Autism Self Evaluation - Metropolitan Borough of St...

Improving Health and Lives:Learning Disabilities Observatory

Autism Self Evaluation

Local authority area

1. How many Clinical Commissioning Groups do you need to work with to implement the AdultAutism Strategy in your local authority area?

1

Comment

St. Helens has one CCG group and we work with them implementing the St. Helens Autism Strategy

2. Are you working with other local authorities to implement part or all of the priorities of the strategy?YesNo

cunniffeb

APPENDIX 2

www.ihal.org.uk/projects/datacollection/autism 2

If yes, how are you doing this?

St. Helens Local Authority representatives continue to attend the National Autistic Societys' North West Autism Service DevelopmentGroup Events which provide the opportunity for all ASDG's to receive update information, share good practice and network with otherLocal Authorities and Partners.

Leads from other Authorities and partners have been requested to attend future Autism Service Development Group (ASDG)meetings to share good practice.

Extract from the last St. Helens Autism Service Development Group meeting held 24September 2013 3-5pm Room 5 St. Helens Town Hall

PresentCW Assistant Director ASC&HJ G Service User RepresentativeERDS HealthwatchAM CYPSKD School Age Team Manager CYPSCC Training & Development OfficerJP Principal Educational Psychologist CYPSBL Commissioner ASC&HKD Parent Partnership Co-Ordinator CYPSAB 5 Boroughs Partnership Foundation TrustLB ASD Pathway Co-ordinator CYPSMB Associate Specialist Alder Hey HospSS Commissioner Knowsley CouncilApologiesDW Coalition of Disabled PeopleRH St. Helens CCGDOK Autism UnionLM CYPSMP Safeguarding/CWDOS CCG Lead ED Consultant Child and Adolescent Psychiatrist CAMHSK P Parent/Carer Rep

3. Action PlanGood Practice Examples from KnowsleySS from Knowsley had been invited to share aspects of good practice with the group.Explained that services are provided with small budget via 'stand alone' services:-*Autism Awareness - have provided local stakeholder Events from 2010 - on National Autism Awareness Day each year - in adifferent venue each year/ providing a information market *Universal services with sub-contracts to specific providers as required*Training - 3 prong approach - Free training - Paid trainer - Autism full day sessions- Experts by Experience - United Response Social Enterprise- Press releases- Autism Parent/Carers groups (Adults) *Updated on Pathway for Diagnosis 2012 (Adults) - 5 Borough Partnership Foundation Trust 60% and Merseycare the remainder. Diagnostic pathway now has new CCG lead. Children Diagnostic pathway started at 16yrs of age now CCG have changes to 18 yrs.*Housing - as St. Helens*Employment - stand alone project for 2 people paid work (Aspergers- Autism without Learning Disabilities*Knowsley Inclusion Training & Employment (KITE) - supported employment services from various groups/agencies ie CIC*Alert Cards/CJS/Ambulance - not done as yetCW - Acknowledged good to listen to similar in place/issues/difficulties etc

Planning

http://www.improvinghealthandlives.org.uk/projects/autism/AutismSAF2013#Anchor1


3. Do you have a named joint commissioner/senior manager of responsible for services for adultswith autism?

YesNo

If yes, what are their responsibilities and who do they report to? Please provide their name and contact details.

In St. Helens the Lead for commissioning services for adults with autism ensures that the Local Authority are committed to the St.Helens Autism Strategy and Action Plan, which is grounded in the recommendations of the National Strategy and focuses on localneed.The St. Helens Autism Service Development Group (ASDG) brings together representatives for:-*People with autism*Parents*Carers*Children & Young People*Adult Social Care & Health*HealthThis serves in the assessment, planning, implementation and evaluating of the required support and services for people with Autismin St Helens, regardless of their age to provide the same opportunities as anyone else to live fulfilling and rewarding lives.Progress on actions taken to ensure the aims of St. Helens Autism Strategy is met and is reported back to the St. Helens ValuingPeople Partnership Board, The aim of the St. Helens Autism Strategy is to: - Provide a vision for how Adult Social Care and Health services and Partners should work together to promote and secure betterservices for adults with autism across St. Helens.- Ensure individuals with Autism have access to the diagnostic pathway and access support as required, and they can depend onmainstream public services to treat them fairly as individuals, helping them to make the most of their abilities.- Effective intervention of Adult Autism Services will transform lives and create positive outcomes for individuals with autism and theirfamily/carers.

Contact detailsMike Wyatt - Director Adult Social Care & [email protected] 676309

JG comment - Re 3. ...Just a few lines and update name & contact details ASC&H Reply completed as requested.

4. Is Autism included in the local JSNA?RedAmberGreen


Comment

St. Helens JSNA 2013 includes Autism Spectrum Disorder as below:Work carried out by the National Autistic Society (2013) indicates that 1% of children and young people less than 18 years of agehave an autism spectrum disorder (N.B. 40%- 67% will have a learning disability as well). On the current estimate of 385 St. Helensresidents having an autism spectrum disorder will grow to 399 in 2021.

The rates of autism in males and females are vastly different and the 1% population estimate disguises the detail of who is likely tohave an autism spectrum disorder. The population rate amongst males is calculated to be 1.8%, whilst amongst females it is 0.2%(average 1%).

Not only do the rates vary with gender but so does diagnosis - 20% of females are diagnosed correctly with autism spectrumdisorders by the age of 11 compared to 50% of males. The table below shows estimates for adults in St. Helens:

Figure 49: The estimated numbers of 18 to 64-year-olds with an autism spectrum disorder in St. Helens.GenderNumber with an autism spectrum disorderMale 956Female 107Total1063Source: PANSI

JG Comment - Barely amber as we only have some estimates and the statistics for a few young people going through transition ASC&H Reply completed as requested as Autism is included and will be updated each year.

5. Have you started to collect data on people with a diagnosis of autism?RedAmberGreen

Comment

We have rated this as amber but progressing towards green

At present information regarding Autism is captured directly from the Learning Disability Team, however the St. Helens Autism ActionPlan 2013 identifies how this will be captured in the future:-

* To agree a Performance Management Framework for autism in St Helens with clear baselines to support benchmarking. Thereforeperformance can be monitored - including outcomes for individuals are reported and evidence is available.* Identify how many people with Autism live in St Helens, therefore a better understanding of the needs of the local population toinform service demand and delivery.

