Peachy (and others)... multi-disciplinary panels

[debs40]

Peachy, I remember in your tip-top essay that you had looked at ASD assessment and best practice.

Our area has a multi-disciplinary panel - SALT, Paed, CAMHS, sometimes OT, sometimes Ed Psych. However,

Paed has no direct involvement in the diagnosis - we saw him once for ten mins last June as part of the gateway process to CAMHS.

SALT assess, report and discharge leaving SCD to schools

Ed Psych is not involved as a matter of routine and only reports in those cases where a child has been under their care (usually because they've been causing problems for schools)

On top of this, the professionals who have actually seen the child are not the ones who necessarily sit on the panel - it will be any SALT, Ed Psych, Paed etc.

I think this undermines the multi-disciplinary process which I understand is intended to give a complete picture of a child. You are basically then just reliant on a CAMHS psychologist and psychiatrist who are largely relying on their ADOS tests.

There is no provision for parents to feed in to this.

What are your views on panels conducted in this way?

ADOS is the observation and ADI is the interview with parents but that is an assessment of the child's development (and whether they family are the cause of it all - as far as I can see!)

Peachy had quoted research about the difference in outcome when parents are involved in the process of reaching a diagnosis.

As far as im aware Debs, you should be invited to the MD meeting, where the dx is made?

Not here, they make a decision and you get sent a report a few weeks later and you can ask to discuss it with them....

Oh tis just another joy of the dx process in this area....it feels like they think they are doing you a favour every step of the way...

The way it worked here is, Paed referred us to ASD specialist team.

ASD specialist and SALT observed and interacted with ds (that would be ADOS?)

SALT then wrote a report.

I saw ASD specialist alone and gave developmental history (that would be ADI?)

They then discuss ds at monthly meeting (and work out whereabouts on the spectrum he is, i guess).

We then have the MD meeting, that both i and the school are invited to attend.

Dont know if that is any help to you, have you asked if you can attend?

We have a panel meeting in our area too Debs were it is decided if a child will have an official diagnosis of SCD. Basically if its not glaringly obvious then you get be tooing and froing with the consultant Paed for years before you even get to sniff CAMHs for an ADOS test for your child. So if you have a passive, academic ASD child you are stuffed unless he develops anxiety as a teenager.

DS was assessed at a joint clinic - only 1.5 hours so not the most in-depth process - but there was a SALT, paed and ed psych observing DS and getting info from me. SALT was a senior SALT who had never dealt with Ds before. As DS didn't end up with a DX, we were told orally then and there, with report following a few weeks later. I don't know if it would have been different if he had ended up with a DX. So I'm quite taken aback at professionals DXing who haven't had sight of the child. Peachy would have a good idea as to whether ADOS is a substitute for personal observation.

I think Claw you would know (and they should have told you) if you were undertaking the ADOS as it is a formalised protocol with modules and structured observation. I am told it takes about 3-4 hours. It is then scored.

The ADI is a formal development history with parents. We had a 'gateway' development history taking with CAMHS on joining but this was not the formal ADI. it still took an hour and a half and its purpose was to 'weed' out cases which may be presenting as ASD but may have other causes.

When you get through that, you get on the SCD waiting list which means we will get an ADOS and ADO eventually. ADOS will be with psychologist and psychiatrist

The apptment with psychologist and her school visit were a result of my badgering them to do soemthing while we waited for formal assessment.

We have a similar MD panel thing here. DS is due to attend soon.
But the parents are involved with it. You attend 3 Wednesdays in a row with DS and do all observations/assessments and 4th Wedneday you go without DS to hear results and official diagnosis. Paed told me though that the 4th week diagnosis will in no way be a 'surprise' though as we will be speaking to all the panel and be told their opinions each week as they make them..

There has been no mention of ADOS or ADI

Senior SALT did an assessment/observation in school and according to her report 'ds was assessed using both formal and informal assessment tools' whatever that means (had to wait over a year for this assessment)

Then moved borough's and Paed referred to ASD team stating 'partial assessment was undertaken in previous borough for ASD'

Different ASD specialist and SALT observed and interacted with ds for about 2 hours.

SALT then wrote a report.

I saw ASD specialist alone and gave developmental history took about 2 hours.

Now waiting for montly meeting and MD meeting.

However ds has been assessed every 6 months by SALT since 2006, perhaps SALT involvement from an early age, makes a difference to the process?

Its confusing to be honest!

It is isn't it? Why don't they just produce a leaflet saying .... this is what we do? Other hospital depts manage it.

Because they would then fall back on every child with ASD has individual difficulties and should be assessed according to their difficulties!

They have it pretty much sewn up Debs, back and forth from 'we need a diagnosis, so we know what we are working with' to 'its not about a diagnosis, its about a child's needs' which suits them at the time is more like it!

Claw you are spot on with that one... the 'who needs a dx when we can address your needs/how can we address your needs when you haven't been assessed' is a familiar dichotomy

Star - yes, of course, you produce information and you might be held to it.

It seems like the light of 21st century good practice has yet to be shown in this area. Other areas of the hospital are not like this, e.g. when I've taken DS2 for hearing check ups etc.

Given that it is often psychology teams dealing with these ASD issues, communication really should be understood as crucially important. it really is piss poor practice of the highest order - that's the technical term for it