Why might we communicate?

Some of the reasons a child or young person may try to communicate with us may include: to express our wants and needs, to gain attention or interaction, to express pain/discomfort and to express likes/dislikes. It is important to view behaviour as communication and consider what a young person may be trying to tell us through their behaviour.

Communication Styles

Young people may use a range of different means to communicate. Some of these are adapted and some may be maladapted e.g. using behaviours of concern to communicate their wants/needs. It is important young people are supported to make and understand choices, express feelings and needs, and involve themselves in the world around them.

Ways young people communicate

•            Makaton/British Sign Language (BSL)

•            Picture Exchange Communication System (PECS)

•            Photos or pictures

•            Communication software (tablets/ mobiles)

•            Gesture

•            Objects of reference

•            Physical guidance

•            Behaviour

To understand which form of communication is best for the young person, it is important we spend time with the young person and others around them who know them well.

Barriers to communication

There can be many barriers to affective communication. This can cause an increase in frustration and anxiety in a child or young person. Some of these include:

•            Lack of skill building for young people

•            Lack of resources

•            People using too many or too complicated words

•            Speaking too quickly

•            Lack of availability of training for parents and carers

•            Tone not matching facial expression

•            Too many instructions at one time

•            Not being given enough processing time

•            Lots of noise / distraction in the background

To help reduce these barriers, it is also important we share information with young people that is accessible and in a format best for them to be able to understand the information

Why are relationships important?

As humans, the relationships we form with other people are vital to our physical, mental and emotional wellbeing. A positive relationship can be shared between any two people who love, support, encourage and help each other practically as well as emotionally.

Relationship difficulties

Your child or young person may find that they have difficulties in some of their relationships. These might include:

• Forming relationships
• Managing communication differences / barriers
• Social Understanding (norms and rules of relationships)
• Engaging in ‘one way’ conversations that are led by the child’s special interests (i.e. lack of turn taking)
• Understanding how other people feel / what they want from the relationship
• Managing relationship fall outs / endings
• Keeping themselves safe in relationships (e.g. on line)

Factors affecting relationships:

Our first experiences of relationships as infants sets a template for how we form relationships later on in life.  If these early experiences are negative, then these negative patterns of relating can be repeated throughout development (i.e. in relationships formed in school, as teenagers, as adults, as parents) If we have experienced positive, safe, secure and healthy relationships as infants and children, we have a solid foundation on which to build future relationships.  This is known as ‘attachment’.

Attachment

It is important that young people learn to develop secure attachments. Caregivers can provide a secure base for attachments by being:

• Attuned
• Responsive
• Consistent
• Reliable
• Safe

If a ‘secure base’ is formed with an adult caregiver, then the child learns to use that person as a base from which to explore the world. It gives the child the best chance to learn about themselves, other people, and the world in a positive way. It is associated with numerous positive outcomes for that child which last throughout that child’s life and makes them more likely to replicate a similar positive outcome for their own children should they become parents themselves.

Factors affecting healthy attachment

• Extended or repeated separations (parental loss, parental physical or emotional unavailability)
• Unresolved pain
• Frequent moves (school, home)
• Trauma (abuse, grief and loss, injury)
• All forms of abuse (physical, emotional, sexual, neglect)

How does anxiety affect us?

• Sometimes we can get through these times of feeling anxious and these feelings reduce.
• Sometimes anxiety can last much longer and take over our lives.
• It can stop us from doing the things we would like to be able to do.
• It can damage our relationships with family and friends.
• It can affect our self-esteem and confidence and how we feel others perceive us.
• Anxiety is very common, but many people don’t ask for help about their anxious feelings.

Why do people experience anxiety differently?

How anxious we feel depends on lots of things such as:

• Family history (genetic predisposition)
• How we were brought up (learned behaviours)
• What happens to us in our lives (our experiences)
• The way we have learned to manage things (the coping resources we have developed)
• Individuality (the way we think about things and process our thoughts can vary from person to person)

It is important to know what makes your child feel anxious and how you can help them to cope with these feelings.

