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The role of nurses in child and adolescent services

The Audit Commission document Children in Mind  described a four-tier model for the delivery of child and adolescent services. Tier 1 services are provided by primary care and other front-line services offering advice for mild to moderate problems and promoting mental health. Tier 2 services are generally provided by specialist professionals working on their own with links to primary care (Tier 1 services) and the specialist multi-disciplinary CAMHS services. Tier 4 services deal with complex severe cases with links to inpatient child and adolescent beds. As with all nursing posts, commitment to ongoing continuing professional development and lifelong learning is essential. There are a range of courses and developmental opportunities for registered nurses working within child and adolescent mental health services. A number of these were approved by the former English National Board and include child and adolescent mental health nursing for nurses. Nurses with specialist training in child and adolescent psychiatry are uniquely placed to work in all four tiers of the service. At Tier 1, nurses are able to take on the role of primary care mental health workers (PMHWs). Besides providing first line intervention they have a role to support other professionals working in primary care and provide links between Tier 1 and specialist services. PMHWs also play an important role as gatekeepers to specialist services. Nurses with specialist training in a range of therapies, including cognitive behavioural therapy, family therapy and counselling, work independently at Tier 2 level on their own or as members of the Tier 3 multidisciplinary service. At Tiers 3 and 4, community psychiatric nurses will increasingly play a central role in the services for adolescents with first onset psychosis. Services for this group are currently being developed in line with recommendations in the National Service Framework for Mental Health. While there is an emphasis on multi-disciplinary working in inpatient adolescent units, nurses provide care and therapeutic input as the core group of specialists who outnumber other professionals.

Children admitted to such units often need medication for serious psychotic problems, and careful assessment of risk and monitoring of the effects of medication is an important role for nurses. Health visitors and school nurses with training in child development and assessment of children are uniquely placed to provide a service at Tier 2 level with support from specialist CAMHS services and are seen as less stigmatizing services for mild to moderate cases. There is evidence that community treatment of mothers with postnatal depression by child health nurses can lead to greater levels of improvement than a control group. Opportunities exist for the appointment of nurse consultants to Tier 4 services although such posts are relatively new within child and adolescent services.

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