Agenda for Scrutiny Panel on Services for Adults with Autistic Spectrum Conditions on Friday, 19th November, 2010, 2.00pm
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PDF 180 KBVenue: Council Chamber, Hove Town Hall. View directions
Contact: Kath Vlcek
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Procedural Business Additional documents: Minutes: 32. Procedural Business
32a Declaration of Substitutes
32.1 There were none
32b Declarations of Interest
32.2 Councillor Harmer-Strange declared a non-prejudicial interest in the remit of the panel as a parent with two children on the autistic spectrum.
32c Declarations of Party Whip
32.3 There were none
32d Exclusion of Press and Public
32.4 In accordance with section 100A(4) of the Local Government Act 1972, it was considered whether the press and public should be excluded from the meeting during the consideration of any items contained in the agenda, having regard to the nature of the business to be transacted and the nature of the proceedings and the likelihood as to whether, if members of the press and public were present, there would be disclosure to them of confidential or exempt information as defined in section 100I (1) of the said Act.
32.5 RESOLVED – that the press and public be not excluded from the meeting. |
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Minutes of the Previous Meeting Additional documents: Minutes: 33.1 These were agreed. |
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Chairman's Introduction Additional documents: Minutes: 34.1 The Chairman of the panel welcomed everyone to the panel meeting. He introduced the other panel members and advised everyone that the meeting was being recorded for use as a training resource but it was not being broadcast live.
Councillor Harmer-Strange reminded people that there was also a meeting arranged for the following week for members of the public, people with Autistic Spectrum Conditions, parents and carers to speak to the panel about their experiences and said that he hoped that some of the audience would be able to join them.
34.2 The Chairman said that there was a very packed meeting planned, looking at improving diagnosis and pathways to care; awareness of Autistic Spectrum Conditions for frontline workers, and at adapting services to enable people with Autistic Spectrum Conditions to access them. |
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Improving Diagnosis and Pathways - Dr Becky Jarvis
To hear from: Additional documents: Minutes: 35.1 Dr Jarvis has been a fulltime GP since 1995; she works at the St Peter’s Centre which has the fulltime equivalent staffing of 5 GPs.
They have 11.500 patients. Of their patients aged under 18, 1.2% have a diagnosis of autism, and 0.3% a diagnosis of Asperger’s Syndrome. In their patients aged over 18, 0.2% have a diagnosis of Asperger’s Syndrome and 0.1% have a diagnosis of autism. These figures are much higher than expected, and might reflect the GPs’ own personal experiences of Autistic Spectrum Conditions.
Dr Jarvis also looks at general Mental Health services in the city as part of her practice-based commissioning work. GPs were surveyed in summer 2010 and were asked whether there were any gaps in the Mental Health services being provided. Several GPs said that they did not think that an adequate service was provided for people with ASC currently.
35.2 Dr Jarvis had been thinking about how services for people with ASC had changed over the last fifteen years.
There were a number of positives. There was a greater public and professional awareness of ASC for children and young people. There was a higher chance that a young person would receive a diagnosis through primary care or through educational services. Once a diagnosis was made, parents received a support package which, although not ideal, had improved consistently over time. Parents might be able to get help with benefits, help within schools etc. There was more multi agency working.
The other major positive change was the introduction of a local diagnostic service; this had been introduced in the last few years. Prior to this, people had to be referred out of area for assessment.
35.3 Dr Jarvis also commented on the negative aspects of the current services for adults with ASC. There was a general lack of awareness in the general public; this was mirrored by primary care practitioners. Dr Jarvis was unaware of any training for GPs on how to diagnose ASC in adults or how to manage it. GPs had limited knowledge about Aspire and Assert, usually acquired through patient feedback and limited knowledge of Professor Critchley’s service or how it operated.
35.4 There were three groups of people who came to Dr Jarvis as adults: patients who were discharged from CAMHS without any support being offered after the age of 18; patients who self-diagnosed or who had a private diagnosis; and parents of adult children who had not received a diagnosis previously. Dr Jarvis gave the example of the parent of a 33-year old man that she saw yesterday who had not received a diagnosis although he displayed many of the signs of ASC.
When Dr Jarvis sees a patient who seems to have ASC, she can refer them on to Aspire or Assert. She can also refer into Mental Health services, but sometimes people have already been to those services and received an incorrect diagnosis or medication so they may be reluctant to go back. Patients are also unhappy with the Mental Health label.
There seems to be little support for carers and little help with claiming benefits
After someone receives an assessment there is often a long delay before they are seen by Professor Critchley’s specialist team due to the demands on the service. He will complete a thorough and comprehensive assessment, and make recommendations for services to be put into place. However the diagnostic team might make recommendations that the Recovery Team does not have the facility to provide in terms of long term support. It is hard for primary care to fill this gap.
