ADMISSION OF YOUNG PERSONS TO AN ADULT WARD IN EXCEPTIONAL CIRCUMSTANCES

Transcription

1 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances ` SECTION: 17 SAFEGUARDING POLICY NO: NATURE AND SCOPE: SUBJECT: POLICY TRUST WIDE ADMISSION OF YOUNG PERSONS TO AN ADULT WARD IN EXCEPTIONAL CIRCUMSTANCES This plicy must be fllwed in the rare instances when it is felt admissin t an Adult Mental Health (AMH) r Adult Intellectual Disability Assessment and Treatment (LD) Ward is required fr a yung persn aged 16 t 18 years f age and utlines the respnsibilities in regards t admitting yung peple t Adult wards. DATE OF LATEST RATIFICATION: AUGUST 2014 (Re-issued January 2015) RATIFIED BY: TRUSTWIDE STRATEGIC SAFEGUARDING GROUP IMPLEMENTATION DATE: JANUARY 2015 REVIEW DATE: JULY 2017 ASOCIATED TRUST POLICIES AND PROCEDURES Safeguarding Children Children Visiting Inpatient & Residential Areas (except High Secure) Jint Agency Sectin 136 Mental Health Act 1983 Prcedures Reprting f Accidents, Incidents & Near Miss Situatins including Serius Incidents (SIs) ISSUE 9 JANUARY 2015

2 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances NOTTINGHAMSHIRE HEALTHCARE NHS TRUST ADMISSION OF YOUNG PERSONS TO AN ADULT WARD IN EXCEPTIONAL CIRCUMSTANCES POLICY CONTENTS 1.0 Intrductin 2.0 Plicy Principles 3.0 Definitins 4.0 Duties 5.0 Admissin Practices 5.1 Admissin 5.3 Admissin under sectin 136 Mental Health Act 6.0 Rles & Respnsibilities 6.1 CAMHS Clinical Nurse specialist (r if n leave nminated persn) 6.2 Clinical nurse specialist 6.3 Tier 3 CAMHS Wrker 6.5 Adult Mental Health/Learning Disability Ward Staff 6.7 Return t CAMHS 7.0 Implementatin 8.0 Training 9.0 Target Audience 10.0 Review Date 11.0 Cnsultatin 12.0 Relevant Trust Plicies 13.0 Mnitring Cmpliance 14.0 Equality Impact Assessment 15.0 Legislatin Cmpliance 16.0 Champin & Expert Writer 17.0 References /Surce Dcuments Appendix 1 Ntificatin t Care Quality Cmmissin and Named Nurse Safeguarding Children Appendix 2 Sectin 136 suite - Ntificatin t Named Nurse Safeguarding Children nly Appendix 3 Safe and Apprpriate Care fr Yung Peple n Adult Mental Health Wards Essential Criteria Appendix 4 Recrd f Changes Appendix 5 Recrd f Emplyee Having Read the Plicy ISSUE 9 JANUARY

3 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances NOTTINGHAMSHIRE HEALTHCARE NHS TRUST ADMISSION OF YOUNG PERSONS TO AN ADULT WARD IN EXCEPTIONAL CIRCUMSTANCES POLICY 1.0 INTRODUCTION 1.1 All children and adlescents are best accmmdated within specialised services prvided by CAMHS. This is in accrdance with the Mental Health Act Cde f Practice (Chapter 36) 1.2 This plicy caters fr the exceptinal circumstances fr the admissin/transfer f children/adlescents t adult wards, their treatment and accmmdatin needs. 1.3 It is in the best interests f the child/yung persn nt t be transferred between wards a number f times. The aim shuld be t prvide cnsistency f care 1.4 N yung persn under 16 years f age sill be admitted t an adult ward under any circumstances 2.0 POLICY PRINCIPLES 2.1 This plicy has been develped and must be fllwed in the rare instances when it is felt admissin t an Adult Mental Health (AMH) r Adult Intellectual Disability (ID) Assessment and Treatment is required fr a yung persn aged 16 t 18 years f age. It is apprpriate t admit r transfer a Yung persn under 18 t an adult ward fr the fllwing reasns: The behaviur f the yung persn may pse a significant danger t themselves r thers. Examples f this may be fire setting, vilent and aggressive behaviur r safeguarding cncerns which may impact n the safety f ther yung peple that can nt be managed n the adlescent unit Where every attempt t place the yung persn n the adlescent unit has been unsuccessful and care in the cmmunity is nt cnsidered a viable ptin Where the needs f the adlescent unit t admit and manage the behaviur f a yung persn necessitate the transfer f anther yung persn Where in the pinin f the CAMHS/AMH/ID team it is cnsidered that the needs f the yung persn are best met in an adult envirnment (this must be a jint decisin). 2.2 Sectin 131A f the Mental Health Act 1983 (MHA) requires hspital managers t ensure that patients age 18 r under are admitted t an envirnment suitable fr their age (subject t their need). This duty applies t bth detained and infrmal patients. It is nt an abslute prhibitin n the admissin f such patients. The Mental Health Act allws fr admissin t an adult ward in exceptinal circumstances if their need is either: Overriding: When a yung persn needs immediate admissin fr their safety r that f thers. This acknwledges that, althugh an inpatient CAMHS unit is nrmally the preferred envirnment fr a persn under age 18, there will be ccasins when a bed r ther CAMHS alternative (e.g. intensive utreach) is nt available. Atypical: When, even if a CAMHS bed was available, an adult ward is the mst apprpriate clinical placement. Fr example, a yung persn nearly 18 and is being treated by the Early Interventin Psychsis team.. Hwever, even in these circumstances there is still an bligatin t ensure that safeguards are in place fr an under 18 year ld in line with their status as a minr ISSUE 9 JANUARY

