6 results
28 - Tier 4 options
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- By Tim McDougall, Cheshire & Wirral NHS Foundation Trust, Anne Worrall-Davies, University of Leeds, Lesley Hewson, Bradford District Care Trust, Rosie Beer, Greg Richardson, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 259-269
-
- Chapter
- Export citation
-
Summary
‘Two roads diverged in a wood, and I–
I took the one less travelled by,
And that has made all the difference.’
Robert Frost (1874–1963)Introduction
Tier 4 CAMHS aim to meet the needs of children and young people with the most complex, severe or persistent mental health problems. Tier 4 services include in-patient care (see Chapter 29), as well as a range of day care and intensive community home-based and outreach services for specific groups of children and young people.
Day services
Early descriptions of child and adolescent mental health day units emphasised 5-day ‘milieu’ provision with a strong emphasis on education and behaviour management (Brown, 1996), whereas now they frequently provide daily focused activities to which children and families are invited, depending on their needs. Currently, about half of UK day services are linked to in-patient units, and many in-patient units have a day programme (Green & Jacobs, 1998). It is impossible to classify day services owing to the enormous range in milieu and interventions provided (Green & Worrall- Davies, 2008). However, day services broadly offer:
• support and transition to community services following in-patient admission;
• intensive 5 days per week treatment packages for children and their families;
• treatment of disruptive behaviour, using multimodal treatment strategies with a combination of individual, family and psychopharmacological interventions;
• specialist management and programmes of care for younger children with developmental disorders such as autism, speech and language disorders or neuropsychiatric disorders;
• intensive intervention aimed at improving family functioning in situations of family breakdown or child maltreatment.
Provision and organisation
Day units can offer assessment and therapeutic services that are more specialised, complex and intensive than out-patient services, although they are still community-based and less disruptive than in-patient admission. Most also have the benefit of educational input. Close liaison with specialised education and Social Services is central to their work. There is general acceptance of the central importance of maintaining attachments and working with whole systems if the complex needs of children are to be met. Day units can work with children and young people individually and in groups, as well as with their families, while keeping the focus of concern within the community and avoiding the ‘out of sight, out of mind’ dilemma of in-patient services.
29 - In-patient psychiatric care
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- By Angela Sergeant, Leigh House Hospital, Winchester, Greg Richardson, North Yorkshire & York Primary Care Trust, Ian Partridge, Lime Trees CAMHS, York, Tim McDougall, Cheshire & Wirral NHS Foundation Trust, Anne Worrall-Davies, University of Leeds, Lesley Hewson, Bradford District Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 270-283
-
- Chapter
- Export citation
-
Summary
‘“It all comes”, said Pooh crossly, “of not having front doors big enough.”’
A. A. Milne, Winnie the PoohIntroduction
Despite the development of home treatment teams and early intervention psychosis services, the demand for in-patient child and adolescent beds remains. It is rare for young people with mental disorders to require inpatient services, but when they do, beds are few and far between. Reasons for admission include severity of illness, deterioration in psychological functioning despite community treatment, high risk to self or others, or family difficulties making treatment difficult, any of which may lead to the need for 24-hour care (Green & Worrall-Davies, 2008). In-patient care is a specialised field providing treatment for young people with serious psychiatric illness by skilled and experienced staff.
Who and what are in-patient units for?
There is a range of psychiatric, educational, social, criminal and societal indicators for admission to an in-patient service. It is usually impossible to separate the different aspects or contributors to the young person's disorder so that each can be provided by the different agencies responsible for it. Psychological disorders, because of adverse life experiences, are common and pure psychiatric disorders are rare, but they all have educational and social precursors and sequelae. Trying to compartmentalise children into unidisciplinary treatment pigeonholes is problematic as:
• admission to psychiatric in-patient units considerably disrupts education and the young person's functioning in the community
• education authorities have to meet young people's special educational needs but cannot isolate these from other social and mental health factors, which they often do not have the resources to address
• residential policies of Social Services departments tend to address young people's mental health and educational needs only as secondary considerations
• the Home Office and Ministry of Justice, which will provide care in a prison setting, have little investment in childhood preventative work for the large proportion of young people with conduct disorder and complex needs when they become adults.
Work on sharing residential responsibility and input requires considerable inter-departmental and inter-agency working, but each agency will be uncertain who is going to reap the most for investing in them, and the harvest is not guaranteed.
28 - Tier 4 options
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- By Tim McDougall, Lead Nurse, Cheshire & Wirral NHS Foundation Trust, Anne Worrall-Davies, MBChB, MMedSc, MRCPsych, Senior Lecturer in Child and Adolescent Psychiatry, University of Leeds, and Honorary Consultant in Child and Adolescent Psychiatry, NHS Leeds, Lesley Hewson, MBChB, MRCPsych, FRCPsych, Consultant Child and Adolescent Psychiatrist, Bradford District Care Trust, Rosie Beer, Retired Consultant in Child and Adolescent Psychiatry, Leeds, Greg Richardson, MBChB, DCH, DPM, FRCPsych, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published online:
- 02 January 2018
- Print publication:
- 01 February 2010, pp 259-269
-
- Chapter
- Export citation
-
Summary
‘Two roads diverged in a wood, and I–
I took the one less travelled by,
And that has made all the difference.’
Robert Frost (1874–1963)Introduction
Tier 4 CAMHS aim to meet the needs of children and young people with the most complex, severe or persistent mental health problems. Tier 4 services include in-patient care (see Chapter 29), as well as a range of day care and intensive community home-based and outreach services for specific groups of children and young people.
