HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Rowland, J. Articles by Garfield, P. Search for Related Content PubMed Articles by Rowland, J. Articles by Garfield, P.

Referral letters to child and adolescent mental health services

Exeter

Paul Garfield, Consultant Child and Adolescent Psychiatrist

Ivy House, 23 Henley Road, Ipswich IP1 3TF

In the face of substantial demand, many out-patient child and adolescent mental health services (CAMHS) triage referrals on the basis of referral letter information. The validity of this procedure is uncertain; it is often asserted that referral letters provide a poor guide to clinical status. Using routinely collected data from one CAMHS team, we investigated the congruence between the main problem highlighted in the referral letter, and the subsequent specialist assessment diagnosis.

Among 98 children whose main problem in the referral letter was a behaviour problem, there were various diagnoses at assessment: hyperkinetic disorders formed the single largest group (23%), with almost as many emotional (17%) or conduct disorders (17%). Hyperactivity/inattention was the main problem in 39 referral letters: 51% of these children subsequently received a diagnosis of hyperkinetic disorder. Four of the eight children whose main problem in the referral letter was an eating problem received a diagnosis of anorexia or bulimia. The greatest specificity was from the 83 letters highlighting emotional symptoms as the main problem: 67% received a diagnosis of an emotional disorder (two combined with conduct disorder). Thus, letters identifying emotional problems or hyperactivity/inattention often provided a guide to clinical diagnosis.

However, children referred with ‘behaviour problems’ could be found to have any of a number of clinical diagnoses at assessment. This suggests that such referrals cannot be reliably triaged before assessment without considering additional information. This presents a serious problem for services with substantial assessment waiting lists. Other factors that might also influence triage, such as the child’s functional impairment, problem severity, or risk behaviour, need similar investigation.

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Rowland, J. Articles by Garfield, P. Search for Related Content PubMed Articles by Rowland, J. Articles by Garfield, P.