Primary Child and Adolescent Mental Health RRAADD--SSPPEENNDDEERR--1111--00330044--CC000000--VV11..iinndddd ii 2299//0066//1111 88::3399 AAMM RRAADD--SSPPEENNDDEERR--1111--00330044--CC000000--VV11..iinndddd iiii 2299//0066//1111 88::3399 AAMM 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 RRAADD--SSPPEENNDDEERR--1111--00330044--CC000000--VV11..iinndddd iiiiii 2299//0066//1111 88::3399 AAMM 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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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ght Typeset by KnowledgeWorks Global Ltd, Chennai, India RRAADD--SSPPEENNDDEERR--1111--00330044--CC000000--VV11..iinndddd iivv 2299//0066//1111 88::3399 AAMM 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 RRAADD--SSPPEENNDDEERR--1111--00330044--CC000000--VV11..iinndddd vv 2299//0066//1111 88::3399 AAMM 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 RRAADD--SSPPEENNDDEERR--1111--00330044--CC000000--VV11..iinndddd vvii 2299//0066//1111 88::3399 AAMM 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: RRAADD--SSPPEENNDDEERR--1111--00330044--CC000000--VV11..iinndddd vviiii 2299//0066//1111 88::3399 AAMM 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 RRAADD--SSPPEENNDDEERR--1111--00330044--CC000000--VV11..iinndddd vviiiiii 2299//0066//1111 88::3399 AAMM 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. RRAADD--SSPPEENNDDEERR--1111--00330044--CC000000--VV11..iinndddd iixx 2299//0066//1111 88::3399 AAMM