Evaluation of referral trends for the
LTHT Multi-Specialism Paediatric
Psychology Service
Catherine Wintermeyer
Commissioned by Dr Sara Matley and Dr Amy Naylor
Prepared on the Leeds D.Clin.Psy. Programme, 2019 2
1. Introduction ................................................................................................................... 3
1.1. Background ............................................................................................................ 3 1.2. CYP & Physical Health Problems ........................................................................ 3 1.3. Clinical Health Psychology & Paediatric Psychology Services.......................... 3
1.4. LTHT Paediatric Psychology Service .................................................................. 5 1.5. Leeds Multi-Specialism Paediatric Psychology Service ..................................... 5 1.6. Referrals to the LMPS ........................................................................................... 6 1.7. Rationale for Service Evaluation Project ............................................................ 7 1.8. Research Aims ........................................................................................................ 7
2. Method ........................................................................................................................... 8 2.1. Design ...................................................................................................................... 8 2.2. Data Cleaning ......................................................................................................... 8 2.3. Data Analysis .......................................................................................................... 9 2.4 Ethical Considerations ........................................................................................... 9
3. Results ............................................................................................................................ 9
3.1 Sample ...................................................................................................................... 9 3.2 Descriptive & frequency data .............................................................................. 10
3.2.1. Referral reason & whether this was accepted/rejected. ............................ 10 3.2.2. Referral department. .................................................................................... 12 3.2.3. Age of CYP referred. .................................................................................... 13
3.2.4. Reasons why referrals were rejected. .......................................................... 14 3.2.5. Time of year CYP referred. ......................................................................... 15
4. Discussion..................................................................................................................... 17 4.1 Key Findings .......................................................................................................... 17
4.1.1. Were there are any patterns in presenting concern in referral reasons? 17
4.1.2. Were there any patterns around referrals from different departments? 19 4.1.3. Were there any patterns in the ages of referrals? ...................................... 19
4.1.4. Were there any patterns in why referrals are rejected? ........................... 20 4.1.5. Time of year of referral. ............................................................................... 21
4.2. Key Recommendations ........................................................................................ 21 4.3. Strengths & Limitations ...................................................................................... 24
4.4 Conclusion ............................................................................................................. 25 4.5. Dissemination of results ....................................................................................... 25
References ........................................................................................................................ 26 Appendix .......................................................................................................................... 28
Prepared on the Leeds D.Clin.Psy. Programme, 2019 3
1. Introduction
1.1. Background
Leeds Teaching Hospital Trusts is one of the largest NHS Trusts in England, and
offers general and specialist hospital services (LTHT, 2019). Within LTHT, there is a
specialised Children’s Hospital. Leeds Children’s Hospital is one of the biggest UK’s
children’s hospitals providing support for a comprehensive range of specialist paediatric
services for children and young people (CYP) of Leeds and across the Yorkshire and
Humber region. The speciality departments include: ‘children's medicine and surgery,
gastroenterology, cystic fibrosis, respiratory medicine, hepatobiliary services, renal
medicine, neurosciences, paediatric critical care, neonatal services, oncology and
haematology, endocrinology, rheumatology, cardiac services, allergy, immunology and
infectious diseases and diabetes’ (LTHT, 2019).
1.2. CYP & Physical Health Problems
Between 10 and 30% of CYP are affected by acute or chronic physical illness or
physical health problems (BPS, 2019). Whilst many CYP and families cope well with
acute or chronic physical illness, for some CYP their health condition can affect their
emotional and social development and impact on their schooling and family life (BPS,
2019). CYP are more likely to successfully manage their health condition if their
healthcare addresses both their physical and psychological well-being (Jacobs, Titman, &
Edwards, 2012). CYP with physical health conditions are also more likely to experience
significant low mood, anxiety and psychological distress compared to their peers without
health conditions (BPS, 2019).
1.3. Clinical Health Psychology & Paediatric Psychology Services
There is an emerging evidence base for the clinical effectiveness of psychological
intervention in health care settings for a number of medical conditions and illnesses
(Jacobs et al., 2012). Government guidelines also recognise the importance of providing
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psychological support for CYP with physical health problems (BPS, 2019). The BPS
argue that good psychological services can be beneficial at every stage of the physical
health care pathway. Psychological input can be helpful at the diagnosis stage to make
sense of the condition and planning of care and can also be helpful in making sense of,
coping with and adhering to treatment plans (BPS, 2019; NES, 2019). Psychological
support can also be helpful for CYP, families and staff during hospital stays as
understandably this can be a highly distressing and anxiety provoking time.
Paediatric Clinical Psychology is an ‘established but expanding’ area for CYP
with physical health needs (BPS, 2019). Psychology services are increasingly considered
to be an integral and routine part of CYP’s medical care, rather than just part of crisis
management (BPS, 2019). Research suggests that psychological support can have a direct
positive impact on health outcomes, improving use of health care as well as increasing
treatment adherence and reducing psychological distress (BPS, 2019; NES, 2019).
The most prevalent model of a Paediatric Psychology Service is that they are
located within a specialist Children’s Hospital, with psychology input being part of care
pathways for specific multi-disciplinary health speciality teams, with some services also
providing generic cover across paediatric specialities (Young et al., 2008). Within
specialist hospitals, there are often differences in service provision for different physical
health conditions (both medical and psychological provision), challenging nationwide
and local NHS aims to provide equitable services (BPS, 2019; LTHT, 2019). NHS
England has moved to a model of devolving budgets to local Trusts, who then make
decisions on local service priorities, meaning that psychological input can often be
vulnerable to priorities of current leadership teams and commissioning, funding and
service pressures (Young et al., 2008). Some areas have guidelines and specifications to
provide psychological input such as Paediatric Oncology (NICE, 2014), Diabetes (NHS
England, 2013) and Cystic Fibrosis (Cystic Fibrosis Trust, 2011) which has therefore
increased psychological provision in these areas (Young et al., 2019). However, there are
other physical health conditions which have very limited or no psychological provision.
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1.4. LTHT Paediatric Psychology Service
Currently within LTHT, there are paediatric services that commission specific
psychology input for the following departments: Cardiology, Cleft Lip & Palate, Cystic
Fibrosis, Diabetes, Oncology, Neuropsychology, Pain, staff support for Neonates PICU,
Renal and Rheumatology departments. However, there are departments that do not
commission any psychological input into their teams.
