Section 1 Self Harm Flow chart for the management of self harm from Primary Care to Specialist CAMHS Overdoses Suicidal Needs Medical Attention Refer directly to Accident Emergency Department at District General Hospital Previous suicide attempts History of self harm Alcohol or drug abuse Chronic physical illness Evidence of mental illness Refer directly to Paediatric Ward for admission and assessment Arrange Appropriate Support System Child/young person presents in Primary Care setting following suicide attempt/deliberate self harm Consider safeguarding issues throughout assessment. Consider discussion with Health Board Safeguarding Team Assess Risk use Pathos and Self Injury Scale (Appendix 2) Ensure there are appropriate support systems before person leaves you No Yes Status quo, resolution, discharge, advice on services No previous history of suicide attempt/self harm. No (suicidal) intent only requires basic first aid If admission is deemed inappropriate or refused, seek advice/consultation/joint appointment with Primary Mental Health Specialist No Concerns Yes Refer to Specialist CAMHS
Powys Teaching Health Board Integrated Care Pathway (ICP) and Combined Referral ICP Reference No:... This integrated care pathway is to be used with all children and young people who present with self-harm behaviour. The ICP starts once the child or young person who presents is seen by a health care professional and ends once the child or young person has been discharged or transferred. CAMHS SELF HARM CARE PATHWAY for GPs/Tier 1 Professionals Children and young people under the age of 18 years Initial Assessor:... Department:.... This ICP was developed by: Kate Davies, Primary Mental Health Specialist Please use black ink throughout the completion of this form 2
How to use this integrated care pathway This Integrated Care Pathway (ICP) serves as a guide to treatment and progress. Professional judgement should always be used and will override, but any variations in care must be clearly documented. This ICP is intended to clarify the assessment process for all children and young people who present with self harm behaviour and ensure appropriate referral into Specialist CAMHS. Integrated Care Pathways can ensure that care is: High quality Evidence based Efficient The multidisciplinary team has met together to discuss and agree the care that is best for a typical patient who meets the criteria for this ICP. The ICP is therefore a guideline for the best multidisciplinary care for a patient. Remember, however, that every patient is an individual and that this ICP is not a substitute for clinical judgement and expertise. You are advised to use this document as follows. Instructions The Integrated Care Pathway is an inclusive element of the notes and as such forms a part of the service user s care record. Everyone using the Pathway documents their name, signature and initials on the page provided. Any variations from the outlined Pathway should be documented by the relevant professional as a variance and where necessary, acted upon accordingly. Provision is made for the documentation of variances throughout the pathway. In the event of there being a lack of space for such recording, a separate sheet should be attached to the rear of the document. Where it has been necessary to remove the patient from the Pathway, documentation should continue in the medical and nursing notes. Variations may or may not result in the discontinuing of the Pathway, professional judgement should always be applied. As far as possible, the Integrated Care Pathway should stay a complete document. Where this has not been possible the relevant professional must ensure that the documentation is returned to its complete state as soon as possible. The Service Users Name, and Date of Birth should be on every page. 3
Signature Sheet All disciplines writing in this ICP must sign below prior to writing in the ICP Full Name (Print) Designation Signature Initials Date of Entry 4
Care Pathway for managing the wellbeing of children and young people that have self harmed check list Activity Indicate Yes/no /x Notes/ variants Date/ Initials Child/young person presents following self harming behaviour. Assessment undertaken by doctor/nurse in an appropriate area. Integrated Care Pathway started. Assessment should address: (Pathos see Appendix 2) Issues of confidentiality Fraser Competence/Gillick Competence Parental consent Child protection/the Children s Act Record of Assessment completed and findings communicated to: District General Hospital School Nurse/Health Visitor Safeguarding Children Team GP Community Paediatrician Specialist CAMHS/Primary Mental Health Specialist ASSESSING IMMEDIATE RISK (VIOLENT ATTEMPT) Attempted hanging Overdose Carbon monoxide poisoning Serious lacerations requiring sutures Evidence of serious intent Child Protection issues 7. Evidence of psychiatric illness or psychosis 8. Violent Attempt 9. Attempted shooting 10. Substance misuse 7. 8. 9. 10. 5
Care Pathway for managing the wellbeing of children and young people that self harm check list Activity Indicate Yes/no /x Notes/ variants Date/ Initials If immediate risk identified: Check Child Protection Register and follow All Wales Child Protection Procedures Transfer to District General Hospital ASSESSING SERIOUS RISK History of self harm Substance misuse Previous suicide attempts Chronic physical illness Evidence of continued suicidal ideation or intent Overdose IF SERIOUS RISK IDENTIFIED Check Child Protection Register and follow Child Protection Procedures Transfer to District General Hospital ASSESSING LESSER RISK First episode of self harm with: No evidence of psychiatric illness No evidence of continued suicidal ideation or intent No history of drug or alcohol abuse Evidence the Crisis is over Overdose (admission to a District General Hospital) Other professionals involved: Social Worker Educational Psychologist Health Visitor School Nurse Youth Offending Other Professionals...continued on next page 6
Care Pathway for managing the wellbeing of children and young people that self harm check list Activity Indicate Yes/no /x Notes/ variants Date/ Initials Refer for appropriate medical advice e.g. Paediatrician, GP, Shrop Doc regarding DISCHARGE and refer onto Specialist CAMHS. Fax the referral to the local Specialist CAMHS, follow up with a telephone call (Monday Friday, 09.00hrs 17.00hrs) for an out-patient appointment which will take place within five working days. Contact numbers: South Team Tel: 01874 712 491 Fax: 01874 712 492 North Team Tel: 01686 617 450 Fax: 01686 617 440 PLEASE ENSURE THAT ALL ASSESSMENTS WHICH RESULT IN AN ONWARD REFERRAL ARE SENT WITH THE PATHWAY TO CAMHS CAMHS (Brecknockshire and Radnorshire) Hillview House, Bronllys Hospital, Bronllys, Brecon, Powys, LD3 0LU Tel: 01874 712 491 Fax: 01874 712 492 CAMHS (Montgomeryshire) Community Health Offices, Ynys-y-Plant, Plantation Lane, Newtown, Powys, SY16 1LH Tel: 01686 617 450 Fax: 01686 617440 7