35.5 In terms of improvements that could be made, Dr Jarvis suggested: more training in primary care; easy access to resources for patients and practitioners; developing a primary care CPN service may help as they may be able to have Autism champions in the service, helping with the initial assessments.
In terms of information for GPs, it would be helpful to know what interventions were most helpful, eg does Cognitive Behavioural Therapy have a positive impact. It would be helpful to know about support for carers too.
35.6 Dr Jarvis answered questions from the panel.
The panel asked how GPs accessed training; how could it be put into place for single GP practices?
Dr Jarvis said that training could be approached in a number of ways; not one size would fit all practices. All GPs had to undertake training as part of their ongoing appraisal and revalidation. In Brighton, there was a GP update course held twice a year; one of these sessions would reach a large number of GPs. Training could be held in evening sessions; all members of a particular practice could attend a half-day training session as part of the protected learning scheme– in this instance the PCT would pay for locum cover.
If a primary care Mental Health service was established, with CPNs in the surgery, they could hold lunchtime training meetings.
On a larger scale, it was possible to incentivize training; in primary care there are is a voluntary enhanced services scheme, where GPs can provide an enhanced level of care to their patients, and get paid for the extra time taken. This would take a big shift in approach and may not necessarily be appropriate for patients with ASC.
35.7 Members asked what happened to young people when they came to the end of their time with CAMHS; was further support provided? Dr Jarvis said that if the young person had Learning Disabilities as well as ASC, they were likely to receive a good service from the Adult Learning Disabilities Services as their way of working was similar to that of CAMHS. However generally there was no set referral system from CAMHS to the Recovery or Access Teams or to Adult Mental Health Services and no system for a direct referral to the diagnostic clinic.
Dr Jarvis’s experience was that there did not seem to be any one person or team providing ongoing holistic support. There were pockets of excellent practice but the services were not coordinated.
When asked who would be the best group to coordinate services, Dr Jarvis said that it could be anybody including GPs, the PCT, the Council, Mental Health services etc. One of the key things for any of these teams would be to agree what a care package should look like for that particular person.
It was important for the services to acknowledge that there would be a period of transition for the young person.
Dr Jarvis was aware that it might not be appropriate to refer a person on to Adult Mental Health services but it was difficult to know where else the support might sit.
35.8 In terms of diagnosis, Dr Jarvis said that she did not feel qualified to make a diagnosis. She would not feel comfortable labelling someone as having ASC until this had been confirmed by someone properly qualified. It was very important to get it right, particularly as ASC could overlap with other conditions. Dr Jarvis did not think that many GPs would be comfortable diagnosing ASC.
Dr Jarvis said that she would refer a young person for assessment to the Seaside View Centre at Brighton General Hospital. There was a two month waiting time. Sometimes the young person was diagnosed in one visit; on other occasions they may need repeat appointments.
For adults, there was a two to three month waiting list for the first assessment to be carried out, after which the person might be referred on to be seen by Dr Critchley. Lat time Dr Jarvis had referred someone on, there had been a nine month waiting list to be seen at the diagnostic clinic.
35.9 Panel members asked for more information about what resources could help with diagnosing and supporting someone with ASC. Dr Jarvis said that she felt that it was linked to the need for training. She felt that there might be excellent resources in the city but GPs were unaware of what was available in Brighton and Hove other than Aspire and Assert.
Dr Jarvis explained that GPs used a resource called a ‘Map of Medicine’ when making a diagnosis and looking for guidelines, which provides local information about resources. This could be updated to include standard information about resources for ASC in the city. This would help to provide a standard city-wide response from GPs.
35.10 The panel asked Dr Jarvis how she envisaged the role of an ‘Autism Champion’ developing. If there was a Primary Care Mental Health service, there would be people within the surgeries who could refer onto secondary services, building close links with the appropriate services. This would bridge the gap between primary and secondary care. More widely there could be champions within each surgery, such as was currently in place for Infection Control champions etc, but this would be more resource-intensive.
35.11 Finally, Dr Jarvis said that the one thing, other than training, that could make a difference for people with ASC would be a holistic support package with multiagency working.
35.12 The panel thanked Dr Jarvis for her input.
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Professor Hugo Critchley, Neurobehavioural Clinic Additional documents: Minutes: 36.1 Professor Hugo Critchley introduced himself to the Panel; he is an academic based at the university’s Neuro-behavioural medical school. He has a background in neuro-science, working at various premises including the Maudesley hospital.
