The Multidisciplinary Team in a Community Child and Adolescent Mental Health Service - Essay Example

What should a multidisciplinary team consider when a child and family present to Child and Adolescent Mental Health Services? Introduction Multidisciplinary team in a Community Child and Adolescent Mental Health Service (CAMHS) consists of a whole range of healthcare professionals that include but are not limited to psychiatrists, clinical psychologists, educational psychologists, social workers, counselors, family therapists, primary health workers, and occupational therapists. CAMHS has five specialist teams that offer services specifically to under fives, children with neurodevelopmental disorders (NDT), looked after children (LAC), adolescent outreach (AOT), children away from the Pupil Referral units (PRUs) mainstream schools. CAMHS provides children with mental health service ranging from infants to 18 year olds as well as their families. CAMHS also renders service to the mothers whose capacity to parent is impacted by their mental health problems throughout from the point of conception to postnatal period. Teams comprise different healthcare professionals from and beyond this list depending upon the individualistic needs of the patient presenting to the hospital. Some teams have art therapists, psychotherapists, nurses and others whereas others have psychologists and behavioral therapists. Patients who have minor mental health problems may be referred to a team of social workers and counselors whereas patients with extreme mental health problems are treated by a team of psychiatrists and nurses. Community CAMHS is rendered by “a Priority One Team (for urgent assessments) two multidisciplinary teams that are organised geographically to meet the needs of all children in their area through integrated work with other providers including Family Support, Children’s Social Care, and Schools” (Whittington Health NHS, 2013). In addition to this, the precise staffing level varies according to deprivation indices, whether CAMHS is in an urban or a rural setting, teaching responsibilities and the number of partnerships required (The National Archives, 2011). Multidisciplinary teams in CAMHS have three major considerations; information about the child, analysis of potential causes, and follow-up care and treatment plan after in-depth study of the patient’s history and assessment. Information about the patient The prime considerations in any case are the age and gender of the patient and the age at which the disruptive behavior starts to show up. The team interrogates the patient’s family or caregivers in order to find out when the behavior got noticed, who noticed the behavior, in what ways the behavior differed from the normal behavior of the patient, in what setting was the unusual behavior executed, and its frequency of occurrence. Answers to these questions provide the team with a holistic insight into the behavioral profile of the patient. Having learnt this, the team inquires about the general health of the patient including asking questions about the patient’s eating, sleeping, and playing habits and their bathroom routines. The team learns whether the issue has been reported by close relatives or outsiders including teachings and police etcetera. It is customary to use informant information rather than direct interview because children’s tendency to response may be affected by their lack of understanding, immaturity, and shyness. Therefore, CAMHS practitioners may use the Antisocial Process Screening Device (APSD) in order to gather information about 6 to 13 year old children (Tiffin and Kaplan, 2004, p. 58). The instrument consists of 20 items that cover three behavioral domains including narcissism, callousness, and impulsivity and the instrument takes 10 minutes to administer. It is well-suited for use as a screening device and tool for characteristics which may be pre-cursors of later psychopathy. Mental health issues may even be linked to the prenatal development as the health of a child is directly influenced by the health and mental stability of the mother, so the team tries to identify possible problems in the prenatal development. “Although the mental health of the children/young person is the ultimate focus of CAMHS assessment and interventions (achieved both through direct sessions with the child/young person and indirect work through the carers), the impact of adult mental health problems in the patent/carer also needs to be recognized and understood by the CAMHS practitioner” (NHS, 2011). In addition, the team tries to learn about the patient’s genetic predisposition to certain mental health issues by inquiring about and studying the mental and physical health of the siblings. Sometimes, mental impairment like autism is linked with other health issues like Rett Syndrome. Almost 25% to 40% people having Rett Syndrome display characteristics of Autism Spectrum Disorder (ASD) (Moss and Oliver, 2012). Children having Rett Syndrome are commonly misdiagnosed with ASD with 18% of them being diagnosed with ASD before being diagnosed with Rett Syndrome (Moss and Oliver, 2012). Inquiring about the academic status and performance at school provides the team with an insight not only into the patient’s association with school, but also his/her persona among the peers and society in general. After inquiring about all these aspects and elements of the patient’s life, the team should consider the distance