The Leeds Paediatric Psychology Service provides for this commissioned
psychological input. The team is made up of Clinical Psychologists, Neuropsychologists,
Counsellors, and Assistant Psychologists. Trainee Clinical Psychologists from local
Doctorate of Clinical Psychology programmes and students on a placement year from the
University of Leeds also work with the team. The Leeds Paediatric Psychology service
provides support for CYP around their health condition, including managing diagnoses,
treatment and procedures and coping with their health condition (LTHT, 2019).
1.5. Leeds Multi-Specialism Paediatric Psychology Service
The Leeds Multi-Specialism Paediatric Psychology Service (LMPS) sits within
the wider Leeds Paediatric Psychology Service. The LMPS provides inpatient and
outpatient psychological input to any paediatric service within LTHT that does not have
commissioned input from a specific clinical psychologist. Therefore, referrals come from
consultants across different clinical areas which results in a large range of patients being
seen from across the Children’s Hospital.
The LMPS has been running in LTHT since 2003. The service was historically
structured so that once a referral had been received from a consultant, CYP were placed
on a waiting list and would be picked up for assessment and intervention by trainee
clinical psychologists on placement within the wider team and also newly qualified or
new members of staff also picking up a limited number of cases from the LMPS waiting
list. As the service was based on an unpredictable level of resource (depending on how
many, if any, trainees were on placement) the waiting times for CYP to be seen were
long, at one point waiting times were in excess of 12 months. A successful business case
Prepared on the Leeds D.Clin.Psy. Programme, 2019 6
to tackle these long waits was successful in creating a post for a designated Clinical
Psychologist for the LMPS and this role was taken up in December 2017 by a full time
Clinical Psychologist. Some CYP are still seen by a Trainee Clinical Psychologist.
1.6. Referrals to the LMPS
Referrals to the LMPS are accepted via letter or email from the referring
Paediatric Consultant and are discussed and allocated at a weekly referrals meeting.
Appropriate referrals are placed on the LMPS waiting list. If a referral does not meet
LMPS criteria or does not contain enough information in order to determine eligibility,
then the referral is rejected and sent back to the referrer. The aim is to offer patients first
appointments within 18 weeks of referral.
The ‘Inclusion criteria’ for the service details that the CYP must be:
under the age of 16 years old
receiving active treatment from a Paediatric Consultant at LTHT, for an acute or
chronic health condition
be presenting with emotional, well-being and adjustment difficulties around their
health condition or struggling to manage medical treatment effectively. (i.e.
emotional and behavioural problems not relating to a medical condition, and not
affecting treatment, should be referred by the medical team to locality services such
as CAMHS.)
The ‘Exclusion criteria’ for LMPS details that the referral will be rejected for the
CYP if they:
do not have a physical health condition. A clear medical diagnosis of difficulties is
required to access the psychology service.
are not under a LTHT consultant, or receiving active care from a LTHT consultant.
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do not medically need to be under LTHT review (e.g. consultant is keeping them
open to purely access psychology service)
have psychological difficulties not relating to medical condition/ treatment (e.g.
family separation, custody disputes, bereavement work, sleep difficulties, tantrums)
have psychological difficulties in the context of significant sexual or physical abuse
have Medically Unexplained Symptoms (MSU) referrals where medical
investigations are on-going and physical causes have not been ruled out. A clear
medical diagnosis of difficulties is required to access the psychology service.
have Chronic Fatigue Syndrome. Regionally commissioned MDT support for CFT
is based at Sheffield Children’s hospital.
have mental health difficulties such as self-harm or suicidal thinking at a level
which needs to be managed by CAMHS with access to psychiatry
have a condition where specific services have been commissioned regionally and
therefore are centres of expertise held outside LTHT. (e.g. Obesity - Watch it
programme)
1.7. Rationale for Service Evaluation Project
This service evaluation project (SEP) has been commissioned by the LMPS. The
LMPS are interested in exploring some of the patterns of referral trends to the service in
order to tailor the interventions provided as demand for the service has been increasing.
Referral information for the last 20 months has been routinely gathered on an electronic
database. This SEP will examine this referral database.
1.8. Research Aims
Using this data, the SEP will aim to explore whether there are any patterns in referrals
including around exploring whether there are any:
patterns in presenting concern in referral reasons?
- e.g. could identifying any patterns provide a rationale for specific
interventions, e.g. a therapeutic group?
patterns around referrals from different departments?
Prepared on the Leeds D.Clin.Psy. Programme, 2019 8
- e.g. do certain departments refer more patients? Can this inform the support
we offer to particular departments?
patterns in the ages of referrals?
- e.g. are children of certain ages more frequently referred? Do these patterns
coincide with any transitional phases for young people i.e. school transitions?
patterns in why referrals are rejected?
2. Method
2.1. Design
Referral information for the past 20 months has been routinely inputted by the
LMPS team into a customised Microsoft Excel 2010 spreadsheet database. Referral
information that has been inputted by the team includes: date referral was received,
referral information (e.g. which consultant and department the referral was from and
reason for referral), name of CYP, NHS number and date of birth, outcome of referral
(accepted or rejected) and if rejected, the reason why the referral was rejected. It was
agreed that this time frame and the amount of data collected was suitable to gain an
understanding of referrals and patterns for this SEP. A quantitative methodology was
chosen to answer the research questions and aims because of the amount of data collected
and because the aims of the LMPS were to explore this data, it was felt descriptive and
frequency statistics would be helpful to satisfy these aims.
In order to examine the customised Microsoft Excel 2010 referrals database and
any potential patterns in referrals:
2.2. Data Cleaning
Firstly, the database was cleaned and data were coded for the analysis stage. The
age of participants at their referral date was calculated from their date of birth. Referral
Prepared on the Leeds D.Clin.Psy. Programme, 2019 9
dates were also coded by month of referral. The reasons for referral were condensed for
analysis as were departments referring and reasons for not being accepted. This
condensing down was done with the commissioners of the SEP. Referral and rejection
reasons were coded by an overarching area of referral or rejection reason and some
departments were condensed into similar areas of speciality. Please see Appendix 1 for
the original referral reasons, referring departments and rejection reasons before
condensing.
2.3. Data Analysis
The referrals database was then analysed using Pivot tables in Microsoft Excel
2010 to gain descriptive and frequency statistics.
