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As Clinical Psychologists in Surrey and Borders NHS Trust, we are working to promote autism-informed care for people with and without learning disabilities (LD). In line with the LD Professional Senate we are working with mainstream services to ensure they are supported to make all reasonable adjustments required by people with learning disabilities and/or autism.
The Clinical Psychologists in our Trust are trained in taking detailed developmental histories and additionally are all now Autism Diagnostic Observation Schedule (ADOS) trained so we can contribute to complex multidisciplinary team discussions around autism diagnoses, particularly where diagnosis is not straight forward or where trauma or other neurological differences may need understanding. We work in a formulation-driven approach and incorporate the presentation of each individual’s unique autism factors into their package of care, be that individual therapy or positive behaviour support (PBS) plans. We work alongside other agencies and services to prevent deterioration in wellbeing and/or placement breakdowns for people with autism, with or without learning disability. This might involve providing training around the individual, or more generally the factors associated more widely with autism spectrum disorder. For people who come through our services, where it is felt a diagnostic assessment would be appropriate, we promote that people are assessed by the appropriate service (this may be us or may be mainstream services) if it is helpful to them regardless of their presenting problem. Following NICE guidance, we ensure that we have identified that the autistic presentation is pervasive and lifelong by taking detailed developmental histories to ensure a diagnosis can be made. By working with our skills and knowledge set, both inside and outside of learning disabilities, we work to prevent misdiagnosis and thus inappropriate interventions which could exacerbate the person’s presentation.
Interventions are always person-centred, based on an individual formulation gathered as a result of thorough assessment. Interventions may include a therapeutic intervention to help the person to manage the impact of autism; it could be helping the family and surrounding system in how best to support the person or helping them to manage their relationships together. All interventions are monitored using adapted qualitative and quantitative methodologies to ensure the continued development of evidence-based practice.
The particular skills that the psychological profession bring are the ability to use formulation to unpick the differential diagnoses that individuals might also need support with, for example interpersonal difficulties, trauma or Obsessive Compulsive Disorder. Interventions in line with the evidence base from NICE are utilised but adapted according to the population needs. Psychological professions colleagues also work with colleagues from other disciplines and other services to offer consultation and advice to ensure that people with autism and learning disabilities get the support they need from mainstream services by supporting the development of knowledge and confidence in other professionals in treating comorbid mental health difficulties.
Dr Jo Jennison & Dr Lizzie Goad
Surrey & Borders Partnership NHS Foundation Trust