Specialists tend to concentrate on just one ‘bit’ of your child; speech therapists focus on communication, physiotherapists on movement, and so on. This doesn’t mean they’re not interested in your child as a whole person, but the fact is that parents are the people who know the most about their own children. You see your child every day, you know what treatments he or she is receiving and you know how they affect your child. You are probably the one constant figure in your child’s care, and you understand them better than anyone else. With this unique knowledge, you should expect to be treated by professionals as a respected and valued partner in all aspects of your child’s care.
“Nobody told us so many people could be involved in treating our children. Someone we know counted 22 appointments in two months! Sometimes it can feel like being your child’s personal manager, juggling appointments and supervising treatment at home.”
Your first health service Contacts Some of us knew before our babies were born that they were likely to have some sort of disability, although it wasn’t always clear how severe it would be. It’s a time for lots of questions: ‘What treatment is there?’ ‘Will the baby need surgery?’ ‘Is it life-threatening?’ ‘Where can I find out more?’ Many of these questions will be answered by a consultant who can talk through with you what is likely to happen. You may be referred for extra tests, this may be done in Musgrove Park Hospital or you may be referred to Bristol Children’s Hospital.
“Every child with Downs Syndrome is going to be different from every other; every child with Autism is different from every other; how does a professional know exactly where your child’s strengths and weaknesses are, or what exactly their comprehension level is?”
Sometimes our babies started life on the Neonatal Intensive Care Units in hospital. These units care for premature babies and those who may require specialist medical support when they’re born. They have a counsellor attached to the unit, who is there if you need help adjusting to the fact that this baby isn’t the one you expected or hoped for. Staff at the unit can offer you advice and support. The vast majority of us, however, will find that our child’s difficulties are first picked up by our health visitor, our GP or our child’s school.
The Health Visitor Service is made up of Health Visitors, Community Nurses, Nursery Nurses and Administrators. They provide the Healthy Child programme, which is an early identification and early intervention programme. This is based on offering a universal service to all families with children 0 – 5 years old. Health Visitors are based at local Children’s Centres, or other NHS buildings. Health Visitor teams work across Geographical areas. Where you live will affect which Health Visitor team is allocated to you. They work closely with Midwifery, General Practice (GP), Children Centres and Early Years providers. Health Visitors are a source of general information about local groups, activities and ways of supporting your child’s health and development, so try and make use of their local knowledge.
At your first contact, the Health Visitor will commence a Family Health Needs Assessment, using an assessment tool, completed in partnership with you. If a health need is identified they will agree a personalised care plan with you, which will include the intervention on offer from the service, what you can do to help and what help may be required from others. The Family Health Needs Assessment will be updated and any new needs identified and care plans developed at each of these visits. All parents are visited by the Health Visitor antenatally, before your baby is born (between 26 – 36 weeks), the Health Visitor will visit you at home after the birth of your baby (at 10-14 days) and when the baby is 6-12 weeks old. Health Visitors will also contact or visit you when your child is 6-12 months, two and a half years and three and a quarter years, or if you move into an area and have a child under five.
In addition to and as part of the Healthy Child Programme, Health Visitors will provide drop in information sessions that aim to answer anything from breast-feeding queries to questions on sleep difficulties. Health Visitors are particularly skilled at providing interventions to reduce obesity, improve emotional health and wellbeing of parents and children, and provide information on breastfeeding, infant feeding and accident prevention. Members of the team will provide information and intervention on many topics around child development and minor illness in children. Essentially, if you have any questions and you don’t know where to go, try your Health Visitor first as it is likely that they will be able to signpost you in the right direction.
