child and adolescent mental health (camhs) for children and young people with learning disabilities...
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Child and Adolescent Mental Health (CAMHs) for children and young people with learning disabilities (or lack of them): An update
Sarah H Bernard
Consultant Psychiatrist
The Michael Rutter Centre
Overview
The past What has changed? What else needs to change? How can a highly skilled, effective,
evidenced based mental health service for children and young people with LD be provided?
Background
Biblical times – infanticide….. Society became more caring….. Asylum Education for all….MHA….NHS Move from institutions to community
care De-medicalization Child 1st approach (NSF)
What we know
Children with LD Are at an increased risk of developing
behavioural/mental health problems Are more likely to have co-morbidities Are more likely to have aversive
psychosocial circumstances Are less likely to receive a service
Recent Developments
CSIP Proxy target Program of activities Increase in provision But…….time of cuts, changes to
commissioning…….
Current situation (London)
Child 1st model EI services being promoted CAMHS vs PND/community paeds IQ lottery Variable assessments Lack of resources for intervention
What do we need?
Services for all Early identification Awareness of diagnostic
overshadowing Appropriate assessments which
inform intervention Effective liaison with education/social
care
How might services be delivered?
Identifiable care pathway Adequate resources Appropriate environment Skilled team Community based provision Access to emergency provision IP beds????
Assessment
Comprehensive Involvement of family/carers Involvement of education/social care Psychometrics ASD assessment Access to paediatricians, paediatric
neurologists, genetics…..
Intervention
Behavioural Group work Medication Psychoeducation Home, school, respite
Also
Safeguarding Medicolegal work Transition Training
What are the Pitfalls?!
Unclear service remit Restrictions from commissioners Gaps in service Lack of planning Lack of respite Inadequate provision of care
pathways for emergencies/crises
Good Practice
Sally. 5yr old. Moderate LD. Recently started at MLD primary schoolIncreasingly distressed. Sleep disrupted. Mild SIBRef to CAMHS. Observed at home and school. Parents interviewedSally interviewedPsychometry. ADIGenetics
Outcome – to discuss
Less Good Practice
Sally. 5yr old. Moderate LD. Recently started at MLD primary schoolIncreasingly distressed. Sleep disrupted. Mild SIBRef to CAMHS.CAMHS are not commissioned to see children at MLD
schoolsDelays….then passed to education psych……family
advised about how to manage Sally although not observed at home/school.
Sally increasingly distressed. Escalation of SIB with lacerations
Poor sleep, family exhausted…….Ref back to CAMHS…possible depression…..Still not seen…….
A Vision for the Future
Comprehensive services for all children
Timely assessments and interventions No discrimination Effective, respectful multiagency
working