4 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances Where, exceptinally, a yung persn is admitted in an emergency situatin it must be fr the briefest time pssible. (See als MHA Cde ). Where a child is admitted t an adult mental health ward, this qualifies as a serius incident as utlined in the Natinal Framewrk fr Reprting and Learning frm Serius Incidents Requiring Investigatin and shuld be respnded t using the Trust s serius incident plicy ref Reprting f Accidents, Incidents & Near Miss Situatins including Serius Incidents (SIs) The fllwing guidance shuld be fllwed when cmpleting such frms: The Incident Grup that must be used is: Clinical Care (Inc Death) The Incident Type that must be used is: Child Admissin Adult Ward 3.0 DEFINITIONS 3.1 Yung persn ver the f age 16 and under the age f 18 years 3,2 A ward means an inpatient hspital unit where the patient has been admitted and allcated a bed. The sectin 136 suites at Millbrk r at the Queens Medical Centre are nt classified as wards. 4.0 DUTIES 4.1 The primary respnsibility fr ensuring this plicy is adhered t rests with thse staff wh are making the immediate decisins relating t a yung persns admissin. 4.2 Secndary respnsibility lies with the unit managers f the admitting ward t ensure that staff members are aware f the requirements f this plicy and its implicatins fr their practice. 5.0 ADMISSION PRACTICES 5.1 Admissin Once the need fr admissin has been established fr a yung persn t be admitted t an AMH/IB ward, the yung persn must always be assessed by the CAMHS SPR/Cnsultant if there is n CAMHS bed available the CAMHS SPR/ Cnsultant shuld infrm AMH General Manager/ Specialist Services General Manager, r brnze n-call manager must be infrmed immediately. This manager will be furnished with all the relevant details, fr example, name, date f birth, reasns fr ptential admissin etc, f the yung persn and liaise with the Adlescent Unit in the fllwing ways: It is the respnsibility f the persn requesting admissin t AMH/ID ward t clearly recrd the reasns fr the admissin t these wards identifying clearly why they cannt be admitted t a CAMHS bed. This shuld be recrded in the MDT recrds and n the initiated SUI 1 and subsequent SUI In wrking hurs - The AMH General Manager/r silver n-call manager will infrm the Specialist Services General Manager r deputy as sn as is practically pssible, relating all the relevant details. On receiving this infrmatin the Specialist Services General Manager will establish, via the unit cnsultant, Clinical Nurse Specialist, unit manager r nminated deputy the current bed ccupancy and assess if the CAMHS ward is able t accept the yung persn. They must recrd all decisins made. It is the respnsibility f the yung persn s key wrker t ensure that all dcumentatin relating t this are entered int the yung persn s MDT recrds. ISSUE 9 JANUARY

5 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances Where this yung persn is nt knwn t the service it is the respnsibility f the n-call CAMHS SpR/Cnsultant t ensure this ccurs If an admissin t an AMH/ID ward is required the Specialist Services General Manager will cntact the AMH General Manager/ brnze n call manager and advise them f the need fr an admissin recrding why an admissin t the Adlescent unit is neither safe and/nr practical. The assessing practitiner will establish if the yung persn is knwn t any areas f the CAMHS service, r ther Trust services, and if s will quickly establish what care has s far been prvided and will liaise with the SSD General Manager regarding this. The assessing practitiner will als alert the relevant Operatinal Manager within CAMHS that a Yung Persn has been admitted t an AMH/ID ward, giving details f admissin, and ensuring that if the yung persn is unknwn the case has immediate allcatin Out f wrking hurs - The brnze n-call manager fr the Specialist Services Divisn will establish, the current bed ccupancy and current risk factrs within the Adlescent Unit which will help guide the ptential admissin t an AMH ward. The Brnze n call SSD will dcument all the details f the admissin, discussins and decisins n the handver recrding sheet) and prvide a verbal handver f this infrmatin the fllwing mrning t the Adlescent Unit Manager, Clinical Nurse Specialist r Tier 4 Service Manager wh will ensure the Mdern Matrn is infrmed and the Yung persn s Key Wrker. 5.2 Lcal Services Divisin f Nttinghamshire Healthcare Trust will identify relevant wards within the Trust where the yung peple can be safely placed. These areas must fulfill the requirements highlighted belw and assurance shuld be prvided within the appendixed alert frm that these requirements have been cnfirmed and are in place Brnze and silver managers n call must be aware f the designated wards and aware f the assurance requirements, it is their respnsibility ut f hurs t ensure the relevant safety measures belw are in place fr any yung persn admitted t an adult ward. When a yung persn under the age f 18 years is admitted t AMH/ID wards, cnsideratins must be given t their safety and vulnerability frm ther patients r/and visitrs t the ward. They must be placed n 1 t 1 within arm s length bservatins at all times. This can nly be reduced t n less than within eye sight bservatins if agreed by the clinical team and it is in the yung persn s best interests and their safety can be maintained e.g. they are finding the prximity difficult t cpe with. The yung persn must have an en-suite single rm which is in clse prximity t the ward ffice/nurses statin. The educatinal needs f all patients under the age f 18 must als be cnsidered. Staff must discuss this with the yung persn during their admissin and help liaisn between the persn s schl/cllege as required and if clinically apprpriate. ISSUE 9 JANUARY

