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CAMHS Emergency/Paediatric Liaison plays a vital role in the mental and physical health of children and adults, and has numerous benefits, both for the practitioners and for the patients. This report presents a systematic review of literature on the effectiveness and roles of CAMHS emergency/paediatric liaison teams in general hospital/paediatric settings. The main source of literature that were used in this study comprised of journal articles obtained from different scientific databases such as PubMed and Emerald. Whilst the role of CAMHS emergency/Paediatric liaison teams in healthcare are acknowledged in this research, it has been established that their effectiveness is hampered by their current limited capacity.
In healthcare, interdisciplinary or multidisciplinary teams play a key role in provision of overall services to different groups of interest. Such teams comprise of healthcare professionals and workers specialised in different disciplines, each providing different services that contribute to the overall well-being of the patient(s) (Ke et al., 2013). An example of such teams is the collaboration between professionals in child and adolescent mental health services (CAMHS) and paediatrics, who work in liaison to provide mental and physical health interventions for children in different healthcare settings (Lamb & Murphy, 2013).
The link between mental and physical health problems among children have been recognized for a long time, and one way in which this can be addressed is through the integration of child psychiatric and paediatric services (Herrenkohl et al., 2013). Child psychiatrists who work in paediatric liaison settings argue that there are several cases of children whose parents/guardians incur high service costs in treating physical symptoms that turn out to have underlying psychiatric issues (Costello et al., 2014). Such conditions include Somatoform disorders, which are exhibited through physical symptoms(Perez et al., 2015). These high costs can be effectively through hospital paediatric liaison mental health services because it facilitates evidence-informed diagnoses and treatment from both physical and psychiatric practitioners. Other benefits include proper interventions for physical and psychiatric health issues among children(Costello et al., 2014). However, evidence from researches such as Foster (2009) indicated that in the United Kingdom, such liaisons are few and as well, have a high vulnerability to service cuts.
As this literature review explores of the effectiveness and roles of CAMHS emergency/paediatric liaison teams in general hospital/paediatric settings, it critically evaluates its possible positive and negative implications in child care. It is based on this reviews that recommendations for practice can be provided to ensure that such multidisciplinary teams solve the problems that may be currently being faced as a result of the shortage of paediatric liaison mental health services (PL CAMHS). The objectives that are to be addressed in this review of literature are as listed below:
To examine how CAMHS Emergency/Paediatric Liaison Teams in general hospital/Paediatric settings work.
To establish the effectiveness of CAMHS Emergency/Paediatric Liaison Teams in general hospital/Paediatric settings.
During this research, a secondary study approach, through a systematic literature review, was used. This research approach involved the utilization of data from sources that have already been published on the subject being studied. The selection of this research approach was because a lot of information can be obtained from a wide variety of sources within a short time (Lilford, et al., 2017). This is as compared to primary research where respondents would have to be selected, and data collection approached administered to them, which is both time consuming and costly.
With regards to the inclusion and exclusion criterion, priority was given to article that have been published in reputable journal databases such as Pubmed, Wiley Online Library, Biomed and Emerald. This was instrumental in ensuring the authenticity of both the sources and the information contained in them because journal articles published on these databases undergo a rigorous process of review. When searching for data sources on the internet, keywords were used in order to return the articles, books or reports that had the most relevance for the research. Some of the key words that were used included ‘paediatrics, ‘child mental health’, ‘CAMHS Emergency/Paediatric Liaison’ and ‘multidisciplinary teams in healthcare’.
Another criterion used for selection was the time of publication. The sources used were only to be those published within the past 10 years. Selection of recent data sources is ideal because it provides information that is still relevant and valid. Given that the UK health sector undergoes constant changes in order to make it more effective and efficient, reliance on older sources might provide an inaccurate description of the current situation with regards to CAMHS Emergency/Paediatric Liaison. On application of these search, inclusion and exclusion criteria in searching for secondary sources, there was an assurance that the information presented in the systematic review was highly relevant. Tables were used in the presentation of results.
In most cases, caregivers of the patients may be concerned, and wish to access some advice so as to determine the possible impact of an illness to a child and also explore some of the possible ways of getting to communicate about the illnesses (Herbert et al., 2016). Referrals in most cases get to typically involve those situations where there are some additional psychological issues. The liaison service has a great advantage as it is multidisciplinary and it provides so many interventions that could include; psychiatric nursing, family work, and some psychological therapies. Teaching, consultation, supervision and training is provided for the therapists and also the staff that is working hard towards the provision of the required services.
Young people and child mental health is sub-specialty of both paediatrics and also mental health. The disparity that exists between the fields leads to some delay in the development of young people and child mental health services (Wilson, Metcalfe & McLeod, 2015). Berelowitz, and Hugo (2015) claim that liaison between the mental health and general services can be quite challenging and it is often unmanaged and unplanned. The need for a robust liaison model is recognized, however collaborative working especially between the professionals is rarely evident. A framework that is multidisciplinary is the most effective working model for liaison. There needs to be a lot of commitment in the psychiatric, paediatric and also psychological disciplines as they are very essential to its overall success.
