KNOWSLEY CHILD

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THE 5 BOROUGHS PARTNERSHIP NHS TRUST

• KNOWSLEY CHILD ADOLESCENT
• MENTAL HEALTH SERVICES
• (KCAMHS)
• Tel. No. 0151 489 6137

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FACTORS DETERMINING THE SIGNIFICANCE OF A MENTAL
HEALTH PROBLEM OR DISORDER
The level of distress or concern it is causing to
the child, family or agency and hence the amount
of care the child may require
Severity
The number of incapacitating features or
symptoms present and the presence or otherwise
of another disorder or complex family and social
situation
Complexity
Persistence
The length of time the problem has been present
or is likely to last
The risk of secondary handicap
E.g. the possibility of specific learning
difficulties contributing to the development of
a conduct disorder
State of childs development
Whether the problem is considered to be normal
for the age and stage of development of the
child, e.g. nocturnal enuresis, fear of the dark
etc.
Presence or absence of protective factors
E.g. good quality early attachment relationships
Presence or absence of risk factors
Marital disharmony/violence or parental separation
with persisting conflict
Presence or absence of social and cultural
factors
E.g. family under stress from social or economic
disadvantage
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PREVALENCE OF SPECIFIC CHILD AND ADOLESCENT
MENTAL HEALTH PROBLEMS DISORDERS
Emotional problems/disorders -onset in childhood
25 - 33 amongst CAMHS attenders
0.5 - 2.5 amongst children 2-8 amongst
adolescents
Major depression
Conduct problems/disorders
33- 50 among CAMHS attenders
1 - 13 in boys 1 - 11 in girls
Tic disorders
Obsessive compulsive disorder
1.9 of adolescents
Attention deficit disorder
17 of children - predominantly boys 0.5 with
severe ADHD
2.3 of boys 0.7 of girls (7-8 yrs) 1.3 of
boys 0.3 of girls (11 - 12yrs)
Encopresis
0.5 - 1 of 12 - 19 yr olds 10 times more common
in girls
Anorexia
Bulimia
1 of adolescent girls and young women
Attempted suicide
2- 4 of adolescents
Suicide
0.75 per 10.000 15 - 19 yr olds
Substance misuse Alcohol
Solvents/illegal drugs Cannabis Heroine
and cocaine Hallucinogens
79 of 13 yr olds have drunk alcohol 29
drinking once a week 16 of 16 yr olds involved
in regular use 3 - 5 of 11 - 16 yr olds have
used it 17 in older teenagers less than
1 Increase reported
Epidemiologically-based needs assessment CAMHS
Wallace, Crown, Cox and Berger 1995
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INCIDENCE OF MENTAL ILL-HEALTH WITH KNOWSLEY
POPULATION OF CHILDREN AND ADOLESCENTS

• Knowsley has a population of 43,124 children and
  adolescents up to 19 years of age
• It is acknowledged that up to 20 of any child
  and adolescent population have mental health
  problems requiring a service and 10 have a
  presentation sufficient to warrant the their
  mental health difficulties being described as a
  disorder.
• Epidemiological studies indicate that social
  deprivation factors increase the likelihood of
  mental health problems and disorders.
• 8,600 children and adolescents will have mental
  health problems.
• 4,300 children and adolescents will have mental
  health disorders.

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CURRENT SERVICE PROVISION

• 0 - end of Yr 11 (High School)
• December 2006, service will extend to 18th
  birthday
• Primarily Tier 3 Service - also some service to
  Tiers 1 2 - mainly via consultation
• Monday - Friday between 9.00 am - 5.00 pm
• Daytime emergency duty rota
• Beds on paediatric wards at Whiston Hospital
• Tertiary service via Alder Hey Hospital, Dewi
  Jones Unit and Young Peoples Centre in Chester

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SERVICE PROVISION JANUARY 2007

• Referral criteria
• Complex psychiatric/psychological consequences of
  child abuse/neglect
• Deliberate self-harm
• Depressive disorders
• Psychotic disorders
• Disorders associated with substance misuse
  (including alcohol) and dual diagnosis
• Anxiety disorders and psychosomatic disorders
• Eating disorders
• Obsessive/compulsive disorders
• Phobic disorders
• Psychological reactions to significant events
• The assessment of complex family dynamics
• Consultation and/or assessment in cases of
  complex needs
• Non-compliance with medical treatment
• Problems associated with chronic childhood
  illnesses
• Severe oppositional/conduct disorders
• Autistic spectrum disorders
• Serious tic disorders

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PROBLEMS NOT ACCEPTED BY CAMHS JANUARY 2007

• Mental Health Problems not Accepted by CAMHS
• - Behavioural difficulties, e.g. anger
• - Family relationship problems affecting the
  child
• - Moderate anxiety/mood problems
• - Prolonged adjustment problems (grief, divorce,
  separation, bereavement)
• - Pre-school behavioural difficulties
• - Soiling/Wetting
• - Eating/feeding problems
• - Parenting/parental control
• -Predominantly school-based problems
• Knowsley CAMHS will provide consultative guidance
  to colleagues in partner agencies who wish to
  discuss the mental health needs of a child/young
  person and seek advice on referral where
  appropriate.

