�Dr Diana Cassell, AMD for CAMHS and consultant child and adolescent psychiatrist in Kingston

�Tier 3 multidisciplinary team provides DSH service to Kingston Hospital and emergency liaison/out of hours on call

�Tier 2 services in the Borough- FASS Tier 2 services provided by Children’s Services/Education and Tier 2 workers in YOT, CWD and LAC provided by the Trust

�Tier 4 services for the sector: Adolescent resource centre provides for acute psychiatry; Priory for ED admissions

� ADHD assessment and treatment planning

� ASD assessment and care planning

� Comorbid Behaviour problems with ADHD/or ASD

� Specific anxiety disorders: e.g. OCD/panic disorder/phobias

� Oppositional defiant disorder/serious behaviour problems usually with family with other problems e.g. parental mental health problems

� Mixed emotional disorders, usually with family with other problems e.g. parental mental health problems

� Emotional disorders such as somatoform, or reflecting significant damage to child’s emotional development

� School refusal in a child with difficult Behaviour/ significant distress

� Reactive attachment disorder

� Mood disorders including severe depression

� Self harm and need for risk assessments

� Psychosis, schizophrenia, single episodes and drug-induced

� Trauma reactions, including PTSD

� Eating disorders, anorexia and bulimia nervosa

� Psychological Reactions to severe stress e.g. after abuse, bullying

� Dual diagnosis situations with SM issues and mental health problems

� Each child’s problems will be considered and a care plan tailored to meet their specific needs, usually of a combination of the elements listed below:

� Range of neurodevelopment assessments, including psychometric testing, DISCO interview, school observations

� Risk assessments, including at the DGH after overdose / DSH episode requiring treatment there

� Full assessment of young person’s problems

� Psychoeducation about the child’s specific needs and disorder

� Cognitive behaviour therapy

� Family therapy

� Child Psychotherapy

� Counselling

� Arts therapies

� Pharmacotherapy with advice and monitoring

� Parent work around the child’s needs

� Group work, focused on certain problems e.g. mood management

� Consultations and network meetings with other professionals

� Eating Disorders clinics

� Substance Misuse Nurses

�Deliberate Self Harm assessment services at

KHMST project for Kingston and Merton (DH

pilot site)

�CAPA model so no waiting lists and care

planned in line with families wishes

Co-production

� Service users, parents and carers involved in

design and planning of service- web based

groups to attract young people

�Users on interview panels

� Your Welcome standards

� “Mystery shoppers”

Choice Appointment - a brief

intervention:

� consider the child’s difficulties

� offer immediate advice and strategies

� clinician screen for eligibility

� family to choose whether to take forwards

and set goals for the work

�Allocated to team member identified to have

skills as needed

�No waiting lists

�All clinicians have throughput of clinical work

and job plans reflecting this

� Focus on working to empower family to

achieve their goals

�Assists in managing capacity and demand

Service Transformation

�Development of Care packages - evidence

based care. Families will receive information

about their child’s care and what they can

expect at the first appointment.

�Children’s IAPT- workers to be trained in

specific treatments: CBT, parent training,

family therapy and IPT. Involves session by

session outcome monitoring leading to better

results.

� Specialist services to be provided by teams

across the Trust’s area

Care pathways

� Important to have clear pathways so early

intervention can occur and lead smoothly to

care from higher tiers when needed.

� Tier 3 provides assessment and referral to

Tier 4 when needed- we keep many out of

these placements by managing the pathway.

� Safeguarding is a focus

� Promoting emotional resilience underpins our

work

THE

CAMHS

RECOVERY

APROACH HOPE

FRIENDS

FAMILY

OPPORTUNITY

HEALTH

LEISURE EDUCATION

SAFETY

TAKING

CONTROL.

GROWTH &

DEVELOPMENT