Information for professionals
The Croft Child and Family Unit is a 12-bed unit providing in-patient psychiatric services for children aged 0-12 years and their families. We are the only provider of Tier 4 Child and Adolescent Mental Health services for children in the region. We are a 7 day service. We also provide a day patient service to local children who do not require the in-patient facility. Most admissions are for a time limited period of six to eight weeks although some children will need a longer therapeutic admission.
The unit provides an assessment and treatment resource for children with complex developmental/psychiatric disorders or children presenting with severe emotional and behavioural problems. We also provide intensive support for parenting and parenting assessments if needed.
We usually admit children with their parent/carer and sometimes with other family members depending on family circumstances and clinical need. We encourage parents and other family members to participate in the programme as much as possible. Older children can stay on the unit on their own, but this is usually after a period of time residing with a parent. We also provide a day patient service for children who live locally and do not require 24-hour treatment or observation. The Croft is located on the Ida Darwin site in Fulbourn near Cambridge.
Who can refer and why refer
The Croft accepts referrals from:
Child and Adolescent Mental Health (CAMH) teams (referrals need to have been discussed with and agreed with the team consultant CAMH psychiatrist)
Other specialist health paediatric teams as long as the referral has been discussed with, and is supported by the local community CAMH service and there is an allocated CAMH care coordinator who can attend regular care planning meetings during the admission and who will coordinate post admission contact with the community CAMH team if needed.
Reasons for referral
Assessment of children with complex presentations - eg, co-morbid physical disorders, complex psychosocial situations, etc - where outpatient assessment has proved inconclusive or additional information is required.
Children requiring specialised treatments under close observation - eg, medication or behavioural modification.
Children requiring assessment or treatment away from the home environment - eg, psychosomatic disorders.
Children with severe mental health problems associated with significant risk or where their illness is signficantly affecting their development - eg, children with eating disorders who are physically compromised, or children with depression leading to social withdrawal and lack of access to education.
Children who need intensive mental health support for rehabilitation
Assessment of parenting capacity for parents with mental illness.
In addition we have developed special expertise in the assessment of pervasive developmental disorders (Autism and Asperger Syndrome) and we receive referrals from around the eastern region for assessment of children where this is a possible diagnosis.
We are always happy to discuss potential referrals on a case by case basis.
From their initial assessment the waiting time before a child is admitted to the Croft will normally be up to 18 weeks.
How to refer
The Croft encourage services thinking of making a referral to contact us directly on 01223 534500 to discuss the potential referral.
The Croft Child and Family Unit is a nationally commissioned specialist service. This means that we are one of a number of services around the country that provide inpatient mental health care and treatment for children. All of these services are commissioned through NHS England rather than through local health commissioners (CCGs) although this may change in the future.
Referrals are made by completing and submitting the national referral form (see foot of page for link) into inpatient services for children and young people. This form should be sent to the Croft team via email: cpm-tr.CPFT-Croft@nhs.net The form should also be sent to the appropriate national commissioner case manager. The Croft team are happy to discuss any potential referrals by phone prior to referral for advice.
If a child 12 or under urgently needs admission then referrers are encouraged to use the national bed finding website to identify a unit which has a bed available. For urgent referrals to our service we request that the referring clinician calls the unit directly (01223 534500) to discuss the referral as well as sending the national form. If a senior clinician is not immediately available to discuss the referral they will return the call within 4 hours.
CAMHS Tier 4 Bed Availability System can be found here: www.camhsbedavailability.nhs.uk
Assessment and therapies
The Croft uses a range of therapies and assessment strategies in supporting children and helping their development, including the following:
This therapy uses techniques to encourage desired behavious and discourage undesired behaviours. It involves the use of carefully chosen rewards and consequences to help shape a child's behaviour.
This is an approach that tries to understand how a child's difficulties connect with the people in his/her life. These can include parents, carers, siblings, wider family, friends and school, etc. Understanding the ways in which the relationships connect can be helpful for all those involved. Family therapy usually involves children being seen with their parents together with their brothers and sisters.
Once a week parents meet to explore and understand their own past and current difficulties and how they may impact on their parenting. The group allows parents to feel supported by other parents who share their experience, and helps to make them feel less isolated.
The music therapist works at The Croft for two days a week. Individual sessions, group sessions and sessions for children and their families are offered as part of this service. The music therapist uses his/her musical skills and knowledge of music to establish musical interactions with children and families. These musical interactions may shed new light on the children’s and/or the families’ strengths and difficulties. Music therapy diagnostic assessments can assist the team in assessing children or families. Short-term music therapy treatment may be able to address some of the difficulties a child or a family may be experiencing.