2.4 Ethical Considerations
Ethical approval was sought for this SEP and granted from the University of
Leeds SEP Ethics Committee on the 22nd November 2018. See Appendix 2 for a copy of
this approval email. Identifying details such as name and NHS number were deleted from
a copy of the database made for this SEP analysis before the researcher accessed this
database.
3. Results
3.1 Sample
In total, there were 225 referrals made to the LMPS between the 1st April 2016
and the 14th November 2018. 136 of the referrals were accepted, 89 referrals were not
accepted – therefore, 39.6% of referrals were rejected.
Information about the referrals that had been inputted into the dataset was almost
fully complete – there were only seven referral reasons that were listed as ‘unknown’.
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These referrals were still included and were coded as ‘no needs identified’ in the
condensed referral reasons.
3.2 Descriptive & frequency data
The following sections summarise the descriptive and frequency statistics from the
collected data:
3.2.1. Referral reason & whether this was accepted/rejected.
Figure 1. Overview of referral reasons and which reasons were accepted and rejected by
the LMPS.
Overall, the top five referral reasons were ‘impact of and/or coping with health
conditions’, ‘mental health’, ‘procedural distress’, ‘pain and headaches’ and ‘behavioural
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difficulties’. See Figure 1 for an overview of referral reasons and why reasons were
accepted and rejected by the LMPS.
The referral reason of ‘impact of and/or coping with health condition’ was
referred 96 times, constituting 42.2% of the overall referral reasons. When broken down
into accepted and rejected referrals, of those referrals accepted, ‘impact of and/or coping
with health condition’ reasons made up 50% of referrals and made up 30.3% of those
referrals reasons that were rejected. After ‘impact of and/or coping with health
conditions’, ‘mental health’ and ‘procedural distress’ were referred 23 times each (10.2%
of overall referral reasons). ‘Mental health’ reasons made up 5.9% of accepted referrals
and 16.9% of rejected referrals. ‘Procedural distress’ reasons made up 14.7% of the
accepted referrals and 3.4% of rejected referrals. ‘Pain and headaches’ were referred 16
times (7.1% of referrals) and were accepted 6 times (4.4%) and rejected 10 times
(11.2%). ‘Behavioural difficulties’ were referred 13 times and were accepted 6 times
(4.4%) and rejected 7 times (7.9%).
See Table 1 for numbers of referral reasons, referral departments and age of CYP
broken down by overall referral number, those accepted and rejected and corresponding
percentages.
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3.2.2. Referral department.
Figure 2. Overview of specialist paediatric departments referring to the LMPS.
The four highest referrers were neurology (53, 23.5% of referrals), dermatology
(33, 14.7% of referrals), endocrinology (25, 11.1% of referrals) and general paediatrics
(22, 9.8% of referrals). See Figure 2 for an overview of specialist paediatric departments
referring to the LMPS.
See Table 1 for numbers of referral reasons, referral departments and age of CYP
broken down by overall referral number, those accepted and rejected and corresponding
percentages.
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3.2.3. Age of CYP referred.
Figure 3. Overview of ages of CYP referred to the LMPS .
For ages of CYP referred, 12 year olds were the most referred (28 times, 12.4%)
with 8, 11 and 15 year olds being referred 22 times each (9.8%). There were 11 people
that were referred that were over 16 (4.9%) and, therefore, unable to access the service.
Excluding the clients that were over 16 when they were referred, the range of ages was
from 0-15 and the mean age referred was 9 years old. See Figure 3 for an overview of
ages of CYP referred to the LMPS.
See Table 1 for numbers of referral reasons, referral departments and age of CYP
broken down by overall referral number, those accepted and rejected and corresponding
percentages.
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3.2.4. Reasons why referrals were rejected.
Figure 4. Overview of why referrals were rejected by the LMPS.
Of the 89 rejected referrals, the top three reasons most reported for why referrals
were rejected were ‘difficulties not related to health condition’ 38 times (42.7% of
rejected rationales), CYP ‘over 16’ 12 times (13.5%) and ‘signpost to other LTHT
psychology speciality’ 11 times (12.4%). See Figure 4 for an overview of why referrals
were rejected by the LMPS.
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3.2.5. Time of year CYP referred.
Figure 5. Overview of time of year CYP were referred.
The month that received the highest number of referrals was March 2018 with 23
of the overall referrals. The lowest number of referrals in one complete month of referrals
was 4 referrals in September 2017. The average number of referrals per month was 11.25.
See Figure 5 for an overview of time of year CYP were referred.
Table 1. Numbers of referral reasons, referral departments and age of CYP broken down
by overall referral number, those accepted and rejected and corresponding percentages.