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TYPES OF ASSESSMENTS

• Individual mental health assessments
• Family assessments
• Risk assessments (emergency and routine)
• Therapeutic assessments, eg. appropriateness for
  individual counselling/therapy
• Specialist assessment - Autism/Aspergers, ADHD,
  neurological
• All assessments are based on presentation being
  complex, severe and persistent

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DIRECT AND INDIRECT INTERVENTIONS

• Direct Interventions
• Individual psychological therapies, eg. cognitive
  behaviour therapy and brief, solution focused
  therapy
• Family therapy
• Individual counselling/psychotherapy
• Medication
• Clinical hypnosis
• Drama/play therapy
• Indirect Interventions
• Consultation to other agencies
• Teaching/training enskilling at Tier 1 and Tier 2
  levels

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Number of Referrals to KCAMHS 1999 to 2007
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KCAMHS ZERO WAITING LIST POLICY

• Knowsley CAMHS has a commitment to a zero
  waiting list
• policy as a cornerstone of its Operational
  Policy
• Emergency referrals are seen within 24 hours
• Moderately urgent referrals are seen within 14
  days
• Routine referrals are seen within 6 to 13 weeks
  
• Knowsley CAMHS performance against these
  targets is
• monitored in quarterly reports

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KCAMHS INTER-AGENCY MODEL OF INTEGRATED
CHILDRENS SERVICES
Looked After Children
Primary Care
Youth Offending
Educational Social Workers
KNOWSLEY CHILD AND ADOLESCENT MENTAL HEALTH
SERVICES
Behaviour Education Support Teams
Paediatric Liaison
Substance Misuse
Early Intervention in Psychosis
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KNOWSLEY CAMHS TEAM COMPOSITION

• Consultant Family Therapist/Service Manager 1.0
• Consultant Child Adolescent Psychiatrist 2.0
• Consultant Clinical Psychologist 1.0
• Clinical Psychologist (Eating disorders) 0.2
• Principal Family Therapist (CAMHS/LAC) 1.0
• Senior Family Therapist (LAC) 1.0
• Lead Nurse Specialist (YOT) 1.0
• Nurse Specialist (Substance misuse) 1.0
• Nurse Specialist (E.I.P.) 1.0
• Nurse Specialist (LAC) 1.0
• Nurse Specialist Learning Disability 1.0
• Health Care Assistant Learning Disability 1.0
• Nurse Specialists 4.0
• Mental Health Practitioners 2.0
• Paediatric Liaison Specialist/Family
  Therapist 1.0
• Therapists (CAMHS/Education) 2.0
• 22,2

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KNOWSLEY CAMHS TEAM COMPOSITION

Knowsley CAMHS staff complement is, currently,
22.2 whole time equivalent staff including
vacancies. However several of KCAMHS 19.8
posts are either partially or fully integrated
into specialist roles outside KCAMHS generic
specialist team CAMHS/ Education 2.0
staff Looked After Children 2.5 staff Youth
Offending Team 0.5 staff Early Intervention in
Psychosis 0.5 staff Substance Misuse Team 0.5
staff Paediatric Liaison 0.5
staff Management Responsibilities 1.0
staff 7.5 wte This leaves approximately 14.5
wte clinical staff which forms the generic
Specialist Tier 3 CAMHS
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INTRODUCING CHOICE PARTNERSHIP(C.A.P.A.)

In order to manage the demands on our CAMHS
clinical capacity, we are introducing C.A.P.A. in
January 2007. C.A.P.A. will offer service users
full choice of appointment times and dates at
point of booking (NHS Choose and Book
compliant) Following an assessment appointment,
service users will be offered the choice of a
partnership cycle of treatment sessions to
achieve mutually agreed goals. (No more than 7
sessions in any one cycle of treatment). C.A.P.A.
, through a focus on targeted intervention, makes
more efficient use of limited clinical
resources. Knowsley CAMHS will also continue to
offer more intensive work with a smaller
percentage of service users based on the nature
of the disorder presentation.