CAMHs Role Descriptions

The Hive, Redruth

TRAINING POST

TRAINING BASE

TRAINER

JOB DESCRIPTION

The aim of this post is to provide trainees with the necessary experience and skills to assess and manage severe and high risk mental health presentations in adolescent patients.

Learning opportunities will include assessment and ongoing management of new patients referred to the Crisis/In Reach team and patients being discharged to the Crisis team from the inpatient hospital, assessment of new presentations to the general hospital and assessment and management of patients on the day patient treatment programme at Sowenna Hospital.

As such the post will involve working closely alongside the Consultant trainer and the Crisis / In Reach MDT as well as the day patient MDT at Sowenna Hospital. There may also be scope for some involvement with the assessment and treatment of patients admitted as inpatients to the inpatient ward.
There is scope to tailor the timetable and clinical focus to the particular learning needs and interests of the trainee. There will also be the opportunity to contribute towards quality improvement and audit projects.

There will also be scope to learn and reflect on the specific clinical, communication and psychotherapeutic skills as relevant to CAMHS patients. I will ensure there is protected time for 1 hour of supervision per week.

TRAINING POST

TRAINING BASE

TRAINER

JOB DESCRIPTION

This post is within Tier 3 Plymouth CAMHS (Child and Adolescent Mental Health Service) based at Revive, Mount Gould Hospital, Plymouth.

The Higher Trainee will be able to arrange experience, depending upon their training needs (balanced with the service needs and availability of suitable experience) in any of the above pathways. Each of these pathways have multidisciplinary teams which include a range of different professionals. The trainee will have the opportunity to take on a small caseload of patients and the management of these patients can be discussed in regular supervision, with other professionals co-working the case or in the relevant clinical meeting of each pathway. This will involve assessments and ongoing psychiatric management. There will be the opportunity to complete assessments / reviews outside of Revive (such as at home and at Derriford Hospital).

There will also be the opportunity to attend the Core Meeting which happens on Tuesday mornings and Thursday afternoons. This is an opportunity for professionals to discuss referral within the various pathways and represents a good opportunity to learn.

The trainee can also arrange a level of experience within the therapeutic pathways if required. These include:

- High Intensity CBT
- Family Therapy
- Art Therapy
- Child Psychotherapy

There is an out-of-hours on-call rota for Plymouth CAMHS covering:
- the regional adolescent Tier 4 unit, Plym Bridge House (which is near Derriford Hospital)
- Derriford Hospital
- CYP POS (located in Plym Bridge House)
There is an on-call guide written by Dr Sarah Huline-Dickens detailing the arrangements and how the on call system works. Generally the higher trainee is second on-call to a core trainee (but not in Derriford, where there is a COT team operating 8am-8pm).
- The rota is 1:7 for a whole-time equivalent trainee.
- Banding 1C
- To finish at 4pm after a night on call
- To take a Monday in lieu if on call previous week-end (and if not the Monday, a day within 72 hours unless there are exceptional circumstances)
- There is a consultant backing up the trainee on call at all times.

There is an internal academic programme which includes case conferences and journal presentations every Wednesday morning which the trainee can attend subject to this not clashing with core clinical responsibilities (as there is a separate CAMHS academic programme – see below). Some of these meetings may be chaired by the ST4-6.

There will be opportunities for teaching of medical staff and students as well as other members of the multidisciplinary team.

There is a Child and Adolescent Psychiatry academic programme in term time on alternate Fridays based in Bristol (also accessible via video-link). Attendance at this is encouraged (and indeed it is a mandatory curriculum requirement). In addition the Specialty Training Committee (STC) meets every three months to review developments in the specialty and this provides another opportunity for journal club and case presentations.

One hour of supervision weekly with the consultant on Monday or Friday.

9am out-patients 

11am COT meeting

12pm supervision

9am - admin

10am – CAMHS ED Team Meeting

10am – 12pm – Core Meeting

Out-patients

3pm – 5pm – Core Meeting

TRAINING POST

TRAINING BASE

TRAINER

JOB DESCRIPTION

The post is in community CAMHS at Bolitho House in Penzance. The job involves a basic 40 hour 9am – 5pm week, with call rota arrangements to be confirmed.

The job involves:

• Comprehensive assessment of new patients in the community, including history, mental state examination, investigations and interview with parents/carers and liaison with other parties such as education.
• Regular review of community patients; discussion with multi-disciplinary team informally and in MDT meetings.
• Communication with GPs and other agencies.
• Seeing new clinic patients under supervision.