Referral reasons (RR)
Number of
overall RR
% of
overall
RR
Number
of
accepted
RR
% of
accepted RR
Number
of
rejected
RR
% of
rejected
RR
Allergies & food aversion 4 1.8 2 1.5 2 2.2
Bed wetting/soiling 3 1.3 2 1.5 1 1.1
Behavioural difficulties 13 5.8 6 4.4 7 7.9
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Bullying 6 2.7 4 2.9 2 2.2
Compliance 9 4.0 7 5.1 2 2.2
Concerns around
fabricated illness 1 0.4 - - 1 1.1
Impact of health condition
on mood & coping with
condition 95 42.2 68 50.0 27 30.3
Mental health 23 10.2 8 5.9 15 16.9
Neuro assessment 2 0.9 - - 2 2.2
No needs identified 10 4.4 1 0.7 9 10.1
Pain and headaches 16 7.1 6 4.4 10 11.2
Parental adjustment 8 3.6 7 5.1 1 1.1
Procedural distress 23 10.2 20 14.7 3 3.4
RTA 2 0.9 2 1.5 - -
Sleep 2 0.9 - - 2 2.2
Surgery build up 4 1.8 2 1.5 2 2.2
Tics and Tourette’s 4 1.8 1 0.7 3 3.4
Total 225 - 136 - 89 -
Referring departments
Number of
overall
referrals
% of
overall
referrals
Number
of
accepted
referrals
% of
accepted
referrals
Number
of
rejected
referrals
% of
rejected
referrals
A&E 3 1.3 - - 3 3.4
Allergies 16 7.1 12 8.8 4 4.5
Cardiology 2 0.9 - - 2 2.2
Community Paediatrics 2 0.9 - - 2 2.2
Dermatology 33 14.7 25 18.4 8 9.0
Endocrinology 25 11.1 15 11.0 10 11.2
ENT 2 0.9 - - 2 2.2
Gastroenterology 16 7.1 7 5.1 9 10.1
General Paediatrics 22 9.8 15 11.0 7 7.9
Gynaecology 1 0.4 1 0.7 - -
Liver 1 0.4 1 0.7 - -
Neurology 53 23.6 33 24.3 20 22.5
Neurophysiology 1 0.4 - - 1 1.1
None 1 0.4 - - 1 1.1
Ophthalmology 5 2.2 3 2.2 2 2.2
Oral Maxillofacial surgery 1 0.4 1 0.7 - -
Orthodontics 2 0.9 - - 2 2.2
Orthopaedics 1 0.4 - - 1 1.1
Paediatric Medicine 2 0.9 - - 2 2.2
Paediatric Surgery 12 5.3 8 5.9 4 4.5
Pain 3 1.3 2 1.5 1 1.1
Plastic Surgery 2 0.9 1 0.7 1 1.1
Radiology 1 0.4 - - 1 1.1
Renal 5 2.2 2 1.5 3 3.4
Respiratory 2 0.9 1 0.7 1 1.1
Rheumatology 3 1.3 1 0.7 2 2.2
Urology 8 3.6 8 5.9 - -
Total 225 - 136 - 89 -
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Age of CYP referred
Number of
overall ages of
CYP referred
(ACR)
% of
overall
ACR
Number
of
accepted
ACR
% of
accepted
ACR
Number
of
rejected
ACR
% of
rejected
ACR
0Years Old 1 0.4 1 0.7 - -
1Years Old 3 1.3 2 1.5 1 1.1
2Years Old 8 3.6 5 3.7 3 3.4
3Years Old 6 2.7 3 2.2 3 3.4
4Years Old 5 2.2 2 1.5 3 3.4
5Years Old 8 3.6 5 3.7 3 3.4
6Years Old 8 3.6 6 4.4 2 2.2
7Years Old 17 7.6 11 8.1 6 6.7
8Years Old 22 9.8 15 11.0 7 7.9
9Years Old 11 4.9 8 5.9 3 3.4
10Years Old 14 6.2 7 5.1 7 7.9
11Years Old 22 9.8 11 8.1 11 12.4
12Years Old 28 12.4 20 14.7 8 9.0
13Years Old 18 8.0 12 8.8 6 6.7
14Years Old 21 9.3 16 11.8 5 5.6
15Years Old 22 9.8 12 8.8 10 11.2
16Years Old + 11 4.9 - - 11 12.4
Total 225 - 136 - 89 -
4. Discussion
4.1 Key Findings
This SEP was conducted to gain a greater understanding about the referrals to the
LMPS and to explore potential patterns in referrals. In total, there were 225 referrals
made to the LMPS over a 20 month period, between the 1st April 2016 and the 14th
November 2018. 136 of the referrals were accepted, 89 referrals were not accepted
meaning that a large proportion of referrals were rejected (39.6%). The highest referral
reason was for ‘impact of and/or coping with health condition’ and the ‘Neurology’
department referred the most CYP into the LMPS.
When considering the aims of this project (as specified in Section 2 of this
report), the following findings are of importance:
4.1.1. Were there are any patterns in presenting concern in referral reasons?
The results show that the top five referral reasons were ‘impact of and/or coping
with health conditions’, ‘mental health’, ‘procedural distress’, ‘pain and headaches’ and
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‘behavioural difficulties’. It is promising that the top referral reason was ‘impact of
and/or coping with health conditions’ as this referral reason constitutes the majority of
the inclusion criteria for the LMPS.
It is interesting, however, that ‘mental health’ was the second highest referral
reason as ‘mental health difficulties’ not related to or not in the context of the physical
health condition is explicitly stated as an exclusion criterion. ‘Behavioural difficulties’
are also not something that LMPS accept referrals for if these are not related to the health
condition. This could warrant some future work with different clinical areas to think
about how general ‘mental health’ or ‘behavioural’ difficulties can be supported on wards
as the provision the CYP would be usually be referred to for support around these
difficulties is CAMHS, but CAMHS currently have very high referral thresholds (Young
Minds, 2018). Increased understanding of the role and remit of paediatric psychology
and how this differs from the support available in CAMHS would be useful. It could be
helpful to consider how to increase awareness in the referring departments of the referral
criteria and also other services that can support CYP to try and reduce the amount of
inappropriate referrals to the LMPS.
The results indicate that there are common issues for the CYP referred across
health specialities such as low self-esteem and anxiety in the context of the health
condition. This could mean that interventions across health specialities for these common
referred issues could be beneficial for CYP and these could be delivered through
therapeutic groups for CYP. Plante, Lobato and Engel (2001) argue that there are well-
established group interventions for a variety of paediatric populations but that more
research is needed to evaluate the efficacy of most group interventions for CYP with
physical health conditions.
Although the LMPS is experiencing an increased demand for their service, it
could be helpful to increase the profile of the LMPS within eligible departments so that
appropriate cases can be referred in for support. Teaching and training could also be
delivered to upskill ward staff and teams’ confidence in helping families manage these
difficulties as well as signpost to appropriate community services, such as ICAN nurses
and health visitors.
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It is also interesting that the findings show that for the majority of the condensed
referral reasons, referrals were both accepted and rejected. It may be useful for the LMPS
to think about how they use their referral inclusion/exclusion criteria, and how they could
refine this referral criterion or develop ways that the criteria are used to ensure more
consistent use by the service.
4.1.2. Were there any patterns around referrals from different departments?
For departments that referred into the LMPS, the highest referrer was the
Neurology department, contributing almost a quarter of all referrals. As reported in the
results, of these referrals from Neurology 60% were accepted which constitutes a sizeable
amount of the LMPS caseload at 24.3%. Dermatology, Endocrinology and General
Paediatrics were the next largest referring departments to the LMPS. There were some
departments that referred into the LMPS that have their own commissioned psychological
support (Gastroenterology, Liver, Renal and Rheumatology). These referrals may have
come into the LMPS due to sickness or maternity leave of the named Clinical
Psychologist, however, it may also be that some Paediatric consultants were not aware of
the correct referral pathways for psychological support within their department. Again,
some of these inappropriate referrals were accepted and some were rejected. It would be
interesting to further investigate this qualitatively with LMPS staff as to why they did end
up accepting some of these referrals. As this would have to be done retrospectively, it
may be helpful to have a section on the database where any decisions that are made
despite the inclusion/exclusion criteria can be documented for future analysis.
