Referral Criteria 

NSAMS offer 4 categories of referral; please select which category you are requesting:

NSAMS offer 4 categories of referral; please select which category you are requesting: Required

For all referrals;

  • The young person must have been seen by a local consultant psychiatrist/senior psychologist for a face-to-face appointment to review the clinical presentation and determine appropriateness of referral.   
  • The young person must be under the care of CAMHS/CYPS at the time of referral. They must remain open to the CAMHS/CYPS team with an appropriate CPA care coordinator/lead professional identified, and hold local clinical responsibility with the young person and family throughout the period of involvement from the National Specialist Adolescent Mood Disorders Service (NSAMS). 
  • Referrals are accepted from clinicians working in CAMHS/CYPS supported by a consultant psychiatrist and/or clinical psychologist involved in a young person’s care. The young person must have had a first line assessment by their local CAMHS/CYPS
  • For referrals outside of Northumberland, Tyne and Wear, please include Information about the local funding commissioners so they can be approached for funding. If you wish to discuss this further, then please contact the team coordinator on 0191 2875262.

Referrals must include: 

  • SAMS electronic referral form with all sections completed.
  • Copies of reports relating to initial mood disorder/MDT assessment - this must include a diagnostic report summarising the first line assessment. References to reports being available on electronic health records will not be accepted. 

Without the above, the NSAMS team are not able to process referrals.

Please email the team if you wish to discuss a referral e-mail NSAMS@cntw.nhs.uk (NOTE: the email address is case sensitive)

Child or young person's essential details

Required
Date of birth Required
Invalid date
Preferred pronouns Required
Required
Birth assigned gender Required
Current gender identity Required
Address Required
Required
Required
Required
GP address Required
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Required

Local commissioner details

Only applicable to referrals from outside of the Northumberland, Tyne and Wear footprint

Referral details

Referral date Required
Invalid date
Is the young person/family aware of the referral? Required
Are the family able to travel to SAMS base for appointments? Required

Background information

(Please include history of presenting illness, family history, comorbid conditions, current/past management strategies used by services, previous/current medication details) 

Required

Risks

(Please attach any risk documentation, including any implication for SAMS team members completing home visits) 

To self Required
To others Required
To property Required
Of explotation Required

Documents

Referral details

Referrer details

Required
Required
Address Required
Required

The SAMS Team may contact you to discuss the referral.

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Required
Required
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Required
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Required