ࡱ> FHG (ɀ\pOXP User Ba==wk+ 8X@"1Arial1Arial1Arial1Arial1Arial1Arial1Arial1 Arial1Arial1Arial""#,##0;\-""#,##0""#,##0;[Red]\-""#,##0""#,##0.00;\-""#,##0.00#""#,##0.00;[Red]\-""#,##0.005*0_-""* #,##0_-;\-""* #,##0_-;_-""* "-"_-;_-@_-,)'_-* #,##0_-;\-* #,##0_-;_-* "-"_-;_-@_-=,8_-""* #,##0.00_-;\-""* #,##0.00_-;_-""* "-"??_-;_-@_-4+/_-* #,##0.00_-;\-* #,##0.00_-;_-* "-"??_-;_-@_-                + ) , *  "            (  X+  x@ @ + " "8@ @ "8  X "    8 x@ @ + x @ +  (        " "8@@ "8@ "8 @  x@@ +  x@ +  x @ + "8@  8@        `OA Source data,_Category matchingcskills summary,T ,$FROM EVIDENCE TO SKILLS. FIRST DRAFTDISORDERS OF CONDUCTLevel of evidenceABUnder 12 AdolescentSKILLS SUMMARY&Best practice drawn from the evidence &Parent training for children <10HParent training with individual child skills programme for children 8-12Multi systemic therapySpecialist foster placementiReducing opportunities for delinquent behaviour and increasing skills such as problem solving or coping.Use of novel antipsychotics with combined dopaminergic and serotonergic action, such as risperidone, may be cautiously considered for children and young people who have not been responsive to a comprehensive trial of psychosocial treatmentsparenting multi systemic therapy social work input interdisciplinary work prescribing, medical AWorkforce implications ie skill sets/expertise/ disciplinary mix 8Ability to run individual and group parenting programmeslAbility to run individual and group parenting programmes Expertise in skills training with children!Trained multi systemic therapistsNInter-disciplinary approach and strong links with social care - SW in T3 team?fInter-disciplinary approach and strong links with schools, YOS, substance misuse services, youth work.-Prescribing, medical monitoring - Psychiatry?Tier3 and 4DISTURBANCES OF ATTENTIONIf diagnostic criteria for ADHD are met following a comprehensive assessment by a suitably qualified professional, and other reasons for the behaviour have been excluded, then a trial of medication is indicated as the first line of interventionEffective monitoring of children given medication is needed to minimise adverse side effects and optimise treatment benefits. Discontinuous medication (i.e. holiday breaks) may reduce the risk of mild growth suppression./Children should be started on a short acting preparation of methylphenidate or on dexamphetamine. Atomoxetine is probably the evidence based second line treatment, but although there is relevant RCT evidence to support effectiveness this is a new drug and reports of side effects need to be monitored. As it is not possible to predict which dose will be effective, dosage should be increased within safe limits until an effect is achieved.If there is insufficient resolution of symptoms with stimulants or atomoxetine, then other medication should be considered.The alternatives include: clonidine, selective serotonin reuptake inhibitors, tricyclic anti-depressants and selective monoamine oxidase inhibitorsIf there is insufficient response to medication, then parent training and individual behavioural therapy with the child should be added.Where individual behavioural interventions are used, these need to be provided in the child s school as well as within the home as they do not generalise across settings.RThere is some evidence to support the use of omega 3 and 6 dietary supplementationBehavioural intervention in addition to medication can also be offered as a way of achieving similar outcomes to medication alone but with reduced levels of medication}prescribing, medical parenting behaviour therapy interdisciplinary work nutrition input CPrescribing, medical monitoring - Psychiatry? Shared care with GPs?ZAbility to run individual and group parenting programmes. Expertise in behavioural therapyFInter-disciplinary and multi-agency working, specifically with schoolsInput of expertise on nutrition Expertise in behavioural therapyANXIETY DISORDERSBehaviour therapy and cognitive behavioural therapy (in group or individual format) first-line treatment for children with specific phobias and children with generalised anxiety.