6 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances Yung Persn Detained and referred t the 136 Suite Where a yung persn is detained and referred t a sectin 136 suite, they are nt deemed admitted t a ward. Once the assessment has taken place within the 48 hurs, the yung persn may then be admitted t a ward. It will be the respnsibility f the 136 Suite t cmplete an IR1 and cmplete the initial SUI dcumentatin. The ward the yung persn mves n t will cmplete the SUI2 frm. Where the yung persn is discharged frm the 136 Suite in t the cmmunity r t anther prvider, it will be the respnsibility f the 136 Suite t cmplete the SUI2 frm. The s 136 staff d nt have t ntify the CQC that a yung persn has been admitted t the suite. Hwever, the Named Nurse Safeguarding Children and Adults must be infrmed using the frm in the appendix t this plicy. 6.0 ROLES AND RESPONSIBILITIES 6.1 CAMHS Clinical Nurse Specialist (CNS) /Matrn (r if n leave nminated persn) Once the decisin has been taken t admit a yung persn t an AMH r ID ward the CNS fr CAMHS will liaise directly with the admitting ward and the multi-disciplinary team respnsible fr the yung persn and will arrange t visit the AMH/ID Ward within 48 hurs t cnduct a safeguarding assessment, using the Ryal Cllege f Psychiatrists guidelines, regarding the AMH/ID envirnment, and ensure that the Yung Persn is nt subject t any significant risk f harm. The Brnze n call will be expected t ensure their safety until this pint. The utcme f the visit will be recrded in the MDT recrds f the yung persn. Where pssible the visit shuld be carried ut jintly with the yung persn s key wrker r a member f staff frm the team where the key wrker is nt available, t ensure that delivery f clinical care is targeted apprpriately fr a yung persn, making the distinctin between a yung persn and an adult. This jint assessment will establish the apprpriateness f the yung persns cntinued placement n the AMH r ID ward. The CNS will meet with the yung persn, if clinically apprpriate, and discuss hw they are. They must ask them specifically if they feel safe, d they have 1 t 1 supprt and have they been visited by CAMHS staff. They must recrd the utcme f the meeting in the yung persn s MDT recrds 6.2 CNS/Matrn The CNS/Matrn will take the lead in: Discussing the issue with the safeguarding team where required and acting n and disseminating their advice where given Ensuring that there is a rbust care plan in place that is understd by all parties. Discussin with all members f the MDT, especially the key wrker regarding safeguarding issues. Reviewing ntes/care plans. Offering specialist advice and supprt regarding CAMHS safeguarding. Regular planned attendance fr cntinued review f safeguarding elements f care. ISSUE 9 JANUARY

7 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances Cnsider transitin t an under 18 bed. Checking relevant dcumentatin has been cmpleted (e.g. IR 1 s and SUI s). 6.3 The Yung Persn s Key Wrker The Tier 3 CAMHS wrker will: Meet with the yung persn and establish the necessary therapeutic relatinship, and cmmence a CAMHS mental health assessment. Offer specialist CAMHS clinical advice and supprt Deliver regular planned attendance n the ward fr cntinued clinical assessment and review Develp a plan f actin fr nging clinical care whilst n an AMH/ID ward. Feedback t their clinical team within CAMHS 6.4 The CNS/Matrn will prvide an immediate and nging updates t the Specialist Services General Manager, Mdern Matrn and the adlescent unit leadership team. 6.5 Adult Mental Health/Intellectual Disability Ward Staff The Nurse in charge f the admitting ward will: Ntify the Care Quality Cmmissin and the Named Nurse Safeguarding Children f any admissins t nn CAMHS beds fr adlescents between the age f using the template in Appendix 1- Ntificatin t Care Quality Cmmissin. The Care Quality Cmmissin Fax Named Nurse Safeguarding Children Fax , cpied t the Lcal Services Safeguarding Lead fr infrmatin Ntify the CNS/Matrn via f the admissin. Initially cmplete a SUI1 and key details sheet and ensure a SUI2 is cmpleted (please remember that all patient identifiable infrmatin must be sent passwrd prtected). Cmplete an incident frm (IR1). The admitting wards staff shuld have gd understanding f the increased vulnerability f yung peple and shuld ensure that the Ryal Cllege f Psychiatrists, Safe & Apprpriate Care fr Yung Peple n Adult Mental Health Wards, 2009 dcument is adhered t, particularly criteria rated as essential. Failure t meet these criteria wuld result in a significant threat t patient safety, rights r dignity and /r wuld breach the law. (Page 12). The essential criteria fr the seven sectins can be fund in Appendix 2. Essential criteria fr the seven sectins can be fund in Appendix 2. ISSUE 9 JANUARY

