Looked after and Adopted Children: How Should Specialist CAMHS Be Involved?

Abstract

Looked after children are at high risk of developing mental health problems and these are often complex and related to other needs and agency involvement. Consequently, there is increasing policy emphasis on the importance of joint service planning and implementation. In practice, however, the distinction between mental health needs, problems and disorders is not clearly defined. Therefore, there is considerable service variation, lack of models and consensus on which children and young people would benefit from specialist child and adolescent mental health services (CAMHS) input. Pradeep Rao, Alvina Ali and Panos Vostanis report on a study that aimed to compare the characteristics of looked after and adopted children referred to a designated CAMHS team, and to identify whether these fell within the perceived remit of specialist CAMHS. The referrals, over one year, were rated by an independent researcher using a checklist that contained details of the referrer, the child's placement and reason for referral, outcome and reasons for decisions. Children with indication of likely disorders were accepted, while there was less consistency on decisions related to attachment and behavioural problems, and the role of different agencies. Mental health and social care services for vulnerable children need jointly to develop clear care pathways, with definition of agency roles. The presence of behavioural and attachment problems per se should not justify referral to specialist CAMHS, which would depend on other concurrent mental health difficulties and risk factors involved. Implications for defining the role and components of mental health services for vulnerable children and young people are discussed.