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Trafford Autism and Social Communication Pathway

Project Group Lead

Jo Parry (Consultant Psychologist)

Project Group Members

Bo White/Jo Bryan (Commissioners)

Christine Suddons/Maliheh Rashid (Speech and Language Therapists)

Sree Ukkadam (Community Paediatrics)

Karen Harris/Steph Littleton (Education Psychology)

Dr Tulika Singh/ Lisa Lewer/ Sarah Leah/ (Healthy Young Minds - CAMHS)

Jan Trainor (Head of North Area Family Support Team/ Health Visiting)

Sue McAlinden (Service Manager – Complex Needs Service (health) Service Manager/

Team Leader – Trafford Children’s Therapy Service)

Chris Hamlett (Operational Manager Central Health Visiting and School Nursing)

Geraldine Thompson-Curran (Manager of Trafford Extended Service - Diagnostic and post diagnostic service for Autism)

Geraldine English/Simon Frankham (Parent and Young People’s Partnership)

Justine Bailey (Trafford Parents Forum)

Barbara Jarkowski (SEN Advisory Service Consultant)

Richard Johnson (Complex Needs (children’s social care) Service Manager)

Jane Forrest (Autism Coordinator)

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TRAFFORD AUTISM & SOCIAL COMMUNICATION CARE PATHWAY

A ‘care pathway’, also sometimes referred to as a ‘clinical pathway’, ‘integrated care

pathway’ or ‘care map’ is a tool that standardises the care people receive from a service and

enhances the quality.

Care pathways seek to promote organised and efficient client care which is built upon

evidence based practice.

Evidence shows that the implementation of care pathways significantly reduces the

variability in clinical practice and improves outcomes (Panella, 2003).

The Autism and Social Communication Care Pathway is a diagnostic and management

pathway for children and young people who are suspected to have Autism or Social

Communication Disorders.

This document presents how a number of different agencies across health, education, social

care and others will work together to meet the needs of children, young people (CYP) and

their families presenting with autism and social communication disorders. In line with the

recent and on-going service transformation, the care pathways detailed have been

conceptualised in a manner consistent with ‘THRIVE’, a model of service delivery for

children and adolescent mental health services developed by The Tavistock and The Anna

Freud Centre (Wolpert et al., 2014). More information on the THRIVE model can be found at

https://www.annafreud.org/media/3214/thrive-elaborated-2nd-edition29042016.pdf.

Should a family or professional wish to make any complaints regarding this pathway, the

standard complaints procedure should be followed.

The THRIVE model (see figure below) sets out a number of levels of need and support that

a child or young person might require and differentiates between treatment on one hand and

support on the other. The image to the left describes the input offered for each group and the

image to the right describes the state of being of people in that group.

The pathway also follows the principles of person-centred planning. This approach focuses

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on what the child or young person wants to achieve and the support needed to do this. It

helps to make sure that the views, wishes and feelings of the child or young person and their

family are central to any planning.

Care Pathway Scope

This Pathway outlines the process for the diagnosis and management of Autism and Social

Communication for the Trafford Autism and Social Communication Team (TASC). The

pathway applies to all the families, children and young people who can access TASC. This

is, in most instances, children registered with a Trafford GP between the ages of 0 and 18.

The pathway takes into account the National Institute for Health and Care Excellence’s

(NICE) clinical guidelines on Autistic Spectrum Disorder in under 19s.

The pathway covers the assessment and management of children and young people aged

0-18 years with suspected or diagnosed Autism and Social Communication Disorders

The pathway is aimed at:

People using services, families and carers.

Primary, community and secondary healthcare and education professionals who

have direct contact with, and make decisions about, the care of children and young

people with suspected Social Communication Disorders and Autism.

It may also be relevant for people working in social services, voluntary sector

organisations, young offender institutions.

The pathway aims to provide evidence-based recommendations for the effective diagnosis

and treatment of children and young people with Autism and Social Communication

Disorders. It also provides some guidance on early help access, the role of professionals

and service related outcomes for children and young people with suspected Autism and

Social Communication Disorders.

How are Autism and Social Communication Difficulties defined?

Autism is a lifelong developmental disability that affects how a person communicates with,

and relates to, other people. It also affects how they make sense of the world around them.

It is a spectrum condition, which means that, while all people with autism share certain

difficulties, their condition will affect them in different ways. Some people with autism are

able to live independent lives but others, with or without an accompanying learning

disability, may be in need of a lifetime of specialist support. People with autism may also

experience over or under-sensitivity to sounds, touch, tastes, smells, light, colours etc.

More information can be found on The National Autistic Society website:

(www.autism.org.uk).