Integrated Adults System (IAS) collects comprehensive information on all of our service users and haa been recommissioned - itcollects under the Primary Category of Learning Disabilities and Subcategories of: *mild*moderate*severe*profound.

Autism Specific data will allow local specifications and requirements to be collected to reflect the working practices of St. Helens LocalAuthority for individuals with Autism for whom a service is provided. St. Helens continues to provide at moderate criteria.

JG Comment - Similarly, we really have no numbers nor the means to start collecting them until April next year.ASC&H Reply completed as amber because it is recognised that systems to collect this information will be in place April 2014 - but inthe meanwhile we can gather the information via other sources if required.

6. Do you collect data on the number of people with a diagnosis of autism meeting eligibility criteriafor social care (irrespective of whether they receive any)?

YesNo


If yes, what is

the total number of people?

the number who are also identified as having a learning disability?

the number who are identified as also having mental health problems?

Comment

Plans are in place to capture this information separately on the Integrated Adults System (IAS) as below.

Reported Health Conditions - Although the NHS Information Centre is requesting that as a minimum, only the classification sub-classes for Autism and Asperger's Syndrome is recorded for 2014/2015, the IAS will enable recording for the full set of healthconditions proposed by the NHS Information Centre.

ClassificationReported Health Condition (sub-class)

Long Term Health Chronic Obstructive Pulmonary DiseaseCondition - PhysicalCancer Acquired Physical Injury HIV / AIDS OtherLong Term Health StrokeCondition - NeurologicalParkinson's Motor Neurone Disease Acquired Brain Injury OtherSensory Impairment Visually Impaired Hearing Impaired OtherLearning, Developmental Learning Disabilityor Intellectual DisabilityAutism (excluding Asperger's Syndrome / High Functioning Autism) Asperger's Syndrome / High Functioning Autism OtherMental Health ConditionDementia Other

7. Does your commissioning plan reflect local data and needs of people with autism?YesNo


If yes, how is this demonstrated?

The information from the St. Helens JSNA 2013 includes current estimates of St. Helens residents having an autism spectrumdisorder, and projects that this is likely to increase by 2021.It identifies the population rates of autism in males and females to be vastly different, and highlights a higher percentage of malesbeing diagnosed at a younger age than females.

The Transition service (ASCH) identified that 51 young people with a diagnosis of Autism or Aspergers are going through transition asat June 2013 this number has increased in the last year (24 as of Jan 2012).

No of PeopleDiagnosis26 Autism only (including ASD) 9 Aspergers16 More than one diagnosis, including Autism (eg Autism and Epilepsy/ADHD)51 Total

It identifies that there is a higher number of 16 and 17 year olds in general this year coming from Childrens and Young PersonsService.

Over the last few years the average number of young people annually coming through transition has been 10, this year there are 2617-18 year olds and 16 18-19 year olds.

St. Helens Local Authority and St. Helens CCG have been working proactively developing closer relationships and have recentlyannounced the development of an integrated commissioning team. As a result of this partnership working there is now improveddiagnostic pathways which may contribute to the increase of young people with autism coming through transition.

It is proposed that future data collection will recognise the needs of individuals over 65 year olds with autism and therefore reflect inthe future Commissioning Plan.

Such information informs and shapes the Commissioning Plan for the preparation and delivery of appropriate support and services inthe future for adults with a Autism Spectrum Disorder known or unknown to services

St. Helens Adult Social Care Market Position Statement is in the latter stages of being completed and will identify common needs forparticular groups to enable providers to see gaps and provide services to meet the needs of people living in St. Helens.

JG Comment - I really doubt 'yes' is correct. While we clearly have plans to have plans, currently we lack the local data and needs areunknown.ASC&H Reply - Identify how this is happening within this section

8. What data collection sources do you use?RedRed/AmberAmberAmber/GreenGreen


Comment

1. Adult Diagnostic Pathway: inform how many individuals have a diagnosis and at what level on the Autism Spectrum

2. Social Care Teams* Children & Young People Service (CYPS): ensuring seamless service to ASC&H * Transitional Team (ASC&H): to liase between individual /CYPS/ASCH/Parents/carers etc - commissioners re futureservices required* Adult Social Care & Health (ASC&H) Learning Disability Team3. Health Needs Assessment (HNA)4. Clinical Commissioning Group (CCG) 5. Joint Strategic Needs Assessment (JSNA)6. Integrated Adults System (IAS): information sharing and recording tool used by adult social care and other agencies7. Intelligence & Outcome Unit (IOU): monitoring information on services provided8. Autism Service Development Group (ASDG) - Partners/Parent/Carers - inform commissioning9. Other ie National Autistic Society/Local Groups/Consultations etc

JG Comment - Whatever sparse data there is, I hope someone collects it. Note it's only legitimate to list primary sources 1 and 2which the others will also be using.ASC&H Reply - Examples of sources are correct

9. Is your local Clinical Commissioning Group or Clinical Commissioning Groups (including theSupport Service) engaged in the planning and implementation of the strategy in your local area?

RedAmberGreen


Comment

St. Helens is now moving to an integrated commissioning service. An integrated approach is already implemented in:

* St. Helens Autism Service Development Group and therefore included in the planning of services for Autism and recognised as leadon specific 'actions' to be delivered within the St. Helens ASDG Strategy Action Plan.

* The generation of the learning disability and autism health needs assessment

* Streamlining access to autism diagnoses in the local Mental Health Team for adults. This was achieved by introducing a blockcontract to provide diagnoses replacing the previous system where each diagnoses had to be requested individually. This hasspeeded up the process for service users and supported the establishment of a specialist diagnostic service through committedresource.

* The CCG commissioner is a member of the childrens autism diagnostic pathway group.

* The CCG representative is also an active member of the Valuing People Partnership Board.

St. Helens Autism Strategy Action Plan - CCG Representative Actions:-Improve general understanding of autism amongst the local population by:* Using opportunities to raise awareness of Autism and its impact on individuals, their families and carers at a range of events. E.g.Big Health Day, Listen and Change, Healthwatch, coffee mornings etc.Outcome - more understanding of Autism amongst the general public. Improved services/ response to individuals with Autism.

