G122(P) National survey of child and adolescent psychiatrists’ clinical activity using the child and adolescent psychiatry surveillance system (CAPSS)

Abstract

Aims This study surveyed Child and Adolescent Psychiatrists (CAPs) to explore the service settings and conditions that CAPSS may cover. Child and Adolescent Mental Health Services (CAMHS) have widely varying criteria for accepting referrals. When children are seen in CAMHS, CAPs involvement in their care also varies considerably. This variation in practice creates a problem for service based surveillance through CAPSS, which collaborates with the British Paediatric Surveillance Unit (BPSU). CAPSS surveillance is only meaningful if CAPs are involved with the care of the conditions studied. Methods Online survey of CAPSS members across the UK and Ireland using postal and email contacts. Results Survey participation was 49%. CAPs reported working in services that generally will see children and young people with psychosis, mood disorder, eating disorder, (psychological) trauma, psychological disorder associated with physical symptoms, self-harm, Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD) and Tourette (syndrome). Specialist CAMHS with CAPs are described particularly for Learning Disability (LD), psychosis and eating disorder. At least half reported that alcohol/drug problems and under 5s were seen in services with no CAP. Referrals for ASD, psychological disorder associated with physical symptoms, ADHD, Tourette, trauma and self-harm may also be seen in services with no CAP; comments highlighted the importance of paediatric services for some of these. Two-thirds of inpatient and day unit CAMHS had exclusion criteria, commonly for LD and alcohol/drug problems. CAPs are usually involved with presentations to CAMHS of psychosis, mood disorder, eating disorder, ADHD, Tourette and ASD, however self-harm, trauma, psychological disorders associated with physical symptoms and LD may be seen without CAPs’ involvement. CAPs are unlikely to be involved in CAMHS with alcohol/ drug problems and under 5s. Conclusion The survey confirms the variation in CAPs’ involvement with conditions that may be referred to CAMHS. CAPSS case ascertainment is therefore limited for some conditions and joint surveillance with BPSU may improve this. It is interesting that CAMHS patients with LD who may have complex medical histories are often seen without CAP involvement.