One of the largest professional mental health bodies has said it “cannot endorse” the Health Service Executive’s new autism protocol.
The College of Psychiatrists of Ireland has “several significant concerns” about the scheme, which the HSE hopes will tackle long waiting lists for assessments of need (AON) for autistic people.
Trish Byrne, the college’s chair of its faculty of child and adolescent psychiatry, said the planned new “tiered approach” to diagnosing autism, which will see assessments offered across HSE services and not just by disability teams as is currently the case, is a “move away from standard, validated assessment” process.
“We have huge concerns and cannot endorse the protocol as it stands.”
RM Block
The protocol’s language was “contradictory” and “vague”, she said. There were risks of “false negatives” where autistic people were told they were not, and “false positives” where people were told they were autistic but in fact had other challenges.
The protocol was an attempt to “spread the load of an overwhelmed system into other systems that are already also overloaded”.
“The crux of the issue is that HSE disability services are not resourced adequately to meet the needs,” said Byrne.
Minister for Health Jennifer Carroll MacNeill, Minister for Children Norma Foley, Minister of State for disability Emer Higgins and the HSE chief executive Anne O’Connor announced details of the new ‘autism assessment and intervention pathway protocol’ last week.
It “represents a significant step forward in how we support autistic people” they said, and “as a result, many families may not feel the need to apply for an AON”.
It will provide three ‘tiers’ of assessment depending on the complexity of the case, the HSE said.
Implementation planning, beginning later this year, will include training for HSE staff, and the establishment of 20 “expert teams” each to include a psychologist, speech and language therapist, occupational therapist and an administrator.
An explanatory HSE note says: “Tier 1 autism assessment is the default assessment for relatively clear presentations of autism” to be “typically completed in less than 10 hours” including assessment, report and feedback time.
The college’s concerns centre on the tier 1, which they described as an “abridged” process that is inappropriate where the individual is new to services with no prior multidisciplinary input.
[ Autism charity under review told HSE it was ‘transitioning away’ from UK parentOpens in new window ]
Tier 2 will be an “extended assessment ... where the presentation of autism is less clear” while tier 3 will involve “continuing assessment ... for the most complex and unclear presentations”.
The protocol is not a replacement for the AON, which remains a statutory right under the 2005 Disability Act, and the mechanism by which disabled children get a formal statement of their educational, social and occupational needs.
Legislation states a child has a right to a completed AON within six months of a valid application. Current waiting times, however, are up to 27 months, forcing many parents who can afford it to get private assessments.
Although psychiatry is not involved in assessing for autism, Byrne said: “As a college we have expertise in understanding autism. There is a high rate of associated mental health disorder, so it is a relevant area for the college to comment on.”
A HSE spokeswoman said the executive had had “positive engagement” with the college in developing the protocol.
“Representatives of the college ... were involved in developing the framework for competency components which will assist and guide clinicians as we move towards implementation.”
Implementation planning is due to start in the third quarter of this year, and will include training needs analysis and the identification of clinical and governance requirements.
“The resourcing concerns raised ... will be addressed by the recruitment of in-reach teams in the health regions,” said the spokeswoman.
“These teams will work to upskill autism assessment competency and confidence across all community teams to ensure inclusive practice, access and sustainability when supporting autistic people.”
