Paediatric Liaison Team – King’s College Hospital – SLAM – (NCCMH)

The Paediatric Liaison Team at King’s College Hospital provide emergency mental health assessment and intervention on wards and in the emergency department, outpatient multidisciplinary assessment and treatment, and mental health liaison and consultation for hospital staff caring for children and young people with acute and chronic physical health conditions. The team has a particular interest in medically unexplained symptoms and neuropsychiatry and has staff embedded in epilepsy surgery, bariatric surgery, liver and small bowel transplant, sickle cell, cystic fibrosis, asthma, feeding and gastroenterology specialities.

Co-Production

  • From start: No
  • During process: Yes
  • In evaluation: No

Evaluation

  • Peer: No
  • Academic: Yes
  • PP Collaborative: No

Find out more

The Paediatric Liaison Team at King’s College Hospital provide emergency mental health assessment and intervention on wards and in the emergency department, outpatient multidisciplinary assessment and treatment, and mental health liaison and consultation for hospital staff caring for children and young people with acute and chronic physical health conditions. The team has a particular interest in medically unexplained symptoms and neuropsychiatry and has staff embedded in epilepsy surgery, bariatric surgery, liver and small bowel transplant, sickle cell, cystic fibrosis, asthma, feeding and gastroenterology specialities.

 

Access

Young people can self-refer for an emergency assessment via walking into accident and emergency (A&E), or by asking any professional in the hospital.  Urgent referrals from professionals are phoned through or delivered in person. Once a referral is received, a staff member from the paediatric liaison team will attend A&E or the ward to complete an assessment. A 7-day follow up is then arranged with local CAMHS, or if it is agreed that the child or young person does not require CAMHS follow-up, they will be signposted to other services.

 

Biopsychosocial assessment and care plans

All children and young people have a full psychiatric assessment informed by collateral information gathered from schools, CAMHS, social care and other agencies (with consent of families). For complex and high risk cases, such as children and young people who are looked after or frequently self-harming, a care coordinator from CAMHS, and/or the looked after children’s team is invited to join the emergency assessment, develop shared care plans and deliver specific management interventions.

 

Safeguarding

Many of the children and young people seen by the service have significant social care needs (90% of A&E presentations have at least one safeguarding issue). The liaison team conduct joint assessments with the hospital safeguarding children’s team, in order to protect the child and family from repeated assessments and ensure full information sharing. All A&E presentations are discussed weekly in a child review meeting attended by a senior emergency department nurse, emergency department consultant and paediatric consultant.  If any safeguarding concerns arise, action is taken. Whenever a child or young person attends the emergency department, the school nurse is notified of their attendance. The paediatric liaison team also contribute to level 3 safeguarding training on fabricated and induced illness, biopsychosocial assessments, multi professional working, and feedback from serious case reviews.

 

Close relationship with health

The service offers consultation and advice to professionals within the hospital and outside. This can be ad-hoc or formal and ongoing. The team work closely with child health staff at King’s College Hospital, and collaborate in audits and shared learning. They are co-located with child health, near the children’s wards and outpatient clinics. This means child health staff can easily access informal consultation and are prompted to think ‘mind and body’ by the team’s physical presence in their midst.

 

Support for families and carers

The team acknowledges that having a child who is acutely unwell or has a chronic illness can be stressful for the child and distressing for the family around them. The team offers input to parents in acute states of distress, for example in intensive care, as well as to those who require ongoing support in relation to their own or their child’s emotional or behavioural reactions to a chronic or life-limiting disease or the effects of treatment. If parents need formal help in their own right, the team will signpost to appropriate adult services.

 

Workforce

The paediatric liaison team have a strong philosophy of professional and clinical development. All

members of staff receive regular supervision and are encouraged to attend teaching at the Maudsley, as well as externally. Monthly complex case discussion groups and multidisciplinary assessment slots enable team members to garner multiple perspectives on their casework. The team conduct frequent audits, with information and learning circulated within the hospital, to local commissioning groups, the London health network and NHS England.

 

Research

The team have been involved with a number of research projects, including; risk factors for psychiatric disorder in children with epilepsy; psychiatric disorders in children being assessed for epilepsy surgery; methylphenidate and seizure control in children with severe epilepsy; selective serotonin reuptake inhibitor  use in children with severe epilepsy; influence of family factors on psychiatric disorder in children following brain injury; systematic review examining the association between maternal post-traumatic distress disorder during the perinatal period and child outcomes; systemic review of tools for quantifying social contextual factors in under 18s presenting to emergency departments with self-harm

 

Further details

Commissioning Part funded by a portion of the Southwark CCG CAMHS budget. Non-SLaM emergency assessments are charged back to the originating CCG. Elective work is funded on a cost-per-case basis by the respective CCG
ProvidersSouth London and Maudsley NHS Foundation Trust (SLaM)
Workforce (whole-time equivalent)Generic team: 1.25 consultant psychiatrists, 0.5 clinical psychologist, 0.1 family therapist, 1.6 children’s nurses, 2 administrators

Specialist team: 2.2 clinical psychologists and 0.15 consultant psychiatrist embedded within child health teams.

Out of hours assessments are conducted by a Kings-based psychiatry core trainee, supported by a CAMHS specialist trainee and CAMHS consultant.

Population sizeAll age population of Lambeth and Southwark as of 2011 census – 464,262
CaseloadIn 2015/16, the team saw 321 A&E emergencies and 118 ward emergencies

 

Prevention and resilience – universal and early intervention for at riskSpecific specialist assessments e.g. ADHDIn-reach, inpatient and residential
Access and advice – consultation lines, triage and signpostingScheduled careCrisis
Early support and brief interventionsNational and regional interventions 
Biopsychosocial assessmentIntensive interventions  

 

 

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