What can trigger anxiety?

There are so many things that could lead to a person having anxious feelings, some of the common reasons we see include:

• Communication difficulties (e.g. not being understood, difficulties expressing wants and needs, asking for help, telling people how you feel….)
• Friendship problems – bullying, feeling alone
• Traumatic experiences
• Hormonal changes
• Change and routine disruption, transitions, unpredictability
• Having special interests and becoming obsessed with them
• Getting into trouble/ getting things wrong
• Keeping up with school work / expectations

What does anxiety look like?

People can respond different to anxious feelings, some of the signs you might notice include:

• Rapid and/or changing heart beat
• Fast breathing 
• Churning stomach / diarrhoea and/or slowed digestive system and constipation
• Sleep difficulties
• Headaches
• Change in mood, being irritable /angry
• Feel sad or very low 
• Preoccupation with thoughts and worries

Avoidance

One of the many ways both adults and children try to manage anxiety is to avoid the environment, situation, object altogether. That way they don’t have to cope with the discomfort they feel. Learning to tolerate the anxious feelings until they pass is an important way to manage anxiety. Avoidance does not allow your child to get used to a situation/ stimulus and instead reinforces the negative emotion/ feeling that they cannot cope, as your child has no positive experiences to draw on in relation to feared experiences.

Supporting young people with their anxiety

If you are supported by CAMHS LD we will be able to work with you on how to support young child’s anxious feelings. We may speak about:

Emotional Coaching

Emotion coaching helps to support people through an emotional challenging event, labelling emotions and promoting positive responses e.g. telling your child “I can see you are feeling worried.  It’s ok to feel worried.  Let’s try some slow breathing to help you feel calm”.

Positive mental attitude

Try to help them the person you are supporting develop a positive mental attitude (e.g. “I’m safe”, “I can manage these feelings”). Support the young person by saying you (or another trusted adult) will be there with them to help them through their feelings. It is important that you remain calm, you are non-judgemental and you feel confident in what you are doing as the child will pick up on your anxiety and interpret this as a reason why they should feel anxious themselves.

Breathing techniques:

• Coloured breathing (involves mentally picturing/meditating on a colour that represents how you want to feel and what you want to let go of in your life (stressor)
• 5 - Finger breathing (the idea is to use the five fingers to count each breath cycle).
• Milkshake breathing (Your child breathes in deeply through their nose and breathes out slowly through the straw. Encourage them to blow SMALL bubbles in the cup very gently – they'll know they have it right if they make gentle bubbles without spilling any water).
• Square breathing (involves exhaling to a count of four, holding your lungs empty for a four-count, inhaling at the same pace, and holding air in your lungs for a count of four before exhaling and beginning the pattern again.  It is also referred to as box breathing, 4×4 breathing, and 4-part breath).

Awareness of triggers

Know and understand their triggers and support them to notice them too. This may be done through A-B-C charts  or a PBS Plan. Triggers can be fast or slow and both need to be considered. A fast trigger may be being told ‘no’ to a desired object or activity. A slow trigger may be an upcoming event e.g. a birthday or Christmas.

Graded Exposure

Graded exposure can help a person build up their tolerance of the thing which causes them anxiety. By being exposed slowly and carefully to the situation which is causing the anxiety, a young person can begin to build up their tolerance of the levels of anxiety this may cause. Remember, avoiding the things which causes anxiety is a short-term solution and does not fix the bigger problem.

Relaxation

Yoga, meditation, or massage relaxes your breathing and helps us feel calm so we can deal with anxious feelings.

Exercise

This can make us feel better. It releases hormones that can make us feel happy and prevent us from feeling anxious in the first place.

Healthy Eating

Eating good food regularly throughout the day.  Caffeine and sugar can make anxiety worse.

Sleep

Have a good sleep routine and ensure you are getting the amount of sleep your body needs.