It is the Health Visitor’s job to assess the development of children under five. If, during these assessments, they decide that additional help or support is required for you or your child then they will plan this with you and see you more regularly. This is called Universal Plus Service. They may refer you to other professionals – such as the Integrated Therapy Service, which consists of Speech & Language Therapists, Occupational Therapists and Physiotherapists. They will work with the identified professionals to make sure that your child gets the right support and ensure that services are co-ordinated. If many professionals or services are involved, the Health Visitor will provide what is called the Universal Partnership Service, working together with you and others to plan and provide the intervention required. The Health Visitor Service will often take a lead professional role while your child is under 5 years old. If you would like to talk to your Health Visitor you can get their contact details from your GP. You can also access some information from Somerset Partnership NHS Foundation Trust website:- www.sompar.nhs.uk/our_services/childrenandyoungpeople/HealthVisiting
In Somerset children with additional needs are referred to a Multiagency, Assessment and Intervention Service in the Early Years (MAISEY) where a range of professionals will discuss the concerns and agree a way forward with you, often supporting you to access services and support locally. Your Health Visitor will be part of the MAISEY team for your child.
Your GP may be one of the first people you discuss your child’s difficulties with. They may also be the best person to ask if you think your child would benefit from seeing a specialist health professional. It’s important to keep up the relationship with your GP, even if most of your child’s subsequent treatment is at a clinic. Support from GPs can be helpful if you’re trying to speed up appointments or find respite care. And of course children with Special Educational Needs (SEN) get ordinary illnesses, just like their brothers and sisters. It’s easy to forget that while specialist doctors are working with children similar to yours all the time, your own GP may only have a few children with SEN in the practice. If your child has a very rare condition, the GP may be meeting it for the first time. A good GP will appreciate all the information that you are able to give, and respect the skills and knowledge you are sure to acquire.
“Our GP always takes time to listen to my 10 year old son and takes the opportunity to ask him questions as well asking me. I feel this helps him to feel like a respected individual.”
Some parents, though, find it useful to have a different GP from their children, believing it gives them a better chance of being seen as an individual rather than as the parent of a disabled child. If your relationship with your GP isn’t working, it’s worth considering changing to another within the practice or, as a last resort, to another practice altogether. These days the easiest way to find a new GP is via the NHS Choices website www.nhs.uk. You can use a search facility to find all GPs in your area who are currently accepting new patients. You can also read quite detailed reviews of their service from other patients and see an overall rating they received from patients according to key criteria. If you’re not online, you should be able to find a list of local doctors at your library or the Citizen’s Advice Bureau.
“My GP has always been a wonderful support to my whole family, has listened to my concerns and always respected that as parent to my disabled children I have a high level of knowledge, I would recommend to other parents to consider changing GPs if this relationship is not a positive one for them.”
Following an initial contact with a practioner like your GP or health visitor, your child may be referred for a Specialist Assessment. This assessment or advice may be provided by specialist nurses, doctors, paediatricians or therapists to name but a few. If it’s taking too long to get an appointment or the situation is getting worse, go back to your GP or Health Visitor and see if they can speed up the process for you. Alternatively your GP may ask for advice and guidance regarding a specific condition which will save you needing to attend a further appointment. Medical problems that need more help or expertise than can be given by your GP should be referred to a paediatrician, preferably as close as possible to where you live. Your GP should know of and be able to give you information about the (Community) services available outside hospital as well as hospital-based specialist services and will be able to make the referral.
Community based services, such as services for children with toileting or behavioural problems vary across Somerset. Ask your GP, Health Visitor or School Nurse about what help with health matters can be provided; even if they cannot help themsleves they will know who can.