Day services
Early descriptions of child and adolescent mental health day units emphasised 5-day ‘milieu’ provision with a strong emphasis on education and behaviour management (Brown, 1996), whereas now they frequently provide daily focused activities to which children and families are invited, depending on their needs. Currently, about half of UK day services are linked to in-patient units, and many in-patient units have a day programme (Green & Jacobs, 1998). It is impossible to classify day services owing to the enormous range in milieu and interventions provided (Green & Worrall- Davies, 2008). However, day services broadly offer:
• support and transition to community services following in-patient admission;
• intensive 5 days per week treatment packages for children and their families;
• treatment of disruptive behaviour, using multimodal treatment strategies with a combination of individual, family and psychopharmacological interventions;
• specialist management and programmes of care for younger children with developmental disorders such as autism, speech and language disorders or neuropsychiatric disorders;
• intensive intervention aimed at improving family functioning in situations of family breakdown or child maltreatment.
Provision and organisation
Day units can offer assessment and therapeutic services that are more specialised, complex and intensive than out-patient services, although they are still community-based and less disruptive than in-patient admission. Most also have the benefit of educational input. Close liaison with specialised education and Social Services is central to their work. There is general acceptance of the central importance of maintaining attachments and working with whole systems if the complex needs of children are to be met. Day units can work with children and young people individually and in groups, as well as with their families, while keeping the focus of concern within the community and avoiding the ‘out of sight, out of mind’ dilemma of in-patient services.
29 - In-patient psychiatric care
-
- By Angela Sergeant, RMN, RGN, MSc, ENB 603, Consultant Nurse in Child and Adolescent Psychiatry, Leigh House Hospital, Winchester, Hampshire Partnership Trust, Greg Richardson, MBChB, DCH, DPM, FRCPsych, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust, Ian Partridge, MA, MSc, CQSW, Social Worker, formerly at Lime Trees CAMHS, York, Tim McDougall, Lead Nurse, Cheshire & Wirral NHS Foundation Trust, Anne Worrall-Davies, MBChB, MMedSc, MRCPsych, Senior Lecturer in Child and Adolescent Psychiatry, University of Leeds, and Honorary Consultant in Child and Adolescent Psychiatry, NHS Leeds, Lesley Hewson, MBChB, MRCPsych, FRCPsych, Consultant Child and Adolescent Psychiatrist, Bradford District Care Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published online:
- 02 January 2018
- Print publication:
- 01 February 2010, pp 270-283
-
- Chapter
- Export citation
-
Summary
‘“It all comes”, said Pooh crossly, “of not having front doors big enough.”’
A. A. Milne, Winnie the PoohIntroduction
Despite the development of home treatment teams and early intervention psychosis services, the demand for in-patient child and adolescent beds remains. It is rare for young people with mental disorders to require inpatient services, but when they do, beds are few and far between. Reasons for admission include severity of illness, deterioration in psychological functioning despite community treatment, high risk to self or others, or family difficulties making treatment difficult, any of which may lead to the need for 24-hour care (Green & Worrall-Davies, 2008). In-patient care is a specialised field providing treatment for young people with serious psychiatric illness by skilled and experienced staff.
Who and what are in-patient units for?
There is a range of psychiatric, educational, social, criminal and societal indicators for admission to an in-patient service. It is usually impossible to separate the different aspects or contributors to the young person's disorder so that each can be provided by the different agencies responsible for it. Psychological disorders, because of adverse life experiences, are common and pure psychiatric disorders are rare, but they all have educational and social precursors and sequelae. Trying to compartmentalise children into unidisciplinary treatment pigeonholes is problematic as:
• admission to psychiatric in-patient units considerably •• disrupts education and the young person's functioning in the community
• education authorities have to meet young people's special educational needs but cannot isolate these from other social and mental health factors, which they often do not have the resources to address
• residential policies of Social Services departments tend to address young people's mental health and educational needs only as secondary considerations
• the Home Office and Ministry of Justice, which will provide care in a prison setting, have little investment in childhood preventative work for the large proportion of young people with conduct disorder and complex needs when they become adults.
Work on sharing residential responsibility and input requires considerable inter-departmental and inter-agency working, but each agency will be uncertain who is going to reap the most for investing in them, and the harvest is not guaranteed.
Taking on the management: training specialist registrars in child and adolescent psychiatry
- Lesley Hewson, Susie Hooper, Anne Worrall-Davies
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- Journal:
- Psychiatric Bulletin / Volume 30 / Issue 2 / February 2006
- Published online by Cambridge University Press:
- 02 January 2018, pp. 71-74
- Print publication:
- February 2006
-
- Article
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- You have access Access
- Open access
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The proposal that management training should be integral to the training of all doctors, including psychiatrists, is not new (Gadd, 1990). The Child and Adolescent Psychiatry Specialist Advisory Sub-Committee (CAPSAC) training guidelines (1999) recognise that future consultants will need sufficient management skills to be leaders in service development as well as effective clinicians, and outline the knowledge and experience to be gained during higher professional training (Box 1). This paper describes the Yorkshire scheme's approach to supporting trainees to achieve these objectives and highlights the need to engage trainees, trainers and managers in taking forward this important agenda.
Joint trainers and trainees forum – a collaborative approach to higher specialist training
- Lesley Hewson, Barry Wright
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- Journal:
- Psychiatric Bulletin / Volume 26 / Issue 1 / January 2002
- Published online by Cambridge University Press:
- 02 January 2018, pp. 33-35
- Print publication:
- January 2002
-
- Article
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- You have access Access
- Open access
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The Royal College of Psychiatrists' Higher Specialist Training Handbook (1998) emphasises the need for training schemes to be well organised in order to provide an environment in which training needs can be met. Training programme directors are tasked to provide “regular meetings with the trainees as a group to discuss the scheme and its placements” as well as “occasional meetings with trainers to discuss the scheme and its further development”.