Children and young people must have persistent deficits in social communication and

social interaction across multiple contexts and at different levels to be diagnosed with

autism spectrum disorder. These difficulties are seen from a young age and cause a

significant impairment in their life. Older children may have developed coping mechanisms

to mask some of the signs and symptoms.

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Social Communication Difficulties

Lack of development of spoken language or a severe delay, with evidence from a

specialist speech and language therapist.

Marked impairment in the ability to initiate or sustain a conversation with others.

Stereotyped or repetitive use of language.

Social Interaction Difficulties

Lack of, or marked impairment, in the use of non-verbal behaviours during

interactions, for example, eye contact, facial expression and gesture/body postures

to regulate interactions.

Failure or limited development of peer relationships, appropriate to developmental

level.

Does not spontaneously share enjoyment, interests and achievements with others

Shows a lack of social and emotional reciprocity, i.e. ‘give and take’, normal back-

and-forth conversation.

Difficulties in sharing imaginative play.

Difficulties adjusting behaviour to suit various social contexts.

Difficulties with Social Imagination and Flexible Thinking

Shows a pre-occupation with one or more stereotyped interests, and has restricted

patterns of interests, that are unusually intense or focused.

Shows an inflexible adherence to specific non-functional routines or rituals.

Shows stereotyped or repetitive motor mannerisms, for example, hand flapping,

twisting or turning in circles, complex whole body movements.

Highly restricted, persistent pre-occupation with an object or part of an object.

Additional Features

Over or under-sensitivity to light, sound, smell, taste, pain or noise.

Difficulty or disorder in early development, e.g. toilet training.

Difficulty with fine and/or gross motor skill development.

Advanced skill or ability in a specific aspect or area of the curriculum.

High level of cognitive ability but deficits in social skills.

For further information please refer to NICE guidelines and DSM – 5 and ICD-10 criteria.

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Stage 1: Initial Concerns

Generic Support Offered from a wide range of agencies following

Trafford’s graduated approach to supporting special education

needs and disabilities.

School/Agencies collate concerns/monitor interventions for two

school terms.

Autism and Social Communication Pathway

Are problems indicating ASD? No

Review, monitor and

continue SEND support

Yes

Stage 2: Referral

Lead professional identified.

Referral signed off by ASD specialist and sent to single point of contact

Stage 3: Assessment Planning

Information gathering and screening/assessments from HYM,

paediatrics, SALT if required

Development of Assessment Action Plan to determine which

assessments are relevant (if any)

Stage 5: Diagnosis

Multidisciplinary meeting every 2 weeks to discuss/ evaluate findings

and evidence

Confirmation/exclusion of ASD and social communication difficulties

Stage 6: Post Diagnostic Support

Parent/carer receives information pack

Refer to other agencies/ pathways if required

Six week follow up appointment

Parent/carer workshops

Stage 4: Assessment

ADOS and other assessments/observations as required

Stage 7: Transition to Adulthood

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STAGE 1: INITIAL CONCERNS

This stage aligns to the Thriving/Getting Advice section of the THRIVE model. This is where

the extent of the child or young person’s social communication difficulties is unknown and it

may be that interventions within the community setting may successfully manage the

concerns.

Community based support for parents/carers

Initial concerns around a child or young person’s social communication may be identified by

the family, education setting or other professionals.

The first stages of support may include:

Referral to the Family Health Visitor if the child is under 5

Referral to the School Nurse if over 5

Referral to Special Education Needs Advisory Service (SENAS)

Support from the Early Years Provider, School or College via Trafford’s Graduated

approach to supporting special educational needs and disabilities.

An Early Help Assessment completed in conjunction with parents/carers by the

professional who knows the child best. This is useful where there are multiple

challenges for the child/family or where the difficulties are not presenting themselves

across different settings.

Trafford’s Early Help Hubs

Third Sector Support from a range of agencies

Referral to SEND Local Offer Advisor via Multiagency Referral and Assessment

Team (MARAT)

Details of some of the organisations that can be contacted at stage 1 can be found on the

Trafford Local Offer.

Within an early years, school or college setting it is expected that the following steps will take

place:

1. Any concerns around social communication difficulties should be discussed in a

meeting between the setting and parents/carers (and young person if appropriate).

Any concerns around a young person’s risk e.g. to self or others or concerns in

relation to mental health issues should be referred to Healthy Young Minds. Progress

should be monitored and if there is no progress after one term, move on to step 2.

