CAMHS Reference and Resource File

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CAMHS Reference and

Resource File

•

What CAMHS is and how it works

•

The tier system

•

South East and Mid Surrey CAMHS and referral

procedure

•

Referral criteria

•

What makes a good refer

r

al

•

The CAMHS referral pathway

•

Primary Mental Health Trust referrals

•

The services that work with CAMHS

•

Leaflets of the services that work with CAMHS

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Information and advice leafle

t

s fo

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oung people

and pa

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ents

CAMHS

CAMHS Reference and Resource File:

•

What CAMHS is and how it works

•

The tier system

•

South East and Mid Surrey CAMHS and referral procedure

•

Referral criteria

•

What makes a good referral

•

The CAMHS referral pathway

•

Primary Mental Health Trust referrals

•

The services that CAMHS work with

•

Leaflets of the services that work with CAMHS

What is CAMHS?

CAMHS is the Child and Adolescent Mental Health Service. CAMHS exists to promote emotional well-being and to deliver preventative services and treatment

to children and young people with mental health problems. CAMHS is a

partnership between Surrey County Council, Surrey's Primary Care Trusts, three NHS delivery trusts for mental health and voluntary organisations.

CAM

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CAMHS is organized around a tier system:

Tier 1

Professionals working with young people. Although these professionals, (e.g. teachers, youth workers, school nurses, health visitors, GP's and social

workers)are not directly employed to promote mental health, with appropriate training and support they are ideally placed to offer early intervention strategies as they may already have a collaborative therapeutic relationship with their clients.

Tier 2

Primary Mental Health Workers (PMHW). These specialist professionals provide consultation, training and support to young people with a mental health problem, emotional problem, or challenging behaviour.

Tier 3

Multi-disciplinary Teams work with young people with complex mental health problems. The teams include psychologists, psychiatrists, therapists, art psychotherapists, play therapists, family therapists, social workers and

community nurses. The teams work collaboratively together to help young people with severe mental health problems, their parents and carers.

Tier 3 plus service

HOPE Service. This service is a CAMHS Outreach service for adolescents with complex needs and challenging behaviour. The service aims to prevent problems escalating and children needing hospital care or a specialist placement. This service provides healthcare, education and social care to young people at a site

in Epsom and Guildford. HOPE isaccessed by CAMHS Tier 3 and via Area Placement Panels.

Placement Stability Service works with looked after children to help prevent a placement breaking down. It offers treatment to young people, and training and support to carers.

Tier 4

Specialised care for young people suffering serious mental health problems e.g. inpatient hospital care. Education and health facilities are available on the same site (i.e. Chalk Hill in Haywards Heath West Sussex).

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Tier

Professionals Providing the

service include:

Tier 1:

Aprin?arylevelofcare

•

GP's

•

Health visitors

•

School nurses

•

Teachers

•

Juvenile justice workers

•

Voluntary agencies

•

Social services

Tier 2:

A service provided by

•

Child and Adolescent Mental health

professionals relating to

s

workers

workers in primary care

_•

•

Pa_Educedia_att_irici_{onal p}ans _sycholo(esp. commun_gists ity)

•

Child &Adolescent psychiatrists

•

Child &Adolescent

psychotherapists

•

Community nurses/nurse specialist

•

Familv therapist

Tier 3:

A specialised service for more

•

Child &Adolescent psychiatrists

severe, complex or persistent

•

Clinical child psychologists

disorders.

•

Nurses (community orin-patient)

•

Child psychotherapists

•

Occupational therapists

Tier 4:

_

.

_{Speech and language therapists}

Essential tertiary level

_•

•

ArtFamily th, music aerapistnd drama therapists

services such as day units,

highly specialised out-patient

teems and in-patient units.

Function/Ser

v

ice

CAMHS at this level are provided by professionals

working in universal services in a position to:

)- Identify mental health problems early in their development

)- Offer general advice

)- Pursue opportunities for mental health promotion and prevention

.