Paediatricians are trained in the assessment and management of health problems affecting children of all ages.They will be able to refer patients on to specialist services (such as those based in hospitals in large cities) if necessary, and they will also have an overview of all aspects of health care for your child. The paediatric teams include Community Children’s Nurses and Dieticians. They also work closely with other healthcare professionals and specialist services based in or linked with the hospital. Your local paediatrician will also be familiar with the various non-medical Services, such as Integrated Therapy Service, Education Psychologists, Social Services, Education Providers and the local Child & Adolescent Mental Health Service (CAMHS) team located in the area and will be able to help with access to these. In Somerset the hospitals with paediatricians are:
1) Taunton and Somerset NHS Foundation Trust, known as Musgrove Park Hospital, clinics also at Bridgwater; Burnham on Sea; Wells; Chard and Minehead; www.musgroveparkhospital.nhs.uk/wards-and-departments/departments-services/paediatrics-(children)/
2) Yeovil District Hospital NHS Foundation Trust also runs clinics in South Petherton; Wincanton; Crewkerne and Glastonbury. Visit www.yeovilhospital.co.uk/services/paediatrics/
3) Bath Royal United Hospital also runs clinics in Shepton Mallet and Frome. Visitwww.ruh.nhs.uk/patients/services/clinical_depts/paediatrics/index.asp?menu_id=1
All these hospitals have separate Children’s Inpatient and Outpatient areas and paediatricians may work in one or both areas. The inpatient wards provide assessment and management of acutely unwell children and look after children admitted for planned routine and emergency surgery. The outpatient department cares for children and families with general paediatric and specialist conditions. They also have a Neonatal Intensive Care unit where premature and new born babies with medical problems are cared for, together with Accident & Emergency Departments for emergency care. Specialist services are supplemented with visiting tertiary consultants from Bristol Children’s Hospital.
The Community Child Health Department consists of doctors and nurses who specialise in children with long term complex conditions. They work both in the hospital and in the community liaising with the health, education and therapy teams as necessary.
In-patient treatment. In Somerset, most children who require inpatient treatment will be admitted to one of three hospitals: Yeovil District Hospital NHS Foundation Trust, Taunton and Somerset NHS Foundation Trust or Royal United Hospital Bath. Each offers similar services and treatments and endeavours to make young person’s stay as comfortable as possible. You will always be welcome to stay with your child. This may be with a bed alongside theirs, in a reclining chair or in a separate room depending on availability. You will see a doctor each day and any queries, questions or concerns can be addressed at any time of day.
“You have to be very specific and say, ‘Look, she really is like this’, and ‘No, she can’t do this’, and ‘If you’re calm, she’ll be calm’, or whatever. Be up front so that they know the problems….spell it out!”
Tips for admissions to hospital. If your child has communication difficulties, write out a guide to help the staff understand what he or she is saying. For example, if they use eye signals, how do they indicate for ‘toilet’ or ‘ouch, that hurts’?
- Important messages that you want everybody to be aware of could be written out and taped above the bed or on the locker.
- Talk to everyone, whenever you can, to ensure that as many people as possible understand your child’s needs.
- Don’t forget that domestic staff may see the children more often than doctors and can be very good at making children feel secure.
- Don’t assume that every member of staff knows everything about your child’s condition. The information you gave the person in ENT won’t necessarily have got through to the X-ray department by the time you will see them.
- Explain to other children in the ward about your child’s SEN and find out what your child would like them to know
As a parent carer, you are an advocate for your child: if you don’t feel that the treatment is being communicated or offered in a way that is conducive to your child’s needs then don’t be afraid to say and offer a possible solution.
“It is your child, it is not the doctor’s child, and if you don’t like the way they’re bandaging him or they’re doing something that you know will upset your child – even though all the other children with that syndrome are bandaged in that way – you say so… you negotiate.”
Trips to A&E. Accidents and emergencies might happen to anyone at any time. There are several Emergency Departments in Somerset including: Yeovil District Hospital NHS Foundation Trust; Taunton and Somerset NHS Foundation Trust (Musgrove Park Hospital); Bath Royal United Hospital; Weston General Hospital
“If your injury is not life threatening, be prepared for a long wait in A&E. It’s not like the Casualty TV drama! I was lucky in that the paramedics stayed with us until our daughter was found a cubicle and then we were on our own. Much of my time was spent making sure she didn’t do a runner! (I failed once and had to chase her down the corridor.)”
You can’t take it for granted that other A&E departments will always have qualified paediatric nurses on duty, and also, if you are away in another part of the country, your child’s medical records will not be readily available. Obviously, in this situation, parents have a crucial role to play in helping staff to help their child.
“If, like us, you spend a fair bit of time in hospital, including A&E, I recommend all parent carers to have an emergency bag (I keep mine in the boot of my car) packed and ready with change of underwear, favourite drinks, snacks with a long shelf life and things to entertain your children/young people. Don’t forget to take something for yourself!”
