Assessment, Psychosocial and Prescribing Support to the Adult Neurodevelopmental (ND) (Autism and ADHD) Service

Provision of Autism Spectrum Disorder clinics and ADHD clinics including assessment, diagnosis, titration and stabilisation for adults 18 years and above in Kent and Medway delivered over a 3-year period (01.04.22 to 31.03.25)

The provider(s) will contribute to the bespoke face to face clinical MDTs for ASC diagnostics and post diagnostic interventions, and online ADHD diagnostics, prescribing and titration for service users

It is anticipated that the provider(s) will only undertake face to face assessment for ADHD for those individuals who have high levels of complex needs or difficulties engaging with the process of virtual consultations.

The provider(s) will deliver online / face to face assessments for ADHD, which will be led by a psychiatrist with specialist clinical knowledge and experience and will include a full clinical and psychosocial assessment of the person; including discussion about behaviour and symptoms in the different domains and settings of the person's everyday life.

An assessment of the person's needs, coexisting conditions, social, familial and educational or occupational circumstances and physical health will also be undertaken through the use of pre-assessment questionnaires and taking a case history.

Following a diagnosis of ADHD, a structured discussion will be held with the individual (and their families/carers as appropriate) about how ADHD could affect their life. This structured discussion will inform the shared treatment plan/report that will be provided following the assessment.

Psychological treatments which include individual and group adapted cognitive behavioural therapy will be offered only when agreed through KCHFT and/or the governance groups have been consulted and agreed to the treatment.

The provider will access existing resources in mental health and social care services for identified needs of service users'. Where existing services do not meet service users' needs, then the provider should make suggestions about alternate options on how these needs could be met and make recommendations about processes and staffing requirements in line with the NICE guidance on Autism Spectrum Conditions and ADHD.

Where an individual is identified as having moderate to severe mental health co-morbid requirements, then referral to the Community Mental Health Teams may be made.

Where presenting autistic behaviour is complex and or challenging and the individual is at risk of inpatient and or out of area treatment then the provider will follow the agreed protocols for assessment and treatment, which may include onward referral to other specialists within the Complex Autism Service.

Where the individual exhibits behaviour which places them at risk of offending, then onward referral to the local forensic service for assessment may be required.

Providing a comprehensive assessment of suspected autism will be:-

• Undertaken by professionals who are trained and competent
• Team-based and draw on a range of professions and skills
• Where possible involve a family member, partner, carer or other informant or use documentary evidence.

To aid diagnosis and assessment for adults, the provider should consider using a formal assessment tool, such as:

• Adult Asperger Assessment (AAA; includes the Autism-Spectrum Quotient [AQ] and Empathy Quotient [EQ])[6]
• Autism Diagnostic Interview - Revised (ADI-R)[7]
• Autism Diagnostic Observation Schedule 2 - (ADOS-2)[8]
• Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI)[9]
• Ritvo Autism Asperger Diagnostic Scale - Revised (RAADS-R)[10]

The recommended approach is via MDT and Multimodal:

The process should be:

i) Accessible information, guidance & advice available

ii) Initial phone consultation

iii) Screening tools

iv) Assessment process

v) Report

vi) Feedback

vii) Follow up if necessary

Online Digital Provision

Where appropriate to deliver safe, effective treatment and with the explicit patient consent or agreement that this is their preference, then digital access and use of virtual online provision may be used. NB Where diagnostic assessment processes are dependent on tools and complex interactions then face to face services may be more appropriate.

Training to Professionals and Carers

There may be occasions whereby the provider is requested to support the training of health and social care professionals as well as carers in order to increase their levels of awareness and understanding of autism and ADHD in order to support the needs of the person for whom they are caring.

In addition, there may be a requirement to support primary care GPs with advice, guidance and training around any issues of on-going prescribing for ADHD medication. This may be by telephone, email or contribution to any formal training sessions, where these have been agreed by the governance partnership to provide

Service Coverage - Hours

The provider will deliver a core service over 52 weeks per annum, which is available throughout accepted business working times of 09.00hrs to 17.00hrs, Monday to Friday.

There may also be a requirement for the provider to offer additional access to their service in order to support the whole Adult ND pathway, which will be available on at least 2 evenings per week (between 5-8pm) and alternate Saturday sessions of no less than 4 hours per session. Where required, KCHFT will discuss and agree with the provider the scope of any additional hours, prior to them taking place.

Reports / Information to service users

There will be a maximum of 4 weeks from completion of assessment to the provision of a written report with recommendations which incorporates:

• Patient details
• Report author, date and those present during assessment
• Documents seen before and during assessment
• Diagnostic tools used, purpose and respective contributors
• Referee history (e.g. developmental, family, educational)
• Referee presentation (e.g. appearance, communication, empathy)
• Diagnosis (e.g. meeting c…