CAMHSprofessionals should be able to offer

:

)- Training and consultation to other professionals (who might be within Tl)

~ Consultation to professionals and families

)- Outreach

)- Assessment

Services offer:

)- Assessment and Treatment

)- Assessment for referrals to T4

)- Contributions to the services, consultation and training at Tl and 2

~ Child and Adolescent in-patient units ~ Secure forensic units

)- Eating disorders units

~ Specialist teams (e.g. For sexual abuse)

SOUTH EAST AND MID SURREY CAMHS

We aim to work with, or offer support to others who are working with, children or young people with emotionaJfpsychological or mental health difficulties from birth to their 18th birthday. This help and support will, in the first instance, involve their

families. We can usually recognise these children and young people by the behaviours they use.

Following a national audit of child mental health services in 1995 (Together We . Stand) CAMHS services were organised into 4 'tiers' to support children and families with emotional, psychological and mental health difficulties, and those professionals who work with them.

Tier 1 -'Universal Services' - any professional or voluntary service working with children/young people.

Tier 2 - CAMHS Primary Mental Health Service - mild to moderate

Tier 3 - CAMHS Multi-disciplinary team - moderate to severe/chronic/acute

Tier 4 - CAMHS inpatient, day-patient or specialist assessment service

Referral Any professional or voluntary sector employee can refer a child to

CAMHS.

We do not accept self-referrals.

Discuss with parents and young person before making a referral.

We do not see children or young people without the knowledge or consent of their parents/carers. However, we will offer advice/risk assessment.

Let us know what has happened, what has been tried, what the family and child want.

Name and address of GP

When the referral is received bythe appropriate CAMHS clinic it will go to a 'Screening Meeting' where it will be allocated to Tier 2 or 3.

We will then either contact you direct to offer consultation, advice or joint visit or we will send you a copy of the letter we have sent to the family.

Those referrals that are allocated to the Tier 3 team will be prioritised into Emergency/Urgent/Standard and contacted within an appropriate time scale. The Emergency referrals will be contacted the same day.

At the moment in Redhill the Standard referrals are offered an assessment appointment in 7/8 weeks.

If you would like to discuss a concern you have or a possible referral before you send it you can telephone the appropriate Primary Mental Health Worker:

Horley/Reigate RedhilllHorley Tandridge Mole Valley Epsom East Elmbridge Martin Longhurst 01737 287002 Graham Pritchard 01737 287002 Chandra Atkinson 01883 388303 Patricia Allardyce 001306 502708

Charlie Fancy/Liz Ephgrave 01372 204120 Sue Fraser 20082247878

or Carol Bason Community Development Manager 01737287002

•

R

EFERRAL CRITERIA

The service accepts referrals for children and young people up to their 14th birthday if they meet the following criteria:

DEPRESSION

• Where the difficulties are beyond age-appropriate mood variation.

• Where there isanimpact on daily living - e.g. sleeping, eating and/or school attendance.

• Where there is positive family history of mental illness or suicidal ideation.

SELF-HARM

• Where there is concern about self-harrn inthecontext ofother difficulties.

• Overdose cases should be sent directly to the Southampton General Hospital or local District General

,

.

Hospital for immediate medical care. They should NOT be referred to the Child and Adolescent Mental Health Service.

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ANXIETY

• Where itis affecting thechild's development or leveloffunctioning.

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Where it is outof proportion to the family circumstances.

• Where there is an impact onthe parentlcarer/child relationship.

T'. Where there isa sudden change or deterioration.

OBSESSIONAL-COMPULSIVE DISORDER

PJease consider anearly referral if the symptoms are interfering with the child's functioning.

1-PSYCHOSIS

f}efer immediately tothe Child andAdolescent Mental Health Service, including those secondary to substance

misuse.

E

A

TlNG DISORDERS

• Please consider an early referral tothe service where there aresymptoms ofanemerging eating

disorder.

• It ishelpful tocomplete medical investigations (bloods, weightlheight, etc) viathe GPprior to referral.

COMPLEX DEVELOPMENTAL PROBLEMS

Difficulties may include:

• Impaired social communication.

~... Unusual or very fixed interests.

• Marked preference for routine anddifficulties adapting tochange or rigid behaviours.

',' • Hyperactivity, impulsivity, inattention inchildren that is unresponsive to behavioural intervention in the

home and school.

There is currently no service for children with severe learning disabilities within CAMHS.

FAMIL Y DIFFICUL TIES

R'. Children andyoung people may present with emotional and behavioural difficulties in response tofamily

rr'· stress - e.g. parental discord or separation. Ifreferrers are aware of these issues, please be aware that

parents should be encouraged to make efforts to resolve problems prior toreferring the child.

CA. The Child and Adolescent Mental Health Service should not beused tosupport children insituations

where problems need to be resolved byparents. More appropriate support can beobtained from other

agencies - e.g. Mediation Service andRelate. The service will not be involved inany legal issues in

relation to parental separation. Solicitors should commission reports for court from professionals who

work onaprivate basis.

'f}OMA TOFORM DISORDER

Where a child isexperiencing significant impairment of function that may berelated to psychological difficulties.

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RESPONSE TO BEREA VEMENT

You may want to consider referral when the child is experiencing significant distress following a death that has

occurred within traumatic circumstances (e.g.suicide), oran abnormal grief reaction. Inthese cases we may choose to meet carers without the child to offer them advice and support. It is notappropriate to refer when this

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POST-TRAUMATIC STRESS DISORDER

Where a child continues to demonstrate hyper-vigilance, avoidance, flashbacks, or amarked increase in

~nexplained temper tantrums orepisodes of other distress.

SCHOOL REFUSAL

Itwould be most appropriate to refer a child inthe first instance tothe Education Welfare Service, however, refer to CAMHS when the following conditions apply:

When there is severe difficulty in the child attending school, often amounting to prolonged absence and where

the child is experiencing severe emotional upset on being faced with the prospect ofattending school. Thismay bedemonstrated by excessive fearfulness, anxiety, temper, misery and complaints offeeling unwell without

obvious cause.

COMPLEX ENURESIS OR SOILING

'(. In the first instance the specialist community constipation clinic or paediatrician should seethese

oc children.

c. • Werecommend referrals to come from the specialist within these clinics.

.)

ItisNOTappropriate to refer:

,.; • Children and young people whose problems are primarily school-based (refer to school concerned).

v~ • Children and young people where the behaviour, although challenging, isage-appropriate.

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With acknowledgement to:

The Battenburg Clinic, Portsmouth Primary Care Trust.

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AND ADOLESCENT MENTAL HEALTH SERVICE

SPECIALIST CAMHS

This example of what makes a good referral was taken from Cooper et al (2005) Child and Adolescent Mental

Health Theory and Practice. Edward Arnold, London. It shows the sort of information that a Tier 3 CAMHS

would consider makes a good referral and lists referral criteria. It was used by Ashurst Hospital Tier 3Service

who provide aCAMHS service for children aged 0-14 years of age (and their families and carers), who have

highly complex or severe mental health problems.

WHAT MAKES A GOOD R

E

FERRA

L

?

General Considerations

• Itisimportant that you have met with the parent(s)/carer(s) andthe referred child/children.

• Itis essential thatthe referral to our service has been discussed with the parent(s)/carer(s) and the

referred child/children and they are in agreement with the referral being made.

Basic Information

• Name and date of birth ofreferred child/children.

( • Address and telephone number.

• Who has parental responsibility?

• Surnames if different to child's

c,

C • GP details

i-'{r;

~fi!ason for referral

",vi'. What are the specific difficulties that you want our service toaddress?

h'. How long has this been aproblem and why is thefamily seeking help now?

• Your understanding of the problem / issues involved.

X;;rther helpful information

r- • Who else is living at home and details of separated parents if appropriate.

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• Name of school.

• Who else has been oris professionally involved andin what capacity?

• Hasthere beenany previous contact with ourservice and what was the outcome?

• Any relevant history, i.e.family, life events and/or developmental factors.

h. Is the child 'Looked After' by the Local Authority?

• Is the child on the Child Protection Register?

1{~yOUhave any queries regarding referral tothe service please contact the team.

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PROTECTION

.If-you are concerned that a child is at risk of harm from physical, sexual or emotional abuse, you must refer to

Social Services in the first instance, specifying your concerns. All referrals toSocial Services should be made in

writing, or if made bytelephone, should befollowed up inwritlng.

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Consultation

1--I

Meetings

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School! home vsits

I--Paper Referral Form (e.g. from teacher, school nurse et c)

TIER 1

~ CAMHS

Primary Mental

I...

1

Health Team

TIER2

CAMHS Referral Pathway

CAMHS Referral

.---_----"~L---, Meeting ~

Not taken up Refer on to other Agencies

Emerging mild! moderate. Less than

18 months duration I Complex! Serious! Chronic Clinic Specialist Team TIER3 Simple Phobias Anxiety

Emotional! Behavioural problems School issues! refusal

Mild Self-harm Loss

Mild! Moderate eating disorder

Attachment disorders ADHD

Severe depression Major trauma

Risk of suicide! high risk DSH Suspicion of psychotic disorder Moderate! severe eating disorder Complex emotional! behavioural problem

Consultation, Short term work (max 6 sessions), Joint - work (Multi-professional), Group! family work

Consultation, Individual, Specialist (e.g. psychiatrist), Group! family work.

1

Review, Closure or Transfer to Tier 3

Review, Closure or

Appropriate Prima

ry

Mental Heath Trust Referrals

Cases appropriate for intervention from PMHT:

• Less complex mental health problems, e.g.

o Mild anxiety

o Moderate self-esteem issues

o Mild depression

o Adjustment problems following divorce 1loss 1bereavement.

o Early signs of Phobia, QCD, PTSD.

o Disruptive behaviour in school 1other setting where

neurodevelopmental issues are not apparent at assessment.

• Where time-limited intervention appears appropriate.

• Where referrer is not the GP or where the family identify a front-line

professional who is already closely supporting the family (PMHT can then

provide consultation to the professional concerned).

• Where a network meeting is the most helpful way of supporting the child 1

young person and where substantial additional input is not needed for the

child or family.

Other services PM HT can offer:

• Information to professionals (e.g. assessment clinicians about local

services available in the locality - alongside resource files that are being

assembled at present).

• Home visits and appointments in the locality (at schools 1at health centres

etc).

• Consultation to professionals already involved with the family.

• Training to tier 1 staff.

Points to consider:

• It is not appropriate to give the PMHT telephone number to families who

may need additional advice following the initial assessment appointment.

If itis unclear whether people will need additional support, please use the

"leave the case open for 3 months" option and askthe family to contact

• PM HT have more flexibility to offer home visits and attend network

meetings. This does not mean that they are the only clinicians able to do this and PMHT involvement should be about early, brief intervention and

CAMHS work with:

Action for Carers provide support for and training for carers in Surrey. Tel: 01737277757. [email protected]. They run the Surrey Young

Carers Project, Tel: 01737248111. [email protected]

Attention Deficit Hyperactivity Disorder (ADHD) parent support groups.

CAMHS assists parents in who have children with ADHD

Childline is a free confidential support service for children. It provides leaflets and advice. Tel: 0800 1111. www.childine.org.uk

Connexions. The Surrey Peer Support Project is an example of CAMHS work

with Connexions. The Project provides anearly intervention service for young people in secondary school education based around peer support. The

Surrey Peer Support Project, Tel: 01483458664.

Cruise Bereavement Care is a charity providing support for carers and children who have experienced bereavement. Tel:0208 939 9530. www.rd4u.org.uk. [email protected]. Young persons free phone: 0808 808 1677

Drug and Alcohol Action Teams. Surrey Young People's Services (SYPS) is

Surrey's drug and alcohol intervention team. They provide drug advice,

counseling, drug therapies and aftercare packages for young people aged under 19. They also run music graffiti and design workshops. Tel: 01737773482. They have a staff member dedicated to CAMHS work. www.surreydat.org.uk

East Surrey Domestic Violence Forum is an outreach service who offers

confidential listening, practical advice and support for those suffering domestic violence. Tel: 01737 771350. Email: [email protected]. www.esdvf.org.uk

Family Information Service is an internet, telephone and outreach service giving parents and prospective parents information about all services for children aged 0-19 years (up to 25 years for children with special needs). Tel: 0300200 1004.www.surreycc.gov.uk/fis

Family Line provides a one-to-one telephone service for anyone with family concerns. Tel: 01306743233, Helpline: 0808 800 5678. www.familyline.org.uk.