4.1.3. Were there any patterns in the ages of referrals?
12 year olds were the biggest age group that were referred into the LMPS. After 12 year
olds, 8, 11 and 15 year olds were the next largest numbers to be referred. Aside from
managing their physical health condition, in thinking about the wider context that CYP
exist within, it was discussed with the commissioners that for 12 year olds this age is
when CYP generally have transitioned into secondary school. This may have contributed
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to the referral and to CYP struggling to cope with their health condition for reasons
including the potential different expectations secondary schools have of CYP compared
to primary school, differences in the level of support available as well as other CYP being
more aware of differences as they move into larger year groups and peers they have not
grown up with. A report written for the Department of Health around school transitions
discussed how difficult school transitions can be for CYP and their parents/carers
detailing how they can negatively affect CYP’s emotional, social and academic outcomes
(Roberts, 2015). Roberts (2015) describes how CYP from disadvantaged backgrounds
such as those with special educational needs, looked after children or those with English
as an additional language are most at risk of experiencing poor school transitions,
however, CYP with physical health issues are not considered as a specific group in this
report. It would be useful to be able to explore further qualitatively with CYP, families
and medical staff as to whether periods of transition or other age/stage of life related
factors contributed to the CYP being referred for psychological support within LTHT.
There were 11 people that were referred that were over 16 and, therefore, unable
to access the service. Future work around increasing knowledge around referral criteria
could help to curtail these inappropriate referrals and ensure patients are referred to the
correct support in the first instance.
4.1.4. Were there any patterns in why referrals are rejected?
The top three reasons why referrals to the LMPS were rejected were that the
‘difficulty was not relating to health condition’, the CYP was ‘over 16’ and that there was
already a ‘commissioned psychological support for that department’. This also seems to
highlight again that the referral criteria do not always seem to be well understood (or held
in mind) by some paediatric consultants as these reasons are all explicitly listed exclusion
criteria.
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4.1.5. Time of year of referral.
There was an average of 11.3 referrals per month, with the highest referrals in one
month being 23 and the lowest in a month being 4 referrals. As the database only spans
one and a half years, there was not enough data to see whether there were any patterns or
differences in the time of year that CYP were being referred. However, it was discussed
with commissioners that this would be interesting to consider in future analysis of the
LMPS database as the commissioners felt as if referrals did peak at certain times of the
year so this could help tailor future support, and times of year this support is offered.
4.2. Key Recommendations
After consideration of the results of this SEP, the following recommendations are
suggested:
1. Consider running groups for CYP across health conditions and departments
providing support for common issues such as low self-esteem, anxiety and low
mood connected to and/or coping with health conditions and dealing with
difference (i.e. how to answer difficult questions from people etc.).
- It may be interesting to further examine the age of CYP referred after more
data has been collected to see whether there are still any patterns for CYP
being referred in around times of transitions, for example, going to secondary
school. A qualitative SEP exploring this with CYP, families and staff could
help to examine this further.
2. Consider refining referral criteria and how this is used in referral meetings (as
currently some referral reasons are both accepted and rejected) to ensure
consistency in accepting and rejecting referrals.
- It would be helpful to develop and publish clearer guidelines around why
referrals are accepted or rejected (regardless of whether referral criteria are
refined).
Prepared on the Leeds D.Clin.Psy. Programme, 2019 22
- It would also be useful to also record on the database if there any times a
referral that does not fit the inclusion criteria is accepted and reasons for this.
- It could also be helpful for the LMPS to have a referral form with the referral
reason categories listed with a box to tick (instead of a free text box) to
remind referrers of the accepted referral reasons and help keep consistency in
the inputting of these referral reasons on the database.
3. Consider ways to increase knowledge in departments about the LMPS and the
referral criteria.
- Numerous reasons for rejected referrals were seemingly around departments
not knowing referral criteria (i.e. referring for issues not related to the health
problem and the CYP being too old for the service) so improving the
awareness of referral criteria for departments could help lower the number of
inappropriate referrals and improve the efficiency of referral pathways
(benefiting the CYP, the referring department and the LMPS).
- It might be helpful for the LMPS to spend some time with high referral
departments to gauge their understanding of the LMPS, referral criteria and
also the psychological support (including assessment and intervention) that
the LMPS can provide. This could be done, for example, through attending
some ward huddles and team meetings and providing advice on whether a
referral is appropriate, explaining the psychological theory and explanation
behind the acceptance/rejection or whether there is a different service better
placed to support the CYP and/or their family.
- This could include normalising distress within these health settings and
upskilling medical staff to feel more confident to manage, for example,
difficult situations with CYP on wards.
4. Consider developing and making available effective psychological resources (i.e.
psychoeducation leaflets and other resources) for both CYP and parents/family
members and departments around common issues CYP with a physical health
Prepared on the Leeds D.Clin.Psy. Programme, 2019 23
condition face, as well as some specific leaflets for common issues within a health
speciality.
- Consider what teaching and training could be delivered to staff and staff
teams, (i.e. psychoeducation around common issues families face and coping
strategies for these) to upskill ward staff and improve their knowledge and
confidence in supporting families.
- It would also be helpful to develop the Leeds Paediatric Psychology Service
section on the LTHT website as another resource for CYP, families and
professionals to use– which could also have downloadable copies of any
available leaflets etc.
- Leaflets/information about other services that are available to support CYP
and their families could also be included on here so that everybody has access
to this signposting information.
5. Consider whether there are any business cases for certain departments for funding
for commissioned psychological input. For example, there were many referrals
from the ‘Neurology’ speciality areas and a specific commissioned psychology
role for this department or others such as ‘Dermatology’ or ‘Endocrinology’ could
be useful for CYP, families and staff.
6. Ensure that all referrals continue to be recorded on the database. This is so that
referral data can continue to be analysed in future and if any changes are
implemented, that the utility of these changes can be examined.
- As discussed, there was not enough data to look at differences in times of year
that CYP are being referred but this could be something a future audit could
examine.
- It could also be important to think about what other information could be
recorded on the database (any information that might be useful to record that
is also easily acquired information for clinicians) such as gender and ethnicity
to gain this information to analyse. This could further help develop suitable
interventions for the service.