1a. For early years children in a setting, an integrated review between a health visitor and

the setting would be completed first which could include ASQ3, ASQ:SE-2 and/or a

Wellcomm assessment. The setting should then implement early support strategies

which could include interventions form the Big Book of Ideas or ASQ:SE-2 activity

sheets . If a child is not under the Special Educational Needs Advisory Service

(SENAS), another option for the setting at this stage could be to consider making a

referral SENAS to get support with implementation of strategies.

2. The setting and parent/carer would complete a screening document (Red-flag

questionnaire) together to identify areas of social communication concern. This will

start the process of completing relevant documentation which will help inform referral

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to specialist services at a later stage if required. For early years settings, the Special

Educational Needs Advisory Service (SENAS) will provide support to use the

screening document (Red flag questionnaire) with the parent/carer

3. The meeting may also highlight additional concerns that require referrals to other

agencies for support e.g. early help support, SALT referral, behavioural services etc.

4. Parents/carers may benefit from support around specific difficulties - information

sheets shared with parents/carers as appropriate or parents signposted to additional

reading and services (SEND Local Offer). A resource pack is available for schools

and parents/carers.

5. The setting should make observations/surveillance of the child/young person in class

and unstructured times to clarify needs.

6. The setting should implement early support strategies as per Trafford’s Graduated

approach to supporting special educational needs and disabilities and monitor

progress against this plan across two school terms (or if no progress is made after

one term then move to step 7). Further details on the graduated approach can be

found on the SEND Local Offer. For early years settings, this could include

implementing interventions from the Big Book of Ideas.

7. The setting should consult with other agencies with expertise in social

communication to advise on referral to Trafford’s Autism and Social Communication

Team (Speech and Language, Educational Psychology or other relevant agencies).

They can review the completed questionnaires and may undertake an observation in

class/unstructured context or advice and consultation.

It may be helpful for early years providers/schools/colleges to offer a sensory screen and

offer low level strategies to support any sensory issues. This should follow the same

graduated approach as outlined above and may require referral to Occupational Therapy for

a sensory assessment.

If after two school terms, difficulties persist despite additional strategies and support in place,

then a referral to Trafford’s Autism and Social Communication Team may be needed. In

some instances, there may be very profound difficulties, risk of exclusion, sudden loss of

language, placement breakdown, safeguarding concerns or other clinical concerns which

make it necessary to make a referral concurrent with implementing early support. This will be

at the discretion of Trafford’s Autism and Social Communication Team (TASC).

If a child is already being seen by a Paediatrician, Speech and Language Therapist or other

professional for a different matter and concerns about social communication or autism are

raised, then the professional should seek consent from the parent/carer to contact the

school/college/early years provider. The professional should contact the setting for a

discussion and send them the “Social Communication Concerns” form to detail the concerns,

give advice on potential interventions and ensure the setting is aware of their responsibilities

via the graduated approach and pathway.

If a child is not in a formal early years or education setting i.e. pre-school age or is home

schooled, excluded or a school refuser then it may be necessary to identify an alternative

means to observe and trial interventions. For pre-school children this generally will mean a

referral to Speech and Language Therapy to attend an assessment group, or if they are

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already under the Trafford Early Development Service (TEDS) then referral to a social

communication group. In these instances the Speech and Language, TEDS or a

paediatrician would need to act as the lead professional for guiding interventions in

accordance with the graduated approach for two school terms. For home schooled, excluded

or school refusers it is advisable for any relevant professional to make a direct referral to

TASC for advice.

If a school is refusing to provide interventions, perhaps as difficulties are not displaying

within the school environment, then another professional can make a referral to TASC for

advice and for a professional within TASC to contact the school to discuss with

parental/carer consent.

If the parent/carer or young person disengages at any point during the pathway, it will be up

to the lead professional/TASC (depending how far through the pathway the family is) to

make a decision as to which stage of the pathway they can re-enter and which elements of

the assessment need to be obtained again.

Communication with Parents/ Young people with capacity to consent At this stage the parents/carers (or young person where appropriate) are given information on the sources of support that are available to them and signposted to any relevant agencies. They should also be given generic information on sleep/toileting/sensory issues as appropriate. Parents/carers will be involved and kept up to date with strategies and support on offer and advised on the support they can provide in the home environment. Schools and early years providers need to ensure that there is close liaison with families throughout the process.

STAGE 2: SPECIALIST REFERRAL

This stage aligns to the Getting Help section of the THRIVE model. This is the group of

young people assessed as being likely to benefit from evidence-based, goal focused

interventions. If after a period of additional support and strategies there are still on-going

concerns around a child or young person’s social communication affecting functioning then a

referral to Trafford’s Autism and Social Communication Team (TASC) should be discussed

with parent/carers (and young person if appropriate). It is important to ensure that all early

intervention steps have been taken prior to referral. A referral will not be accepted without

evidence that some interventions have been trialled and results recorded either in the

education setting via the graduated approach or in the home environment through an Early

Help Assessment.