Professor Critchley moved to Brighton and had the opportunity in 2007 to establish a Brighton and Hove clinical and diagnostic service through the Sussex Partnership Foundation Trust (SPFT). This is primarily focussed on ASC but also including other neuro-developmental conditions that overlap with autism. The remit was to help meet a priority need to diagnose Asperger’s Syndrome as a hidden disability, which had not been well diagnosed or supported previously.
36.2 The clinic covers Brighton, Hove and East Sussex. It has received 380 referrals, of which 210 were specifically diagnosed with ASC. The clinic operates one day a week and is multi-disciplinary. It sees adults who do not have Learning Disabilities, who may or may not have been through CAMHS as young people. There is a waiting list of about nine months.
The clinic tries to diagnose ASC and co-morbidities, and to come up with recommendations from the evaluations, referring these back to the original referral team, whether this is the Recovery or Access teams. In the clinic they have tried to build up their knowledge about local services so that they can tailor their recommendations appropriately. They rely a lot on voluntary sector groups such as Assert, to implement recommendations and support the clients.
36.3 Professor Critchley said that what was missing in the service was a fast track path to diagnosis. A strategic decision was taken at the start of the process to route the pathway to the clinic through Mental Health, due to the secondary mental health conditions are often present, and that need priority management through Mental Health services.
The service was set up purely as a diagnostic service rather than as an ongoing support service for people with ASC. Due to its limited resources, the diagnostic team cannot take responsibility for following up the recommendations made; these are given back to the referring Mental Health teams.
36.4 Professor Critchley addressed questions from the panel. In response to a question about the level of contact that the clinic had with GPs in terms of referrals, the panel heard that GPs were asked to refer via the Recovery or Access teams, rather than directly to the clinic. They try to offer a limited follow-up service for clients, to find out whether recommendations have been taken up.
Professor Critchley said that he thought it would be very beneficial to have someone to coordinate and navigate the different referral systems for users including Health Care, educational providers, occupational health etc. They all had different ways of working and different priorities and it would be useful for there to be a guide.
36.5 The panel asked whether the clinic had enough in terms of resources to meet the demand. Professor Critchley said that in comparison to other similar provision, the service in Brighton and Hove was doing quite well, although the nine month waiting list was unsatisfactory. He would ultimately like to see a triage system such as that in place in West Sussex. This would allow people to respond earlier to referrals.
36.6 Professor Critchley said that the clinic had some contact with CAMHS as children became adults, although there was less contact with regard to young people with ASC in comparison to the level of contact had for young people with ADHD, which was also seen in the clinic. There was a co-morbidity between ADHD and ASC, with a third of people having both conditions.
36.7 The panel asked Professor Critchley for his view on the level of support available for adults with ASC. He said that it was often the case that a diagnosis could help in terms of being able to access advocacy etc. However there seemed to be a lack of provision for more ongoing support needs such as counselling, and it did not seem that Adult Mental Health services were structured in a way that helped support people who were vulnerable to escalating mental health issues without support.
Many people did not have any long-term management or support; Mental Health services are reactive to crises rather than proactive. Often the only support is through voluntary sector groups.
If long-term management was in place, it would make a difference in terms of occupational and educational needs being met. This would only take low level support and would help improve the quality of life for many people with ASC. The clinic saw a number of people who have dropped out of school or college, due to lack of support. It was important to have student support in place in schools and universities.
36.8 Professor Critchley said he thought the Brighton and Hove clinic was the only clinic nationally to have a dedicated Speech and Language therapist as part of the assessment process. This was important in picking up communication problems, part of the triad of impairments. The Speech and Language therapist could make the necessary recommendations in terms of communication problems.
The panel asked whether there were enough resources to see the communication recommendations put into place after they had been made. They heard that there was differing provision in East Sussex and in Brighton & Hove. More resources would be beneficial; there was a lot of work that needed to be done in terms of the responses to all recommendations. |
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Ian Watling, Sussex Partnership Foundation Trust Additional documents: Minutes: 37.1 Ian Watling, Deputy Service Director from Sussex Partnership Foundation Trust (SPFT) introduced himself to the panel.
Mr Watling manages Adult Mental Health services in Brighton and Hove, in particular the community services. They have a number of clients with a diagnosis of ASC.
The service is currently organised to try and provide a smooth pathway. The services are in the process of being redesigned.
37.2 In general, if someone in Brighton and Hove experiences a mental health problem, they would go to their GP and be referred onto Access Services. Access Services are divided into teams across the city. Their role is to work with the person to assess the nature of their problems and to see whether short-term or long-term intervention would be beneficial. Short-term intervention might be appropriate for conditions such as anxiety and depression whilst long-term intervention would be appropriate for longer term, more enduring mental health problems. When people require longer-term intervention, they are moved to the one of the three Recovery teams in the city; these were formerly known as Community Mental Health Teams. Some of the people referred on have higher levels of risk.
