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Appendix D

Summary of relevant NICE guidance recommendations.

Risk factors Recommendations

Antenatal and postnatal mental health



Antenatal and postnatal mental health: clinical management and service guidance, CG192 (2014)

  • Develop an integrated care plan for women with a mental health problem in pregnancy and the postnatal period, which is co-ordinated by a health professional
  • Provide culturally relevant information on mental health problems in pregnancy
  • During the early postnatal period, ask depression identification questions as part of a general discussion about a woman’s mental health and wellbeing in primary care setting
  • Health professionals should understand the variations in the presentation and course of mental health problems during and after pregnancy, and how these variations affect treatment, and the context in which they are assessed and treated (for example, maternity services, health visiting and mental health services)
  • Discuss with a woman whose baby is stillborn or dies soon after birth, and her partner and family, the option of 1 or more of the following: seeing or holding the baby, having mementos of the baby, seeing a photograph of the baby
  • Clinical networks should be established for perinatal mental health services, managed by a coordinating board of healthcare professionals, commissioners, managers, and service users and carers.
Social and emotional wellbeing in the early years Social and emotional wellbeing: early years, PH40 (2012)

  • Health and wellbeing boards should ensure arrangements are in place for integrated commissioning of universal and targeted services for children aged under 5
  • All health and early years professionals should develop trusting relationships with vulnerable families and adopt a non-judgmental approach, while focusing on the child’s needs.
  • Health professionals in antenatal and postnatal services should identify factors that may pose a risk to a child’s social and emotional wellbeing.
  • Health visitors, school nurses and early years practitioners should identify factors that may pose a risk to a child’s social and emotional wellbeing, as part of an ongoing assessment of their development.
  • Family welfare, housing, voluntary services, the police and others who are in contact with a vulnerable child and their family should be aware of factors that pose a risk to the child’s social and emotional wellbeing.
  • Health visitors or midwives should offer a series of intensive home visits by an appropriately trained nurse to parents assessed to be in need of additional support
  • Health visitors or midwives should try to ensure both parents can fully participate in home visits, by taking into account their domestic and working priorities and commitments.
  • Health visitors and midwives should consider evidence-based interventions, such as baby massage and video interaction guidance, to improve maternal sensitivity and mother–infant attachment. For example, this approach might be effective when the mother has depression or the infant shows signs of behavioural difficulties.
  • Local authority children’s services should ensure all vulnerable children can benefit from high quality childcare outside the home on a part- or full-time basis and can take up their entitlement to early childhood education, where appropriate.
  • Managers and providers of early education and childcare services should ensure all vulnerable children can benefit from high quality services which aim to enhance their social and emotional wellbeing and build their capacity to learn.
Social and emotional wellbeing in primary education Social and emotional wellbeing in primary education, PH12 (2008)

  • Local authorities should ensure primary schools provide an emotionally secure environment that prevents bullying and provides help and support for children (and their families) who may have problems.
  • Schools should have a programme to help develop all children’s emotional and social wellbeing. It should be integrated it into all aspects of the curriculum and staff should be trained to deliver it effectively.
  • Schools should also plan activities to help children develop social and emotional skills and wellbeing, and to help parents develop their parenting skills.
  • Schools and local authorities should make sure teachers and other staff are trained to identify when children at school show signs of anxiety or social and emotional problems. They should be able to discuss the problems with parents and carers and develop a plan to deal with them, involving specialists where needed. Those at higher risk of these problems include looked after children, those in families where there is instability or conflict and those who have had a bereavement
Social and emotional wellbeing in secondary education Social and emotional wellbeing in secondary education, PH20 (2009)

  • Secondary education establishments should have access to the specialist skills, advice and support they require.
  • Practitioners should have the knowledge, understanding and skills they need to develop young people’s social and emotional wellbeing.
  • Secondary education establishments should provide a safe environment which nurtures and encourages young people’s sense of self-worth, reduces the threat of bullying and violence and promotes positive behaviour.
  • Social and emotional skills education should be tailored to the developmental needs of young people.
Looked-after children and young people PH28
Domestic violence and abuse Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively, PH50 (2014)