All referrals will need to include prior approval from a professional with expertise in social

communication i.e. Psychology (Complex Needs), Educational Psychology, Speech and

Language Therapy or Paediatrician.

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A lead professional will need to be identified who knows the young person best and s/he

should collate (or support parents/carers and early years setting to collate) the information

required to evidence an appropriate referral. The lead professional can be from health,

education or social care. For education settings, the lead professional will generally be the

Special Educational Needs Coordinator (SENCO). They should liaise with the core team

around the child (child/young person, parents/carers, education, social care, health, Early

Help Hubs, SEN Advisory Service, Trafford Early Development Service (TEDS), community

and voluntary professionals, Connexions, youth workers etc.) to gather information to

complete the referral form (see section on ‘Documentation To Be Used By TASC’) and

ensure that the relevant information has been included. Information from parents/carers is of

paramount importance in gaining a holistic view of the child. Any additional information from

parents/carers (e.g. videos) will be welcomed.

Referrals should be made with the informed consent of the parent/carer and the young

person (if they have the capacity to consent). Informed consent means that

parents/carers/young people should be informed that the service will be delivered in

conjunction with Healthy Young Minds (CAMHS), Educational Psychology, Paediatrics, and

Speech and Language Therapy and that there may be information sharing, joint

assessments and close working between the services as appropriate according to clinical

need.

Referrers need to ensure that the assessment process has been fully explained to the

parent/carer/young person and that they understand that information will be shared across

agencies.

Communication with Parents/carers/young person with capacity to consent Parent/carers/young people must be informed that a referral is being made. They should be asked to sign the consent form to show that they understand the process and that information will be shared across agencies. Parents/young people should be asked to fill in a questionnaire to gather their input into the difficulties experienced.

The referral must include:

A check that the child or young person is registered with a Trafford GP

Signed consent from parent/carer or young person where they have capacity to

consent

Professional/Parent/Young person’s Questionnaire populated in all sections (Pre-

School or School Aged)

Details of any psychosocial history/social services involvement and Early Help

Assessment if available

Details of intervention/support accessed within the community/education setting

Any professional reports or observations completed on the child/young person e.g.

Specialist ASD education report, HYM/CAMHS reports, Education Psychology report,

Paediatric reports, Portage reports, School reports (including IEPs), Speech &

Language reports.

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Any other information that may be relevant

All of the forms above will be made available through Trafford’s Local Offer.

If a GP is approached for a referral via a parent/carer they should signpost the parent/carer

to other professionals such as the SENCO to complete the information required for referral.

GPs will no longer make direct referrals under this pathway apart from in specific

circumstances.

If a young person is approaching the age of 18, then the lead professional should consult

with them to establish whether they would prefer to be referred to Trafford Extended Service

(adult autism diagnosis service). The lead professional should also discuss the referral with

the Trafford Extended Service in order to reach a pragmatically determine which service

would be most relevant for young people aged 17 and approaching their 18th birthday.

Once a referral is received by Trafford’s Autism and Social Communication Team (TASC), it

will be checked by the Trafford Autism and Social Communication Team Administrator to

ensure that all appropriate information is available prior to triage. At this stage, the following

will be considered:

Has the parent/carer/young person (if appropriate) given multi-agency consent?

Has the parent/carer/professional/young person questionnaire been completed?

Has the documentation been signed off by a relevant professional with experience of

social communication and autism?

Have relevant reports been attached i.e. paediatrician, speech & language therapy,

Educational Psychology

Does the child/young person have a Trafford GP?

The Trafford Autism and Social Communication Team Administrator will be checking that the

documentation has been populated correctly from the relevant parties. If not, the form will be

sent back to the lead professional for clarity. The referral is accepted by the pathway at this

stage.

Communication with Parents/Carers/Young person At this stage the Trafford Autism and Social Communication Team Administrator will contact the parent/carers/young person if appropriate to explain the process, whether any further screening is needed and likely timescales. They will be sent the sources of support information and a link to the local offer (FAQ video) to explain that the process may result in an autism diagnosis. If generic information on sleep/toileting/sensory issues has not been received then this will be given. Parent/carers/young people will be advised that they can nominate a representative as a communication point, however at the point of diagnosis, information will only be given direct to parent/carers/young person. Communication with Referrer The Trafford Autism and Social Communication Team Administrator will contact the professional who made the referral to explain the process and likely timescales.

