走出社交孤立 (3): 克服社恐
Part 4: What is the CAMHS referral procedure
(Chinese version only)
WHO CAN REFER to CAMHS?
Referrals can be made by a variety of agencies including:
- (GP) / General Practitioners (GPs)
- Specialist Schools
- Schools can refer following recommendations from Educational Psychologists or Specialist Advisory Teachers
- Health Visitors
- Educational Psychologists
- School Nurses
- Community Paediatricians
- Social workers
- School teachers
- Young people aged 16 and above are able to consent to referral in their own right. Some young people under the age of 16 who have the capacity to consent to a referral can also do so.)
若情況非常緊急，請致電111或查閱下列網站以找可提供的即時服務 https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/ 或當區的危機處理小組熱線 https://www.nhs.uk/service-search/mental-health/find-an-urgent-mental-health-helpline/location
他們通常第一次會寫信與你聯絡，告訴你約見的日期。當你收信時，這可能只是邀請該有困難的孩子及你們 (身為父母親/照料者) 見面，或者可能會邀請全家人見面。你亦可能會接到電話問你是否已收到來信，及看看你們是否可以出席。
你可能在收信後要等數星期才到約見日期，因為很多 CAMHS 組都非常忙碌。如果 你在等候約見期間認為你孩子的問題愈來愈嚴重，請通知 CAMHS 組 – 他們也許 能提議在等候面談期間，你可以做些甚麼去幫助你的孩子。
CAMHS 組在很多不同的地方工作，包括他們自己的診療室，或會派工作人員到你 的家中、孩子的學校，或你醫生的診所與你們會面。大多數約見都是在星期一至五日間時間進行，但如可能的話，他們也許能安排在放學後或黃昏的時間。在首次會面時，你與孩子會與在 CAMHS 組工作的一位或兩位人士會面。視乎孩子的年齡，他們亦可能會要求單獨與你的孩子會面。
- 向他們提出任何你有的問題 – 例如為何會安排你的孩子與 CAMHS 組人員見面
- 請他們解釋 – 你的孩子可能會有的精神健康問題，及這對他們可能會有甚麼影響
- 告訴他們所有事情 – 有關你可能留意到你的孩子的情況，及有多久 – 這會幫助 CAMHS 組明白發生了甚麼及你的孩子可能需要甚麼協助。
- 切勿因為有些困擾著你的事情看來輕微而感到憂慮或尷尬或甚至愚昧 –CAMHS 的人員曾受訓練聆聽和考慮所有事情，他們是不會覺得你愚昧的。
工作人員希望能在這首次會面中，從你與孩子盡量得到更多資料，以便他們能與 你及孩子一起計劃你們可能需要甚麼協助。這時最重要的是要提出所有問題，及 確保你明白他們告訴你的事情。
第一部份： CAMHS團隊成員會先了解孩子的家庭狀況，例如有沒有兄弟姐妹，從中繪製家庭關係圖，這有助 他們了解孩子苦惱之源，是否與家庭問題（例如父母離異）有關，並探討你和家人的關係； 他們也可能會詢問孩子的童年，這將有助他們分析你面臨的問題，是否存在已久。 這部分通常和你們一家在同一會見室內進行。
- 服食藥物 (雖然這並不普遍)
- 你孩子所需的約見次數。可能一至兩次已足夠 – 或者有時候你的孩子可能需要連續幾星每週約見。
- CAMHS 組可能會建議你的孩子需要入醫院 – 但這是很罕有的 – 在這情況下，請確保你明白是入院原因及需要前往哪兒。
- 本地免費或資助輔導服務；你可上網搜尋，或利用”Youth Access directory”
- 保密 – 與你及你孩子會面的人員應該向你們解釋，他們會怎樣及與誰人共用 你們提供的任何資料
- 同意書 – 與你會面的人員應確保你及你的孩子都同意接受他們建議的協助，及解釋如你們不同意的話會有甚麼其他選擇
- 你們的需要 – 舉例來說，如果你或家人需要傳譯員協助，或想帶一位你們信 任的朋友陪同出席，或想用某種方式來分享資料 (例如，將資料寫下讓你拿走)，你們必須告訴 CAMHS 職員，而他們應設法為你們安排。
- 投訴 – 如果你們對獲得的協助感到不滿意，你們應告訴 CAMHS 職員。所有 CAMHS 組都設有投訴程序，及如你提出的話，他們應清楚告訴你這些程序。
PART 3: What information is needed for GP/ CAMHS assessment?