Be Healthy: * Big Health Day - to inform health plans - (ASC&H was be involved in this event) * Implement Health Passport for all service users * Health checks to be completed for all people with autism.Outcome - to increase the number of people who have received a health check and used a Health Passport

Ensure autism included in JSNA:* April - March 2013/14Outcome - Autism has a new section in the refreshed JSNA for 2013/14, this information and that from the Health Needs Assessmentwill be used by the Council and the CCG together to consider how to improve services for those with autism

Complete self assessment as appropriate to health - use information to inform commissioning.* July - September 2013Outcome - Improved understanding of gaps in services and understanding of what works well

10. How have you and your partners engaged people with autism and their carers in planning?RedAmberGreen


Please give an example to demonstrate your score.

Autism Service Development Group (ASDG)Representatives of people with Autism and their carers attend the St. Helens ASDG and liase with their respective groups to cascadeinformation/challenge areas of development etc.They have contributed to the St. Helens Autism Strategy and Action Plan and the implementation of this plan where appropriate,representatives are also members of the Valuing People Partnership Board were such information is reported.

St. Helens Autism Strategy Action Plan - People with Autism and Carers Actions: Leisure* Adjustments have now been made in the local Cinema and Leisure facilities to enable people to access these venues. * Views Forum - Coalition of Disabled People - St. Helens Young Peoples GroupOutcome - Produce an 'autism friendly' checklist

Leadership and governance * ASDG formally report into Valuing People Partnership Board* Carer Representative identified to report Outcome - Clear reporting process in place.

Promote the use of Safe in Town venues and use of alert card (see below)* Community Safety & Views ForumOutcome - More venues engaged in the project. St Helens is felt to be a Safe place for individuals to access. Safer in TownEnsuring St. Helens is a safe place to access local amenities/transport is important to everyone but individuals with a learningdisability wanted to be included in such projects to ensure their voice was heard.The Views Forum and Younger People's Talk Back Group (Coalition of Disabled People) and People Choice (Self Advocacy) havebeen involved in extensive consultations around Safety in St. Helens providing the Local Authorities Safer Communities BusinessManager with the evidence of their results; this includes safe places at night time.

Younger members accessing social and leisure opportunities on an evening have been made aware of 'safe venues' in the towncentre should there be a problem.The Views Forum offer a 'Induction Workshop' to all new members of the Safer in Town scheme. The mentors and self advocates willprovide information on how the scheme works and provide a walk around providing information on the location of 'safe venues'.

11. Have reasonable adjustments been made to everyday services to improve access and supportfor people with autism?

RedAmberGreen


Please give an example.

St. Helens CineworldCineworld Cinemas are willing to provide Autism friendly screenings of films with 12, 15 and 18 certifications for adults with autism. However, currently they provide autism friendly screenings for films aimed at children and families, so the St. Helens Autism andAspergers Union are requesting that this provision be extended to adults as advertised.

St.Helens College Learner Support

What support is available?* Assessment of Individual Needs* One to one skill development tutorials* In - class support* Access to Specialist Equipment* Adaptation of materials e.g. Braille, large print, electronic format * Communication support for BSL /SSE users* Teacher of the Deaf* Assistance with Personal care / Health Needs* Mobility assistance* DSA support (HE)

How is this support accessed?* By contacting the Learner Support Manager prior to enrolment at College* Completing the LA1d form at enrolment* Asking your Tutor to complete the Learner Support referral form on the College intranetDeafCan offer a variety of support for all learners who are Deaf, deafened or Hard of hearing.Communication Support in BSL/SSEA learner, who uses BSL as their first language, has the option of in class support from a Communication Support Worker (CSW); andlanguage modification.Note TakerA note taker can be provided for lectures or in any situation where a learner may need to take notes. These can be word processed ifrequired.One to One TutorialsThis session can be arranged with the Teacher of the Deaf to clarify notes, or assignment tasks that need to be completed.Specialist Equipment There are various types of equipment available for use within the classroom i.e. loop systems (fixed and portable), pager system.Visual ImpairmentLearners with a Visual Impairment can access specialist support to enable them to access information when on Programme.One to one Support in classA Learner Support Officer (LSO) will assist with note taking and reader support. Use of specialist equipment and ensuring materialsare accessible.Mobility/OrientationSighted Guide support is available to ensure safe access around College.Specialist EquipmentThere is a variety of equipment available to learners on Programme. Magnification / Screen Reader Software - Super Nova, ZoomText, Jaws Large Keys keyboards, CCTV readers, Pocket magnifiers, Screen filters etc.Adaptation of MaterialsLecture notes and handouts can be adapted into large print, Braille, or electronic format. Learners can access the Sensory Supportand Assessment room to use the specialist equipment to complete assignments etcExam ConsiderationsLearners with a visual impairment are entitled to receive special exam arrangements. This can be a Reader and/or Scribe support, upto 100% extra time, use of specialist equipment and a modified exam paper (large print, Braille).Disabled Student Allowance (HE Learners)What is DSA?The Disabled Student's Allowance is a grant to help meet the extra course costs a student may incur, as a direct result of a disability,health condition or specific learning difficulty.What can the DSA be used for?* Specialist equipment you will need for your course i.e. laptop, computer software.* Non medical helper i.e. note taker or reader* Extra travel costs because of disability* Other costs i.e. books and materialsThe amount you receive is based on an assessment of your individual needs.The College can provide: * Assessment of support needs


* Help applying for the DSA* Updating assessment reports* Providing a structured programme of support* Help with organising / planning your time and assignments* Help with revision* Liaising with your tutors i.e. ensuring they are aware of your needs, arranging exam considerations if applicableIn class support available: Additional tutorial support sessions can be accessed with the Specialist Tutor relating to course content and assignments. TheSpecialist Tutor will assist with any issues you may have while on the course.

St. Helens Day OpportunitiesThis service supports adults with learning, physical and sensory disabilities to maximise their potential for independent living. Many ofthe people using this service spend much, if not all, their time in community venues participating in a range of social, leisure, voluntaryor work related activities.Activities can take place in the wider community such as leisure centres (swimming, tai chi), cafes etc. Within the Day Centre thereare developmental activities which pursue learning and the achievement of new skills and abilities, such as:*Craft and painting *Gardening *Flower arranging *Music groups *Sensory room *Beauty care Service users may have complex physical and/or sensory disabilities and display challenging behaviours. Responding to those withcomplex needs is a central aspect of the service, as many people using the service require dedicated 1:1 staff support.

Changing Places Changing places are an important necessity for some individuals and can mean they can access local amenities and opportunities. St. Helens has developed these facilities around various leisure/activity amenities and will continue to consider further ChangingPlaces as required ensuring individuals have the opportunity to included within the community.