The dramatherapist is on the ward for 13 hours per week. It is an activity-based therapy which uses various creative methods to explore issues. It is also a strength-based method which enables children or their parents find helpful qualities in themselves that they may have forgotten about or that have been hidden. A weekly parent group, individual sessions for children and parents and dyadic work is offered. The parent group is a space for parents to gather together and use creative activities offered by the dramatherapist to reflect on themselves. Parents usually find the group helpful to build their resilience and sometimes to just have fun together. The families at the Croft are often in crisis and the relationship between parent and child compromised. The dramatherapist uses her specialist knowledge of play to plan interventions to work on exploring and improving the connection between parent and child through various dramatherapy tools and techniques. Often children can struggle to communicate. Dramatherapy interventions provide alternative ways for the child to relate and also help the parent understand their child’s presentation.
In this technique, children are presented with a range of different family scenarios as the beginnings of a story, using doll and animal figures as well as language. The child is then invited to complete the stories in whatever way they like. This allows assessment of the child's expectations and perceptions of family roles, attachments and relationships, without asking the child direct questions about their family which might cause them conflict and anxiety. It also has the advantage for younger children of allowing both verbal and non-verbal means of representation.
Autism Diagnostic Observation Schedule (ADOS)
The Croft uses ADOS to provide accurate assessment and diagnosis of autism and pervasive development disorders in children related to their age, development level and language skills.It consists of four modules each requiring 35 to 40 minutes to administer. The child being evaluated is given just one module depending on his or her expressive language level and chronological age.
Autism Diagnostic Interview (ADI)
The Autism Diagnostic Interview is a structured interview conducted with the parents of children who have been referred for the evaluation of possible autism or autism spectrum disorders. The interview measures behavior in the areas of social interaction, communication and language, and patterns of behaviour.
Wechsler Intelligence Scale for Children (WISC-IV)
WISC is an individually administered intelligence test for children between the ages of 6 and 16 that can be completed without reading or writing. The WISC test takes 65–80 minutes to administer and generates an IQ score which represents a child’s general cognitive ability.
The Croft provides an independent advocacy service for patients. Its aims are to:
Safeguard the rights of service users
Empower service users to make informed decisions about their care and treatment and to take greater control over their lives
Support service users to get their views heard
Represent the views of service users as if they were their own if the service user wishes it
Support service users in seeking resolution to issues which concern them
Protect service users who are particularly vulnerable for reasons of their illness or lack of capacity to make informed decisions
Feed back issues raised by service users to those providing and commissioning services so that services can be constantly improved .
Advocacy is provided by NYAS and it can be contacted at email@example.com or through its website www.nyas.net. It provides a direct service to children, but will help parents find their own advocate if requested to do so.
Service evaluation and parent/patient involvement is prominent within the culture of our service. We evaluate our service in many different ways, including: questionnaires, groups and through informal conversations with our families.
An annual report (which can be made available upon request) provides a section on service evaluation and patient/parent experience. Below is a summary of some of the main findings from the annual report, completed for the reporting period 1st April 2019 – 31st March 2020. A poster summary of the Annual Report can be found linked at the bottom of this page.
Families (parent/carers and children) complete either a monthly ‘Experience of Service Questionnaire (ESQ)’ covering the following areas: care and welfare, nutritional needs, respect and involvement and additional support, or a ‘Carer Survey’ (parent/carers only) which covers 5 important areas of carer involvement.
- 21% of families agreed that this is a good ward for their friends and family to be looked after by if they needed similar care or treatment to them. No families reported that it is not a good ward, but 13.69% were undecided.
- 07% of responders rated their overall care as Very Good, and 17.24% as Good, 6.9% as Fair. No one reported their overall care as poor, representing the high level of care delivered at the Croft.
- The combined satisfaction percentage from all ESQ’s submitted in this period was 15%.
- The combined satisfaction percentage from all Carer questionnaires submitted in this period was 64%.
- The results of the ESQ and Carer Survey highlight that families have a high level of satisfaction in the care they receive at the Croft, with only 2 areas falling below the expected satisfaction value.
On the week leading up to discharge, young people and their parent/carers are asked to complete an exit survey about their experience of service.
- The exit survey for parent/carers was revised in October 2019, to include more quantitative data which can be looked at and to ask for families opinions on the Crofts Family Model.
- Parents primarily report high satisfaction with the service they have received in all areas.
- The data collected from the older child feedback shows that all the children found it difficult at times at the Croft.
- Although none of the children reported always enjoying their time at the Croft, 3/5 reported finding it helpful.
- 4/5 children understood why they were there and felt that their views were listened to.
- The surveys completed by younger children showed very dissimilar experiences of the Croft. Different experiences of the service are to expected due to the diverse range of children and difficulties, however it is important to hear the views and voice of the younger children during their stay at the Croft.
If parents/carers give permission on discharge, a 6 month follow up questionnaire is mailed. Return rates are low, however it gives us an understanding of how some of our families manage after discharge.
