Psychological Medicine Intervention Service

The Department of Child and Adolescent Mental Health has an Intervention Service, coordinated by the Psychological Medicine Team, that offers brief, focused, evidence-based treatments to children with mental health difficulties.

Service overview

  • The service is available to children attending services at GOSH who have significant mental health needs that require further assessment and treatment. External referrals will also be considered
  • The focus is on integrating mental and physical health care
  • We deliver evidence-based treatment packages for mental health conditions occurring in conjunction with physical illness
  • Packages of care will be individualised to meet the specific needs of the child and their family

We work in conjunction with the Paediatric Psychology serviceto the hospital, and have joined up care pathways. Referrals from the general hospital should be discussed with the Paediatric Psychologist attached to the service. A full list of Paediatric Psychologists is found on the meet the team page.

Scope of Paediatric Psychology

Paediatric Psychology will generally assess and manage:

  • Adjustment to diagnosis and facilitating treatment for the child and family
  • Anxiety or distress related to symptoms/condition (below threshold for mental health diagnosis)
  • Pain management
  • Procedural anxiety
  • Medically unexplained symptoms 

The Intervention Service will deliver: 

  • Mental health diagnostic assessments and evidence-based treatments for specific mental health conditions occurring in children who have complex presentations, either because of comorbid physical illness or multiple other comorbidities.
  • Scientifically validated treatment protocols for childhood mental health conditions, including: Depression, Anxiety Disorders, Obsessive Compulsive Disorder, Attention Deficit Hyperactivity Disorder and Disruptive behaviour disorders.
  • Services for children where medical tests have not fully explained the severity or impact of symptoms, and help to detect and treat any psychological difficulties. We aim to develop a joined up care pathway with the Paediatric Psychology service to provide intervention packages for children presenting with medically unexplained symptoms incorporating a stepped care approach. 

We emphasise: 

  • Measuring treatment outcome and evaluation of patient and family satisfaction
  • Multi-Disciplinary Team working including psychologists, child and adolescent psychiatrists, systemic psychotherapists and a paediatrician
  • Stepped-care (offering the most effective and least intrusive treatment based on the severity of the problem)
  • Low intensitye.g. guided self-help
  • Medium intensitye.g. weekly cognitive behaviour therapy for 12 weeks
  • High intensitye.g. daily treatment for several days or preparation for in-patient treatment
  • Close liaison/co-working with community mental health teams (CAMHS)
  • Flexible psychological treatment delivery e.g. telemedicine using telephone 

A typical referral is described below: 

Reason for referral:

  • Sam is a 14 year old boy who has a complex history of cardiological problems, a skin disorder and Tourette syndrome
  • Sam had previously had input from child mental health services attending the Tourette syndrome group for teenagers and completing a detailed cognitive assessment
  • Sam’s assessment indicated that he met the criteria for depression –he was sad, unable to enjoy life, sleeping badly and wondering whether life was worth living, missing lots of days of school and had stopped seeing his friends
  • Sam was referred to the intervention service and began an evidence based talking therapy, cognitive behaviour therapy. This was a 12 week course of therapy sessions, with carefully designed exercises to practice at home, the impact of which was evaluated using standard measures
  • The intervention service also liaised with Sam’s school to support them to implement strategies to help him engage more within class and try extra-curricular activities 

Key team members

Assessments and treatments are delivered by:

  • ·Dr Eve McAllister, Clinical Psychologist
  • ·Dr Laura Markham, Clinical Psychologist

Other clinicians in the department may also undertake treatment according to the clinical needs of the child and family. 

The service is coordinated by the Psychological Medicine Team. It is led, supervised and evaluated by senior clinicians and academics including:

  • Dr Isobel Heyman, Consultant Child and Adolescent Psychiatrist
  • Dr Rachel Bryant-Waugh, Consultant Clinical Psychologist
  • Dr Tara Murphy, Consultant Neuropsychologist
  • Professor Roz Shafran, Professor of Translational Psychology and Honorary Consultant Clinical Psychologist

In general, medical responsibility for GOSH referrals will remain with the referring consultant, however all referrals will be discussed within a multidisciplinary team meeting. In some cases it may be considered appropriate for medical responsibility to be held by a consultant psychiatrist within the team, after discussion with the referrer.

Referrals

Referrals can be made by writing to:

The Intervention Service
Department of Child and Adolescent Mental Health
Great Ormond Street Hospital for Children NHS Foundation Trust
Great Ormond Street
London
WC1N 3JH 

If you have any questions, please contact the Team Administrator by emailing psych.med@gosh.nhs.uk

Research

We have an active programme of research. Children and families attending our service may be invited to participate in one of these.

Current projects include:

  • Guided self-help for child mental health problems in the context of physical illness
  • Detection of mental health problems in children attending neurology clinics at GOSH