The Health and Wellbeing Strategy was subject to an Equality Impact Assessment - this ensured that the Health and WellbeingStrategy included the following statement"All members of the Health and Wellbeing Board will give due regard to the general duty of the Equality Act 2010 in all decisions andcommissioning which arises from the implementation of this strategy. This must include relevant equality analysis being used toinform decisions, and reasonable mitigation where an adverse impact is identified for a protected group."People with Learning Disabilities are a priority group within the Health and Wellbeing Strategy.

St.Helens Council has a Corporate Equality Impact Assessment Tool. The Equality Impact Assessment tool requires an analysis ofthe impact of policies, processes and decisions on all the protected characteristics of the Equality Act 2010 - this includes all disabledpeople, and people with learning disabilities are specifically incorporated within this. Although carers are not a protected characteristicunder the Equality Act 2010, they are a priority group for the Council Equality Policy and also included within the Equality ImpactAssessment tool.

The Impact Assessment Tool will look to ensure that Human Rights and equality duties are considered in all Council decisions. It isnot only decisions about commissioning services for people with learning disabilities, but ensuring that people with learning disabilities(and their carers) are not disadvantaged by any council decision and have equality of opportunity to access and enjoy all CouncilServices. This includes the workplace, work placements and employment opportunities.

The Council's Equality Officer sits on the JSNA and Health and Wellbeing Strategy Development Group and the Valuing PeoplePartnership Board. The Council's Equality Officer supports departments in the completion of Equality Impact Assessments. Thisprovides a challenge for managers.

Equality Impact Assessment Tool is integrated within: (i) the Council's Decision Making Framework, which includes Delegated Decisions, Cabinet Decisions and Full Council Decisions.(ii) the Council's contract database, which includes all contract commissioned by Adult Social Care and Health Department, Children'sSocial Care Division, the Public Health Department and the Housing Division.

All strategies must be accompanied by and Equality Impact Assessment to be placed on the delegated decision Database or on theAgenda for Cabinet or Full Council.

The Equality Impact Assessment records how the needs of learning disabled people (and the other protected characteristics) weretaken into account within the decision.

Therefore all Local Authority Policies and decisions in relation to the provision of support, care and housing for Learning DisabledPeople are ratified through a Delegated Decision, Cabinet Decision or Full Council Decision and will be informed by an EqualityImpact Assessment.


JG Comment - I'd only give the two examples of Cineworld and the college. No point in listing the general legal duty of Equality.ASC&H Reply - This answer was provided by the St. Helens Equality Officer and we feel it is important to so show how equalityimpacts on the positive development of services

12. Do you have a Transition process in place from Children's social services to Adult socialservices?

YesNo

If yes, please give brief details of whether this is automatic or requires a parental request, the mechanism andany restrictions on who it applies to.

As a result of a collaborative piece of work between Adult Social Care and Children & Young People Services St. Helens has aTransitional Protocol with a clear pathway.Implementation of the Transitions Policy is being led by a dedicated manager. The implementation will ensure all relevant partnersand agencies are included and informed. Information leaflets will also be developed for young people and their carers to ensure theyhave a clear understanding of what they can expect during the transitions process.

13. Does your planning consider the particular needs of older people with Autism?RedAmberGreen

Comment

Specialist LD Teams already retain individuals in the service who are over 65yrs. Anyone new coming into the service would havetheir needs thoroughly assessed and reviewed ensuring all needs are met.

Training

14. Have you got a multi-agency autism training plan?YesNo

15. Is autism awareness training being/been made available to all staff working in health and socialcare?

RedAmberGreen



Comment: Specify whether Self-Advocates with autism are included in the design of training and/or whether theyhave a role as trainers. If the latter specify whether face-to-face or on video/other recorded media.

Autism Awareness Training is available for all staff who work with people with autism through the Learning Disability Training Alliance,we have a range of positive developments in place for people working in Adult Social Care & Health.

Self advocates will now be involved in the delivery of autism awareness training and as part of the Autism Service DevelopmentGroup will be involved in the design of future training.

The duty in the Statutory Guidance means that adults with autism, their families and carers can expect that all staff working in socialcare and health have access to autism training and that key members of staff (such as GPs, Care Managers and Commissioners)receive specialist autism training. Adults with autism and parents/carers should be involved in planning and commissioning of thetraining.

In partnership with the ASCH Care Management Team the Council Training team has been working with Partners to complete actionsrequired to produce the following;

*Training and development opportunities now reviewed and St. Helens Multi Agency Training Plan now in place*Considered how autism awareness could be included in induction training for Council staff and partner organisations*Ensure that these requirements are fed into the workforce development plan *St. Helens Autism Strategy incorporates Autism Awareness Training to local collegues eg to 5 Borough Partnership NHSFoundation Trust employees within St Helens.

The St. Helens Autism Strategy Action Plan states that all staff working in Social Care, education and health should have access tofoundation training that supports their understanding of recognition of autism therefore improving awareness. Strategic Workforce Priority 4: Workforce Development, of the St. Helens Adult Social Care Integrated Local Area Workforce Strategy2013-2016 contains an action to ensure that training and development programmes address legislative and policy requirements andare responsive to local needs such as the Autism Strategy.The refreshed St. Helens Multi Agency Training Plan ensures that Specialist Enhanced Training is provided for key staff working withchildren, adults and their carers with autism. The outcomes will be that the training provided is accredited and bespoke to the needsof the group and therefore improve skills for staff, better diagnosis, assessment and service delivery for individuals with autism.

The 5 Borough Partnership NHS Foundation Trust delivers a 2 day training on Autism Awareness via the Learning Disability JointTraining Partnership, one of the collective training partnerships in the North West.This has been available to the Learning Disability Teams. Across the wider Trust, there are currently no routinely identifiable trainingresources or established courses disseminated and easily accessible within the existing training schedules/intranet, either at the levelof basic Autism Spectrum Condition awareness or more specialist levels of intervention. Across the Trust there are a number of practitioners who have accessed higher level training in regard to therapeutic interventionsand diagnostic assessments for Autism Spectrum Condition's JG Comment - A lot of aspirations. How many people have actually used the training? Can we collect numbers?ASC&H Reply - This is a developing area and as answer we are including more people within ASC&H as well as other serviceproviders to ensure a positive approach to Autism Awareness.