The Recovery Team also operates a homeless team and manages five recovery support houses in the city.
37.3 Brighton and Hove is fortunate in having a pathway for ASC; this is not the case across other parts of Sussex. There is the diagnostic clinic at Buckingham Road, run by Professor Critchley, where people are assessed.
The pathway should work in a way that a person is referred into Access Services, referred to the diagnostic clinic for a diagnosis and referred back to the Recovery Team after diagnosis. This might not work if, for example, the Access Point does not pick up the ASC or misdiagnoses it as another condition.
37.4 Mr Watling said that there were about 25 new referrals to Recovery per year; this is rising. This may be because of improved awareness about ASC. Between 2007-2010, there were approximately 52 people with ASC on the SPFT’s caseload.
37.5 The issues that the partnership faces include: · a lack of awareness of ASC at the screening stage; · going into recovery with a mis-diagnosis can lead to the wrong treatment or lead to delays; · the Recovery team being unable to fulfil the recommendations made by the diagnostic clinic, maybe if they relate to Adult Social Care services and the person is ineligible for that service · limited number and high costs of specialist services (although they can provide excellent outcomes)
37.6 There is great informal enthusiasm amongst the Recovery staff but the lack of formal services can be a problem and the relatively low number of people being seen with ASC means that skills might not develop very quickly.
37.7 SPFT is looking to improve the level of training in the Recovery teams. They have identified a worker in each of the three Recovery teams who will be the identified lead worker for ASC.
The West Recovery Team (which covers Hove) is the one that is most likely to lead on this work, as they have a caseload of 35 people with ASC, due to the services available in Hove for people with ASC.
To summarise, this means that there is a growing awareness of ASC, a growing caseload, more staff showing an interest in the condition, and a real opportunity to shape services for the future.
37.8 Mr Watling said that it had not proved possible to easily find a list of people who have had a diagnosis of ASC. This may be indicative of the low priority that ASC had been given in the past and some of the issues that need to be addressed by all of us. We all need to improve our data collection. SPFT has an initiative starting this year to better improve the way in which they record diagnosis.
37.9 Some workers had found it a challenge over the past few years to deal with some of the difficult behaviours that some people with ASC displayed, eg violent behaviour. However a lot had been learnt over the years and it was felt that things were improving.
Mr Watling said that SPFT needed to improve its relationship with the third sector. One way that this could be taken forward could be for the identified lead officer mentioned previously to carry out training with the third sector and to then share this learning with their colleagues.
37.10 Mr Watling explained that SPFT services were currently being reorganised with more of a focus around care management and assessment and treatment. They will have assessment/ treatment centres in the city, enabling them to reorganise staff in a way that will be able to provide more treatment for people with ASC and other conditions.
When Mr Watling undertook this work, it highlighted the fact that there appeared to have been four admissions of people with ASC to acute inpatient services in the last month. This is very concerning; people with ASC do not cope with change easily, and the nature of acute services means that there are often changes of staff, which would be very distressing. The new service model needs to include much more continuity.
37.11 Mr Watling answered questions from the panel.
The panel asked how people were referred to SPFT. Mr Watling said that it seemed that most people came through from Access Services. There were Liaison services at the hospital, and SPFT were looking to improve this. This may prove to be a new pathway.
37.12 What was the general trend with regard to acute admissions? Mr Watling said that over the last year, about 20 people had been admitted into acute admissions, so the last month’s intake had been exceptionally high. He will be looking at these admissions in greater detail to find out what happened.
37.13 The panel asked about crisis management, and the time taken for the crisis team to respond. Members of the public had told the panel previously that they had been on the verge of suicide before they received help from the crisis team.
Mr Watling said that there were often unrealistic expectations about the role of the crisis team; they are not there to support anyone in a mental health crisis. They are tasked to provide support only for people who would otherwise be admitted as an inpatient. There are many people who have a crisis who are not likely to be admitted, so they would not be eligible for help from the team.
However, one of the big pieces of work that is taking place in conjunction with the PCT is to look at the emergency and urgent referrals from GPs. SPFT and the PCT are looking at how the service can be improved to provide more of an urgent response for people.
37.14 The panel asked whether SPFT received any referrals from the prison service. The SPFT has the potential to take those referrals although the data was not currently known. The Secure and Forensic services are linked closely to the prison.
37.15 The panel asked how the recommendations from the diagnostic clinic were met and why they might not always be met. Mr Watling said that they needed to do more to understand the various components of the work.