Prepared on the Leeds D.Clin.Psy. Programme, 2019 24
- Consider admin input into the department – support in maintaining the
database and communicating outcomes of referrals could be useful as
currently costly clinical time is being used to carry out these tasks.
4.3. Strengths & Limitations
A key strength of this SEP is that it is the first analysis of referrals and the referral
database for the LMPS. The results highlight some ways that the service and referral
criteria can be improved to help meet increasing demand. The referral database itself was
almost fully completed, with all of the necessary information recorded (expect for seven
unknown referrals reasons) which is a strength when undertaking analysis of the LMPS
database. Another strength of this SEP is in terms of the applications of this SEP. There
has been a 10 month closure of the LMPS due to the staff member leaving LTHT and
issues with recruiting to fill the vacancy. There are new Clinical Psychologists starting at
the LMPS as this SEP report has been finalised meaning that the results and
recommendations can be used to help further develop and shape the LMPS with these
new members of staff.
However, there are also limitations of this SEP. As the database has only been
kept electronically for 18 months, this meant that not enough data had been collected to
run any inferential statistics on whether there were any significant differences with
variables such as time of the year affecting referral rates. This was something that was
discussed at the conception of the planning of the project but was unable to be carried out
due to the limited time period that has been captured on the database.
A limitation of the data collected, which has already been discussed, is that there
was an inconsistency in the accepting and rejecting of similar referral reasons. This
highlights the need for refining the inclusion criteria and that the decision rationale is
recorded on the database for referrals that are accepted that do not meet inclusion criteria
so that the LMPS and referring departments can be very clear about referral criteria for
the LMPS.
Another limitation of this SEP was in the condensing of things such as the referral
reasons and referring departments. Although this decision was made so that an overview
Prepared on the Leeds D.Clin.Psy. Programme, 2019 25
and summary of information (such as similar referral reasons and departments in similar
areas referring in) could be made sense of and some conclusions around meaningful
patterns could be drawn, it also meant that some of the intricacies of the data such as
idiosyncratic referring reasons were lost. The condensing down of these lists was also
done by the researcher and commissioners (trainee/clinical psychologists) so there might
have been some bias in judging which referral reasons were similar or which departments
were similar that might have been condensed differently by medical professionals.
4.4 Conclusion
Overall, this SEP has provided a useful insight for the LMPS into their referral
database and some patterns within the referral data which should help to develop the
LMPS further. Recommendations have been suggested which the LMPS can consider
implementing to further develop the service to help make the LMPS more streamlined,
efficient and effective for CYP, their families and referring departments to ensure CYP
access the appropriate service to meet their needs and that they receive timely and
effective care.
4.5. Dissemination of results
This SEP was presented at a University of Leeds poster conference to the Leeds
Clinical Psychology Doctorate Course trainees, course team and some local clinical
psychologists who commissioned SEPs undertaken by the current cohort of trainees. The
commissioners and LMPS will receive a written copy of this report. The results of this
SEP will also be presented at the monthly LTHT Paediatric Psychology Team meeting in
due course.
Prepared on the Leeds D.Clin.Psy. Programme, 2019 26
References
British Psychological Society (2019). Paediatric Psychology Network UK (PPN-UK).
Retrieved from: https://www.bps.org.uk/member-microsites/dcp-faculty-children-
young-people-families
Cystic Fibrosis Trust (2011). Standards for the Clinical Care of Children and Adults with
Cystic Fibrosis in the UK. London: Cystic Fibrosis Trust.
Jacobs, K., Titman, P. & Edwards, M. (2012). Bridging Psychological and Physical
Health Care. The Psychologist, 25 (3), 190-193.
Leeds Teaching Hospitals Trust (2019). Retrieved from: https://www.leedsth.nhs.uk/a-z-
of-services/paediatric-psychology/
NHS Education for Scotland NES (2019). Paediatric Psychology - Psychosocial
Interventions. Retrieved from: https://www.nes.scot.nhs.uk/education-and-
training/by-discipline/psychology/multiprofessional-psychology/paediatric-
psychology-psychosocial-interventions.aspx
NHS England (2013). Best Practice for Commissioning Diabetes Services: An Integrated
Care Framework. Retrieved from: https://diabetes-resources-production.s3-eu-
west-1.amazonaws.com/diabetes-storage/migration/pdf/best-practice-
commissioning-diabetes-services-integrated-care-framework-0313.pdf
National Institute for Health and Care Excellence (2014). Cancer Services for Children
and Young People. London: National Institute for Health and Care Excellence.
Plante, W. A., Lobato, D., & Engel, R. (2001). Review of group interventions for
pediatric chronic conditions. Journal of pediatric psychology, 26(7), 435-453.
Roberts, J. (2015). Improving school transitions for health equity. Report to the UK
Department of Health. London: UCL Institute of Health Equity.
Young, J., O'Curry, S., Mastroyannopoulou, K., Deiros Collado, M., Gibbins, J., Donnan,
J., ... & Griffiths, H. (2018). Paediatric Psychology Network United Kingdom
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(PPN-UK): From inception to the current day. Clinical Practice in Paediatric
Psychology, 6(4), 331.
Young Minds (2018). #FightingFor Report. Retrieved from:
https://youngminds.org.uk/media/2258/youngminds-fightingfor-report.pdf
Prepared on the Leeds D.Clin.Psy. Programme, 2019 28
Appendix
Appendices 1
List of original and condensed referral reasons.
Referral Reasons Coded referral problem Superseding referral problem
"Emotional lability" following
symptoms of epilepsy.
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Adjusting to health condition-
turner syndrome.
Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Adjustment to diagnosis
(epilepsy)/coping with diagnosis-
low mood.
Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Adjustment to diagnosis- anxiety. Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Adjustment to diagnosis. Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Adjustment to diagnosis. Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Adjustment to diagnosis. Anxiety. Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Adjustment to/coping with health
condition.
Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Allergies and food aversion Allergies & food aversion Allergies & food aversion
Anger due to health condition. Coping with condition Impact of health condition on
mood & coping with condition
Anger related to health condition. Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety Mental health - anxiety Mental health
Anxiety about being different. Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety about home
circumstances.
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety after trauma Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety and IBS Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety and migraines Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety around health. Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety at school Mental health - anxiety Mental health
Anxiety due to accident Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety due to condition-
allergies.
