Services A to Z

Skye House first opened on 25th February 2009. It is a purpose-built facility on the Stobhill Hospital site for young people aged 12 to 18 years from across the West of Scotland. Skye House provides a range of dedicated services for young people who are experiencing thoughts and feelings which make it difficult to cope with everyday life. Skye House is a 24-bedded unit.

Mental health services for young people are planned on a regional basis by the West of Scotland NHS Boards (NHS Ayrshire and Arran, NHS Dumfries and Galloway, NHS Forth Valley, NHSGGC and NHS Lanarkshire). Skye House is funded by all these NHS Boards to deliver a service to young people from each area.

The service provides inpatient treatment for young people with conditions like severe depression, eating disorders, psychosis and obsessive-compulsive disorders. Young people may also be experiencing a period of distress whereby they may be safer in an in-patient environment. Length of stay is individual and will always be determined by the best interest of the young person.

At Skye House, we are more than aware of how worried families and young people may be about their admission and subsequent stay. We want you to be reassured that our aim is to work with you collaboratively and our communication and practice is driven by compassionate and individually focused care.

Skye House Adolescent Unit is part of Stobhill Hospital and is made up of three separate buildings:

• Therapies Block – Main reception, Staff offices, Group rooms, Therapeutic Kitchen and a Music Room.
• Accommodation Block – contains the 3 wings (Mull, Harris and Lewis). There are 8 en-suite bedrooms in each wing. There is also a TV lounge in each wing and there are two dining rooms where all meals and snacks are eaten.
• School Block – there are 4 classrooms and a Gym, where young people attend a range of school classes. The Gym can also be used in the evening exclusively by Skye House patients.

We have access to outdoor space. We continue to work to make our outdoor space useable for everyone in a range of ways.

Young people will be admitted to one of the wings. Sometimes they may move to another wing for a variety of circumstances. This will always be discussed with you and your family.

Young people in Skye House are allocated a Psychiatrist, a Named Nurse and an Associate Nurse who will be responsible for the day to day care. You might also work with other colleagues including psychologists, speech and language therapists, dieticians and occupational therapists.

It would always be our intention to admit young people under the age of 18 years to an age-appropriate environment. Very occasionally if a bed is not immediately available and a young person is not safe with community CAMHS support they may need to be admitted into an adult ward. Please be reassured that if this should happen, we will involve you and it will be for as short a time as possible. When on an adult ward young people are supported with age-appropriate activities, remain supervised depending on their care plan and we ensure they are comfortable and safe in this environment. However, on some occasions, this is not possible.

Click here for more information held in our welcome pack.

Maternity and Neonatal Psychological Intervention (MNPI) Service operates between three acute based sites:

• Queen Elizabeth University Hospital (QEUH)
• Royal Alexandria Hospital (RAH)
• Princess Royal Maternity Hospital (PRMH)

Hospitals are supported by Clinical and Business Support Staff.

Royal Hospital for Children
Govan
Glasgow
G51 4TF

This service offers antenatal and postnatal psychological assessment and intervention on an in-patient and out-patient basis for abnormal pregnancy and birth, including but not limited to:

• Foetal abnormality
• Traumatic birth
• Premature birth/congenital birth problem(s)
• Recurrent loss
• Neonatal death
• Antenatal anxiety/low mood

Wee Minds Matter is an infant mental health service. We support babies and their families from pregnancy through to the end of the first three years.

Infant mental health is a baby’s developing capacity to communicate and regulate their emotions, form close and intimate relationships, to be able to explore their environment and learn. This all takes place in the context of the first early relationships with parents/primary caregivers.

Supporting the Perinatal and Infant Mental Health Universal Pathway

We recognise that essential valuable work is already taking place with babies and their families across Glasgow and Clyde through the universal pathway within Health, Social care and valuable third sector services.

The Wee minds matter service does not wish to duplicate this work. Instead, we aim to strengthen the capacity of the existing pathway by supporting the existing network. This may be through offering consultation; reflective practice; exploring opportunities for joint working; raising awareness sessions on specific topics; contributing to developing aspects of the pathway e.g. antenatal; and by offering a daily duty line for health professionals for support in thinking about a particular baby and their family, and discussing potential future referrals.

We will work directly with families once all support within the pathway has been exhausted and/or when specialist direct intervention is indicated through joint assessment with referrers and the family and where there are persistent and ongoing concerns for a baby and the parent infant relationship.

Service Offered

Consultation

This will be offered when referrers have a dilemma/question or are concerned about a lack of change in the work with a baby and their family. A consultation will offer a space for joint thinking, within the context of GIRFEC. Clear outcomes will be identified as a result. Consent is always required from the family for this to take place.

Care Planning

Following any request for help we will discuss the current care plan with the referrer, and identify what interventions and support have already been explored and tried, including outcomes. We will think carefully with the team around the baby about the level and type of support needed for the baby and family. During pregnancy, an anticipatory care plan will be prepared to take into account planning for the emotional needs of the baby post-birth.

We aim to ensure that the experience and voice of the baby are adequately and proportionately included within any care plan.

Direct Clinical Work

Direct clinical work will include a range of specialist interventions including speech and language therapy, occupational therapy, Newborn Behavioural Observation (NBO), infant observation, enhanced Solihull approach, Parent infant psychotherapy, art-based group work, circle of security (individual or group), parent-infant support sessions.

Request for Help

If you have concerns about a baby or a parent/infant relationship and require specialist support or would like to discuss a potential referral, please ring our duty line on 0141 201 0808 from Monday to Friday at 9 am – 5 pm.

The service actively encourages early referrals during pregnancy and the first 6 months of an infant’s life as this is an optimal time for growth. However, we will consider all requests for any child under 3 years of age.

Click here for a leaflet for parents called Wee Minds Matter.

The National Child Psychiatry Inpatient Unit, located in Ward 4 at the Glasgow Royal Hospital for Children, provides flexible in-patient psychiatric services for children aged 5-11 years with severe psychiatric disorders, which may be complicated by neurodevelopmental disorders, physical health problems and complex psychosocial factors, requiring the specialist assessment and treatment skills of the multi-disciplinary Child Psychiatry Team based in the Unit. As the unit is a national service we consider referrals from all Scottish Health Boards.

Who Are We

Our team is a well established, highly experienced and a dedicated multidisciplinary team. The team comprises of child and adolescent psychiatrists, mental health nurses, clinical psychologists, a Speech and Language Therapist, occupational therapists, a Mental Health Staff Grade Paediatrician, a Family & Systemic Therapist, an Art Therapist and Administrative Staff. The In-patient Team has a close relationship with paediatric services within the children’s hospital. The team also has close links with a range of other community-based professionals and agencies.

What We Offer

Our team is dedicated to providing care, treatment and support for children under 12 years of age, who are experiencing severe and complex mental disorders leading to significant impairment and/or risk, which cannot be adequately treated within the locality of the Child and Adolescent Mental Health Services (CAMHS). We offer:

• In-patient admission for a comprehensive mental health assessment. This may include neuro-developmental assessment bespoke individual and family assessment and therapeutic intervention, as well as advice on further management.
• In-patient admission for a closely supervised medication review. This is particularly when outpatient monitoring is deemed unsafe or insufficient.
• Consultation to professionals via interagency meetings on complex clinical problems with children who are not necessarily referred for admission.
• Teaching and Training
• Research and Audit

Referral Process

Referrals are accepted from Child and Adolescent Psychiatrists working within Community CAMHS Teams. In the first instance, the referring clinician should contact the ward and discuss the case with a senior member of staff who may request that a Referral Form is completed for further information. The patient will then be discussed by the Senior Referrals Team and the outcome discussed with the referrer by telephone.

Contact the National Child Psychiatry In-patient Unit

National Child Psychiatry In-patient Unit
Ward 4 Royal Hospital for Children
1345 Govan Road
Glasgow G51 4TF

0141 452 4535 (office hours)
0141 452 4540 (evenings and weekends)

Welcome to the Paediatric Clinical Psychology Service at the Royal Hospital for Children (RHC) in Glasgow. We are a team made up mainly of Clinical Psychologists who provide assessments and interventions to children and young people up to the age of 18 years old who are having emotional or psychological difficulties as a result of their medical condition and who are inpatients or regularly attend the RHC.

The children we see are typically experiencing difficulties with their thoughts, feelings, behaviour and ability to cope, as a result of their medical condition, and this might be impacting their ability to manage their medical condition.

We also work with parents who require psychological intervention to help them adjust to their child’s condition or treatment in order that they can support their child as best they can.

Paediatric Clinical Psychology Service Information Leaflet

Who We See in Paediatric Psychology

There are lots of different reasons for a child or young person, with a diagnosed medical condition, and their family, to come to see a Clinical Psychologist. Children and young people who have been referred will be experiencing difficulties with their thoughts, feelings, behaviours and ability to cope. These difficulties will be as a result of their medical condition and/or will be impacting on their ability to manage their condition. Some of the most common reasons for referral are listed below.

Emotional Distress

Having a medical condition can sometimes make a child or young person feel anxious or scared, either about coming into hospital or about how to cope in daily life. Sometimes there are fears about the future, and how best to manage things. It often takes time to understand and accept a diagnosis or injury. Sometimes there will be feelings of anger, sadness and grief over the changes to life.

Adjustment

Sometimes children can become worried about their treatments, or just struggle to take their medication. It can take time and energy to stick to a medication regime. This can be harder still when it means time away from doing things that are fun or where you feel different or separate from your peers. Sometimes there are changes to how a child or young person looks or feels in their body, and adjustment to this can take time.

Acceptance

At other times it might be hard for a child and family to learn to accept and cope with living with a medical condition. Having a new diagnosis often means a big change to life for the whole family. There can be mixed feelings about these changes.

Trauma

Occasionally children and young people may be affected by traumatic events which have occurred at the time of diagnosis or injury or following complicated procedures. In the immediate aftermath of sudden scary events, distress and anxiety are normal responses. However, sometimes, after a longer period of time, the memory of these events can still trigger feelings of distress and can begin to interfere with day to day functioning.

Parental and Family Support

When a child or young person has become unwell or is given a new diagnosis, or where complex decisions must be made, parents can often benefit from the opportunity to reflect upon events and receive emotional support. We are also aware of the impact that a child with a medical condition can have on siblings within a family. Where possible we try to involve the whole family when offering support and advice.

Procedural Distress

The Play Specialists in the RHC do a lot to support children and young people with worries and understanding procedures but sometimes Clinical Psychology is needed too. Children or young people can often feel very anxious and distressed about having medical procedures, attending clinics or receiving feedback at clinics e.g. some young people with Diabetes feel really worried when attending clinics to discuss their HBA1C levels. This can often mean worry in the lead up to hospital appointments and finding it difficult to relax once they get here. Sometimes this can make them not want to come for procedures or attend clinics, or feel very upset when undergoing treatments.

Who We Are

Our team is made up of:

• Clinical Psychologists
• Child and Adolescent Therapists
• Assistant Psychologists
• Psychology Trainees

What Happens at an Appointment

Out-patient appointments with the Paediatric Clinical Psychology Service normally take place in the ‘Therapies Hub’ on the ground floor of the Children’s Hospital, also known as Clinic 12 or Clinic 1. If you are an in-patient, appointments will take place in a quiet room on the ward, or in a medical speciality clinic.

Assessment

First appointments will normally last between 45 minutes and an hour when we will meet with you and your parents/guardians. If you are a young person, we will give you the opportunity to meet on your own with the Clinical Psychologist for some of these appointments.

At a first appointment, it is helpful for us to hear all about you, your life, hobbies, school/college/work, friends and family, as well as the background of your medical condition. We will also think together about the difficulties that you have been experiencing, how these are impacting your life and condition, and how you and your family cope.

First appointments involve some talking and listening and sometimes drawing and playing with toys together too.

Follow-up

If it is thought that it would be helpful for you to return for further appointments, this will normally be arranged in the first appointment. Follow up appointments will allow us to get to know you better, formulate your difficulties and come up with a plan for supporting you and your family.

We use a number of different therapies, all of which have an evidence base. That is, we know from research that these can be helpful for children and young people struggling with the same kinds of difficulties as you. These might include, among others:

• Cognitive Behavioural Therapy
• Acceptance and Commitment Therapy
• Solution Focused Therapy
• Compassion Focused Therapy
• Trauma-Focused Cognitive Behavioural Therapy
• Family and Systemic Interventions
• Motivational Interviewing Approaches
• EMDR (Eye Movement Desensitisation and Response)
• Narrative Therapy
• Parenting Approaches
• Guided Self Help
• Group Approaches

Families may be seen on either an inpatient, outpatient basis or a combination of both.

Feedback, Complaints and Compliments

At the end of our work together, you will be asked to complete an Experience of Service questionnaire. The information you provide will be anonymous. This is an opportunity to let us know aspects of your care that you have found helpful or unhelpful.

We also welcome feedback via the Care Opinion website. For information about the NHS Greater Glasgow and Clyde complaints procedure, please visit our Complaints page.

What do Paediatric Psychology do to Help?

When we meet we will try to come to an understanding together of the things which are difficult for a child or young person and how best to help. We do this through talking and asking questions, but above all listening to what matters to that child or young person. We play games or draw together, to help us get to know a young person better. Sometimes we will ask a young person to keep a diary or chart to record their thoughts, feelings, actions or symptoms. For example – ‘My Emotions Worksheet’.

We use a number of different therapies, all of which have an evidence base. That is, we know from research that these can be helpful for children and young people struggling with the same kinds of difficulties as you. These might include, among others:

• Cognitive Behavioural Therapy
• Acceptance and Commitment Therapy
• Solution Focused Therapy
• Compassion Focused Therapy
• Trauma Focused Cognitive Behavioural Therapy
• Family and Systemic Interventions
• Motivational lnterviewing Approaches
• EMDR (Eye Movement Desensitisation and Response)
• Guided Self Help

Group Work

In addition, we regularly run psycho-educational or therapeutic groups for parents or for young people. Both will have an opportunity to meet with and work with others with similar issues.

Teaching and Training

We contribute as a team to the teaching and training of other multi-disciplinary staff working with children within the hospital. We run regular CPD as part of the NHS Education Scotland Psychosocial Interventions Modules. We also teach students in training to become Clinical Psychologists and therefore have close links with the Doctoral courses at both the University of Glasgow and the University of Edinburgh.

Preparing for Hospital

Below are a number of websites, leaflets and links to other resources which can help you prepare your child for coming to hospital.

• Preparing for Hospital – ‘What? Why? Children in Hospital’ Chartiy – This charity website gives access to videos and information to help you better support your child when coming into hospital.
• The HospiChill App – The HospiChill App was designed by our Consultant Clinical Psychologist, Dr. Janie Donnan, and is downloadable from the apple apps website. It gives you options for saving upcoming appointments and lots of hints, tips and relaxation strategies which can be used through your phone, to help prepare you for coming into hospital.
• The Hospital Passport – The Hospital Passport is a passport for children which can be brought in with them to each appointment. It includes space for preferences around treatment, stickers for achievements, and strategies for better coping. You can ask the pre-assessment team or your medical team for one of these if you think it would be helpful for your child.
• RHC Specialist Play Service – We work closely with the Play Specialists, based in the Teddy Bear Hospital on the ground floor of the Children’s Hospital. This can be a helpful place for children to meet and work therapeutically with Play Specialists and familiarise themselves with the hospital environment through play with real and toy medical equipment. We or a child’s Consultant can make referrals to the Play Service on your behalf.
• Having a Hospital Clinic Appointment (GOSH Information Sheets) – these are ‘easy to read’ information sheets from Great Ormond Street Hospital, London, for young children and children with learning disabilities, which explain what happens when you come for a hospital appointment. These include information on coming along for a CT scan, a blood test or an ECG, among others.
• Resource for parents of children with ASD (Parents Guide to Blood Draws) – This resource has lots of good information and strategies on how best to prepare your child with Autistic Spectrum Disorder for having a blood test carried out, but could be applied to all young children.

Parents- Looking after Yourself

When times are difficult, it is really important for parents to take time out to look after themselves and their own mental health. Below are some resources which may be helpful.

Information leaflets

• Parental Stress
• Helping Children to Cope
• Helping Siblings to Cope
• Early Support when your Child has Complex Needs

Websites

• Breathing Space
• Bereavement Services NHS GGC

Medical Specialities

We accept referrals from all medical specialities within the hospital. We have an embedded psychologist as part of the following Paediatric Medical Speciality Teams:

• Burns (Supporting Children with Burns)
• Cardiology
• Diabetes
• DSD (Differences in Sexual Development)
• Feeding
• Gastroenterology
• OBPI (Obstetric Brachial Plexus Injury)
• Oncology, Haematology and Stem Cell Transplant
• Pain
• Paediatric Intensive Care
• Renal and Renal Transplant
• Respiratory
• Rheumatology

Links for Children and Young People

Below are some useful links and resources for children and young people.

• Royal Hospital for Children
• Young Minds
• Childline (call 0800 1111)
• Breathing Space – helpline plus advice and information, call 0800 838587
• Aye Mind – resources for young people
• Calm Harm – resources to resist or manage the urge to self-harm
• SafeSpot – coping strategies and resources to help keep young people safe
• Get Self Help – self-help resources
• Hands On Scotland – advice for parents to support young person’s mental wellbeing
• What Why Children in Hospital
• HospiChill – downloadable app to help with worries related to hospital appointments, admissions and procedures

Welcome to the Paediatric Liaison Psychiatry Team at the Royal Hospital for Children (RHC). We are a specialist multi-disciplinary team offering mental health assessments and interventions for children and young people who are inpatients at the RHC or who have regular input from RHC medical or surgical teams.

