Referral criteria - childhood depression

Referral criteria

• for children and young people, the following factors should be used by healthcare professionals as indications that management can remain at tier 1:
  
  
  • exposure to a single undesirable event in the absence of other risk factors for depression
    
    
  • exposure to a recent undesirable life event in the presence of 2 or more other risk factors with no evidence of depression and/or self-harm
    
    
  • exposure to a recent undesirable life event, where 1 or more family members (parents or children) have multiple-risk histories for depression, providing that there is no evidence of depression and/or self-harm in the child or young person
    
    
  • mild depression without comorbidity
    
    
• for children and young people, the following factors should be used by healthcare professionals as criteria for referral to tier 2 or 3 CAMHS:
  
  
  • depression with 2 or more other risk factors for depression depression where 1 or more family members (parents or children) have multiple-risk histories for depression
    
    
  • mild depression in those who have not responded to interventions in tier 1 after 2-3 months
    
    
  • moderate or severe depression (including psychotic depression)
    
    
  • signs of a recurrence of depression in those who have recovered from previous moderate or severe depression
    
    
  • unexplained self-neglect of at least 1 month's duration that could be harmful to their physical health active
    
    
  • suicidal ideas or plans
    
    
  • referral requested by a young person or their parents or carers
    
    
• for children and young people, the following factors should be used by healthcare professionals as criteria for referral to tier 4 services:
  
  
  • high recurrent risk of acts of self-harm or suicide significant
    
    
  • ongoing self-neglect (such as poor personal hygiene or significant reduction in eating that could be harmful to their physical health)
    
    
  • requirement for intensity of assessment/treatment and/or level of supervision that is not available in tier 2 or

Notes:

• Tier 1
  • primary care services including GPs, paediatricians, health visitors, school nurses, social workers, teachers, juvenile justice workers, voluntary agencies and social services
    
    
• Tier 2 CAMHS
  • services provided by professionals relating to workers in primary care including clinical child psychologists, paediatricians with specialist training in mental health, educational psychologists, child and adolescent psychiatrists, child and adolescent psychotherapists, counsellors, community nurses/nurse specialists and family therapists
    
    
• Tier 3 CAMHS
  • specialised services for more severe, complex or persistent disorders including child and adolescent psychiatrists, clinical child psychologists, nurses (community or inpatient), child and adolescent psychotherapists, occupational therapists, speech and language therapists, art, music and drama therapists, and family therapists
    
    
• Tier 4 CAMHS
  • tertiary-level services such as day units, highly specialised outpatient teams and inpatient units

Reference:

• NICE (June 2019).Depression in children and young people: identifification and management