More children and also adolescents are presenting the A & E departments with harm that they cause on themselves, they are admitted with other conditions that include, psychosis, psychosomatic problems and also some eating disorders (Griffith &Glasby, 2015). It has generally led to an increase in the number that is accommodated on the adolescent units and the pediatric wards. Provision of the inpatient CAMHS is yet to catch up with an increase in the recognition of the increased need. The mental health needs of the children and adolescents have received a high priority especially in those health policies that have been formulated recently. The nurses have a role to ensure that they provides collaborative and also evidence based mental healthcare for the children and adolescents as well irrespective of their clinical environment (Wilson, Metcalfe & McLeod, 2015).
CAMHS nursing role is very specific and adds a lot of dimension in most cases to the care that the children and also adolescents that have the mental health issues need. It is inclusive of those other disciplines that lack time, resources and also skills so as to deliver effectively. Liaison nursing has its major focus on the relationship that exists between the patients and also the nurses rather than the treatment and also diagnosis of various diseases (Cleaver, 2014). Nurses that are available in CAMHS liaison have the duty of providing, consultation, clinical care, education, supervision, nursing and also ensure that they undertake research(Ke et al., 2013). They ensure that they provide both support and also nursing advice to the colleagues that are in the paediatric setting and they all the time as they have a responsibility of ensuring that the wellbeing and also safety of the clients is provided fully. Recognition of the fact that nurses are providing care in an environment that is less than perfect is very important to the building of partnerships that are effective. It also leads to the acknowledgement of the challenges of caring for those adolescents that are troubled in the emergency departments or even the paediatric ward (Herbert et al., 2016).
Glazebrook, Townsend and Sayal (2015) found out that the response given to the children and adolescent mental health needs requires some serious consideration of the variety of services that are provided at different levels. They are the early intervention programs, the ones of mental health promotion, the primary and also community mental health care services, and specialist services on mental health for those conditions that are more serious. A lot of evidence has been documented to clearly demonstrate that the behavioural difficulties and also early implementation of the programs that are meant to support the families can lead to better outcomes in the health of the children and also adolescents that are at risk of developing chronic mental health problems (Griffith & Glasby, 2015).
CAMHS programs have been very crucial in addressing the risks that are faced and also providing some protective factors early in life need (Glazebrook, Townsend & Sayal, 2015).Wilson, Metcalfe, and McLeod (2015) add that for those children and also adolescents that are at more risk, this includes those ones that come from families that have a lower income, low levels of education, and also all those ones that live in those areas that are disadvantaged. The schools also have a role of ensuring that they focus on promoting positive mental health. An approach that is based on the school encompasses the whole learning environment of the learner and this includes the physical environment, curriculum, and also the links that exist between the community and the parents as well (Cleaver, 2014).
There are some capacity building and also personal elements of mental development that lead to the general improvement of the children and also provide more opportunities that promote their wellbeing. Prevention of bullying is a key element that leads to the promotion of health, so there is need to develop some policies that deter such vices from existing in the learning environments(Costello et al., 2014). Adolescent is a very crucial stage in the psychological development of a child. The children require a lot of understanding of the life challenges that they face so that they can develop skills so as to cope with those emotions that are considered to be difficult (Cleaver, 2014). The adolescence stage is a time that a higher risk of poor mental health that may result in depression, anxiety, depression, psychosis, substance misuse and even some eating disorders. There is also an increasing risk of suicidal behaviour and even deliberate self-harm. CAMHS is very crucial in providing the children and also adolescents the services that they need (Glazebrook, Townsend & Sayal, 2015).
The increasing number of both children and also young people who have mental problems and receive care in the paediatric settings presents a huge challenge to the nurses. Some of them do not have any mental nursing experiences or even qualifications (Herbert et al., 2016). Cleaver (2014) claims that on call nursing support is something that most of the nurses feel is the most beneficial, aspect of the services of liaison teaching and also individual support with the young person is very important. There is need to ensure that a project is initiated that will lead to improvement of liaison in the general paediatric wards and the child and also adolescent mental health services. There is a gap that exists in addressing the need of the many children and young adults that have physical illnesses and also some mental health needs. CAMHS paediatric liaison service tends to focus on the mind and also body interface. The service offers consultation to so many referrers. They provide a lot of help to the children and also adolescents that have mental health problems. Interventions that they offer are of help not only to the affected group, but also to their families as well (Cleaver, 2014). Herbert et al. (2016) assert that they also target the psychological barriers that exist to physical care, the psychological management of the physical symptoms among many other issues. It has over the years provided consultation and also advice to adult services especially in the hospital for those patients that need some care due to their mental state.
