Putting the pieces together

Transcription

1 Putting the pieces together The Jigsaw Clinic A Specialist Social and Developmental Assessment Clinic Dr Peter Corr & Dr Laura McGowan Wolverhampton CAMHS

2 Outline for presentation Background to Jigsaw About the clinic The assessments Strengths & weaknesses Looking forwards

3 Background Inconsistent diagnostic processes both within CAMHS and across services for ASD + ADHD Differences included: diagnostic thresholds, assessment methods, consideration of differential diagnoses, time-frames, multi-agency involvement, post-diagnostic feedback mechanisms Parent and service user feedback ASD Guidance: National Autism Plan for Children (NIASA, 2003), Autism spectrum disorders in children and young people: final scope (NICE, 2009) ADHD Guidance: Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults (NICE, 2008)

4 The Jigsaw Clinic A CAMHS specialist resource that offers extended assessments to children and young people who have social and developmental difficulties leading to a clinical query of ADHD or ASD. The analogy of a jigsaw is used in terms of treating the assessment phase as a means of creating and assembling a comprehensive picture of a child s strengths and needs Referral Criteria 1. A child 5-18 years of age currently within the CAMHS system 2. There is a clear indication/justification made by the CAMHS worker that a specialist developmental assessment is justified 3. Necessary data/information is obtained in advance (referral form, CBCL/DBC, ADHD or ASD screening sheet and Jigsaw school report form)

5 Composition 2 x Consultant Clinical Psychologist, 1 x Specialist Clinical Psychologist (maternity leave), 1 x Social Worker/Psychotherapist, 1 x Specialist ADHD Nurse Practitioner, 1 x Senior Learning Disability Nurse, 1 x Educational Psychologist, 1 x Assistant Psychologist, 1 x Secretary, Additional CAMHS resources available: Consultant Child and Adolescent Psychiatrist (attends alternate weeks), Consultant Family and Systemic Psychotherapist Wider service links: Paediatricians, Speech and Language, Occupational Therapy etc. 8.45am 1.15pm weekly on a Friday 4 cases seen per week, with the opportunity to see child and parents separately Clinic established since April 2010

6 Jigsaw Clinic Pathway CAMHS Referrer Jigsaw Referral Jigsaw Team Main Assessment Jigsaw Specialist ASD Assessment Report/Feedback Jigsaw Specialist ADHD Assessment ASD Diagnosis Given Relevant Interventions ADHD Diagnosis Given Relevant Interventions Diagnosis Not Given Relevant Interventions

7 Assessment Process Each case is assigned a keyworker case is still also held by referring CAMHS team Reflective space for clinicians before and after each session as a Jigsaw Team String of appointments booked in advance after initial session At final assessment appointment review draft Jigsaw report, discuss diagnostic conclusions and hypotheses with young person and family Post-diagnostic session offered within Jigsaw clinic where appropriate, psychoeducation etc. Post-assessment - usual CAMHS intervention options applicable + referrals to other services/agencies where necessary Discharged from Jigsaw Clinic

8 Assessment Menu Main Assessment - Clinical interview - Extended developmental history - Family History extended genogram - Observations (home/school) - Paediatric health check - (Cognitive assessment e.g., WISC-IV UK ) - (Systemic assessment; Risk assessment, playbased assessment) Specialist ASD Assessment - ASD assessment tools (e.g., ADOS) - Speech and Language referral/assessment - Occupational therapy referral/assessment - Additional cognitive assessment (e.g., NEPSY) - Psychiatric opinion - Co-morbidity considerations Specialist ADHD Assessment - ADHD assessment tools (e.g., Brown Scales, Connors) - Educational Psychology referral/assessment - Occupational therapy referral/assessment - Additional cognitive assessment (e.g., NEPSY, Tea-Ch) - Psychiatric opinion - Co-morbidity considerations

9 Strengths CAMHS Clinic: combines mainstream CAMHS (Child and Family Service) with LD (Inspire) clinicians, multi-disciplinary expertise Timed process: how appointments are arranged, separating child and parent/family work out in the same slot, more efficient assessment process Key Worker role improves communication and sense of containment for parents Clear remit of an assessment clinic Evidence-based assessment process based on DSM-IV/ICD-10 criteria: use of assessment record/menu identifies specific assessment needs for all children in Jigsaw Multi-disciplinary approach offers varying perspectives on differential diagnoses/hypotheses, further enhanced by protected reflective team space Regular education slots for team within clinic time, topic derived from identified need from client assessments Regular business meetings to review progress of clinic

10 Future Developments Include other services and agencies within the Jigsaw Clinic slots, e.g., speech and language assessments, Paediatric health checks Development of more post-diagnostic interventions and resources across CAMHS More formal quantitative and qualitative evaluation of clinic Existing clinic developed out of existing CAMHS resources, therefore secure specific funding to increase capacity of clinic, free up clinicians from other duties, protect report admin time Possibly widen referral pathway to incorporate referrals external to CAMHS e.g., from Paediatricians Possibly widen referral criteria to assess under 5s and/or other developmental queries e.g., psychosomatic presentations Replicate Jigsaw model onto other mental health conditions to improve formulation process across CAMHS (e.g., OCD, Depression) and linking to Payment by Results clusters

11 Questions Any Questions???? For further information regarding the Wolverhampton CAMHS Jigsaw Clinic, please contact: Dr Laura McGowan, Specialist Clinical Psychologist, Jigsaw Clinic Lead Dr Peter Corr, Consultant Clinical Psychologist, Inspire Service Manager