CAMHS Knowsley Service Overview

KCAMHS provides a service for children and adolescents from 0- end of Yr. 11 (high school).

Most families, children and adolescents will be seen at our bases in Huyton, Kirkby and Halewood. KCAMHS ensures that families are always seen at a base or facility within easy reach of their home address. Sometimes local Health Centres, Educational and Social Services premises are used. Where necessary and appropriate, domiciliary visits are undertaken.

A service is provided from Monday to Friday, i.e. between 9 am - 5 pm. In Spring 2004, it is envisaged that KCAMHS will provide ‘twilight clinics’ subject to service users’ preferences. There is no out of hours on-call service provided by KCAMHS. After 5.00pm., an answerphone

Patients admitted to Whiston Hospital over the weekend will be assessed by a member of the KCAMHS emergency duty team on the following Monday

KCAMHS operates a daytime emergency on call system to respond to cases requiring urgent assessment.

There are considerations being given to offering service users twilight clinics (up to 7.30 pm) from April 2004.

CLINICAL TEAM (JANUARY 2004)

SECRETARIAL TEAM

* Posts with remits which extend beyond the generic CAMHS

ELIGIBILITY CRITERIA – WHO CAN AND CAN’T ACCESS THE SERVICE

• Complex psychiatric/psychological sequelae of child abuse/neglect not otherwise negotiable by the local child protection procedures
• Depressive disorders
• Psychotic Disorders
• Disorder associated with substance misuse (including alcohol) and dual diagnosis
• Deliberate self-harm
• Anxiety disorders
• Psychosomatic disorders
• Eating disorders
• Obsessive-compulsive disorders
• Phobias
• Psychological reactions to significant life events
• The assessment of complex family dynamics
• Consultation and/or assessment of children with complex needs
• Non-compliance with medical treatment
• Serious oppositional/conduct disorders
• Autistic spectrum disorders
• Psychological problems associated with chronic childhood illnesses
• Tic disorders
• Forensic mental health assessment

Referrals to our KCAMHS are accepted from a variety of agencies including most commonly:-

• General Practitioners
• Hospital Paediatrics and Community Paediatricians
• Social Services
• Health Visitors
• Knowsley Child Guidance
• School Attendance Service
• Head Teachers, Deputy Heads, SENCO’s, and Heads of Pastoral Care
• School Nurses Voluntary Organisations
• The Legal System

Referrals, if accepted from all these professional colleagues, will be on the understanding that, in all cases referred to KCAMHS, it is our policy to keep the General Practitioner informed of the referral.

REFERRAL FORMS AND ROUTE(S) INTO THE SERVICE

KCAMHS operates a ‘no waiting list’ as service level agreement with its commissioner, Knowsley PCT.

Standard ‘client referral forms’ have been created to facilitate the quality and speed of processing referrals. Written referrals should, therefore, be submitted on these forms except for emergency referrals. Emergency referrals can be made by fax or by telephoning either of the contact numbers, followed up by completion of the Standardised Client Referral Form

In exceptional circumstances, advice and guidance can be given by the KCAMHS Team Coordinator or a member of the Daytime Emergency Duty Rota to children, adolescents or their care givers who might be seeking help and guidance as to how to access necessary preliminary assessment from colleagues at Tiers 1 and 2 Levels of service provision

Referrers may state their preference for the involvement of a specific team member. Ultimately, nominations of keyworkers will, however, occur taking these preferences into account by discussion with the KCAMHS Team Coordinator and Multi-disciplinary Team.

Within the current clinical resources of KCAMHS, a service cannot be provided for residents living outside the Borough of Knowsley, with the exception, subject to discussion, for children and teenagers in the care of the Local Authority.

All requests for court reports or legal requests must be directed to the Borough Director, 5 Boroughs Partnership Trust, in the first instance. Prior to contacting the Borough Director, the clinician concerned must first approach and draw the matter to the attention of his/her KCAMHS line manager.

All referrals, irrespective of to whom they are addressed, are processed by the KCAMHS Team Coordinator, or, in his absence the deputy team coordinator.

The KCAMHS Team Coordinator., having evaluated and prioritised each referral, will ensure that referrals are brought to the Weekly Team Allocation Meeting. After this meeting, referrals are allocated a keyworker, who assumes clinical responsibility for that case. The referral is then processed through the KCAMHS Computerised Clinical Audit and Management System (MAISY) by the Team Coordinator., whose responsibility for that particular referral then ceases (Appendix 18). Emergency and urgent referrals may be
allocated outside the Weekly Team Allocation Meeting according to the needs of the referral.

At the Weekly Team Allocation Meeting, every referral will be allocated a keyworker. If accepted, a decision is made by the KCAMHS Team Coordinator. in relation to the appropriate level of response from KCAMHS.

