Transcript Tier 2 CAMHS Presentation

07/06/2016
Aims of Presentation-
• Introduce staff at Tier 2 CAMHS;
• Increase awareness of SPA, Tier 2 CAMHS
provision and referral criteria;
• Tracking the child’s journey through Tier 2;
• Areas for improvement;
• Celebrating successes!
Child and Adolescent Mental Health
Services in Medway
• Tier 2 CAMHS – Medway Council Service Jointly
managed by Sussex Partnership & staff from both
organisations. - New Horizons, Chatham
• Tier 3 ChYPS - Sussex Partnership NHS Foundation Trust.
- The Courtyard, Gillingham
There is a Step-up and step-down pathway between
services
Tier 2 CAMHS
 The core purpose of our targeted (Tier 2) Children’s Mental
Health Service is to provide assessment and targeted
treatment of mild to moderate mental health difficulties and
associated risks in all young people under 18 years
 Targeted treatment between 6-12 sessions
 Therapeutic interventions and consultation
Who Works in Tier 2?
 Service Managers - Bob Lomas (NHS) / Andy Willetts (LA).
 Team leader- Zoe Jackson
 Clinical Psychologist – Anna Moriarty
 Primary Mental Health Workers - Sarah Long , Rachel Dewey, Anna Scarr & Leona
Smith
 Mental Health Support Workers - Scott Baggley, Paula Potter & Lauren Heritage
 Mental Health Key Workers – Amelia Norgate, Katie Thomas, Yvonne Temah
 CAMHS Nurse – Amma Osie-Kuffor
 Trainee Clinical Psychologist - Hannah Prytherch
 Administrative support – Patricia James, Sam Yates & Janet Outred
Single Point of Access
 Sits within Tier 2 CAMHS.
 Referrals from any professional
 Referrals can be made via Telephone or form that is
emailed. We also accept letters.
SPA Challenges
 NOT ENOUGH INFORMATION !!!!
 Does not meet criteria for a mental health service.
 YP has not accessed anything at T1/Universal
level.
SPA Outcomes
Possible outcomes following referral:
• Accepted by Tier 2 for assessment.
• Accepted by Tier 3 or other specialist services e.g.
Child in Care Team.
• Accepted by Oakfields or Post abuse service (All
Saints).
• Discussed with Community Paediatricians (joint
clinic).
• Declined with advice/recommendations
SPA facts and figures
 Equal split in referrers from Health, Social
Care and Education.
 Approximately 200 referrals received.
 Approximately 50 – 75 are accepted
by Tier 2 and assessed.
Referral trends
 Majority of referrals to T2 in regards to anxiety problems.
 Recent increase in social anxiety in both males and females.
 Primary school aged children with complex
neurodevelopmental profiles and co-morbid behavioural
and/or attachment issues.
 High referral rate primary and secondary age for children
with ASD and behavioural and/or anxiety problems
Tier 2- Referral Criteria
 Significant mental health problems which are;
1) Not transient (i.e. short term / reactive to a particular
situation which will pass – e.g. exam stresses);
2) Present and impacting in at least 2 areas of
functioning i.e. significant impairment of personal, family,
academic or social functioning;
3) A lack of sufficient response to universal
interventions (at Tier 1), e.g school counselling.
Tier 2 Referral Criteria- Depression
Depression Mild to Moderate or persistent low mood
• Core symptoms – depressed mood, loss of interest and enjoyment,
increased fatigue.
• Physical symptoms – poor sleep, altered appetite or weight
• Cognitive symptoms – reduced self-esteem and self-confidence, guilt
and worthlessness, bleak and pessimistic views of the future
• Suicidal ideation – ideas or acts of self-harm (please consider level of
intent and current thoughts)
• Co-existing – depression often occurs alongside other mental health
problems (especially anxiety)
Self-harming behaviour where these are assessed at lower
risk.
Tier 2 Referral Criteria - Anxiety
Mild – Moderate Anxiety Disorders which impact on
daily functioning including:
• OCD
• Phobias impacting on functioning
• Social Anxiety
• Separation Anxiety in context of Attachment Disorder
• Generalised Anxiety Disorder
• Panic
Tier 2 Referral Criteria - Other
 Eating Disorders and difficulties with eating; where there
is a mental health issue and is not behavioral/fussiness.
 Trauma – past trauma impacting on mental health and
functioning ie. mood, anxiety in addition to symptoms
such as severe sleep disturbance
 Physical health conditions only when co-morbid mental
health difficulties
 ASD and ADHD only when co-morbid mental health
difficulties
What we don’t accept Referrals about apparent mild or transient concerns.
 Referrals for school based problems such as bullying and
non-attendance without mental health co-morbidity.
 Referrals where social and environment factors
dominate, without any identified mental health or
psychological needs.
 Physical health conditions/ adjustment to illness in the
absence of co-morbid mental health difficulty.
 Anger management/ Behavioural without psychiatric comorbidity
 ASD / ADHD without co-morbid mental health.
Tier 2 Assessment
 Initial mental health assessment by any member of
the team.
 Possibility for extended assessment.
 Joint assessment with community paediatricians / Tier
3 CAMHS if required.
Assessments are discussed in supervision or in
fortnightly Case Discussion meetings with the whole
team.
Tier 2 Interventions
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6-12 session model
CBT informed work
Solution Focussed work
Psychoeducational work
Systemic work
Parent training
Behavioural work
• Community, Health Centres, Schools, Drop-in clinics
• Individual, parents, family or group
Journey Through Tier 2
Telephone / Online Referral
Initial Assessment
Treatment Sessions
Closure
Staff review and discuss cases regularly – at any point a case may take an
Alternative route if more appropriate – T3, Universal, NFA
Tier 2 Moving forwards
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Current recruitment drive
Deliver more group interventions
Stronger links / joint working with Tier 3 & Social Care
Further service user involvement
Taking more opportunities to collect and monitor
feedback and to evidence outcomes
Successes
 Survived the turbulent transition from CAST to Tier
2 CAMHS!
 Recruitment is underway … positive impact on
waiting times.
 Joint working with Tier 3 has increased.
 Positive feedback received from families.
 Positive feedback from professionals.
Successes
‘The programme helped us to
feel so much happier and [our
child] now has parents that
are able to reach her full
potential.’
‘Having someone to talk to has
helped me so so much.’
Any Questions?