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Child and Adolescent Trauma, Anxiety and Depression Clinic

How our service can help you

Our service is for children and adolescents with difficulties arising from exposure to traumatic and severely stressful events.

We offer assessment and treatment to children and adolescents who experience severe and/or treatment-resistant post-traumatic stress disorder (PTSD), anxiety disorders and unipolar depression. We also provide second opinion assessments for the diagnosis and treatment of complex trauma, anxiety and/or depression.

We deliver clinical training and offer clinical supervision to local teams and schools. We collaborate with the UK government and local commissioning groups to set up and manage public health initiatives related to disasters and emergencies.

We lead in research on ways of improving and disseminating evidence-based treatments for traumatised young people and their families. People seen in our clinic are often invited to participate in ongoing research projects.

We also provide training in the assessment and treatment of post-traumatic responses in young people and families.

  • Service Borough Covers: National (Child and Adolescent services) Treatment type: Outpatient

  • Contact the service

    Site Location: Maudsley Hospital Known As: Trauma, Anxiety and Depression (TAD) Clinic Email: tad@slam.nhs.uk Phone Number: 020 3228 2657
  • Disabled Access:
    • Wheelchair accessible building
    • Ground floor therapy rooms
    • Accessible toilets on all levels
    • Lift access to the 1stfloor.
  • Address: Michael Rutter Centre
    Maudsley Hospital
    De Crespigny Park,
    London,
    SE5 8AZ
  • Business Hours/Visiting Hours: Monday to Friday, 9am to 5pm

    • Other essential information

  • Conditions: Anxiety, Body dysmorphic disorder (BDD), Depression, Obsessive, TAD. Trauma, Anxiety and Depression compulsive disorder (OCD), Post-traumatic stress disorder (PTSD)

Interventions

What we offer young people

Assessment and Treatment of Post-Traumatic Stress Disorder (PTSD) and stress-related psychopathology

Our service is for young people with difficulties arising from exposure to traumatic and severely stressful events. This can include events such as:

  • Physical, emotional, and sexual abuse
  • Traumatic loss of family
  • Violent crimes
  • Traumatic events experienced by asylum seekers and refugees
  • Emergencies and disasters
  • Accidents and physical injuries

We offer specialist diagnostic assessments to identify broad post-traumatic stress reactions, including post-traumatic stress disorder (PTSD), complex bereavement, anxiety disorders, depression, and other conditions. We offer evidence-based, NICE-recommended treatment for PTSD and related disorders, both for single-incident trauma and complex PTSD. We have several treatment packages available which will be tailored to suit the needs of the individual and their family. We also provide psychopharmacological treatment when indicated.

Assessment and treatment of anxiety disorders

We also work with young people with severe and/or treatment resistant anxiety disorders. This includes:

  • Generalised anxiety disorder
  • Social anxiety disorder
  • Specific phobias and agoraphobia
  • Health anxiety
  • Separation anxiety disorder
  • Other worries or fears
  • Panic disorder
  • Selective mutism
  • Obsessive compulsive disorder
  • Body dysmorphic disorder

We offer expert diagnostic assessments and evidence-based, NICE-recommended treatments for anxiety disorders, including both psychotherapy and pharmacotherapy. We have several treatment packages available, which will be tailored to suit the needs of the individual and their family.

Assessment and treatment of depression

We offer expert diagnostic assessment and evidence-based, NICE-recommended treatments for young people with severe and/or treatment resistant unipolar depression, including both psychotherapy and pharmacotherapy. We have several treatment packages available, which will be tailored to suit the needs of the individual and their family.

