14. barnsley autism model
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This document discusses developing a community model and pathway for adults with autism spectrum disorder (ASD) without intellectual disabilities. It outlines several key steps to developing an ASD pathway, including calculating demand, considering pathway options, modeling capacity, and discussing scenarios with commissioners. Potential pathway options are presented ranging from specialist diagnosis and care to screening by GPs. The pathway would include referral, diagnosis, needs assessment, interventions addressing health issues related to ASD and any comorbidities, and community support. Developing the pathway requires input from clinical, finance, business development, and commissioning perspectives to design an integrated system.
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14. barnsley autism model
- 1. 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
- 2. 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
- 5. 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
- 6. 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
- 7. 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
- 8. DiagnosisDiagnosisDiagnosisDiagnosis It is a process i.e. a series of actions or steps taken in order to achieve a particular end. Collect Information Synthesize Information Interpret Information Match according to criteria Reach conclusion
- 9. 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 scenaria across pathway options and commissioner options
- 10. Calculate Demand Consider Pathway Options Model Capacity for each pathway option Discuss scenaria across pathway options and commissioner options 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?
- 11. Calculate DemandCalculate DemandCalculate DemandCalculate 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
- 12. Calculate Demand Consider Pathway Options Model Capacity for each pathway option Discuss scenaria across pathway options and commissioner options 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?
- 14. 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.
- 15. ASD PATHWAY OPTIONS (C, C+)ASD PATHWAY OPTIONS (C, C+)ASD PATHWAY OPTIONS (C, C+)ASD PATHWAY OPTIONS (C, C+) Referral MDT (Specialist Triage/ Case Discussion) Diagnosis by HP only but ACCESS to doctor for complex cases Care (specialist health and social interventions by specialist Team)- Caseload Management P L U S
- 16. ASD PATHWAY OPTIONS (A, A+)ASD PATHWAY OPTIONS (A, A+)ASD PATHWAY OPTIONS (A, A+)ASD PATHWAY OPTIONS (A, A+) Referral MDT (Specialist Triage/ Case Discussion) MDT Diagnosis (both HP and Doctor) Care (specialist health and social interventions by specialist Team)- Caseload Management P L U S
- 17. ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+) Referral MDT (Specialist Triage/ Case Discussion) Screening by GP or Doctor of referrals MDT Diagnosis (HP and access to Doctor for complex cases) Care (specialist health and social interventions by specialist Team)- Caseload Management P L U S
- 19. DiagnosisDiagnosisDiagnosisDiagnosis It is a process i.e. a series of actions or steps taken in order to achieve a particular end. Collect Information Synthesize Information Interpret Information Match according to criteria Reach conclusion
- 20. Care in AutismCare in AutismCare in AutismCare in Autism Health Social Community
- 21. Health InterventionsHealth InterventionsHealth InterventionsHealth Interventions Relate to Autism Relate to Comorbidity
- 22. 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, and associated 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.
- 23. 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.
- 24. Social Care Interventions Relate to Autism Relate to Comorbidity
- 25. 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
- 29. 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
- 30. Ladder of Change in Autism Autism is major barrier Accepting some support Stable Learning for yourself Choice and Self Reliance
- 31. 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 scenaria across pathway options and commissioner options
- 32. ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+)ASD PATHWAY OPTIONS (B, B+) Referral MDT (Specialist Triage/ Case Discussion) Screening by GP or Doctor of referrals MDT Diagnosis (HP and access to Doctor for complex cases) Care (specialist health and social interventions by specialist Team)- Caseload Management P L U S
- 33. 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 scenaria across pathway options and commissioner options
- 35. 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
- 36. Integrated seamless pathwayIntegrated seamless pathwayIntegrated seamless pathwayIntegrated seamless pathway Health Social Community