The National Deaf Child and Adolescent Mental Health Services (NDCAMHS) provides a highly specialised mental health service to deaf children and young people (aged 0 to 18th birthday) and hearing children of Deaf adults, in both the community and in-patient setting, on behalf of NHS England.
What We Did
The National Deaf Child and Adolescent Mental Health Services (NDCAMHS) provides a highly specialised mental health service to deaf children and young people (aged 0 to 18th birthday) and hearing children of Deaf adults, in both the community and in-patient setting, on behalf of NHS England. It was established as a Highly Specialised Service in recognition of the specific complex needs associated with deaf children and young people with mental health problems and the poorer mental health and life outcomes for this group of young people in both childhood and adulthood. The NDCAMHS philosophy of care is to operate as a bilingual and bicultural Service where: the nature of clients as deaf and hearing individuals (and their families) is acknowledged and fully understood; their linguistic and cultural preferences are respected and met, and their mental health needs are effectively catered for.
Our Service provides a high level of expertise and has added value to mainstream mental health services to a population with complex needs, increased vulnerability of mental health problems compared to the hearing population and difficulty accessing the right services and support We constitute an example of excellence in good team-working. The hearing and deaf staff in our Service represent the integration of two different cultures, providing positive role models for deaf young people, struggling to find an identity, and for their families, who can find it hard to accept their child’s difference.
In addition to the regular feedback pathways (i.e. ESQs, comments boxes and boards, etc) the South East team recently ran two service user engagement days at local partnership schools with whom we have regular contact/consultation and receive regular referrals.
This were delivered by a Deaf Family Support Worker, an OT and the Communication Facilitator. The two workshops involved a total of 24 deaf young people and focused on young people’s preferences around care planning, particularly looking at how young people wanted to receive records of these documents. The engagement from the schools and young people was really positive and the days were enjoyed by all and offered an opportunity to promote the team and mental health awareness as well as collect meaningful input around this issue. Feedback from the partnership agencies has also been positive.
Looking Back/Challenges Faced
Being a Highly Specialist Service it takes a lot of knowledge of local networks and existing regional resources to build up working relationships and to disseminate information about the service remit and provision. And being a team based in the community and quite remote to the main sites of our Trust means that establishing effective ways of communication does take time.
Our highly specialised work happens within the framework of a Trust with an ample variety of services, mainly with adult focus and limited understanding of deaf issues. We have established new forums across the Trust to spread the necessary knowledge for hearing and deaf staff and for clients to be adequately supported, including a session on deaf awareness as part of the corporate induction, the introduction and strong presence of disability champions in our Service as well as Trust wide and a Deaf forum.
Being a small team covering an extremely wide geographical area the team has developed different ideas and strategies to use effectively and consistently its resources: We became the first Specialist CAMHS team in our Trust to introduce CAPA, providing a robust framework for service delivery -Regular consultation and clinics in School for Deaf children and hearing impairment units.
Assessments, follow-ups and joint work with the local CAMHS clinics; Training to other professionals and agencies working with Deaf young people and their families to help them to identify the most common mental health problems likely to affect them and pathways leading to right support; Regular liaison with the other national teams to ensure that our client group benefits nationally of innovative examples and local initiatives of good practice.
QNCC report following their review in 2015 listed the following: What are the main strengths of the service?
Referral and Access: Young people and parents reported that the service was very supportive to them while they were waiting for their first appointment; Parents reported that they received comprehensive and clearly written information before their child’s first appointment, which detailed what they should expect from the service. This reduced levels of anxiety before the first assessment; Parents reported that the waiting times were shorter than they expected and they were very happy about this.
Assessment and Care Planning: Parents felt that they were actively involved in their child’s care and their feedback around the care plan was listened to.
Care and Intervention: Parents reported that the service was very easy to contact and that any calls or enquires made about their child’s care were always responded to as quickly as possible; Young people and parents felt very informed about the types of treatments and interventions available and that they had received excellent information about their care; Young people and parents reported that really felt listened to in their appointments and that the advice that they receive was always very helpful, demonstrating to the review team the services dedication to their roles.
Rights and Safeguarding: Parents 100% felt that they and their children were treated with the upmost respect and that their views were listened to; Parents reported that they knew of the complaints procedure and who they would approach if they felt they needed to make a complaint.
Transfer of Care: Young People reported that they felt entirely supported through their discharge process and that the service has offered them an ‘open door’ should they wish to discuss a re-referral.
Multi-Agency Working: The CAMHS team are relatively small but it was clear from the multi-agency discussion that they are a massive part of the wider service and that the work they do is invaluable to the local services they work with; Multi-agency workers reported that the service has excellent communication, dealing with situations proactively and overcoming challenges as they arrive.; The review team felt there was particularly good joint working with local schools. This is shown in the high number of appointments that take place at schools, demonstrating the support that the service offers in wide settings; Always interpreter for assessments – good links; Multi-agency workers all reported that response rates from the service were excellent and that their calls and emails are always answered promptly.
Staffing and Training: The review team felt that CAMHS staff are very supportive of each other and partner workers. Staff gel well in the work that they do and each team member is given equal value in the service; The review team were impressed with the commitment and flexibility of the staff. This is shown in the time spent by clinicians driving to appointments and the choice given to young people by holding assessments at schools.
Location, Environment and Facilities: Young people and parents commented that the service’s environment felt comfortable and relaxing and that they were happy attending appointments; While the space in the centre was quite limited, the review team were impressed with the way in which the space was used. It is a comfortable environment that does feel clinical; The close proximity to the audiology team means that good joint working can take place, with each team supporting the other with advice and shared learning.
Part of the work embedded in the service is to educate and skill up professionals and people living and looking after young deaf people. As part of that, the staff delivers regular deaf awareness and mental health training to a varied audience in a wide range of settings including mental health mainstream services, trainees and students of several disciplines, Audiology services, Social Care, Education.
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Our Service has been extremely proactive in addressing the lack of standardised resources and therapies for the deaf young people by being part of several research projects: validation and translation to BSL of the Strengths and Difficulties Questionnaire and the Autism Diagnostic Observations Schedule and Interview. These adjustments will be key to a more accurate assessment of the needs of deaf children and subsequent recommendations for their care.
We have developed a library of video resources to support the information and psycho-education provided in our day to day work. We have expanded our consultations and increased the training packages we deliver as an essential aspect of our Service is liaising and consulting with other professionals (i.e. specialist schools and hearing support units, Children’s Services, Audiology Departments, etc.) to increase their skill set and empower them to confidently manage and meet deaf young people’s needs.
To maximise the efficient use of our resources we have dedicated special attention to improving our access to technology by updating our teleconferencing system and looking at ways of introducing the use of Skype among our staff and with families and young people.