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STAGE 3: ASSESSMENT PLANNING

Assessment planning takes place by the Autism and Social Communication Team on a

weekly rota in pairs, during which an Assessment Action Plan will be drawn up.

The Autism and Social Communication Team will determine whether there is any other

information required to inform the assessment from other agencies. For example:

Is a paediatric screening needed? (i.e. for all under 5s, a regression in motor skills,

any child with an indication of developmental issues, dysmorphic features, syndromic

conditions, strong family history). Paediatrics will carry out a physical examination. If

paediatrics are planning to carry out a developmental history as part of their

screening, it will be requested that they use the ASD standard developmental history

form.

Has the child/young person already been seen by Speech and Language Therapy? If

not, is a language assessment required? It would be required where the child is of

primary school age or where there is an indication of other language/comprehension

difficulties in addition to social communication. If so, then a language assessment

may be necessary to determine language levels and rule out other language

difficulties.

Does the child have associated mental health conditions or a complex presentation?

If so, then a referral will be made to Healthy Young Minds for an initial assessment

(Choice appointment) to determine what ongoing HYM support is required. HYM will

continue to provide interventions during the assessment process as appropriate.

The Assessment Action Plan will also determine which elements, if any, are required in order

to diagnose a potential autistic spectrum disorder.

Reasons for not undertaking a multi-agency assessment are likely to be if:

There is already significant evidence to diagnose an Autistic Spectrum Condition and

therefore an assessment is not necessary - the case will progress straight to the

diagnosis stage.

A young person is nearing 18, discussion should take place with Trafford Extended

Services (adults) to determine which service is best placed to undertake the

assessment or whether a joint assessment is appropriate. This should take into

account the young person’s preference at the referral stage.

The team will also determine whether there is evidence towards any other

comorbidities and alternative diagnoses and refer to other pathways e.g. ADHD.

Should an onward referral be required, with the consent of the parent/carer/young

person the Autism Social Communication Team would refer to other pathways or

services as appropriate utilising any information gathered during the process.

Communication with Parents/Carers/Young person/Referrer At this stage the Trafford Autism and Social Communication Team Administrator will contact the parent/carers/young person, and referrer within two weeks to advise them of the

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content of the Assessment Action Plan. It is important that the parent/carer/young person understands the reasons for any additional screening/assessments and understands that the Autism Diagnostic Observation Schedule (ADOS) is only one element.

STAGE 4: ASSESSMENT

The child/young person will be allocated appointments in accordance with the Assessment

Action Plan. This may include:

An ADOS (Autism Diagnostic Observation Schedule) undertaken by two members of

the multi-disciplinary team (Speech and Language Therapy, Psychiatry/Paediatrics,

Educational Psychology or Clinical Psychology) depending on complexity.

Autism Spectrum Disorder (ASD) specific developmental history completed with

parents/carers consistent with NICE guidelines unless already completed. The panel

will look at which professionals are already working with the child/young person and

determine if they can undertake the developmental history as part of the assessment

(i.e. Healthy Young Minds or Paediatrics). If not, one of the assessment team will

carry it out if required.

School/college/early years setting observation if required to support clinical decision

making.

Home visit if required to support clinical decision making.

Sensory information gathered if there is an indication that there may be significant

sensory issues contributing to the presentation, in accordance with the graduated

approach and sensory pathway delivered by Occupational Therapy.

The clinical assessment should start within 12 weeks of referral to Trafford’s Autism

and Social Communication Team. The duration of the assessment may depend on case

complexity – most should be completed within four to six months. However, this will be

dependent on completeness of information received, the level of co-morbidities and the

opportunity for patient contact. If a comprehensive assessment has not been completed one

year from referral, then this should be flagged to commissioners as part of contract

monitoring.

Summary information from each assessment/information source will be inserted into the

diagnostic information template by the TASC Administrator. At the end of the assessment,

the parent/carer/young person should be advised of the timescales for diagnosis and a

follow up appointment made to discuss the results within six weeks.

Communication with Parents/Carers/Referrers/Young people It is important to ensure that parents/carers, young people and referrers understand that the ADOS is just one part of the information that leads to a diagnosis. It is not definitive.

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STAGE 5: DIAGNOSIS

A multi-disciplinary meeting will be held every two weeks to discuss and evaluate the

findings and evidence. The meeting consists of a core team of representative from clinical

commissioned services (including clinical psychology, speech and language therapy,

educational psychology, psychiatry, and paediatrics). Wider professionals such as education

will be invited as appropriate to provide a holistic view. The minimum participants for the

meeting to take place will include speech and language, psychology and a paediatrician

and/or child and adolescent psychiatrist. The team will make a diagnosis of ASD in

accordance with NICE guidelines.