“I think you can help the health service to be more useful to you. We were up at the A&E department at the County three weeks running one time, and I always find if you’re in a place like that where you might have to wait a long time, it’s no use just sitting there waiting and hoping your child won’t have a massive tantrum. You’ve got to be upfront and you’ve got to tell them exactly why your child’s got to be seen next, and they were always absolutely brilliant and got her in there really fast.”
“My son has had to attend the minor injuries unit at our local hospital and was very well looked after and listened to as the staff there were very aware of his disorder and how it impacts on his behaviour.”
Children’s Community Nurses are a small number of teams that cover Somerset and provide nursing support for children with complex health needs. These teams consist of Nurses and Health Care Assistants. Their aim is to prevent or reduce the need for hospital admissions by visiting homes, schools and other locations. Referral to these teams is usually via your Consultant Paediatrician.
Compass Team is a team that covers Somerset and provides palliative care and support to children and families with life limiting conditions. The team consists of Doctors, Nurses, Psychologists and Play Therapists, providing as much support and information as each family needs – either at home or in hospital.
Specialist Continence Nurses are a team of paediatric continence nurses who help support Health Visitors, School Nurses, GPs and families themselves in allowing young people with continence issues to self -manage their problems. Ask your Paediatrician, GP, School Nurse or Health Visitor for further information about how you can access this service.
Your child’s Pre-School or School. You may find that the first you hear about your child having any difficulties is from their nursery worker or class teacher. Perhaps they’re having difficulty getting along with other children at nursery or perhaps they’re having trouble reading or concentrating during lessons. The teacher may get you to discuss their difficulties in more detail with the Special Educational Needs Co-ordinator (SENCO) or suggest your child is referred to one of the specialist services, for example the Educational Psychology Service, for further assessment. We discuss the special educational needs process in much more detail in the ‘Education’ sections. Another person that you might talk to about your child’s difficulties at this point is the School Nurse if your child is over the age of 5, or your Health Visitor if your child is under the age of 5. He or she can check your child’s health and development and refer you to other people if necessary.
Sensory, Physical Impairment and Medical Support Service (SPMSS) PIMS work in schools in collaboration with children/young people, parent carers and other agencies to ensure that children and young people with physical and/ or medical support needs are educationally and socially included in schools are able to reach their full potential. The PIMS Service will support pupils in mainstream schools who have either a diagnosed physical impairment or complex medical support need. The team can help schools and education settings in a range of ways including making access arrangements and reasonable adjustments, setting up medical care plans and associated staff training and using assistive equipment. The Compass Team, the Specialist Continence team and the Integrated Therapy Service all link with the Physical Impairment and Medical Support Team (PIMS.) The PIMS Team. The Physical Impairment and Medical Support Team consists (PIMS) Team offers discussion, advice and training on whole school issues related to individual pupils with physical impairment and/or medical needs in the following areas:
- Guidance, procedures and developments
- Personal Assistance Guidance and Toilet Management Plan
- Voice of the child, including transition of schools for pupils in need of PIMS
- Augmentative and Alternative Communication (AAC)
- Epilepsy Toolkit
- Physical Access
- Curriculum Access
- Specialist Equipment
- SENITAS (Special Educational Needs Information Technology Advisory Support) Equipment and software training
- Disability Equality Training
- Moving and Handling
- Medical information
- Personal Emergency Evacuation (EvacPEEP)
- Including Disabled Children in Trips & Visits Outside School Guidance
- Training of School Staff in Medical Procedures
The PIMS Team can be contacted through the Area Bases listed below.
- Bridgwater Tel: 01278 446445 ~ click here for the referal form to download
- Wells Tel: 01749 678500 ~ click here for the referal form to download
- Yeovil Tel: 01935 476130 ~ click here for the referal form to download
- Taunton Tel: 01823 334475 ~ click here for the referal form to download
The Hearing Support Team work closely with health to help with understanding the detail of your child’s hearing loss and to provide you with a joined up early years programme. The team continue to work with health when your child enters school so that this joining up continues. The joining up is particularly important for; Monitoring and helping with any infections or middle ear difficulties; Setting up and getting the best from your child’s hearing aid/cochlear implant; Helping your child’s language and communication development. You will meet specialist advisory teachers and the service Educational Audiologist.
