1. Dr. Pamela Wood Senior Clinical Psychologist
Autism Spectrum Assessment Service (ASAS) North Staffs Combined Healthcare NHS Trust
Dr. Pamela Wood
Senior Clinical Psychologist

2. Aim of presentation Introduction to our team and what we do
Provide information about the work we have done over the past 2 years including referral and diagnosis rates
Provide recent updates about the service

3. What is the Autism Spectrum Assessment Service (ASAS) ?
Specially commissioned service - established as a team in June 2015
Provide assessment for adults who do not have a learning disability to determine whether or not they have a diagnosis of Autism Spectrum Disorder (ASD)
Provide recommendations and signposting where appropriate, whether diagnosis is given or not
Where diagnosis is given, provide brief follow up where appropriate

4. Who are we? Multi-disciplinary team:
Social Worker (Team Manager)
Administrator
Consultant Psychiatrist
Mental Health Practitioner
Occupational Therapist
Speech and Language Therapist
Clinical Psychologist
Based at the Hazlehurst Unit, Harplands Hospital
All trained to use the Adult Asperger Assessment (AAA)

5. Adult Asperger Assessment (AAA)
Adult Asperger Assessment (AAA) (Baron-Cohen and Wheelwright, 2000) updated by Bradley (2011).
The Adult Asperger Assessment (AAA) is a computer scorable assessment measure which enables the integration of 3 screening measures and a clinical interview. It is based on the DSM-IV (1994) criteria for Asperger Syndrome or autistic disorder but owing to the addition of further relevant criteria, is more stringent and allows fewer false positives.

6. Adult Asperger Assessment (AAA)
The AAA assesses for lifelong difficulties in the following areas:
a) Qualitative impairment in verbal and nonverbal communication
b) Qualitative impairment in social interaction
c) Restricted, repetitive and stereotyped patterns of behavior and interests
Whilst not included as a distinct category in the DSM-IV, the AAA also distinguishes difficulties with:
d) Impairment in imagination

7. Service history Inherited waiting list
Consistently received a high level of referrals – average of 14.4 referrals per month
Resulted in a 6 month+ waiting list
Closed to referrals in November 2016
Re-opened to new referrals on 4th September 2017

8. Current Referral process
2 routes:
Direct GP referrals - no longer via Mental Health Access Team.
Reduces appointments and repetition for clients. Requires GP’s to address risks and mental health problems as needed
Internally within Combined Healthcare
Emphasis on ensuring referrals are appropriate at the outset – clear information about lifelong autism traits is required from referrers.

9. Referral received by ASAS TEAM
Referral screened by qualified member of ASAS TEAM
& discussed at MDT meeting if necessary
Initial acceptance of referral
Acceptance letter sent to client & referrer +
Questionnaires sent out
Referrer contacted requesting more information
Referral not accepted
Letter to referrer & client explaining why

10. Questionnaire pack sent to client
Given 1 month to return questionnaires
Support given to complete questionnaires if needed
Reminder letter sent if questionnaires not returned
Returned questionnaires scored & reviewed
Accepted for full clinical assessment
Not accepted for full clinical assessment

11. 1st stage of assessment: Questionnaires
Where a referral is accepted, questionnaire packs are sent out:
Autism Quotient (AQ50)
Cambridge Behaviour Scale – Empathy Quotient (EQ)
Relative’s Questionnaire (RQ)
Cambridge Lifespan Autism Assessment Patient’s Questionnaire (PQ)
As well as screening, questionnaires provide additional information which helps guide our assessment
Completing the questionnaires enables clients and carers to prepare for issues that will be considered during the clinical assessment interview
Clients are offered support to complete these if needed.

12. Team audit of questionnaires
Audit of questionnaire scores against diagnostic outcomes
Found expected pattern of predictability of questionnaire scores in relation diagnostic outcome
Relative’s questionnaire (RQ) is most predictive of outcome
As noted clinically there were a number of anomalies, indicating ongoing need for flexibility when interpreting questionnaires

13. 2nd stage of assessment: Clinical interview
3 hour face to face interview with client and ideally a family member, completed with 2 members of ASAS team:
Background information (family & developmental history, education, employment history, health issues, daily living skills, sensory difficulties & preferences, personal strengths)
Adult Asperger Assessment (AAA)

14. Assessment outcome
Scoring agreed post assessment interview between clinicians assessing
Further information requested if needed/available
Assessment fed back at MDT, in detail if necessary and any disagreement / discrepancies discussed
Diagnosis or non diagnosis agreed by team
Lead clinician drafts report