^Behaviour therapy and cognitive behavioural therapy should be considered for children with OCDClomipramine and selective serotonin reuptake inhibitors should be considered in the treatment of OCD when cognitive behavioural therapy alone has proved ineffective.Selective serotonin reuptake inhibitors should be considered in the treatment of social anxieties when cognitive behavioural therapy alone has proved ineffective_ Educational support should be considered in the management of children with anxiety problems.`behaviour therapy prescribing, medical CBT interdisciplinary work+Expertise in behavioural therapy and in CBT2 and 3 POST TRAUMATIC STRESS DISORDERJDebriefing should not be offered routinely immediately following a trauma Children and young people with PTSD,including those who have experiencedtraumatic events other than sexual abuse,should be offered a course of trauma focused CBTadapted to suit their age circumstances and level of development.VPTSD knowledge/therapeutic skill trauma focused CBTAccess to expertise in PTSDExpertise in trauma focused CBTDEPRESSIVE DISORDERSGiven the high rate of remission in control groups, initial psychological treatment (either CBT, family therapy or Inter-Personal Therapy) for up to three months should be offered as the first line of treatment. *If psychological treatment does not produce improvement in symptoms by six weeks, anti-depressant medication should be offered for adolescents (and cautiously considered for younger children) incombination with longer term psychological treatment using either CBT, psychotherapy or family therapy. Depression is a condition which is liable to recur. Clinical follow-up and  booster sessions may be helpful in reducing relapse.family therapy IPT CBT prescribing, medical -Range of therapies: family therapy, CBT, IPT.ERange of therapies plus Prescribing, medical monitoring - Psychiatry?PSYCHOTIC DISORDERS MNeuroleptics are the treatment of choice for the acute phase of schizophreniaClozapine should be cautiously considered in cases of treatment resistant schizophrenia, in line with the nationally agreed protocolBecause of the side effects of traditional neuroleptics atypical neuroleptics should normally be used, although caution should be exercised as these too have side effects. `Lithium should be considered in the first instance in the acute phase of manic/bipolar disorder.prescribing, medical Tier EATING DISORDERSFamily therapy (behavioural/structural) is recommended as the treatment of choice for anorexia nervosa, either as an outpatient or after in-patient treatment.RBehavioural treatment should be considered in hospital in order to increase weight,family therapy behaviour therapyExpertise in family therapyDELIBERATE SELF HARMWhen instituting schools based interventions, selection of material should be made with reference to existing evaluated programmessFollowing a suicide attempt by a child or young person, brief interventions involving families should be consideredyFor young people who have self-harmed several times, consideration should be given to the addition of group psychotherapy7family work group psychotherapy"Consultancy and support to schoolsExpertise in family work Expertise in group psychotherapy2 and 3SUBSTANCE MISUSEPFamily therapy should be considered the first line treatment of substance misuseiMulti-systemic therapy should be considered where substance misuse is part of a wider pattern of problemsKfamily therapy multi-systemic therapy!PERVASIVE DEVELOPMENTAL DISORDERSIntensive behavioural interventions, either individual or group, should be considered to help improve the adaptive behaviour of children with autism<Medication is not indicated for the treatment of core symptoms of autism but may be used to reduce specific behaviours associated with autism inchildren.1behaviour therapy prescribing, medical TOURETTES SYNDROMEbNeuroleptics and clonidine should be considered as first choice treatments for Tourette s syndrome. Since the evidence for effectiveness does not differentiate between them, the decision as to which medication to use may be based on the clinician s and family s view of the different side effects.The atypical neuroleptics usually have fewer side effectsfThe presence of tics is not a contraindication to the use of mehthylphenidate in the treatment of ADHDSelective serotonin reuptake inhibitors should be considered in Tourette s syndrome with co-morbid OCD, but the response may be less favourable than in OCD without co-morbidity. PHYSICAL SYMPTOMS NO KNOWN CAUSEOCognitive behavioural therapy should be considered for recurrent abdominal pain{If attention to diet has not already been considered, trial of a high fibre diet is indicated for recurrent abdominal pain.