1. Specialist Child and Adolescent Mental Health Service (CAMHS)
Introduce myself – nearly 3 years in this role, working closely with commissioners and partner agencies to develop services
Key points today:
Overview of current services and structure
Underpinning principles and philosophy
Clarity about accessing the service – Requests For Involvement
Specialist Child and Adolescent Mental Health Service (CAMHS)
May 2012
Alison Chisholm, Service Manager

2. Overview of service
Secondary/specialist multi-disciplinary mental health service for children and young people from 0 – 18 (19 with additional needs)
Community Mental Health Teams (Tier 3)
Inpatient Unit (Tier 4) – Wessex House, Bridgwater
Outreach/home treatment
Specialist substance misuse service – integrated with community CAMHS
ND CAMHS – specialist service for Deaf children and young people
Learning Disabilities/Mental Health - Additional Needs resource
Links to Youth Offending Team – one seconded CAMHS post
C0MPASS (Musgrove Park Hospital) – psychological interventions for children and young people with life limiting conditions
Overview – more details on subsequent slides…

3. Community CAMHS – (1)
Multi-disciplinary teams (psychology, psychiatry, nurses, social workers, therapists, occupational therapists, primary mental health link workers, managers)
Mendip: Priory House, Wells
South Somerset: Balidon Centre, Yeovil
Taunton Deane: CAMHS West, Foundation House
Somerset Coast: Taunton

4. Community CAMHS (2) Assessment - formulation/diagnosis
Care planning – Recovery model
Collaboratively agreed goals and timescales
Wide range of direct therapeutic interventions:
Brief Solution Focused Therapy, Cognitive Behaviour Therapy, Family Therapy, Creative Therapy, medication
Advice and consultation
“Signposting” to more appropriate services
Training
Brought the Taunton and Somerset Coast teams together in June 2009, to build capacity and strengthen service delivery across the West of the county – CAMHS West.
Also identified range of other bases across Somereset Coast and West Somerset – GP practices, children’s centres, accessing Rio remotely to make best use of practitioners’ time and reducing travel where possible
Recognise that on the East of the county geography presents different challenges, so working closely with Nigel and the teams to develop closer working across the patch, but in different ways.
Upgrading our community bases to ensure they are fit for purpose – Foundation House completed, Balidon Centre in progress
Size of multi-disciplinary teams – equivalent of approximately 8 whole time equivalents in each sector, so essential to make best use of our limited resources – at the lower end in terms of CAMHS Mapping/national benchmark

5. Community CAMHS (3) Referral criteria:
Mental health = significant impact on function (e.g. inability to attend to school due to severity of anxiety)
Significant or severe levels of risk of harm to self or others
Complex problematic substance misuse
Timescales:
Emergency – within 24 hours/immediate
Urgent – within 7 day
Routine – within 3 weeks

6. Community CAMHS (4): mental health conditions
depression
anxiety
obsessive compulsive disorder
psychosis
significant self harm and/or suicidal ideation
eating disorder
complex emotional and family problems
Attention Deficit Hyperactivity Disorder (complex, or with additional needs)
post traumatic stress disorder
dual diagnosis (e.g. Autistic Spectrum Condition/Learning Disability plus any of above)

7. Substance misuse
Integrated specialist substance misuse treatment service
Working with young people with complex and high risk drug and alcohol problems
Joint working with Community CAMHS for young people with additional mental health needs
Inter-agency working (YOT, Targeted Youth Service, Turning Point
4 whole time specialist substance misuse workers, based in CAMHS community teams across the county
4 x Tier 3 very experienced and committed Substance Misuse Workers

8. Referral sources: GPs Health Visitors
Special Educational Needs Co-ordinators (SENCOs)
School pastoral leads/Heads of Year
School Nurses
Parent and Family Support Advisors (PFSAs)
Children’s Centres*
Children’s Social Care*
Youth Offending Teams and Targeted Youth Support Service*
Educational Psychologists
Somerset Direct
Paediatricians (community and acute)
Acute hospitals children’s ward
Integrated Therapy Service*
Somerset Advocacy Service*
Children and young people discharged from Specialist CAMHS with an agreed ‘fast track’ route to re-referral as part of an agreed discharge/relapse management plan (“Orange Card”)
*NB The Request for Involvement must be discussed with and agreed by relevant managers within each organisation.

