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CAMHS Infant Mental Health Pathway Parent or Carer Request for Help

CAMHS Infant Mental Health Pathway Parent or Carer Request for Help

Complete this form to request help from CAMHS Infant Mental Health Pathway

If you would prefer to call us to discuss, we can help to complete: 01752 435125 and choose option 2.

Date of birth(Required)
Address

Family details

Parental responsibility
Parental responsibility
If we need to know more about you / your child how would you like us to contact you

Risk Factors

Are there any current / past child protection or risk issues?
Child Protection Plan
Child in Need Plan
EHAT completed
Date of next EHAT/CIN/CP meeting

Consent to share information

We would like your consent to contact any agencies that are currently involved or who we consider may be of help. We may also want to contact other agencies that know you, such as your school or GP, to help us provide a better service to you. We will ensure that your personal information is kept confidential, unless there are specific concerns that require us to share your details, e.g. child protection concerns. You will be told of this.
Please tick the box if you are agreeable to consenting to use the CAMHS appointment reminder service. This means that you will receive an appointment reminder via mobile text message.

I agree to information being shared between agencies to help me / my child
Completion of this field will act as the signature of the principal parent/main carer
Date

Infant Mental Health Pathway Consent to Share Information – Guidance for patients and servicer users

We (Livewell Southwest Infant Mental Health Pathway (IMH) often receive information about children, babies, and their parents and families. As we are a 0-5 service most information will be recorded on your child’s record on SystmOne (our electronic record keeping system), the referral will also be in the child’s name. This means that other health providers who use system one, such as health visitors and GP’s, will have access to the information recorded. In order to respect your privacy and protect the information you share with the IMH anything that is disclosed which pertains solely to you (parents/carers) will be recorded on your clinical record on SystmOne. Reference to this recording will be made on the child’s record but there will not be a detailed entry unless it is necessary due to child safety. For example it may say, “during the appointment we discussed the relationship that mum had with her own parents – (please see mother’s record if clinically relevant)”. There are rare occasions when a parent does not have a SystmOne record (for instance if your GP doesn’t use this system), therefore the IMH will need to open a record in your name. Your SystmOne record forms part of your total health record. You may request to see your current IMH record from your health professional. Alternatively you can ask for a copy of all the clinical information that is held in your Livewell Southwest health record by writing to the Data Disclosure Team, Hatfield House, Burrington Way, PL5 3LZ. Livewell Southwest can only provide information related to services provided by us, which will not necessarily constitute your full health record. In addition, any information about any third parties will be removed before you are given a copy of your record. Once we have opened your SystmOne record we may be able to view information recorded by other services you may be involved with, such as your GP, CMHT, Podiatrist etc. While our staff will not actively look at this information it may be on screen, and in cases where there are significant concerns about child safety we may be required to look at your information. There are occasions when it may be helpful to liaise with other services you are involved with e.g. perinatal team, CMHT, in these cases we will endeavour to seek your permission on this matter. By information sharing in this way we can provide a better service to you and your child. However if you do not wish to share information between these organisations please let your health professional know and this can be stopped. However some information related to risk and child safety might still be shared. In the future your child may wish to access his or her own health record and having the information related to you, recorded in your own record will prevent any information that you may not wish to be shared with your child in that manner from reaching them. For antenatal patients only: While you are seen antenatally (before baby is born) the referral to Infant mental health pathway will be in your name and all recording of appointments will go on your health record. Once your child is born, if you are still open to IMH, the referral in your name will be closed and the case will be reopened in your child’s health record. Please read above to understand the full details around consent to share information.