3. Long - term problems
Many problems that we see in CAMHS are lifelong issues -autism, learning disability, recurrent disorders such as OCD, psychosocial deprivation and parental mental health problems.
Acknowledging that these things may need ongoing help is being realistic - but this may not have to be with CAMHS, unless you are commissioned to do this of course! Quick access back to your service, or infrequent boosters may work best. Being honest with the family (the Choice philosophy) helps families understand the nature of the difficulties and that there may not be a quick fix, whilst promoting hope and development.
Helping families and young people to manage their own difficulties is important. CAPA helps to mobilise strengths and resources - make use of these in the family and community. Can you help a support group get off the ground? Could you start multi-family group work? Is there a Staying Positive workshop locally (part of the Expert Patient programme)?
One way to think of problems are in terms of duration (long-term, chronic), multiple issues and agencies (complex) and intense problems or behaviours (severe).
Managing Chronic problems
These things are worth a try:
- Self-management strategies i.e. moving to the family and young person planning how to cope for themselves
- Support groups
- Psycho-education
- Rapid access to services in crisis
- Being creative in finding solutions outside an agency response.
Complex problems
We find:
- Multiagency planning is essential
- Have multiagency agreements for managing complex cases
- Use of Lead Professional (Every Child Matters framework in England) across agencies
- Be clear about different roles of Lead Professional across agencies and role of Key Worker within your team.
Severe problems
Usually involve significant risk e.g. suicidality, risk taking behaviours, child protection:
- Be clear about who does the ongoing risk assessments
- Sharing risk assessments across networks is helpful
- Frequent contact
- Be clear about roles of different agencies and team members
- Zoning of risk (red, amber, green - who are you really worried about this week?) - can help.
Thinking in the team about the impact of these different aspects on case management can be helpful.