8 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances Return t CAMHS Admissin t an AMH/ID ward shuld always be fr the minimum time and plans fr the transfer back t CAMHS shuld begin as sn as the yung persn is admitted t the AMH/ID ward. This will be with the supprt f the Clinical Nurse Specialist and Specialist Services Mdern Matrn and the apprpriate yung persn s key wrker The yung persn will be familiar with members f the CAMHS team and this will be established by regular visits frm the team Transfer will be agreed between the clinical teams based n a thrugh risk assessment. Bth General Managers will be infrmed f this assessment. 7.0 IMPLEMENTATION 7.1 This plicy seeks t frmalise the management f admissin f yung peple (16 18 years ld) t Adult Mental Health and Adult Intellectual Disability Assessment and Treatment Wards. 7.2 T ensure Trust plicies and natinal guidance are adhered t and safeguarding measures are in place t guarantee that existing clinical practice takes accunt f the need t prvide safe and age-apprpriate care t these yung peple. 7.3 Ward and General Managers shuld therefre ensure that all Trust staff invlved with any aspect f admissin management fr this age grup are fully cnversant with the cntent f this plicy and that they are cnfident and cmpetent t carry ut their respnsibilities accrding t the principles described. Clinical supervisin and appraisal prcesses shuld be used t determine this. 8.0 TRAINING 8.1 All clinical staff t be made aware f the plicy during inductin t the clinical team. Operatinal Managers will ensure that all peratinal staff are familiarised with the requirements f this lcal plicy and the specific implicatins fr their rle. 8.2 Extra training may be required by adult mental health services/ Intellectual Disability Directrate and will be facilitated thrugh the Specialist Services Matrn and CAMHS wrkers. 9.0 TARGET AUDIENCE 9.1 All care staff in Adult Mental Health, Adult Intellectual Disabilities, Child and Adlescent Mental Health Services 9.2 Senir Management taking n the rle f Brnze and Silver Cmmand 10.0 REVIEW DATE 10.1 This plicy will be reviewed in 3 years r in light f rganisatinal r legislative changes CONSULTATION 11.1 ELC, Trust wide Strategic Safeguarding Grup ISSUE 9 JANUARY

9 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances RELEVANT TRUST POLICIES 12.1 Safeguarding Children Jint Agency Sectin 136 Mental Health Act 1983 Prcedures 13.0 MONITORING COMPLIANCE 13.1 Under 16s and 16/17 year lds frm part f Lcal Services Dashbard and are mnitred mnthly at the CAMHS directrate business meetings Mnitring cmpliance at a Directrate Level will be the respnsibility f the CAMHS Matrn in partnership with the Tier 4 Operatinal Manager EQUALITY IMPACT ASSESSMENT 14.1 This plicy has been assessed fllwing the Equality Impact Assessment; the utcme f the initial screening assessment was that it des nt adversely affect different grups n grunds f disability, BME, gender, age r sexual rientatin LEGISLATION COMPLIANCE 15.1 Mental Health Act 1983 which specific reference t Sectin 131A f the Act CHAMPION AND EXPERT WRITER 16.1 The Champin f this plicy is Dean Hwells, Executive Directr, Nursing Quality and Patient Experience The expert writers are: Tina Hymas Taylr Named Nurse Safeguarding Children and Adults and Michael Sergeant, Mental Health Act/Mental Capacity Act Lead (Lcal Services Divisin) 17.0 REFERENCES /SOURCE DOCUMENTS 17.1 Safe & Apprpriate Care fr Yung Peple n Adult Mental Health Wards, The Ryal Cllege f Psychiatrists Mental Health Act 1983 as amended (2007) Care Quality Cmmissin (2012) The admissin f children and adlescents t adult mental health wards and the duty t prvide age apprpriate services Plicy fr the Reprting and Management f Serius Incidents in the East Midlands (2012) Natinal Framewrk fr Reprting and Learning frm Serius Incidents Requiring Investigatin (2010). ISSUE 9 JANUARY

10 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances NOTIFICATION TO CARE QUALITY COMMISSION APPENDIX 1 Care Quality Cmmissin CARE QUALITY COMMISSION MONITORING The admissin f children and minrs under the Mental Health Act 1983 Ntificatin f the detentin f a child r minr n an adult ward. Ntificatin t be frwarded t the Care Quality Cmmissin as sn as pssible after admissin t be frwarded as sn as pssible after admissin By Fax n In additin a cpy t: The Named Nurse Safeguarding Children by Fax n The Cmmissin is aware that sme f the requested infrmatin may nt be available. Please prvide as much detail as pssible and indicate where the infrmatin is nt knwn r available. PART A SERVICE PROVIDER DETAILS Name f Service Prvider Name and Address f Hspital patient is detained at Telephne: Fax: Name f ward Name Respnsible Clinician Is the RC a specialist in child/adlescent psychiatry? (Please tick): Yes N PATIENT DETAILS Name Date f Birth Ethnicity Gender Sectin and Date f Sectin Date f Admissin t adult ward Brief Descriptin f ward e.g. Acute, Secure, PICU Is the ward a single r mixed sex ward Single Mixed Sex Des the patient have their wn rm Yes N Is the ward designated t take minrs Yes N ISSUE 9 JANUARY

11 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances Where was the patient admitted frm: (Please tick) Scial Services care establishment Anther NHS facility Hme Address Other If "Other", please give details Was the admissin: (Please tick) Planned Emergency Directed by curt Other If "Other", please give details Is Advcacy available If answer is yes, is this child centred advcacy Yes N Yes N Frm cmpleted by Date Psitin Cntact Telephne Number PART TWO T be cmpleted upn Transfer/discharge frm ward Name and Address f Hspital patient is Transfer/discharged frm Patient name Date discharge/transfer tk place Please tick Patient discharged frm detentin in hspital Patient discharged frm detentin but will remain in hspital as infrmal patient Patient transferred t specialist CAMHS Unit Patient transferred t ther unit Date Of Birth If patient transferred t anther unit (CAMHS r ther) please give name f unit and ward ISSUE 9 JANUARY