When starting the trainee will be supported in setting up their own clinics and considering how they wish to organise their time as well as what fits in with the service (rooms available etc.)

Clinical staff in the team

Penwith CAMHS is a friendly team who enjoy having trainees of all disciplines. We have long standing team members including psychologists, nurses, psychotherapists and admin. We also benefit from having CAPS (clinical associate psychologists). The team values wellbeing including a weekly lunchtime swim.

Supervising Consultant: Dr Hermione Roy, Consultant Psychiatrist

Medical Secretary: Nikky McNally

Other doctors in team: Dr Alison Birch, Associate Specialist

Team Colleagues: Hannah Lapham (Interim Team manager), Lisa Gilmour (specialist clinical psychologist), Wendy Shallcross (principle child psychotherapist), Leeanne Nicholls (clinical psychologist), Beth Greagsby (CAMHS nurse), Rebecca Goff (CAP), Sallie Haynes (CAP), Caitlin Bray (CAP), Emma Lovegrove (CAP), Claudia McLoughlin (child psychotherapist), Joe Suart (adult psychotherapist)

Community Mental Health Team Base and Facilities

Bolitho House and garden was given to the Trust by the Bolitho Family. It sits on the sea front in Wherrytown and houses local adult and older adult psychiatric teams as well as CAMHS.

The doctor will have dedicated secretarial support shared with the consultant and will have office space, taking into account the need for confidentiality, security of information and supervision requirements of the post.  There is a choice of sharing an office with the local consultant or joining other team members in shared offices.

A PC or laptop will be available with internet connection and IT support.

There is a small kitchen with tea making facilities, a fridge and microwave. Numerous shops and cafes are within a 5 minute walk.  Free parking is available on site.

Training opportunities

Educational objectives are agreed between the trainee and the supervising consultant at the start of the post and reviewed 3 monthly. These will vary depending on stage of training and also if the trainee is on a CAMHS scheme or is an ST6 on an adult scheme.

As part of the post:

• To gain confidence in psychiatric disorders that emerge in adolescence e.g. eating disorders, depression, self-harm, OCD. This includes emerging emotionally unstable personality disorder and how early trauma and developmental disorders may influence symptoms and management.

• To increase confidence in the diagnosis and management of complex developmental disorders, where ADHD may be part of the presentation along with attachment and other developmental traits.

• A chance to join the multidisciplinary ASD group in the team and join in ASD assessments. This includes gaining experience taking detailed developmental histories and using ADOS.

• There is an opportunity to join the family therapy team. This will be as part of the reflective team unless the trainee has previous experience of family therapy. This is to gain a working knowledge of the theory and practice of family therapy and systemic work.

• Therapeutic modalities such as STAU, CBT, DBT, EMDR, brief psychodynamic psychotherapy, parent support are all used commonly in the team. In house CBT supervision is available- both individually and group. Supervision for other modalities can be arranged on request.

• There is an opportunity for joint working and sessions with the Neurodevelopmental Assessment Team, Eating Disorders Team, Intensive Support Team and Sowenna inpatient unit.

• CAMHS work with other agencies in most cases. This gives a chance to gain experience with multi-agency working including attending child protection meetings. This along with safeguarding supervision will help expand the trainees understanding of safeguarding issues. Liaising with other agencies also includes linking with adult services to support patients’ transition.

Theoretical:

• Monthly CPD is provided by the trust at regional meetings on the 4^th Wednesday of the month. The team also meets monthly for an hour to share knowledge and invites speakers.

• A study budget of £563 is available as well as 30 days study leave to allow STs to attend external courses as well as regional training.

• Attendance at monthly regional ST/SPR meetings is expected and protected time for this provided.

Management

There are different opportunities to gain an understanding of management and leadership skills. These include:

• Shadowing managers in CAMHS
• Charing MDT, CPA and formulation meetings
• Attending Senior Medical Staff Committee and business part of countywide consultant meetings

There will also be support with daily management skills within teams such as organisation and management of clinics, prioritisation of clinical and non-clinical work and co-working (including delegation and difficult conversations). 

Some practical experience leading change in a complex organisation such as CAMHS can be gained by implementing simple changes in the service after audits or reflection on guidelines.

Teaching

There is a local weekly training programme which includes taught seminars. STs are expected to help teach their junior colleagues at these on occasion. There is often also the opportunity to teach medical students in clinic as well as giving occasional lectures for Exeter medical school.

The team has a monthly CPD slot where members of the team can give talks. ST input here would be greatly appreciated, as would informal teaching to colleagues from other professions.

