Transitions Pathway between Child and Adolescent (CAMHS) and Adult Mental Health Services (AMHS) and arrangements for new referrals of 17½ year olds to 18 year olds

Contents

1.Aim of Protocol

2.Scope of Protocol

3.The Care Pathway for young people aged 17 years and 6 months

4.Transitions from CAMHS to AMHS

5.New referrals of 17 year olds and 6 months

6.Resolving Disputes

7.Early Intervention Service

8.Accident and Emergency Referrals 0900hrs – 17.00hrs

9.Accident and Emergency Referrals 1700hrs – 0900hrs

10.References

11.Referrals to AMHS or CAMHS of young people aged over 17 years and 6 months

  1. Aim of Protocol

A key aim of both Trusts is that all of our services are centred on the needs of the individual service user, and where appropriate their carers or significant others. As people progress through the stages of their illness, consistency and continuity of care, together with an uninterrupted responsibility for meeting their treatment needs, becomes vital to achieving effective outcomes.

It is therefore essential that the Trusts do not allow artificial barriers, boundaries or inappropriate use of cut off dates (such as age) to take precedence over the clinical needs of the service user. Both services should ensure that service users have full and proper support during the period of time they are progressing through services that address the needs of different age groups. It is important for staff from respective Trusts/services to collaborate and work together to ensure that the service user does not fall between services at this vulnerable time.

This will mean that on some occasions when it is clinically indicated, staff from AMHS will become involved before a cut off age of 18 for CAMHS has been reached and/or staff from the CAMH service may carry on after that age has been passed. The prime determinant for making such a decision will always be the clinical needs of the young person.

The following pathway is intended to provide the procedural guidance that will be followed in these circumstances in conjunction with the both Trusts existing policies and procedures

  • To ensure a smooth and seamless transfer of care for any individual
  • To ensure a clear and consistent system is in place across and between mental health trusts
  • To promote a young person and carer centred focus to all transition planning work

To specify the required steps to be taken by the team and/or individual clinicians as part of a transfer of care

  1. Scope of Protocol

This protocol applies to all professionals employed by North Bristol NHS Trust and those employed by Avon and Wiltshire Mental Health Partnership NHS Trust.

This protocol provides guidance for clinician’s responsible assessing new referrals into the team and for managing the transfer of care of a young person in receipt of Child and Adolescent Mental Health Services to the Adult Mental Health Services.

The guiding principles that underpin this protocol are based upon every health clinician and their services accepting and trusting each other’s clinical judgement and practice in applying the principles of national and local policy and best practice in managing transitions. It requires all parties to work together in partnership and actively familiarise themselves with each other’s services, and, most importantly, ensure that the individual service user is at the centre of decision making, as part of a service user centred approach, including the promotion of non-discriminatory practice.

  1. The Care Pathway for young people aged 17 years and 6 months in need of Specialist Mental Health Services in Bristol and South Gloucestershire

This flowchart summarises the care pathway for young people, including those already known to services (transition planning for moves from CAMHS to AMHS) and new referrals.

The three main options within the care pathway are:

Service(s) are provided by Child & Adolescent Mental Health Services (CAMHS)

Service(s) are provided by Adult Mental Health services (AMHS)

Service(s) are provided by joint working between CAMHS and AMHS

The main principles underpinning this pathway are:

  • The service provided should be based on that which best meets the needs of the young person.
  • The young person (and their carer(s), if appropriate), should be involved in the choice of service(s) where possible.
  • Effective communication and relationshipsare at the heart of robust care pathways, particularly at points of change or transition of services.
  • CAMHS and AMHS should provide advice, support and signposting to each other for the provision of services to 16 and 17 year olds.
  • Where a service identifies a need for a joint assessment or joint working, all mental health services will actively participate in the process.
  • Although referrers should be provided with guidance on referral, a referral to any mental health service should enable access to all options in the care pathway, both at the point of referral, and at any subsequent point in the care pathway.
  • 17½ year olds who are experiencing psychotic symptoms or where psychosis appears to be emerging should be seen by the Bristol or South Gloucestershire Early Intervention in Psychosis Teams.