Interventions

Our evidence-based interventions include:

  • Comprehensive multidisciplinary assessment involving a structured diagnostic interview, problem formulation, and treatment recommendations
  • Expert medico-legal assessments of post-traumatic reactions
  • Individually tailored, specialist trauma-focused cognitive behavioural therapy (TF-CBT) for single-event or complex traumas, and intensive treatment where appropriate
  • Narrative exposure therapy (NET)
  • Eye movement desensitisation and reprocessing (EMDR)
  • Individually tailored, specialist cognitive behavioural therapy (CBT) for anxiety disorders using disorder-specific treatment approaches
  • Family-focused CBT
  • Individually tailored, specialist CBT for depression, with a large behavioural activation and rumination focus
  • Interpersonal psychotherapy for adolescents (IPT-A) for depression
  • Mindfulness based CBT (MBCT) for depression
  • Specialist psychopharmacological treatment

Eligibility criteria

  • Young people who have been exposed to a potentially traumatic event, resulting in PTSD symptoms, adjustment disorder, complicated bereavement, and other stress-related psychopathology
  • Known or possible diagnosis of an anxiety disorder, including:
    • Generalised anxiety disorder
    • Social anxiety disorder
    • Specific phobias and agoraphobia
    • Health anxiety
    • Separation anxiety disorder
    • Panic disorder
    • Selective mutism
    • Obsessive compulsive disorder
    • Body dysmorphic disorder
    • Depression (unipolar)

Exclusion

  • Psychiatric symptoms and risk requiring urgent assessment
  • Young people with a suspected diagnosis of Bipolar Disorder should be referred to our colleagues in the Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Team  
  • Adult referrals for post-traumatic stress disorder (PTSD) and anxiety disorders and should be addressed to the South London and Maudsley Centre for Anxiety Disorders and Trauma (CADAT)
  • Adult referrals for depression and should be addressed to the National Affective Disorders Service

Outcomes

Outcomes

Expected outcomes may include:

  • Formulation and diagnosis
  • Reduced symptoms of post-traumatic stress disorder (PTSD), anxiety or depression
  • Improved quality of life for the young person and their family

Our results

Our clinic has developed and implemented new psychological treatments for PTSD. In a randomised-controlled trial, we showed (see below) that our 12-week treatment has powerful effects on reducing symptoms of PTSD, anxiety, and depression; and on improving day to day functioning. These important effects were maintained when we re-assessed young people six months after treatment had finished.

changes in self reported PTSD chart

CPSS = Child post-traumatic stress scale

CBT = Cognitive behaviour therapy

Wait = Wait List control condition

Smith P, Yule W, Perrin S, Tranah T, Dalgleish T and Clark D (2007). Cognitive-Behavioural Therapy for PTSD in Children and Adolescents: A Preliminary Randomized Controlled Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8), pp.1051-1061.

The effects of our innovative psychotherapeutic and psychopharmacological approaches can be seen in changes on the Children’s Global Assessment Scale (CGAS), a broad measure of functioning in daily life. We show below that our treatment leads to improvement from a median CGAS intake and assessment score of 60 (Panel A), signalling some noticeable problems in more than one area, to a median CGAS discharge score of 75 (Panel B), associated with overall good functioning – with an average treatment effect of 15 CGAS points.

Panel A: CGAS at intake

CGAS at intake

Panel B: CGAS at discharge 

CGAS at discharge

Care Options

Care option: Assessment

Unit: Per assessment

In preparation for the assessment, the families are asked to complete a comprehensive online screening questionnaire and the clinicians review all available material. The face-to-face assessment led by specialist clinical psychologists and a consultant child and adolescent psychiatrist involves both joint and individual interviews with the young person and the parents or carers. The assessment generally takes place in our clinic at the Maudsley hospital but we are also able to offer off-site assessments if required. The assessment session includes a semi-structured diagnostic interview for ICD-10 and DSM-IV disorders, and standardised self- and parent-reported measures of symptoms and functionality. A specialist report detailing the diagnostic formulation and the treatment recommendations is provided. Assessment can be with the view to providing treatment in the clinic or as a specialist second opinion assessment to inform care planning in local services.