There may the possibility to help supervise a core trainee with some of their work place based assessments with support from the locality consultant. Year 3 medical students also have week long placements here at Bolitho.

Training is also offered by the South West Peninsula Postgraduate Medical Education to improve supervision and teaching skills

Research

CFT is a research active NHS Trust. We have a Research Team of 14 staff and an annual funding of £400,000 per year. We recruit to over 30 national studies annually through the NIHR Local Clinical Research Network. We usually recruit over 500 patients per year to studies. We are also a national leader in research in intellectual disabilities, especially in epilepsy. The Cornwall Intellectual Disability and Epilepsy Research Centre (CIDER) is led by Dr Rohit Shankar. 

Beth Chapman is the consultant who leads on research in CAMHS and she is enthusiastic about getting trainees involved. This can be flexible depending on their needs.

There are currently several studies trainees could join occurring in Sowenna and other studies that recruit from 16 years that are open for community CAMHS patients. Trainees could help look at caseloads, see who might be eligible and then support case coordinators in recruitment.  If there is a study they are particularly interested in they could join a research team member and learn about the consenting process and the study intervention.  Trainees are also welcome to start their own research study.

Quality improvement

Accountability for Clinical Governance rests with the Director of Quality and Governance, Sharon Linter.  The post holder is expected participation in:

• Service/team evaluation and the planning of future service developments
• Clinical Audit
• Clinical Effectiveness
• Complaints
• Legal Issues and Claims
• Risk Management/Patient Safety including Controls Assurance
• Safeguarding children and vulnerable adults

As a team we are currently involving service users in improving the waiting area and outdoor spaces. Many young people and children prefer to be seen outside in the garden or on the beach. There would be an opportunity for the trainee to help improve young people’s participation and gain feedback.

Joining the QNCC and potential visiting other teams will support an understanding of standards and help the trainee notice weaknesses in the service and identify an area they wish to audit.

There would be a chance to present audit findings at the countywide CAMHS consultant meeting and flag any concerns to senior managers who attend for part of the meeting.

Supervision

Individual supervision is available weekly with the locality consultant. The trainee is also encouraged to attend peer supervision both local and countywide. These meeting occur monthly. Specific safeguarding supervision is also available monthly from the lead nurses for safeguarding in the trust.

Complex case reflection meetings are held fortnightly in the team and led by a psychotherapist. There is also a monthly Ballint group which STs are welcome to attend.

Fortnightly ADHD clinic

9.30-11 MDT

11-12- Fortnightly reflective session led by psychotherapist in team

1^st  Grand round and senior doctors meeting

2^nd  Local peer group

3^rd  Admin

9-12.30 Generic clinic

ADHD clinic alternating with Admin for assessment clinic

Generic clinic 3 weeks of the month

1pm-2pm Fortnightly CBT SV with team psychologist- individual CBT SV available on request.

1-3pm Monthly ADOS

1^st Ballint group and admin

2^nd Admin

3^rd  Admin

1.30-4 Generic clinic

TRAINING POST

TRAINING BASE

TRAINER

JOB DESCRIPTION

This training post is as part of the Devon Child and Adolescent Assertive Outreach Team, AOT, a county wide service in Devon CAMHS which provides intensive outreach to support treatment in the community as an alternative to hospital admission for the most unwell and high need children and young people across Devon. The team is proud to have won the Royal college of Psychiatry’s children and young people team of the year award in 2022 for its work in helping young people stay closer to home whilst still making progress with their mental health and longer term aims for the future. For those who do still need an inpatient admission, the team also acts to facilitate admission and discharge.  

Young people open to Devon CAMHS AOT generally present with complex needs across a combination of areas such as emotional dysregulation (‘emerging’ emotionally unstable personality disorders) eating disorders and autistic spectrum conditions. Most young people on the case load have difficulties across two or more areas. This post therefore gives clinical experience across both a range of presentations as well as managing comorbidity.

Many social determinants of mental illness are also commonly present and complex, multi-agency working is therefore key to the work of the team.

The service provides planned care as a home treatment alternative to hospital, to wrap around the usual community CAMHS offer from core services. The overarching model uses AMBIT (Adaptive mentalization-based integrative treatment). Social prescribing, behavioural activation and skills associated with Dialectical Behavioural Therapy form the core interventions. A central intervention is often the re-establishing of engagement with education, which can include facilitating EHCPs. The team are also developing skills in non-violent resistance and motivational interviewing. We support physical health monitoring and prescribing and can co-ordinate, and contribute to, urgent autism assessments. There is also considerable liaison with other services including social care, CAMHS inpatient units, Paediatrics and other health care professions working with young people. There is considerable flexibility in the post to adjust to meet individual training needs and interests.

