Self Referral – The Brandon Centre, Camden CYP IAPT Partnership

Context:

The Brandon Centre Psychotherapy Service provides psychological therapies to young people aged 12 to 24 years. It was founded over 40 years ago in the context of a contraceptive and sexual health service addressing the needs of young people. The service was set up to be easily accessible for young people, and confidentiality has always been paramount.

Currently 54% of all referrals to the Brandon Centre Psychotherapy Service are self-referrals (includes referrals by young people or family members). Other referrals come from GPs, Child and Adult Mental Health Services, Social Care, Schools/colleges, universities, drug services, etc.

Self-Referral Process:

Young people or parents/carers can phone, email or drop in to the centre to refer themselves (or their child).  Emails are usually followed up with a phone conversation to gather more information.

The referrals coordinator speaks to the young person/parent and initially gathers some basic information (age, address, GP) to check that they are within our age range and area, then goes through a referral form with the young person/parent, asking sensitively about why they are requesting therapy. They ask about involvement of other services, who recommended the centre, and if they are under 18, whether anyone knows about the referral. If the young person is presenting with risk issues (e.g. suicidal thoughts/behaviours, self-harm, or other ways of putting themselves or others at risk) then advice around safety may be given over the phone, and it is made clear that we do not provide an emergency service. They are asked about their availability times to attend, and informed of the length of time that they are likely to be waiting for their first appointment.

All referrals are discussed with the Lead Clinician or Director, and if appropriate the clinician contacts the young person or parent to gather more information, and with consent, may involve appropriate services to manage risk or direct them to other services (if we are not the appropriate service, or while they are waiting to be seen).

Some of the Pros of self-referral:

  1. The service has validity for young people. They recommend their peers, and even bring in friends if they are concerned about them.
  2. Young people are able to access the service, particularly those who may not be involved in other services and are unlikely to go via their GP.
  3. Young people who self-refer are usually motivated to access help for themselves and are more likely to engage in the service.
  4. Some young people who were referred as young teenagers return to the service when they are a bit older when they feel ready to address some of their difficulties. At this point they may not have been referred by a professional to other services (CAMHS or AMH services), but are now ready to make use of help. The self-referral process allows young people to develop a more proactive relationship to helping services.

Some difficult issues to consider about self-referral:

  1. With the very nature of self-referral, you don’t have much information prior to seeing the young person. Staff need to be open to hearing what the young person is bringing and always consider issues of risk on a case by case basis.
  2. Issues around risk may need to be managed differently because of how confidentiality is interpreted. The therapists are supported to be working with high levels of risk and addressing this using the strength of the relationship with the young person as a way of keeping the young person safe until they can bring in other support around them.
  3. When young people self-refer it can be harder to put in place appropriate support around them.
  4. Referrers often ask a young person to refer themselves when their work is coming to an end. Although this can show motivation in the young person, sometimes they are referred to several other services as well, with poor communication across the services, which can be unhelpful and confusing for young people and staff.

What we have found helpful:

  1. Having excellent administrative staff – who are able to listen to and talk to young people and parents with respect and concern when they are making their first contact. Administrative staff are supported in developing their skills and in knowing their limitations. i.e. when to pass the call over to a clinician or ensure that a clinician follows it up.
  2. Ongoing weekly supervision for admin/referrals staff by the lead clinician
  3. All new assessments are discussed in the weekly team meeting soon after they have been seen.
  4. Monitoring of the waiting list: we contact young people who are waiting to be seen for the first time and if there are concerns we will check in with some young people/parents while they are waiting, and if appropriate signposted to services (e.g. housing, drug services, employment services, crisis team, etc) while they are on the waiting list.
  5. Working closely with other services – GPs, CAMHS and AMH teams, Social Care, schools/colleges, etc.
  6. Reviewing the system as things change in the wider context.

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