Various services in the local area were concerned about the increase in young adolescents presenting in crisis, with either potential self-harm or harm to others. Police and ambulance workers were often required to intervene, and emergency department beds used.
In many cases a potential diagnosis of autism was suspected to be the underlying issue. However, the average wait-time for an assessment through the local Child and Adolescent Development Unit was 18-24 months, acting as an inadvertent block to the gateway for intervention and support.
This project aims to reduce the waitlist time for a multidisciplinary diagnostic assessment for older school age and adolescent children, by 25% by March 2018.
- More timely assessment of young adolescents referred for possible diagnosis on the autism spectrum, and priority given for allocation to a specific assessment clinic.
- Reduced waitlist time from 18-24 months to 9-12 months as a result of immediate allocation for assessment at points of crisis or transition.
- Reduced demands and disruption to the emergency department, hospital, and mental health system.
- Less stress for staff.
Local services, including education, police, juvenile justice and health, were reporting an increase in the number of young adolescents with complex learning, social and behaviour difficulties, presenting in dramatic crisis situations and requiring intervention, with no clear referral pathway to health and support services.
Adolescents with comorbid mental health diagnoses and autism spectrum disorder, particularly when the latter has not been identified, are at greater risk of becoming involved with juvenile justice and the court system, because of maladaptive social and emotional behaviour. They are also at risk of presenting to hospital emergency departments following incidents of self-harm or harm to others, or emotional/psychological problems.
A thorough and timely assessment is needed to identify any potential neurodevelopmental diagnosis, such as autism spectrum disorder, and ensure that the adolescent has access to services targeting more specific interventions.
- Three separate assessment clinics were established: one for older school age and adolescent children; another for children aged <7 years; and a third clinic offering developmental assessments for children under 5 years.
- At the same time, a thorough review of the current waitlist was completed, with children allocated to their age-appropriate clinics. Immediate priority for assessment was given to any child with a current waitlist time greater than 18-24 months.
- A second Plan, Do, Study, Act cycle was commenced.
- A review of the priority policy was made to bring it into line with other developmental units and health services, and current NDIS requirements.
Implementation - The project is ready for implementation or is currently being implemented, piloted or tested.
Child and Adolescent Development Unit, Blue Mountains District and Anzac Memorial Hospital, Nepean Blue Mountains Local Health District.
Representatives from local paediatric, education, and police services, and non-government early intervention services.
- In January 2018 there was an initial increase in the average waitlist time, due to an increase in referrals and department closure for Christmas leave.
- By June 2018 the waitlist time for older children and adolescents had fallen 37% to an average of 250 days, with a 25% increase in the number of assessments completed.
- Procedures have been established to ensure better use of team resources and a steady allocation of children to clinics.
- More developmental assessments with younger kids were completed within targeted clinic time, with a subsequent reduction in waitlist times.
- One balancing measure - the younger diagnostic assessment group - has shown an increase in waitlist time to 6-9 months. Managing this will be part of another review.
- An update of Priority Policy for allocation to available clinic times has been established in line with similar services.
An important 'Aha!' moment was the realisation that a waitlist is constantly changing, and not set in stone. It should be assertively and strategically managed, according to current priority considerations, funding issues, and service availability.
Another key learning was the importance of good team work, readiness for change, shared goals, and good leadership; look to the resources available in the existing team, there is always room for improvement, and manage that waitlist!
Team Leader/Clinical Psychologist
Child and Adolescent Development Unit, Blue Mountains Hospital
Nepean Blue Mountains Local Health District
Phone: 02 4784 6671