Transition from CAMHS to HEDS (Highland Eating Disorder Service)

• Referral to be made to HEDS by CAMHS ED Hub with an aim to submit 6 months before the patient turns 18 (referral may be closer to the 18th birthday if patient is newto CAMHS).
• CAMHS to refer all patients with an eating disorder (excluding ARFID* unless co-morbid with another eating disorder) who are approaching the age of 18, even if discharge is planned as the transition process can be cancelled if the transition is not necessary
• “CAMHS to HEDS” referral form to be used to ensure the minimum referral information is communicated as per TAM guidelines (see attached).
• Copies to:
  • GP
  • Patient and family
  • Any other services involved

*ARFID cases should be referred on to dietetic services: northhighlandcommunitydietetics@nhs.scot

• On receipt of referral, HEDS to allocate a named therapist.
• Waiting list letter to be sent to the patient, with copies to CAMHS and GP, advising of receipt of referral and plans for a future transition.

Following allocation, HEDS therapist to contact CAMHS ED Hub to arrange a date for an initial transition meeting.

Once the date is agreed, invite the patient, family and any other professionals involved.

The purpose of the initial transition meeting is to introduce the patient to the HEDS therapist and to discuss future plans for the transition and agree the proposed timeframe for the handover of care, and the process of joint working before and after this date

The letter should be drafted by CAMHS in conjunction with others at the transition meeting and include:

• Timing of the transition
• Work before transition
• Period of joint working
• Management of co-morbidities and specification of the roles of all teams and agencies involved (? Need for CPA for complex cases)
• Views of patients and carers
• MHA considerations and identification of RMO in HEDS where appropriate
• Agreed meal plans
• Prescribed medication / supplements
• Therapeutic model to be used
• HEDS day service / meal support plan where appropriate

A period of 8 weeks of joint working should overlap the transition date (usually the patient’s 18th birthday). Ideally this should be 4 weeks of joint sessions before the transition date and a further 4 weeks after the transition date, before agreeing formal discharge from CAMHS. Joint working can be extended where necessary.

Any patient who is in “crisis” (rapid weight loss, medically unstable or having the potential for needing an inpatient admission) should not be discharged from CAMHS at that time. An extension to the transition date should be discussed and agreed between CAMHS and HEDS to avoid the loss of the therapeutic relationship with CAMHS and the risk of poor engagement with HEDS. This may lead to an extension of the joint working period.

If there is a requirement for an inpatient admission to a specialist eating disorder unit, CAMHS should refer to Dudhope if under 18 and the Eden Unit (see attached referral form, to be signed off by Consultant Psychiatrist) for anyone over the age of 18. Transitions from Dudhope to the Eden Unit should be initiated by Dudhope. HEDS to be invited to Dudhope meetings in the 4 weeks before transition. If there is the potential for an Eden Unit admission, CAMHS to link in to the Eden Unit liaison meeting (2nd Thursday of the month at 9.30am, HEDS to share the link when necessary).

Admissions for medical stabilisation will be to the paediatric ward for under 16s and to 7C for over 16s. The MEED protocol should be followed where appropriate: Medical emergencies in eating disorders (MEED): Guidance on recognition and management(CR233)

In addition to individual liaison meetings, CAMHS and HEDS will meet quarterly (HEDS to share the link and CAMHS hub to invite the relevant professionals). This is an opportunity to flag potential upcoming transition cases, to provide wider updates to the whole team, as well as to cover service developments and training opportunities.

HEDS meet monthly with the Eden Unit to discuss inpatient admissions and where there are possible transition patients requiring admission, CAMHS can also attend these meetings (HEDS to send the link when necessary, 2nd Thursday of the month at 9:30am).

The discharge date from CAMHS will be mutually agreed with all involved in the individual case. CAMHS will follow their own discharge process and a discharge letter will be sent to the patient, GP, HEDS and any other service involved in the patient’s care.

tcp-july-2018.pdf

5. I Am Fully Involved In Planning And Agreeing My Transitions- Child And Adolescent Mental Health Services: nationalservice specification - gov.scot

• ARFID: avoidant restrictive food intake disorder
• CAMHS: Child and Adolescent Mental Health Services
• CPA: care approach programme
• ED: eating disorder
• HEDS: Highland Eating Disorder Service
• MEED: Medical Emergencies in Eating Disorders
• MHA: mental health act
• RMO: Responsible Medical Officer