The Vision Support Team work closely with health to help with understanding the detail of your child’s visual impairment and to provide you with a joined up early years programme and on into school. The joining up is particularly important for: Monitoring your child’s visual impairment and any changes to visual functioning; Setting up and getting the best from any assistive equipment and aids; Helping your child’s mobility, independence and development. You will meet specialist advisory teachers and support staff including the educational mobility specialist.
Educational Psychology Services are part of the Education Children’s Services area teams. In each team there are Educational Psychologists who can support parents and their children up to the age of 19. If your child’s difficulties are first picked up at school or pre-school they may be referred to see an Educational Psychologist (EP). If your child is already known to other professionals, they may also make a referral. EPs will assess your child’s developmental progress and will give advice on appropriate educational help. They will normally be able to give you a clear idea of your child’s difficulties and in some cases will also refer on to other professionals for further assessment.
Educational Psychologists also manage the two home visiting services – Portage and Time Together and may feel that their intervention would be helpful to you. Portage offers home visits to support the development of children with Special Educational Needs. Time Together supports relationships between young children and their families through play. Read more about these services in ‘Education’ sections.
The Primary Care Dental Service are a team of dentists, therapists, hygienists, dental nurses and non-clinical administrative staff providing dental care from ten different sites across Somerset. This may be referred to as Access Dentists.They accept referrals from general dental practitioners for assistance in treating patients who cannot reasonably access dental care through the General Dental Services. They also accept referrals for minor oral surgery and non registered patients with dental pain. Click the following link to find out more information about services near you. www.sompar.nhs.uk/our_services/specialist_services/dental_service_primary_care/. They accept and treat patients for a very broad range of reasons that generally fit into the categories below:
– Patients with various qualifying physical conditions
– Patients with various qualifying medical conditions
– Patients with various qualifying conditions affecting their mental health
– Patients with learning difficulties
– Some young patients with a high decay rate
– Some phobic patients
– Patients with certain additional behavioural needs
Therapies Fact Files: Resources developed by the Integrated Therapy Service to support practitioners and Parent Carers for Children and Young People in Somerset Partnership NHS Foundation Trust has developed two highly innovative resources. They are designed to support practioners who work with children and young people in Somerset, in order that they will have a greater understanding of children’s development and the ways they can help children, young people and their families.The two resources are the: Fact File for Early Years (0 – 4 years); Fact File for School Age (5 – 19 years). Both Fact Files contain information on:
- Typical development of babies, children and young people in the areas that fall within the expertise of Speech and Language Therapists, Occupational Therapists and Physiotherapists
- How to identify common and acceptable variations in children and young people’s development
- How to decide which babies, children and young people may need additional support to promote their development
- Practical Advice Sheets which professionals can share with parents/carers or parents and carers can use directly
- When and how to refer for specialist assessment by the Integrated Therapy Service
Many children and young people will show difficulties at some point in their development but most will progress given the right environment and simple strategies used by those around them. The Fact Files are intended to give practitioners who work with babies, children and young people the information and confidence to be able to meet their needs and advise their parents and carers. Early identification of children needing extra support is vital but this does not always mean early referral. A small proportion of children and young people will require specialist support from the Integrated Therapy Service to enable them to carry out the activities that they need or want to do. The Fact Files will help you to identify which children or young people may require this specialist support. For more information about who may use the Fact Files and to download the sections you require go to: www.sompar.nhs.uk/our_services/childrenandyoungpeople/integrated_therapy_service/fact_files_its and follow the instructions.
“As a parent of 2 children with communication and sensory processing difficulties, these resources have proved invaluable. The tables were useful to help us plot where we felt they were in terms of their development, identify questions and share with professionals. I am often feeling overwhelmed and emotional at meetings and this affects my ability to communicate effectively. Fact Files gave the meeting a focus and also a resource for me to remember the points I wanted to cover. The activity sheets were a great reminder to try different things to help our children develop their skills.”
