Hello everyone! I’m really thrilled to bring you some exciting news about a new Assessment Pathway for Social Communication difficulties in Manchester – the process for getting a clinical diagnosis, on the NHS, for children with a social and communication disorder, such as autism.
Our parent-carer surveys have shown that the old SCAIT system really isn’t working any more, with difficulty of access, long waiting times, duplication of assessments and inconsistency in services across the city. Many of these problems are due to a huge increase in the number of referrals – when the current SCAIT (Social Communication Assessment and Intervention Teams) were first set up in 1999, they received 40 referrals a year in each district (North, Central and South Manchester). Currently, 30 referrals are received in South Manchester alone per month. The old pathway is no longer fit for purpose, and a new system is needed.
All the services involved, together with the MPCF, have worked together over the past several months to design a revolutionary new pathway, in a spirit of co-production which has been exemplary. Our meetings have had consistent and committed representation from CAMHS (Child and Adolescent Mental Health Services), Paediatricians, Speech and Language Therapists (SLT), Occupational Therapists (OT), Health Visitors and Educational Psychologists, as well as the forum to represent parent-carers. The NHS Clinical Commissioners have agreed to fund a two year pilot of the new pathway, which will take place initially in South Manchester but will be rolled out to Central and North in due course.
The pilot will begin in October this year (2018) for families in the South Manchester area, covered by CAMHS at the Carol Kendrick centre in Wythenshawe. There is currently a waiting list for assessment, and families on this list will be assessed first, so that initially there will be some referral delays until the system is up and running; but it is expected that these will soon reduce. New referrals will be sent the new forms as of now, so that their cases can be assessed under the new system as soon as they are taken up. Those already waiting for assessment will be informed how the process is changing, and may be asked to send in additional information as needed.
What is changing with the new pathway?
The new pathway requires all professionals to think and work differently together and to use resources more efficiently, placing assessment at the core of the needs of the child or young person.
Referrals will be assessed by a core triage team of advanced clinical practitioners taken from all the services, meeting together as a group each week to look at new cases. Further information can be gathered as needed from relevant sources.
Each referral case will be assigned a named key-worker to support and inform them throughout the assessment process and assist them into the right intervention strategies. Usually this will be a clinician best suited to the child’s needs – for example, SALT if their difficulties lie mainly in speech, OT for physical or sensory needs, Clinical Psychology for behaviour.
Initial appointments will be with two clinicians, so that a developmental history can be taken from the parent-carer while the child has a clinical observation such as the ADOS. A second appointment will usually be made at the educational setting, for observation within the peer group. Parents will not be present at this observation but will be informed of the outcome.
The new pathway formalises the assessment tools and process so that families will receive the same service no matter where they are assessed. It will also provide clear data for auditing and future planning, also undertaken with parent-carer involvement.
The process will improve transparency and communication, making parent-carer involvement key, with a new referral form designed specifically for parent-carers. Health referrals will be streamlined, the role of education made clearer, and evidence will be gathered in detail at an early stage of the process so that assessment is not held up by lack of information.
It takes assessment out of CAMHS and puts it into the community; autism is not a mental health problem but currently the diagnosis rests entirely in CAMHS, which can be upsetting for families and young people themselves. Some appointments will still be made at CAMHS clinics, due to resource and space allocation within the NHS, but some will now be made in local health clinics or community centres.
All these changes should make social communication assessment much more equitable, efficient and family/child friendly and it’s really an exciting and hopeful time for us Manchester parent-carers. I hope I’ve managed to explain things clearly, but if you have any questions, please feel free to comment and I’ll do my best to help.
MPCF core steering group
Mother to a 10 year old with ASC and ADHD