Primary Child and Adolescent Mental Health: A Practical Guide, Volume 1

260 Pages·2018·5.05 MB·English

by  Quentin Spender

Primary Child and Adolescent Mental Health
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Primary Child and Adolescent
Mental Health
A practical guide
VOLUME I
Second Edition
Dr Quentin Spender
Consultant in Child and Adolescent Psychiatry
Wolverhampton City Primary Care Trust
Wolverhampton, UK
Dr Judith Barnsley
Consultant in Child and Adolescent Psychiatry
Dorset Healthcare University NHS Foundation Trust
Poole, UK
Alison Davies
Primary Mental Health Worker
Sussex Partnership NHS Foundation Trust
Chichester, UK
and
Dr Jenny Murphy
Clinical Psychologist
Dorset Healthcare University NHS Foundation Trust
Poole, UK
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
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First published 2011 by Radcliffe Publishing
Published 2016 by CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2011 Quentin Spender, Judith Barnsley, Alison Davies and Jenny Murphy
CRC Press is an imprint of Taylor & Francis Group, an Informa business
First Edition 2001
No claim to original U.S. Government works
ISBN-13: 978-1-84619-542-6 (pbk)
Quentin Spender, Judith Barnsley, Alison Davies and Jenny Murphy have asserted their right
under the Copyright, Designs and Patents Act 1998 to be identified as the author of this work.
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Contents
Preface to the second edition vi
About the authors xiii
Acknowledgements xiv
Part 1: Overview 1
1 T he context for provision of Child and Adolescent Mental
Health Services 3
2 Preschool 19
3 Middle childhood 34
4 Adolescence 68
Part 2: General issues 87
5 Temperament 89
6 Resilience and risk 93
7 Attachment theory and looked-after children 102
8 Family issues 115
9 Separation, divorce and reconstituted families 140
10 Death, dying and bereavement 153
11 E ffects of parental mental illness (including substance misuse)
on children and families 168
12 Child abuse and safeguarding 176
13 Behaviour management 201
Index 237
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Preface to the second edition
In the decade since the fi rst edition of this book, the way in which mental health
services in the United Kingdom are provided to children and adolescents has
changed in a number of ways. Although geographical uniformity has proved dif-
fi cult to achieve, frontline services have been extensively developed to improve the
mental health of the under-18 population.
Th e aim of this book is to give those working at the frontline – the fi rst profes-
sionals that a child or parent may meet when asking for help – a practical guide
about what to do. Th e chapters are structured to enable relevant theoretical issues
to be summarised simply, followed by detailed suggestions about how to gather
relevant information and how to help, leaving referral to specialised services as a
last resort.
Our vision is that a whole variety of professionals to whom children or parents
may turn for help will have at their fi ngertips a means of understanding the prob-
lems presented, and will be able to off er straightforward ways of helping. Profes-
sionals at the frontline need training and advice from more experienced and highly
trained colleagues; but we hope this book will also play a role in their professional
development and provide an additional source of support, either as a component
of learning or as a resource for teaching.
It would be foolhardy not to acknowledge some of the diffi culties inherent in
providing a universal Child and Adolescent Mental Health Service (CAMHS) that
can meet everyone’s needs. Th ese barriers include the following.
➤ Agency cooperation – Using the broadest defi nition of CAMHS, services are
provided and professionals employed by not only the National Health Service
but also by Educational and Social Care organisations; others play a role, such
as the youth criminal justice system, substance misuse services and counselling
charities. A single child may have contact with a bewildering array of diff erent
organisations and individuals, making eff ective cooperation between them a
signifi cant challenge.
➤ Management issues – Th e joint management of Education and Social Care, and
the appointment of jointly funded Commissioners, has been introduced to help
coordinate the main involved agencies. Th ere remains tremendous variation in
management structures. Considering now the narrow defi nition of CAMHS,
specialised services may be part of Mental Health Trusts, Primary Care Trusts
vi
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PREFACE TO THE SECOND EDITION vii
or Trusts providing hospital paediatric care. Within these Trusts, specialised
CAMHS may be in a directorate with a variety of bedfellows, for instance: adult
mental health; adult learning diffi culty; community paediatrics; hospital pae-
diatrics; health visiting; school nursing; and many others. Some Trusts favour
medics in managerial roles such as that of CAMHS Clinical Director; some
Trusts prefer non-clinicians for service management roles; others prefer clini-
cians such as nurses, psychologists or social workers for both clinical and ser-
vice management roles.
➤ Th is variation in management structures is part of the ‘postcode lottery’, mean-
ing that services may be available in one area but not another, and that where
the child and family live may be as much a factor in determining what help is
available as the skill-mix of professionals. Another component of this is that
areas of deprivation have higher per capita funding, but in relatively affl uent
areas, a higher proportion of the population in need may present for help, with