12 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances APPENDIX 2 NOTIFICATION OF YOUNG PERSON ADMISSION TO s 136 SUITE AND/OR ADULT WARD Fax t Named Nurse Safeguarding Children Fax THIS FORM DOES NOT NEED TO GO TO THE CARE QUALITY COMMISSION Name: Hme Address: Admitted Frm: Date f Birth: Ethnicity: Gender: Lcatin f s 136 Suite/Adult Ward: Reasn fr Admissin: Date f Admissin t s 136 Suite/ Adult Ward: Date f discharge frm s 136 Suite/ Adult Ward Destinatin pst n discharge frm s 136 Suite/Adult Ward Hme: Ward: Ward name: Have the relevant assurance measures as identified in the admissin f under 18 s t an adult ward been implemented if the yung persn has nt been admitted t CAMHS? Other: Signed Nurse in charge f s 136 Suite/Adult Ward PRINT NAME: Date. ISSUE 9 JANUARY

13 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances APPENDIX 3 SAFE AND APPROPRIATE CARE FOR YOUNG PEOPLE ON ADULT MENTAL HEALTH WARDS SECTION 1: ENVIRONMENT AND FACILITIES: General (including facilities) 1.1 The ward, identified by the Trust fr the admissin f yung peple, participates in a quality imprvement prcess that includes an element f peer review, and can demnstrate that it meets these standards and the AIMS standards type 1 and 2 r an equivalent measure f quality imprvement. 1.6 Yung peple n the ward have easy access t utside space n a daily basis fr exercise and fresh air Staff take the necessary actin t ensure the yung persn's safety utside by, fr example, prviding a member f staff t escrt the yung persn utside Reasns fr denying access t utside space must relate t a yung persn's individual clinical risk, and be justified and recrded in the ntes each time access is denied. Safety 1.7 There are plicies and prcedures t prevent unwanted visitrs entering the ward and fr adult service users entering areas designated fr yung peple. 1.8 The ward has a plicy t supprt and safeguard visitrs under the age f Yung peple shuld be given the mst apprpriate bed accrding t their clinical need, i.e. thse at a high risk shuld be given a bed lcated in an area with clear lines f sight fr clser bservatin. Privacy 1.11 The yung persn's sleeping area is in a securely separated area f the ward away frm the ppsite-sex All yung peple can bathe and wash in privacy and in areas separate frm the ppsite sex. SECTION 2: STAFFING AND TRAINING Staffing 2.1 Ward staff are able t access a named CAMHS prfessinal fr cnsultatin and advice thrughut a yung persn's admissin and receive supervisin frm a named CAMHS cnsultant. 2.5 There are named staff members wh take respnsibility fr safeguarding the rights f yung peple admitted. Staff training 2.6 Staff wrking with yung peple n an adult ward have received relevant statutry and mandatry training n: All staff are trained in Safeguarding Children: - Level 1-fr all staff; - Level 2-fr staff that wrk with yung peple, r lcal equivalent. Risk assessment and awareness f risk factrs in abuse and abuse t thers, indicatrs f abuse and prcedures fr dealing with abuse Legal framewrks such as the Children Acts, Mental Health Act 1983 (as amended by the 2007 Act) and the revised Cde f Practice, Disability Discriminatin Act and the Mental Capacity Act Pharmaclgical interventins fr (fr staff that prescribe, dispense, r administer medicatin t yung peple), including the use f psychactive medicatin, recgnitin f side effects and nn-cncrdance. Nte: Refer t NICE guidelines fr use f medicatin ff-licence. Evidence based psychlgical interventins Issues f cnsent, cmpetency, parental rights, cnfidentiality and advcacy. Management f imminent and actual vilence, age-apprpriate breakaway techniques and restraint measures. Nte: This is generally cvered in restraint technique curses fr mental health staff. Staffing safeguards 2.9 All staff (including temprary r agency staff and ancillary staff) have enhanced Criminal Recrd Bureau (CRB) disclsure checks that are reviewed every three years, and are checked against the Prtectin f the Children Act (POCA) register befre appintment All staff (including temprary r agency staff) receive an inductin which cvers key aspects f caring fr yung peple n the ward (e.g. bservatin and child prtectin) befre they can have unsupervised access t the yung peple 2.11 Legal advice is available fr practitiners when needed, specifically in relatin t the Mental Health Act 1983, Mental Capacity Act 2005, and Children Act 1989 and There is a trust plicy and written guidance available t staff abut whistle blwing, which frms part f the inductin training. Nte: Staff shuld knw hw t raise cncerns abut pr practice. ISSUE 9 JANUARY

