1. Mental Health Needs/Service Provision for Children and Adolescents with Challenging Behaviour/Learning Disability Dr Sarah Bernard Consultant Psychiatrist The Michael Rutter Centre

2. Background  Children with LD are a seriously neglected group.  High risk of behavioural/mental health problems (50-95%)  Morbidity impacts on child, family, school.  Input can, AND DOES, make a difference  DoH has been addressing the gaps in service provision

3. Current Situation  Varies according to district  CAMHS vs LD psychiatry services  Variety of models – CAMHS, child neuropsych., lifespan, paediatric and others  Promotion of child 1 st model – this supported by NSF  Training is a priority

4. What is needed - assessment  MDT approach  Understanding of child psychopathology  Understanding of disability  Flexible approach – community based  Multiagency working  Cultural sensitivity  Understanding of safeguarding

5. What is needed - management  MDT/multiagency approach  Behavioural interventions – not short term  Role of medication  Impact of environment – education  Respite  Emergency protocol  Ongoing review and monitoring

6. The MDT  Psychiatry  Psychology  Behavioural Therapy  SALT  Social Services  OT  Other……..

7. The Future  A comprehensive CAMHS for all  Appropriate provision – local and national/specialist  More research/evidence based practice

8. Discussion points What is challenging behaviour? How does the definition fit into a CAMHS service model? Current financial constraints (new services not likely to be developed) Motivation and interest