Autism Services for children
A look at service needs
Dr Gabriel Whitlingum and Dr Mark Harman – Royal Hampshire County Hospital
The Paediatric Psychology Service
Twice monthly clinic at Winchester
5-6 patients per morning
Paediatric Consultant & Psychologist
One clinic joined by Hampshire Autistic Society
50% Autistic (AS) and 50% Non-Autistic (nAS)
Complex medical needs 50% of AS (25% total patients)
Service Pathway
Adjusted to complexity , tier 2 fewer steps, tier 3 AS patients generally undergo
the following “full assessment” – not necessarily in this order.
Appointments/ Process
Steps
1st
Physical assessments; developmental history; information
collation from outside sources (schools, etc); parent
education; possible working diagnosis
2nd
Joint Psychology clinic: identify next steps to assessment,
discuss management strategies; working diagnosis
3rd
ADOS and explanation of results; confirm diagnosis, if
possible
4th
Psychologist liaise/observation at school
5th
Multiagency diagnostic session; ADI-R; all representatives
(parents, schools, psychology, paediatrics etc) gather to
discuss and finalise diagnosis and plan support and
follow up.
The 3 Tier
Service
r-based Service
Non-complex
Initial data and reports, inc parents,
education clearly consistent with ICD10/DSM IV AS criteria
Collate information
Share diagnosis
Signpost support
Follow up as appropriate
The 3 Tier
Service
r-based Service
Complex
Cases which could meet AS criteria
Assessments are not definitively clear for
diagnosis
Other established diagnoses
complex background
The 3 Tier
Service
r-based Service
Very-complex
Complex, co-morbid cases
Discordant professional opinions on
diagnosis
Often need 3rd-5th appointment/step to
finalise diagnosis
A collaborative approach –
health and education
Parent interviews
Evaluate mental
health
Liaisons
Cognitive
Assessments
Psychology/CAMS
Paeds-Psych Clinic
Differential diagnosis
Co-morbidities
Diagnosis and support
T2
T3
T1
Paediatrics
Physical assessment
Observation
Medical Tests
Evaluate medical needs
Education
OT
SALT
BST
Autism outreach
E.P./School report
Attend MDT Diagnostic
interviews
Evaluate education
needs
Parent survey
Method
• Casemix data
• Telephone survey
• Typed and made
Proforma
• Either of parents
Numbers
• Phoned
• Answered
• Agreed
55
29
28
Expectation of the forthcoming
assessment
18%
39%
18%
25%
Diagnosis
Find help
Diagnosis + help
Not sure
Parent survey
Information helpful
Not sure 4%
Did not
receive
Not true
anything
0%
4%
Partly true
14%
Assessment thorough
Not true 4%
Not sure 4%
Partly true
14%
Very true
78%
Very true
78%
Parent survey
Easy to talk to people
Concerns taken seriously
Not true 0%
Not true 4% Not sure 4%
Not sure 4%
Partly true
14%
Partly true
14%
Very true
78%
Very true 82%
Support pack from HAS
helpful?
Meeting with outreach
officer of HAS was
helpful?
Would have liked the
opportunity to meet
Outreach Officer
7% 0%
0%
7%
29%
11%
25%
57%
50%
11%
14%
Very true
Partly true
15%
74%
Not true
Not sure
Parent survey
Likely to contact outreach officer again?
Not true
3%
Partly true
25%
Not sure 11%
Very true
61%
Statement
Very true
Partly true
Not true
Would have liked to meet
outreach officer
Meet with outreach officer again
Not sure
Outreach officer meeting
Working together
Explanation about supports
Support pack from HAS
Worries taken seriously
Easy to talk to people
Thorough assessment
Information
Number of responders
Satisfaction variable
30
25
20
15
10
5
0
Parent survey
Good
Not so good
Situation taken seriously and
positive vibe
Post diagnosis support
Expertise and communication
Multidisciplinary involvement
Diagnostic process
OT access
Multiagency involvement
Waiting time
Thorough, video recording and two
persons opinion on video, d/w
school and joint discussions
Letters and communication with other
specialties
Hampshire autistic society,
communication with school, quick
diagnosis