Criteria to help inform the most appropriate pathway

These criteria are for guidance. The overriding principle is about how the needs of the young person and their family be most effectively met.

It is most likely that a young person will be seen by a CAMHS Team if:

Young person is under 17 years and 6 months

Young person is living with their family

Young person is a child in care

Young person under 18 will always require an ‘age appropriate bed’ as defined by the Mental Health Act Code of Practice

It is most likely that a young person will be seen by an AMHS Team if:

Young person is thought to be experiencing psychotic symptoms

Young person is not living with their family

Young person is over 17 years 6 months

  1. Transitions from CAMHS to AMHS

CAMHS Responsibilities

It is the responsibility of each CAMHS professional to consider whether a young person’s mental health needs would be best met within the AMHS as they approach their 18th birthday.

For all young people who are identified as requiring transfer to secondary or tertiary adult mental health services, it is expected that transition assessment and planning work be commenced well in advance and preferably at least 6 months before any anticipated need to transfer care with a formal referral to AMHS, therefore at 17½ years old. The CAMHS professional should approach the CAMHS link worker or the appropriate adult team to discuss the transition.

If it is not clear that the young person will meet the thresholds for secondary or tertiary adult mental health services, the CAMHS professional should liaise with the relevant adult mental health service to ensure that the transition referral is appropriate. There is an expectation that joint care planning should be in place 6 months prior to transfer where this is possible.

Transition assessment and planning work should consider the following:

  • A full and current assessment of risks and associated management plan
  • Appropriate access to the young person’s CAMHS records
  • Exploration of the individual service user’s own views on their future needs and concerns
  • Consideration of other family members
  • Consideration and agreement on any periods of joint working
  • A list of other service providers involved outside the NHS including contacts, roles, interventions, funding arrangements, role in adulthood, etc.

The CAMHS professional will be responsible for liaison with the individual, family and all significant others in order to help prepare a transfer of care that is viable for both service user and carer(s).

It is very important that when families have received considerable contact and support from CAMHS that transfer planning includes the timing for the reduction of family support or identifying the alternative means for this to be met in the future.

The CAMHS professional should continue to assume responsibility for the coordination of the young person’s care until the hand-over has been completed at the final joint agency meeting or other agreed point in time.

It is possible that a service user may continue to have mental health care needs that may benefit from intervention, but do not meet the threshold for adult secondary services. In these cases the CAMHS professional should consider what supports are available from primary care adult mental health services or other agencies.

Responsibilities AMHS receiving the referral

As stated, it is good practice for the referring CAMHS professional to liaise with the relevant AMHS Recovery Team Manager to ensure in the first instance existing services are in place to meet the needs of the service user. Once established, the following process should be followed:

On receipt of a referral from CAMHS, the relevant AMHS Team Manager is responsible for:

a)Ensuring that allocation of all referrals from CAMHS are given due weight and importance

b)Ensuring there is attendance at the CAMHS review or subsequent Professionals Meeting if indicated.

c)Ensuring allocation is within agreed timescales according to level of need and potential risk factors that will best meet the ongoing health needs of the individual referred

d)Ensuring that there is clear transition plan under CPA and the care plan after transition is clearly communicated.

The role of the identified AMHS Care Coordinator will include:

a)Contributing to the assessment, planning and agreement of the transition work and care to be delivered both during and after the transition process

b)Regularly briefing the Team Manager who will be involved for the service user once transition to the adult team is completed

It is expected that the receiving team acknowledges and where appropriate agrees a plan to manage transfer within 4 weeks of receipt of referral.

At any point during or after transfer, any requirements for inpatient care should be met in a way that is consistent with national and local policy regarding admission of those under 18.