Tool Kit

Create a tool kit to help manage your anxiety. This may include sensory/fidget toys, weighted blankets, favoured activities, visual choice boards or checklists

The senses

In total there are 8 senses, 5 of which will be commonly known and 3 could be thought of as ‘hidden senses’.

When we think about senses we often think of the 5 basic human senses:

• Sight (visual)

• Sound (auditory)

• Smell (olfactory)

• Taste (gustatory)

• Touch (tactile)

In addition to these 5 basic human sense, it is important to also consider:

• Proprioception – Movement, muscle control and body position.  

• Vestibular – Sense of balance and motion

• Interoception – How our body tells our brain what is going on inside our body. For example, hunger, temperature, needing the toilet.

Sensory Processing Issues

We all process the world around us via our senses, also we are all individuals and are more, or less ‘sensitive’ to stimulus. A person (child or adult) with sensory processing issues is someone who is beyond the ‘typical’ range, meaning their brains focus and pay too much (more than average) attention or too little (less than average) attention to a stimulus. This is also linked to the neurotransmitters, or chemicals in our bodies, that help to relay messages via our nerves to our brains.

Children and adults can have processing problems associated with a specific sense or all their senses. It is important to try to understand this in order to support the person to feel regulated, in balance and maintain that ‘just right feeling’.  

Some people will ‘seek out’ additional stimulus for their brains to process, an example might be someone who; likes to wear patterns and bold colours (sight- visually), likes lots of noise and hustle and bustle (sound- auditory). Likes lots of physical contact / hugs from others (touch- tactile), enjoys super spicy foods (taste- gustatory), wears strong perfumes (smell- olfactory), likes lots of movement, jumping off things, is a bit of an adrenaline junkie (movement- proproiception and balance- vestibular). 

The opposite of the above would be someone who avoids existing/ additional stimulus for their brains to process, an example might be someone who; wears plain clothes no pattern and muted or pastel tones (sight- visual), dislikes noise, may put their fingers in their ears, struggles to concentrate in noisy environments or chooses to avoid these (noise- auditory). Dislikes contact from others, particularly unanticipated contact or the feel of some fabrics/ clothes on their skin (touch-tactile). They may choose a bland diet (taste- gustatory), dislike strong smells especially synthetic ones (smell- olfactory), avoids lots of movement particularly head movement (movement- proprioception and balance- vestibular).

In reality children and adults can be a mixture of the above, enjoying the stimulus from some senses and struggling with others, hence people’s sensory profiles being personal and unique to them and their sensory systems.

Supporting Sensory Regulation

It is important to consider a young person’s sensory needs when trying to facilitate their sensory regulation. Its also important to consider the long-term effect on the young person and ideally those supporting them should try to develop the young person’s tolerances. For example, if the young person struggles with noise, at times they may need to use ear defenders but ideally this should be at times when they are really struggling or need to concentrate and at other times they should be encouraged to leave the ear defenders off to give their bodies chance to experience this stimulus, it may be helpful to combine this with items in ‘what can help’ (see below).

Temporary examples of removing/reducing stimulus if this feels overwhelming for a young person may be:

• Using eye masks to block out visual stimulation
• Turning down the lights/ using soft low lights
• Sitting in a dark tent
• Using ear defenders to block out excessive noise or ear loops to reduce it (if age appropriate)

Long term examples may be:

• Wearing a cap or sunglasses when outdoors (both reduce the visual field so reduce the stimulus received.
• Wearing muted tones without patterns or decorating in muted/ pastel tones and having minimal decoration/ clutter.
• Going into the community at carefully planned times, so such as going shopping early or late so there will be less people to see and hear, this would then support a reduction in both the visual (seeing) and auditory (hearing) stimuli.

Just like it can be helpful to make short-term adjustments to remove stimulus or make long-term adjustments to reduce them. For those people who need more stimulation or information from the world around them its just as helpful for these people to explore strategies that increase the stimulus that they can receive.