The follow is the approach of assessment and questions that are likely to appear in an assessment appointment. A good preparation and the provision of the right information will help in getting the appropriate supports for the children and young people.
- Current concerns / problems of parents and children
- Has anything happened recently to make your child/you seek help at this time?
- Duration of the problem existed
- Severity of the Problem (Outside of usual development of the individual child/young person and current circumstances)
A. Any risk?
- Self-harm behaviour (increasing frequency, unsafe methods, intent to harm, few coping strategies, lack of resilience)
- Harm to others
- Suicide ideation; intent to end life, plan in place, little or no protective factors, means to carry out plan, previous attempts
- Misuse of substances impacting on safety and functioning of the child/young person
- Engaging with risky / harmful sexual activities
- Harmful use of social media which is negatively impacting on emotional / mental health
B. Any Health Issue?
- Increased or reduced appetite
- Concerning changes in sleep pattern
- Concerning changes in weight
- Concerning eating habits
- Excessive exercise
- Increased physical symptoms which may be psychosomatic (headaches, stomach aches etc with no other explanation)
- Worsening of diagnosed chronic health conditions (with no other explanation)
- Onset of acute physical illness
- Co-morbidities e.g autism spectrum disorder/attention deficit hyperactivity disorder/tics/tourettes/intellectual disability
C. Any Negative Thoughts?
- Distorted thought patterns
- Acting on intrusive thoughts
- Increasing level of distress from intrusive thoughts
- Unhelpful thoughts which impact on the ability to function
D. Any Mood Issue?
- Feeling low
- Difficulty in controlling emotions
E. Impact on the child/young person’s family, education and social relationships
Impact on Family relationship
- Withdrawing from family members
- Needing to have more contact with family members than before
- Increased arguments / conflict
- Concerns regarding parenting ability / lack of parent support/comfort
- Excessive reassurance seeking from child/young person
- Change in family activities
- Change in family set up/dynamics
- Loss or bereavement
- Mental and physical health of family members which may impact on the young person
Impact on Education and Learning
- Attendance dropping
- Persistent absences / truanting
- Attainment changing
- Change in motivation / lack of engagement
- Change of concentration level
- Behaviour pattern changing (withdrawal / challenging etc)
Impact on Social Relationships
- Changes in friendship groups
- Bullying behaviour or Subject of bullying
- Change in quality of friendships such as are they still communicating with friends?
- Loss or bereavement
- Engaging with inappropriate relationships
Impact on Social Functioning
- Decreased enjoyment of previously enjoyed activities and/or interests
- Withdrawal from activities
- Lack of engagement
- Change in self-care skills (change in how they dress / present themselves)
- Offending behaviour / persistent anti-social behaviour
Relevant psychosocial and family issues including who is in the family or important people in the kinship system
- Big family events
The Responses to previous attempts to help / To what extent the problem has improved If the child or young person has already received support from one of the following parties?
- School health service involvement
- Student support within school
- Family service intervention
- Private/voluntary counselling
- School counselling
- Domestic abuse services
- Bereavement services
- Relevant voluntary agencies
- self-help websites
Part 2: The service scope of CAMHS
Specialist CAMHS services are available to children and young people who have severe, complex and enduring emotional/behavioural/mental health difficulties. Specialist CAMHS services are, for example, not appropriate for children / young people who are experiencing a normal reaction to a significant life event (e.g. a normal bereavement or a normal reaction to parental separation). A good understanding of the service scope and assessment criteria will help clients in getting the right service.
A. Type of problem
1. Severe or life-threatening conditions
- Risk of suicide or severe self-harm
- Severe depressive episode
- Anorexia Nervosa
2. Conditions leading to severe functional impairment
- Severe Obsessive-Compulsive Disorder (OCD)
- Severe anxiety / phobic / panic disorders / Bipolar Disorder
- Bulimia Nervosa
- Neurodevelopmental Difficulties (NDD)
- Autistic spectrum conditions (ASC) /Autistic Spectrum disorders
- ADHD where there is significant psychiatric co-morbidity
- Tics and Tourette’s
- School refusal where mental health disorder plays a significant role
- Conduct Disorder or Conduct difficulties which co-exist with other disorders and where specific interventions may influence outcome
- Severe and / or complex relationship difficulties leading to significant impairment of functioning and wellbeing
- Gender identity disorders
3. Emotional/behavioral/mental health difficulties in children and young people with learning disabilities.
This includes children and young people with specific as well as mild learning disabilities. The mental health needs of children and young people with more moderate to severe learning disability are provided for by specialist teams. There is a CAMHS Learning Disability Team and Child Disability Team in most of the areas.