of the family’s location from the CAMHS team in order to work out the best treatment schedule. Nearly 15 to 35 per cent of all appointments at CAMHS get missed in the UK every year (virgincare, 2014). Considering the distance between CAMHS center and the family’s location, the team suggests whether it is better for the family to visit CAMHS for the service or it would be more convenient for the family to avail some other service located near them. Identification of potential causes The multidisciplinary team considers a range of potential causes of mental health problems in the children. These causes include but are not limited to prenatal and postnatal stresses and traumas, family history, home environment, social risk factors, cultural traditions and beliefs, traumatic family events, and parental issues. In some cases, atypical behaviors and mental disorders are passed on in generations, so genetic predisposition can be a cause of mental health problems; “We were able to identify smaller changes in chromosome structure that may play an important role in schizophrenia - and that these often involve more than one gene in a single person with the illness” (Bassett cited in CAMH, 2012). Home environment can be a cause of mental health problems because of the possibility of such issues as racism, sexism, discrimination, and gender oppression. Children exposed to sexual abuse are at high risk of developing mental health problems and contribute to the overrepresentation of victims and survivors of child sexual abuse in the adult mental health services. In a study to find out the risk and rate of personality and clinical disorders in the adults that have experienced sexual abuse in the childhood, forensic medical records of sexually abused children were examined and comparison with the controls revealed that lifetime contact rate with the public mental health services in the sexually abused individuals was three times higher i.e. 23.3% compared with that of the controls i.e. 7.7% (Cutajar et al., 2010). Social risk factors that might cause mental health problems include exposure to dangerous substances, and domestic or peer violence. The team should enquire about cultural traditions and beliefs because what is normal to the CAMHS team may not be normal to the family and vice versa. For example, Japanese culture encourages individual solitary play; “Japanese babies are more likely to be seen as avoidant” (Gordon and Browne, 2012, p. 78), so children might seem secluded or antisocial, which can, to a CAMHS team, appear as signs of an Autistic Spectrum Disorder, however this is perfectly standard for that society. Any significant family events either recently or in the child’s infancy are of concern to the multidisciplinary team treating the child. The structure of family leaves a lasting impact on the psychology of a child. This imparts the need for the team to consider whether the child was raised by single parent, or were there other factors involved like gay marriage, divorce, cohabitation, and step-parenting etcetera. Follow-up care and treatment after patient history assessment The team should assess the level of danger to which the child is exposed. This can be determined on the basis of the source of symptoms that can be genetic or familial. For children that display apparent risk of self-harm or drug abuse, the team needs to prepare an emergency care plan immediately. It is important to realize the kind of specialist in the team who would make first contact with the child and who is best-suited to appear with the initial treatment plan. It is equally important for the team to understand the needs of the family, family’s affordability of sessions and accessibility of care, and the sort of outcome that will best serve the family’s and the child’s status. The team should look out for the possible signs of psychiatric disorder development; the child might need specialist tests including CT scan, bloodwork, MRIs, and such other tests. The relationship, dealing, and rapport building between the patients and the CAMHS practitioners also plays a very important role in effective assessment and successful intervention. While CAMHS practitioners might feel initial anxieties while making robust assessments with triage assessment since it is time constrained, their level of confidence in and competence with the assessment process increases. One CAMHS practitioner said in the post-intervention interview, “I suppose the other thing I think with triage is that over the year I’m more confident about actually saying to that family today ‘you don’t need to come to this service’ – I would never have done that a year ago” (Evans, 2014, p. 9). Patients also feel their comfort level developed with the CAMHS practitioners with successive sessions as shared by another CAMHS practitioner in the post-intervention interview, “Despite people’s concern about the risk, I felt it was actually a well managed risk because if there was any doubt about risks and uncertainty after assessment, [the patient] just came back for a full assessment. After a bit of reassuring… I think people felt that much easier about it” (Evans, 2014, p. 10). Conclusion Over the last few years, new service models incorporating feedback systems on alliance and progress have surfaced. These models are promising in terms of improving the overall outcomes for CAMHS users. A small community CAMHS team developed the Outcome Oriented Child and Adolescent Mental