Some of the problems could be due to the Fair Access to Care regulations- not all patients would be eligible for funding under the regulations. However when the SPFT begins to thinks more creatively, it might be that they no longer need to purchase the services from the council and will rely less on Adult Social Care.
37.16 Mr Watling was asked what would be the most useful thing that could be done as a result of the panel. He said that it would be helpful for the council to remind SPFT that they were there to provide services for everyone in the city, and to act in an inclusive way. People have different ways of experiencing crisis, and it is useful for SPFT to remember that.
Mr Watling said that the fact that the panel had been convened and the questions that had been asked had encouraged SPFT to review how they provide services for adults with ASC and to begin to reshape some of their practices.
37.17 The panel asked Mr Watling for his view of the transition process. He said that the process had been designed so that it worked well but that tended to cause difficulties for some individuals. For example, the way in which the CAMHS service is organised is very different to the way in which adult Mental Health services is organised; the CAMHS approach is a lot more involved. This can mean that young people moving from CAMHS to the adult service can feel a sense of loss; this is exacerbated for young people with ASC who cannot manage change.
Work is underway to help design a better transition pathway from CAMHS, maybe to include a worker from CAMHS becoming involved with the adult services for up to a year to make the pathway smoother and offer continuity. However it needed to be remembered that CAMHS also included all aspects of the young person’s life including education etc, which did not happen in adult provision.
The panel asked whether there was any legal reason that there had to be a separate children’s and adult’s service, as there was such a difference in service provision between the two. Mr Watling said that he was not aware that there had to be two different systems but that there was an issue about capacity and demand.
There was an ever increasing demand for adult Mental Health services, and SPFT needed to be more responsive to both short-term and long-term needs. SPFT was assigning Care Coordinators to people with higher levels of needs as a key worker, to provide a level of continuity and help them to access the right level of treatment and support.
37.18 Mr Watling was thanked for his time and for the information that he had provided.
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Awareness of Autistic Spectrum Conditions for Frontline Services - Guy Montague-Smith, Access Point
To hear from:
Additional documents: Minutes: 38.1 Guy Montague- Smith, Manager of Access Point, Brighton & Hove City Council introduced himself and the service.
Access Point is the main point of referral for all Adult Social Care enquiries and referrals. It has two main functions, one to provide advice, information and signposting and the other part is determining eligibility for services using the Fair Access to Care criteria. This is usually done over the telephone, although there is also an online form and some assessments are carried out over email.
The team operates from Monday to Friday all day. They have just started an outreach service, connected with local voluntary groups and carrying out face to face assessments. This has helped people who have communication issues and cannot communicate over the phone.
The service is very busy. They have approximately 2,500 contacts per month, of which two thirds are seeking advice and information, and one third are seeking assessments. At present, about 94% of cases are completed by Access Point.
The team acts as a safe haven for safeguarding adult alerts. These are triaged to the most appropriate team for investigations. The team can also set up basic services such as Meals on Wheels, minor adaptations or home help. They provide guidance with self-directed support.
38.2 The team has a number of areas that it is working on. These include increasing their knowledge of Autistic Spectrum Conditions and Learning Disabilities, including a rapid response team to help people with ASC.
Most of the services that Access Point deals with are geared up for people with physical disabilities; this is probably one of the main stumbling blocks for people with ASC. The teams that Access Point refers on to might not have much knowledge about ASC and what is needed, and might not recognise the issues.
The team does not cover Mental Health services as these fall outside of Adult Social Care and are provided by SPFT.
38.9 Mr Montague-Smith responded to questions from the panel.
Would someone approaching Access Point need a diagnosis before receiving support? Mr Montague-Smith said that people do not need a diagnosis to get help from Access Point but he does feel that services that they have are not currently geared up to help people with ASC.
They talk to Assert for assistance now if its needed but they would prefer to have a specialist within the team, particularly to help with safeguarding queries in relation to people with Learning Disabilities.
38.10 The team needs to improve its knowledge of ASC in terms of safeguarding. They have a very high level of referrals – 278 in the last quarter- with half being Mental Health related issues. The Support and Intervention team that deals with a large number of safeguarding issues is more used to dealing with physical issues, so training is needed to raise awareness of the issues.
Most members of the Access Point team have had some element of Autistic Spectrum Conditions training through the Learning and Development team although it has not been possible to release everyone for training at once. The training has also been offered to the other assessment teams.
The training was developed by the Aspergers’ Stakeholder Group and is provided for the council by Southdown Housing.
38.11 The team model that Access Point uses is very resource efficient, it is very effective in reducing waiting lists and referrals to the main assessment teams, allowing specialists to deal with specialist provision.
