Merton Specialist CAMHS

Merton Children’s Trust Board 18th September 2015

Dedicated & Local Team Structure

ND

R K S M W

ED CLD

SPASPR SPR SPASPA

MST MST

Services from Merton Tier 3 Team

• Mental state examination, diagnostic assessment and medication where required

• Psychological assessment and treatments such as cognitive behavioural therapy (CBT)

• Monitoring, treatments and care coordination• Interface working to meet social care and other needs• Psychodynamic assessment and counselling• Family work, family therapy, parents support and psycho-

education• Opportunities for children and young people to be ‘participants’

Conditions that present in referrals to the service

Psychosis Mood Disorders Eating Disorders Dangerous Self Harm Significantly impairing Anxiety Disorders of a

diagnosable level (e.g. OCD, PTSD) Complex ADHD/ASD/Tourette’s (Tic Disorders) (i.e.

comorbid/ with MH problems) Children with Learning Disabilities who have a mental

health condition

Focus on Outcomes – Clinical (1) Merton CYP IAPT

Merton Consent Rate = 28.32%

  Assessment Measures* Goal(s) set* Current View / EET* Feedback Measures**CYP IAPT Consented

Clients69.14% (186/269) 18.22% (49/269) 45.72% (123/269) 16.33% (8/49)

All CAMHS Clients 37.58% (357/950) 13.89% (132/950) 30.53% (290/950) 6.73% (15/223)

Equivalent CYP IAPT Wave Comparison***

54.40% Wave 3 8.20% Wave 3 28.60% Wave 3 16.30% Wave 3

  Paired Goals** Paired Measures** Paired + EET 90%** CHI-ESQ Completion**CYP IAPT Consented

Clients34.69% (17/49) 28.57% (14/49) 6.12% (3/49) 28.57% (14/49)

All CAMHS Clients 22.42% (50/223) 15.70% (35/223) 0.90% (2/223) 15.25% (34/223)

Equivalent CYP IAPT Wave Comparison***

13.10% Wave 3 31.90% Wave 3 16.80% Wave 3 19.20% Wave 3

* criteria = 1st recorded event in reporting

quarter

last updated: 07/09/15 11:03** criteria = 3 or more

events and closed episode

*** source: Q4 14-15 CORC CYP IAPT

Report

Focus on Outcomes - Experience (2)

Case Example (1)

Presenting issuesChild A attended CAMHS having presented with a long standing fear of vomiting, and an interlinked problem of being fearful of sleeping alone. She lives with her parents and younger sister and attends school regularly (Year 10).

Following initial assessment, Child A was seen with her mother for a total of eight sessions. Work included cognitive restructuring, behavioural experiments and graded exposure (CBT), as well as work with her mother’s beliefs that appeared to be maintaining the problem. Mum herself suffered from panic attacks and anxiety as a teenager which re-emerged at times.   Outcome Child A developed skills to recognise when she was misinterpreting bodily signs and reframe them as signs of anxiety rather than physical illness, as well as challenge her negative beliefs about the likelihood and danger of vomiting and her own under-estimation of her capacity to cope.

Child A started to sleep alone, and at friend’s houses, as well as eat in restaurants and be around people who were unwell. Investigating parental beliefs was an important step towards supporting the young person through this troubling time.

 

Case Study (2)Problem:Boy aged 6 referred by school (school also referred to Social Care) Disruptive behaviour, poor concentration, hyperactivity, inappropriate language and volatile relationship between separated parents.

Initial intervention ADHD assessment which identified a conflict between parents reinforced by professionals’ views that the young person’s behaviour was a result of the parental relationships. Diagnosed with ADHD and medication prescribed.

Treatment:Child protection plan for emotional abuse: Social worker to monitor parental behaviour and separate parenting classes for each parent. CAMHS input includes medication and annual reviews with contribution to the child protection core group meetings and conferences. Ongoing consultation with the school to monitor young persons mental wellbeing.

Outcome: Child Protection plan in place and case overseen by a consultant psychiatrist.