for children and young people, the following factors should be used by healthcare professionals as indications that management can remain at tier 1:
exposure to a single undesirable event in the absence of other risk factors for depression
exposure to a recent undesirable life event in the presence of 2 or more other risk factors with no evidence of depression and/or self-harm
exposure to a recent undesirable life event, where 1 or more family members (parents or children) have multiple-risk histories for depression, providing that there is no evidence of depression and/or self-harm in the child or young person
mild depression without comorbidity
for children and young people, the following factors should be used by healthcare professionals as criteria for referral to tier 2 or 3 CAMHS:
depression with 2 or more other risk factors for depression depression where 1 or more family members (parents or children) have multiple-risk histories for depression
mild depression in those who have not responded to interventions in tier 1 after 2-3 months
moderate or severe depression (including psychotic depression)
signs of a recurrence of depression in those who have recovered from previous moderate or severe depression
unexplained self-neglect of at least 1 month's duration that could be harmful to their physical health active
suicidal ideas or plans
referral requested by a young person or their parents or carers
for children and young people, the following factors should be used by healthcare professionals as criteria for referral to tier 4 services:
high recurrent risk of acts of self-harm or suicide significant
ongoing self-neglect (such as poor personal hygiene or significant reduction in eating that could be harmful to their physical health)
requirement for intensity of assessment/treatment and/or level of supervision that is not available in tier 2 or
Notes:
Tier 1
primary care services including GPs, paediatricians, health visitors, school nurses, social workers, teachers, juvenile justice workers, voluntary agencies and social services
Tier 2 CAMHS
services provided by professionals relating to workers in primary care including clinical child psychologists, paediatricians with specialist training in mental health, educational psychologists, child and adolescent psychiatrists, child and adolescent psychotherapists, counsellors, community nurses/nurse specialists and family therapists
Tier 3 CAMHS
specialised services for more severe, complex or persistent disorders including child and adolescent psychiatrists, clinical child psychologists, nurses (community or inpatient), child and adolescent psychotherapists, occupational therapists, speech and language therapists, art, music and drama therapists, and family therapists
Tier 4 CAMHS
tertiary-level services such as day units, highly specialised outpatient teams and inpatient units
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