For all children the normal route to assessment would be through referral to Community Paediatrics. If the outcome is unclear or a complex presentation is described a referral to Specialist CAMHS may be considered.
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 Specialist CAMHS is made.
Specialist CAMHS would not normally assess a child for ADHD until they have completed at least one term within P1.
(all types including generalised, separation, OCD, social, phobias etc) Those with recently emerging, mild difficulties should be directed to tier 1 and 2 Services.
Children who show persistent, moderate to severe symptoms of anxiety which interfere with the child’s life should be referred to Specialist CAMHS.
Grief is a normal process and the child & family need time to adjust to the loss.
Referral to specialist CAMHS is only necessary when the loss has had an extreme impact on the child and their functioning; where the child is experiencing difficulties after bereavement support; or where the child is experiencing significant distress and / or difficulties following a bereavement that has occurred in extreme circumstances (e.g. trauma, illness, suicide or accident).
Conduct and behavioural problems
Initial presentations of defiant or challenging behaviour should be addressed by Tier 1 / 2. Early intervention is preferable in such cases and often leads to better outcomes.
CAMHS would consider referrals where:
– The child has a mental health or developmental problem including a learning disability in addition to this behaviour
– Where the child’s parent has had significant support from community agencies and has co-operated well with these but the child’s behaviour has not improved.
We may in the first instance consult with the other professionals involved with a child/family. Referrals are best made via a Child’s Plan so we can be clear on what has already been offered.
Children who are out with parental control should be referred to Social Work in the first instance.
Where symptoms are mild in nature guided self-help and the support of tier 1 and 2 services is often sufficient.
For persistent, moderate to severe symptoms, or if concerns exist regarding significant suicidal thoughts then referral to Specialist CAMHS would be appropriate.
Where there is concern in relation to an eating disorder it is advisable to direct the child / young person / family to their GP in the first instance to consider medical investigations (blood tests, weight, height, weight for height etc) prior to referral. These assessments not only give us an indication of physical state but assist with prioritisation in terms of level of urgency.
If there has been a recent rapid weight loss (1kg+ per week with ED cognitions present) with no physical cause, request urgent appointment.
Early Years and Attachment Insecurities
CAMHS involvement with this age range should be secondary not primary.
Consequently, families should have already received significant advice and intervention from other named professionals such as paediatricians, health visitors, social workers and educational support services including within Nursery.
For more complex difficulties including selective mutism, consultation from Specialist CAMHS may be sought.
Enuresis and Encopresis
Refer to Paediatrician in the first instance who will then refer to other specialist services if appropriate.
You may wish to find out more information from www.eric.org.uk which includes a free downloadable toolkit for parents and professionals
Feeding and Faltering Growth
Consult Health Visitor/Public Health Nurse in the first instance. Refer on to paediatrician and dietetics as necessary.
Initial screening and treatment should be undertaken by the paediatric team who will then refer to CAMHS as appropriate.
Looked After or Accommodated children and young People
Referrals to specialist CAMHS are best made by the responsible social worker (Lead Professional). If concerns exist they will have been discussed in multi agency groups. Local authority services 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.
Referrals for children in this category need to identify whether the 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.
Learning Disabilities and/or Autism Spectrum Disorder (ASD) affecting Children and Young People
Learning disability and/or ASD on its own are not grounds for referral to CAMHS. For CAMHS to become involved there have to be additional concerns about mental health or significant behavioural problems.
CAMHS do not conduct initial diagnostic assessments for learning disability or ASD unless there are complex issues present. Paediatricians, Educational Psychologists, specialist teachers and Speech and Language Therapists all have a role in assessing children for learning disability and/or ASD.
Specialist CAMHS can offer consultation to those professionals working with children and young people with a learning disability and/or ASD who are not referred or open cases to CAMHS.
Referral to Specialist CAMHS is indicated.
If urgent, contact CAMHS within normal working hours. Outside this time contact Accident and Emergency if emergency assessment is required.
Where a child is experiencing physical symptoms initial referral to a paediatrician is recommended to rule out any organic cause.
For persistent and moderate to severe symptoms which have a significant impact on the child’s functioning referral to Specialist CAMHS may be appropriate.
Post Traumatic Stress Disorder / Acute stress disorder
Psychological intervention is unlikely to be possible where the child’s living situation continues to be insecure and traumatic.
It is important to know whether there are legal proceedings pending and to clarify the purpose of assessment (for legal processes, or to receive treatment).
Where symptoms have not settled one month after the traumatic experience and where persistent, moderate to severe symptoms exist, referral to Specialist CAMHS may be appropriate.
Schools and education departments have their own resources (e.g. inclusion support workers, educational psychologists and behavioural support services) which should be implemented and evidenced prior to referral being accepted.
CAMHS will not accept referrals for school truancy only and referrers should consult with other Children’s Services in the first instance.
Self Harming Behaviour
(with and without suicidal intent) Overdose and other incidents of serious self-harm should be sent directly to A&E in the first instance.
If you are concerned that the self harming behaviour is indicative of a disturbance of mental health then you should refer to CAMHS. For persistent, moderate to severe symptoms, referral to Specialist CAMHS may be appropriate.
Tourette’s Syndrome and Complex Tic Disorders
Tics are relatively common in children and don’t usually cause any problems. You may be able to reassure parents using the advice/self-help links. If tics significantly interfere with a child or Young Person’s day to day functioning or cause significant distress/anxiety referral to CAMHS may be appropriate.
If the tics are part of a neurodevelopmental disorder then a community paediatrician may be more appropriate as the first point of referral.