14. barnsley autism model

Community Model for Adults with Autism (not ID)

Professor Marios Adamou, Clinical Lead, ADHD and Autism Service, SWYPFT

Jane Wood, Head of Joint Commissioning, Barnsley MBC/NHS Barnsley CCG

What we will talk about

• Who we are

• Novel classification of mental disorders

• Structuring a healthcare pathway

• Developing an Autism Pathway

• Making informed choices on an Autism Pathway

• Concluding remarks and questions

Adult ADHDAdult Autism

Organisation of Mental Health ServicesOrganisation of Mental Health ServicesOrganisation of Mental Health ServicesOrganisation of Mental Health Services

Neurodevelopmental Disorders

(ADHD, ASD)

(4+1=5%)

Mental Illness

(Schizophrenia, Depression, Anxiety)

10%

Neurodegenerative Disorders

(Dementias, CDC)

1.3%

AGE

IQ

PathwayPathwayPathwayPathway Structure for any Healthcare conditionStructure for any Healthcare conditionStructure for any Healthcare conditionStructure for any Healthcare condition

Referral

Diagnosis

Assessment of Need

Interventions

Community Support

Referral

Diagnosis

Assessment of Need

Interventions

Community Support

PathwayPathwayPathwayPathway Structure for any Healthcare conditionStructure for any Healthcare conditionStructure for any Healthcare conditionStructure for any Healthcare condition

Diagnosis Diagnosis Diagnosis Diagnosis

It is a process i.e. a series of actions or steps taken in order to achievea particular end.

Collect Information

Synthesize Information

Interpret

Information

Match according to

criteria

Reach conclusion

How would you develop a pathway for Autism?How would you develop a pathway for Autism?How would you develop a pathway for Autism?How would you develop a pathway for Autism?

Calculate Demand

Consider Pathway Options

Model Capacity for

each pathway option

Discuss scenariaacross

pathway options and

commissioner options

Calculate Demand


Model Capacity for

each pathway option


pathway options and



Calculate Demand Calculate Demand Calculate Demand Calculate Demand –––– watch the GPs!!watch the GPs!!watch the GPs!!watch the GPs!!

• No national guidance for planned Service Capacity

• Epidemiology can overestimate Demand

• Consider Transition from Children’s Services BOTH Local Authority packages of Care (if integrated Service) or CAMHS cases

Calculate Demand


Model Capacity for

each pathway option


pathway options and



NICE Quality standard QS51NICE Quality standard QS51NICE Quality standard QS51NICE Quality standard QS51

• Statement 1. People with possible autism who are referred to an autism team for a diagnostic assessment have the diagnostic assessment started within 3 months of their referral.

• Statement 2. People having a diagnostic assessment for autism are also assessed for coexisting physical health conditions and mental health problems.

• Statement 3. People with autism have a personalised plan that is developed and implemented in a partnership between them and their family and carers (if appropriate) and the autism team.

• Statement 4. People with autism are offered a named key worker to coordinate the care and support detailed in their personalised plan.

• Statement 5. People with autism have a documented discussion with a member of the autism team about opportunities to take part in age-appropriate psychosocial interventions to help address the core features of autism.

• Statement 6. People with autism are not prescribed medication to address the core features of autism.

• Statement 7. People with autism who develop behaviour that challenges are assessed for possible triggers, including physical health conditions, mental health problems and environmental factors.

• Statement 8. People with autism and behaviour that challenges are not offered antipsychotic medication for the behaviour unless it is being considered because psychosocial or other interventions are insufficient or cannot be delivered because of the severity of the behaviour.

ASD PATHWAY OPTIONS (C, C+)ASD PATHWAY OPTIONS (C, C+)ASD PATHWAY OPTIONS (C, C+)ASD PATHWAY OPTIONS (C, C+)

ReferralMDT (Specialist Triage/

Case Discussion)

Diagnosis by HP onlybut ACCESS to doctor

for complex cases

Care (specialist health and social interventions

by specialist Team)-Caseload Management

P

L

U

S

ASD PATHWAY OPTIONS (A, A+)ASD PATHWAY OPTIONS (A, A+)ASD PATHWAY OPTIONS (A, A+)ASD PATHWAY OPTIONS (A, A+)


Case Discussion)MDT Diagnosis (both HP

and Doctor)



P

L

U

S

ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)


Case Discussion)

Screening by GP or Doctor of referrals

MDT Diagnosis (HP and access to Doctor for

complex cases)



P

L

U

S

Diagnosis Diagnosis Diagnosis Diagnosis

It is a process i.e. a series of actions or steps taken in order to achievea particular end.

Collect Information

Synthesize Information

Interpret

Information

Match according to

criteria

Reach conclusion

Care in AutismCare in AutismCare in AutismCare in Autism

Health

Social Community

Health InterventionsHealth InterventionsHealth InterventionsHealth Interventions

Relate to Autism

Relate to Comorbidity

ComorbidityComorbidityComorbidityComorbidity

• 70% of participants had at least one comorbid disorder and 41% had two or more:

• social anxiety disorder 29.2%

• attention-deficit/hyperactivity disorder 28.2%

• oppositional defiant disorder 28.1%

• Simonoff, E., A. Pickles, et al. (2008). "Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, andassociated factors in a population-derived sample." J Am Acad Child Adolesc Psychiatry 47(8): 921-929.

• Vannucchi, G., G. Masi, et al. (2014). "Clinical features, developmental course, and psychiatric comorbidity of adult autism spectrum disorders." CNS Spectr 19(2): 157-164.

Wong, A. Y., Y. Hsia, et al. (2014). "The variation of psychopharmacological prescription rates for people with autism

spectrum disorder (ASD) in 30 countries." Autism Res 7(5): 543-554.

Social Care Interventions

Relate to Autism

Relate to Comorbidity

Models of Social Care Approach

• Social Model Applied to Medical Services

• Traditional Model Applied to Social Care Services

• Social Model Applied to Social Care Services

Structuring the Interventions

Spectrum Star- Focus on Recovery

• Physical health

• Living skills & self care

• Well-being & self-esteem

• Sensory differences

• Communication

• Social skills

• Relationships

• Socially responsible behaviour

• Time and activities

Ladder of Change in Autism

Autism is major barrier

Accepting some support

Stable

Learning for yourself

Choice and Self Reliance


Calculate Demand


Model Capacity for

each pathway option


pathway options and


ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)


Case Discussion)

Screening by GP or Doctor of referrals

MDT Diagnosis (HP and access to Doctor for

complex cases)



P

L

U

S


Calculate Demand


Model Capacity for

each pathway option


pathway options and


Clinical

Finance

Business Development

Commissioning

Clinical Input

• Design pathway

• Process map patient journey

• Recommend workforce

• Estimate clinical activity requirements

Business Development

•Model demand and capacity requirements

•Build scenaria

•Develop KPIs•Manage implementation of Project

•Risk management

•Profile patient flow

Finance

• Estimate costs

• Estimate budget allocation per period

• Set up financial planning assumptions

• establish systems and processes to enable the timely and accurate delivery of monthly management accounts and budget information

Commissioner

• Choose model

• Set KPI

• Monitor Performance

• Monitor Compliance

Integrated seamless pathwayIntegrated seamless pathwayIntegrated seamless pathwayIntegrated seamless pathway

Health

Social Community