Multidisciplinary assessment at a child development centre: do we conform to recommended standards?
BACKGROUND
A proposed standard for the multidisciplinary assessment (MDA) of children with autism has been recently published by the National Autistic Society. This prompted a review of current practice at the child development centre in our local centre, to judge whether we were able to conform to the proposed national standard. The recommendation is that a child should complete a three-stage assessment process from referral to completion of assessment within 30 weeks, with set times for completion of each stage (6, 7 and 17 weeks respectively). We applied this assessment model to children with a range of neurodevelopment problems, as the process of MDA is the same, irrespective of diagnosis.


METHODS
A retrospective analysis of medical and therapy records of all MDAs was carried out between April 2001 and March 2002.


RESULTS
In the 12-month period studied, 52 MDAs were performed. Delays occurred, as judged by the standard, at all three stages of the assessment process. A total of 42% of children were seen within 6 weeks of initial referral, 37% within a further 7 weeks for specialist assessment, and 37% within a further 17 weeks for completion of MDA. As delays occurred at all stages, the cumulative total showed that only 19% of children completed all three stages within the recommended 30-week standard. Barriers encountered included waiting times to see professionals, parental non-attendance and prolonged assessment of complex problems. Some of these factors are outside our control, and on removing these factors the data were re-analysed. This resulted in a slight improvement to 45%, 48% and 49% for completion of stages 1, 2 and 3 respectively. The major reason for delay remained the service capacity.


CONCLUSIONS
In our experience the standards proposed by the National Autistic Society are not practical within present resources. We suggest that a reasonable expectation is to complete all assessments, from first concern to completed MDA, should be carried out within 52 weeks with present levels of resources. Any further improvement will require additional resources to reduce waiting times and increase the capacity.
Preece
P M
PM
Chesterfield Royal Hospital NHS Foundation Trust, Calow Chesterfield, UK. philip.preece@chesterfieldroyal.nhs.uk
Mott
J
J
D001321:Autistic Disorder / Q000175:diagnosis*; D002648:Child; D002657:Child Development; D002662:Child Health Services / Q000592:standards*; D002658:Developmental Disabilities / Q000175:diagnosis; D006801:Humans; D010348:Patient Care Team; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors