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Contents

1. Introduction
2. What is Available?
3. Who can Refer?
4. Referral Process
5. Criteria for Referrals for Direct Work
6. Criteria for Group Work Referrals
7. Criteria for Referral for Consultation
8. Definitions of Psychological Need

1. Introduction

The ATTACH Team is a referrals based service within Oxfordshire Children, Young People and Families Directorate.  The team comprises clinical psychologists and specialist social workers.  The role of the service is to contribute to improving the well being of children looked after, with specific reference to their mental health needs, in accordance with the Governments Quality Protects Initiative.

2. What is Available?

The ATTACH Team has three key functions:

• Direct work with a referred child and or their carers.  This could include assessments and time limited interventions.
• Consultation for social workers, family workers, foster carers and residential staff.  Consultation can be requested for a specific child or group of children.  Up to two 90-minute sessions will be offered.
• Development Projects (time limited).  The Service works on a variety of short-term projects, which will include groups for children and/or carers.  The groups will not run every term, and details will be circulated as needed.

3. Who can Refer?

1. Referrals for direct work (including group work for children) should usually be made by the child’s social worker, after discussion with the relevant Team Manager.  Where appropriate, referrals can be initiated by other Directorate employees.
2. Referrals for consultation can be made by any professionals within the Directorate.  Foster carers can also make self-referrals.

4. Referral Process

In addition to completing a Referral form, referrers are asked to include copies of recent reports and/or information on the child’s psychosocial history.  This information aids the referral process in terms of whether a referral is accepted and the nature of the work offered.  Referrals are considered at a weekly referral meeting.

5. Criteria for Referrals for Direct Work

Referrals for direct work (assessment and/or intervention) can be initiated when both the following are met:

1. The child has psychological needs which may include:
   
   Attachment disorder/difficulties  
   Behavioural difficulties (e.g. oppositional defiant disorder, conduct disorder)  
   Anxiety (e.g. separation anxiety, sleep difficulties)  
   Depression  
   Self-esteem issues  
   Identity Issues  
   Feeding difficulties in the context of early failure to thrive  
   Sub-clinical eating disorders.  
   Enuresis/Encopresis (wetting and soiling)  
   Bereavement issues or chronic parental illness.
   
   
2. One (or more) of the following applies:
   
   The child is Looked After  
   Mental health needs in the context of home or placement breakdown  
   Difficulties are experienced in the home setting (i.e. not school only)  
   Refusal to be referred to or refusal to attend CAMHS Services.  
   Does not meet referral criteria for CAMHS  
   Not receiving a service from Tier 4  
   Not receiving a learning disability service.

6. Criteria for Group Work Referrals

As for direct work – but specific criteria will be circulated with each group ran.

7. Criteria for Referral for Consultation

Consultations will offer an opportunity to reflect on issues relating to the care of a particular child or group of children.  The criteria for direct work will therefore also apply to consultation, with reference to the named child.  Issues may include placement related concerns or placement planning.

Anyone of the previously mentioned workers may self refer.

The referral criteria will be routinely reviewed to ensure the principle of equity of access.

8. Definitions of Psychological Need

8.1 Attachment Disorder/Difficulties

A persistent pattern of unsatisfactory relationships with adults/caregivers, which has been present since before 5 years of age.  These relationships are characterised in the child as either a pattern of withdrawn behaviour, or being over friendly or indiscriminate in nature.

8.2 Behavioural Difficulties

Behaviour that is anti social (which may include a history of offending) and may include: a persistent failure to conform to reasonable requests from an authority figure, lying, aggression, truancy and fire setting.  These behaviours may also be accompanied by problems with attention, concentration and impulsivity.

8.3 Anxiety

Anxiety disorders are generally characterised by a marked pattern of avoidance of one or more of the following: social situations, school (not due to truancy) separation or linked to a traumatic situation.  Anxiety symptoms also include physiological symptoms such as hyperventilation, nausea, sweating, headaches and increased heart rate which cannot be accounted for by another medical condition.  This category includes symptoms consistent with the re-experiencing, either through thoughts or images, of a traumatic event and symptoms consistent with obsessive-compulsive disorders.

8.4  Depression

A pattern of low self worth (see self esteem) hopelessness and low mood which may be indicated by a number of symptoms (withdrawal, school refusal) which will differ in presentation with children and adolescents.  These symptoms may lead to a disturbance in normal sleep and appetite.

8.5  Self Esteem Issues

These may be manifest by the child or young person having a poor self-image and a low appraisal of themselves compared to their peers in a number of aspects of their life (social, academic)

8.6  Identity Issues

These may be manifest by conflict (resulting in depression or anxiety) in the context of their perception of their race, gender or disability.  Not exclusively seen in the context of abuse (e.g. racial abuse or bullying)

8.7  Feeding Difficulties in the Context of Early Failure to Thrive

Where there is a persistent failure despite interventions from primary care to feed a young child due to their refusal or restricted diet (‘faddiness’) and a failure to develop physically and psychologically.

8.8  Sub-clinical Eating Disorders

Where there are indicators such as a strict eating regime, binging, vomiting and a fear of weight gain without significant self-induced weight loss necessary for a diagnosis of bulimia or anorexia nervosa (i.e. body weight that is 15% below that expected of their age).

8.9  Enuresis and Encopresis

Urination and defecation in inappropriate places (e.g. bed, underwear) which has not responded to primary care intervention, is not expected of their chronological age and has either been present since birth, or has recurred after a period of continence.  It is not accounted for by a medical condition.  This category can include faecal smearing.

8.10  Bereavement Issues or Chronic Illness in a Parent

Bereavement issues may be manifest by a persistent pattern of grief and despair following the death of a loved one that has not been resolved significantly within a period of at least six months and/or has not responded to help from other agencies, or as a result of a chronic illness in a parent which has a negative impact on the child such as fear of parent’s impending death or inappropriate care responsibilities for the child’s chronological age.

End