38.12 Mr Montague-Smith was thanked for his input and the information provided.
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Graham Bourne, Revenues and Benefits Additional documents: Minutes: 39.1 Graham Bourne is the Head of Revenues and Benefits for Brighton & Hove City Council, incorporating Council Tax and Housing Benefit administration. Mr Bourne said that he has a particular interest in this subject as he has a son on the autistic spectrum.
39.2 Mr Bourne was asked to speak to the panel as his service deals with a large percentage of the adult population in Brighton and Hove. Mr Bourne explained that there were 125,000 domestic properties registered for Council Tax in the city; a fifth of those were in receipt of Council Tax Benefit and/ or Housing Benefit.
His service is a high contact service for a lot of residents of Brighton and Hove. They deal with a very wide range of customers and aim to provide an inclusive accessible service. Staff are trained in customer service and mental health awareness, giving them the tools to understand customers and decide the best way to communicate with them.
39.3 In terms of seeing customers on the autistic spectrum, it is more likely that the team will see people with high-functioning autism, as they can have more of an ability to function without support. However within that group people still have different levels of coping and managing. It is essential that staff can adapt themselves to find the best way of communicating with an individual on a one-to-one level.
Mr Bourne said that he tended to be the point of reference for customers with ASC due to his personal knowledge. He has intervened in a handful of cases where he felt it necessary, mainly in terms of communication. Some people interpret rules in a very black and white way and questions needed to be asked in a way that cause the least distress.
39.4 Mr Bourne said that there was a small sub-team – the Housing Benefit and Homeless Prevention Team – whose role it was to try and support people who have fallen through the net in terms of housing and benefits, trying to fill the gaps between Benefits, Housing and Adult Social Care. They link to third sector groups and link in to other services to try and help the person in a holistic way. It worked well because of the shared customer-focussed approach of all of the partners involved, who engage well with the Revenues and Benefits team.
Mr Bourne said that Brighton and Hove had a very high rate of people claiming Housing Benefit in relation to its size so it was worth resourcing the team in order to prevent problems further down the line.
The team has a lot of knowledge and experience of homeless prevention work and has had extensive Mental Health and related training. This model has been highly praised by the Department of Communities and Local Government as a model of homeless prevention. It is highly effective in preventing extra costs escalating in other areas by supporting the person now.
39.5 Mr Bourne answered questions from the panel. He was asked about the impact of the forthcoming national welfare reforms on people with ASC.
Mr Bourne said that any change is difficult for people with ASC. The welfare reforms will change things for a lot of people, both in terms of the level of benefits paid and on how the system was administered. It is vital to make sure that people do not fall through the net purely when the system was altered. He was not sure how many people with ASC claimed benefits, so he could not say how many people would be affected.
39.6 Mr Bourne was asked whether there was any one recommendation that he would like to see. He said that his only comment would be that it might be possible for some people to have been diagnosed with ASC earlier which may have made a difference to their lives.
39.7 Mr Bourne was thanked for his input and the information that he provided. The panel was pleased to hear that the team was doing so well in supporting people with a wide range of different conditions and requirements.
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James Crane, Housing Options Additional documents: Minutes: 40.1 James Crane, Service Improvement Manager for Housing Options including homelessness services, spoke to the panel. Since 2004, Housing Options has aimed to deliver its housing options in a more specialised way; in 2008 it received funding for a Learning Disabilities Housing Options post, whose role includes helping people with housing options including people with ASC.
40.2 Since 2008, the Learning Disabilities Housing Options officer has received twenty referrals for people with ASC; these were divided into 17 males and 3 females, with an age range between 18 and 49. People were referred by the Community Learning Disabilities service; Mental Health services; Millview; Assert and the Supported living Service.
The service would try to engage the person to talk about their housing need; the primary focus is to try and avoid homelessness. There is an integrated support pathway; this has 700 bedspaces for people with a range of vulnerabilities including low level mental health needs or substance misuse. There are also the Mental Health beds funded by SPFT.
40.3 The project worker works closely with Assert and with the Asperger’s stakeholder group. They feel that due to poor self reporting skills, people with ASC are often getting a poor service.
40.4 One of the particular problems in housing is the waiting list for diagnosis, particularly if someone has high-functioning ASC. If someone is able to work and manage their lives it can be hard to see how they whether they might be assessed as ‘in priority need’ if they are homeless.
It would not be reasonable to keep someone in temporary accommodation for twelve months whilst waiting for a formal diagnosis and so they have to use the available information from GPs in order to make their decision about whether someone should be accepted as priority homeless or not. It would be useful if the waiting lists could be reduced in order to help address this problem.