Care option: Treatment

Unit: Per session

Treatment provision includes both psychology sessions and medication review sessions. Standard treatment packages include 12 to 25 weekly one-hour psychology sessions and medication review sessions as required. However, we are able to tailor length and frequency of individual sessions and the overall duration of treatment based on clinical needs. Psychological treatment is provided by clinical psychologists specialising in cognitive and behavioural approaches, who are also clinical researchers and CBT trainers. Pharmacological treatment is provided or supervised by a consultant child & adolescent psychiatrist, who is an expert in psychopharmacological approaches to treatment-resistant anxiety disorders and trauma-related psychopathology.

Care option: Consultation

Unit: Per consultation

We provide consultation to local CAMHS teams on assessment methods (including selection of appropriate measures), formulation (including differential diagnosis), care planning and treatment (including specialist psychological and pharmacological approaches), and service development. We also have experience in delivering specialist training on assessment and treatment of post-traumatic stress disorder (PTSD) and anxiety disorders and depression.

Care option: Supervision

Unit: Per session

We offer supervision packages to both individual clinicians and groups. We have experience in providing supervision in person and also remotely via video-link (for example, Skype).

Care option: Medico-legal service

Unit: Per hour

We offer a medico-legal service and can provide court reports as required.

Teaching and Training

Teaching and training

We regularly facilitate teaching and skills-based training events on the assessment and evidence-based treatment of emotional disorders in young people. These events take place in-house in south London or across the country in local child and adolescent mental health services (CAMHS) teams. We pride ourselves on offering interactive, engaging teaching that is tailored to the specific needs of the attendees.

Our training events usually focus on cognitive behavioural therapy (CBT) for a specific difficulty; post-traumatic stress disorder (PTSD) and related disorders, anxiety or depression. Training can be tailored to a wide range of skill levels, from novice CBT practitioners to CPD for more experienced clinicians. Packages can vary in number of days provided, for example from a one day workshop to a three-day course.

Please contact the clinic to discuss your training needs for a personalised financial quote.

Supervision

We offer face-to-face or remote clinical supervision packages for both individuals and groups, with a British Association for Behavioural and Cognitive Psychotherapies (BABCP) accredited supervisor on request. Please contact the clinic for more details.

Public health

We collaborate with the UK government and local commissioning groups to set up and manage public health initiatives related to disasters and emergencies. Together with the South London and Maudsley Centre for Anxiety Disorders and Trauma, we have led a Department of Health and Public Health England scheme to assess and treat victims of terrorist attacks in Tunisia, Belgium, and France and their families.

We have also worked together with local commissioners to plan the care for asylum seekers and refugees during the Syrian crisis. Finally, we have worked with schools to assist teachers and young people coping with bereavement and witnessing of violence (for example, stabbing incidents).

Research

Our research is uncovering the mechanisms through which childhood exposure to traumatic stress can cause mental and physical health problems, in order to inform new preventative and treatment strategies. Our research has also been leading the way in improving and disseminating evidence-based treatments for trauma-related psychopathology and anxiety in young people. All senior team members are also affiliated with the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) at King’s College London.

Families seen in our clinic are often invited to participate in ongoing research projects. We have contributed to several external projects to provide resources for professionals, young people and families, such as e-learning materials for MindEd, ACAMH, and NSPCC.

Research from our team helps clinicians to understand what happens to young people who experience traumatic stress, giving insight into new ways of preventing and treating trauma-related psychopathology. These insights are informing initiatives by the National Society for the Prevention of Cruelty to Children (NSPCC). These insights are also informing public health strategies discussed at the UK House of Commons, the World Health Organisation (WHO), and United Nations International Children’s Emergency Fund (UNICEF):

Our experts

Prof Andrea Danese, Professor of Child and Adolescent Psychiatry

Dr Patrick Smith, Honorary Consultant Clinical Psychologist

Dr Jessica Richardson, Principal Clinical Psychologist

Dr Zoë Maiden, Senior Clinical Psychologist

Dr Sarah Miles, Clinical Psychologist

 

 

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