you analyse whether you are delivering a fair and equitable service. Social factors are significant determinants of health outcomes. Please consult these types of potential sources as appropriate. There are links on the Trust website:• Joint strategic needs analysis (JSNA) for each borough• Demographic data and other statistics, including census findings• Recent research findings (local and national)• Results from consultation or engagement you have undertaken• Service user monitoring data (including age, disability, ethnicity, gender, religion/belief, sexual orientation and)• Information from relevant groups or agencies, for example trade unions and voluntary/community organisations• Analysis of records of enquiries about your service, or complaints or compliments about them• Recommendations of external inspections or audit reports

Key questions (supports EDS Goals)Your ResponsePlease reference data, research and information that you have reviewed which you have used to form your response

2.1 What evidence, data or information have you considered to determine how this development contributes to delivering better health outcomes for all?

http://www.youngminds.org.uk/training_services/policy/policy_in_the_uk/camhs_policy_in_england?gclid=CPDsme-n1sgCFYTnGwodcEIPGg

2.2 What evidence, data or information have you considered to determine how this development contributes to improving patient access and experience?

http://www.youngminds.org.uk/training_services/policy/policy_in_the_uk/camhs_policy_in_england?gclid=CPDsme-n1sgCFYTnGwodcEIPGg

2.4 What evidence, data or information have http://www.youngminds.org.uk/training_services/


you considered to determine how this change/development/plan contributes to inclusive leadership and governance?

policy/policy_in_the_uk/camhs_policy_in_england?gclid=CPDsme-n1sgCFYTnGwodcEIPGg

3. It is Trust policy that you explain your proposed development or change to people who might be affected by it, or their representatives. Please outline how you plan to do this.

Group Methods of engagement

CAMHS Services Requested contribution and engagement

GPs Requested contribution and engagement

Local CYP Agencies Requested contribution and engagement

4. Equality Impact Analysis Improvement PlanIf your analysis indicates some negative impacts, please list actions that you plan to take as a result of this analysis to reduce those impacts, or rebalance opportunities. These actions should be based upon the analysis of data and engagement, any gaps in the data you have identified, and any steps you will be taking to address any negative impacts or remove barriers. The actions need to be built into your service planning framework. Actions/targets should be measurable, achievable, realistic and time framed.Negative impacts identified Actions planned By who

6. Sign off and publishingOnce you have completed this form, it needs to be ‘approved’ by Service Director, Clinical Director or an Executive Director or their nominated deputy. If this Equality Impact Analysis relates to a policy, procedure or protocol, please attach it to the policy and process it through the normal approval process. Following this sign off by the Policy Review and Monitoring Committee your policy and the associated EqIAn will be published by the Trust’s policy lead on the website.If your EqIAn related to a service development or business /financial plan or strategy, once your Director or the relevant committee has approved it please send a copy to the Equalities Team ([email protected]), who will publish it on the Trust’s website. Keep a copy for your own records.I have conducted this equality Impact analysis in line with Trust guidanceYour name: Andrew Smith Position: Interim Projects Manager

Signed: Andrew Smith Date: October 2015

Approved by:Your name: PositionSign:Date

Checklist for the Review and Approval of procedural DocumentTo be completed and attached to any document which guides practice when


submitted to the appropriate committee for consideration and approval.

Title of document being reviewed: Yes/No/Unsure Comments

1. TitleIs the title simple and clear to everyone who reads it? Yes

Is it clear whether the document is a guideline, policy, protocol or standard?

Yes

2. RationaleAre reasons for development of the document stated? Yes

3. Development ProcessIs the method described in brief? YesAre individuals involved in the development identified? Yes

Do you feel a reasonable attempt has been made to ensure relevant expertise has been used?

Yes

Is there evidence of consultation with stakeholders and users? Yes

4. ContentIs the objective of the document clear? Yes

Is the target population clear and unambiguous? Yes

Are the intended outcomes described? Yes

Are the statements clear and unambiguous? Yes

5. Evidence BaseIs the type of evidence to support the document identified explicitly?

Yes

Are key references cited? YesAre the references cited in full? YesAre local/organisational supporting documents referenced?

Yes

6. ApprovalDoes the document identify which committee/group will approve it?

Yes

If appropriate, have the joint staff side committee (or equivalent)

Yes


Title of document being reviewed: Yes/No/Unsure Comments

approved the document?

7. Dissemination and ImplementationIs there an outline/plan to identify how this will be done? Yes

Does the plan include the necessary training/support to ensure compliance?

Yes

8. Document ControlDoes the document identify where it will be stored? Yes

Have archiving arrangements for superseded documents been addressed?

Yes

9. Process for Monitoring ComplianceAre there measurable standard to support monitoring compliance of the document?

Yes

Is there a plan to review or audit compliance with the document? Yes

10. Review Date

Is the review date identified? YesIs the frequency of review identified? If so, is it acceptable? Yes

11.

Overall Responsibility for the DocumentIs it clear who will be responsible for coordinating the dissemination, implementation and review of the documentation?

Yes


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