Health Services (OO-CAMHS) as a new whole service model as a result of the increased awareness with the outcome literature along with an endeavor to improve patient outcomes (Timimi et al., 2012). OO-CAMHS combines the major aspects of evidence base on elements that can have a differential positive effect on the outcomes while eliminating the aspects that do not. Clinical models for CAMHS based on patient feedback are increasingly being introduced in response to the disappointing outcomes realized by the conventional diagnostic-based approaches to mental health problems of children and adolescents especially as implemented in the routine clinical settings. Bickman et al. (2007) argued that improved outcomes can only be attained by using a ‘common factors’ perspective. Building in processes which enhance the quality and amount of information received by clinicians regarding the effects of intervention is the key to success. ‘The Peabody Treatment Progress Manual’ (Bickman et al., 2007) contains 11 treatment process and progress measures which can be generally applied and adapted to most of the treatments sought by children and adolescents in the CAMHS. AusEinet findings suggest that parent training in the most effective primitive programs of intervention for behavioral problems make a central focus of intervention (Sanders, 2000). Cultural support provides a lot of help in successful treatment by CAMHS. In their study, McClintock, Moeke-Maxwell, and Mellsop (2011) found that the 25 whanau were generally satisfied with the services provided by the CAMHS and their acceptance was grounded in adequate cultural support development and respectful partnerships. While the benefits and effectiveness of CAMHS is well-documented in the latest research, multifarious issues of implementation have also been identified including the best way of reporting the outcomes for young people and children seen only for assessment, for the ones whose treatment and management spans several months and sometimes even years, for work completed in bridging posts between primary care and specialist CAMHS, and work that mainly addresses the concerns of families and parents instead of psychopathology in the child (Garralda, 2009, p. 389). Implementation in the regular clinical practice is generally subdued by small returns, even though audits and research projects generally obtain good returns in such self-contained services as in-patient units. References: Bickman, L., Riemer, M., Lambert, E. W., Kelley, S. D., Breda, C., Dew, S. E., …Vides de Andrade, A. R. (Eds.) (2007). Manual of the Peabody treatment progress battery [Electronic version]. Nashville, TN: Vanderbilt University. CAMH. (2012). CAMH scientists discover genetic changes that may contribute to the onset of schizophrenia. Retrieved from http://www.camh.ca/en/hospital/about_camh/newsroom/news_releases_media_advisories_and_backgrounders/current_year/Pages/CAMH-scientists-discover-genetic-changes-that-may-contribute-to-the-onset-of-schizophrenia-.aspx. Cutajar, M. C., Mullen, P. E., Ogloff, J. R. P., Thomas, S. D., Wells, D. L., and Spataro, J. (2010). Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse and Neglect, 34, 813–822. Garralda, E. M. (2009). Accountability of specialist child and adolescent mental health services. The British Journal of Psychiatry. 194, 389-391. Evans, N. (2014). Improving the timeliness of mental health assessment for children and adolescents in a multidisciplinary team. International Practice Development Journal. 4(1), 1-13. Gordon, A., and Browne, K. W. (2012). Beginning Essentials in Early Childhood Education. Cengage Learning. Moss, J., and Oliver, C. (2012). Autism in genetic syndromes: Implications for assessment and intervention. Cerebra. Retrieved from http://www.birmingham.ac.uk/Documents/college-les/psych/cerebra/Autism-Spectrum-Disorder-in-Genetic-Syndromes.pdf. McClintock, K., Moeke-Maxwell, T., and Mellsop, G. (2011). Appropriate child and adolescent mental health service (CAMHS): Maori caregiver’s perspectives. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 9(2), 387-398. NHS. (2011, Sep.). A competence framework for Child and Adolescent Mental Health Services. UCL. Retrieved from http://www.ucl.ac.uk/clinical-psychology/CORE/child-adolescent-competences/CAMHS%20Competences%20Framework_V1%20(2).pdf. Sanders, M.R. et al (2000). Early intervention in conduct problems in children in Kosky, R. et al (Eds) Clinical Approaches To Early Intervention In Child And Adolescent Mental Health, Australian Early Intervention Network for Mental Health in Young People, 3, Adelaide. The National Archives. (2011). Developing High Quality Multi-disciplinary CAMHS Teams. Retrieved from http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/browsable/dh_4868892. Tiffin, P., and Kaplan, C. (2004). Dangerous Children: Assessment and Management of Risk. Child and Adolescent Mental Health Volume. 9(2), 56-64. Timimi, S., Tetley, D., Burgoine, W., and Walker, G. (2012). Outcome Orientated Child and Adolescent Mental Health Services (OO-CAMHS): A whole service model. Clinical Child Psychology and Psychiatry. 0(0), 1-16. Virgincare. (2014, Sep. 8). The mental health appointment people don’t want to miss. Retrieved from http://www.virgincare.co.uk/mental-health-appointment-people-dont-want-miss/. Whittington Health NHS. (2013). Child and adolescent mental health service (CAMHS). Retrieved from http://www.whittington.nhs.uk/default.asp?c=10157. Read More