ERDS Comment - Red - sorry but I would suggest we are here. People may have been trained but they are few and far between.Raising awareness is the biggest issue locally I would suggest and needs to be a high priority.ASC&H Reply - This is a High Priority and we now have a St. Helens Multi- Disaplinary Autism Training & Development Programmefor 2013-16

16. Is specific training being/been provided to staff that carry out statutory assessments on how tomake adjustments in their approach and communication?

RedAmberGreen


Comments

Members of the Learning Disability Team have already commenced training on Sensory Considerations and provided positivefeedback.

This training will commence again from Nov 2013 for the following teams:* Learning Disability Team* Supported Living Service

The following programmes* Intermediate autism knowledge and skills* Autism skills for specialist workersWill be delivered to key staff working with children and/or adults with autism and their carersQualificationsThe following units are part of the the Level 2 and 3 Diplomas in Health and Social Care (HSC)* LD_210_Autistic_Spectrum_Conditions * LD_310_Autistic_Spectrum_Conditions

17. Have Clinical Commissioning Group(s) been involved in the development of workforce planningand are general practitioners and primary care practitioners engaged included in the training agenda?

YesNo

Please comment further on any developments and challenges.

A Learning Disability Training Alliance (LDTA) two-day training course provides the intermediate skills and knowledge required bypractitioners and carers who have frequent or intensive contact with people with autism or those who spend little time but have highimpact on outcomes for people with autism such as a proportion of staff in all teams and services.

Health professionals who have attended the autism training for:-* 2012/13 = 2 staff (Haydock Medical Centre)* 2013/14 = 1 health professional (Garswood Clinic).

It has been considered that the reason that training was not being attended by more health professionals is that it incurred a cost,however, this year (2013/14) the training is being provided free of charge therefore providing an opportunity to get more HealthProfessionals trained up.

JG Comment - So far as I know 'no'. Are there any developments and challenges?ASC&H - Yes as the answer states

18. Have local Criminal Justice services engaged in the training agenda?YesNo

Please comment further on any developments and challenges.

The Criminal Justice Liaison Team (5 Boroughs Partnership NHS Foundation Trust) are part of the Learning Disability Liaison andDiversion Project.This is a process whereby people of all ages passing through the criminal justice system are assessed and those with mental health,learning disability, autism, substance misuse and other vulnerabilities are identified as soon as possible in the offender pathway.The Criminal Justice Liaison Team are developing and delivering Learning Disability awareness training for police, probation, HMP,Courts etc - St. Helens Local Authority has now arranged to be part of this process to ensure Autism Awareness Training is on theagenda to be provided to the local Criminal Justice Services.

JG Comment - 'no'. from what I hear, they are not interested. Have we though of combining with other Merseyside ASDGs andapproaching the Police Commissioner? Have we got anywhere with 'Alert Cards'?ASC&H Reply - as answer - Alert Cards was on the last Agenda for the ASDG but the person delivering the presentation could notattend - however will be at the next meeting to develop this further.

Diagnosis led by the local NHS Commissioner



19. Have you got an established local diagnostic pathway?RedAmberGreen

Please provide further comment.

Established Diagnostic Pathways are available for both Children and Adults in St. Helens.

The Adult Diagnostic PathwayThis work has been led by the 5 Boroughs Partnership NHS Foundation Trust.

JG Comment - Yes. I thought the 5BP pathway was nearly up and running?ASC&H Reply - It is.

20. If you have got an established local diagnostic pathway, when was the pathway put in place?

Month (Numerical, e.g. January 01)

7

Year (Four figures, e.g. 2013)

2012

Comment

The Established Childrens and Adults Local Diagnostic Pathway has been operational since 2012

21. How long is the average wait for referral to diagnostic services?Please report the total number of weeks

7

Comment

For the financial year 2012-2013, the average waiting time for St Helens is 7.6 weeks (53.7 days).

22. How many people have completed the pathway in the last year?

8

Comment

JG Comment - a large increase in referrals this year.ASC&H Reply - Yes possibly due to the developed pathway

23. Has the local Clinical Commissioning Group(s)/support services taken the lead in developing the pathway?

YesNo

Comment

The diagnostic pathway was developed in partnership with a multi-agency group and finalised by the 5 Borough Partnership NHSFoundation Trust and is operationally managed with clinical support by appropriate individuals and commissioned by the CCG.There is on-going work with relevant members of the local Autism Service Development Group to further develop this pathwayalongside the children's diagnostic pathway, to ensure issues of transition are addressed appropriately.


24. How would you describe the local diagnostic pathway, ie Integrated with mainstream statutoryservices with a specialist awareness of autism for diagnosis or a specialist autism specific service?

a. Integrated with mainstream statutory services with a specialist awareness of autism for diagnosisb. Specialist autism specific service

Please comment further

The local diagnostic pathway is a bespoke and newly developed specialist Autism specific (diagnostic) service.The pathway has an open access referral process with a comprehensive range of assessments available. There is specific multi-disciplinary support available within the provider assessment team from within the 5 Borough Partnership NHS Foundation Trust,comprised of Speech and Language Therapists, Psychologists and Community Nurses. Informing the service user at each stage of the process is an important part of the pathway process and assessments only proceed tothe formal diagnostic stage (using the ADI-R, ADOS, or DISCO as core diagnostic tools as and where appropriate to the clinicalpresentation) with the informed consent of the service user (or potentially as an outcome form a Best Interest Meeting under theMental Capacity Act 2009). This pathway provides the opportunity for a comprehensive assessment beyond the completion of a formalised diagnostic interview. Where indicated this pathway provides as standard an assessment of intellectual functioning, screening for a number of mood relatedissues (depression, stress, and anxiety), and communication assessment. The intention of this pathway is to providerecommendations beyond provision of a diagnosis, with guidelines to support the service user in all areas of contact with servicespost-diagnosis.

25. In your local diagnostic path does a diagnosis of autism automatically trigger an offer of aCommunity Care Assessment?

YesNo

Please comment, i.e. if not who receives notification from diagnosticians when someone has received adiagnosis?

A referral is made formerly on behalf of the clients with this diagnosis, their consent pending.

26. What post-diagnostic support (in a wider personalisation perspective, not just assuming statutoryservices), is available to people diagnosed?

