Who else can help
Referrals into Specialist and Statutory Services may be appropriate for Severe or Enduring Mental health Conditions and Serious Safeguarding Circumstances.
An appropriate time to refer to CAMHS specialist services for intervention or additional support and guidance is if a young person’s mental health is impacting on their daily function and preventing access to social or educational opportunities, or when universal and targeted resources have already been implemented and concerns are ongoing.
It is beneficial for early help and targeted provision to be in place and to complement any specialist support.
Consider whether an Early Help Assessment is needed and it is recommended to gather information and try to talk to all people involved as part of the process and to help evidence the need for Specialist or Statutory Service level involvement.
Also; use Thresholds and Pathways Guidance and information on this tool* to help you decide if you need to make a referral.
All referrals for young people needing EH&WB services, Youth Counselling or specialist CAMHS is via the Referral Management Centre where referrals are screened by clinicians and facilitated to the NHFT team or partner service best able to respond to the difficulties outlined in the referral .
If you are considering referring to CAMHS or for Emotional Health and wellbeing services, and would like some guidance and support then please call the CAMHS consultation line:
0300 1111 022 option 1 option 1
Acccess the NHFT website for information and referral form:
Report a concern
If a child is in immediate danger, left alone or missing, you should contact the police directly and/or an ambulance using 999
If there is no immediate danger, you will need to establish the level of need and risk before you take action. Thresholds and Pathways will help you to do this.
Level 1 - Needs are met through engagement with universal services
Features
Features at this level indicate existing resilience factors in the child, young person and their family which need to be considered in all assessments at all levels of need.
You can use the document below to help assess the child or young person's level of need:
Thresholds and Pathways - October 2015 - (PDF 737KB)Level 2 - Emerging needs require early help or intervention
Features
Children and young people needing some early help or intervention support fall into this category.
Without intervention they are likely to be at risk of not reaching their full potential.
You can use the document below to help assess the child or young person's level of need:
What actions you should take
To address the needs of the child or family, follow the:
If you have any case at Level 2 or Level 3 which is proving complex to resolve and where additional advice or an additional or alternative intervention may be helpful please refer to the:
Level 3 - Needs causing concern require a targeted response
Features
Children and young people who fall into this category have significant additional needs. In some cases their development is further impaired by an additional unmet need, such as compromised parenting or environmental factors.
Due to the nature, complexity, range or intensity of the needs, children and young people will require intervention from specialist or statutory services.
This will include situations where current or previous interventions have not achieved desired outcomes. In a number of cases they may require longer term intervention from those specialist and/or statutory services.
You can use the document below to help assess the child or young person's level of need:
What action you should take
To address the needs of the child or family, follow the:
If you have any case at Level 2 or Level 3 which is proving complex to resolve and where additional advice or an additional or alternative intervention may be helpful please refer to the:
Level 4 - Needs require specialist or statutory services - Complete the multi-agency referral form
Features
There will be a small number of children and young people with presenting needs which are so enduring, complex, intense and/or unpredictable that they impact upon all areas of functioning and require a coordinated response from all key agencies.
The presenting needs of these children and young people will be such that they require an immediate response or statutory intervention from specialist services.
This will either be a safeguarding response or a coordinated urgent support response.
You can use the document below to help assess the child or young person's level of need:
What action you should take
What if I need advice about identifying levels of need?
If you need advice about the levels of need and whether to make a referral, please contact the Multi-Agency Safeguarding Hub (MASH).
Training on child safeguarding
We deliver child safeguarding training in partnership with Northamptonshire Safeguarding Children's Board (NSCB) and Barnado's.
Use the CGAS tool and the Guidance to help you determine which level of service might be best placed to support a presenting need.
Please Consult with someone from within your own organisation or other agency to receive help, advice or confirmation about your concern.
Some concerns, especially if there are a number of presenting features or needs, may require being supported from more than one level of service and organisation.
C-GAS Initial Baseline Measure
Children's Global Assessment Scale
The Children's Global Assessment Scale (CGAS) is a numeric scale (1 through 100) used by mental health clinicians to rate the general functioning of children under the age of 18.
Application: Ratings on a CGAS scale should be independent of specific mental health diagnoses. The scale is presented and described Shaffer D, Gould MS, Brasic J, et al. (1983) A children's global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228-1231.
Universal
100-91
DOING VERY WELL
Superior functioning in all areas (at home, at school and with peers), involved in a range of activities and has many interests (e.g. has hobbies or participates in extracurricular activities or belongs to an organised group such as Scouts, etc.). Likeable, confident, everyday worries never get out of hand. Doing well in school. No symptoms.
90-81
DOING WELL
Good functioning in all areas. Secure in family, school, and with peers. There may be transient difficulties and "everyday" worries that occasionally get out of hand (e.g. mild anxiety associated with an important exam, occasionally "blow-ups" with siblings, parents or peers).
Targeted
80-71
DOING ALL RIGHT –minor impairment
No more than slight impairment in functioning at home, at school or with peers. Some disturbance of behaviour or emotional distress may be present in response to life stresses (e.g. parental separations, deaths, birth of a sibling) but these are brief and interference with functioning is transient; such children are only minimally disturbing to others and are not considered deviant by those who know them.
70-61
SOME PROBLEMS - in one area only
Some difficulty in a single area, but generally functioning pretty well, (e.g. sporadic or isolated antisocial acts such as occasionally playing hooky, petty theft; consistent minor difficulties with school work, mood changes of brief duration, fears and anxieties which do not lead to gross avoidance behaviour; self-doubts). Has some meaningful interpersonal relationships. Most people who do not know the child well would not consider him/her deviant but those who do know him/her well might express concern.