Temporary examples of adding/ increasing stimulus may be:

• Looking at a book or iPad or TV
• Having lights on

Long-term examples may be:

• Wearing patterns and having lots of interesting colours on clothing, also wearing bright colourful jewellery
• Decorating the home in bold colours/ patterns, having lots of decorations and items that ‘catch the eye’

What can help?

Some senses can be really helpful as they can have a calming affect over the other senses.

• Firm massages, this involves deep tissue pressure and can be calming.
• Laying over (on their front or back) a gym ball can be calming, this also uses deep tissue pressure the child’s weight will be supported across their abdomen or back, so covers a big surface area and is different from the usual experience of weight being absorbed by the feet.
• Another strategy can be to use movement (proprioception) so lots of movement particularly when combined with resistance can be really helpful, this can be such as pushing, pulling, dragging and lifting items or the persons own body weight. The later might be hanging on a climbing frame, push-ups on a wall/ floor, bouncing on a trampoline.

It may be useful to make a ‘sensory toolbox’ for the young person you are supporting. This can be personalised and help them to meet their individual sensory needs.

More information can be found at: Sensory processing difficulties :: Lincolnshire Children's Therapy Services (lincolnshirechildrenstherapyservices.nhs.uk)

No medication... why?

Medication might not be the best way to help children and young people with learning disabilities and/or autism who are showing behaviours that concern us.

Introduction
When someone we care about is showing behaviours of concern that are worrying and difficult to manage, we want an answer. We want the behaviours to change or stop as soon as possible.

You may have thought by meeting with CAMHS or the Children and Young Persons Mental Health Service (CYPMHS), someone may have prescribed some medication and now you are told that medication, at this stage, is not something we would advise. Parents and carers in this position often feel or say the following:

“Surely a tablet will help?”

“I’m not being listened to.”

“They aren’t taking the problem seriously.”

This leaflet is to help you understand why medication hasn’t been prescribed at this stage and to give ideas around what else could help instead.

Medication or not?
You haven’t been given a prescription for medication, but that doesn’t mean that the professionals in CYPMHS, including the doctor and independent prescriber thinks the problem you face is any less significant.

There are a lot of serious symptoms, conditions and behaviours relating to a child’s learning disability and/or neurodiversity, which can’t be cured with medication.

Each person showing behaviour changes will be doing so for different reasons. Unlike some other conditions, there is not one standard medication type that treats behaviours that cause concern or are challenging, but still may be helped by adjustments to daily life, treatment or a specific often adapted therapy.

In addition, the decision not to prescribe medication is not based on cost. Most medication used is not expensive.

Have I wasted my time?
No. You will have given professionals a lot of useful information that they will be considering and using to decide on the best way of helping. You are a step closer to getting the right help.

When should medication be used?
If behaviours of concern can be linked to a mental health specific diagnosis, there could be an effective medication to help treat this illness. We will openly discuss this with you at your assessment and visits.

If the behaviour is thought to be linked to epilepsy or physical health problems, it is appropriate to prescribe medication to treat these conditions (e.g., anti-epileptics, pain killers, antibiotics.)

However, often the behaviours of concern is not a symptom of one of these illnesses, but a person’s way of showing that something else is wrong.

Could the medication do harm?
Medication that is used to treat a person’s mind or mental state is called Psychotropic medication. This includes antidepressants and antipsychotics.

All psychotropic medication has effects. Medications are chemicals and so it is easy to understand why adding something ‘foreign’ to the body may make the body feel worse before it has a chance to show if it is also useful.

Antipsychotics have some serious side effects which children or young people with a learning disability or autism may be especially sensitive to. These include sleepiness, weight gain, movement problems and blood pressure/heart problems.

Recent studies have shown...
Medication is being given to ‘treat’ behaviours of concern even when the cause of the behaviour is not clear.

In most cases of inappropriate prescribing, the drugs are just acting as a sedative (making the person sleepy) rather than actually doing anything to sort out the underlying problems.

