5th March 2020
Mr. Andrew Davis Chief Executive Officer Cooperative Research Centre for Living with Autism (Autism CRC)
Dear Mr. Davis,
Re: National Guidelines for Assessment and Diagnosis of Autistic Spectrum Disorders in Australia
The Australian College of Nurse Practitioners (ACNP) is the national peak organisation for Nurse Practitioners, advancing nursing practice and consumer access to health care. A key focus for the role and scope of practice development for nurse practitioners is on unmet needs within the community and increasing access to health care for people of all ages and backgrounds.
We have a significant number of nurse practitioners in Australia working in the area of Paediatrics, and Neurodevelopmental disorders. Nurse practitioners provide advanced assessment underpinning diagnosis, and treatment as well as care co-ordination.
Recently, the ACNP has had contact from several members and other stakeholders with concerns about the waiting periods for diagnosis of Neurodevelopmental Disorders, and the serious impacts this has on timely access to appropriate treatment and education. We also receive regular feedback from consumers, in particular parents, around the delays to diagnosis and the impacts that has on the child, young person, and family.
The ACNP requests your consideration of a review of the national guidelines to include nurse practitioners in diagnostic evaluation.
As highlighted in Table 5 of the guidelines, a nurse practitioner is a registered nurse with the experience and expertise to diagnose and treat people of all ages with a variety of acute or chronic health conditions. Table 4 excludes a nurse practitioner from being authorised to conduct a diagnostic evaluation. This exclusion creates a significant barrier to young people and their families, restricting access to timely diagnostic clarification, and adding to their psychological and financial burden.
Amending the national guidelines to enable a nurse practitioner to formally diagnose Autism Spectrum Disorders would provide an accessible and affordable avenue for those families seeking verification, reduce waiting periods, and remove potential barriers to care. Enabling nurse practitioners to formally make this diagnosis allows for more immediate contingency planning for these vulnerable individuals enabling supports to be established from both a health and educational perspective. Additionally, this promotes consistency of care, and reduced the burden of multiple referrals and waiting lists.
The nurse practitioner has a holistic appreciation of all developmental aspects of a person thus ensuring individualised and comprehensive assessment and accurate diagnosis leading to the establishment of tailored management for future interventions. This ultimately provides avenues for appropriate and comprehensive service intervention, fosters positive health outcomes, enhances educational and learning supports and offers a more favourable trajectory. There is clear evidence that nurse practitioners improve access to care, provide cost effective health care, target at-risk populations, and provide services when and where they are most needed, including in rural and remote communities, where access to specialist services is often extremely limited.
Nurse practitioners have been educated at the Master’s level. This Master’s level education incorporates a ‘whole of lifespan’ and ‘all body system’ approach, focussed on assessment, diagnostics and prescribing. This expands upon the already extensive experience, advanced practice and education of the Registered Nurse. As such, Nurse Practitioners have the skills and knowledge, and experience to perform this role.
We respectfully suggest that the following changes would improve access to high quality timely care and diagnosis, and facilitate earlier establishment of educational and psychological supports in a cost-effective manner:
Table 4 (page 17)
- The addition a row for Nurse Practitioners across all columns, with ‘selected’ in each of the four columns.
- We suggest this is annotated in each of the four columns with:
To conduct a Diagnostic Evaluation, nurse practitioners are recommended to have specialist qualifications in the field of community child health, general paediatrics, psychiatry or neurology, or have general registration with at least six years of relevant experience in the assessment of neurodevelopmental disorders.
We would be pleased to discuss this with you further, and assist with any further evidence you may require in order to support this change.
Kind regards
Leanne Boase President
cc. Prof. Anne Kelso AO, Chief Executive Officer, National Health and Medical Research Council