Further Patient and Parent/Carer Involvement in Service Evaluation
- A monthly “Have your say” meeting with all young people and the advocate, where they can raise worries, concerns, ideas or suggestions about the way the service operates. Engagement in this group has been minimal, however, the Head of Patient and Parent Involvement regularly visits the unit in between meetings for the young people and parents to talk to if needed.
- A weekly ‘coffee group’ for parents to spend time off the unit with other parents and staff, where they can also raise worries, concerns, ideas or suggestions about the way the service operates. Feedback by the parents is acted upon an communicated back through a ‘You Said/We Did’ document put on display in the communal area.
- 1-1 Advocacy
- Service Design & Development, including parent involvement in staff interviews.
- The introduction in the GDPR ‘consent to contacts’ so that families can be contacted for involvement opportunities and feedback in the future.
Comments about the Crofts Family Model
- 71% of families report that they would not have accepted the admission to the Croft if they were not able to stay residentially too.
“I feel that this is a fundamental positive attribute of the Croft, encouraging involvement, parent/staff partnership and empowerment. Also, reduce child’s anxiety about coming to the Croft.”
“Very positive, encouraging involvement, parent/staff partnership and empowerment and providing a shared experience with child/others. Also very helpful to have this option from a logistic point of view, which could otherwise cause stress.”
“Very pleasant, warm environment (once acclimatised) with well-designed living and kitchen spaces. Good consideration shown to non-resident siblings, finding opportunities to involve them during a difficult time for them too.”
“I have learnt so much from the staff. We have been on a journey as a family and I’ve felt included every step of the way. We are leaving stronger and more connected as a family”
“The parenting groups were great, both for helping me as a person and in my role as a mother. My other children have also been made to feel very welcome when visiting”
Other feedback from Parents of the Croft can be found here
As well our own internal service evaluations, we are annually reviewed by the Quality Network for In-patient CAMHS (QNIC) and monitored by OFSTED.
The Croft is linked to the University of Cambridge Department of Developmental Psychiatry and has participated in research looking at the genetic basis of Autism Spectrum Disorders. We have been involved in a Department of Health audit of the role of child and adolescnet inpatient services. We have hosted research projects on the unit looking at the role of music therapy in the assessment and treatment of children with Autism Spectrum Disorders and the psychotherapeutic understanding of emotional recognition and regulation in children with Autism Spectrum Disorders.
Between 2000 and 2003 a major research project was undertaken at The Croft, looking at music therapy and children on the autistic spectrum. Included in this research was an evaluation of the individual music therapy diagnostic assessments carried out with thirty children at The Croft.
Holmes, J, Oldfield, A. and Polichroniades (2011) 'Creating Change for Complex Children and Their Families: A Multidisciplinary Approach to Mulit-Family Work.', Jessica Kingsley Publications.
This book, written by the Croft team, describes the work of the unit and in particular the multi-disciplinary family-based model of care that the Croft team has developed, and offers suggestions for all professionals working with children with complex needs.
Using detailed case studies to illustrate the model, the book focuses on the needs of children with a wide range of developmental, emotional and behavioural difficulties, and explores the complicated interactions between these children their families and their communities. Based on the clinical experiences of working intensively with groups of families, the team examines how to integrate multi-disciplinary interventions and how to use the powerful relationships that develop to enable families to achieve positive, lasting changes.
Jo Holmes has been the Medical Director of the Croft for more than 12 years. She undertakes specialist assessments of children relating to autism spectrum disorders, attachment disorders and other conditions. Amelia Oldfield is a music therapist at the Croft and has worked in child and family psychiatry for more than 20 years. Marion Polichroniadis was formerly a consultant clinical psychologist and has more than 30 years’ experience in a range of settings, including education, child development centres and child and adolescent mental health services.
The book is available from Amazon through this link: http://www.amazon.co.uk/Creating-Change-Complex-Children-Families/dp/1843109654
Publications on music therapy work at The Croft include:
Carter, E. and Oldfield, A. (2002) ‘A Music Therapy Group to
assist Clinical Diagnoses in Child and Family Psychiatry’ in: Davies A and Richards E (eds) Group Work in Music Therapy, London, Jessica Kingsley Publications.
Oldfield, A. and Bunce, L. (2001) ‘Mummy can play too… - Music Therapy with Mothers and Young Children’, British Journal of Music Therapy. Vol 15, no 1 pp. 27-36.
Oldfield A. (2000) ‘Music Therapy as a Contribution to the
Diagnosis made by the Staff Team in Child and Family Psychiatry – an Initial Description of a Methodology that is still emerging through Clinical Practice’ in: Wigram T. (ed) Assessment and Evaluation in the Arts Therapies, St Albans, UK: Harper House Publications, pp.93-101.
Carter, E. (2002) ‘Playing our part; the role of a music therapy group as an aid to diagnosis.’ paper given at World Congress of Music Therapy, Oxford 2002.