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The Leeds Autism Diagnostic Service (LADS) is an all IQ service accepting professional and self-referrals, from age 18, for diagnostic assessment. LADS is unusual compared to other diagnostic services in England, in that it accepts self-referrals. The purpose of this paper is to compare diagnostic outcome between self-referrals and other referral sources.

This is a service evaluation of all 692 referrals for diagnostic assessment into LADS, over a three year period, from 2016 to 2018. The diagnostic outcomes were compared between self-referrals and other referral sources. Secondary analysis looked at age and gender differences between these groups.

There were 98 self-referrals over three years with autism diagnosed in 65 per cent. In total, 594 other referrals were received during this time period, with autism diagnosed in 44 per cent. This showed a significant difference of 21 per cent with 95% confidence intervals of 10–31 per cent (p=0.0001) using a n−1 χ² test. In total, 59 per cent of self-referrals were from patients identifying as female, which compared to 35 per cent identifying as female from other referrals. This was a difference of 24 per cent with 95% confidence interval of 14–34 per cent (p<0.0001) on the n−1 χ² test.

Factors which may influence the ability to generalise from these results are: that LADS covers a large mainly urban and suburban area with a range of ethnic and socioeconomic diversity; that LADS is an all IQ service unlike some other autism diagnostic services; historical and service-related factors unique to Leeds may be dissimilar to other locations. It was beyond the scope of this evaluation to perform a qualitative analysis to compare the referral sources, but this may be an area for further study.

This evaluation supports the use of a self-referral route for adult autism diagnostic services on a local level and may support its use more widely in other services.

This evaluation, in demonstrating proportionately significantly higher autism diagnosis from self-referrals is likely to be reducing the work load of professionals who would normally make referrals. Alternatively, it may be capturing a subgroup of the autism population who would not otherwise have sought diagnosis. In either scenario, it supports and is consistent with a patient centred approach to accessing appropriate diagnostic services.

The authors are not aware that any previous evaluation of this nature has been conducted and feel this evaluation supports the use of a self-referral pathway in adult autism diagnostic services.

Despite today’s accelerating rate and extent of change, the needed improvements within many areas of performance and quality of life have not taken place. Posits that productivity is remaining the same or even going down in many areas. Infers that learning and change have not been effective. Change involves a subject or self, who is acting, and an object which is acted on. Until now there has been an imbalanced focus on the object. In order to achieve more effective learning ‐ through a synergy of objective and subjective approaches to change ‐ suggests a comprehensive model of change where the emphasis is shifted from the object to the subject. In higher stages of human development, the subject increasingly experiences an enhanced capacity for accomplishment. Argues that this transformation of the actor provides the stable premiss for overcoming many of the shortcomings of contemporary learning and change strategies. In order to implement in practice the expanded change conception, introduces a mental technique ‐ transcendental meditation ‐ which systematically fosters human growth to higher stages of development, as shown by scientific research.

The workload of acute hospitals in the United Kingdom is largely determined by referrals by general practitioners (GPs), and there have been studies that show great variation in the rate and pattern of referrals by different GPs. The other major route is to attend the accident and emergency department (A&E) without attending the GP. It is argued in this paper that the ‘problem’ of variations in GP must be seen in the general context of patient flows to hospital, since little is known of the relationship between referrals and self‐referrals. If it is the case that self‐referral behaviour depends on the likelihood of being referred by a GP, then differences in GP behaviour will not have a direct effect on hospital workload. Equally, changing their behaviour will not reduce the demand for hospital services. Two other options are worth considering — attempting to change the behaviour of patients by public education, and controlling access to hospital by triage. The paper sets out a research agenda to help resolve some of these issues.

Insomnia is highly prevalent and has severe negative consequences, yet help‐seeking remains low. Cognitive behavioural therapy for insomnia (CBT‐I) is an evidence‐based treatment, which targets factors that perpetuate insomnia over time. Using a format developed by Brown and colleagues (1999) of offering self‐referral psycho‐educational workshops for the community, one‐day CBT‐I workshops were run on a routine basis, throughout 2007, for the general public. These intensive workshop days were led by two clinical/counselling psychologists, and attracted a large number of self‐referrals. Participants completed a battery of measures at the introductory and follow up phases of the workshop programme including measures of insomnia, anxiety and depression. Of the 60 people who self‐referred, the large majority were women, 58% had clinical insomnia as indicated by the Insomnia Severity Index (ISI) and 75% had clinical levels of depression as measured by the Beck Depression Inventory (BDI; scores over 10). At the follow‐up stage, there were significant improvements on all measures, and there was a high degree of participant satisfaction with the workshops. Such large‐scale interventions offer an important, potentially cost‐effective means of disseminating evidence‐based psychological interventions to large numbers of people.

Patients are often ill‐equipped to know which speciality to choose for their health problem. Especially in the presence of non‐specific symptoms, choosing the right specialist might not be so obvious. In such cases, misdirected self‐referrals by patients to self‐chosen specialists can sometimes lead to misdiagnosis resulting in unwarranted delays in getting the right treatment. The general physicians, on the other hand, are in a unique position to oversee the big picture of patients’ health, and are therefore better equipped to identify and sort out their individual health problems. Hence instead of a specialist if the first place of contact for patients is a general physician, they are likely to be guided along the right path of treatment for their various health problems. Such a system will minimize errors on the part of the patients by making certain that they are referred to the appropriate specialists.