Current provider has included the following:* Supported access for mental health support and made recommendations for reasonable adjustments to therapeutic delivery. * We have supported referrals to secondary mental health services and given recommendation on therapies and approaches to bestsupport that person.* We have offered everyone a referral for an assessment of needs by social services and supported these referrals to make sureclients and families are receiving the right support.* We have provided recommendations to employers to help support their staff members as well as supporting occupational healthassessments where appropriate.* We have helped with benefit support in terms of providing clients with the correct advocacy services to support them in meetingsand form filling.* We also provide information on local support available for individuals' and families.

Care and support



27. Of those adults who were assessed as being eligible for adult social care services and are inreceipt of a personal care budget, how many people have a diagnosis of Autism both with a co-occurring learning disability and without?

a. Number of adults assessed as being eligible for adult social care services and in receipt of apersonal budget

17

b. Number of those reported in 27a. who have a diagnosis of Autism but not learning disability

10

c. Number of those reported in 27a. who have both a diagnosis of Autism AND Learning Disability

7

Comment

28. Do you have a single identifiable contact point where people with autism whether or not in receiptof statutory services can get information signposting autism-friendly entry points for a wide range oflocal services?

YesNo

If yes, please give details

Contact CentreFor individuals who have an enquiry about services available the Contact Centre is available to any member of the public as asignposting service.May be contacted by email/telephone (8:00am to 8:00pm weekdays, 10am to 2pm Saturdays) and reception is open Monday toFriday 9:00am till 5:00pm.

Online Directory"A signposting service for people looking for adult care and support services in St.Helens" The St Helens Service Directory can also be accessed to identify Autism services via the following link then type Autism in the searchbox. http://www.sthelens.gov.uk/servicedirectory

29. Do you have a recognised pathway for people with autism but without a learning disability toaccess a community care assessment and other support?

YesNo


If yes, please give details

As Section 47 of the NHS & Community Care ActThe local authority has a duty of care to provide an assessment when it appears that someone may be in need of community careservices that they can provide.

This assessment may be gained by approaching St.Helens local authority directly, through the GP or another health professional.

As from 1st April 2013 St. Helens Council agreed a contract for provider of Information, Advice and Advocacy locally to SHAIR (StHelens Advocacy and Information Resource).

SHAIR is a collaborative organisation made up of two local prominent partners in the Voluntary Sector; Age UK Mid Mersey and StHelens Coalition of Disabled people.

The service will be available to Adults aged 18 + who are ordinarily resident and/ or living in the borough of St Helens who requireinformation, advice and/or advocacy Typically this may include:*Older People (including those living in care homes). *Adults with physical or sensory impairments, including people living with long-term conditions. *Adults with a learning disability *Adults with a mental Health Problem who do not qualify for statutory advocacy (IMHA and IMCA). *Adults who are St Helens residents and have been placed outside the Borough, and who do not qualify for statutory advocacyservices. *Individuals in the transition period between Children's and Adults services.

St. Helens Local Authority will assess an individual and advise of the type of appropriate support required by Social Care.

30. Do you have a programme in place to ensure that all advocates working with people with autismhave training in their specific requirements?

RedAmberGreen

Comment

St Helens Council now have an independent and integrated Information, Advice and Advocacy (IAA) Service - St. Helens Advocacy &Information Resource (SHAIR). The aim of this service is to ensure the provision of high quality, responsive and effective Information, Advisory and Advocacyservices that meet the needs of the population of St. Helens.The Provider has a Training Policy and a Training Programme, which demonstrates a commitment to support training opportunitiesand maintenance of professional knowledge and competence.SHAIR ensure that each staff member has a Personal Development Plan (PDP) agreed, implemented and reviewed annually.Advocates of this service have attended Autism Awareness Training and it is envisaged that they will attend further training in order toenhance their learning and understanding of Autism Spectrum Disorder. The Advocates would endeavour to provide support however if it was felt that the team lacked the necessary skills to best support theindividual then they we would look to signpost to an appropriate alternative service.

31. Do adults with autism who could not otherwise meaningfully participate in needs assessments,care and support planning, appeals, reviews, or safeguarding processes have access to anadvocate?

RedAmberGreen


Comment

St. Helens provider of Information, Advice and Advocacy locally SHAIR (St Helens Advocacy and Information Resource) wouldprovide this service.SHAIR is a collaborative organisation made up of two local prominent partners in the Voluntary Sector; Age UK Mid Mersey and StHelens Coalition of Disabled people.The service is available to Adults aged 18 + who are ordinarily resident and/ or living in the borough of St Helens who requireinformation, advice and/or advocacy Typically this may include:Older People (including those living in care homes). Adults with physical or sensory impairments, including people living with long-term conditions. Adults with a learning disability including AutismAdults with a Mental Health Problem who do not qualify for statutory advocacy (IMHA and IMCA). Adults who are St Helens residents and have been placed outside the Borough, and who do not qualify for statutory advocacyservices. Individuals in the transition period between Children's and Adults services could also access:Childrens Rights Service Independant Advocacy Service for ChildrenViews Forum Coalition of Disabled People

32. Can people with autism access support if they are non Fair Access Criteria eligible or not eligiblefor statutory services?

YesNo

Provide an example of the type of support that is available in your area.

Online Directory - The St Helens Service Directory can also be accessed to identify services via the following linkhttp://www.sthelens.gov.uk/servicedirectory

"A signposting service for people looking for adult care and support services in St.Helens."

St. Helens Service Directory is easily accessible online for anyone to access and it then, signposts individuals to the requiredservices/situation/urgent help. It provides a list of services for individuals with Autism within the local community.

If an individual does not wish to access information via the internet then the St. Helens Contact Centre could be contacted by phoneand will then signpost as appropriate.

St. Helens Advocacy & Information Resource (SHAIR)Provide information and advice on various topics, one of these being Local Services.

33. How would you assess the level of information about local support in your area being accessibleto people with autism?

RedAmberGreen


Comment

The ASDG is the forum to request individuals with autism and their carers to 'test' if some aspects are accessible ie as St. HelensAutism Strategy Action Plan:*Information*Leisure*Safety in Town

Example of this:St. Helens Autism Strategy Action Plan:Issue: Awareness of available services and support accessible to all.Action: Mapping exercise to be completed. Information uploaded on ASCH service directory.Timescale: OngoingOutcomes: Knowledge of and access to services is readily available for service users, carers and staff.Progress: Mapping exercise completed - to be shared with members of the ASDG for comments etc - needs to be regularly refreshedvia service directory.