There is a key worker service for people with autism and intellectual disability allied with the team and additional experience in post diagnostic support can be gained there to complement experience in autism diagnosis within the outreach team.

In addition to the main clinical experience with AOT, for trainees who wish there is an opportunity to work with the CAMHS in reach team for the Atkinson secure children’s home in Exeter. This provides a great opportunity to see the care and help available there and an interesting comparison with tier 4 inpatient provision. Whilst AOT is not a crisis service, the young people open to AOT also have frequent crisis presentations and there is close working with the crisis teams, where additional experience can be gained. 

The trainee would expect to gain experience in:

• Risk planning and management in a community setting
• Family based approaches, working with families and carers is an integral part of the work
• Eating Disorders Management
• Diagnosis of neurodevelopmental disorders
• Therapeutic parenting principals
• Looked after Children (there is an additional opportunity to contribute to CAMHS in reach into the Atkinson secure children’s home in Exeter)
• DBT informed skills (If the trainee has the flexibility to commit to a longer involvement there may be chance to gain direct therapy experience in DBT)
• Working with people with autism including to support sensory and communication needs and positive behaviour support plans
• Mental health act work including inpatient RC work under supervision for detained patients on paediatric wards
• Legal and ethical interplay between mental health act, capacity act and the children’s act

As outreach works alongside core CAMHS, there will be joint working with the locality CAMHS pathways of most relevance to AOT:

• Eating disorders
• Managing emotions and relationships

AOT is a constantly evolving team, adapting to meet the changing needs of children and young people and the changing organisation of services. There is lots of opportunity for QI and service development work for those interested. There are ready opportunities for audit and quality improvement projects within the team and any research ideas will be encouraged and supported.

The supervising consultant runs the regional MRCPsych course for core trainees and there will be opportunity to get involved in teaching or the organisation and development of medical education, for interested trainees.

The post would suit trainees with interests in:

• Children and young people’s mental health
• The developmental origins of severe and enduring mental illness
• Eating disorders
• Crisis Work
• Inter-agency working
• Understanding mental distress as part of wider systems
• Legal and ethical principles in children’s mental health services
• Service development
• The interplay between trauma and neurodevelopmental disorders in the aetiology of mental illness
• Social determinants of mental illness
• Transitions psychiatry

Skills to be gained

The team consists of highly experienced CAMHS clinicians from mental health nursing, social care, speech and language therapy, educational and psychotherapy backgrounds and experiences. The trainee will have opportunity to work with a full range of CAMHS professionals, gaining experience in the communication with young people and a broad understanding of the needs and challenges young people present with.

Trainees will be supported to develop holistic plans of care addressing needs which might lead to hospital admission if unmet. As well as the treatment and care of the mental illness this often includes recognising other stressors in the system (bio-psycho-social). The team prides itself on flexibility. There will be opportunity to take on the commencement and review of a range of psychotropic medication and therapeutic experience and trainees joining the team are encouraged to make contact early to plan specific experience desired.

Many cases open to AOT are also open to social care and the trainee will learn about safe guarding procedures and processes and be encouraged to attend child protection meetings.

Assertive outreach maintains links with young people in inpatient settings. In CAMHS this can mean being many miles away. There is opportunity to visit inpatient settings where Devon children are placed including secure and specialist settings out of area.

There will be opportunities to develop management experience by attending senior management meetings, shadowing senior managers and participating in service development programmes. Undertaking management projects will be encouraged and supported.

Supervision and training

There is a minimum of a protected, 1 hour, slot for weekly clinical supervision. Much AOT work occurs alongside colleagues and there is therefore considerable opportunity to learn from and work with the wider team. Supervisory cover from other consultants and senior clinicians in the service will be arranged for leave. Trainees are expected to complete a local induction programme and Child Protection Training. Study leave will be granted according to deanery and trust policies. Trainees will be expected to participate in the appropriate academic programme for higher training, and supported to protect the time available to attend this and other relevant training identified in their personal development plan.

Outreach / home visits / inpatient liaison

Team CPD/Business meeting/reflective space/formulation meeting in rotation

Outreach / Eating disorders pathway meeting and reviews)

Academic programme / special interest

Outreach / home visits / inpatient liaison

Locality Risk MDTs (crisis teams)

Clinical reviews – Atkinson Secure children’s home

Outreach / home visits / inpatient liaison

Academic programme / special interest