Adult ADHD Service in Northamptonshire. Kobus van Rensburg - Consultant Clinical Psychologist UKAAN 7 th International Congress 22 nd September 2017
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1 Adult ADHD Service in Northamptonshire Kobus van Rensburg - Consultant Clinical Psychologist UKAAN 7 th International Congress 22 nd September 2017
2 14 th October 2012
3 Speed of Sound = 768 miles/hour Felix Baumgartner = miles/hour
4 History Statistics/trends Diagnostic Assessments Treatment / support options Ongoing challenges for services in 2017
5 History 2003 Transition and Liaison Team (TLT) Additional funding in 2008, 2010 & ADHD and Asperger s Team (AAT)
6 Northamptonshire model Specialist Neurodevelopmental service ADHD Asperger s Syndrome Tourette s Syndrome
7 Clinical Psychologists Workforce model Clinical Nurse Specialists Occupational Therapists Support workers Most Consultant Psychiatrists based in AMHTs have become expert in the field of ADHD Future plan: dedicated Psychiatrist time in Team Clinicians = 12wte; Admin = 2.2wte
8 Referral trends year on year within Adult Service 2004 (10/month) 2017 (91/month) 100+ referrals/month received during 3 months >50% Diagnostic Assessment Requests
9 Benefits of a Neurodevelopmental service Single point of access for all ND referrals Clinicians become experts in both ADHD and ASD (and also Tourette s Disorder) Comorbidity high Up to 40% of AS patients also have ADHD Up to 25% of ADHD patients also have ASD When AS comorbid with ADHD, treatment/support could be provided within same service
10 Children s Service to Adult Services C C C not clear who to refer to If accepted, nature of service very different Seamless service? A
11 Childhood to Adulthood Hyperactivity declines Misperceptions grow out of it Inattention & executive functioning difficulties remain Functional impairment
12 Service delivery model 1. Screening appointment 2. Diagnostic assessment 3. Treatment Medication/ ADHD psychoeducation workshop/adhd Group (monthly) Individual consultations - CNS - medication review - Psychological treatment - OT transitional support - Support Worker support
13 DIAGNOSTIC ASSESSMENT Comprehensive School reports Working diagnosis Provisional diagnosis Features Self-report Qs ASRS/Wender-Utah ADHD Scales DIVA/Brown ADD Scales Neuropsychological assessment TEA/CPT Informant information Wender-Utah Impairment Scales Weiss/Barkley
14 Women with possible ADD/ADHD are very often not recognised
15 Adult ADHD: Treatment Goals Reduce symptoms Medication Improve functioning in areas of impairment Quality of Life Educational Occupational Family Friends/Social Self-esteem Therefore, adults with ADHD will benefit from a range of different pharmacological, psychosocial, and psychological interventions
16 Non-pharmacological treatment/interventions Education of patients and their families (psychoeducation) Psychological interventions (e.g. CBT, ACT, family therapy) Psychosocial interventions Supportive coaching Career counseling Utilising technology College/workplace accommodations Other treatment options Mindfulness /exercise
17 Treatment focus during Transition Seamless transition between CAMHS/CYPAAS & AAT/CMHT Ongoing monitoring of medication Further Education (linking with Connexions and local colleges) Vocational support Often unable to get/keep job/managing interviews Training issues Independent Living
18 Where are local ADHD services now? Need more resources New Fighting for survival
19 Where are your local gaps? Diagnosis - do you have an agreed multi-agency care pathway? Treatment Only post diagnostic support? Medication only? Some psychosocial support? Transitional support Adult provision
20 What is the ideal? What would I do if I had unlimited resources, and experienced and committed clinicians?
21 What is the absolute minimum to cope with the demand?
22 Screen (for appropriateness) Diagnose (to confirm) Key Issues/Challenges Identify (co-morbidities) Treat (for improvement) Discharge
23
24 ADHD and NUMBERS (3% = ADHD) How many people are NOT seen? and therefore NOT diagnosed NOT treated and therefore NOT getting better How many are NOT in employment?
25 Co-production Innovation Technology (SKYPE/TRELLO) Design that matters
26 Samuel Pierpont Langley vs Wright Brothers
27 The Golden Circle (Simon Sinek)
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