Children who have more complex needs and difficulties may require help to learn some of the skills they will need to cope with daily living. If parents are concerned about their child’s speech and language development then it may be necessary for the child to be referred to a Speech and Language Therapist. Help with movement and balance can be provided by a Physiotherapist and help with daily living skills can be provided by an Occupational Therapist.
Speech and Language Therapy, Occupational Therapy and Physiotherapy for babies, children and young people, in Somerset are all provided by the Integrated Therapy Service (ITS). To find out more about the ITS you can look on their website at: www.sompar.nhs.uk/our_services/childrenandyoungpeople/integrated_therapy_service/. You can discuss your concerns with a qualified therapist by telephoning the ITS Telephone Advice Line. The line is open from 09.00 – 12.00 on Mondays, Wednesdays, Thursdays and Fridays (not including Bank Holidays) and the number to call is 0303 033 3002. Or you can make a referral yourself or it can be made by a practioner already working with your child. This is done by completing the ITS Referral Form which is on the ITS website. All referrals to the service are ‘triaged’ which means that they are checked by a team of therapists to decide if your child needs to be assessed and, if so, by which therapy professionals. If there is not enough information in the referral to help the ITS make this decision, you or the person who referred your child will be contacted to gather more details. The waiting time from referral to actually being seen by the therapist is generally several weeks. If you have concerns while you are waiting for the assessment, you can call the Telephone Advice Line for guidance on how to help your child in the meantime.
At the first appointment, the therapist will gather further information about your child or young person and your family, to gain a better understanding of your child’s current development and the nature of your concern. They will also ask for some background information. They may talk to your child’s nursery, playgroup or school teacher to get a clearer idea of how your child is functioning within their setting. Following the assessment, the therapist will discuss their findings with you, and possibly with other professionals involved, and explain their conclusions, including what intervention, if any, your child needs and who will carry it out. A report will be written and, with your consent, sent to you, the person who referred your child and any other professionals involved, such as the school, Health Visitor or GP. If the therapist decides that your child has needs that can be supported by the ITS, a therapy care plan will be developed. If your child needs support from two or three of other members of the Integrated Therapy Service, one therapist will take on the role of lead professional and provide a single point of contact for your family.Depending on your child’s needs and difficulties, one or more of these options may be selected, through discussion between you and the therapist:
- advice and support on the management of your child’s difficulties
- a programme of activities to carry out at home
- a programme of activities to be carried out in school or pre-school setting
- training for yourself or other professionals to meet your child’s needs
- a review to check your child’s progress after a few months
- a block of individual or group therapy sessions
- general advice and discharge from further follow-up with the ITS
- referral to a more appropriate service
Speech and Language Therapists (SLTs) diagnose and treat problems of understanding, communicating and speaking and can also help with swallowing and eating difficulties. If you think your child has these kinds of difficulties or someone working with your child suggests that they do, you should be referred to the Speech and Language Therapy Service with your consent.
Occupational Therapy (OTs) help children develop everyday skills, such as feeding themselves, getting dressed and playing, if these are affected by physical, developmental or sensory disabilities. They will assess and treat children at home, at school or pre-school or in one of the Integrated Therapy Service Clinics. After assessment, the OT will write a report that identifies any areas where your child needs help. This might also include advice on programmes of activity, how to adapt tasks to your child’s ability or advice on equipment.
There’s another kind of OT, who is employed by social services to carry out assessments for families who need equipment and adaptations at home. Be aware that these won’t be the same OTs you meet through the Integrated Therapy Service. Read about this and other ways to consider getting adaptations for your home and education settingsin ‘Education’ sections and soon in the Help with Daily Life (still under development).
Physiotherapists (PTs) help with children’s movement skills and physical mobility.
Psychological Therapies (CAHMS). If your child has been assessed as having mental health, behavioural or learning difficulties they may benefit from different psychological therapies. Some of these therapies may be provided by specialist Child and Adolescent Mental Health (CAMHS) practitioners. Each child or young person with an open referral to CAMHS will have a RecoveryCare Plan. This will outline and integrate the interventions listed below, as well as those provided by other agencies, family members or other key people.