the result that services may paradoxically be more stretched in more affl uent
areas. Th is can be exacerbated by the cost of housing contributing to diffi culties
in recruiting staff . Th e independent sector is just as patchy in its provision (per-
haps more). Added to all this is the variation in the four countries of the UK:
England, Scotland, Wales and Northern Ireland. We have not attempted in this
book to do justice to this, but have stuck to what we know, which is our own
practice within three diff erent regions of England: we cannot claim with our
limited joint experience to understand the range of service provision within
even one country.
➤ Service lacunae (gaps in what is provided) have persisted, despite a variety of
attempts to make services more uniform, such as the National Service Frame-
work1 and the establishment of a peer-reviewing system.2 An example is the
service received by children with learning diffi culties and their families, which
is still extremely patchy and highly variable.
➤ Funding issues – It is beyond the scope of this book to present the arguments
about the inequitable share of the funding cake allocated to under-18s com-
pared to other age groups, or mental health problems compared to other cat-
egories of ill health. Killers such as cancer, heart disease or premature birth are
more likely to get the sort of publicity that mobilises political will. Some have
described CAMHS as the ‘Cinderella of Cinderellas’. Periods of investment tend
to be followed by periods of renewed fi nancial stringency. Joint commission-
ing arrangements may not be able to prevent huge sums being spent on highly
specialised provision for a small number of individuals, thus stifl ing investment
in small-scale outpatient teams: a larger scale preventative approach may be
necessary for this.
➤ Customer confusion – All of this variation may leave parents very confused
about how best to access help for their child. Professionals may also be con-
fused about who is best placed to deliver the best help at the best time: the
professional who fi rst sees the child may be chosen more by accident than by
any logical process. Some acronyms (abbreviations) may add to the overall con-
fusion. We give here a selection:
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viii PREFACE TO THE SECOND EDITION
— ABE Achieving Best Evidence
— ASBO Antisocial Behaviour Order
— ASSIST Asylum Seeker Support Initiative Short Term
— BESD Behavioural, Educational and Social Diffi culties
— BEST Behavioural and Educational Support Team
— BOSS Business Opportunity Sourcing Service
— BPD Borderline Personality Disorder
— BPD Bipolar Disorder
— BPD Broncho-Pulmonary Dysplasia
— BPS British Psychological Society
— CAF Common Assessment Framework
— CAFE Child and Adolescent Faculty Executive
— CAP Child and Adolescent Psychiatry
— CORC CAMHS Outcome Research Consortium
— CPD Continuing Professional Development
— CPD Continuous Peritoneal Dialysis
— CPS Crown Prosecution Service
— CRB Criminal Records Bureau
— DAT Drug and Alcohol Team
— DAT Drug Action Team
— DCSF Department for Children, Schools and Families
— DNA Did Not Arrive
— DNA Deoxyribonucleic acid
— DoH Department of Health
— DTO Detention and Training Order
— EBD Educational and Behavioural Diffi culties
— EBPD Emerging Borderline Personality Disorder
— E2E Entry to Employment
— FAST Family Advice and Support Team
— FIP Family Intervention Project
— FRT Family Resource Team
— GAP Guideline Appraisal Panel
— HAVOC Having an Alternative View of Crime
— HMYOI Her Majesty’s Young Off ender Institution
— IRS worker Integrated Resettlement Support worker
— ISP Initial Supervision Plan
— ISSP Intensive Supervision and Surveillance Programme
— JAR Joint Area Review
— KYPE Keeping Young People Engaged
— LAC Looked-Aft er Children
— LD Learning Diffi culty
— MAPPA Multi-Agency Public Protection Arrangements
— MAST Multi-Agency Support Team
— MHPW Mental Health and Psychological Wellbeing
— MLD Moderate Learning Diffi culty
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PREFACE TO THE SECOND EDITION ix
— NEET Not in Education, Employment or Training
— NHS National Health Service
— NICE National Institute for Health and Clinical
Excellence
— OFSTED Offi ce for Standards in Education
— OoH Out of Hours
— PAYP Positive Activities for Young People
— PCAMHW Primary Child and Adolescent Mental Health Worker
— PCSO Police Community Service Offi cer
— PCT Primary Care Trust
— PDP Personal Development Plan
— PHEW Psychological Health and Emotional Wellbeing
— PMHW Primary Mental Health Worker
— PREMs Patient-Reported Experience Measures
— PROMs Patient-Reported Outcome Measures
— PRU Pupil Referral Unit
— PTSD Post Traumatic Stress Disorder
— PSA Parenting Support Adviser
— PSR Pre-Sentence Report
— RAP Recurrent Abdominal Pain
— RAP Resource Allocation Panel
— RAP Resettlement and Aft ercare Provision
— RoH Risk of Harm
— SENCo Special Educational Needs Coordinator
— SIG Special Interest Group
— SIPS Social Inclusion and Pupil Support
— SLA Service Level Agreement
— SLD Severe Learning Diffi culty
— SMART Specifi c, Measurable, Achievable, Realistic and
Time-bounded
— SPP Senior Parenting Practitioner
— SSIW Social Services Inspectorate for Wales
— TAC Team Around the Child
— TaMHS Targeted Mental Health in Schools
— TPU Teenage Pregnancy Unit
— VLO Victim Liaison Offi cer
— WPI Wales Programme for Improvement
— YADAS Young Adults’ Drug and Alcohol Service
— YIP Youth Inclusion Programme
— YISP Youth Inclusion Support Panel
— YJB Youth Justice Board
— YOI Young Off ender’s Institution
— YOIS Youth Off ending Information System
— YOT Youth Off ending Team
— … and many others.
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