Post by roland on Jan 19, 2009 19:42:24 GMT
Since we now know that the NHS look at our forum (as evidenced by West London Mental Health NHS Trust's request for input), I thought this would be a good time to start designing our ideal adult ADHD clinic so that the NHS knows what we need.
As a start, I will post the list that has now been sent to WLMHT by AADD-UK, and please add your own suggestions for our clinics, not just for services to be provided, but also your recommendations as to how these services can be implemented and provided:
1. Have clear divisions of responsibilities between GP’s, PCTs, local NHS mental health teams, private clinics, social workers, disability advisors, drug teams, and so on.
2. Set the clinic up so that GP’s can make direct referrals for assessment.
3. Educate all GP’s within your remit so that they have some understanding of adult ADHD, and know how to make referrals to the clinic.
4. Make sure all GP’s have a list, to be handed to patients, of school records, reports, etc that patients can bring to the clinic for their first appointment. This list could also be posted on the Trust’s website so that patients can find another copy if they lose one.
5. Set up a webpage for the clinic with contact details, referral details, support groups, and any other useful information.
6. Have a short waiting time between referral and appointment; delays, long waits, and bureaucracy are upsetting for adults with ADHD.
7. Reward patients for arriving early (e.g. have a pot of coffee available and some biscuits). It’s actually a form of punishment to expect them to arrive early and wait in a dingy waiting room with only torn and out of date magazines to read.
8. Have ADHD related reading materials (journal articles, books) that can be read while in the waiting room but cannot be taken home (another reward for arriving early)
9. Send email and/or text reminders for appointments in addition to phone calls and the standard letter which can be lost.
10. Keep form filling to the absolute minimum.
11. Ensure that consultants, psychologists, and all staff are willing to listen to the patients.
12. At the end of an appointment, give the patients a list of topics covered, and any follow-up actions required.
13. Make sure that patients are given contact information including telephone numbers, and include a telephone number for out of hours calls
14. Make sure patients fully understand the treatment plan, including medication titration, benefits, and possible side effects
15. Regular follow-ups to see if medication is effective, if the dose needs adjusting, or if different meds need to be tried.
16. Be willing to try various medications and dosages for individual patients, not a one-size-fits-all solution.
17. Nutritional advice to ensure optimum performance of medications.
18. Remember that diagnosis and provision of medications alone is not a complete treatment plan.
19. Give patients a written copy of their treatment plan and include a timeline for treatment and care reviews
20. In addition to the treatment plan, give patients a care plan which will include employment needs, college and educational matters, time management and organisation, nutritional advice, exercise plans & goals, self-image needs, career planning, addiction issues, occupational therapy, anger management, gender specific issues, daily living skills, decluttering advice & help for home and office, social skills training, treatment of co-morbid anxiety and depression, family and relationship counselling, benefits advice, disability discrimination advice. The care plan should include goals, and review dates
21. There should be access to life skills or self-organization and time management classes. These should be delivered as practical trainings with homework and practical exercises for people to do at home. Maybe with help/assistance.
22. Better access to and well developed occupational therapy services to help people develop vocational and practical skills, also the necessary self organisation and regulation skills
23. Consider using mentors to help with home, university, work, and social issues.
24. Be prepared to liaise with student support services at colleges and universities, also with HR Departments for those who need accommodations at work.
25. If possible, avoid cancelling appointments
26. Be prepared to discuss the diagnosis and take care to highlight strengths
27. Provide access psychological therapy when necessary to help with adjustment to diagnosis, as well as with co-morbidities such as anxiety and depression.
28. Provide access to psychological therapy when needed to help deal with consequences from not being diagnosed early (poor social skills, loneliness, poor self-esteem, as well as help overcoming the frustration and anger resulting from being bullied and/or misunderstood)
29. Offer CBT, as a part of the treatment plan to help adults with problem solving, and for developing new skills for managing symptoms, and for dealing with relationships.
30. Offer access to ADHD coaching services if needed.
31. Provide a care coordinator, a single point of contact, for patients. This person should be responsible for managing the care that the service user receives from different sources and for liaising with other professionals and services. Transitions between services should be kept as smooth as possible.
32. Ensure a smooth transition from child & adolescent to adult mental healthcare for those that need it.
33. Provide information about local support groups for adults with ADHD and also for partners/spouses/families/carers.
34. Put in place a programme for artners/spouses/families/carers of adults with ADHD that will help them deal with stress and their own needs.
35. Liaise, interact with, and support the support groups, also be prepared to provide speakers to the groups.
36. Ensure that patients see the same consultant at each appointment
37. Get regular feedback from the patients about their experiences using services because only by examining people's experiences of services can the NHS identify what works and what doesn't.