Gingerbread provides help and advice for lone parents and their children. www.gingerbread.org.uk. TEL: 08000184318

Heads Together offers a professional counseling service for young people aged

14 - 24. Tel: 01737378481. [email protected]

Healthy schools. This whole school improvement programme promotes the health and well being of pupils and staff; through the development of personal,

social, health education, healthy eating, physical activity and emotional health and well-being (including bullying)

The Hideout is a website offering support to young people living with domestic

abuse. www.thehideout,org.uk/

Home Start offer support and friendship for parents through home visiting, family

and specialist groups and social events. Tel: 01737770220

It's not your fault is a website for young people who are worried about their

parents splitting up.www.itsnotyourfault.org.uk

Jigsaw Bereavement Service offers training advice and support for families and

clinicians. Tel: 01342313895

Kidscape helpline for parents and relatives of bullied children. www.kidscape.org.uk. Tel: 0845205204

Mental health work in youth offending. There are two dedicated mental health

workers in this team

National Autistic Society (NAS) EarlyBird Programme is for parents of

children under five with a diagnosis of autistic spectrum disorder. It is times a three month programme, one day a week working with six families at a time. Tel: 01737 737979

National Children's Home's Family First Service works with children and

young people with services for children with disabilities, family and community services work with young people leaving care and rural children's services.

CAMHS has a mental health worker in this team

NSPCC After Sexual Abuse Project (ASAP) offers a therapeutic service to help

children and young people who have experienced sexual abuse. Tel: 01372 375372. Email [email protected]

National Youth Advocacy Service (NYAS) provides a voice for young people

who use CAMHS

Parenting education and support offers a range of educational and supportive

measures to help parents understand their children's health and development needs. Parentline Plus www.parentlineplus.orq.uk. Tel: 08088002222

Partnership with parents provides support for parents of children with

suspected or diagnosed special educational needs. Tel: 01737737300. Email [email protected]. www.pwpsurrey.org.

Rainer 16 plus offers support to young people who are leaving care. CAMHS

Rethink - At Ease provide information about mental health problems. Tel: 02073 309100. Email: [email protected]. www.rethink.org/at-ease

Rape and Sexual Abuse Support Centre (RASASC) provides counselling for

young people who have experienced rape or sexual abuse. Tel: 01483546400

RU OK? is a self-help website for teenagers, parents and carers and

professionals. www.areyouok.org.uk

Samaritans is a 24 hour service offering confidential emotional support to

anyone who is in crisis. Helpline: 08457909090. www.samaritans.org

Social Services. Tel: 01737778675. Emergency duty team (after 5pm or

weekends): 01483563317

Studio Centre support for children and parents living with a child with ADHD.Tel: 01306 712300

Surrey Drug Care provides drugs information for parents and carers. Tel: 01483

300112. www.surreycafis.org.uk/

Surrey Family Mediation Service is a child counseling programme for children

faced with parental separation Idivorce. Tel: 01306741777. [email protected]

Surrey Young Peoples Service provides drug advice and care packages for

under 19's. Tel: 01737 773482

Teenage Health Freak is a website with information, stories and advice for teenagers on health issues. www.teenagehealthfreak.com

There 4 Megives 12 to 14 year olds advice about bullying, relationships, exams,

drugs and difficulties at home. www.there4me.com

West Surrey Youth Counselling Service provides free and confidential

counselling for people ages 12 to 24 years. Tel: 08456002516

Winston's Wish supports bereaved children and young people through home

visits, residential weekends, social activities and support programmes. Tel: 01452394377. [email protected]