40.5 Thinking about the supported accommodation pathway, there is no one particular project that deals with specifically with people with ASC. The one most likely to be used would be accommodation provided by Carr Gomm, for people with either Learning Disabilities or Mental Health issues.
40.6 Mr Crane said that there was a lot of confusion about the definition of 'priority need' throughout housing. Having a particular condition in itself was not necessarily an indication of someone being in priority need, it depended on how they managed their condition and how this was affected by their accommodation.
40.7 People with ASC tend to be unable to describe how their condition affects their daily life -one customer was quoted as saying 'I don't know what you mean when you ask how this affects my daily life, it is my daily life'. This can make it very hard for Housing Options staff to make a decision about someone's housing need or whether they are eligible for help.
40.8 If someone was on the Joint Housing Register, and they lived in at home or in supported housing, it was likely that they would be given Band C banding due to their medical needs. The Housing Options Officer said that it seemed hard to get a higher banding than this. Most council allocated accommodation tends to go to people in Bands A and B so it was difficult to access housing.
Council accommodation on housing estates was not always suitable for people with ASC, particularly in terms of noise etc and could increase problems. It was often the case that private rented accommodation or specialist accommodation was more appropriate.
40.9 In terms of accessibility, the team had developed visual guides to go alongside council leaflets about housing options, tenancy agreements etc.
40.10 Members asked Mr Crane what type of property tended to be offered by the council as they had heard about problems that tenants with ASC had had in council accommodation. Mr Crane said that they were restricted by what was available although they tried to make suitable matches. The Allocations team was unable to discriminate on the basis of possible future problems that someone may cause if they were not currently causing a problem, but had to be ready to offer support in those situations.
40.11 It was possible to offer floating support services to help someone deal with neighbour problems rather than moving someone to live in supported accommodation.
Floating support services were provided by Southdown Housing and Brighton Housing Trust. Support services worked successfully in keeping someone in their tenancy; problems tended to occur if the support worker changed or if other care services had been withdrawn without the council's knowledge. This could mean that issues could escalate outside of the council's control.
40.12 Mr Crane was asked whether it was possible to increase the levels of people with Asperger’s syndrome being identified as he had referred to them having poor self-reporting skills. He said that officers currently asked clients if they had physical or mental health problems but were less likely to ask if someone had a learning disability. Mr Crane suggested that the team could start asking this and recording the responses.
40.13 Mr Crane was asked how the Medical Advisor carried out the banding. He said that there was an in-house Medical Officer in Homemove who managed a lot of the banding, but the council could also access external experts if needed. The Medical Advisor recommends the banding based on medical need.
40.14 The panel heard that the Homemove eligibility criteria was decided by the council's administration and could be reviewed and amended at any time should the administration choose to do so.
40.15 Mr Crane was thanked for his contribution to the panel. |
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Alex Cooter, Youth Offending Team and Miranda Wharam, Children's Disability Social Work Team Additional documents: Minutes: 41.1 Alex Cooter, Practice Manager at Brighton and Hove's Youth Offending Service (YOS) and Miranda Wharam, Manager, Integrated Child Development and Disability Service, introduced themselves to the panel.
41.2 Ms Cooter explained that the YOS is a multi-disciplinary team, covering a wide range of services in order to provide a holistic response to offending. All new casework includes a comprehensive assessment of the young person including their family, living arrangements, vulnerability etc.
The team works across different tiers. They currently have 48 cases open to them at a preventative level, where the young person might not have a criminal response, but will have some services provided for the whole family by the YOS; there are 128 cases open on court orders, either leading to community orders or custodial sentences.
41.3 It has proved very hard to get data about how many of the young people have ASC. Of the 128 on court orders, at least three have had diagnoses before they came to the attention of YOS. Ms Cooter estimated that, over a year, the YOS would have five or six new cases where the young person had already had a diagnosis.
The three young men that Ms Cooter mentioned previously all have Asperger’s and ADHD. All have significant substance misuse and family difficulties. Two are at risk of homelessness, one is in custody following a violent offence, committed two days after he left school having received a year of intensive support and tuition. Ms Cooter pointed out that the transition stage for this young person began at sixteen, as he left education then.
The young people who come to the attention of the YOS are lucky in that they have access to a wide range of experts who will work with them to address their behaviour and to support them into change. Transition into the adult world is difficult for all of their clients.
41.4 Ms Cooter said that in her experience, most of the young people with ASC do not want to have that label attached to them and do not want to work with specialist services. Fortunately the court orders quite often determine that the young person will work with the YOS and receive those services.
