across situations and settings – at home, school, and in public – which began before 7 years of age. Families with children who display difficulties in these categories should have already received significant advice and intervention from other professionals such as paediatricians, health visitors, social workers and educational support services before referral to Tier 3 CAMHS is made. unclear or a severe/complex presentation is described a referral to Tier 3 CAMHS may be considered. CAMHS would not normally assess a child for ADHD until they have completed at least one term within P1. The PMHW Service may offer consultation to those adults supporting the child/young person when their behavioural needs are causing concern. Anxiety Anxiety is a normal and common part of childhood. In most cases, anxiety in children is temporary, and may be triggered by a specific stressful event. In some cases, anxiety in children can be persistent and intense, interfering with a child’s daily routines and activities. Anxiety disorders include phobias, general anxiety, panic or persistent unexplained physical symptoms, such as headache or stomach-ache, where physical cause has been excluded. Those with recently emerging, less severe difficulties may be directed to the PMHW Service via consultation. Children who show persistent or severe symptoms of anxiety should be referred to Tier 3 These cases would include the following: Where the child’s development or level of functioning has been seriously affected or there has been a sudden deterioration. the anxiety appears to be out of proportion to the family circumstances. Where there is a significant impact on the parent/carer-child relationship - please describe in referral. You may wish to find out more at: Bereavement: Children’s response to grief will vary dependent on age, cognitive and developmental stage. Quite often it can be the subsequent change in circumstances or other family members’ reactions that can prove difficult for the child. Consult with PMHW in the first instance describing what support has already been offered and how the difficulties are affecting the child’s day to day functioning. The PMHW may work directly with the child/young person or may signpost to other services that can provide bereavement support. Although painful for everyone including professionals, you may wish to give the & family some time to experience a normal grief process You may wish to consider referral to CHAS at Home (the Highland outreach service for the Children’s Hospice Association of Scotland),
their day to day social functioning. OR, an associated risk that the child/young person may cause serious harm to themselves or others. For persistent and severe symptoms, referral to Tier 3 CAMHS may be appropriate. This includes not subjecting children to multiple assessments or to repeat information that other agencies hold. Therefore it is important that information is shared and accessed through, for example, the Integrated Assessment Framework, or Staged Intervention process and Child Protection processes. Given these principles (GIRFEC) it is important that professionals who are concerned about children utilise their existing referral protocols into our Service rather than suggest to the family that they attend their GP. It is helpful to know how the is affected by their symptoms - how their day to day functioning is affected. Young People with Learning Disabilities and/or Young People with Autism Spectrum Disorder (ASD) Learning disability and/or Autism Spectrum Disorder (ASD) on its own is not grounds for referral to Tier 3 CAMHS. For CAMHS to become involved there have to be additional concerns about mental health or significant behavioural problems. Children and young people with a learning disability or ASD can present with any of the mental health problems described in this document but their presentation and identification may be complicated by factors such as cognitive difficulties, social and communication difficulties and sensory sensitivities. We will also accept referrals from locality ASD who require a CAMHS assessment to complete the ASD diagnostic assessment. do not conduct initial diagnostic assessments for learning disability. Paediatricians, Educational Psychologists and pre-school special teachers assess children for learning disability. CAMHS do not accept referrals to initiate ASD diagnostic assessments. Professionals concerned about a child/young person with ASD can refer to the Highland Framework for Assessment and Diagnosis of Autism Spectrum Disorders, a multi-disciplinary framework agreed by Highland Services. If a CAMHS assessment is required as part of this assessment, the locality team (paediatrician & speech and language therapist) can refer to CAMHS. Young people aged 18 and over should be referred to adult learning disability services. National Autistic Society offers information and support CHIP+ offers information, support and advice to the families and carers of children and young people with additional support needs, and to professionals who work with them. Tier 3 also offers consultation to those professionals working with children and young people with a learning disability and/or ASD who are not referred or open cases to Tier 3 CAMHS.