  • Ensure staff can recognise the indicators of domestic violence and abuse and understand how it affects children and young people.
  • Ensure staff are trained and confident to discuss domestic violence and abuse with children and young people who are affected by or experiencing it directly. The violence and abuse may be happening in their own intimate relationships or among adults they know or live with.
  • Put clear information-sharing protocols in place to ensure staff gather and share information and have a clear picture of the child or young person’s circumstances, risks and needs.
  • Develop or adapt and implement clear referral pathways to local services that can support children and young people affected by domestic violence and abuse.
  • Ensure staff know how to refer children and young people to child protection services. They should also know how to contact safeguarding leads, senior clinicians or managers to discuss whether or not a referral would be appropriate.
  • Ensure staff know about the services, policies and procedures of all relevant local agencies for children and young people in relation to domestic violence and abuse.
  • Involve children and young people in developing and evaluating local policies and services dealing with domestic violence and abuse.
  • Monitor these policies and services with regard to children’s and young people’s needs.
  • Address the emotional, psychological and physical harms arising from a child or young person being affected by domestic violence and abuse, as well as their safety. This includes the wider educational, behavioural and social effects.
  • Provide a coordinated package of care and support that takes individual preferences and needs into account.
  • Ensure the support matches the child’s developmental stage (for example, infant, preadolescent or adolescent). Interventions should be timely and should continue over a long enough period to achieve lasting effects. Recognise that long-term interventions are more effective.
  • Provide interventions that aim to strengthen the relationship between the child or young person and their non-abusive parent or carer. This may involve individual or group sessions, or both. The sessions should include advocacy, therapy and other support that addresses the impact of domestic violence and abuse on parenting. Sessions should be delivered to children and their non-abusive parent or carer in parallel, or together.
  • Provide support and services for children and young people experiencing domestic violence and abuse in their own intimate relationships.
Self-harm CG16 and CG133
Depression CG28
Post-traumatic stress disorder CG26
Personality disorders CG77 and CG78
Substance abuse PH4
Anti-social behaviour and conduct disorders Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management, CG158 (2013)

  • During initial assessment for a possible conduct disorder, assess for the presence of the following significant complicating factors:
    • a coexisting mental health problem (for example, depression, post-traumatic stress disorder)
    • a neurodevelopmental condition (in particular ADHD and autism)
    • a learning disability or difficulty
    • substance misuse in young people
  • Health professionals working with children and young people should take into account that stigma and discrimination are often associated with using mental health services, and that there may be possible variations in the presentation of mental health problems in children and young people of different genders, ages, cultural, ethnic, religious or other diverse backgrounds
  • Conduct a comprehensive assessment of the child or young person’s parents or carers, including parental wellbeing, encompassing mental health, substance misuse (including whether alcohol or drugs were used during pregnancy) and criminal behaviour.
Eating disorders CG9
Psychosis and schizophrenia Psychosis and schizophrenia in children and young people: Recognition and management, CG155 (2013)

  • When a child or young person experiences psychotic symptoms, refer for assessment without delay to a specialist mental health service such as CAMHS or an early intervention in psychosis service (14 years or over).
  • When a diagnosis of psychosis or schizophrenia is not appropriate:
    • consider individual cognitive behavioural therapy (CBT) with or without family intervention, and
    • offer treatments recommended in NICE guidance for children and young people with any of the anxiety disorders, depression, emerging personality disorder or substance misuse.
  • Do not offer antipsychotic medication if there is not a diagnosis of psychosis or schizophrenia, or to reduce the risk of psychosis
  • If the child or young person and their parents or carers wish to try psychological interventions (family intervention with individual CBT) alone without antipsychotic medication, advise that psychological interventions are more effective when delivered in conjunction with antipsychotic medication. If the child or young person and their parents or carers still wish to try psychological interventions alone, then offer family intervention with individual CBT. Agree a time limit (1 month or less) for reviewing treatment options, including introducing antipsychotic medication. Continue to monitor symptoms, level of distress, impairment and level of functioning, including educational engagement and achievement, regularly.
  • For subsequent acute episodes:
    • Offer family intervention to all families of children and young people with psychosis or schizophrenia, particularly for preventing and reducing relapse. This can be started either during the acute phase or later, including in inpatient settings
    • Before referral for hospital care, think about the impact on the child or young person and their parents, carers and other family members, especially when the inpatient unit is a long way from where they live. Consider alternative care within the community wherever possible. If hospital admission is unavoidable, provide support for parents or carers when the child or young person is admitted
Autism CG128