There is no evidence that the routine use of medication in the management of behaviours of concern brings additional benefits.

NB: Public Health England estimates that every day 30,000 to 35,000 adults with a learning disability are being prescribed a psychotropic medication without an appropriate clinical reason.

What do guidelines say?
In 2018, a project by NHS England called STOMP (Stopping the Over Medication of People with learning disabilities, autism or both) and STAMP (Supporting Treatment and Appropriate Medication in Paediatrics) in 2019, campaigned for a reduction in the inappropriate and sometimes harmful use of psychotropic medication. In Lincolnshire CYPMHS, we strive to ensure all our patients are given individualised care and would apply the same approach.

NICE (National Institute for Health and Care Excellence) produced some clear guidance in 2015. This was based on looking at all the research evidence. They recommend that anti-psychotics should only be considered if:
• Treating any underlying physical or mental illness has not improved the symptoms, or
• Psychological or other interventions alone do not produce change.
• The risk to the person or others is very severe (e.g., extreme aggression or self-injury).

NICE also emphasise that if medication is used, it should only be done so in combination with psychological or social interventions.

So, no medication... what now?
Professionals in the CYPMHS will discuss what can be done to support your child and your family.

This should lead to a detailed assessment of the behaviours of concern called a ‘functional assessment’, to identify any health, psychological, environmental, communication and social factors that could be contributing to the behaviour. Getting a full understanding of the reasons behind the behaviour is the key to changing it.

The assessment should result in the development of a care plan, which may include Positive Behaviour Support, adapted therapies or pscyho-education to help your child understand why they may be feeling and acting differently.

In the meantime
It may feel like things are taking a long time to change. There are things that you can do in the meantime to help speed the process up.

Think about whether the child or young person you care for could be physically unwell. Are there signs of pain, infection or seizure changes? It is worth asking the GP to help you check for this. Sometimes there are ‘hidden’ problems such as bladder, bowel, ear or dental problems.

Keep a diary to record the behaviours you observe in your child. The more details that you can give CYPMHS about the behaviours, the better we can help with a solution. Keeping a sleep chart and detailed seizure records can also be helpful, if this is relevant for your child.

Think about whether there are things going on around the child or young person you care for that could be upsetting or confusing them. Have there been any changes recently? Talk to other people who spend time with the person and prepare a list of any of these changes.

Has the child or young person you care for had any input from other professionals before? Look for any previous assessments, reports, training notes and recommendations. These may include a communication passport, sensory assessment, school behavioural plans or a psychology report. There may also be letters from a paediatrician or neurologist. These could have some useful ideas to try which may have been forgotten over time.

Think about whether there have been any medication changes recently. Take a list of all medication your child has been taking recently and in the past to all appointments, including the use of any extra medication you have used.

If there is a ‘keep safe’ plan or reports of behavioural incidents in school, please share these with us to help us understand the risks to your child and those around them.

Contact your lead professional or GP in between appointments if there is a serious incident that puts the person you care for, or others, at significant risk of harm.

Look after yourself. Remember that you are seen as an essential part of the team that can help improve the current problems.

Not everything will work straight away. Sometimes a lot of effort is needed to only produce a small change in behaviour.

Share any frustrations and concerns with the us. There may be training or carer support that could help you now, or help you to to help others in the future.

Credit to Coventry and Warwickshire Partnership NHS Trust

What changes do I need to be aware of?

When your child reaches 16 years of age they will fall under the Mental Capacity Act. This means that they must be assumed to be able to make decisions for themselves, including health-related decisions such as giving consent for examinations, treatments and tests.

If your child is aged between 16 and 18 you will only be able to make these decisions for them if they lack the mental capacity to do so and you have Parental Responsibility for them. You may not be able to make all health-related decisions on their behalf.

What is mental capacity?

Having mental capacity means being able to use and understand information necessary to make a decision and to communicate that decision. Someone who is able to do this is said to have capacity and someone who is not able to do this is said to lack capacity.

