Referral Criteria for Barnet Child and Adolescent Mental Health Services

Most young people with mild emotional or behavioural difficulties are best served by universal services e.g. General Practitioners, schools, health visitors and community groups etc. Before making a referral to CAMHS, these other options should be considered.

When the difficulties are complex and enduring and there is a significant impact on functioning, referral to targeted community based services or specialist clinic based mental health services may be appropriate.

The referral criteria in this document will enable you to determine whether it would be appropriate to make a referral to mental health services in schools (Barnet Primary and Secondary CAMHS Project) or specialist clinic based child and adolescent mental health services (CAMHS). The latter includes specialist community adolescent services (BAS), services for children with mental health problems associated with moderate to severe learning disabilities (SCAN) as well as the Paediatric Liaison Service based at Barnet GeneralHospital.

The core business of CAMHS is:

The assessment and treatment of serious mental health disturbances and associated risks in young people upto theage of 18 years.

Child Protection

If you are concerned that a child is at risk of physical, sexual or emotional abuse or neglect, you must refer to Social Care in the first instance, specifying your concerns and following your agency’s child protection guidelines. It would not be appropriate to refer to CAMHS before those concerns have been addressed.

When there is ongoing Social Care involvement with a child/family, the Social Worker needs to be advised of and in agreement with the referral to CAMHS, to ensure inter-agency liaison.

On a fortnightly basis, CAMHS and Social Care have a joint consultation meeting, where those families with a high level of need and who may benefit from both services are discussed.

Problems Appropriate for CAMHS referral

1. Depression or Mood Disorder

  • When the young person has persistent low mood which is beyond age-appropriate mood variation, of at least 2-3 weeks duration, (unless an urgent presentation /suicidal ideation in which case see below under Self Harm)
  • Activities of daily living are affected– e.g.losses of interest in friends, school work, disturbances of sleeping or eating.

The child should have been seen by the GP or other health professional for an assessment of mental state, physical health and risk prior to referral.

2. Self Harm

  • Where there are concerns about self harm, the GP should be consulted initially for advice on the urgency of the presentation. If there are concerns regarding milder forms of self-harming behaviours, a referral can be made to the Barnet Primary and Secondary Schools project for an assessment.
  • If there is an acute risk of self harm, families should be sent directly to Accident & Emergency Department for immediate medical care, and the protocol for management by A&E/Paediatrics/CAMHS followed
  • If the self harm is chronic, we would advise a GP assessment regarding current risk and mental state priorto referral to CAMHS, so that the young person can be prioritised appropriately.

3. Psychosis

  • Where there are concerns around any unusual and sudden changes in behaviour ormood e.g. paranoia – (verbally expressing this or avoidance of people/ activities because of this), withdrawn and isolated, unusual movements or behaviours, lack of interest in others and activities they used to enjoy), please requestan emergency GP assessment who will decide if an urgent referral needs to be made to CAMHS or A&E.

4.Anxiety including Post Traumatic Stress Disorder andObsessive Compulsive Disorder

  • Significant anxiety which is persistent and affects day to day functioning.
  • Generally persistence of four or more weeks duration for Post Traumatic Stress (severe distress occurring after a traumatic incident.)
  • An early referral for children and young people with Obsessive Compulsive Disorder is recommended. This is when young people are overly preoccupied by repetitive behaviour and rituals e.g. re checking behaviours and/or repetitive behaviours such as constant hand washing, in response to upsetting thoughts and feelings.

5. Eating Disorders (Anorexia, Bulimia, and Highly Selective Eating)

  • GP to assess physical and mental state prior to referral.
  • For less severe cases of selective eating and fears about food in young children, ask for support from the Health Visitor or School Nurse in the first instance.The Primary and Secondary schools Project (Tier 2 CAMHS) may also be able to offer consultation to parents and school staff who may be concerned about selective eating and fears about food in one or more settings.

6. Significant Learning disability with co –morbidity of enduring challenging behaviour/mental health problems

7. Complex Neurodevelopmental problems eg Autistic Spectrum, Asperger’s Syndrome, ADHD, Tourettes and Complex Tic Disorders

  • Autistic Spectrum Disorders: For children under the age of 7 years, refer to Community Paediatrics. Those older than 7 years of age, refer to CAMHS. Possible presentations include:
  • Significant difficulties with the child’s peer group relationships/social interactions with others.
  • Unusual or very fixed interests.
  • Marked preference for routine and difficulty managing change.
  • Bizarre or unusual behaviours.
  • ADHDFor children under 5 years of age, consider referral to health visitors or Community Paediatrics. Those children over 5 years of age, refer to CAMHS. Possible presentation includes.
  • Persistent attention difficulties in two or more settings e.g. school /home
  • Unresponsive to behavioural intervention in school despite involvement of school based support
  • Hyperactivity, impulsivity or inattention
  • Early age of onset and duration for more than 6 months

CAMHS cannot assess problems such as:

  • Dyspraxia: refer to Occupational Therapy
  • Dyslexia
  • Cognitive assessments: these are not carried out by CAMHS.

