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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This is the first assessment for this service. This key question has been rated Good.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on the latest evidence and good practice. There was a diverse and experienced staff group. Following some concerns by staff about workloads, staff were supported in smaller teams, with regular meetings, and provided with relevant training and regular supervision and appraisals. They had opportunities for professional development within the organisation. Staff worked with other agencies involved in people’s care for the best outcomes and smooth transitions. Staff made sure people understood their care and treatment to enable them to give informed consent.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive assessment of patients’ needs on referral to the service, and ensured that this was updated at least every 12 weeks.

Following a detailed assessment for neurodiverse needs such as autism, attention deficit hyperactivity disorder (ADHD) and specific learning difficulties, including dyslexia and dyscalculia, patients were offered support in the form of psychoeducation sessions and education navigation. When patients were prescribed medicines for ADHD, clear care plans were developed with them that met their needs identified during their assessments.

Assessors told us that they were able to gather enough evidence about patients to form a diagnosis, through a very detailed developmental history, and observations and interaction online. For autism assessments, the service had developed a one-day model. Staff noted that in recent months they had noted an increase in more complex cases such as borderline presentations, or comorbidity. Two staff carried out each autism assessment, followed by a formulation meeting to consider diagnosis. If an assessment indicated that there was not a diagnosis, staff would involve a team leader in the decision-making process. Where there were concerns raised about patients’ wellbeing, staff discussed cases with their team leaders to decide on the best way to provide support.

At the time of the inspection, there were different teams undertaking each type of assessment such as autism or ADHD. However, staff said that they working towards comorbidity assessment (for more than one diagnosis) in the future.

Assessors came from a range of backgrounds including occupational therapists, psychologists, paediatric, general and registered mental health nurses. They had access to psychiatrists, and a GP within the team.

Feedback from people using the service was positive about the assessment process. Patients told us that they felt confident that staff understood their individual and cultural needs. Staff checked people’s health, care, and wellbeing needs.

The service planned and delivered people’s assessments and any treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance.

Staff provided a range of care and treatment interventions suitable for the patient group. There were clear suitability criteria for the service, which was only available in an online and video format. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). This included medication for ADHD, and psychoeducation.

All clients accessing the service via the Right To Choose process were offered 4, 90-minute psychoeducation webinars, held on the same day and time each week. The service were also planning to offer access to recorded versions as well as live events, to increase the option for clients in terms of preferred format, environment and time that suited them.

The medical team prescribed medicines to treat ADHD, which were safe, effective, and evidence based. They ensured that patients undertook all necessary physical health checks including an electrocardiogram prior to prescribing, and employed a cardiologist to check these.

The service carried out monthly prescription audits for each non-medical prescriber treatment and audits of treatment planning sessions. There were also regular audits of risk and safety plans for patients. There were quality check audits for all assessments, with approximately 10% of autism reports reviewed monthly, and a slightly lower percentage for ADHD assessments. The rate of positive diagnoses for the service ranged from 76-91% (slightly lower than the NHS).

Smaller scale reviews included monitoring client feedback by the chief data officer, analysing trends, staffing, and research and development plans for the next year. The provider was working to form external clinical partnerships and had recently entered into a research partnership with a UK university.

All of the services autism assessing clinicians were Autism Diagnostic Observation Schedule (ADOS)and Autism Diagnostic Interview - Revised (ADiR) trained. However, as an online service, observation with semi-structured questions and tasks were used along with a semi-structured informant interview as recommended by NICE guidance.

There were clear requirements for staff working for the service. Staff required a core health care professional degree/diplomaand registration with a professional body and appropriate certification, specified lengths of time working in the area, as well as the core training provided by the service. There was an ongoing continuing professional development programme and monthly webinars for staff, and the clinical advisory group arranged regular presentations for example regarding neurology.

The service had introduced a development programme where they brought in qualified mental health clinicians and trained them to be specialist neurodevelopmental assessors.

The service worked well across teams to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different teams. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support.