Ensuring full information is accessed and utilised

It is the responsibilityof any CAMHS clinician at the onset of initial transfer to make contact with AMHS service to:

a)Clarify the nature of past involvement with the individual and their family

b)Clarify any risks

c)Clarify successful and unsuccessful interventions

d)Clarify role for CAMHS in supporting current work and needs and especially with the family

e)Clarify the Crisis response during the transition period

f)Clarify any arrangements for joint working

g)Agree a plan to manage transfer

Supporting Delivery of the Pathway

Each team involved in the care pathway will have identified link workers for young people, aged 16 & 17 (see appendix).

The Primary Care Liaison Team Manager (PCL), Recovery Team Manager will meet with the CAMHS link workers, together with CAMHS Area Health Manager/Service Manager,in each area (in Bristol and South Glos) every three months to review implementation of the pathway.

Terms of Reference for this group will include:

  • Review the use of the care pathway, considering throughput, capacity and service user feedback
  • Identify any problems in implementation and provide options for solutions
  • Promote development of best practice for the care and treatment of this cohort, including access to appropriate training, supervision and support
  • Discuss complex and/or problematic individual care pathways
  • Decide whether any other staff are required to attend to discuss specific issues
  1. New referrals of 17 years old and 6 months

New referrals of people aged 17½ years old should be initially directed to the relevant CAMHS Team. Those 18 years and over are the responsibility of AMHS.

If the CAMHS Team Manager/duty clinician thinks that an assessment for AMHS is more appropriate for a young person, then this should be negotiated with the relevant Primary Care Liaison Team. Factors to be considered may include social or emotional development of the young person, probable long term significant mental health need and service user choice.

  1. Resolving Disputes

If there is disagreement between CAMHS and AMHS regarding the level of needs/threshold which can not be resolved by the relevant Area Health/Service Manager (CAMHS) or Managing Director (AMHS), the case must be brought to the Partnership Directors (CAMHS) or Clinical Director (AMHS). This must be within 10 working days of the dispute arising. The Partnership Manager/Clinical Director will work with the teams to resolve the dispute, it is expected that this will take no longer than a further 10 working days.

  1. Early Intervention Service

The Early Intervention Service (EIS) has been designed to work with young people from the age of 14 years who have experienced a psychotic illness. In most cases, these young people will already be known and jointly worked between services. In cases which are not known to EIS, CAMHS clinicians should contact the EIS team manager to initiate the referral process as appropriate

  1. Accident and Emergency Referrals 0900hrs – 17.00hrs

Young people under the age of 18 are seen by the CAMHS Deliberate Self Harm Team

Those 18 years and older are seen by the Adult Service Hospital Liaison Team

  1. Accident and Emergency Referrals 1700hrs – 0900hrs
  • Young people below the age of 16 will be seen by the CAMHS on call.
  • The decision as to whether a young person aged 16/17 should be assessed by a child mental health (CAMHS) or adult mental health (AMHS) doctor or whether a joint CAMHS/AMHS assessment should be undertaken is a clinical decision based upon clinical need and the young person’s circumstances, not solely on age alone.
  • The following criteria should be used to request an assessment by the CAMHS on-call (via BRI switchboard)

Young person is an active case to CAMHS

Young person is under 17 years and 6 months

Young person is living with their family

Young person is a child in care

  • The following criteria should be used to request an assessment by the AMHS on-call (via Callington Road Switchboard (Trustwide):

Young person is an active case to AMHS

Young person is not living with their family

Young person is over 17 years 6 months

  • If it is the opinion of the receiving doctor that the ‘other’ mental health service is best placed to assess the young person then the referral should NOT be ‘bounced back’ to the referrer. It is the responsibility of the receiving doctor to liaise with his/her counter-part.
  • Sometimes, it will be essential to achieving good outcomes for the young person for there to be a joint AMHS/CAMHS assessment and a joint decision about referral-on (eg if it remains unclear as to the most appropriate pathway). It is the responsibility of the receiving doctor to consider whether a joint assessment is required and it is the responsibility of the non-receiving doctor to respond, provided that the above criteria have been applied appropriately.
  • Following an initial ‘out of hours’ assessment and referral to the appropriate AMHS or CAMHS team there may be further discussion and an assessment as part of the overall AMHS / CAMHS protocol
  • If the CAMHS/AMHS on-call doctors cannot agree who should undertake the assessment, then this in itself indicates that a joint assessment needs to be undertaken.
  1. References

Every Child Matters, DCSF, 2003

Childrens NSF (2004) Standard 9

National CAMHS Review, DCSF, 2009

Planning Mental Health Services for Young Adults Improving Transitions, NMHDU, 2010

Transition: getting it right for young people: improving the transition of young people with long term conditions from children’s to adult mental health services. DOH, 2006.

