CAMHS Central Referral Hub is a single point of access for referrals into Specialist CAMHS services, including generic CAMHS, Paediatric Psychology, CAMHS looked after children, CAMHS ASD, as well as Tier 2 commissioned services younger mind counselling service, Dove bereavement, Dove generic counselling service, Mindzone and Changes.
CAMHS Central Referral Hub is a single point of access for referrals into Specialist CAMHS services, including generic CAMHS, Paediatric Psychology, CAMHS looked after children, CAMHS ASD, as well as Tier 2 commissioned services younger mind counselling service, Dove bereavement, Dove generic counselling service, Mindzone and Changes.
An advice line was implemented in August 2016. This offers consultation with a hub clinician prior to making a referral. This provides the opportunity to discuss concerns, agree information required to send in a referral and to ensure that the referral is being made to the most appropriate service.
It provides the criteria for referral to CAMHS and provides guidance on how to refer to CAMHS. It acts as a gateway for all CAMHS referrals and provides the opportunity to discuss whether all necessary interventions have been tried/ actioned by universal services.
Staff are able to give advice on further actions to be taken before a referral is made, including signposting to another agency if that is appropriate.
It provides advice on interventions and support that could be tried with a young person and also provides advice on early prevention strategies.
If the referral being discussed is felt to be urgent, referral information will be taken over the telephone.
There are two clinicians available daily (Monday to Friday, 9am-5pm) to respond to the advice line.
Referrals are triaged daily by the multi-disciplinary team and clinical decisions made. If further information is required for clarification around risk, the family is contacted. This consists of mental health practitioners, tier 2 and social work
Referrals are also received by telephone from the Royal Stoke Hospital to the CAMHS Priority Service who provide assessment for young people presenting at A&E, CAU and paediatric wards with immediate risks around mental health.
All referrals requiring urgent assessment where significant risk around mental health is identified will be contacted the same day to discuss and offer an appointment for urgent face to face assessment. Urgent assessments are usually arranged within a week and advice is given on accessing support in the interim if concerns escalate. We are able to see some young people the same day if referrals indicate acute crisis. This early intervention has avoided presentation at A&E/ admission to paediatrics. This has a positive impact on the young person and their families, as well as the wider health economy. All young people receive a comprehensive mental health assessment and risk assessment. An intervention plan is completed in collaboration with them and their families.
We are committed to family – centred care and provide a service that is responsive to the needs of the young person and their carers (often in crisis). We will facilitate appointments in the clinic, schools or home.
As a team we are able to offer brief crisis intervention/ risk management. This can reduce the numbers being referred into community CAMHS.
Team working is key in our service. As Specialist Mental Health Practitioners, we ensure a coordinated and holistic approach is provided to the young people and their families. Being part of a MDT ensures team working and support.
Families value the response they receive.
Since the implementation of the advice line, there has been increased contact with referral agencies, including GPs, social care and Tier 2 services. They have a better understanding of our referral criteria and have welcomed this resource. As a scarce specialist resource where access to service was lengthy, this has seen a reduction in inappropriate referrals.
There has been support from local commissioners to facilitate the SPA model.
We have established links with the mental health lead at the Royal Stoke Hospital. Regular meetings are held with the service manager to discuss and highlight any concerns. This enables feedback and improving ways of working. He has attended the team meeting to explain his role. We have also developed the Child and Adolescent Mental Health Pathway which has been implemented on the paediatric wards. There are also excellent links with the paediatric staff and we work in conjunction with each other to ensure that the young person’s needs are being met.
We have invited members of the youth council to visit and encourage their feedback regarding the environment. They felt that the clinic is relaxed and welcoming.
They have also attended our team meeting and explained their roles. Families are encouraged to complete the Friends and Family Test – we have received very positive feedback regarding our service:
“Friendly, helpful staff take their time to listen and offer advice.”
“Very helpful, good advice given, really happy.”
“Because it’s good to get the right help.”
“The support received was excellent. My daughter was listened to and was made to feel comfortable in an awkward situation.”
“The staff member was considerate and listened when we spoke. Showed compassion and understanding. Helped us understand how our daughter was feeling.”
“I feel I can say things without being judged.”
We also encourage new members of staff / trainees to spend time in the hub to appreciate the process, demand for the service, take part in the MDT discussions and to observe the staff completing the thorough assessments in clinic and on the paediatric wards/ A&E:
“Thank you so much – really appreciate finally getting somewhere after feeling fobbed off in the past. Such a relief.”
There have been some challenges from referrers to contact the advice line due to pressure of time to do so. Through continued liaison and communication this has improved. We have also provided information/ referral criteria to GPs to upload on their map of medicine. This too, has enabled them to make appropriate referrals.
The demand for the advice line has increased and needs to be resourced to accommodate this. What started as a professional’s advice line has developed into an advice line for parents and young people themselves.
Demand for urgent assessments is high and at times the clinic is unable to accommodate this. We have therefore facilitated visits to homes although this impacts on clinicians’ availability in the clinic to respond to the advice line/ other demands of the service. We have also offered additional assessments in the clinic.
The demand for the service has grown – the service resource is small.
Improvements in data collection to quantify activity and demand.
We actively encourage community staff to spend time in the hub which assists with their own development and training.
Staff within the hub team are experience clinicians and are able to demonstrate leadership.
Our service is reviewed by commissioners regularly to ensure that delivery of service is effective.
We hold regular meetings with our tier 2 partner agency.
The team hold regular peer supervision to ensure reflection and share their experiences.
The team were awarded the spotlight award from the trust in recognition of the work they do.
All young people referred into the hub who require an urgent assessment are seen within 1 week. Priority referrals are seen the same day.
We continue to receive feedback from young people, families and referrers about our response time and regarding their experience during the assessment. This is very positive.
We receive positive feedback from referrers and families regarding the advice line.
At a recent away day, the referral hub did a presentation explaining the service and the impact that a specialist, dedicated and consistent team had made on reducing inappropriate referrals considerably. This has meant that young people are waiting less time to access the service and that the right young people are being seen.
We have a visual display of comments in our waiting room that we receive and also send them to our patient experience team.
Referral numbers to the Priority Service:
Jan 2014 – Jan 2015 = 172
Jan 2015 – Jan 2016 = 224
Jan 2016 – Jan 2017 = 258
Referrals received into CAMHS:
2014/15 = 3,410; accepted 3,097
2015/16 = 5,507; accepted 2,663
Recent self-harm statistics showed an increase in:
Overdose by 42%
Ligature by 50% and Cutting by 285%