Staff members were supported by their team members and team leaders. Teams met daily, and all staff had regular monthly supervision from their line manager. Team managers felt supported by the clinical leads, and managed teams of approximately 8 staff. They noted that team sizes had been reduced recently as a result of staff feedback and described providing performance management when necessary. They checked that staff were meeting key performance indicators, such as recording notes within 24 hours of an assessment. There were weekly multidisciplinary team meetings for assessors, and prescribers to discuss patients, celebrate successes, and any learning to be shared. Relevant issues were then taken forward to clinical lead meetings and passed on to senior management or the board as appropriate. There was a daily zoning for any clinician to attend with cases of concern.

ADHD and autism assessors we spoke with came from a wide range of backgrounds including clinical psychologists, occupational therapists, speech and language therapists, mental health nurses, and health visitors.

An induction week for new clinical staff was provided every 3 weeks, followed by a period of shadowing, and with strict protocols for checking all new starters work until they were deemed to be exempt. The service had funded three staff to complete ADOS qualification training with supervision.

Staff had mandatory training to complete including role specific training and competencies. All staff, both clinical and non-clinical, completed neurodiversity awareness training, including the Oliver McGowan Mandatory Training. There was additional training for all clinical staff around trauma informed care and other topics – delivered by the service’s clinical advisory group.

An inhouse clinical advisor group provided training about changes or updates to practice and opportunities for continuing professional development.

Every clinician had an hour of clinical supervision at least monthly. This was managed at team lead level and checked at weekly meetings with the clinical leads. At the time of the inspection there was no function to run a percentage oversight of staff supervision, but management indicated that they were moving this to another data system which would mean they could then generate a monthly report, thus providing more robust senior oversight. We reviewed a sample of supervision records and found that these covered relevant topics and mapped against people’s values. In the last year 100% of staff appraisals were completed.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control.

Psychoeducation was integral to the service offer, and this was provided post-diagnosis for all patients. There was also a medicines team, and a team of education navigation team of special educational needs coordinators. Talk therapies were provided to some patients using the service.

For children and young people following a diagnosis, the educational navigation service provided tailored assistance to help manage how their neurodevelopmental needs present within the school environment. The service worked collaboratively with the child, their family, and school staff to develop personalised strategies that enabled the young person to not just engage, but also to thrive, within education.
 

At the time of the inspection, the provider was the only healthcare provider to offer psychoeducation sessions through Right to Choose for the NHS. They understood that receiving an autism and/or ADHD diagnosis may bring mixed emotions for individuals and their families, varying from relief and validation, to uncertainty and isolation.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There were standard operating procedures in place for all parts of the service’s activities. Mangers carried out regular audits of activity including observations of all new staff assessments, and a sample of all staff assessments with permission from patients.

Two assessors worked to complete autism assessments in one day, including a 30-minute feedback session to patients and carers. Overall, the rates of diagnosis for the service were slightly lower than those recorded for the NHS, with diagnosis rates of 76-91%.

The service used recognised tools to record outcomes includingthe Autism Diagnostic Observation Schedule (ADOS), Adult ADHD Self-Report Scale (ASRSc1.1), and the SNAP-IV Teacher and Parent Rating Scale for ADHD. Staff said that they worked with patients to create their own goals.

Medicines prescribers used strict protocols of physical health checks prior to prescribing. The service said they were looking at how to verify blood pressure and weight readings submitting, including consideration of sending out blood pressure cuffs to all relevant patients so that they could check their blood pressure during a video call.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in evidence-based clinical guidance.

The service told people about their rights around consent and privacy and respected these when delivering person-centred care and treatment.

Staff had an understanding of the Mental Capacity Act (MCA) and the five statutory principles. They also understood the principles of Gillick competence for patients under 16. The service had a policy on the MCA, which was available to staff.

Staff confirmed patients’ consent verbally prior to assessment or treatment. Prior to any assessment, patients needed to consent to the service requesting and sharing information with their GP.

The service recognised that consent and capacity could change, and therefore ensured that both were collected and assessed at the beginning of the patient journey as well as at each
subsequent session by clinicians. This was recorded within consultation notes.