14 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances SECTION 3: ASSESSMENT, ADMISSION, TRANSFERS AND DISCHARGE Assessment and admissin - In additin t AIMS standards 9.1 t (AIMS 3rd Ed) 3.1 The adult ward, CAMHS team, Early Interventin Psychsis Team, A&E and Lcal Authrity have jintly agreed integrated care pathways and agreed prtcls fr the admissin (bth infrmal and cmpulsry) f yung peple t the adult ward, including emergency and 'ut f hurs' admissins Fr yung peple with an verriding need (see intrductin fr definitin), the ward has agreed with relevant agencies and services that the referral letters include evidence that all ther CAMHS ptins have been exhausted prir t referral. Individual risk assessment 3.2 The ward uses an apprach t clinical risk assessment that is agreed with CAMHS as being apprpriate fr the under 18s age grup. 3.3 Yung peple admitted are individually risk assessed and the risk is regularly reviewed by apprpriately trained staff, ne f whm has experience f wrking with yung peple in CAMHS. 3.5 All 16 and 17 year lds must be escrted by a chaperne (whse gender they can chse) fr intimate medical examinatins. Ward envirnment risk assessment 3.7 Prir t the admissin f a yung persn, the admitting clinician cnsults with a CAMHS prfessinal and ward manager abut the suitability f the ward envirnment. 3.9 All ward staff are made aware f the yung persn's risk status including the risks psed by ther patients and where pertinent risks psed t ther persns by the yung persn (i.e. fire setting). Reprting and mnitring 3.10 The apprpriate authrities are ntified when a yung persn under the age f 18 is admitted t an adult ward: The Care Quality Cmmissin is infrmed if the yung persn is detained The Lcal CAMHS team is ntified Named nurse fr safeguarding children is ntified t take verall mnitring respnsibility. Overriding need admissins (emergencies) 3.14 Fr yung peple admitted in an emergency with an verriding need, the ward staff immediately cntact the named CAMHS r 16 t 19 team wh initiate transfer arrangements t an adlescent CAMHS unit r anther age apprpriate care ptin (e.g. therapeutic cmmunity) t ensure their stay is fr as brief a time as is pssible. Transfers 3.19 There are plicies and prtcls in place t guide the transfer f a yung persn t anther service and the respnsibilities are clearly allcated t named prfessinals in accrdance with the Care Prgramme Apprach (CPA). Discharge planning - In additin t AIMS standards (3rd Editin) 15.1 t The care f all yung peple takes place within a frmal Care Prgramme Apprach (CPA) framewrk (England nly) r a lcal care plan that is based n the CPA t avid prtracted stays within an inpatient envirnment The discharge plan names the lead agency and prfessinal respnsible fr verseeing the yung persn's aftercare plan Fr thse detained under the MHA, sectin 117 meetings are held prir t the discharge f all yung peple detained under a treatment sectin f the Mental Health Act. SECTION 4: CARE AND TREATMENT Care Planning In additin t AIMS standards 13.1 t 15.5 (3 rd Editin) 4.18 Assessed risk is addressed in the care plan and recrded cmprehensively within the yung persns ntes Recrd keeping 4.27 The care plan clearly states the date f referral, assessments, admissin, date f transfer t anther service and date f discharge The yung persn s legal status is recrded in the care plan e.g. if the yung persn has been frmally detained the relevant sectin has been nted in the health recrd Infrmatin abut the date and time f discharge and the yung persn s address fllwing discharge frm the ward shuld be recrded in the yung persn s care plan. Yung peple n a care rder 4.30 If a lcal authrity has parental respnsibility as a result f a care rder, then the hspital shuld btain the lcal authrity's cnsent where necessary, and cnsult n the yung persn's management r care plan When a care rder is in place, subject t advice frm the Lcal Authrity, there is als cnsultatin with the parent with regard t the management r care plan. ISSUE 9 JANUARY

15 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances Where a yung persn is subject t a care rder the hspital check that the lcal scial service authrity arrange fr visits and take 'such ther steps in relatin t the patient while in hspital...as wuld be expected t be taken by his parents' (Sectin 116 MHA 1983). Activities- In additin t AIMS standards 38.1 t 40.3 (3rd Editin) 4.37 N disciplinary measures are used which include any frm f crpral punishment, any deprivatin f fd r drink, any restrictin f visits r cmmunicatin by phne r pst, bathing and use f the tilet. SECTION 5: SECTION 6: EDUCATION AND FURTHER LEARNING N essential criteria is identified but there are expected criteria t be adhered t fr yung peple admitted with an Atypical need whse stay is lnger than 48 hurs INFORMATION, CONSENT, CONFIDENTIALITY AND ADVOCACY Infrmatin - Nte: Staff shuld prvide infrmatin as many times as necessary fr the yung persn t understand regardless f illness. 6.1 Yung peple and parent/carers are presented with infrmatin in a way that they can understand, fr example, the language used is plain, jargn free and 'child and yung persn friendly. Refer t: Headspace tlkit Yung Minds leaflets see On the day f their admissin the yung persn is given a welcme pack r intrductry bklet giving specific infrmatin abut: The ward's facilities Mdes f treatment Yung persn's rights Hw t cmplain Access t advcacy and ther services The ward's activity prgramme highlighting activities suitable fr yung peple. 6.7 Yung peple and parents/carers wh need it, are given infrmatin in languages ther than English and in frms in which peple with sight, learning and ther disabilities can use, within a specified perid as determined by the Hspital/Trust. 6.9 Staff always check that the infrmatin they have cmmunicated has been understd On the day f their admissin and as ften as is required, staff explain and prvide infrmatin abut why they have been admitted. Thrughut their stay (n matter hw brief) yung peple are given infrmatin abut: 6.11 the level f bservatin they are under, the reasns fr that level and hw ften it will be reviewed the medicatin they are given, what it is fr and hw it wuld effect them the treatments they are ffered Cmplaints prcedures are well-publicised and there is help n hw t use them Yung peple and their parents/carers receive infrmatin abut hw cmplaints may be made withut the knwledge and invlvement f the persn cmplained abut, and with the assurance that they will nt be discriminated against if they cmplain There is infrmatin available n hw t get independent help and advcacy in making cmplaints. Frmal admissins 6.17 Yung peple are given infrmatin abut the Mental Health Act and when it might be used, in a manner they can use and a frmat they can retain Yung peple are prvided with infrmatin (verbal explanatin and written) abut being given treatment withut their cnsent and the prcedures that must take place befre such treatment is given Staff take time t explain why they have been detained and hw the Act applies t them Yung peple are prvided with infrmatin abut their rights t access a mental health tribunal and/r managers' hearings that explains hw they can apply t be discharged frm detentin including the rle f the tribunal and the hspital manager, their rights t legal representatin, and hw lng they shuld expect t wait fr a hearing date Staff explain wh the yung persn's Nearest Relative (NR) is and why this is relevant Staff explain wh the yung persn's Nearest Relative (NR) is and why this is relevant. ISSUE 9 JANUARY

