1. Mindsight CAMHS service and a Behaviour, Emotional and Neurodevelopmental Pathway
Dr Phil Ferreira-Lay
Clinical Director for CYPS
Lead Consultant Child Psychiatrist
Consultant Psychiatrist in Adult ADHD & ASD Service

2. What we stand for
We provide services to improve the mental health and wellbeing of children and young people in Surrey
We consider this our duty and in line with our values, which guide all that we do – it’s all about doing the right thing and is in line with the principles and values outlined in the NHS Constitution
- to treat people well
involve and not ignore
create respectful places
be open, honest and accountable
We proactively seek feedback from people who use our services in order to learn lessons and improve.
And the way we treat and involve our staff is also important to us and we were delighted this summer when we were named by the Health Service Journal and Nursing Times as one of the top 100 places to work in the NHS.
But our CAMHS services are also about making connections – with mental and physical health, families, communities and the places we live.

3. Service Model Diagram
Our integrated service model puts children and young people at the heart of all we do with a focus on getting them to the right support first time and preventing ill health. You will see here there are four levels of service:
Wellbeing and resilience which includes prevention and online support services
Targeted services for specific needs such as looked after children and a new adopted support service
Specialist Services which include a new complex behaviour service and eating disorder services
Crisis Support service which will include more 24hr support for children and young people including a home treatment team for 16-18yr olds
We are providing this new model of care in partnership with other voluntary, statutory and private providers who are all experts in child and adolescent support.
All the CAMHS partners are ambitious about supporting Surrey families to live well and achieve an excellent quality of life.

4. One Team
We’re going to move on now to talk about our partnership (Question 1.2) as we are here today as part of a partnership of organisations committed to providing the best possible services – you can see the logos of the organisations that form a part of our partnership on the screen. Together we form One Team for Surrey

5. What is Different
' CAMHS One Stop' - Referral & Information Centre for all referrals, which will navigate children and young people to the most appropriate service and through the system, , from 1 April
A “no wrong door” i.e. all children, young people and families will be supported to find the right help at the right time
The threshold criteria for acceptance into CAMHS will be lowered and volumes are expected to increase significantly
Expanded operating hours 8am-8pm Monday to Friday and 9-12 on Saturday
Services will be made more accessible and user friendly through convenient locations and online services
Automated clinical scheduling will ensure capacity, appointments and room availability is transparent and easier to manage
A more managed model of care with clear outcome monitoring after every session
A fully operationalised range of NICE compliant pathways, including:
New behaviour pathway
Introduction of CYP IAPT
Additional and specific support for adopted children and their families.
Many other current CAMHS pathways will be enhanced
Reporting requirements from commissioners on activities and outcomes will be more demanding
Continued work with CAMHS Youth Advisors and development of an employment pathway for young people.

6. CAMHS-One Stop (Beacon) Means No Wrong Door

7. Building Wellbeing and Resilience
Guided self help and support materials
Primary mental health
Kooth.com
CYP IAPT
TAMHS
Youth Support Service
Voluntary Sector Counselling
Parental Support Programmes
We want to provide help and support to children and young people when they begin to feel unwell – to build wellbeing and resilience before their condition may worsen and they may risk having to attend A&E or be admitted to hospital.
Our partnership will provide this support at all levels of need in a number of ways, including…

8. Targeted Services Primary Mental Health
3Cs Looked After Children* (expanded)
Adopted Children*
CAMHS Care Leavers (expanded)*
HOPE and Extended HOPE
STARS (Sexual Trauma and Recovery Support) (expanded)*
PIMHS (Parent and Infant MH Service)
Behaviour Pathway for children with Neurodevelopmental Disorders*

9. Specialist Services Community CAMHS CYP Learning Disabilities Service
Eating Disorder Service
Mindful year olds (Expanded)

10. Crisis Support Services
Extended HOPE Service
365 / 24 / 7 psychiatrist on call
Paediatric liaison
Home treatment team for year olds
Extending the safe haven model for children and young people
Referral through CAMHS One-Stop

11. Behaviour Pathways- Why are we here?
In 2013/14, as part of a wider stakeholder engagement to set our 5 year strategic direction, Surrey Commissioners identified the need for improvements to Behavioural services for children and young people.
With the re-procurement of CAMHS services, an opportunity arose to address these concerns.
We had the opportunity to specify a much more joined-up model of service provision and address some of the “gaps” in the care and management of children and young people with Behavioural Problems.

12. Needs assessment - Surrey
National prevalence: 1 in 10 children between age 5 and 16 years have a mental health problem
“There is an estimated increase in the number of children with mental health disorders in Surrey from 5,884 in 2009 to 6,014 in 2012, based on an increase in the population estimates.”
Surrey Health Needs Assessment, Jan 2014

13. Needs assessment - Surrey
The prevalence of ADHD in the UK is estimated at between 2 and 5%.
In North West Surrey that equates to a population of around 2, ,000 children.

14. NW Surrey Service Illustration
Acute Paediatrics Behavioural Services – ASPH seeing about 1, ,000 children per year
Developmental Paediatrics – VCSL seeing about 250 new patients per year
Tier 3 Specialised CAMHS services – SABP seeing about patients per year
Youth Counselling --VCSL
Education and Schools – PMHW/ School link workers/Educational Psychologist
Surrey County Council – Tier 2 Targeted CAMHS services -- SABP
Family Support Service
Youth support service
Voluntary/third sector e.g. Carers’ Support, Family Voice, Surrey Youth Action
The current services available in NWS are confusing and unclear. GP’s and Families often find themselves bounced between agencies who due to increasing demand and lack of capacity raise thresholds and acceptance criteria. This slide shows the complexity of the current system. There is significant of lack of joined up working between health and education where our children spend the vast majority of their time and where most intervention should be aimed.

15. Young Person’s Journey- Since April 2016
Beacon SPA Screens Referral
Referrals will come via the Single Point of Access (SPA) and will include all Children and Young People meeting the criteria with mild to severe difficulties
Decision will be made whether the CYP needs to be referred into the BEN pathway.
This first stage assessment stage will involve telephone interviews with families, schools and other professionals to gather background information. Also clinical details and completed clinical ASD & ADHD questionnaire.
If the young person is not eligible for BEN pathway the young person will be signposted to other areas of the CAMHS service for an initial face-to-face assessment interview.

16. Hub Received Completed Tool
Accepted referrals for the BEN Pathway will either go into the ASD, ADHD pathway or Complex Behaviour Pathway (incl. FASD)

21. Diagnostic Assessment
Diagnostic assessment will differ depending on the complexity and will be done in a variety of locations within Surrey depending of the need of the young person.
If the outcome is:
Positive they will have a multidisciplinary review, therapeutic interventions plus medication where indicated
Negative they would step down and be discharged out of the other service

23. Step Down & Exit Plans
Transition to adult ADHD or ASD service
Discharge if moved out area
No longer require support
Discontinued medication

24. Pre-Diagnostic & Post-Diagnostic Support
Pre-diagnostic support - Will involve individualised and / or group based interventions such us parenting groups, ADHD/ASD support and psychoeducation.
For ASD this can involve parenting groups and web based support and psychoeducation
Post-diagnostic support – individual and group based interventions will be available.

25. Get in touch CAMHS One Stop 0300 222 5755
website sabp.nhs.uk/mindsightsurreycamhs

26. Thank you