Who Are We?

A multi-disciplinary team comprising of:

• Child and Adolescent Psychiatrists
• Clinical Psychologists
• Learning Disability Mental Health Nurses
• Mental Health Paediatrician

* Medical, nursing and clinical psychology trainees are often part of the team.

Our Service

Our specialist team is available to children of all ages, all ranges of learning ability and from all geographical areas, as long as there is a clear role for the Paediatric Liaison Team.

Children and young people who are inpatients in the hospital are generally seen within one working day of referral. There is usually no waiting list for standard out-patient appointments.

We also provide an on-call service for advice and assessment regarding acute mental health presentations in children and adolescents within the RHC, and under-18s presenting in A&E at Glasgow Royal Infirmary and Queen Elizabeth University Hospitals. We actively participate in research and audit to improve patient care.

How can we help?

We can offer a number of services:

• On call assessment for acute mental health presentations Monday to Friday 9am – 5pm.
• Routine assessment and treatment of mental health difficulties in children and adolescents who are frequent attenders of Paediatrics within RHC.
• Advice, if needed urgently, regarding the mental health of a parent or care giver of a young person who is an inpatient.
• Joint working with other hospital-based professionals, such as:
  • Paediatricians
  • Paediatric Neurologists
  • The Pain Management Service
  • Specialist Nurses
• Collaborative working with:
  • Intensive CAMHS (ICAMHS)
  • Connect-ED
  • Supporting paediatric staff with care planning and management of admissions for young people with learning disabilities, neurodevelopmental disorders or complex mental health difficulties, who require psychologically informed approaches to their care.
  • Liaison with RHC Paediatric Clinical Psychology and Child and Adolescent Mental Health Services (CAMHS), education and social work.
  • Consultation to other hospital based and community services.
  • Training to paediatric staff regarding mental health and neurodevelopment and neuropsychiatric conditions.

The Way We Work

We offer an initial assessment to determine what service would be most helpful. Where possible the child or young person and their family are assessed initially by two members of the team. We frequently find it useful to work together with paediatric colleagues to complete an assessment.

Following assessment, we may discuss referral to another service that would be more appropriate to meet the child and family’s needs. If our service is the most appropriate we may offer individual work, family work and/or medication advice as deemed appropriate. In some cases we may refer the case on to a more appropriate service.

The team uses a range of therapies including:

• Cognitive Behavioural Therapy
• Compassion Focussed Therapy
• Acceptance and Commitment Therapy
• Family and Systemic Interventions
• Problem Solving Approaches

Families may be seen on either an inpatient or outpatient basis or a combination of both.

Reasons for Referral

Referrals are accepted where there are complex mental health needs. Common reasons for referral include:

• Complicated psychological difficulties relating to physical illness for which they are receiving care at the RHC
• Neuropsychiatric disorders
• Physical conditions with significant psychological aetiology or component
• Complex pain disorders
• Overdose or self-injury
• Support with care planning and management for young people with complex neurodevelopmental difficulties receiving care at the RHC
• Eating disorders requiring admission to RHC due to physical health compromise

How do I make a Referral?

We accept referrals from hospital consultants, nurse specialists, allied health professionals and locality CAMHS.
All referrals should be directed to the Paediatric Liaison Psychiatry Business Support Team in the first instance – 0141 451 6529 (86529 for internal calls).

What if it’s Urgent?

It is expected that urgent referrals will be made via telephone contact. The team offers an on-call service Monday to Friday from 9am to 5pm. If an urgent psychiatric response is specifically required and cannot be achieved within team working hours, the referral is passed to the Out of Hour’s duty clinician available via the RHC switchboard (0141 201 0000).

When making an urgent referral, please provide the following information:

• Patient’s full name
• CHI/DOB
• Ward/location
• Named consultant
• Reason for admission
• Mental health concerns

• Urgent referrals are seen within 24 hours

What if it’s Non-Urgent?

For non-urgent referrals, we require that referrers provide the following essential written details:

• Patient’s full name
• CHI/DOB
• Ward if inpatient
• Named consultant
• Reason for referral
• Aims of referral

The Paediatric Liaison Psychiatry Business Support Team will provide a referral pro-forma for completion to action referral. The team meets weekly on Wednesday morning to review new referrals and discuss appropriateness.