16 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances Cnsent - Even if patients are detained (and therefre sme treatments fr mental disrder can be given withut their cnsent) their cnsent still needs t be sught. The MHA Cde f Practice states (23.37) Althugh the Mental Health Act permits sme medical treatment fr mental disrder t be given withut cnsent, the patient s cnsent shuld still be sught befre treatment can be given, wherever practicable. Fr thse aged 16 r ver, capacity t cnsent t treatment must be assessed in accrdance with the Mental Capacity Act The ward staff can access a Trust plicy r prtcl that lists the prcedures fr btaining written cnsent, and what t d when there is disagreement between parties e.g. between a yung persn with capacity t make treatment decisins and their parent(s) r health care prfessinal(s) Staff infrm yung peple bth rally and in writing f their right t agree t r refuse treatment and the limits f this Staff are prficient in assessing a yung persn's capacity t cnsent Yung peple s capacity t cnsent t treatment is assessed in accrdance with Mental Capacity Act Guidance: See the Cde f Practice t the Mental Capacity Act 2005 (Chapter 12). The MHA Cde f Practice states that any assessment f an individual's capacity has t be made in relatin t the particular decisin being made (e.g. prpsed admissin r treatment). Capacity in an individual with a mental disrder can be variable ver time and shuld be assessed at the time the decisin in questin needs t be taken (e.g. admissin r treatment). All assessments f an individual's capacity shuld be fully recrded in the patient's medical ntes (See MHA Cde f Practice 23.29) Cnsent is btained by the persn prpsing t give the treatment, wh uses reasnable skill and care in prviding sufficient infrmatin abut the prpsed treatment and alternatives t it. Where necessary this is with the assistance f a persn wh has received specialist training n advising yung peple abut the interventin The patient s cnsent r refusal is recrded in their ntes in additin t the treating clinician s assessment f the patient's capacity t cnsent t the treatment in questin Where yung peple are nt detained and assessed as nt having capacity, the basis fr prviding the treatment withut the yung persn's cnsent is recrded, and the views f the yung persn are ascertained and taken int accunt Staff tell yung peple that their cnsent t treatment can be withdrawn at any time and that fresh cnsent is required befre further treatment can be given r reinstated Interventins are nly cnducted against the will f yung peple if discussin and mdificatin f the interventin has been exhausted When a yung persn wh is assessed as having capacity is treated against their will, this is cnducted within the apprpriate legal framewrk and is nted in their health recrd Yung peple and their parents/carers are infrmed abut the prcedures fr btaining cnsent where parental respnsibility is held by a third party. Guidance: Fr example, if the yung persn is subject t a care rder (where the lcal authrity has parental respnsibility) r a residence rder (in which case the persn (s) named in the rder will have parental respnsibility) Staff are clear n wh has parental respnsibility and have btained cpies f the relevant curt rders. Cnfidentiality 6.35 Ward staff receive clear guidance n cnfidentiality issues, with regard t family liaisn, yung peple's rights t cnfidentiality and requirements fr parental authrity Yung peple and their parents/carers are infrmed f their right t cnfidentiality and the limits f this, and receive written infrmatin n this right Yung peple wh are assessed as able t make such decisins are asked whether they wish t give r withhld their cnsent t infrmatin abut their care and treatment being disclsed t their parents r carers. Guidance: Staff explain the reasns why it might be helpful fr their parents t be given this infrmatin Yung peple are infrmed when cnfidential infrmatin abut them is t be passed n t ther services and agencies, and the reasns why this is imprtant t their cntinuing care is explained Audi and visual material is kept cnfidential and secure and yung peple and their parents r carers are assured abut this and any limitatins t this. Advcacy - ISSUE 9 JANUARY

