SUBMISSION TO THE SENATE SELECT COMMIETTE ON AUTISM
June 2020
ABOUT MINDFUL, CENTRE FOR RESEARCH AND DEVELOPMENTAL HEALTH
Mindful Centre for Training and Research in Developmental Health is the state-wide unit in Victoria responsible for the delivery of postgraduate courses, training programs, professional development and research programs in child and adolescent mental health. Mindful is auspiced by the University of Melbourne and is funded by a Department of Health grant.
Mindful is the largest provider of Autism Spectrum Disorder (ASD) training in Victoria and attracts participants from across Australia, New Zealand and Asia. This training calendar has been developed and is managed by the Statewide ASD Coordinator.
AIM OF THIS SUBMISSION
The purpose of this submission is to describe a successful model of capacity building in Victorian Child and Adolescent Mental Health Services over the past 10 years that may considered for mental health services in other States and Territories and to identify further areas of development required within the mental health sector.
DEVELOPING AND MAITAINING A SKILLED WORKFORCE IN CHILD & ADOLESCENT MENTAL
HEALTH (CAMHS) IN VICTORIA
The two key elements have been:
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The development of a high quality ASD training calendar in areas of assessment and treatment of comorbidities, that is accessible and affordable for clinicians in both public mental health, and private sector services.
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Providing recurrent funding for ASD coordinators in each CAMHS to facilitate best practice ASD assessment and treatment approaches.
Additionally, the funding of an Statewide ASD coordinator to support the networking and development of the ASD coordinator group has also been important in maintaining the ASD coordinator workforce.
TRAINING & SKILL DEVELOPMENT
It is critical to have a skilled and well-trained mental health workforce knowledgeable in Autism Spectrum Disorder (ASD) and comorbid mental health conditions. The current estimates of ASD prevalence in Australia is 1– 2.5 in 100 (Randall et al., 2016). Mental Health comorbidity in ASD is high (Brookman-Frazee, Stadnick, Chlebowski, Baker-Ericzén, & Ganger, 2018) and is increasingly the reason for clients with ASD presenting to Child and Adolescent/Youth Mental Health Services (CAMHS/CYMHS). Increasing numbers of children, young people and adults are presenting with an underlying ASD that has not previously been identified. For a significant number of these children, and young people with an undiagnosed ASD, their first contact with mental health services are at the Emergency
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Departments of hospitals, where they present with significant mental health concerns including self-harm and suicidal ideation.
Mindful received funding from the Victorian Health Department’s 2009 Autism State plan, to establish a training program of ongoing Professional Development Workshops in Assessment and Treatment of ASD and Neurodevelopmental Disorders.
Over the past 10 years we have developed a comprehensive training calendar (Appendix 1) addressing assessment and treatment of ASD and comorbid mental health conditions. This has made a significant impact on the capability and capacity of Victorian professionals, in both public and private sectors, to diagnosis and treat children, young people and adults with ASD.
Mindful currently provides up to 1000 training places for professionals per year, offering subsidized places for publicly employed mental health professionals in Victoria. The program continues to expand and includes:
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Core training in the fundamentals of ASD assessment and positive behaviour support
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Specialised training in specific Autism assessment tools such as: o Autism diagnostic observation Schedule 2 - ADOS-2 o Autism Diagnostic Interview Revised – ADI-R
o Developmental, Dimensional and Diagnostic Interview, an ASD Computer
Based Diagnostic Interview -3Di
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ASD Skill Development Workshop cover topics such as Gender Dysphoria, Emotional Regulation, Sleeping and Eating Issues, Attachment & Trauma; School Refusal; Anxiety, Sexual Development. These workshops are delivered by expert clinicians.
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Due to high demand, training in assessment and understanding ASD in Adults with comorbid mental health conditions has recently been developed and added to the training calendar.
When training commenced in 2010 it was only offered to CYMHS and CAMHS clinicians in line with the original brief from DHHS. Since training has opened to all clinicians, there has been increasing demand for training from professionals outside of mental health. Analysis of the 2019 training data shows that now 50% of our participants come from outside of CAMHS. These include paediatricians, psychologists, speech pathologists, occupational therapists, teachers, nurses, and others from the private sector and also from other public institutions such as Hospitals, Community Health Centres, Department of Education & Training, DHHS and family support services. Due to the quality of our training and the high demand for ASD training we have participants attending from across Australia, New Zealand and Asia.
This training has developed and maintained an ASD skilled workforce with CAMHS through making training available on regular basis so that training is accessible to all new staff. We offer CAMHS/CYMHS, Headspace, and Adult Mental Health services subsidised training
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places and they make up 50% of participants. These places are heavily subsidized to ensure ongoing upskilling of the Mental health workforce in ASD assessment and treatment.
