Dr. Anna van SpanjeDutch Knowledge Center for Child and Adolescent Psychiatry

ESCAP 2015 congress – Madrid, June 22nd 2015

Clinical autism guidelines in the Netherlands and Belgium

Small distance, small differences?

None

Conflicts of interest

Small distance…

• Include the latest findings from the best studies (both inspired by NICE guideline)

• Include input from researchers, clinicians and patient organizations

• Several feedback moments

• Similar recommendations

Similarities in guideline development

• Belgian guideline only aimed at treatment; Dutch guideline also covers diagnosis

• Netherlands: multiple guidelines for different professionals (prevention vs. diagnosis and treatment)

• Belgian guideline also includes negative recommendations (“what not to do”)

Differences per country

• Scotland:• Diagnosis and intervention

• England:National Institute for Clinical Excellence (NICE)• One for recognition, referral and diagnosis• One for intervention

UK guidelines for children

• No research into implementation• However, clinicians tell us: There are

problems with implementation in spite of thorough developmental process

Guideline implementation

• General: little effort into implementation• Who receives guideline training? • Is the guideline binding?• Policy changes vs. budget cuts• Differences between departments• Multiple ways to interpret guideline

And…• No cooperation between countries!

Implementation issues

• Netherlands: new system for youth mental health care, recent changes

• Belgium: bilingualism

Practical issues that slow down implementation

Influencing factors per country

“There is an imperfect evidence base to support decisions about which guideline

dissemination and implementation strategies are likely to be efficient under

different circumstances.”

Grimshaw, J.M., Thomas, R.E., MacLennan, G. et al. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment, 8(6), 1-72.

What to do?

• Make autism guidelines more hands-on• Avoid ambiguity, include examples and

“what not to do”• Cooperate and actively exchange

knowledge• Include an implementation plan, plus

follow-up (cf. NICE implementation support)

• Work bottom up rather than top down

Recommendations

• Is it possible to make an autism clinical guideline for all clinical settings?

• Is it possible to make a European autism clinical guideline?

The future

• Dr. Annelies de Bildt (Research Psychologist, Accare University Medical Center

Groningen)

• Penny Williams (Consultant Speech & Language Therapist, Children’s

Neurosciences Centre at Evelina London Children’s Hospital)

Special thanks to:

Contact

a.vanspanje@kenniscentrum-kjp.nl

• How are guidelines developed and used in your organization?

• How do you see the future of autism clinical guidelines?

General discussion