The Primary and Secondary schools Project (Tier 2 CAMHS) are able to offer consultation to parents and schools, who may be concerned about their child’s presentation and may want to discuss their options about the most appropriate service.

8. Medical Conditions and Physical Disabilities with mental health complications

  • Refer to Paediatricians who can refer to CAMHS if necessary
  • Paediatricians may refer to Barnet Paediatric Liaison Service in the first instance
  • Children with serious medical illness who are continuing to attend an out-of-borough hospital (e.g. GOSH) may be more appropriately served by that hospital’s Liaison Team.

9. Somatisation Disorders, Hypochondriacal, Dissociative Disorders, Pain Syndromes & Chronic Fatigue Syndromes

Joint work will be undertaken alongside the paediatric services.

10. Enuresis or soiling:

  • An initial physical assessment is needed by GP/Paediatrics before a referraltoCAMHSis made.
  • Paediatric Enuresis Clinic atVale Drive clinic provides assessment and interventions for children aged over 7 years
  • The Primary and Secondary schools Project (Tier 2 CAMHS) are able to offer consultation to parents and schools, who may be concerned about their child, and strategies may be suggested to help individuals to support the child.

11 .School Refusal

  • Refer to education support services in the first instance. A CAF should be completed and all appropriate agencies engaged prior to CAMHS referral.
  • Refer to CAMHS if there is evidence of mental health concerns, e.g. where the child has severe emotional distresslinked to attending school. Symptoms include severe anxiety and frequent symptoms of physical ill health which are medically unexplained.
  • The Primary and Secondary schools Project (Tier 2 CAMHS) are able to offer consultation to parents and schools, at the early stages of school refusal. The child’s refusal to come to school may be due to separation anxiety or difficult circumstances at home. Advice and support may enable parents and school to implement strategies early on to prevent consistent refusal to attend school.

12. Behaviour Problems andConduct Disorders

  • Consider referral to one of the parenting support groups offered by Barnet in the first instance.
  • If there are significant antisocial disorders e.g. truancy, stealing, destructiveness in school then a CAF should be completed initially, to ensure relevant services are co-ordinated to address those concerns. These might include the Family Focus team and Targeted Youth Services
  • Please also see section on behaviour problems mainly in the school setting for further information.

13. Difficulties in the context of parental mental Illness

  • Wewould expect to work jointly with Adult Mental Health Services and other involved agencies.
  • The Primary and Secondary schools Project (Tier 2 CAMHS) can work with children/ young people who are experiencing difficulties in the context of one or both parents having lower level mental health difficulties, who don’t reach the threshold for adult mental health services.

14. Substance Misuse Problems

Refer to Barnet Young People’s Drug and Alcohol Service (YPDAS) if that is the main presenting problem

15. Looked after Children:

There is a dedicated service within CAMHS for Barnet children in care and adoption that supports placements and stability

16. Children known to the Youth Offending Team:

Young people known to the Youth Offending Team can access the psychology service based within that team and they can decide if the referral is more appropriate for CAMHS. If you are thinking of referring a young person known to the Youth Offending Team, please consult with them first.

Barnet Primary and Secondary Project Workers working within the school setting (Tier 2 CAMHS)

Barnet Primary (BPP) and Secondary Project (BSP) offers consultation to school based professionals in relation to children/young people causing concern. The aim of the consultation is to provide early identification and brief intervention to children and young people in relation to mental health needs, and to provide information,advice and support to school based professionals.

This is a Tier 2 service which offers upto six appointments with the young person. Those children, who have more significant difficulties which will require more sustained input, should be referred to clinic based services. Examples of difficulties appropriate for referral to BPP/BSP are given below. In all cases, consultation with allocated Primary Mental Health Worker will help to identify the level of severity i.eappropriateness for Barnet Primary /Secondary service or a need for referral to the specialist CAMHS .