Housing & Accommodation

34. Does your local housing strategy specifically identify Autism?RedAmberGreen

Comment

In St Helens, people with Autism live in a variety of settings. Some people with particularly complex needs may require specialistprovision out of the borough. Commissioners will continue to monitor the numbers of people with autism coming through transition,which are likely to be eligible for support from adult social care, in order to determine how their needs can be met. The focus will beon providing services that promote independence and optimise choice and control for these individuals over their daily lives.(Strategy)

St. Helens Autism Action PlanHousingAccommodation - people live in accommodation that meets their needs.Action- Housing needs assessment - Housing Strategy should include people with autism.OutcomeIdentify Housing Provision available for people with autism

- Engage with Providers and Registered Social Landlord's to facilitate people living in own accommodation - identify numbers, Identifysupport, identify properties.Information to inform review of Supporting People Housing.OutcomeEnsure demand for housing is known

Employment

35. How have you promoted in your area the employment of people on the Autistic Spectrum?RedAmberGreen




Comment

We have rated this as amber but are progressing towards green.

St Helens Council has a Supported Employment Service to support people with Learning Disabilities into work, including people withLearning Disabilities who have Autism.Assessments of need and transition processes conducted and by Adult Social Care will include a needs assessment aroundaccessing work. People with autism, who are eligible for Adult Social Care, can use a Personal Budget to facilitate access to work.Areas that will be worked on in this area are;*Improving information about employment support and benefits for adults with autism and local employers*Establish systems to improve access and support into employment (Strategy)The St.Helens Autism Strategy Action Plan identifies the need to increase opportunities with New Ventures and therefore increase therange of employment opportunities for people with Autism - including opportunities for supporting people to be "work ready"

St. Helens Council will continue to engage with the St. Helens Chamber to encourage employers to employ individuals or provideapprenticeships - help with job adjustments or information and advice.As from July 2013 St. Helens Council Apprenticeship Grants has been increased to provide extra support for recruiting apprenticesand help local businesses to grow.This may provide opportunities for individuals with ASD to gain experience/employment in the future and will be taken to theEmployment of People with a Learning Disability Group meeting for further consultation in the near future.

St.Helens ChamberSt. Helens Chamber has worked alongside Coalition of Disabled People and St Helens Autism Support (SAS) project to identify asmall group of students, primarily to raise awareness amongst local employers about the benefits of employing an individual on theautistic spectrum.

The sessions varied from one to one Mock Interview practice to CV applications and identifying suitable work placements for theindividuals. One of which has had work experience at St Helens Chamber for a couple of hours per week to give him someexperience within an office environment. The other 4 students are experiencing work placements, on a regular basis. The result wouldbe to hopefully secure permanent paid employment.

The 4 young people were all male, with an age range of 17-23.Future plans to evaluate the progress made and identify new work experience placements by raising awareness of autism amongstlocal employers.

Support is available to people with Autism from the Department of Work and Pensions Work Choice programme. This programmeoffers opportunities for people with autism or other disabilities to learn skills and approaches to secure work.

36. Do transition processes to adult services have an employment focus?RedAmberGreen


Comment

St. Helens Adult Social Care & Health has two dedicated Transitional Social Workers based within the wider Learning DisabilityTeam. From the initial transitional meeting (aged 17yrs) education and employment opportunities are discussed, though employment is not ineveryone's plan.At individual reviews after this young people are made aware of the employment support options and if they wish to continue collegebeyond the age of 21 years of age will be supported by the Adult Social Care & Health and Education Department.The policies supporting this are as below:

ST HELENS COUNCIL - POLICY STATEMENT Transition of Young People with a Disability from Children's to Adult Social CareSt Helens Council will ensure that young people with a disability who are making the transition between Children's and Adult SocialCare Services, and their parents are actively involved in planning for their future and remain at the centre of the change process. TheCouncil will ensure that: -* Help young people to deliver their employability skills and access into paid or voluntary work.

ST HELENS COUNCILStandards applying to Transition of Young People with a Disability from Children to Adult Social Care Services 7. EMPLOYMENT, FURTHER EDUCATION AND WORKEmployment, further education and work will form an important part of a young adult's life and a key focus during the time of transitionto adulthood. The Council will ensure that all young people are: -Effectively supported in this area by ensuring that schools put in place effective arrangements to support young people who requireadditional basic skills or skills development prior to starting college courses/work placements.

That relevant care plans, statement of educational needs or enhanced school action plus plans are shared with providers ofemployment and education in order to effectively identify the learners needs and ensure that the right support is provided andappropriate provision is made.

Local college and work placement files will be actively engaged in supporting accessible and adaptable education/training inworkplace environments, in line with the Disability Discrimination Act 1995. This will include: - - Physical accessibility.- Curriculum differentiation with appropriate and effective adjustments.- Provision of accessible information and appropriate (including curriculum materials).

Colleges and learning providers will work together with partners to develop inclusive local provision that will enable young people withlearning difficulties and/or disabilities to learn in St Helens and support and develop skills to progress to independent living andemployment.

The individual's personalised care plan will consider issues relating to future employment training and ongoing education at all times.

Schools will ensure that young people have access to appropriate accurate and impartial careers advice through both its personaltutorial system and connexions.

Schools will make people aware of the demands of courses, employment and progression routes afforded through their curriculumand attendance and involvement with connexions.

Greater Merseyside Connexions Partnership (GMCP) GMCP are commissioned to work with young people aged from 13 up to the age of 25 who have identified learning difficulties and/ordisabilities, this includes young people on the Autistic Spectrum.

Connexions support young people at key transition points and work with other key professionals to ensure that there is a realistictransition plan in place to support this process. All advisers working with these young people have relevant professional sectorrelated qualifications and have significant experience working with this group. Staff are provided with opportunities to update theirknowledge of local and out of borough provision to support the decision making process. GMCP work closely with employers andoffer a vacancy service where young people are matched to suitable vacancies. Professional Advisers help young people tocomplete applications form and offer 'mock' interview activities to support the application process.

Connexions Professional Advisers work closely with young people and their parents to raise aspirations around particular careerideas and identify suitable pathways to support this. Referrals are made to relevant training, education, voluntary and paidopportunities. Connexions are responsible for completing a statutory assessment for all young people with a learning difficulty ordisability that details their plans for the future and identify any support needs they may need and recommends to a future providerwith strategies and support information which have proven to be successful and therefore needs to be included within their package of


support. Professional Advisers will advocate on behalf of young people to progress applications and to identify solutions to specificdifficulties they may face.