38. Provide advice on how to best take advantage of potential improvements in their mental state and level of functioning.
39. Provide ADHD coaching
40. Keep form filling to the minimum
As a start, I will post the list that has now been sent to WLMHT by AADD-UK, and please add your own suggestions for our clinics, not just for services to be provided, but also your recommendations as to how these services can be implemented and provided:
1. Have clear divisions of responsibilities between GP’s, PCTs, local NHS mental health teams, private clinics, social workers, disability advisors, drug teams, and so on.
2. Set the clinic up so that GP’s can make direct referrals for assessment.
3. Educate all GP’s within your remit so that they have some understanding of adult ADHD, and know how to make referrals to the clinic.
4. Make sure all GP’s have a list, to be handed to patients, of school records, reports, etc that patients can bring to the clinic for their first appointment. This list could also be posted on the Trust’s website so that patients can find another copy if they lose one.
5. Set up a webpage for the clinic with contact details, referral details, support groups, and any other useful information.
6. Have a short waiting time between referral and appointment; delays, long waits, and bureaucracy are upsetting for adults with ADHD.
7. Reward patients for arriving early (e.g. have a pot of coffee available and some biscuits). It’s actually a form of punishment to expect them to arrive early and wait in a dingy waiting room with only torn and out of date magazines to read.
8. Have ADHD related reading materials (journal articles, books) that can be read while in the waiting room but cannot be taken home (another reward for arriving early)
9. Send email and/or text reminders for appointments in addition to phone calls and the standard letter which can be lost.
10. Keep form filling to the absolute minimum.
11. Ensure that consultants, psychologists, and all staff are willing to listen to the patients.
12. At the end of an appointment, give the patients a list of topics covered, and any follow-up actions required.
13. Make sure that patients are given contact information including telephone numbers, and include a telephone number for out of hours calls
14. Make sure patients fully understand the treatment plan, including medication titration, benefits, and possible side effects
15. Regular follow-ups to see if medication is effective, if the dose needs adjusting, or if different meds need to be tried.
16. Be willing to try various medications and dosages for individual patients, not a one-size-fits-all solution.
17. Nutritional advice to ensure optimum performance of medications.
18. Remember that diagnosis and provision of medications alone is not a complete treatment plan.
19. Give patients a written copy of their treatment plan and include a timeline for treatment and care reviews
20. In addition to the treatment plan, give patients a care plan which will include employment needs, college and educational matters, time management and organisation, nutritional advice, exercise plans & goals, self-image needs, career planning, addiction issues, occupational therapy, anger management, gender specific issues, daily living skills, decluttering advice & help for home and office, social skills training, treatment of co-morbid anxiety and depression, family and relationship counselling, benefits advice, disability discrimination advice. The care plan should include goals, and review dates
21. There should be access to life skills or self-organization and time management classes. These should be delivered as practical trainings with homework and practical exercises for people to do at home. Maybe with help/assistance.
22. Better access to and well developed occupational therapy services to help people develop vocational and practical skills, also the necessary self organisation and regulation skills
23. Consider using mentors to help with home, university, work, and social issues.
24. Be prepared to liaise with student support services at colleges and universities, also with HR Departments for those who need accommodations at work.
25. If possible, avoid cancelling appointments
26. Be prepared to discuss the diagnosis and take care to highlight strengths
27. Provide access psychological therapy when necessary to help with adjustment to diagnosis, as well as with co-morbidities such as anxiety and depression.
28. Provide access to psychological therapy when needed to help deal with consequences from not being diagnosed early (poor social skills, loneliness, poor self-esteem, as well as help overcoming the frustration and anger resulting from being bullied and/or misunderstood)
29. Offer CBT, as a part of the treatment plan to help adults with problem solving, and for developing new skills for managing symptoms, and for dealing with relationships.
30. Offer access to ADHD coaching services if needed.
31. Provide a care coordinator, a single point of contact, for patients. This person should be responsible for managing the care that the service user receives from different sources and for liaising with other professionals and services. Transitions between services should be kept as smooth as possible.
32. Ensure a smooth transition from child & adolescent to adult mental healthcare for those that need it.
33. Provide information about local support groups for adults with ADHD and also for partners/spouses/families/carers.
34. Put in place a programme for artners/spouses/families/carers of adults with ADHD that will help them deal with stress and their own needs.
35. Liaise, interact with, and support the support groups, also be prepared to provide speakers to the groups.
36. Ensure that patients see the same consultant at each appointment
37. Get regular feedback from the patients about their experiences using services because only by examining people's experiences of services can the NHS identify what works and what doesn't.
38. Provide advice on how to best take advantage of potential improvements in their mental state and level of functioning.
39. Provide ADHD coaching
40. Keep form filling to the minimum