1

Authors: Martin Hember (AWP) and Tracey Henderson (NBT)

Approved: Clinical Effectiveness Group, NBT, 27 November 2013 & AWP Clinical Executive 24 April 2014

  1. Referrals to AMHS or CAMHS of young people aged 17.5 and over

12. Contact Details for South Glos. and BristolCAMHS Teams

Team Name / Name and Email Address of Link / Team Contact Details
South Glos CAMHS / Tracey Henderson
Clinical Psychologist
/ Kingswood Hub
Alma Road,
Kingswood,
BS15 4DA
Tel: 01454 862433
Fx: 01454 863078
East Bristol CAMHS / Mark Purnell
Specialist CAMHS Nurse
/ Downend Clinic,
BuckinghamGardens
Downend
Bristol
BS16 5TW
Tel: 0117 3302285
Fx: 0117 9569043
North WestBristol CAMHS / Stuart Melvin
Adolescent Primary Mental Health Specialist
/ MonksPark House,
SouthmeadHospital,
Southmead
Bristol
Tel: 0117323 5800
Fx: 0117 959 6017
South Bristol CAMHS / Kate Perry
Clinical Psychologist
/ Knowle Clinic
Broadfield Road
Knowle
BristolBS4 2UH
Tel: 0117 9190330
Fx: 0117 9190341

Contact Details for Bristol and South Glos AMHS Teams

Team Name / Name and Email Address of Link / Team Contact Details
Primary Care Liaison Team, Bristol / Team Manager
/ Brookland Hall
Conduit Place, St Werburghs
BristolBS2 9RU
Tel:0117 919 5670
Fx: 0117 919 5625
PCLS, South Glos / Cindey Karylo
Team Manager / Bybrook Lodge, Blackberry Hill Hospital, Manor Road, Fishponds
BristolBS16 2EW
Tel: 0117 378 7960
Fx: 0117 378 7941
South Recovery Team,Bristol / Team Manager
/ Petherton Resource Centre
Hengrove, BristolBS14 9BP
Tel: 01275 796200
Fx: 01275 796205
Central RecoveryTeam, Bristol / Team Manager
/ Brookland Hall
Conduit Place, St Werburghs
BristolBS2 9RU
Tel 0117 955 6098
Fx: 0117 9541954
North Recovery Team, Bristol / Team Manager
/ Gloucester House, Southmead Hospital
Bristol BS10 5NB
Tel: 0117 3235822
Fx: 0117 3236304
Recovery Team, South Glos / Helen Young
Team Manager (North)
Kutie Ngundu
Team Manager(South) / Cedar House
BlackberryHillHospital
Manor Road, Fishponds
BristolBS16 2EW
Tel: 0117 378 4621
Fx: 0117 378 4606
Early Intervention in Psychosis Team, Bristol / Team Manager
/ 1 Colson Fort
Montague Place, Kingsdown
Bristol BS6 5UB
Tel: 0117 919 2371
Fx: 0117 942 7478
Early Intervention Team,
South Glos / Anthony Lacny
Team Manager / Bybrook Lodge
BlackberryHillHospital
Manor Road, Fishponds
BristolBS16 2EW
Tel: 0117 378 7970
Fx:0117 9394592
CAMHS Substance Misuse / Bernie Chinnock
Service Manager
/ Young People Substance Misuse Treatment Service/Hospital CAMHS Team
Specialist CAMHS
38 Southwell Street
BristolBS2 8EJ
Tel: 0117 342 5729/
Fx:0117 342 5045
Mob: 07810 836 123