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety due to eczema Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety due to epilepsy Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety due to health condition Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety due to health condition
(allergies).
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Prepared on the Leeds D.Clin.Psy. Programme, 2019 29
Anxiety due to health condition
(brain injury)
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety due to health condition-
alopecia
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety due to health condition. Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety following brain injury Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Anxiety related to symptoms of
illness
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Aversion to food Allergies & food aversion Allergies & food aversion
Bed wetting Bed wetting/soiling Bed wetting/soiling
Behaviour issues/parenting Behavioural difficulties &
parenting issues
Behavioural difficulties
Behaviour/parenting issues. Behavioural difficulties &
parenting issues
Behavioural difficulties
Behaviour/parenting. Behavioural difficulties &
parenting issues
Behavioural difficulties
Behavioural and social issues Behavioural difficulties Behavioural difficulties
Behavioural difficulties Behavioural difficulties Behavioural difficulties
Behavioural issues/parenting. Behavioural difficulties &
parenting issues
Behavioural difficulties
Behavioural problems Behavioural difficulties Behavioural difficulties
Behavioural regression after
meningitis
Behavioural difficulties Behavioural difficulties
Bullying at school Bullying Bullying
Chronic fatigue from Chron's Chronic fatigue Impact of health condition on
mood & coping with condition
Chronic fatigue syndrome. Chronic fatigue Impact of health condition on
mood & coping with condition
Coming to terms with diagnosis. Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Concerns RE fabricated illness. Concerns around fabricated
illness
Concerns around fabricated
illness
Concerns RE long term impact of
health condition.
Coping with condition Impact of health condition on
mood & coping with condition
Coping with condition- low
mood.
Coping with condition Impact of health condition on
mood & coping with condition
Coping with eczema Coping with condition Impact of health condition on
mood & coping with condition
Coping with eczema- itching. Coping with condition Impact of health condition on
mood & coping with condition
Coping with headaches Headaches Pain and headaches
Coping with health condition
(eczema)
Coping with condition Impact of health condition on
mood & coping with condition
Coping with health condition. Coping with condition Impact of health condition on
mood & coping with condition
Coping with IBS IBS Impact of health condition on
mood & coping with condition
Coping with illness Coping with condition Impact of health condition on
mood & coping with condition
Death/health related anxiety Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Dermatitis artefacta (self-harm Mental health - self-harm Mental health
Prepared on the Leeds D.Clin.Psy. Programme, 2019 30
disguised as health condition).
Difficult to manage behaviour Behavioural difficulties Behavioural difficulties
Difficulties with sleep (not related
to health condition).
Sleep Sleep
Difficulty coping with eczema-
itching and sleep.
Coping with condition Impact of health condition on
mood & coping with condition
Difficulty eating Allergies & food aversion Allergies & food aversion
Distress over medical condition Coping with condition Impact of health condition on
mood & coping with condition
Eating disorder Mental health Mental health
Eczema Coping with condition Impact of health condition on
mood & coping with condition
Family adjusting to health
condition and treatment.
Parental adjustment Parental adjustment
Functional abdominal pain Functional pain/MUS Pain and headaches
Gender identity GID Surgery build up
General issues with mental health
(not health related).
Mental health Mental health
General issues with mental
health/self-harm (not health
related).
Mental health/self-harm Mental health
Headaches Headaches Pain and headaches
Headaches and vomiting Headaches Pain and headaches
Health problems Coping with condition Impact of health condition on
mood & coping with condition
IBS IBS Impact of health condition on
mood & coping with condition
IBS and anxiety Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Issues with eating Allergies & food aversion Allergies & food aversion
Lack of self-compliance Compliance Compliance
Low Mood Mental health - low mood Mental health
Low mood and anxiety due to
health condition
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Low mood due to brain injury Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Low mood due to epilepsy Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Low mood due to health
condition.
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Low mood- not related to health
condition
Mental health - low mood Mental health
Low mood. Mental health - low mood Mental health
Low mood/anxiety due to health
condition
Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Low self-esteem Low self-esteem Impact of health condition on
mood & coping with condition
Managing emotions Impact of health condition on
mood
Impact of health condition on
mood & coping with condition
Managing headaches Headaches Pain and headaches
Managing migraine Headaches Pain and headaches
Managing tics. Tics Tics and Tourette’s
Medically unexplained Functional pain/MUS Pain and headaches
Prepared on the Leeds D.Clin.Psy. Programme, 2019 31
symptoms- nausea.
Medically unexplained
symptoms- stammer.
Functional pain/MUS Pain and headaches
Medication compliance and low
mood.
Compliance & low mood Compliance
Medication compliance. Compliance Compliance
Needs motivation to use a
standing frame
Compliance Compliance
Negative self-image Low self-esteem Impact of health condition on
mood & coping with condition
Neurological decline Neuro assessment Neuro assessment
No psychological needs identified
in referral.
No needs identified No needs identified
Non-compliance with treatment Compliance Compliance
Non epileptic seizures (MUS). Functional pain/MUS Pain and headaches
OCD Mental health/self-harm Mental health
Pain Pain Pain and headaches
Pain management. Pain Pain and headaches
Parasomnia Sleep Sleep
Parent struggling to adjust to
health condition.
Parental adjustment Parental adjustment
Parental anxiety due to health
diagnosis (epilepsy)
Parental adjustment Parental adjustment
Parents struggling to adjust to
DSD
Parental adjustment Parental adjustment
Poor compliance with medication. Compliance Compliance
Procedural distress Procedural distress Procedural distress
Procedural distress and anxiety Procedural distress Procedural distress
Psoriasis triggered by stress Coping with condition Impact of health condition on
mood & coping with condition
Psychological impact of health
condition
Coping with condition Impact of health condition on
mood & coping with condition
Psychological input before
surgery
Surgery build up Surgery build up
Query regarding gender identity. GID Surgery build up
Referral for routine input (not
clear in referral).
No needs identified No needs identified
Refusing medical intervention Compliance Compliance
Review of cognitive ability Neuro assessment Neuro assessment
Sadness due to health condition. Coping with condition Impact of health condition on
mood & coping with condition
Self-esteem and confidence
linked to eczema
Low self-esteem Impact of health condition on
mood & coping with condition
Self-esteem, body image and
responding to curiosity.
