Award Title: Enhancing CAMHS Referrals (EN-CAMHS)
Funder: Department of Health and Social Care

Abstract: Background_x000D_
More than 260,000 children in the UK were referred for help to Child and Adolescent Mental Health Services (CAMHS) in 2018/2019; and this number has risen steadily for the last five years. Following the difficulties young people have experienced through the pandemic, this is likely to rise further. About a quarter of children referred to CAMHS by their GPs, schools or parents are rejected for treatment by the service because the service isn’t well suited to the need, but mainly because the correct referral process has not been followed. This is clearly distressing for children and families who may wait a long time for an appointment at CAMHS and are turned away without necessarily being signposted elsewhere. The process is also costly to services because time is wasted reviewing documents about children who should have been referred for alternative help. We know that children are wrongly referred to CAMHS for a variety of reasons including: lack of awareness by referrers GPs/schools about when children should be sent to CAMHS; lack of knowledge by referrers about other support services; referrers not completing the correct documentation, as well as a range of other reasons._x000D_
_x000D_
Aim_x000D_
We aim to understand what the difficulties are in making referrals to CAMHS services. We want to improve the quality of referrals to CAMHS services so that only children and young people who can be helped by CAMHS are referred; and so that others can be guided to receive help they need elsewhere. A key objective is to talk widely with young people and families, with schools and GPs, people working in CAMHS and mental health leads so that we understand fully what the problems are and how we can develop solutions. We also aim to work with GPs, teachers and parents to find ways to develop and share information about alternative local resources for children who cannot be supported by CAMHS._x000D_
_x000D_
Design & Methods_x000D_
We shall work closely with CAMHS staff and agencies/stakeholders who refer children to CAMHS including GP practices, schools and parents. Through 8 focus groups, we shall document the CAMHS referral process and learn about where problems exist and the reasons why referrers do not always make good referrals nationally and locally. Through a further 4 focus groups, we shall discuss together possible ways to solve the problems identified. We shall also examine data from CAMHS sites to help us understand problems in the referral process. We shall explore problems at a local CAMHS site level and also at regional and national levels, supported by our mental health partners on the project. We shall talk extensively with people to try to find ways to solve the current problems._x000D_
_x000D_
PPI_x000D_
PPI is at the heart of this process. Young people and families who have experienced the CAMHS referral process (successfully and unsuccessfully) have worked with us on this grant application and will be involved throughout the project. We shall continue to work with these groups and families throughout the project._x000D_
_x000D_
Dissemination_x000D_
We want to share our lessons learned in this project widely to enable us to improve the quality of referrals to CAMHS across England. We shall publish our consultation work with referrers in academic journals, on our project website and share widely through social media, mental health charities and other organisations. We will use innovative and accessible techniques such as animation to reach children and young people as well as professionals.

Lay Abstract: More than 260,000 children in the UK were referred for help to Child and Adolescent Mental Health Services (CAMHS) in England in 2018/2019; and this number has risen steadily for the last five years. This number is expected to rise further following the difficulties Children and Young People (CYP) have faced through the pandemic. About one quarter of children referred to CAMHS by their GPs, schools or parents are rejected for treatment by the service because they are not deemed eligible for the service criteria, their service needs cannot be met by a local service but mostly because the correct referral process has not been followed. This is clearly distressing for children and families who may wait a long time for an appointment at CAMHS and are turned away. The process is also costly to services because time is wasted reviewing referral documents and following up with referrers about children who should have been referred for alternative help._x000D_
_x000D_
Aims and Objectives_x000D_
Our overarching aim is to find low-cost and widely reusable mechanisms to reduce inappropriate referrals. Our key objectives are to: 1) engage key stakeholders extensively to clarify the barriers they face in making appropriate referrals 2) analyse CAMHS referrals data to understand and identify problems 3) identify the specific requirements for viable and sustainable solutions 4) explore with key stakeholders how we can improve the referral process and provide signposting to alternative sources of help for CYP 5) identify how best the proposed solutions could be embedded into routine CAMHS referral pathways._x000D_
_x000D_
Methods_x000D_
We shall consult extensively with key stakeholders across 12 focus groups to clarify the criteria for referrals to CAMHS and to understand the barriers to making appropriate referrals including referrals to other services more suited/better aligned to the CYP need. We shall analyse the CAMHS referral data to understand problems in the CAMHS referral pathways. We shall aim to identify with stakeholders potential sustainable solutions to the current problems. We shall also examine the challenges to the adoption and sustainability of proposed solutions. _x000D_
_x000D_
PPI_x000D_
We shall build on our established collaborations with YP and their parents/carers/families. Regular consultations with YP and other CAMHS stakeholders will ensure the study remains relevant and meaningful. Our work will be informed by our advisory groups comprising YP, parents/carers and relevant practitioners/professionals. Our PPI consultations have already indicated the need for improvements to the CAMHS referrals processes._x000D_
_x000D_
Impact and Dissemination_x000D_
We shall identify the problems in CAMHS referrals processes working extensively with key CAMHS stakeholders across England, including young people and their families. Our confirmed collaborators, including our key referrers (GPs, schools), YP partners (CAMHS.Digital; Youth Mental Health Matters), parents/families partners (PLACE, CALM Connections), other third sector collaborators (e.g. MQ Mental Health; Anna Freud Centre; McPinFoundation; 42nd Street), four NHS CAMHS providers, and national and regional strategic leads for CYP mental health will ensure our outputs are shared widely with key beneficiaries. Our extensive dissemination strategy, supported by our long list of mental health and YP collaborators, will ensure maximum impact and enable our outputs to be disseminated to all relevant CAMHS stakeholders.

Research Activity Codes: 7.3 MANAGEMENT AND DECISION MAKING
Health Categories: MENTAL HEALTH