All referrals received will be scrutinised, prior to the weekly team allocation meeting, by the KCAMHS Team Coordinator. or in his absence by the Deputy Team Coordinator. If the Deputy Team Coordinator. is not available, the secretaries will ask whoever is on call to check the referral to determine if any emergency action is required.

All cases are accepted by KCAMHS according to the following prioritisation:

EMERGENCY REFERRALS

From the date these are received by KCAMHS, they will be addressed within 24 hours or next working day. Cases will be considered as emergencies where there is such a risk of harm to self or others, by virtue of psychiatric/psychological
disorder, that a response by KCAMHS is required very urgently. Actual cases of deliberate self-harm in teenagers and young children will need to have immediate medical treatment for that self-harm, either from a General Practitioner or from the local hospital.

For all cases where, as a result of children and teenagers having deliberately tried to harm themselves who then present at a local hospital, protocols have already been agreed with medical staff at Whiston Hospital for their management, including a compulsory assessment of any psychological issues before discharge. Thereafter, appropriate follow-up - including, for a small number of cases, referral to KCAMHS is arranged by the medical staff. A first on-call, daytime emergency duty team rota is provided by KCAMHS’ clinicians. The Consultant Child and Adolescent Psychiatrist(s) also provide a second on-call cover for nonconsultant
clinicians, either to provide consultation or to carry out a direct psychiatric assessment, as appropriate.

URGENT REFERRALS

These will be addressed within 14 days and will, wherever, possible be discussed at the Weekly Team Allocation Meeting.

ROUTINE REFERRALS

These will be discussed at the Weekly Team Allocation Meeting when a decision will be made to identify the keyworker, who will be carrying out the initial assessment, either singly or in collaboration with another KCAMHS’ clinician or with a colleague from another agency. This forum also allows for the discussion of complex ongoing cases, internal referrals and possible co-working within the KCAMHS and an opportunity for peer clinical supervision.

KCAMHS aims to see 80% of routine cases within six weeks of receipt of referral and 100% of routine cases within thirteen weeks of receipt of referral, in line with Patients’ Charter Standards.

KCAMHS is fully committed to maintaining a No Waiting List policy and ensuring all referrals are either seen or responded to within as shorter time as is feasibly possible subject to KCAMHS’ procedures to minimise d.n.a.’s.

Referrals will be discussed at the Weekly Team Allocation Meeting and will, in most instances, be allocated to a keyworker unless more referral information is required to facilitate the allocation process. This will involve three components:

1. An allocation component in which all cases will be allocated to a Keyworker;
2. An internal team consultation, where required, to discuss complex processes;
3. A Team Consultation to partner agencies.

The role of the Consultant Family Therapist/Service Manager ends with the allocation of a keyworker unless the Consultant Family Therapist/Service Manager is himself/herself identified as the keyworker.

During the interim period between the date of receipt of the referral and the date of consideration at the Weekly Team Allocation Meeting, the Consultant Family Therapist/Service Manager will continue to hold responsibility for the referral. In the event
that an urgent case becomes an emergency during this interim period, it will be dealt with by the emergency duty rota team. Furthermore, in the event that more referral information is presented to KCMHS, the Team Coordinator. would be contacted and deal with the case if this is acceptable to the referrer. If not, the case should be dealt with by the emergency duty rota team.

TYPES OF ASSESSMENTS PROVIDED BY KCAMHS

Individual psychiatric/psychological assessments, whether for diagnostic or treatment purposes.

• Family assessments.
• Developmental assessments.
• Risk assessments, arising out of psychiatric/psychological problems/ disorders.
• Therapeutic assessments, e.g. to address appropriateness for individual child psychotherapy.

DIRECT AND INDIRECT INTERVENTIONS OFFERED BY KCAMHS

Direct Interventions

• Individual psychological therapies, e.g. cognitive behavioural therapy, drama therapy, play therapy.
• Family therapy.
• Brief/Solution focused therapy.
• Medication
• Clinical hypnosis.

Indirect Interventions

• Consultation may be provided by KCAMHS’ clinicians to other professional colleagues involved in direct work with a child/family/agency.
• Teaching/training/enskilling at Tier 1 and Tier 2 Levels, e.g. Health Visitors, School Nurses, Paediatric S.H.O.’s, Clinical Medical Officers and Social Workers, Foster Carers, Family Centre Staff, Residential Social Workers and Voluntary
  Agencies’ Staff.
• Training Clinical Medical Officers in the management of common child and adolescent mental health problems.
• Training Paediatricians and Social Workers in the initial assessment of cases of deliberate self-harm.
• Training to Knowsley Youth Offending Team and Knowsley Young Persons Substance Misuse Team.

SERVICE USER VIEWS, COMPLAINTS AND COMPLIMENTS

KCAMHS is committed to working collaboratively with service users to find ways to improve services and service delivery through the use of questionnaires, feedback forms etc.

KCAMHS will work with the 5BP to use the Trust’s resources to work in partnership with service users to continuously improve service delivery.