Diagnosis and assessment
'Primary care professionals should consider including assessments of the triad of impairments as a standard part of all routine surveillance for infants within primary care.
In order to limit waiting times and improve services for assessment and diagnosis of children and adults, resources are required to train and employ more specialist professionals in all agencies.'
What has happened
The SIGN Guideline development will cover surveillance and should consider the evidence base for routine screening.
The diagnosis sub-group of the ASD Reference Group held a clinicians conference in March 2004, to discuss ways of improving assessment and diagnosis. One proposal was for publication of a diagnosis service quality statement aimed at improving the consistency of diagnosis. This quality standard for ASD diagnostic services issued in 2005 offers people with ASD and family carers a clear indication of what can be expected from a diagnostic service and provides a checklist for multi-disciplinary teams providing the service. Responses to a Scottish Executive consultation unanimously supported the adoption of the quality service standard statement (Annex 4) nationally and at local level. It is intended to complement the SIGN guideline currently being developed. We are now looking at how implementation will be measured through the work of NHS Quality Improvement Scotland.
Delegates from the clinician conference are also now able to participate in an e-network, sharing information and discussing issues relating to diagnosis across Scotland.
The diagnosis sub-group agreed to a number of projects to pilot training in diagnostic tools. The aim of the training is to reduce waiting times for diagnosis for families where an individual may have an ASD. The projects are examining the impact of training more professionals at tiers 2 and 3 to undertake diagnosis within multi-disciplinary teams. There are four pilot projects.
- A project in Argyll and Clyde, covering rural and urban areas, to improve confidence of professionals at tier 2 in taking the history of children and young people with suspected ASD and to provide confidence in giving feedback.
- An adult diagnostic services pilot, which aims to increase confidence in tier 2 and will involve the use of the diagnostic instrument ADI-R.
- A school based pilot in Fife based on an observation schedule, which aims to reduce the volume and time delay for referral.
- Training on the diagnostic and assessment tool, DISCO.
A Directory of individuals and teams undertaking assessment and diagnosis of ASD in Scotland has been developed as part of the Autism Argyll/Autism Information Scotland Project. It has been developed by NHS Education Scotland ( NES) to link various professionals involved in the assessment and diagnosis of ASD and to inform primary care health professionals across Scotland where individuals can be referred for a diagnosis of ASD.
The Directory will be distributed to all GP's in Scotland in Spring 2006 and an edited version will be available from the National Service Network website, which is currently being developed.
What still needs to happen
Action on workforce planning and tackling waiting times locally and nationally needs to include the need for specialist services for people with ASD.
An evaluation of the training diagnostic pilots will be conducted. This will be useful for local agencies' to inform decisions about training for tier 2 and 3 professionals which will help to reduce waiting times for individuals with ASD to receive a diagnosis and assessment.