Tier 3

Plus Service Model Objectives

We intend to develop a community based team who will work in an assertive outreach model of intervention for families and children with high levels of complexity whose needs cannot be met by existing tier 3 provision.

The team will offer specialist and extended support in mental health crisis and to avert crisis and admission to hospital, acting as a ‘gate-keeper’ for tier 4 admission. Assessment and intervention will take place between the hours of 8am and 8pm offering personalized packages of care to meet the individual need.

An oncall telephone advice service will operate between 5pm and 9am to partners in acute care and Emergency Duty Team (EDT). The tier 3 plus team will act as extended provision to the current services provided by CAMHS, working closely with colleagues in tier 3 and the various pathways which make up CAMHS provision.

It is intended that there will also be close working relationships with colleagues in social care to develop care plans which are coordinated and productive. Achievements of the service will be shown by reduction in admissions and length of stay to tier 4.

Patient/user satisfaction will be measured through survey using the outcome measures currently adopted by Worcestershire CAMHS The service will be evaluated initially after six months, involving audit procedures to ascertain demand and capacity of service, allowing for flexibility of the model with a full review after 12 months.

Scope

Included:

• Within 24 hours assessment and short term treatment and interventions. 365 days per year, 7 days per week, 8am -8pm
• Provision of oncall telephone advice regarding under 18 referrals between 5pm – 9am
• Response within 4 hours for telephone advice and 24 hours for specialist CAMHS assessment
• New referrals will come through ‘single point of access’ (SPA) between 9am – 5pm, Monday to Friday. On weekends and Bank Holidays referrals will go directly to Tier 3 plus between 8am and 8pm and the oncall line between 8pm and 8am
• Short-term interventions for a maximum of 4 – 6 weeks. These will include CAMHS assessment, mental health risk assessment using the Galatean Risk and Social Care Tool (GRIST). If necessary cases will then be passed to tier 3 or EIS if necessary
• Telephone support and advice will be available to colleagues at GP out of hours service and EDT (Emergency Duty Team) directly to tier 3 plus between 5pm – 9am
• For children who are residing within acute care and need an assessment there will be access directly to tier 3 plus 24 hours a day, 7 days a week, 365 days a year for either advice or assessment within 24 hours
• Medical cover to the team will be provided to emergency cases of those children who cannot be managed in the community and need hospital admission. The tier 3 plus RMO will co-ordinate the case with support from the tier 3 plus clinicians to agree the assessment and admission to tier 4. When the tier 3 plus Medic is unavailable medical cover will be provided via a rota from Monday to Friday.
• The team will work closely with tier 3 level colleagues and EIS (EIS for ages 14 -1 8) to avert mental health crisis in families currently open to CAMHS. The child will retain the existing clinical team including RMO and request for home treatment will come via RMO.

Staff skill mix comprise:

• Staff will be required to work on a rota to cover 8am – 8pm and oncall outside of these times.
• It will be necessary for the team to have a skill mix make up of leadership and strategic ability with clinical experience including a high level and understanding of managing risk and short term therapeutic intervention.
• There will also be the requirement to have accomplished interpersonal and self - management skills.
• The team will need to be resourced to manage a 24 hour, 365 days per year service.

Excluded:

• Any non-mental health related crisis
• Young people and families not in Crisis who will ordinarily be managed by tier 3
• Team will not cover existing cases in tier 3 when clinician is unavailable
• Team will not provide assessment to new referrals between 5pm and 9am but will provide intervention for cases already open to tier 3 plus. New assessments can be arranged out of hours for next day.

We recently held a stakeholder event and online consultations to gain feedback on the Tier 3 Plus Service Model (Business Proposal for CAMHS Tier 3 Extended Service) (PDF 490 KB). 

Watch this space for further updates!

This page was last reviewed 25 April 2013 at 12:47.
The page is next due for review 22 October 2014.