Out of Hours Services

Out with the Paediatric Liaison Psychiatry working hours, Monday-Friday 9am – 5pm, emergency referrals should be directed to the Out of Hours duty clinician, accessed by phoning RHC switchboard on 0141 201 0000 (1000 for internal calls).

Alternative Services – Community and Hospital Based

The Paediatric Liaison Psychiatry team is one of a number of services available to meet the emotional and behavioural needs of children, young people and families. Other services include:

Services based at the Royal Hospital for Children:

• Paediatric Clinical Psychology
• Family Bereavement Service
• Family Support and Information Service
• Chaplaincy and Spiritual Care

Community Based Services

• Child and Adolescent Mental Health Teams (CAMHS) including ICAMHS
• Connect-ED
• Scottish Centre for Autism
• Community Children’s Nursing Teams
• Social Work
• Schools and Educational psychology services
• GPs

If there is uncertainty about which service is most suitable for a referral, this can be discussed with our on-call clinician, who is responsible for taking referrals that day. Referrals that require psychological input based within RHC, but not the expertise of a multi-disciplinary mental health team, may be discussed with the Paediatric Clinical Psychology Service.

If RHC based input is not required, but there is a mental health need, referrals may be passed to an appropriate community team or specialist service after discussion with the referrer, or guidance may be given on services and resources.

Contact Paediatric Liaison Psychiatry

You can contact the Paediatric Liaison Psychiatry Team at:

Paediatric Liaison Psychiatry Team Business Support
Office Block, Zone 2.01
Royal Hospital for Children
Queen Elizabeth University Hospital
1345 Govan Road
Glasgow
G51 4TF

Telephone: 0141 451 6529 (86529 for internal calls)

If you are in a ward in the hospital you can ask one of the nurses to call us using the number above.

The Paediatric Neuropsychology Service (PNS) is a small team of Clinical Psychologists, based at the Royal Hospital for Children, Glasgow. We see children and young people aged 0-18 years, who attend RHC because of a condition that originates in their central nervous system and affects their functioning. This includes children with epilepsy, brain tumours, infections, strokes and head trauma.

We accept both inpatient and outpatient referrals; most of our referrals come from neurology, neurosurgery and neuro-oncology.

Our main job is to assess children’s cognitive, behavioural and emotional functioning and make sense of these in the context of their neurological/developmental condition.

Most children and young people will have a standardised cognitive assessment as part of their contact with the service. This involves them completing a series of puzzles which are designed to find out their cognitive strengths and weaknesses.

We then make recommendations about how they can best be supported at home, school and in their community.

Enquires can be made to

Paediatric Neuropsychology Service
Office Block, Zone 2.01
Royal Hospital for Children
Queen Elizabeth University Hospital
1345 Govan Road
Glasgow
G51 4TF

Tel: 0141 451 6574
Monday – Friday (9am – 5pm)

The Scottish Centre for Autism is now closed and is no longer accepting referrals. Over the years the team have supported many families and the expertise of this team is now transitioning into the Neurodevelopmental Service within Specialist Children’s Services. Should you have any questions you can contact your locality team.

All children and young people who require it should access Child and Adolescent Mental Health Services (CAMHS) at the team local to where they live. Within CAMHS services there are additional supports for children and young people who have a learning disability, whose experiences of adversity past and present have resulted in complex trauma, or who have forensic mental health needs. This supports CAMHS teams in working with these vulnerable groups of children and enables equitable access to mental health services for these children and young people.

The Tier 4 Hub is a specialist service that works with children and young people (0-18 years) at greatest risk and who require a period of intensive assessment and intervention and/or specialist intervention. We work with children and young people with mental health disorders and who have

• Learning disabilities and/or
• Experience of complex trauma and/or
• Severe conduct or offending behaviour (Forensic).

The Tier 4 Hub become involved at the request of their colleagues in the locality of CAMHS.

We are based at

Floor 4
West Glasgow Ambulatory Care Hospital
Dalnair Street
G3 8SJ
Telephone 0141 201 0808

Learning Disabilities

Young people with a learning disability may have difficulties in understanding situations, in expressing themselves, or have fewer opportunities to learn about becoming older and more independent. They can have the same mental health problems as other young people who do not have learning disabilities, but these might look different, be more difficult to detect, and need interventions and treatments that are adjusted to suit individual needs.

Children and young people with learning disabilities, and their families and carers, can expect CAMHS to make reasonable adjustments to enable them to be helped by CAMHS. This might be having an appointment at home rather than in a clinic, having a longer appointment time, using playing and drawing instead of talking, working with parents and carers and others instead of directly with the child, joining with the family, school, health services provided through the school, social work services, etc. in reviews or discussions to think together about the difficulties and how best to help.