Even though the objectives of the research were met, there are several limitations that were encountered in this research that may have limited the effectiveness with which the research objectives could have been met. One of these was the challenge in the selection of article to include in the report, out of hundreds that were found online. In addition to this, the fact that many databases had to be accessed, some of this requiring paid access, also contributed to the limitations of the study.
Whilst the secondary research approach has its strengths, there are some associated limitations. The strengths include the fact that the need for ethical clearance before carrying out the research is less emphasised (Mallett et al., 2012). This is as compared to primary research where research ethics have to be adhered to in order to avoid exposing research subjects to any form of harm. A limitation, on the other hand, is in the fact that the information collected is not first hand and thus, makes it difficult to ascertain that indeed, that is the exact issue or challenge being faced in CAMHS Emergency/Paediatric Liaison situations in the United Kingdom.
In conclusion, the findings from the different sources that were included in this systematic review highlight the importance of CAMHS-PL liaisons in general hospitals. Children and adolescents who may have psychiatric issues that are manifested through physical symptoms have an assurance of getting the necessary intervention and relief by seeking these services. Another advantage is that the overall costs incurred in treatment are less than when physical and mental healthcare are disconnected(Costello et al., 2014). Some of the issues that can be effectively addressed by CAMHS/Paediatric liaisons include tobacco use among adolescents that may lead to mental issues, insecure attachments that contribute towards self-harm, acute mental distress and ICD-10 psychiatric disorders, among others. This justifies the need for more multidisciplinary teams in child and adolescent physical and psychiatric care.
Berelowitz, M., & Hugo, P. (2015). Management of the Really Sick Child or Adolescent with Anorexia Nervosa in Hospital: The Role of Child and Adolescent Mental Health Services. In Critical Care for Anorexia Nervosa (pp. 11-40). Springer International Publishing.
Cleaver, K. (2014). Attitudes of emergency care staff towards young people who self-harm: a scoping review. International emergency nursing, 22(1), 52-61.
Costello, E. J., He, J. P., Sampson, N. A., Kessler, R. C., & Merikangas, K. R. (2014). Services for adolescents with psychiatric disorders: 12-month data from the National Comorbidity Survey–Adolescent. Psychiatric Services, 65 (3), 359-366.
Foster, C. (2009). Adolescents in Acute Mental Distress on Inpatient Pediatric Settings: Reflections From a Pediatric Liaison Practitioner. Journal of Child and Adolescent Psychiatric Nursing, 22 (1), 16–22.
Garralda, M., & Slaveska-Hollis, K. (2016). What is special about a Paediatric Liaison Child and Adolescent Mental Health serviceChild and Adolescent Mental Health, 21 (2), 96–101 .
Glazebrook, K., Townsend, E., & Sayal, K. (2015). The Role of Attachment Style in Predicting Repetition of Adolescent Self?Harm: A Longitudinal Study. Suicide and life-threatening behavior, 45(6), 664-678.
Griffith, L., &Glasby, J. (2015). “When we say ‘urgent’it means now…” Health and social care leaders’ perceptions of each other’s roles and ways of working. Journal of Integrated Care, 23(3), 143-152.
Herbert, A., Christian, C. I. S., & RA, C. (2016). CAMHS/AMHS Transition Policy, Islington. Policy.
Herrenkohl, T. I., Hong, S., Klika, J. B., Herrenkohl, R. C., & Russo, M. J. (2013). Developmental impacts of child abuse and neglect related to adult mental health, substance use, and physical health. Journal of family violence, 28 (2), 191-199.
Ke, K. M., Blazeby, J. M., Strong, S., Carroll, F. E., Ness, A. R., & Hollingworth, W. (2013). Are multidisciplinary teams in secondary care cost-effectiveA systematic review of the literature. Cost Effectiveness and Resource Allocation, 11 (1), 7.
Kulkarni, M., Huddlestone, L., Taylor, A., Sayal, K., & Ratschen, E. (2014). A cross-sectional survey of mental health clinicians’ knowledge, attitudes, and practice relating to tobacco dependence among young people with mental disorders. BMC Health Services Research, 14 (1), 618.
Lamb, C., & Murphy, M. (2013). The divide between child and adult mental health services: points for debate. The British Journal of Psychiatry, 202 (54), s41-s44.
Perez, D. L., Barsky, A. J., Vago, D. R., Baslet, G., & Silbersweig, D. A. (2015). A neural circuit framework for somatosensory amplification in somatoform disorders. The Journal of neuropsychiatry and clinical neurosciences, 27 (1), e40-e50.
Wilson, S., Metcalfe, J., & McLeod, S. (2015). Comparing Choice and Partnership Approach assumptions to Child and Adolescent Mental Health Services in NHS Greater Glasgow and Clyde. International journal of health care quality assurance, 28(8), 812-825.
Wilson, S., Metcalfe, J., & McLeod, S. (2015). Comparing Choice and Partnership Approach assumptions to Child and Adolescent Mental Health Services in NHS Greater Glasgow and Clyde. International Journal of Health Care Quality Assurance, 28 (8), 812 – 825.
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