Rejected referrals to child and adolescent mental health services: audit

Appendix Two: Rejected referrals Topic Guide for focus groups and depth interviews

Introduction (10 mins)

• By moderator
• Name, organisation, short intro to SAMH
• Reminder that you are acting as a researcher today
• Introduce any colleagues viewing / note taking
• Housekeeping: fire alarms / process, toilets, what to do if you want to leave the session

Explanation of purpose of session or interview

• To understand what happens when young people are referred to Child & Adolescent Mental Health Services but do not receive treatment / support from them
• Collecting experiences of young people and their families for a report to Scottish Government.
• Aiming to gather feedback on 350 cases where young people have been in this situation.
• Our aim is to improve the experience of young people (and their families) who are referred to Child & Adolescent Mental Health Services

Introduction to the format of the session

• Around 1 hour
• Group discussion, rather than individual Q&A
• Share experiences in confidence

Explanation of research and group discussions

• No right or wrong answers
• Everyone’s views are important, please don’t be afraid to speak up
• If you are upset or need to leave the focus group please let a member of SAMH staff know, who can assist you

Reassurance over confidentiality and MRS Code of Conduct

• We will not disclose any of your details
• We will anonymise all of our reports
• We will only use the information you provide for the purpose of this research
• Child Protection Statement: The only exception to this is if anyone divulges information during the discussion that indicates a child is in a situation where there is an immediate risk of harm. In that case I have a duty of care to pass this information on to local child protection services.
• Explanation of recording – audio recording – to ensure we correctly capture the detail of what we are being told. This will be transcribed and analysed for use in our report.
• Individual introductions:
  - First name, age, who you live with, what you do for a living/with your time, your favourite film / band / song?

Being Referred (15 mins)

Let’s talk first of all about the process of being referred to Child & Adolescent Mental Health Services. Everyone should have already filled in the short questionnaire about the reasons for referral, so I’d like to focus on talking about your experience of the process…

• Who did you approach to help?
• Who suggested a referral to CAMHS?
  - PROMPTS: young person, family member, GP, teacher, someone else
• Why was a referral to CAMHS suggested?
• How long did you have to wait for a referral?
• What were your expectations at that stage?
  - PROBE: timescales,
• What information were you given?
• How well did you understand the process / what would happen next?

Being Assessed (15 mins)

• How long did you wait for an assessment?
• What support, if any, were you offered during this time?
• Did you take any action whilst waiting for your assessment?
  - PROMPTS: chase the referrer, look for information,
• How did you feel during this time?
• What impact, if any, did the waiting time have on you and your family?
  - PROBE: emotional, behavioural, impact on condition, impact on family life etc
• What did you think of the assessment process?
• What information were you given during / after assessment?
• How well did you understand the process / what would happen next?

Being Rejected (20 mins)

• What happened next?
  - NOTE language used to describe ‘rejection’
• How did you find out that your referral had been rejected? Who told you?
  - PROMPT: Letter from CAMHS, told by referrer ( GP, teacher etc)
• What reasons were you given? What did the letter / referrer say?
• Did you understand the reasons given?
• How did you feel about it?
• What impact did it have on you and your family?
  - PROBE: emotional, behavioural, impact on condition, impact on family life etc
• Were you referred / recommended to contact another service?
  - IF YES: which service?
  - Did you contact the service yourself?
  - Did you get help from this service?
• Did you get help / support elsewhere (for example from a different service that you found out about through another channel)?
  - IF YES: which service?
• How did you find out about this service?

Sum Up (5 mins)

• Overall, how do you feel about the CAMHS referral process?
• What do you think could be improved?
• What, if any, type of support would have helped while you were waiting during the process?
  - IF NOT ALREADY MENTIONED: Did you get any support? Where from?
• What do you think are the most important points for SAMH to take to the Scottish Government about the CAMHS referral process?
• Any final comments?

Thank & Close