The multi-disciplinary meeting will consider all of the information from the assessment and all

of the pre-assessment information available. The diagnostic information template will be

used during the meeting to enable efficient and effective consideration by the panel.

A brief written report will be drawn up based on the multi-agency meeting discussion. The

report will summarise the key findings and recommendations from all parts of the

assessment, outlining the diagnosis and a needs-based management plan including

recommendations for professionals and parents/carers to provide further support. Should an

onward referral be required, with the consent of the parent/carer/young person the Autism

Social Communication Team would refer to other pathways or services as appropriate

utilising any information gathered during the process.

Where children and young people have an Education, Health and Social Care Plan,

diagnosis information and associated support will be detailed within this.

At the end of the diagnostic process there will be a clear outcome:

ASD confirmed/excluded, or;

Social Communication Issues confirmed/excluded, or;

ASD/Social Communication not excluded but further assessments required

Referral for assessment for other potential conditions i.e. Oppositional Defiant

Disorder (ODD), anxiety disorders, attachment disorders, Attention Deficit

Hyperactivity Disorder (ADHD)

Referral for a second opinion if there is disagreement within the panel around the

diagnosis (Agreement made with Social Development Clinic (RMCH) for second

opinions when deemed appropriate by the specialist team - please see section on

‘Documentation To be Used By TASC’ for protocol for second opinion requests)

The confirmation/exclusion of Autism or Social Communication Difficulties will be

communicated to the parents/carers and the child/young person, via a report and face to

face appointment, within six weeks of assessment by the most appropriate professional

involved in the young person's care. If the child/young person is being seen on an ongoing

basis by a service such as speech and language, paediatrics or Healthy Young Minds then

they will be responsible for communicating this information. In other cases, it will be

completed by the team undertaking the assessment. All teams will follow Trafford’s standard

protocol on breaking the news sensitively.

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If the parent/carer/young person disagrees with the outcome of the assessment, then they

should contact the service in writing within three months of the face to face appointment

outlining their reasons and are encouraged to provide any additional information/evidence

around their child’s presentation suggestive of/not suggestive of ASD. The assessment will

be reviewed with the additional information and share the outcome of the review with the

family within 4 weeks. If concerns remain, the family may get in contact with the service

again in 6 months with further evidence and a referral for a second opinion will be

considered.

Communication with Parent/Carers/Child/Young person The confirmation/exclusion of Autism or Social Communication Difficulties will be communicated to the parents/carers and the child/young person, via a face to face appointment, within six weeks of assessment by the most appropriate professional involved in the young person’s care. The written report supporting the diagnosis outcome will be given to the family/young person summarising the key findings and recommendations from all parts of the assessment, outlining the diagnosis and a needs-based management plan. This report will be useful even where a child does not have an autism diagnosis as it will give information on strengths, difficulties and potential interventions that can continue to be used by the setting to support the child/young person.

STAGE 6: POST DIAGNOSTIC SUPPORT

All parents/families with children/young people who are newly diagnosed with Autism by

TASC will be offered a place on the monthly newly-diagnosed Parent Workshop Session.

This will cover understanding autism and the implications.

Parents/carers/children/school will also be provided with materials on ASD and self-help

information within the parent/carer information pack.

There is also a rolling programme of workshops for all parents/carers of children with a

diagnosis of autism or social communication difficulties to attend. These topics are guided by

parents and carers but examples include sensory issues, behaviour, anxiety, and

communication. Drop in sessions may also be available to support peer networking.

Post diagnostic support is for those who have been diagnosed through the Trafford pathway.

Access for parents/carers whose child has not been diagnosed through this pathway will be

at the discretion of the TASC team, in accordance with NICE guidance.

Other support and advice can be obtained from:

The SEND Local Offer Advisor who can support parents/carers to identify universal

or mainstream activities the child could attend or support groups for parents/carers.

The Complex Needs (children’s social care) team can undertake social care

assessments and provide access to specialist support for eligible children.

Early Help Hubs.

Trafford’s multi-disciplinary area teams.

Community and voluntary sector

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These services can also be contacted where there is not a diagnosis of autism.

Communication with professionals The outcome of the assessment will be shared with the referrer and the child/young person’s GP. Where there has been parental/carer/young person’s consent earlier in the process, this information will also be shared with the school/college/early years setting. This communication will all take place in the two weeks following the face to face appointment with the parent/carer/young person. This is to give the family an opportunity to digest the report before it is circulated.

Children and young people will be discharged from TASC once assessment is complete,

ongoing case management may be required by Healthy Young Minds for co-morbid mental

health needs or via paediatrics for co-morbid physical health needs.