*2011 -2014 CAMHS/CYMHS only 2015-2020 CAMHS/CYMHS + Headspace, Public Health
Services+ Private Practitioners
IMPACT OF ESTABLISHING REGIONAL ASD COORDINATORS WITH CAMHS
Under the implementation of the Autism State Plan each Child & Adolescent Mental Health
Service (CAMHS)/ Child & Youth Mental Health Service (CYMHS) and Orygen Youth Health
were allocated ongoing funding for an ASD Coordinator to coordinate the ASD assessment and diagnostic process, oversee the delivery of quality early intervention and ongoing clinical care within the mental health service and facilitate referral pathways to appropriate support services. In addition to coordinating services and demonstrating leadership within the mental health service system regarding ASD, the local coordinators also link in with key service providers in their local areas such as paediatricians, disability services, early childhood services and
student support services from the Department of Education and Early Childhood
Development. These coordinators provide a network of services for children and young people with ASD who have a complex presentation or are difficult to diagnose. Many present with additional mental health disorders such as anxiety and depression. In addition, these children and young people may also have experienced trauma, family breakdown, non-attendance at school; homelessness, criminal justice system, socio economic hardship and /or CALD Background. There is also an increase in the number of girls referred for ASD assessment, which has previously been a largely unrecognised cohort.
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Through this ASD CAMHS/CYMHS network many of our most vulnerable and disadvantaged children and young people with suspected ASD have access to tertiary ASD diagnostic and treatment services. We have begun to see the long-term impact of the accessibility of ASDS training and having key ASD specialists situated in CAMHS. Capacity building in the child and adolescent mental health sector can be demonstrated by the significant increases in the number of high-quality assessments conducted without increases in staffing.
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These ASD/Neurodevelopmental specialist teams provided 667 assessments in 2018/19 representing a 20% increase in assessments, with no increase in EFT, compared with 3 years ago (557), 2015/16.
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An additional 345 assessments occurred within the CAMHS/CYMHS outpatient and inpatient teams demonstrating the wide impact of these specialist teams within their services.
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The total number of ASD assessments 2018/19 =1012 which represents almost 50% increase capacity across CAMHS in Victoria
ASD STATEWIDE COORDINATOR MENTAL HEALTH
Also as part of the implementation of the Autism State Plan funding was provided for the establishment of a dedicated state wide ASD coordinator whose role was to support regional ASD coordinators, to develop practice guidelines, A Guide to Identification,
Diagnosis and Treatment of Autism Spectrum Disorders in Victorian Mental Health Services
(Kerry Bull & Sandra Radovini, April 2013) and establish a high quality ongoing training calendar to facilitate a CMYHS workforce skilled in ASD treatment and diagnosis.
The ASD Statewide coordinator regularly collects data, provided by regional coordinators, regarding regional waiting lists, regional issues and challenges to the provision of quality services, as well as local training needs. This role also provides mentoring and supervision to newly appointed ASD coordinators and facilitating regular peer network meeting where coordinator address common issue and share knowledge further increasing the capacity of this expert group.
FUTHER AREAS FOR DEVELOPMENT
Major issues of concern to the all Victorian ASD coordinators are:
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Inequity of access to services with significantly longer waiting lists in areas of lower socio-economic disadvantage and rural areas (e.g. Western Region of metropolitan Melbourne).
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Young adults with ASD, discharged from mental health services experience limited access to appropriate services.
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Very limited or no access within adult mental health services to ASD assessments. 4
- Sporadic project funding of ASD services and programs for children, young people and families that have positive impacts but are not sustained due to lack of recurrent funding.
Issues specific to rural areas include:
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Lack of access to allied health disciplines, particularly speech pathology
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Limited access to private or public services for ongoing care and treatment and long waiting lists.
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Few Paediatricians and Child & Adolescent Psychiatrists in rural areas.
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Maintenance of a skilled workforce.
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Effective utilization of the skilled ASD workforce in regional areas. Understaffing of rural mental health teams has often means clinicians with specialized training in ASD are not able to offer these assessments due to high demands such risk and crisis assessments.
These issues identified in the Victorian context are likely to be similar to other rural parts of Australia.
F. Saunders
Statewide ASD Coordinator
Mindful, Centre for training and research in developmental health
References
Brookman-Frazee, L., Stadnick, N., Chlebowski, C., Baker-Ericzén, M., & Ganger, W. (2018). Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. Autism, 22(8), 938–952.
Randall, M., Sciberras, E., Brignell, A., Ihsen, E., Efron, D., Dissanayake, C., & Williams, K. (2016). Autism spectrum disorder: Presentation and prevalence in a nationally representative Australian sample. Australian & New Zealand Journal of Psychiatry, 50(3), 243-253
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