https://www.england.nhs.uk/publication/autism-diagnosis-and-operational-guidance/
https://www.openaccessgovernment.org/article/paediatric-autism-communication-therapy-improved-long-term-child-outcomes/155726/
https://therapistndc.org/neurodiversity-affirming-therapy/
New Therapy Launcher
Fund to enable healthcare professionals to train in new therapies with the best evidence
Why is this important? Most therapies that are relevant to autistic people and families are “complex interventions”. This means there are multiple components to the therapy, some of which relate to the therapist, which could affect its impact. To properly deliver these therapies, health and care professionals need to be trained in the manual that is developed (and tested) with the intervention; they also need time to practice delivering it with supervised support.
What is the current situation? The NHS does not have an effective way to roll out new complex interventions. There is no clear route for health and care professionals to become aware of and practiced in delivering new supports that are being designed and tested to help autistic people. When professionals do learn the manual for a new intervention, they often have no time to become practised in it. Instead, they immediately have to return to a heavy caseload with limited ongoing support. As a result, the health and care systems struggle to evolve their offering to autistic people. To replace outdated practices with more effective, more acceptable, and better-evidenced supports, we need to invest in developing our workforce.
A central fund could ensure that a choice selection of the most promising and best-evidenced new therapies are rolled out effectively across the NHS, social care, and education systems. This Fund should cover the training costs for professionals to learn new manualised therapies and enable healthcare providers to backfill roles for a short time – while they focus on delivering the new intervention. Practised professionals would then be able to return to their Integrated Care Systems (ICSs) and embed new practices in local pathways.
Example of an exciting new therapy ready for launching:
PACT The Paediatric Autism Communication Therapy (PACT) is a therapy where parents and therapists work together to identify how a child prefers to play, using video recordings. They then adapt their interactions with their child to match that style. Young children learn a lot of skills through play but may approach it in very different ways. PACT has shown that by supporting the alternative ways autistic children learn, we can help them build stronger social communication skills, help parents feel more empowered, and increase families’ resilience. The therapy addresses autistic people and families second-highest priority for autism research: finding “effective interventions to develop communication and language skills”.52 It also embodies a more progressive approach to support that embraces autistic people’s differences and opposes attempts to ‘normalise’ or ‘mask’ atypical behaviour.29 Crucially, PACT has strong evidence that it is acceptable, feasible, and effective. PACT is currently one of the only early interventions directed at autistic children and families that has demonstrated efficacy through high-quality Randomised Control Trials.53,54 Results from the initial trial prompted NICE to describe a generalised version of PACT in the list of “key priorities for implementation” of its Clinical Guidance for supporting autistic children.55 The second PACT trial was awarded NIHR Signal Study status for its “high-quality design and relevance to UK decision-makers”.56 Other trials have since replicated evidence for its mechanisms in different age groups, countries and service contexts.57,58,59,60,61,62 PACT is ready for use, and accredited training for it is immediately available.63 Both the therapy resources and training for PACT have recently been digitalised for online delivery. An adapted version of PACT is currently being tested in home and education settings, making it cheaper and easier to deliver.64 Despite this, families face a postcode lottery in their access to PACT. This is an unjustified source of health inequality.
Autistica has:
The government needs to:
Establish a central fund to launch new therapies into practice within the NHS, social care, and education systems. The fund should cover the training costs for professionals to learn new manualised therapies and enable services/commissioners to backfill roles for a short time while therapists become practised in the new intervention. The Fund should start by rolling out the PACT therapy nationally and expect to support post-diagnostic empowerment programmes soon. Autistica can provide costings for this.
Apportion a small fund to digitalise training programmes for key therapies. For example, PACT training could be fully digitalised for a small investment of approximately £150-200k. This would reduce the cost of training each professional by up to 50% and make it possible to develop a virtual professional network, to provide ongoing supervision and advice to newly accredited therapists.
Fund an expert group of intervention scientists, autistic people, families, and research bodies to shortlist the most promising interventions for the launcher. Interventions should be prioritised based on their fit to community priorities, the quality of evidence for their acceptability, feasibility, and efficacy, how likely they are to improve existing practice, and how ready they are for roll-out.
You can download and read the whole paper here.:
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00037-2/fulltext
JAMA Network Open. 2023;6(4):e235847. doi:10.1001/jamanetworkopen.2023.5847
https://doi.org/10.1016/S2352-4642(22)00037-2.
doi:10.1001/jamanetworkopen.2021.46415
https://doi.org/10.1016/S2352-4642(22)00037-2