GETTING MORE HELP

If a young person’s presentation means that they are likely to require extensive or intensive

interventions, for example young people with severe or moderate learning disabilities,

psychosis, eating disorders, emotional dysregulation issues, and complex comorbid mood

disorders with additional risk issues, then they may continue to be supported by Healthy

Young Minds (CAMHS) or the Complex Needs Service.

At this level, goal focused / evidence based treatment interventions will be offered to the

young person and their family around comorbidities following diagnosis of ASD. Often

psychological therapies will be offered to parents/carers or other family members present. As

recommended by NICE psychological therapies may include adapted Cognitive behavioural

Therapy (CBT) for young people with comorbid anxiety disorders including Obsessive

Compulsive Disorder (OCD) or low mood. More integrative therapy approaches using

narrative techniques such as externalising and/or focusing on behaviour when young people

struggle with metacognition (thinking about their thinking) are often helpful with this cohort of

children and young people. Routine Outcome Measures (ROMS) will be undertaken at the

beginning, middle and end of therapeutic interventions as a minimum to track the progress

and effectiveness of interventions.

Some young people with complex autism or associated severe learning disabilities, following

an assessment by the Complex Needs (children’s social care), may be eligible for specialist

support. This would be accessed via a referral to MARAT (Multi Agency Referral and

Assessment Team) if the child/young person is not already open to social care. This can

include the provision of a direct payment or personal budget to purchase short break

(respite) support.

If pharmacological treatment is considered appropriate – a full physical examination

including height, weight, blood pressure and pulse rate using standard monitoring forms

would be completed before initiation of treatment where appropriate. Medication trials may

include stimulants for ADHD, or Selective Serotonin Reuptake Inhibitors (SSRI’s) for mood

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disorders, OCD, etc. The relevant care pathway should be followed for the young person’s

presentation e.g. ADHD pathway, Mood and Emotional Disorders pathway etc. Medication

may need to be initiated at a lower dose and may require additional monitoring due to the

risk of side effects in this cohort of young people. Shared care guidelines are in place with

GP’s across Greater Manchester for most medications.

For young people receiving medication alongside other support there will be joint reviews

with psychiatry at regular intervals according to the young person’s needs. Consideration

should be given as to whether the young person would benefit from care management under

the Care Programme Approach (CPA).

GETTING RISK SUPPORT

This considers the group of young people where there might be significant risk, but where

they are not able to benefit from the interventions that are available. This is dependent upon

the risks presented and the level of need or concern. There is sometimes confusion between

psychosis and ASD due to individuals with ASD reporting or presenting as if experiencing

auditory hallucination (“hearing voices”) which are often, on assessment identified as their

own anxious thoughts or internal voice that they have externalised. This can lead to

diagnostic overshadowing and should be considered as part of risk management. There are

also often significant aggressive and controlling behaviours presented by young people

towards families, and “all-or-nothing” thinking that can soon lead to a deterioration in mood

as young people with ASD cannot think of a way to navigate through presenting difficulties.

Young people being seen within Healthy Young Minds (CAMHS) or the Complex

Needs Service during their assessment or post diagnosis management of

comorbidities would receive risk management via their case manager or multi-agency

team;

Young people with a diagnosis of ASD can access the local early help team, Social

care team, and other partner agencies as appropriate. Professionals can seek

consultation with Healthy Young Minds or the Complex Needs Service as required.

Professionals can refer for urgent assessment via the local HYM duty team – e.g. if

there are concerns around significant deterioration in mood or there are thoughts of

suicide. If there have been attempts at suicide (e.g. overdose), or significant self-

harm then the young person should present to A&E for assessment.

If there are safeguarding concerns then professionals should follow local procedures

and refer to MARAT.

Where a child or young person is at risk of an admission to a specialist mental health

hospital, or equivalent learning disability service, as a result of their challenging behaviour

and/or mental health a Care, Education and Treatment Review (CETR) should be held as

soon as possible.

Children at risk of admission, as per the National Service Model for people with Autism

and/or a learning disability (Transforming Care), should be added to the Dynamic Risk

Register and these risks monitored accordingly.

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STAGE 9: PREPARING FOR ADULTHOOD, TRANSITION AND ADULT

SERVICES

Where children with autism also have a moderate to severe learning disability and an

Education, Health and Care Plan (EHCP) they will be transitioned to the adult Community

Learning Disabilities Team, as part of their ‘Preparing for Adulthood’ pathway.

Those with medication needs or serious mental illness (SMI) that meet the criteria for Adult

Mental Health Services will be transitioned to the Adult Autism team (Trafford Extended

Service, who will accept/reject based on their assessment of need in line with their

complexity criteria) or Community Mental Health teams as per Trafford Transition protocol.