17 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances In additin t AIMS standard (3rd Editin) 6.1 The ward prvides access t independent advcacy service that includes IMCA. IMPORTANT NOTE: Access t an Independent Mental Health Advcate (IMHA) is a right fr mst yung peple detained under the Mental Health Act, except fr thse under sectins 4, 5, 135 r 136 (see Cde f Practice ). It is als available t thse subject t guardianship, r thse ''under 18 and being cnsidered fr electr-cnvulsive therapy r any ther treatment t which sectin 58A applies ( a sectin 58A treatment ) (MHA C f P 20.6 pg 158). It is a legal requirement fr staff t infrm patients f this right. Fr infrmal admissins access t an advcate is gd practice and is t be encuraged Within 24 hurs f admissin and as ften as required yung peple (bth detained and infrmal) are given advice abut hw t get independent help and advcacy, and it is explained what advcacy is Infrmatin abut an advcacy service is signpsted n the ward s yung peple can apprach them directly Yung peple can see their advcate in a private rm that is nt audible frm utside. SECTION 7: OTHER SAFEGUARDS Legal status and child prtectin 7.1 Mental Health Act r Children Act status is knwn t staff. 7.2 The child prtectin status f yung peple is knwn t staff t help give clear guidance if abuse is suspected. 7.3 The ward has a named child prtectin lead. 7.4 The ward is cmpliant with child prtectin plicies, prcedures and prtcls. 7.5 The ward has up-t-date and regularly reviewed plicies and prcedures n hw t deal with allegatins f abuse during and ut f wrking hurs. 7.6 Yung peple are infrmed abut what will happen if they tell staff they are being, r have been, abused and they are reassured that what they say will be taken seriusly. Atypical admissins with stays lnger than 3 mnths 7.8 The lcal authrity is alerted if the whereabuts f the persn with parental respnsibility is nt knwn r if that persn has nt visited the yung persn fr a significant perid f time. 7.9 The named child prtectin lead infrms the lcal authrity if a child r yung persn remains, r is likely t remain, an inpatient fr a perid f ver three mnths (in line with sectin 85 f the Children Act 1989). Treatment 7.10 Where drugs are prescribed fr use utside the terms f their licence (ff- label), the medical practitiner r prescriber cmplies with BNF fr Children recmmendatins (2007), Ryal Cllege f Paediatrics and Child Health recmmendatins (2007) and General Medical Cuncil guidance n unlicensed applicatins f licensed medicines (2006) and accesses specialist expertise where indicated There are written guidelines fr the use f rapid tranquilisatin that specify the need t mdify treatment fr yung peple i.e. dse calculatins Ward staff are trained in the use f age-apprpriate physical restraint techniques Physical restraint is used nly when immediate actin is needed t prevent a yung persn frm significantly injuring themselves r thers, r causing serius damage t prperty, r, when a yung persn is detained under the MHA r under the hlding pwer f sectin 5, they attempt t leave the unit withut authrity After restraint the yung persn is cunselled n why it was necessary and their views are sught and included in pst incident reflectins Physical restraint is nly attempted when there are sufficient staff wh have undergne cntrl and restraint training at hand t ensure it can be achieved safely The circumstances and justificatin fr using physical restraint are recrded immediately; every such incident is dcumented within 24 hurs (ne wrking day); the cnsultant r clinician in charge f the patient's case is infrmed and a reprt is submitted by the nurse in charge t the Trust management in line with Trust incident reprting plicy N yung persn is t be deprived f their liberty, except where there is clear legal authrity t d s The ward fllws plicies fr untward ccurrences, r critical incident reprting. Frmal admissins 7.19 Detentin under the Mental Health Act is carried ut in full accrdance with the legislatin 7.20 Hspital managers refer the case f a patient under 18 after ne year (instead f 3 years fr lder patients) where the patient has nt been seen by a First Tier Tribunal (Mental Health) The hspital managers ntify the tribunal service that the patient is under the age f 18 t allw the service t ensure that ne f the tribunal members is a CAMHS panelist Yung peple under 18 wh d nt have a Respnsible Clinician frm a CAMH service are assessed by a CAMHS specialist prir t their Tribunal hearing. ISSUE 9 JANUARY

18 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances APPENDIX 4 Plicy fr: Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances Issue: 09 Status: Authr Name and Title: APPROVED Tina Hymas Taylr Named Nurse Safeguarding Children and Michael Sergeant Mental Health Act/ Mental Capacity Act Lead (Lcal Services Divisin) Issue Date: JANUARY 2015 Review Date: JULY 2017 Apprved by: Distributin/Access: TRUSTWIDE STRATEGIC SAFEGUARDING GROUP (August 2014) NORMAL RECORD OF CHANGES DATE AUTHOR POLICY DETAILS OF CHANGE Aug 05 M Smith CL/SG/03 Plicy style changed t fit huse frmat June 10 August 2012 Jan 13 Sep 13 Apr 14 Oct 14 Jan 15 L Babbingtn- Fwles M Sergeant/T Hymas-Taylr T Hymas - Taylr T Hymas Taylr T Hymas Taylr/ M Sergeant T Hymas Taylr/ M Sergeant T Hymas Taylr/ M Sergeant Plicy changed thrughut (Issue 6) (Issue 7) (Issue 8) (Issue 9) Changes t 2.3, 3.2, 5.3, 6.5, 6.6 Remval f dead URL, 16, Appendix1, Appendix 2 New Frm, Appendix 3 minr changes and remval f dead URL. Sectin additin f last paragraph, 17.4 & 17.5 added Appendix 1 - Change f CQC frm Minr changes thrughut The wrd prcedure changed t plicy thrughut the dcument Appendix 2 replaced, issue number and issue date changed ISSUE 9 JANUARY

19 Admissin f Yung Persns t an Adult Ward in Exceptinal Circumstances EMPLOYEE RECORD OF HAVING READ THE POLICY APPENDIX 5 Plicy: Admissin f Yung Persns t an Adult Ward I have read and understand the principles cntained in the named plicy. PRINT FULL NAME SIGNATURE DATE ISSUE 9 JANUARY