Interventions that may form part of a care plan include;
- A wide range of therapeutic models used within CAMHS including cognitive behavioural therapy, behavioural therapy, family therapy and art therapy. Other therapeutic models may be drawn from as appropriate.
- Medical input including advice on medication, prescribing, detailed diagnostic assessments and other interventions
- Specialist assessment and advice regarding developmental disorders, in combination with additional mental health needs (e.g. Autistic Spectrum Condition, ADHD)
- Risk assessment and management. Therapists will work with you and your child to assess any risks regarding mental health and the care plan will include ways we will work with you and your child to manage those risks.
- CAMHS (Child and Adolescent Mental Health Service) provides a specialist mental health service for children and young people aged 0 – 18 (up to 19 for young people with additional needs), who may be experiencing a range of mental health problems. They also provide a service for young people with complex and problematic substance misuse. The overall goal of the service is to enable children and young people to achieve a fulfilling, meaningful life, and a positive sense of belonging in their community.
Some of the difficulties they might be able to help with include:
- Obsessions and compulsions
- Self harming and suicidal ideas
- Substance misuse
- Complex emotional and family problems
- Hearing voices
- Depression and anxiety
- Eating disorders
- Attention Deficit Hyperactivity Disorder (ADHD)
CAMHS is a multi-disciplinary service. The teams include:
- Consultant Psychiatrists
- Social Workers
- Support Workers
- Occupational Therapists
- Psychological Therapists
- Family Therapists
- Art Therapists
- Primary Mental Health Link Workers
- Specialist Substance Misuse Workers
The front-line practitioners in each area are supported by managers and secretarial and administrative staff. They work in partnership with families, parent carers and other agencies who may be involved with a child or young person referred to the service, but they aim to keep the child or young person at the centre of the process. If another professional or agency is already working with the young person or their family, CAMHS may sometimes (if it is appropriate) work jointly with them alongside the family. Some of the agencies they work with include: Children’s Social Care, Youth Offending Team and Education.
Referrals to CAMHS are made directly to the local teams which are based in Taunton, Yeovil and Wells. You will most often be referred via a request for involvement (RFI) form completed by the referrer. Following this request, one of the specialist CAMHS professionals or managers will review the information. Acceptance of the request will take into account the level of need and combination of the following factors:
- How severe the problem is – the mental health problem needs to have a significant impact on a number of areas of day to day life. Help for problems such as sleeping difficulties, minor eating problems, toileting or behaviour difficulties should be provided by GPs, Health Visitors or other local services.
- What the context is – consideration will be given to the complexity of the problem and any other risk factors such as parental mental health. Understandable or time limited problems due to external stresses (eg bereavement, family breakdown, physical illness) should be provided by other agencies.
- How long there has been a problem – where there have been difficulties for less than 6 months Specialist CAMHS could provide advice/consultation to the GP, Health Visitor or whoever is working with your child. However, a sudden unexplained change in behaviour that may indicate a significant mental health problem should be assessed as a priority by Specialist CAMHS.
If you think your child needs to go to CAMHS, it’s often easiest for you to speak to your GP first and ask for a referral. You could also be referred by another professional such as a School Nurse or Special Educational Needs Co-ordinator (SENCO) or School Pastoral Lead/Head of Year. There is more information available here www.sompar.nhs.uk/our_services/childrenandyoungpeople/camhs
Somerset CAMHS do not accept self-referrals but this may change in the future. The only time that children, young people or their families can self-refer is if they have been discharged from CAMHS and have been given an “Orange Card” as part of their discharge care plan. This encourages the child/young person or their parent carer to contact us directly if their mental health should deteriorate.
Situations which probably wouldn’t be appropriate for CAMHS:
- Where a learning disability is the main problem, and there is no other behavioural or mental health need.
