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
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.
- 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
- 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.
- 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
- 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
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!
- Young Minds
Young Minds is the UK’s leading charity committed to improving the
emotional wellbeing and mental health of children and young
College of Psychiatrists
Improving the lives of young people affected by mental health
beat provides helplines,
online support and a network of UK-wide self-help groups to help
adults and young people in the UK beat their eating disorders.
Self-harm: information about recovery, advice and support
Confidential telephone support and information for children and
Directgov - Bullying
Information on dealing with bullying.
Preventing bullying and protecting children.
Talk to Frank
Friendly, confidential drugs advice.
Prevention of young suicide.
health information for young people.
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This page was last reviewed 25 April 2013 at 12:47.
The page is next due for review 22 October 2014.