15. Feedback & Discharge Client attends for feedback with / without family
Diagnosis given / not given with alternative explanation
Recommendations / plans for further support discussed
Agree final draft of report
Client’s not given a diagnosis discharged from service
Clients given a diagnosis either:
Remain open for 1 month to allow opportunity to discuss understanding / implications of diagnosis, then discharged
Or offered brief intervention, then discharged

16. Referrals (<June 2015 – 1st Nov 2016)
Total of 318 referrals received:
70% were males & 30% were females
270 were initially accepted for assessment
48 not accepted at referral due to not meeting criteria

17. Ethnicity of individuals referred (%) (N=318)
0.25%
White British
Other white back
ground
Asian British
Mixed white & black Caribbean
Other black back
ground
Not
stated

18. Age at referral (N=318) 17-25 years 26-35 years 36-45 years
17-25
years
26-35 years
36-45 years
46-55 years
56+ years
Unknown

19. Source of referral (N=318)3% 3%
GP or Access
Unknown
IAPT
CAMHS
CMHT
Psychology
Other LD

20. Referral processed and discharged (<June 2015 – 1st August 2017)
Of 270 initially accepted for assessment:
27 did not complete screening questionnaires
11 did not attend clinical assessment appointment
3 screened out from questionnaires
3 consultancy
1 deceased
188 completed assessments with additional 37 assessments underway

21. Diagnosis rate Of 188 completed assessments:
61% received a diagnosis of ASD
62% of the males assessed received a diagnosis of ASD
60% of the females assessed received a diagnosis of ASD

22. Recommendations / signposting
Signpost/refer to other services
E.g. CMHT, IAPT services, Lifeworks, NS-AAA, SAAS, Social Agency, North Staffs Carers, Dyslexia Association, SALT, Psychology
Letter to educational establishment and employers
Brief follow up with ASAS if appropriate

23. Follow up work offered
23 people have received structured follow up work
9 communication assessment & recommendations/skills
7 for anxiety management work
3 sensory needs
2 support in accessing psychological therapy
2 cognitive assessments
1 Initial swallowing assessment
1 sleep/relaxation work
1 psychiatric review
Total of 62 follow up sessions attended (excludes cancellations and DNA’s)

24. Client feedback

25. % feedback ratings re “How did we do
% feedback ratings re “How did we do?” (9th July 2015 – 1st Aug 2017: 252 forms)
2 complaints
Very good
Poor
Average
Good
Excellent

26. “Any Comments?” ( 5th Jan 2017 – 19th September 2017)
“The team have shown empathy, kindness and consideration at all times. Helpful and constructive service and for this I am very grateful.”
“I think you explained things in really good understandable terms.”
“I was very happy with the full assessment. Very happy with the diagnosis.”
“Really informative session – although not solved I feel better about what can happen from here.”
One who felt we had not helped their child to adapt to specific aspects of their difficulties

27. “What can we do to improve?” (5th Jan 2017 – 19th Sept 2017)
Comments regarding improvements:
“Maybe a break in between – other than that nothing”
“Warmer room”
One felt insufficient advice was given for further help
5 comments about needing more funding / shorting waiting time
A number of positive comments:
“Nothing really as the service received is outstanding”

28. Additional work
ASD awareness sessions with IAPT services and with the wards at Harplands hospital
Total of 88 attendees
“How useful would you say the training was (1 = not very useful, 10 = very useful)
Average rating of 8.7/10 (Range 7-10)
Collating list of individuals (and also relatives or carers of individuals) who have received a diagnosis of ASD through our service, who are willing to be contacted for research purposes.

29. Research Supporting Trainee Clinical Psychologist research
Gaining insight into what support or aspects of therapy have been helpful for adults with an ASD who experience anxiety
Gaining insight into what support healthcare professionals feel has been helpful to individuals with ASD who experience anxiety.
Aim – to provide a resource for healthcare professionals who support or offer therapy to adults with an ASD experiencing anxiety.

30. Initial information from screening those agreeing to be contacted
65 people who were given a diagnosis had agreed to be contacted regarding research (Nov 2015 – May 2017)
All but 3 reported difficulties with anxiety, stress or depression
Some had complex histories with mental health services, some had experienced difficulties but never sought help.

31. What's happened since we re-opened to new referrals?

32. Data since re-opening to referrals (4th September 2017 – 19th September 2017)
17 initially accepted at point of referral
1 since screened out as questionnaires identified previous assessment
24 with insufficient information – pending further information from referrer
3 did not meet criteria

33. How to contact us Email address: ASAS.Communication@northstaffs.nhs.uk
Telephone number
ext 6347 (with answer phone )
Autism Spectrum Assessment Service
Hazlehurst Unit, Harplands Hospital,
Hilton Road, Stoke-on-Trent, ST4 6TH

34. Thank you for listening! Any questions?