- Reactions to life events that are likely to resolve with time, or with general counselling or advice from other agencies (e.g. bereavement, family breakdown/divorce)
- School related problems or educational difficulties where the problems are mainly in the school, or where the intervention is more appropriately carried out by the Educational Psychology Service
Dealing with a crisis. In an emergency situation, if you believe there is a significant and immediate risk to your child or others please contact your GP. He/she will contact CAMHS or if out of hours contact the GP on call service in your area. If required the on call GP will then contact CAMHS. However if you have a current referral to CAMHS you can contact the care co-ordinator directly by using the contact details they have given you. You may also have agreed a crisis plan with the care co-ordinator and you should try and follow this plan. You could also take the child or young person to the local A&E department or if you need immediate assistance contact the emergency services.
Music Therapy. Your child may be assessed as needing or benefiting from music therapy but this is not often offered. Your child’s school or another service would have to choose to buy this in or you could pay for some music therapy yourself privately, if you can afford it. We cannot recommend any specific people here and encourage parent carers to ask other parent carers or look on this directory www.wellaware.org.uk/
Therapies in Private Practice. If you feel your child would benefit from a particular therapy and you are in a position to pay for this privately, there are Speech and Language Therapists, Occupational Therapists and Psychologists who work in private practice. Again, we cannot recommend any specific people here and encourage parent carers to ask other parent carers or look on this directory www.wellaware.org.uk/
Complementary Therapies includes treatments such as osteopathy, acupuncture, homeopathy, massage and aromatherapy. Some parents have found some of these treatments useful for themselves or their child. It can be difficult, though, to find out whether the practitioners have proper qualifications – often other parents are the best source of information, although some GPs have an interest in this area of medicine. Many of the established forms of complementary medicine have their own governing body or college, which can advise about finding a well-qualified practitioner.Occasionally, some form of complementary medicine may be available under the NHS but more usually it has to be paid for privately or using Direct Payments. Some practitioners, however, will offer treatment on a sliding-scale of payment. Some services may be in the www.wellaware.org.uk/.
Further information about health. In these days of access to home PCs and smart phones, many of us will spend hours ‘Googling’ our child’s condition on the internet. This can be enormously helpful by reminding us we’re not alone and that there are families dealing with many of the same issues as us. However, it can also be time-consuming and unreliable. It’s important to remember that search engines rank for relevance to your query only, they don’t operate any kind of quality control, so you may find that many of the sites you are led to are old, American or trying to sell you something! We wouldn’t deter you from researching your child’s condition or looking for solutions online, but we would advise you to exercise a bit of caution and common sense. If a website belongs to a large national charity or comes from a government department you can usually rely on the quality of its content and its impartiality. If you are trawling some of the smaller, more independent sites, use your common sense and take things they say with ‘a pinch of salt’. Two safe places to start are NHS Choices www.nhs.uk and Contact a Family www.cafamily.org.uk. You can rely on the fact that their information is up to date and thoroughly checked.
For further information about services provided by Somerset Partnership NHS Foundation Trust, you can contact PALS, the Patient Advice and Liaison Service for the Trust. PALS will provide you with advice, support or information, and if they cannot help, then they will be able to signpost you to the appropriate service or organisation.
If you decide that you want to make a formal complaint, then PALS can provide you with information and guidance on how to do this. It is important that you contact the PALS service from the trust that you received the treatment from. This will be one of the following:
- Yeovil District Hospital (Yeovil District Hospital NHS Foundation Trust) is at: yeovilhospital.co.uk/patients-and-visitors/pals/
- Musgrove Park Hospital (Taunton & Somerset District Hospital NHS Foundation Trust) is at: musgroveparkhospital.nhs.uk/patients-and-visitors/patient-experience/patient-advice-and-liaison-service/contacting-pals/
- Somerset Partnership is at: sompar.nhs.uk/contact_us/pals
- Royal United Hospital, Bath is at: ruh.nhs.uk/patients/advice_and_support/pals/contact.asp?menu_id=2
- Weston General Hospital is at: http://www.waht.nhs.uk/Our-Services/Non-Clinical-Services/Patient-Advice-and-Liaison-Service-PALS/
- NHS Somerset CCG is at: somersetccg.nhs.uk/somerset-clinical-commissioning-group/tell-us-what-you-think/pals-and-complaints/pals/