=CBT nutrition adviceExpertise in CBTCOPING WITH PAINFUL PROCEDURESCognitive behavioural therapy, behaviour therapy and hypnosis should be used to counter the stress associated with painful procedures and selected according to the particular types or stages of procedure as well as the developmental stage of the individual child.Gchild development behaviour therapy hypnosis?Expertise in child development, behaviour therapy and hypnosis.'COPING WITH CHRONIC ILLNESS AND DISEASECognitive behavioural therapy and behaviour therapy, tailored to specific illnesses, should be considered for children with hard to control physical symptoms._Psychoanalytic psychotherapy should be considered for the treatment of hard to control diabetesHSystemic family therapy should be considered for the treatment of asthmaProvision of specialist nurse support to families of children newly diagnosed with chronic illness should be considered as a means of improving later physical and psychological outcomesbehaviour therapy CBT psychoanalytic psychotherapy systemic psychotherapy specialist nurse support)Expertise in psychoanalytic psychotherapy"Exertise in systemic psychotherapySpecialist nurse support!NATIONAL CAMHS MAPPING CATEGORIES"DRAWING ON THE EVIDENCE CATEGORIESHyperkinetic disordersDISTURBANCES OF ATTENTION prescribing, medical parenting behaviour therapy interdisciplinary work nutrition input Emotional disordersDEPRESSIVE DISORDERS family therapy IPT CBT prescribing, medical qANXIETY DISORDER behaviour therapy prescribing, medical CBT interdisciplinary workPTSD PTSD knowledge /therapeutic skill trauma focused CBTConduct disordersDISORDERS OF CONDUCT parenting multi systemic therapy social work input interdisciplinary work prescribing, medical Eating disordersBEATING DISORDERS family therapy behaviour therapyPsychotic disorders*PSYCHOTIC DISORDERS prescribing, medical Deliberate self harmLDELIBERATE SELF HARM family work group psychotherapySubstance abuse_SUBSTANCE MISUSE family therapy multi-systemic therapyHabit disorders*TOURETTES SYNDROME prescribing, medical Autistic spectrum disorders_PERVASIVE DEVELOPMENTAL DISORDERS behaviour therapy prescribing, medical *Developmental disordersNot possible to define Otherbehaviour therapy CBT psychoanalytic psychotherapy systemic psychotherapy specialist nurse supportThis worksheet of source data is based on Wolpert et al (2006) Drawing on the Evidence 2nd edition. Its purpose is to identify the skills that most closely match the evidence of effective interventions in CAMHS, in order to assist workforce planning. Caution: this worksheet is not a substitution for the original document named above. Much of the contextual and explanatory text in Drawing on the Evidence is not reproduced here, where only evidence for practice based on category A and B evidence has been used. Go to: http://www.acamh.org.uk/site/upload/document/Drawing_on_the_Evidence_-_text.pdf ?W6This worksheet shows how the categories of mental disorder may be matched, between those used in the National CAMHS mapping and those in Drawing on the Evidence  TW) Ot*"$lR'(c/~19 5s (7 9f; (ɀ  wBJ'RX]  dMbP?_*+%"??U} } } $} } } } } } } I} m} $ w   @         @       @ @      B @  ,,,,, ++++++++++++++++++++++++++++++ , ,,,  - ../ - /  , , , ,,,                   $@@@@@  , ,,,  -....../               !  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F K T  X  \  `  e  i  # / 5 < D I O W  [  D  c  g  *n   < >@7 Oh+'0@HXh yvonneayvonneaMicrosoft Excel@3@ 7՜.+,0 PXd lt| HASO  Source dataCategory matchingskills summary  Worksheets  !"#$%&'()*+,-./012356789:;=>?@ABCRoot Entry F AQWorkbookgSummaryInformation(4DocumentSummaryInformation8<Root Entry FIWorkbookgSummaryInformation(4DocumentSummaryInformation8  !"#$%&'()*+,-./012356789:;J ՜.+,D՜.+,4 PXd lt| HASO  Source dataCategory matchingskills summary  Worksheets@ X_AdHocReviewCycleID_EmailSubject _AuthorEmail_AuthorEmailDisplayName g"website materials camhs workforceY.Anderson@hascas.org.ukYvonne Anderson