When is capacity assessed?

Capacity is decision-specific and each decision must be considered separately. This means your  must be assessed every time a decision has to be made. Capacity can vary according to how complicated the decision to be made is. For example your child might have capacity to decide what to wear  or eat, but lack capacity to make complex health-related decisions. It is possible for someone to temporarily lack capacity due to ill-health, medication or stress.

How is capacity assessed?

The Mental Capacity Acts says that someone must be able to do all of the following:

• Understand the decision that has to be made and all the information relevant to that decision
• Retain the information long enough to make the decision
• Balance the information (weigh up the pros and cons)
• Communicate their decision

If you child is unable to do any of the above they will be assessed as lacking capacity for that decision at that time.

Who assesses capacity?

When the decision involves a medical procedure or treatment the healthcare professional involved will usually assess your child’s capacity and will do this by talking to you and your child.

Decision making for someone who is over 16 and lacks capacity

If it is clear that your child isn’t able to make a particular decision then the decision must be taken on their behalf. The person making the decision may vary depending on the type, or complexity, of decision to be made. You might be able to make the decision or it might be made by a health professional or a social worker acting in your child’s ‘best interests’.

Who will decide what is in my child's best interest?

This will depend on the type of decision that has to be made. Usually the decision will be made by a group of people working together. The healthcare professional in charge of your child’s care will work with you, your child, and other health professionals to make sure any decisions taken are in their best interest.

What happens if we do not agree on best interest?

It can sometimes be complicated deciding what is in someone’s best interests and parents and health professionals may disagree, although this is rare. The Mental Capacity Act and the Court of Protection provide guidance on what must happen in this situation. If necessary, the Court of Protection can be asked to decide on the right course of action and will make the decision.

What happens after my child's 18th birthday?

After their 18th birthday, even if you had Parental Responsibility, you won’t be able to make health-related decisions unless you have been appointed as a Deputy by the Court of Protection. Everyone loses Parental Responsibility when their child reaches 18 years old. Decisions about treatment will be made by two Consultants in your child's best interests. They must consult you and listen to your views before making a best interests decision.

Mencap have more information about best interests decisions. Their helpline number is 0808 808 1111.

Becoming a Deputy under the Court of Protection

Some parents apply to become a ‘Deputy’ under the Court of Protection. If their application is approved they can usually continue to consent to medical treatment and/or manage their child’s affairs after their 18th birthday. There are two sorts of Deputy – one covering property and financial affairs and the other covering personal health and welfare issues. Sometimes there are restrictions on the decisions that a Deputy can make. If you want to become a Deputy you will need to apply to the Court of Protection for both of these. There will be a cost involved but you may be able to get help if you are on a low income. Further information on becoming a Deputy is available at www.gov.uk/becomedeputy/overview.

Are there other changes I should know about?

Benefits

You might be receiving a Disability Living Allowance (DLA) payment to help with any additional costs of caring for your child. When they are 16 they will need to be reassessed to see if they qualify for a different payment called a Personal Independence Payment (PIP). The Department for Work and Pensions (DWP) will contact you before their 16th birthday to explain how to claim for a PIP. More details are available at https://contact.org.uk/media/1163273/pip_guide.pdf or from your local Citizens Advice Bureau (CAB).

Local service changes

The age that children’s health services finish and adult health services start varies depending where people live. In some areas, adult services start at 16 years and in others they start at 18 years. It is a good idea to find out what age this happens where you live. Once your child is 16, if they became unwell or had an accident and needed to go to hospital they might be admitted to a children’s or an adult ward depending on where you live. Your local General Practice (GP) clinic would be able to help you find out about the changes occur in your area.

Assessing Gillick competence

There is no set of defined questions to assess Gillick competency. Professionals need to consider several things when assessing a child's capacity to consent, including:

• the child's age, maturity and mental capacity
• their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact
• their understanding of the risks, implications and consequences that may arise from their decision
• how well they understand any advice or information they have been given
• their understanding of any alternative options, if available
• their ability to explain a rationale around their reasoning and decision making.

