Principle 4: A flexible and integrated approach to engaging multi-stressed families at Safeguarding Support Unit Psychology (a specialist CAMHS Team)

As a specialist CAMHS team embedded within the Safeguarding Support Unit at Sheffield Children’s Hospital, we accept referrals from Consultant Paediatricians who have seen children for a Child Protection Medical or Forensic SARC assessment following concerns about child abuse or neglect. We have very inclusive referral criteria and support any child who is experiencing mental health difficulties in relation to the child protection concern, up to 18 years. If families are struggling to engage, we work with multiagency partners to understand this and facilitate attendance at appointments. Once families have met us and understand how we can support them, they tend to engage well. We provide trauma informed care and work hard to overcome intergenerational mistrust of services. Children have one consistent professional throughout their care episode, to reduce the need for them to tell their trauma story repeatedly to new people. We know in advance if a translator is needed and book face to face translators, preferably who have worked well with the family before. Longer appointment times (90 minutes) are afforded to enable the child and family to feel secure and regulated enough to talk about difficult topics, and to allow space for the complexity of a systemic approach. Travel fairs to and from sessions can be reclaimed for families receiving Benefits. Our entire service is designed and delivered around the needs and preferences of inclusion health groups and safeguarding is integrated in everything we do.

Molly is a 14 year old female, who has experienced intrafamilial sexual abuse. She is the middle child of three siblings and lives with her mother. Her father is in prison. Molly has been out of education for a year. She has been vulnerable to online sexual exploitation and is very isolated due to agoraphobia and removal of electronic devices due to concerns about her safety online. Her mental health has deteriorated in relation to the developmental trauma she has experienced, multiple house and school moves, sibling and parental mental health and behavioural concerns and parental physical health concerns. Family life is chaotic and, due to living in poverty, finances also present a barrier to attendance. Multiple initial sessions were missed, necessitating a multiagency approach, pulling together involved agencies/professionals and requesting a Social Care assessment to fully understand the needs of the whole family. Psychological assessment and formulation informed the multiagency plan for this family. Reintegrating the older two siblings into education was felt to be a priority in enabling this family to stabilise. We referred Molly to a specialist school providing interim provision for children experiencing mental health difficulties which prevent them from attending mainstream school. It was hoped that this would increase age-appropriate structure and stimulation to overcome the risks associated with isolation from healthy peer relationships combined with vulnerability to online exploitation. Once stabilised, Molly will be better able to benefit from psychological therapies in relation to the ongoing impacts of complex trauma experiences. We provide evidence based, NICE recommended therapies appropriate to the presenting problem and try to offer a choice so that service user preference is accounted for. The family may also benefit from family therapy within Community CAMHS services, which we can link to through internal referral systems.