ERDS Comment - Need to mention the scrutiny review done in 2012 re. employment for people with learning disabilities which willhave mentioned autism and also one of the Adult Care & Health panel's areas they are looking at prob. Jan 2014 will be healthprovision for people with autism.

Criminal Justice System (CJS)

37. Are the CJS engaging with you as a key partner in your planning for adults with autism?RedAmberGreen

Comment

St. Helens Local Authority are now engaging with The Criminal Justice Liaison Team (5 Boroughs Partnership NHS Foundation Trust)who are part of the Learning Disability Liaison and Diversion Project.We are liasing with them to ensure that access to specialist training in relation to supporting people with Autism through the criminaljustice system will be progressed.It is expected that this will then provide an understanding of the needs/behaviour of people with Autism to be supported appropriatelythrough the Criminal Justice System. Safer St. HelensHate Crime PartnershipEngagement with learning disabilities communities/groups is a key element of the objective to tackle hate crime in St Helens -engagement, consultation and feedback is mainly via*St. Helens People's Choice (Self Advocacy)*Views Forum (Advocacy Learning Disability)*Valuing Peoples Partnership BoardThis helps to prioritise and align marketing campaigns accordingly, with the aim of encouraging victims to come forward. During2012/13, the hate crime communication plan has been refreshed, which included designing and launching a new poster campaign(one of which focused on disability hate crime).

Safer in Town SchemeThis scheme has been reviewed and revised, getting more venues (shops, etc) signed up, and spreading the word toindividuals/service users via the Carers Centre, etc. As part of this scheme St Helens People's Choice (Self Advocacy) launched a 'Keep Safe' card to assist people with learningdisabilities/autism in the local area.The initiative is part of the 'Safer in Town' scheme with the St Helens Hate Crime Partnership to empower those with learningdifficulties/autism to communicate, become more independent and stand up for their rights.The card, or key ring, will contain useful telephone numbers in case of an accident, injury or crime and will run in association with the'Safer in Town' sticker to be displayed in shop windows throughout St Helens.

Optional Self-advocate stories

Self-advocate stories.Up to 5 stories may be added. These need to be less than 2000 characters. In the first box, indicate the Question

Number(s) of the points they illustrate (may be more than one. In the comment box provide the story.

Self-advocate story one

Question number

10



Comment

The Views Forum

This group of younger people with autism/ learning disabilities are involved in the development and promotion of various schemeswithin the community.

The Views Forum offered to provide an induction and awareness around the use of the Safer in Town card for new individuals orgroups who want to use the scheme.

The session provides*Identifying safer places and safer people in times of distress. *We provide a walk around town to further identify safer places and replicate the use of the card. *The session also includes identifying safer places available during the evening and later at night.

We are looking to also develop an Autism alert card. This can be shown / used in situations of difficulty with the emergency services.The card will identify the need to adjust the perception of the individual and inform an alternative way to engage.

Views Forum - Coalition of Disabled People - 26/09/13

Self-advocate story two

Question number

12

Comment

BackgroundS is a young lady who has autism, she has been a looked after child (LAC) on and off since the age of 4. More recently she has had astable period of care in a children's home out of borough. She goes to school in St Helens and travels every day.

NeedBecause she is LAC she needed housing from her 18th birthday as children's homes stop being suitable at 18.

PlanAs there were no available houses at the beginning of S' 17th year we had to engage with commissioning and housing to make her apriority. She was put on every list that may have given her housing. She was not successful on a number of occasions because she was still under 18.

OutcomeVarious meetings were held to discuss the possibility of a placement in a bungalow within a Supported Housing scheme providingspecialised accommodation which uses technology, and planned care and support services delivered 24 hours a day this wouldensure that S would retain a degree of independence.

When a bungalow became available discussions followed with the young lady and meetings held with the necessary partners toagree that S should be given the bungalow even though she was not yet 18, if this hadn't been agreed S may of been homeless.

Over a period of time S is making the transition from care into the bungalow with Supported Living and may share with another personwith whom she has developed a friendship with.

CJ Transition Social Worker St. Helens Adult Social Care & Health 20/09/13

Self-advocate story three

Question number

31


Comment

I provided advocacy support for a young lady with a diagnosis of autism and with other complex issues. RM was unable to provideinstruction, was in her last year at the residential college and unable to return to the family home.

Family were anxious that appropriate accommodation be identified with RM maintaining the skills gained over her stay at college.

The advocate spent that period of time liasing with all significant people and partner agencys to ensure the transition on leavingcollege be as seamless as possible.

Once the accommodation was identified the advocate along with care management coordinated the care plan and the sharing of bothinformation and practice between the college and the identified service provider.

The advocate ensured that the progress and skill development achieved by RM was recognised and that the care plan reflected theprogress and the plan for this to be maintained. Also the interests and activities undertaken by RM be identified and replicated on herreturn to St Helens.

This was achieved and RM has settled in her accommodation with her services appropriately meeting her needs.

Advocate St. Helens Coalition of Disabled People 26/09/13

Self-advocate story four

Question number

Comment

Self-advocate story five

Question number

Comment

This marks the end of principal data collection.

Can you confirm that the two requirements for the process to be complete have been met?

a. Have you inspected the pdf output to ensure that the answers recorded on the system match what youintended to enter?

Yes

b. Has the response for your Local Authority area been agreed by the Autism Partnership Board or equivalentgroup, and the ratings validated by people who have autism, as requested in the ministerial letter of 5th August2013?

Yes

http://www.improvinghealthandlives.org.uk/gsf.php5?f=17484&fv=18739


The data set used for report-writing purposes will be taken from the system on 30th September 2013.

The data fill will remain open after that for two reasons:

1. to allow entry of the dates on which Health and Well Being Boards discuss the submission and2. to allow modifications arising from this discussion to be made to RAG rated or yes/no questions.

Please note modifications to comment text or additional stories entered after this point will not be used in the final report.

What was the date of the meeting of the Health and Well Being Board that this was discussed?

Please enter in the following format: 01/01/2014 for the 1st January 2014.

Day

28

Month

11

Year

2013

Autism Self Evaluation - Metropolitan Borough of St...

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