Remember that consent is not valid if a young person is being pressured or influenced by someone else.

Children's capacity to consent may be affected by different factors, for example stress, mental health conditions and the complexities of the decision they are making. The same child may be considered Gillick competent to make one decision but not competent to make a different decision.

If you don't think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their parents or carers before proceeding.

In complex medical cases, such as those involving disagreements about treatment, you may wish to seek the opinion of a colleague about a child’s capacity to consent (Care Quality Commission, 2019).

Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020).

Refusal of medical treatment

Gillick competency can be used when young people wish to refuse medical treatment.

However, if a young person refuses treatment which may lead to their death or severe permanent harm, their decision can be overruled. More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation.

Child protection concerns

The child's safety and wellbeing is paramount.

When you are assessing Gillick competency if you have any concerns about the safety of the young person you should check whether previous child protection concerns have been raised, and explore any factors that could put them at risk of abuse.

You must always share child protection concerns with the relevant agencies, even if this goes against a child's wishes.

Where will the appointment with the CAMHS Learning Disability Team take place?

The CAMHS Learning Disability team may visit you and your child at home, complete visits in school and any other setting that your child regularly visits, such as their respite setting. Appointments can also take place at the CAMHS clinic settings, in Boston, Grantham, Lincoln or Louth or at other community settings dependent.

Will the CAMHS LD team visit my child in school – who will they talk to and why?

The CAMHS LD team will complete visits to your child in school to inform the assessment and understand more about how they interact in this environment. This could involve talking to your child’s class teacher and designated teaching assistant to ensure we have a good understanding of your child’s needs, so we can consider what might be the most helpful advice.

Can any family member provide support to my child in an appointment, or does it have to be the parent?

The CAMHS Learning Disability team will always want to talk to a child’s parents/carers at the initial assessment, to gather their views. Following on from that, other family members can provide support to the child, as determined by the parent/carer.

How will you support my child if they don’t engage due to their communication difficulties?

The CAMHS Learning Disability team will communicate with children in their preferred communication style.

If it is identified that my child requires the support of another mental health service/team, do we have to start again with a new referral?

If another mental health service/team is required, the CAMHS Learning Disability team would support the referral into this service. A new referral is not required.

Who else do the CAMHS Learning Disability team gather information from whilst working with my child/young person?

The CAMHS Learning Disability team will ask your consent at the beginning of the assessment and will explain to you who they would find it helpful to talk to as part of the assessment process. This could include your child’s teachers, social workers, respite staff, SEND caseworker’s or anyone else who provides support to your child.

How long will the CAMHS LD team be involved? Is it a fixed period of time or number of sessions?

The CAMHS Learning Disability team provide tailored support to children, based on their identified mental health need, so the length of time will vary from child and young person, dependent upon the needs of the child/young person.

My child does not cope well with unfamiliar people in the house – how will this be managed during appointments and observations?

The CAMHS Learning Disability staff will take this into consideration when visiting your child. The team will make reasonable adjustments and endeavour to be flexible wherever possible.

Will my child be prescribed medication?

On our CAMHS LD webpage, we have a section called “No Medication...Why?”. This outlines the careful considerations that need to be made when considering the use of medications for children and young people.

Useful links

• EATS service - Home :: Electronic Assistive Technology Service
• Lincolnshire Sensory Services – Sight and Hearing Loss Support 
• LIASE - Homepage – Liaise Lincolnshire
• Jam cards - Just a minute of patience | JAM Card | Autism | Hidden disability | Northern Ireland
• Sunflower lanyard HDS - Global
• Mindjam - MindJam | Empowering and Supporting Young People
• Virtual Autism Hub :: Lincolnshire Partnership NHS Trust
• National Autistic Society
• Children in Need website -resources and activities for supporting wellbeing: Resources: wellbeing support for young people and children  - BBC Children in Nee