Young Minds provides leaflets and help for parents and young people

concerned about mental health issues. www.youngminds.org.uk. Tel: 08000182138

Youth Access puts young people in touch with local contacts for counselling,

Youth Counselling Service. This service offers free and confidential one-to-one counseling for people aged 12 to 24 years, on a short-term basis to address a broad range of issues. Young people can self refer to this service. This service operates across West Surrey. Tel: 08456002516. The voluntary organisation Heads Together operates a similar service in East Surrey. Tel: 01737378481 Youth in Mind is a website with information for young people on stress,

emotional and mental health. It has a good booklist. www.youthinmind.com/eng/ YMCA offer exclusive playschemes (Yippee) for young people aged 5-15 with complex special needs or disabilities: Tel: 01737 779979.

[email protected]. At Guildford YMCA there is also an open house counselling service for young people

Leaflets of the services that work

with CAHMS

Please help yourself to the photocopies

of the leaflets

•

Useful

contacts

•

What is

CAMHS?

•

Action for Carers

(support and training for carers in Surrey)

•

Surrey Young Carers

(support for young carers in Surrey)

•

Connexions

(advice for young people on education,

employment, training and choices)

•

Cruise Bereavement Care

(support for young people who

have experienced bereavement)

•

East Surrey Domestic Violence Forum

(listening

,

support and

advice for those suffering bereavement)

•

Family Line

(one-to-one telephone line for family concerns)

•

Heads Together

(counselling service for 14-24 year olds)

•

Home Start

(support and friendship for parents)

•

Jigsaw

(bereavement support)

•

NAS EarlyBird programme

(support for parents of autistic

children under five)

•

.

Partnership with parents

(support for parents of children with

special needs)

•

RASASC

(Rape and sexual abuse support)

•

Surrey Family Mediation Service

(child counselling)

•

Surrey Young Peoples

Service (drug advice and care

packages)

•

Winstons Wish

(support for bereaved

·

children)

•

Yippee

exclusive playscheme (for children aged 5-15 with

complex special needs or disability)

If you would like further copies of any leaflets in this file

please contact

Graham Pritchard

at Redhill CAMHS:

Tel: 01737 287002

Kingsfield Centre

Philanthropic Road

Redhill

Surrey

RH14DP

USEFUL CONTAC

T

S

SINGLE PARENT FAMILY SUPPORT

www.oneparentfamilies.orq.uk offers support and advice to single parents. They also have aphone helpline 08000185026

Single Parent Action Network (SPAN) aims to put single parents in touch with each other via the social networking area on its website (www.singleparents.org.uk) and offers its parenting service at

www.onespace.org.uk

SUPPORT FOR DADS

OadTalk isan online community encouraging allfathers, especially those with teenagers, todo just that, w'/w.dadtalk ..co.uk

www.dads-space.com specifically targets separated fathers, and provides an online space where they can

stay incloser touch with their children.

SUPPORT FOR MUMS

The Netmum's organisation www.netmums.com puts mothers in touch with other mums in their locality, and also with health visitors, who can help with post-natal problems and issues linked to childcare.

CHJLDREN'S MENTAL HEALTH

Young minds vlww.youngmindsora.uk offers a free service to anyone concerned about the mental health ofa

young person, whether caused bybereavement, depression, eating disorders, self-harming or a diagnosed mental health problem. Tel 08000182138

TEENAGE ISSUES

www.gotateenager.org.uk aims torecreate the"school gate" community thal parents lose when their children move on from primary school.

DISABILITIES

www.caramily.ora.uk has lotsofinformation for the parents ofdisabled children, and links them upwith other

rnums and dads who are inthe same position.

SCHOOL RELATED PROBLEMS

The Advisory Centre for Education www.ace-ed.org.uk will offer independent advice toparents on allaspects

ofthe education system, such as admissions, bullying and discrimination. Call 0808 800 5793 Stress

between parents can easily impact onprogress atschool. Relate haslaunched two new initiatives - one online andtheother using text messaging to allow parents toget help quickly w\A/W.relateforparents.org.uk