Targeted Plus
60-51
SOME NOTICEABLE PROBLEMS – in more than one area
Variable functioning with sporadic difficulties or symptoms in several but not all social areas. Disturbance would be apparent to those who encounter the child in a dysfunctional setting or time but not to those who see the child in other settings.
Specialist
50-41
OBVIOUS PROBLEMS – moderate impairment in most areas or severe in one area
Moderate degree of interference in functioning in most social areas or severe impairment functioning in one area, such as might result from, for example, suicidal preoccupations and ruminations, school refusal and other forms of anxiety, obsessive rituals, major conversion symptoms, frequent anxiety attacks, frequent episodes of aggressive or other antisocial behaviour with some preservation of meaningful social relationships.
40-31
SERIOUS PROBLEMS – major impairment in several areas and unable to function in one area
Major impairment in functioning in several areas and unable to function in one of these areas, i.e. disturbed at home, at school, with peers or in the society at large, e.g. persistent aggression without clear instigation; markedly withdrawn and isolated behaviour due to either mood or through disturbance, suicidal attempts with clear lethal intent. Such children are likely to require special schooling and/or hospitalisation or withdrawal from school (but this is not a sufficient criterion for inclusion in this category).
Highly Specialist
30-21
SEVERE PROBLEMS - unable to function in almost all situations
Unable to function in almost all areas, e.g. stays at home, in ward or in bed all day without taking part in social activities OR severe impairment in reality testing OR serious impairment in communication (e.g. sometimes incoherent or inappropriate).
20-11
VERY SEVERELY IMPAIRED -considerable supervision is required for safety
Needs considerable supervision to prevent hurting others or self, e.g. frequently violent, repeated suicide attempts OR to maintain personal hygiene! OR gross impairment in all forms of communication, e.g. severe abnormalities in verbal and gestural communication, marked social aloofness, stupor, etc.
10-1
EXTREMELY IMPAIRED - constant supervision is required for safety
Needs constant supervision (24-hour care) due to severely aggressive or self-destructive behaviour or gross impairment in reality testing, communication, cognition, affect or personal hygiene.
What's on the Web? If you're a young person worried about your mental health there are many organisations which can help you.
YoungMinds does not offer advice to young people – our helpline service is for parents or carers worried about a child or young person. Call (for general enquiries about YoungMinds): 020 7089 5050
Northants CAMHS Children and Young People’s Referral Management Centre (RMC) The RMC now provides a single point of referral for all Professionals. Any professional in the county (e.g. GP, teacher, health visitor, social worker) can now refer using one single referral form to one central place; the Referral Management Centre. Referrals are screened by a clinician from NHFT or NGH and then passed to the most appropriate service or services which best meet the needs of the child or young person – be that NHFT, NGH, a Specialist CAMHS response, youth counselling or youthbased group work. For all referrals there is one integrated referral form. This is available from www.nhft.nhs.uk/cyprmc alongside guidance on how to fill out the form. The RMC can be contacted as follows for information and advice: Tel: 0300 1111 022 Opening Hours Monday – Friday 9am to 5pm
CHILDLINE Freephone 0800 1111 (24 hours) www.childline.org.uk | online chat | message boards Childline is the UK’s free helpline for children and young people. It provides confidential telephone counselling service for any child with a problem. It comforts, advises and protects.
GET CONNECTED Freephone 0808 808 4994 (7 days a week 1pm-11pm) www.getconnected.org.uk Free, confidential telephone and email helpline finding young people the best help whatever the problem. Provides free connections to local or national services, and can text information to callers’ mobile phones.
HEADMEDS www.headmeds.org.uk Straight talk on mental health medication. Look up your medication to find out about side effects and things you might not feel comfortable asking your GP about, and listen to other people's experiences.
SAMARITANS Tel: 08457 90 90 90 (24 hrs 7 days a week) www.samaritans.org Samaritans volunteers listen in confidence to anyone in any type of emotional distress, without judging or telling people what to do.
FRANK Freephone 0800 77 66 00 (24 hour service, free if call from a landline 15/16 and won’t show up on the phone bill, provides translation for nonEnglish speakers) www.talktofrank.com Confidential information and advice for anyone concerned about their own or someone else’s drug or solvent misuse.
STONEWALL What's in my area? Use Stonewall’s area database to find local lesbian, gay, and bisexual community groups, other generic services, and gay friendly solicitors.
B-EAT YOUTH HELPLINE 0845 634 7650 (Monday to Friday evenings from 4.30pm to 8.30pm and Saturdays 1.00pm - 4.30pm) Email fyp@b-eat.co.uk Online community Information, help and support for anyone affected by eating disorders.
THESITE.ORG TheSite.org is an online guide to life for 16 to 25 year-olds. It provides nonjudgemental support and information on everything from sex and exam stress to debt and drugs. YOUTH ACCESS Visit www.youthaccess.org.uk to search their directory of services for help in your area.
Signposting service: 0208 772 9900 (Mon – Fri from 9am-1pm & 2-5pm) A national membership organisation for youth information, advice and counselling agencies. Provides information on youth agencies to children aged 11-25 and their carers but does not provide direct advice.
Coram CHILDREN'S LEGAL CENTRE
If you are calling about family law the number is 0300 330 5480.
If you are calling about education law, the number is 0300 330 5485.
Coram Children's Legal Centre is the UK's leading children's legal charity. We are committed to promoting children's rights in the UK and worldwide. We provide free legal information, advice and representation to children, young people, their families, carers and professionals, as well as training and consultancy on child law and children’s rights.
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