Those on medication not meeting the criteria for adult mental health services will be

monitored by their GP.

Transition from children’s services requires careful and collaborative planning and should

commence a minimum of six months before the point of transition to adult services. Where a

young person has more complex mental health needs that will require support and care co-

ordination from Adult Services then the transition process should commence from age 16, a

Care Programme Approach should be considered and in some instances, this may be even

younger, in line with SEND guidance and Trafford’s Transition Protocol.

Generally, the timing of the assessment should take account of what is most appropriate for

the young person, dependent on their circumstances, level of need and the amount of

transition planning required.

The ‘Preparing for Adulthood’ process includes annually reviewing the young person’s EHC

plan, preparing the young person and family for different roles and responsibilities under the

Care Act, and ensuring a smooth transition of information from children services to adult

services. Information should be communicated to all relevant agencies (primary care and

specialist services) including details of the young person’s needs, risk and care plan.

There will be some children with autism that do not have disabilities impacting them

significantly enough to meet the criteria for adults services, however there is still generic

support available. These young people will be transferred back to their GP.

PATHWAY OUTCOMES

The anticipated outcomes of the Trafford Social Communication Diagnostic Pathway include:

1. Improved waiting times for diagnosis: The majority of children and young people

will be diagnosed with Autism, social communication issues and other comorbid

disorders within a 10.5 month period from referral to diagnosis confirmed to

parent/carer/young person. This is due to the clear and consistent processes brought

about by this pathway. TASC will measure numbers of children and young people

diagnosed and the length of time from referral to diagnosis.

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2. Enhanced Patient Experience: Children and young people and their parent/carers

will be invited to give feedback on the service on an annual basis via an Experience

of Service Questionnaire.

Regular audits will be undertaken to help develop and improve the Trafford Autism and

Social Communication Diagnostic Pathway. These may include audits of adherence to the

pathway, numbers of children and young people diagnosed, the length of time form referral

to diagnosis and patient experience information. This information will be monitored by

commissioners on a quarterly basis.

DATA REQUIREMENTS

The TASC team will be expected to collate the following data to demonstrate the functioning

and effectiveness of the pathway:

Referrals including source, proportion appropriate/inappropriate, demographic profile

Waiting time to begin assessment

Time to complete assessment

Time to diagnosis/breaking the news

Diagnosis outcome – positive for autism, negative for autism, positive for social

communication difficulty, negative for social communication difficulty, second opinion

required

Number offered post diagnostic workshop

Number accepted/attended post diagnostic workshop

Satisfaction

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DOCUMENTATION TO BE USED BY TASC

Referral Tools

Young Person’s Consent Form Parent/Carer Consent Form Professional/parent pre-referral Questionnaire (Pre-school or School)

TASC Screening Documents

Acknowledgement letter template to parents/carers (explaining that they have received the referral – to be copied to referrer) Screening letter to referrer (as above) Parent Report Template (to gather main findings/recommendations from each professional during process)

Screening Checklist (for admin to check all supporting information is present)

Triage Documents

Triage Checklist (for professionals to individually triage those they can) Outcome of triage letter- parent/carer (copied to GP/referrer)

a) Period of further intervention needed b) Refer to adult services c) Not enough evidence to indicate a need for further assessment

for autism or social communication d) ADOS not necessary as have full information (explain process

and likely timescales) e) ADOS will take place (give details of appointment, explain

process, what ADOS is/isn’t, likely timescales)

• Getting More Help

• Getting Risk Support

• Getting Help• Coping

School based interventions

Bibliotherapy

Signposting

Consultation to professionals

Training to professional groups

Referral for specialist assessment via HYM

Formulation and differential diagnosis

Feedback to family

Intervention for comorbidities

Psychoeducation

Consultation

Brief therapy

Case management

Co-facilitation of groups

Psychological therapies

Adapted CBT

Integrative therapies

Narrative approaches

Medication

Within CAMHS:

Case and risk management

Overdose / emergency rota

Early Help/Children's Social Care

Consultation from CAMHS

Inreach/Outreach

A&E

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Assessment and Clinical Tools

ASD Specific Developmental History Template Autism Diagnostic Observation Schedule (ADOS) 3DI and ADIR

Panel template to form parent report

Outcome Report Template

Post- diagnostic information

Parent/carer invite to follow up meeting

Parent/carer invite to post-diagnostic workshops/information on workshops

Standard letter to GP/referrer sharing outcome of assessment and sharing report

Standard letter to schools sharing outcome of assessment and sharing report

Second opinion protocol