Specific Service Inputs:
Adult Psychology Services
The Department of Adult Clinical Psychology provides psychological assessment, formulation and therapy to patients across two bases: in Falkirk and Stirling Community Hospitals. The team comprises clinical psychologists, clinical associates in applied psychology (CAAPs), counsellors and a psycho-sexual counsellor.
The department covers a number of service provision areas including primary care mental health, psycho-sexual health, general health, diabetes, learning disabilities, forensic mental health and oncology.
Clinical input is provided to adults above the age of 18 years, and referrals are accepted from GPs, Community Mental Health teams and Social Services.
Although waiting times vary according to resource variations, within primary care mental health, the waiting time is approximately 7 months. In addition to one to one psychological therapy, primary care also offers group based therapies, including Mindful Living and Stress Control programmes.
Staff from primary care mental health and the specialist ASD diagnostic team in Stirling have been working to strengthen multidisciplinary links and improve the service structure and quality of input to ASD patients. In addition, primary care psychology is reviewing staff training needs and the provision of assessment and therapy to ensure high quality psychological intervention for ASD patients with mental health difficulties living in ForthValley.
Occupational Therapy is only part of the diagnostic pathway for adults in Forth valley who have a learning disability.
The Occupational Therapy (OT) Service for people with Learning Disabilities is embedded within the specialist Learning Disability Service which consists of three community teams, in Stirling, Clackmannanshire and Falkirk, as well as the in-patient services unit at Loch View, Larbert. Occupational Therapy staff within the Learning Disabilities Service are experienced in working with people with ASD and their service may include an asessment, advice and intervention related to an individual’s level of ability to carry out functional tasks associated with daily living, or leisure activities. An OT assessment may comprise an evaluation of an individuals living environment, identifiying a need for specialist equipment, an assessment of sensory processing skills if these are affecting an individual’s level of functional ability, and advice about appropriate sensory strategies.
The Occupational Therapy service within the General Adult Psychiatry service is embedded within the In Patient Psychiatric Acute Admissions Ward at Forth Valley Royal Hospital and the In Patient Rehabilitation Wards at Bellsdyke Hospital. It is integrated with the Community Teams in Stirling Clackmannanshire and Falkirk and the Intensive Home Treatment Team based at Forth Valley Royal Hospital. The criteria for accessing these services is moderate to severe mental illness and there is no specific funding to work with individuals with ASD. This means that individuals with ASD will only be seen by the O.T. service if they have a co-morbid moderate to severe mental health diagnosis. The exception to this is the O.T currently working in a jointly funded post (Stirling Council and NHS/Keepwell Team) within Stirling Council Employability Service. This post is not diagnosis specific and therfore individuals with a primary diagnosis of ASD can be seen if they are progressing towards work. However this post is not a mainstream post and cannot therefore be seen as part of the core service.
O.T. staff will provide asessment, advice and intervention related to an individual’s level of ability to carry out functions of daily living, or leisure activities whether they are a result of ASD or a mental health issue. Again this may also include an assessment of the environment, identifiying a need for specialist equipment and advice about the level and type of onging support services required.
The Children’s Occupational Therapy Service is based at Stirling Community Hospital and Laurieston Health Centre. There is currently no Occupational Therapy service within CAMH.
Speech and Language Therapy
Speech and Language Therapy (SLT) is not currently part of the diagnostic pathway for adults in ForthValley who do not have a learning disability. The adult SLT service sits within the Rehabilitation Care Group and works with people aged 16 years and over. There is an open single point of referral to the service, including self referral, and SLT therapists work in both acute and community settings.
Referrals are usually seen within 4 weeks.
Clinicians working in the service have a wide range of expertise in managing communication support needs in adults, both developmental and acquired, but there is no specific expertise in ASD. If an adult has a diagnosis, or is suspected to have ASD, and the need for a communication assessment has been identified, they may be referred to this service for general advice and support around their communication. The ability to signpost adults to a wider network of ASD support is limited due to reduced experience and knowledge in this field. Where possible clinicians access expertise within the wider professional SLT team, children's and ALD services.
SLT referrals for individuals with ASD are realtively low, there were 3 referrals between May 2012 and 2013, and 3 referrals between May 2013 and May 2014. However, it is likely that this is an unmet need for young people with ASD when trying to access post diagnostic support and when transitioning to adult services.
Authored - FV ASD Assessment and Diagnosis workstream
Justine McCulloch (Chair)