4. Emotional difficulties related to and severely complicating physical conditions where treatment will influence the outcome such as:
- Neurological conditions
- Unexplained pain / somatising disorders
5. Where early intervention is likely to prevent the development of more severe disorder such as :
- Complicated bereavement
- Post-traumatic stress disorder (PTSD)
- Severe attachment difficulties
B. HOW TO DECIDE WHO IS AN APPROPRIATE REFERRAL ?
The CAMHS team will allocate an assessment appointment based on need, judged by:
1. Severity of Symptoms/ difficulties
Specialist CAMHS will accept referrals of children and young people whose symptoms or distress and degree of social and/or functional impairment are severe. The emotional health and wellbeing difficulties need to have a noticeable and substantial impact on a number of areas of functioning: e.g. school, home and social situations.
2. The Duration of the symptoms/difficulties
Usually, the duration of these difficulties should be not less than three months. For severe / life-threatening conditions (see above) and for other conditions where there is severe impairment of functioning, the referral should be made immediately.
Where the child/young person’s symptoms persist beyond this time, and/or they are non-responsive to first line interventions (e.g. school support, community services), i.e. the difficulties are worsening/persisting despite front line interventions being in place e.g. ELSA in school, community parenting support, GP directed self help, they should be referred to CAMHS.
Evidence of recent typical external stressors e.g. family breakdown, bereavement, exams, hospital visits (past or impending) where sufficient time has been allowed for the child to adjust and/or recover with help from immediately available resources
A child/young person should be seen urgently if there is a reported sudden onset of symptoms, symptoms are causing substantial distress or there is probable risk of harm to self or others due to level of difficulty.
3. Severe Mental Health Disorders
Specialist CAMHS will accept referrals where there is a likelihood that the child or young person has a severe mental health disorder.
4. Case Complexity
Specialist CAMHS will accept referrals where there is a high level of case complexity. This might include, for example, multiple risk factors, complex family problems, child protection concerns, such as parental mental health, history of abuse, familyDisruption. Concerns of risk that is ongoing e.g. domestic abuse, physical chastisement, significant substance use, exploitation, risks posed by significant others.
C. HOW TO DECIDE WHO IS NOT AN APPROPRIATE REFERRAL?
In order to improve accessibility for children and young people, the team will find the following not appropriate for referral to specialist CAMHS:
1. Child / Young Person’s Response to Normal Life Events
These are sometimes called “normal adjustment reactions”. Unfortunately, we are unable to provide a service to children and young people whose difficulties are associated with a normal reaction to recent life events (e.g. bereavement, parental separation, physical illness). If intervention is required, these children and young people are usually best helped by counselling, and it is not necessarily appropriate to identify the child/young person with the specialist CAMHS service.
2. Children / Young People Whose Difficulties Occur only at School
Please note that specialist CAMHS does not provide a service for children and young people whose problems are solely related to specific learning or behavioural difficulties within the classroom or other difficulties which occur only at school (e.g. behaviour settled at home; unsettled in school). For these children/young people it is usually more appropriate for educational services to become involved to address the difficulties.
3. Interventions for single symptom presentations
Single symptom such as sleeping difficulties, minor eating problems, toileting issues would not meet CAMHS criteria and should be provided by universal or targeted services (e.g. primary care, local service teams) in the first instance.
Part 1: What is CAMHS?
NHS has a four-tier system for child and adolescent mental health. This document sets out the referral process and criteria for professionals referring to the multi-disciplinary Tier 3 Specialist Child and Adolescent Mental Health Service (CAMHS) which may include CAMHS for children and young people with Learning Disabilities (CAMHS LD). The service is specifically for children and young people who have persistent and complex problems and may include referral to a Tier 4 service if required.
Clients of CAMHS
Children and young people aged under 18 with emotional, behavioural and mental health difficulties.
Professionals in CAMHS
CAMHS are multidisciplinary teams that often consist of:
- Social workers
- Psychological therapists including child psychotherapists, play therapists and creative art therapists
- Family psychotherapists
- Occupational therapists