41.5 Ms Cooter said that there were examples of good practice of police and custodial staff responding well to young people with ASC. This had markedly improved over the five years that Ms Cooter had been involved. A young person does carry an Autism Alert card; there was anecdotal evidence that this has led to child-centred, sensitive approaches from the police.
There is much better partnership working and multi-agency approaches although there is still plenty that can be improved.
The YOS had started to notice recently that they had clients in common with the Children's Disability Social Work team, particularly in terms of clients with learning disabilities. This was a relatively new phenomenon.
41.6 Ms Wharam then spoke to the panel. She manages the Integrated Child Development and Disability Service. It is an integrated service, with social care elements, and medical/ educational aspects. CAMHS is based within their service. They have about 190 staff overall in a wide range of specialisms.
41.7 Members asked whether Ms Cooter and Ms Wharam had noticed a gender split in ASC. Ms Cooter said that most of the YOS's clients were young men (about 70%) though she could not say what percentage of these had ASC. Ms Wharam said that at least 80% of the young people with ASC seen by her service were male.
41.8 Ms Wharam said that one of the major issues has been the police's understanding of ASC. Ms Wharam said that they had been unsuccessful so far in trying to liaise with police to raise awareness and had had quite a negative response. It is key for the police to be aware of the issues and how to approach the young person to avoid the situation escalating. The child protection police had a good understanding of ASC and had done a lot of work regarding safeguarding and appropriate adult representation. This was not necessarily the case for uniformed police officers.
41.9 Ms Cooter said that she believed that the police and the YOS had learned a lot from each other over the years that they had spent working more closely together. She suggested that all police officers should spend some time in the YOS as part of their training and post-qualification so that they could come to know young people better, learn ways of dealing with challenging behaviour and realise that they did not have to approach them with fear.
Jane Frost from Assert added that they had tried to arrange ASC awareness for the police. They had provided two sessions and then the police had stopped it. The Chairman said that this would be taken up at a later meeting where the police were due to attend.
Ian Stephenson from Downsview School commented that a lot of young people with ASC also had epilepsy. This was a very complicated situation and police needed to be aware of this.
41.10 Ms Cooter and Ms Wharam were thanked for their information and contributions.
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Adapting Services to Enable People with ASC to Access Them - Mary Evans, Communities and Equalities
To hear from: Additional documents: Minutes:
42.1 Ms Evans introduced herself and her work to the panel. She is the Commissioner with responsibility for involvement and inclusion and for links with the voluntary sector. Ms Evans was attending the panel to talk about making reasonable adjustments and best practice.
42.2 Ms Evans said that the local authority had a responsibility to undertake reasonable adjustments through equalities legislation; this was embedded in the council's policy. There was an overarching principle of effective communication to ensure that the adjustments are the right ones for people with differing needs. As the panel had heard, there can be an issue with self-reporting or identifying as having ASC, which is a potential issue for the council.
The council needed to ensure that it was making reasonable adjustments in terms of customer service. The panel had heard examples of good practice from Graham Bourne how Revenues and Benefits was using different forms of communication, raising front-line staffs' awareness of issues in order to treat people as individuals etc.
Another area was housing; the council needed to look at whether we made enough adjustments in housing management? Ms Evans did not have any answers at present though she did share some housing management guidance with the panel, eg looking at soundproofing/ bedroom numbers.
Training was another area that needed to be considered. Ms Evans was aware that the council's Learning and Development team had had awareness training themselves and were working to cascade this to colleagues in the council. They were also working to ensure that corporate training was accessible to colleagues with ASC.
42.3 Ms Evans was had the most concern about employment, particularly with the welfare reforms as this was likely to become more of a pressing issue. Issues included the job advert, the application process, and the interview process and then providing employee support and appropriate training.
The council had been working on its employment practices over a number of years and had some good practice in some of the areas above, for example in interviews the council aimed to avoid multiple questions, avoiding hypothetical questions etc. This had been influenced by feedback from the Disabled Workers' Forum who had a number of members both now and in the past who had ASC. There was an ongoing issue with the application process and the length of the application form; this was being explored further. Ms Evans said that she would be interested to hear what Jobcentre+'s approach would be in terms of supporting people into employment.
42.4 Ms Evans also wanted to comment on transition; how could they help the commissioning strategy build in some wrap-around support models? This could have a strong role for the voluntary sector, recognising the good work done in supporting adults and their families and include the good practice already built up. Any intelligent commissioning should include statutory and third sector agencies in a joint working approach.
42.5 Ms Evans said that the police were working with the Community Safety Team to deal with disabled hate crime; they were working well to support victims of crime.
42.6 Ms Evans was thanked for her input to the panel.
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