Do demographic, and clinical characteristics influence meeting NICE quality standards for young people transitioning to adult intellectual disability services?

Purpose This study aims to evaluate the quality of transition from child and adolescent services to adult intellectual disability services, using the relevant National Institute for Health and Care Excellence (NICE) standard (QS140). In addition, this study also identifies any differences in transition quality between those young people with intellectual disability with and without autism. Design/methodology/approach Using routinely collected clinical data, this study identifies demographic and clinical characteristics of, and contextual complexities experienced by, young people in transition between 2017 and 2020. Compliance with the quality standard was assessed by applying dedicated search terms to the records. Findings The study highlighted poor recording of data with only 22% of 306 eligible cases having sufficient data recorded to determine compliance with the NICE quality standard. Available data indicated poor compliance with the standard. Child and adolescent mental health services, generally, did not record mental health co-morbidities. Compliance with three out of the five quality statements was higher for autistic young people, but this only reached statistical significance for one of those statements (i.e. having a named worker, p = 0.02). Research limitations/implications Missing data included basic clinical characteristics such as the level of intellectual disability and the presence of autism. This required adult services to duplicate assessment procedures that potentially delayed clinical outcomes. This study highlights that poor compliance may reflect inaccurate recording that needs addressing through training and introduction of shared protocols. Originality/value To the best of the authors’ knowledge, this is the first study to examine the transition process between children’s and adults’ intellectual disability health services using NICE quality standard 140

Exploring self-harm risk vulnerabilities in autism using the ‘thinking patterns profiling model’

From Springer Nature via Jisc Publications RouterHistory: received 2022-11-21, registration 2023-02-23, accepted 2023-02-23, epub 2023-03-20, online 2023-03-20, collection 2023-12Acknowledgements: This project was conducted through the Structured Operational Research and Training Initiative (SORT IT), a global partnership led by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization. The training is based on a course developed jointly by the International Union Against Tuberculosis and Lung Disease (The Union) and Medécins sans Frontières. This specific SORT IT program was run by Cheshire and Wirral Partnership (CWP) NHS Foundation Trust as part of routine work. Mentorship and the coordination/facilitation of these SORT IT workshops were provided through the CWP NHS Foundation Trust; The Centre for Operational Research, The Union, Paris, France; The Institute of Medicine, University of Chester, UK; and College of Life and Environmental Science, University of Exeter. The authors would like to acknowledge the families who attended the autism diagnostic assessment profiling service, and to thank the experts by experience who shared their insight, contributed to interpretation of the study findings, and reviewed final versions of the manuscript. Experts by experience included Josef de la Moitie and Kevin Carrell who were happy to be named. The authors would also like to thank Professor Taj Nathan (Director of Research and Effectiveness), Dr Fiona Pender (Strategic Director), Anne Casey (Head of Clinical Services), Dr Ian Davidson (Consultant Psychiatrist and Royal College of Psychiatrists Autism Champion), and Heather Pearce (Advanced Specialist Speech and Language Therapist) all at Cheshire and Wirral Partnership NHS Foundation Trust. Finally, thank you to David Tollerfield for permission to use the ‘Thinking Patterns Profiling Model’ digital innovations as part of the diagnostic assessment profiling service.Publication status: PublishedBackground: Autism has been linked to higher rates of self-harm. Research is yet to establish the reason for the association between autism and self-harm as a distress response. Methods: Using the ‘thinking patterns profiling model’, this study explored characteristics associated with self-harm risk in 100 autistic young people. Secondary analysis of routinely collected clinical data was conducted using odds ratios and t-tests. Results: We found the prevalence of reported self-harm risk was 48%. Young people with reported self-harm risks had significantly lower regulation skills (p ≤ 0.01) and lower social flexibility skills (p ≤ 0.01) compared to those without reported self-harm risk. For those described as impulsive, mean scores on the following skills were significantly lower: perspective-taking skills (p ≤ 0.01), flexible thinking for creative problem-solving (p ≤ 0.05) and sensory tolerating (p ≤ 0.05). There was no relationship between reported self-harm risk and adverse childhood experiences. Conclusions: These findings suggest that profiling tools such as ‘Thinking Patterns Profiling Model’ can be used to explore unique patterns of vulnerability and resilience related to self-harm risk in autism. The findings suggest that autistic thinking patterns might interplay with other factors (e.g. impulsivity). Patterns are based on each person’s profile across four core skill-sets: regulation, flexible thinking, sensory coherence, and social perspective-taking. These findings motivate a person-centred and profile-informed approach to planning support and adjustments. Further studies are needed to confirm the ways in which mechanisms typically involved in self-harm risk, may interact with core cognitive and affective differences found in autism

Who is at risk? Adults with intellectual disability at risk of admission to mental health inpatient care

This article is not available on ChesterRepBackground: NHS England's Transforming Care agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission.MethodA cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken.ResultsWe compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis.ConclusionBy furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources

Who is at risk? Adults with intellectual disability at risk of admission to mental health inpatient care.

From PubMed via Jisc Publications RouterHistory: received 2023-07-03, revised 2023-11-30, accepted 2024-01-22Publication status: ppublishNHS England's Transforming Care agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission. A cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken. We compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis. By furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources. [Abstract copyright: © 2024 John Wiley & Sons Ltd.

Short Research Article: Do demographic, socioeconomic and clinical characteristics influence the number of psychological intervention sessions attended by young people in need of mental health care?

From PubMed via Jisc Publications RouterHistory: accepted 2022-10-12Publication status: aheadofprintA cohort study using secondary data assessed associations between baseline characteristics and psychological sessions attended in young persons discharged from a Children and Young People's Mental Health Service in 2019. There were 584 persons who attended a median of seven sessions. On multivariable regression analysis, males attended fewer sessions than females, young people from more affluent communities attended more sessions than those from poorer communities and those presenting with eating disorders and self-harm in particular attended more sessions than those with anxiety. Addressing why these associations occur may improve mental health care in young persons. [Abstract copyright: © 2022 Association for Child and Adolescent Mental Health.

Can the “Current View” show that autistic young people referred to mental health services have more comorbidities and complex needs?

Purpose Autistic young people have health and care needs that may benefit from a multi-agency intervention. The “Current View” tool is routinely used in England to profile the needs of young people referred to mental health services. This study aims to examine associations between comorbidities and complex needs in autistic and non-autistic young people to assess the multifaceted needs of autistic young people. Design/methodology/approach A cohort study was conducted using data from the electronic patient record, comparing autistic and non-autistic young people to see which items in the four “Current View” tool categories were associated with autistic young people. Findings Issues associated with autistic young people were: “community issues”, “attainment issues” and “deemed child in need” (all p < 0.001). Autistic young people scored significantly more items (p < 0.05) in the categories complexity/contextual/educational factors. Comorbidities associated with autistic young people included anxiety, “behavioural difficulties”, “peer relationship difficulties” and “self-care issues” (all p < 0.001). There was an association with increased comorbidities and complexity factors in autistic young people which suggests increased support from agencies may be beneficial. Originality/value Few studies have used data in the “Current View” tool to assess young people referred to services. More use could be made of this data for planning and delivering services