Tier 4 Assessment Neurodevelopment Day 27 th March 2012

ASD Diagnosis Changing thresholds Increasing demands on health services Specialist v Generalist

NICE guidelines Intent = Needs of child & family driven As locally available as possible (with necessary expertise) Process = Multi agency, Needs driven, timely and proportionate Agreed with family

A Suggested Model

Primary (Tier 1) Services role For under 5s, all children will have had SOGS and referrals will be made to the CDT team. For over 5s who are referred to CAMHS or Paediatricians, specialist Educational support information will be obtained before the child is discussed at CDT.

Primary Services For over 5s from problematic families/with a history of difficulties or behavioural problems, the referrer will be expected to have had behavioural intervention. IEP cycles will be expected to have been completed with measurable targets agreed with parents. A cognitive assessment from Education will also be required.

Specialist Tier 2/3 Services Same team of professionals for all ages Assessments required may include: Paediatric assessment Speech and Language Therapy assessment Detailed developmental history OT assessment Educational Psychology assessment CAMHS assessment

Specialist Services Tasks allocated through multi disciplinary meeting – e.g. the current CDT meeting with the added input from CAMHS. From this meeting an assessment plan agreed for each child with key professionals identified. Timescales agreed. Communication with the childs family would be the responsibility of a lead professional identified at the initial CDT meeting. The family would be advised of the agreed assessment plan and time limits for their childs case.

Specialist Services The lead professional meets with the family after the assessment and follow up CDT meeting to discuss diagnosis, needs assessment and other services recommended. A follow up meeting with parents (and the relevant SENCO and/or School Health Nurse ?) one week after diagnostic feedback

Tertiary (Tier 4) level Diagnostic dilemmas with concerns about co-morbidities will lead to a referral to the tertiary clinic. This tertiary clinic will only accept referrals from the CDT team. The use of the tertiary clinic as a second opinion is available in exceptional circumstances only

Team Paediatrician Speech and Language Therapy Psychologist OT Educational Psychologist CAMHS CALD

Tertiary level Feedback to the family will be maintained by the lead professional identified at the original CDT

Considerations Training needs (Levels 1-4?) Tools used Post diagnosis input LA Childrens disability teams Third Sector involvement