The learning disability clinicians in CAMHS are experienced in working with children and young people and with people with learning disabilities and can help with ideas and suggestions about how to understand and tackle problems. This might be working directly with families and other agencies, or supporting their CAMHS colleagues to work with children and young people affected by learning disability.

Some learning disabilities clinicians are based in the local CAMHS teams and others in the ‘Tier 4 HUB’. They are a multi-disciplinary team with skills in learning disability child and adolescent mental health and challenging behaviour (Consultant Child and Adolescent & Learning Disability Psychiatry; Registered Learning Disability Nursing; Clinical Psychology; Speech and Language Therapy; Occupational Therapy; Clinical Support Worker).

Complex Trauma

‘Trauma’ is a widely used term, but in this context it refers to: an event which is exceptionally threatening or catastrophic and is likely to cause distress for almost everyone.

Complex trauma is when these traumatic events are repeated and interpersonal (inflicted by other people). This includes childhood sexual abuse, childhood physical abuse, witnessing domestic abuse, war and neglect. Please note this is not an exhaustive list.

Children and young people with a complex trauma history can develop mental health difficulties which may lead to them presenting in CAMHS.

The Complex Trauma Pathway aims to support our colleagues in the locality CAMHS teams to provide a trauma sensitive approach to their input with young people who have a complex trauma history. As well as provide specialist input directly to young people and their families where needed.

Forensic Child and Adolescent Mental Health Services (FCAMHS)

Information for Young People

What is FCAMHS?

We work with young people who are going through a hard time. You might be getting into trouble with the police and having problems with your mental health.

We have a psychiatrist, speech and language therapist, occupational therapist, psychotherapists and psychologists on our team.

Who comes to FCAMHS?

We see young people under the age of 18. Some have been charged with a serious offence. Some are involved with the police or youth justice social work. Some are in secure care.

What can I expect if I see FCAMHS?

You might already be coming to CAMHS. If you are, your CAMHS worker will introduce us. We can see you at your local CAMHS team. Sometimes we might see you somewhere else e.g. if you are in secure care. When we meet we will tell you about our service. We will also want to find out more about you. We want to listen to you. Then we decide together if we are the best team for you.

What happens when I come to FCAMHS?

We listen to you and talk about the problems you are having. We work with you to understand why you are getting into trouble. We speak with people who know you well. We want to understand how to keep you and other people safe. We work with teachers, social workers and secure care staff to help us think about the best way to keeping you safe and out of trouble.

What else might happen?

We will ask you to fill out a form when we first meet. You might also have to fill out a form at the end. We do this to see if our team is working well. We might ask you what you thought of working with us. We want to know how we can improve.

How can I get help from FCAMHS?

If you are being seen by CAMHS your worker might ask FCAMHS to see you. If you are in secure care then your GP or Social Worker might ask FCAMHS to see you. If you go to ISMS (Glasgow City Council’s Intensive Support and Monitoring Service), then your ISMS worker will ask you to meet with FCAMHS.

Information for Professionals

Who are we?

FCAMHS was developed following a review of the needs of young people who are involved in serious offending behaviour across Greater Glasgow and Clyde (GG&C). We now sit as part of the Tier 4 CAMHS hub, alongside work-streams for complex trauma, and intellectual disability.

The service is a multi-disciplinary team, consisting of Psychology, Psychiatry and a Social Worker. We also have access to Speech and Language Therapy, Occupational Therapy, and Psychotherapy. Unlike the other work-streams, FCAMHS do not have link-nurses. We have therefore, been working to establish links with Tier 3 teams across GG&C.

FCAMHS also consists of commissioned services who offer direct access to children in Secure Care, or children accessing the Glasgow City Council Intensive Support and Monitoring Service (ISMS)

Who is the service for?

We offer a provision for young people up to age 18 living within the GG&C area who have moderate to severe mental health difficulties, and who present a significant risk of harm to others by means of physical or sexual violence or fire-setting. Typically, these are complex cases requiring intensive MDT working and assertive outreach, that may outstrip Tier 3 resources.

What do we do?

We can provide specialist assessment of risk, using structured professional judgement approaches, which are evidenced-based and recommended by the Risk Management Authority.

We support those working with young people to understand the development and maintenance of offending behaviour. This subsequently underpins a holistic ‘Whole Systems’ intervention and care plan to reduce risk.

