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Appendix 2: A Comprehensive CAMHS

Improvement, Expansion and Reform (1) has set the expectation that a comprehensive child and adolescent mental health service (CAMHS) will be available in all areas by 2006. This means that in any locality, there is clarity about how the full range of users' needs are to be met, whether it be the provision of advice for minor problems or the arrangements for admitting to hospital a young person with serious mental illness. This is reiterated in National Standards, Local Action (2), which sets out the priorities for 2005/06-2007/08 for the NHS, and emphasises the need to  maintain the levels of service achieved through the 2003-06 planning round.

Clear pathways should be set out to show how the range of mental health needs of children and young people will be met, whether from within services whose prime purpose is to deliver mental health care or from other services with a different primary function. This will not necessarily mean that all services will be in their final configuration or available in every locality by 2006. Where local provision is not appropriate or possible, commissioners will need to set out the collaborative arrangements that will ensure that there is an agreed care pathway to meet the specific needs from an alternative service.

Further improvements and developments will be required throughout the lifetime of the National Service Framework implementation to extend the range of services provided and ensure the highest standards of care. The aspiration should be to continually improve and develop the services in the context of multi-agency partnerships across the spectrum of need, and informed by the best available evidence.

A comprehensive service in practice

Commissioners will require a clear definition and description of a comprehensive CAMHS. This can be set out under a number of separate headings:

Underpinning Principles:

  • Access to CAMHS should be available to all children and young people regardless of their age, gender, race, religion, ability, class, culture, ethnicity or sexuality.
  • Effective CAMHS commissioning is a multi-agency activity and requires that the commissioners have the requisite skills, knowledge, time and executive authority to undertake the task.
  • Both the commissioning and delivery of services should be informed by a multiagency assessment of need that is updated regularly. This needs to incorporate:
    Locally adjusted epidemiological information on the prevalence of children's mental health problems to reflect the diversity of the population and other local demographic circumstances.
    An assessment of the needs of particular groups of children and young people in the locality who are vulnerable or at risk
    An audit of services currently provided by all agencies that address both directly and indirectly the mental health needs of children and young people.
    An analysis of current service usage.
    The views of all stakeholders including those of the children, young people and families.
    The available evidence of the efficacy and effectiveness of interventions and service models.
    Current national and local policy priorities.
  • Services should be commissioned to ensure that the workforce is of sufficient critical mass to have the capability to meet the range of defined needs safely, effectively and efficiently.

Range of Services:

  • The range of services and their settings should reflect the specific needs:
    Related to the age of children and young people using the service
    Related to the circumstances of the child, particularly if they may affect access to services
    Associated with the presence of a learning disability.
  • Arrangements should be in place to ensure that 24 hour cover is provided to meet urgent needs and a specialist mental health assessment should be undertaken within 24 hours or during the next working day.
  • There needs to be a balance of service provision in order that all levels of need can be met as required:
    Within primary level services (Tier 1), those in contact with children need to be able to have sufficient knowledge of children's mental health to be able to: identify those who need help; offer advice and support to those with mild or minor problems; and have sufficient knowledge of specialist services to be able to refer on appropriately when necessary.
    Child mental health workers (Tier 2) need to be available to support, train, liaise with, consult to and provide direct work with other agencies providing services for children.
    Specialist multidisciplinary teams in all localities should be able to provide:
    - Specialist assessment and treatment services
    - Services for the full range of mental disorders in conjunction with other agencies as appropriate.
    - A mix of short term and long term interventions and care according to levels of complexity, co-morbidity and chronicity.
    - A full range of evidence-based treatments;
    - Specialist services that are commissioned on a regional or multi-district basis, including in-patient care

Workforce and Skills:

  • The professional mix within specialist services and teams should be balanced to ensure the availability of an appropriate representation of skills, in particular, professional and team isolation should be avoided in all services.
  • Staff have the skills, competencies and capabilities that are necessary. All services should ensure they can:
    Work across agency boundaries and within a variety of settings;
    Engage children, young people and their families who have difficulty accessing services.
    Deliver interventions based on the best available evidence.
  • Services require management expertise with sufficient knowledge, understanding and executive authority to be able to support the effective and efficient multiagency delivery of CAMHS.
  • The administrative workforce should be sufficient to ensure that all necessary administrative functions, including data collection, can be fulfilled.
  • Commissioners in conjunction with specialist providers should support the development of CAMH expertise within all children's agencies.

Training and development:

  • Clear supervisory arrangements and structures should be in place to ensure accountable and safe service delivery.
  • Multi-professional training and consultative work, undertaken both within and across agencies, is essential.
  • The necessary resources to support the training and development requirements of the CAMHS workforce should be available.

Organisational arrangements:

  • Agreed protocols should be in place to manage waiting lists and times according to need.
  • Services should be accommodated in buildings fit for supporting all the expected functions.
  • Where services are located in non-CAMHS dedicated community settings (e.g. schools), arrangements should be made to provide suitable accommodation for supporting service delivery.
  • The equipment and accommodation used for direct work with children should ensure that children's safety is of paramount concern.
  • IT resources and equipment to support high quality care and the monitoring and evaluation of services should be available in all appropriate settings.
  • Where interfaces exist between services, as between adult and children's mental health services, arrangements should be negotiated to ensure clarity and effectiveness of separate and joint service responsibilities and smooth transitions of care.
  • Where service delivery demands effective partnerships between agencies (e.g. children and young people with complex, persistent and severe behavioural disorders) joint protocols should be agreed at senior officer level between the NHS, social services and education.
  • Clinical governance arrangements should ensure that all staff are trained, supported and able to deliver sound, ethical and safe services.

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