Low self-esteem Impact of health condition on
mood & coping with condition
Self-harm Mental health - self-harm Mental health
Skin picking Mental health - self-harm Mental health
Social anxiety Mental health - anxiety Mental health
Social support for mum (not
related to health condition)
Parental needs not related to
health condition
No needs identified
Soiling Bed wetting/soiling Bed wetting/soiling
Stress Stress Impact of health condition on
Prepared on the Leeds D.Clin.Psy. Programme, 2019 32
mood & coping with condition
Stress and hair loss Stress & hair loss Impact of health condition on
mood & coping with condition
Struggling to accept condition. Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Struggling with diagnosis Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Struggling with medical
compliance
Compliance Compliance
Support for parental anxiety due
to health condition
Parental adjustment Parental adjustment
Support with weight management Weight Impact of health condition on
mood & coping with condition
Tourette symptoms Tourette’s Tics and Tourette’s
Trauma following RTA RTA RTA
Trauma from accident RTA RTA
Treatment compliance (cream for
eczema)
Compliance Compliance
Trichotillomania Mental health - self-harm Mental health
Turners Syndrome Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Turners Syndrome Adjustment to condition/new
diagnosis
Impact of health condition on
mood & coping with condition
Unclear/letter sent in error. Unknown No needs identified
Unknown Unknown No needs identified
Weight management Weight Impact of health condition on
mood & coping with condition
List of original and condensed referring department.
Original department Condensed list of departments
A&E A&E
Allergies Allergies
Brain Injury trust Neurology
Cardiology Cardiology
Community Paeds Community Paeds
Craniofacial Plastic Surgery
Dermatology Dermatology
Endocrinology Endocrinology
ENT ENT
Epilepsy Neurology
Gastro Gastroenterology
General medicine General Paeds
General or surgical? Paediatric Surgery
General Paeds General Paeds
General Paeds (epilepsy) General Paeds
General surgery Paediatric Surgery
Gynaecology Gynaecology
Hepatology Liver
ICAN nurses Community Paeds
Immunology Allergies
Prepared on the Leeds D.Clin.Psy. Programme, 2019 33
Immunology + Allergy Allergies
Immunology Allergies
Long term ventilation Respiratory
Nephrology Renal
Neurology Neurology
Neurophysiology Neurophysiology
Neurosurgery Neurology
None None
Ophthalmology Ophthalmology
Oral Maxillofacial surgery Oral Maxillofacial surgery
Orthodontics Orthodontics
Orthopaedics Orthodontics
Orthopaedics/pain Orthopaedics
Paediatric Medicine Paediatric Medicine
Paediatric Surgery Paediatric Surgery
Pain Pain
Pain Management Pain
Radiology Radiology
Renal Renal
Respiratory Respiratory
Rheumatology Rheumatology
Urology Urology
Vascular Surgery Paediatric Surgery
List of original and condensed rejected referral reasons.
Original rejection reason. Condensed referral reason.
16 years old. Over 16
16 years old. Forwarded to adults. Over 16
Accessing community support. Accessing support elsewhere
Adult- forwarded to Fielding House. Over 16
Adults. Over 16
Already seen by Amy, refer to CAHMS Signpost to CAMHS
Cardiology patient Signpost to other LTHT psychology speciality
CFS service signposting Signposted to community support
Dc from the hospital. Not under LTHT consultant
Difficulties not related to a health condition Difficulties not related to health condition
Discharged by medical team Not under LTHT consultant
DSD and no clear impact of condition on mood. No current needs identified/routine
DSD pathway. Accessing support elsewhere
Family want local help Family declined support
Forwarded to renal team. Signpost to other LTHT psychology speciality
Forwarded to trauma and orthopaedics. Signpost to other LTHT psychology speciality
GP referral, not under care of LTHT consultant. Not under LTHT consultant
Prepared on the Leeds D.Clin.Psy. Programme, 2019 34
Need to see renal team Signpost to other LTHT psychology speciality
Needs met by CAMHS Signpost to CAMHS
No current concerns, only anticipatory. No current needs identified/routine
No health condition (tics) Difficulties not related to health condition
No health condition (tummy pain) Difficulties not related to health condition
No medical condition identified Difficulties not related to health condition
No medical condition identified. Amy-
Forwarded to orthopaedics team/
Difficulties not related to health condition
No medical condition identified/ Amy-
Forwarded to gastro team.
Difficulties not related to health condition
No psychological difficulties that hinder
treatment
Difficulties not related to health condition
No psychological difficulties that hinder
treatment/problems not related to diagnosis
Difficulties not related to health condition
No referral information. Unknown
No underlying health condition. Difficulties not related to health condition
Not accepted Difficulties not related to health condition
Not due to health condition Difficulties not related to health condition
Not receiving active treatment, no clear needs
identified.
Not under LTHT consultant
Not related to health condition. Difficulties not related to health condition
Not related to health. Difficulties not related to health condition
Not seen due to history of non-engagement Not seen due to history of non-engagement
Not under active care of LTHT Not under LTHT consultant
Not under active care of LTHT consultant. Not under LTHT consultant
Other suitable services who could meet needs. Signposted to community support
Over 16 Over 16
Problems not related to diagnosis. Difficulties not related to health condition
Product of behavioural issues and mum not
accessed community support.
Difficulties not related to health condition
Sees Kate Hall. Over 16
Signpost to adult multispec. Signpost to other LTHT psychology speciality
Signpost to CAMHS. Signpost to CAMHS
Signpost to trauma/orthopaedics. Signpost to other LTHT psychology speciality
Signposted to watch it Signposted to community support
Signposted to watch it. Amy- Signposted to
community LD
Signposted to community support
Too old. Over 16
Under care of another psychology service Under care of another psychology service
Under care of another psychology service.
Amy- Forwarded to renal team.
Under care of another psychology service
Under care of another psychology service/Amy-
Forwarded to rheumatology team.
Under care of another psychology service
Under craniofacial/Maggie Bellew Signpost to other LTHT psychology speciality
Under gastro Signpost to other LTHT psychology speciality
Prepared on the Leeds D.Clin.Psy. Programme, 2019 35
Under Kate Hall Over 16
Under ortho team. Signpost to other LTHT psychology speciality
Weight management. Watch It recommended. Signposted to community support
Difficulties not related to health condition
No current needs identified/routine
Signpost to CAMHS
Appendices 2
Confirmation email for ethics.