Secondary prevention programmes have traditionally employed mass screening approaches to assess for asymptomatic signs of cancer. It has been suggested that early detection strategies involving public education and self‐referral may prove more cost‐effective with low risk populations for cancers with symptomatic presentation. This study, which was commissioned to inform the development of a cancer awareness campaign, aims to examine public perceptions of the early detection of cancer, the psycho‐social barriers to self‐referral amongst a key at‐risk population and the implications for patient education.

An exploratory study using qualitative focus groups with an at‐risk population of older people living in deprived communities in west‐central Scotland.

The findings reveal broad support for initiatives designed to raise symptom awareness. However, fear of cancer can lead to apparently irrational responses to symptoms and subsequent delay, particularly amongst men who are less likely to seek support from lay networks.

Early detection messages need to take account tone and symptom description to allay fears and ensure appropriate presentation. Consideration also needs to be given to the role played by lay and professional opinion formers to informing and supporting patients' decision to present with suspicious symptoms, particularly when targeting harder to reach patients of men, older people, and people living in deprived communities.

Promoting mental health and meeting the needs of the large numbers of the general public with problems of anxiety and depression is a big challenge. Particular difficulties are the low capacity of the therapy services and the reluctance of the general public to seek help. The aim of this study was to compare the attendance, effectiveness and characteristics of participants self‐referring to six different psycho‐educational workshops, each using non‐diagnostic titles: self‐confidence; stress; sleep; relationships; happiness; and anger. The series of day‐long workshops ran for one year and were offered to members of the general public in south east London. Over a quarter had not previously sought help from their GP. The take‐up rates for the self‐confidence, sleep and anger workshops were highest and one month after attending these workshops, participants reported significantly lower depression and distress. It was concluded that a self‐referral route to some day‐long workshops can attract quite large numbers of the general public and provide access to effective psychological treatment. These workshops can be used as an effective way of promoting mental health and improving the provision of evidence‐based mental health treatment in the community, possibly within the Improving Access to Psychological Treatments (IAPT) programme in the UK.

This paper aims to respond to the findings of the initial phase of the Safeguarding Adults Programme (November 2009‐March 2010), which found an unexpected inverse relationship between referral rate for safeguarding adults and population size of local authority in the data captured from April 2008 to March 2009.

An analysis of regional safeguarding referral rates relative to population with a breakdown by service groups was undertaken; statistics from the economic deprivation index (EDI) were also used. A questionnaire was designed and sent out to the authorities regarding thresholds, eligibility, definitions, advice and information available to referrers, accuracy of recording and public awareness. The data analysed here cover the following year's safeguarding referrals.

The questionnaire revealed broad differences in thresholds, eligibility, definitions, advice and information available to referrers, accuracy of recording and public awareness campaigns across the studied authorities. These differences contribute to obscuring real differences in underlying processes. A highly significant relationship between EDI and safeguarding referral rates was found, implying real differences in abuse rates driven by underlying socio‐economic factors. Differences in abuse allegations were systematic, so that authorities with a particularly high level of referrals did not have unusually high contributions from particular service user groups or from particular referral sources. Similarly the nature of abuse allegations did not differ between authorities with high or low‐referral rates.

The paper investigates the reasons for variation and explores thresholds for safeguarding referrals.

The purpose of this paper is to identify neurodevelopmental disorders and difficulties (NDD) in a male prison. The study used standardised tools to carry out screening and diagnostic assessment of the attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID).

The ADHD self-report scale, 20-item autism quotient and the Learning Disability Screening Questionnaire were used to screen 240 male prisoners. Prisoners who screened positive on one or more of these scales or self-reported a diagnosis of ADHD, ASD or ID were further assessed using the diagnostic interview for ADHD in adults, adapted Autism Diagnostic Observation Schedule and the Quick Test.

Of the 87 prisoners who screened positive for NDD and were further assessed, 70 met the study’s diagnostic criteria for ADHD, ASD or ID. Most of those with NDD (51 per cent) had previously gone unrecognised and a high proportion (51 per cent) were identified through staff- or self-referral to the study.

The study demonstrated that improving awareness and providing access to skilled, standardised assessment within a male prison can result in increased recognition and identification of NDD.

Patient-centred care is a key approach used in Australia for the delivery of quality health care, and understanding experiences and perceptions is a key part to this. This paper aims to explore prisoners’ experiences and perceptions of health-care service provision in New South Wales, Australia.

In February and March 2017, 24 focus groups, consisting of 128 participants, were undertaken using semi-structured interviews that explored experiences of health care in prison.

A conceptualisation of the prisoners’ health-care experience around the core category of access to health care emerged from the data. Enablers or barriers to this access were driven by three categories: a prison construct – how the prisoners “see” the prison system influencing access to health care; a health-care system construct – how the prisoners “see” the prison health-care system and the pathways to navigate it; and personal factors. Communication was the category with the greatest number of relational connections.

This study takes a pragmatic approach to the analysis of data, the findings forming the basis for a future quantitative study. The findings identify communication as a key issue for access to health care.

This study provides first-hand accounts of enablers and barriers to accessing health-care services in the prison environment. To the best of the authors’ knowledge, this study is the first of its kind to identify access to health care as a core category and is of value to health workers and researchers that work with the prison population.