  • concerns about a pupil showing early signs of anxiety and depressionfor over 2 weeks in one or more than one setting eg. Fluctuations in behaviour and affect, consistently low in mood, socially isolated, irritable, Barnet Primary and Secondary Project (Tier 2) can provide consultations to school staff and parents on these cases aiming to monitor suggested school and home based interventions. In addition upto 6 sessions of individual work may be offered . Should concerns become more urgent at any point we would assist in making a referral to Tier 3 CAMHS.
  • concerns about pupils whose symptoms (eg. emotionally withdrawn, tearful, outbursts, difficulties in managing worries or anxiety, change in appetite and weight, unable to sleep, lacking in motivation in activities ) are impacting on a child’s functioning . Barnet Primary and Secondary Project (Tier 2) can provide an initial consultation to assess the most appropriate support. Following this it may be deemed appropriate for workers to provide additional assessment and consultation to school staff and parents aiming to monitor suggested school and home based interventions, and advise that a direct referral to be made to either Barnet Primary and Secondary Project or Tier 3 CAMHS.
  • Relationship difficulties affecting the child’s emotional well-being and or social development e.g. on going difficulty making or sustaining friendships, or coping with the effects of bullying. – with the requirement that usual school supports have been put in place in the first instance
  • Barnet Primary project supports young people having difficulties adjusting to the transition to Secondary school. Young people already known to the Barnet Primary Project who are vulnerable to experiencing difficulties with adjustment to Secondary school transition due to mental health issues will continue to be supported by the service for a time limited period within the Secondary school project.
  • Young people with emerging school attendance issues due to mental health concerns
  • Where there are family issues which are affecting the child’s ability to function at school and/or at home e.g. effects of family break-up, consider consultation with BPP/BSP who may provide consultations with school and discuss further with the team to decide whether it may be appropriate to offer some initial sessions with the young person or parents. Cases where there are on going legal proceedings will not be considered as appropriate for the service. After consultation it may be thought more appropriate for the parents to consult with Relate or Mediation e.g. offered by the Institute of Family Therapy .
  • If a pupil presents with behavioural problems e.g. low level behaviours such as tantrums, attention seeking behaviours, or other non age appropriate behaviours, Barnet Primary and Secondary Project (Tier 2) can provide an initial consultation to assess the most appropriate support. If deemed necessary, telephone consultations to school staff a on these cases can be provided over a period of 6 weeks aiming to monitor suggested school and home based interventions. Following the 6 weeks if concerns still exist, we may offer up to a six session intervention at school.

Please note an intensive model is now available for primary and secondary and specialist schools to purchase under the Trust Business Plan – providing increased time input and a range of models of working. Contact Breda O’Neill, Manager of Barnet Primary and Secondary Project to discuss this further on 07855406123 or email : Breda.O’

Problems not suitable for CAMHS referral but may be helped by other services

Family difficulties in the context of separation and divorce with no associated mental health concerns

  • Children and young people may present with emotional and behavioural difficulties in response to family stress – e.g. parental discord, divorce or separation, life adjustment difficulties and parenting problems with no associated mental illness. Such referrals are not appropriate for specialist mental health services, and referral to other agencies – e.g. Barnet Parenting Groups, Mediation Services (such as that provided by The Institute of Family Therapy) or Relate, should be considered. Parents may engage a solicitor who may seek a legal resolution. It is usually inappropriate for CAMHS to get involved in cases where there are ongoing contested legal proceedings as this makes it difficult to build therapeutic relationships, and prevents us working with family members together. Reports for court should be commissioned from professionals who work on a private basis. Once the legal dispute is resolved then children displaying persistent emotional or behavioural problems may be referred to CAMHS.

Some useful websites to direct families to are given below:



Response to bereavement

  • CAMHS are unable to accept referrals for children/young people affected by bereavement as more appropriate support can be offered by other agencies - e.g. Grief Encounter or Winston’s Wish.Consider referral to CAMHS when the child/young person is experiencing significant distress following a death that has occurred in traumatic circumstances (e.g. suicide).
  • Barnet Primary and Secondary schools Project can offer consultation to Teachers and parents where appropriate in relation to families and children/ young people in school who have experienced a loss, and who may need support around processing their grief. In addition the service is part of the support package provided to schools in the event of a bereavement occurring within a school or community, and works closely with Educational Psychology service to support children, families and staff in these circumstances.

Grief Encounter

Grief Encounter offers a flexible and accessible bereavement service which aims to professionally care and respond to the needs of each service user. They aim to support every family with an individual approach. Support is varied and can take the form of anything from a family Fun Day to a one-on-one meeting. Their support can also extend to other family members, school and friends. They run Residential Camps and have a Helplinewhich offersadvice and support.

Winston's wish
email:
Winston's Wish is a charity that helps children deal with bereavement. There are sections on helping children with the grieving process, including online activities and a 'skymap' of memories where they can remember their loved ones. The helpline helps parents and children with the process of loss.

3. Certain types of behaviour problems: If school staff are concerned about a child’s behaviour in school, the SENCO should consider referring to other agencies prior to referral to CAMHS, e.g an attempt should have been made to resolve the difficulties with the help of universal or targeted services such as: community parenting groups or Family Focus teams if appropriate . If the problem relates to school attendance, referrals should be made to the Targeted Youth Support Servicein the first instance.If there are associated learning difficulties, then they can consult their Educational Psychologist. Please see section above on referrals suitable for Primary and Secondary Project – Tier 2

A good source of information about services in Barnet for children, young people and their families is

If a child’s parents seek assistance with their parenting then refer them to the Parent Groups run by Barnet . Parent support programs, groups and workshops cover all child age groups from birth to 18 years.

  • access website for up to date information)

Other useful sites for further information:

Parentline Plus
Tel: 0808 800 2222
A charity offering support and advice to anyone parenting a child. Information is given generally or for specific ages. There are 'hot topics' and news articles in addition to tools for handling difficult situations and online and telephone support services.

YoungMinds
102-108 Clerkenwell Road
LondonEC1M 5SA
Tel: 020 7336 8445