Table 3.

Action plans for adult services: specific service examples

Stage of process	Issue	Services which identified each solution
At all stages	Care pathways	Use a clear pathway for the multi-disciplinary ASD assessment process, detailing the pathway from referral to sharing diagnosis. Develop new/ improve current care pathway. [service 1; 3; 4; 5; 6; 7; 8; 9; 10;11]
		Implement diagnostic pathway to inform assessment process, e.g. appropriate assessments to use in particular situations, minimum no. of required appointments and their purpose. [service 2]
		Improve referral procedures. Make the referral and diagnostic pathway and referral proformas available to referrers. Apply an open referral system. [service 1; 2 ;3 ;4; 8; 10; 11]
		Set time targets for completion of stages of diagnostic assessment process from referral to sharing diagnosis. [service 2; 3; 4; 8]
		Review admin processes/ Ensure adequate administrative support/ delegate admin tasks. [service 3; 4; 5; 6; 7; 10; 11]
		Develop/use report writing template to reduce time taken and improve consistency/ quality of reports and adherence to NICE guidelines. [service 1; 3; 4; 7; 10]
Pre-referral	Inappropriate referrals	Reduce number of inappropriate referrals. Provide information/ training/ leaflets/posters about indicators of ASD to referrers and potential referrers. Find out where to get a list of GPs/ Referrers in locality. [service 2; 3; 5; 6 ;7 ; 8; 10; 11]
		Introduce ASD screening questions for all referrals to the ID team. Screen existing clients in ID service to identify whether ASD assessment is indicated [service 3; 4; 5; 10]
	Limited information pre-referral	Improve quality of information received from referrers. (For example: ensure submission of screening tools with referrals/ Provide AQ-10 forms for all referrers; Send EDQ and AQ with first appointment letter). [service 1; 2; 3; 6; 7; 8]
		Provide basic ‘ASD awareness’ training to referrers. Broaden training team across the MDT to share the load [service 1; 2; 10; 11]
		Develop/ Use proformas for individual, family/ carers or referrers to complete and submit with referral form. [service 2;11]
		Request medical notes or other historical notes on acceptance of referrals. [service 1; 2]
Referral to 1st appointment	Non-attendance	Have a system to pre-empt non-attendances (e.g. opt in letters, phone calls, text messages etc.). Review non-attendance. [service 1; 3; 5; 6; 7; 10]
		Provide service in local area where possible, e.g. initial home visit. [service 1; 3; 4]
		Where appropriate enlist carer or support worker to facilitate attendance and/ or to come with the client to the appointment (e.g. where individual has an intellectual disability). [service 5]
	Reducing wait for 1st appointment	Have identified ASD diagnosis appointments to slot referrals into. [service 1; 4; 5; 6] Make appointments immediately on receipt of referral. [4; 7]
		Use information provided pre-referral to inform diagnostic process. Use screening tools (if not completed by referrer). [service 1;2; 3; 4; 5; 6; 7; 8; 9; 10;11]
	Constructive use of time	Use proformas (for observation, contextual assessment, and clinical history) during assessment and ensure these are available to all staff. [service 2; 5; 6; 7; 9; 11]
		Request that individual, family, referrers or others, as appropriate complete pro-forma requesting relevant developmental and contextual information, prior to 1st appointment. [service 2; 3; 4]
		Develop and implement an abbreviated pathway for those who clearly meet criteria for diagnosis/ less complex cases. [service 4]
First appointment to diagnosis shared	Promote effective multi-disciplinary working	Improve information sharing processes to improve MDT working. [service 3; 5; 6; 8; 9] Have dedicated, protected time for regular scheduled multi-disciplinary review meetings/ case discussions (increased frequency, shorter duration). [service 1; 4]
		Have a multi-disciplinary assessment. Work in conjunction with other diagnostic practitioner(s), with protected and scheduled slots to carry out assessments together. [service 1; 2; 9]
		Complete the diagnostic process in one day (if appropriate). [service 2]
Post diagnosis	Information	Review post diagnostic information provided. Develop/ start using packs for individuals/ carers. Engage with 3rd sector providers of post diagnostic services. [service 2; 3; 5; 6; 8; 9; 10; 11]
Quality	Training	Seek ADI-R training. [service 1; 4 ;7] Seek ADOS training. [service 1; 4; 5; 6; 7; 8]
		Provide autism awareness training in all local teams [service 2]
		Use British Psychological Society ASD Modules to improve knowledge in MDT [service 2]
		Use hints, tips and use resources shared at AAA contact days, Share AAA information with wider team [service 5; 6; 9]
	Local audit	Find out who provides ASD diagnosis in this locality [service 2]
		Find out whether the health board is interested in developing a diagnostic service for adults without ID [service 4]