Abstract
SummaryThis paper reports on the last 8 years in the development of a child mental health learning disability service. The growth, challenges and pitfalls faced by the service are charted here. The paper also shows how a service can cope with rising demand without the development of waiting lists and how a specialist service can be embedded within a generic child and adolescent mental health service (CAMHS) as a tier 3 team, thus creating synergies and commonalities of purpose, while avoiding service gaps that inevitably arise from separate services with specific referral criteria. This is a healthy service model that meets the needs of local children with moderate to severe intellectual disabilities and concomitant child mental health problems.
Highlights
Standard 8 of the National Service Framework for children states that local authorities, primary care trusts and child and adolescent mental health service (CAMHS) must work together to ‘ensure that disabled children have equal access to CAMHS’.20 The Public Service Agreement targets introduced three proxy indicators for improvement in CAMHS, one of which was that a full range of CAMHS be available or accessible for children and young people with intellectual disabilities
Various clinicians are trained in specialist assessment schedules: the Autism Diagnostic Interview-Revised (ADI-R),[23] the Autism Diagnostic Observation Schedule (ADOS)[24] and the Developmental, Dimensional and Diagnostic Interview (3Di).[25]
The CAMHS intellectual disability team has come a long way in 8 years
Summary
Service Framework for children.[2,3] Specific advice about commissioning these services goes back 12 years.[4,5]. One review estimated that in a health district such as ours (Selby and York) with a population of 300 000 one would expect about 120 young people with intellectual disabilities who have ‘substantial’ mental health problems and considerably more if a wider group, with less serious problems, are included.[18] This fits well with our experiences setting up a new service, where after 1 year we had 119 new referrals into the service and were able to discharge only 19 of them in that same period, because of the high levels of need.[19]
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