We can provide assessment and intervention for serious and chronic mental disorder, particularly when this is associated with risk. We also offer interventions focussing on reducing offending.

We support colleagues in Tier 3 CAMHS, by providing specialist training in relation to forensic issues.

We routinely evaluate our services, as well as developing clinical research projects.

How to request assistance.

Requests for assistance come from locality CAMHS teams. All requests are addressed to the Tier 4 Hub. In order to do this, you can contact the FCAMHS duty clinician to discuss. We will request initial assessment and risk (FACE CARAS) reports. We will discuss within weekly Tier 4 referral meeting and the case will be allocated if accepted.

If you are referring for a child not known to GG&C CAMHS, but who is residing in Secure Care, then a referral form can be requested from the unit and sent to:
F.CAMHS@ggc.scot.nhs.uk

All referrals from secure care should be discussed with the child, their consent sought and also sent to the above email address. Both referral and consent forms can be obtained from the secure units.

Unscheduled Child and Adolescent Mental Health Services (UCAMHS) is a specific team of Specialised CAMHS nurses and experienced health care support workers who are trained to support unscheduled presentations in young people experiencing significant mental health difficulties.

What do we do?

Provide and/or contribute to a 24/7 mental health crisis response pathway for children and young people, including support and advice to front line services, assessment and interventions/treatment for mental health crisis presentations, and access to inpatient medical and psychiatric care. Children and Young People can be referred for an urgent mental health assessment via police, police custody, Out of Hours GP, Hospital medical staff, paramedics and locality CAMHS.

We will gather information from the referrer and can offer support/advice via telephone. If appropriate we can offer telephone and/or face-to-face contact to complete an assessment that helps us gain a better understanding of the young person’s mental state. We are motivated to manage risk and support safety planning. We work with multiple other professionals, alongside guardians to make sure it is safe for the young person to return home.

Face-to-face assessments can take place within the Mental Health Assessment Unit for 16/17 year olds to help reduce the need for the Young Person to visit an A&E Department if there is no medical intervention required. Otherwise clinicians will attend any hospital within NHSGGC to meet the young person and/or their guardian.

How do you make a referral?

Referrals are made via telephone contact and are screened by UCAMHS clinicians. Receiving clinicians will clinically risk assess whether an urgent mental health assessment is required and if so, in what form would be the most appropriate for the young person.

Who can make a referral?

• NHSGGC paediatric and adult general hospital wards and Emergency Departments
• Out of Hours GP
• NHSGGC CAMHS
• Police
• Forensic Practitioner at Police Custody Suites
• Scottish Ambulance Service (SAS)

Criteria for UCAMHS referrals include:

• Under 18 years of age
• Not currently open to the Esteem Team
• Presenting within NHSGGC
• Not intoxicated/under the influence of substances
• Does not require medical intervention/deemed medically fit/medical treatment completed
• Presents risk to self or others in context of significant mental health crisis
• Acute medical presentations combined with acute crisis Mental Health concerns can be supported out with Paediatric Liaison Psychiatry hours.

There are 4 different nursing teams working within 4 pathways of care in the community. These teams are the:

Occupational Therapists can support you to join in (participate in) every day activities (occupations) to help you lead a full and happy life, reach your goals and learn the skills you will need during your life to be an active member of your community. 

We aim to support you to do the things that you want and need to do.  We do this by thinking about you, the occupation and the environment.  If these three things are not working together then it can be hard to take part.  We can help you to make changes to improve your enjoyment in everyday life.

Children’s Physiotherapy is the management and care of babies, children and young people from birth to 18 years or school leaving age (some young people may be directed to adult services as appropriate).

Physiotherapists work together with children, young people, their families and others involved in their care. They support children and young people to reach their physical potential.

The Physiotherapy Team is made up of Physiotherapists and Physiotherapy Clinical Support Workers. If needed, the child/young person will be allocated to a named Physiotherapist. This Physiotherapist will help to support you and your child/young person. They will work alongside the team around your child/young person.

Children and young people can have speech, language and communication issues. These issues can stop them from joining in with others and participating in daily life. Some children do not understand what is being said to them or struggle to put words together. A child’s speech may be hard to understand or they may find interaction difficult. Children with communication difficulties may need Speech and Language Therapy.

Speech and Language Therapists assess and support children and young people with communication and/or eating and drinking difficulties.

Sometimes a child’s communication difficulties can have an impact on their everyday life. The Speech and Language Therapy team can offer advice and information to families, nurseries and schools. We will always give advice and ideas on how to support children and young people in their everyday life.