9. Key principles - and challenges
Committed to develop an early intervention model - as well as meeting the needs of the most vulnerable children and young people
Partnership and multi-agency working – across the continuum of education provision
Information sharing – acknowledging the tensions
Identifying, achieving and measuring outcomes
Sustaining reduced waiting times
Ensuring high quality and evidence based practice
Implementing the Recovery Care Programme Approach – in line with adult and older people’s services, putting the child and young person at the heart of the process, building on their aspirations and goals – [separate sheet in packs]

10. Challenges for 2012 and beyond (1)
Small CAMHS service against national benchmarking: approx 133 wte staff (55 wte Inpatient, 78 wte Community)
Pressures on overall NHS budgets
Likelihood of decrease in resources although age range changed from 17 to 18 with new Service Specification
Steady increase in numbers and complexity of referrals to CAMHS from all sources (305 in March 2012)
Current caseload: 1800

11. Challenges for 2012 and beyond (2)
Impact of known and unknown changes in other agencies (particularly CSC/Local Service Teams/Education)
Impact of rise in numbers of children and young people subject to Child Protection Plans or becoming LAC
Responding to statutory framework re Looked After Children (including very complex young people placed in Somerset by external agencies)
Responding to new commissioning arrangements under Health and Social Care Bill – Clinical Commissioning Group (GPs)

12. Responses for 2012 and beyond (1)
Review service delivery model – focus on solution focussed approach (“ready, willing and able” to access treatment)
Review referral criteria and processes
Improve access and information e.g.
telephone help line
web based information (self help, information for professionals, contact details)
Ongoing critical review of all posts/reinvestment/redesign/skill mix
Further develop Recovery Care Programme Approach (personalised care planning) including robust review and timely discharge/transitions
I hope this has provided you with an understanding of CAMHS , its strategy and the aspirations of the service
There are lots of challenges facing us, along with colleagues in other children’s services, and in the current climate, even more important to work effectively together – with the emphasis on early intervention and prevention
Overall, I believe there is a will and enthusiasm within the service to move ahead with a sense of collaboration both within the Trust and with our partner agencies, and with commissioners

13. Responses for 2012 and beyond (2)
Develop integrated training strategy across Children and Young People’s Service – focus on early intervention, sharing skills and building confidence
Priority training programme for School Nurses
Develop care pathways across integrated services (e.g. ADHD, ASD, eating disorders, additional needs)
Pro-active and positive engagement with new commissioners and stakeholders – including education

14. Examples of additional services and joint agency models
Evidence based training packages on specialist subject areas, including:
Making sense of behaviour that is difficult to understand
Preventative interventions
De-escalation and re-integration strategies
Direct interventions with family and schools regarding individual young people
Active planning under way with Educational Psychology and Integrated Therapy Service – working towards a programme building on evidence based TAMHS pilot

15. And finally…
Recognising the limits and limitations of a commissioned Specialist Mental Health Service
Welcoming opportunities to learn more about the challenges facing schools
Finding creative and collaborative solutions
Shared goals – improving outcomes for young people

16. Contact details: Alison Chisholm CAMHS Service Manager
Tel:
Sue Pearson
Team Manager - CAMHS West
Nigel Potter
Operational Manager – Mendip and South Somerset
Tel: or
Maria Gascon-Ramos
Operational Manager - National Deaf CAMHS (ND CAMHS)
Tel: or text:
Follow links on website to access Information for Professionals and Information for Families leaflets, and Request For Involvement forms