1. Medway Tier 2 CAMHS
07/06/2016

2. 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!

3. 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

4. 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

5. 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

6. Single Point of Access Sits within Tier 2 CAMHS.
Referrals from any professional
Referrals can be made via Telephone or form that is ed. We also accept letters.

7. SPA Challenges NOT ENOUGH INFORMATION !!!!
Does not meet criteria for a mental health service.
YP has not accessed anything at T1/Universal level.

8. 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

9. 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.

10. 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

11. 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.

12. 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.

13. 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

14. 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

15. 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 co-morbidity
ASD / ADHD without co-morbid mental health.

16. 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.

17. Tier 2 Interventions 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

18. 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

19. Tier 2 Moving forwards- 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

20. 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.

21. Successes
‘Thank you all so much for saving us from our ‘dark place’. You have made such a difference to our family.’
‘Thank you for looking after me and helping me. We done some really fun activities and I really enjoyed it so here’s a card to say thank you! …sad I have to leave you.’
‘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.’
‘Highly recommended training that I can implement in my day to day work with families … fantastic trainers!

22. Any Questions?
‘I’ve been given strategies that I can use through my whole life now – thank you!’
‘The most informative training on attachment and
Child Development that I have ever attended.’
‘I felt listened to and heard.’
‘They [staff] were fab!’