WEBVTT 00:12:24.000 --> 00:12:39.000 Liz McNeillie: Hello, welcome everyone. Thank you for coming to today's webinar. Just to let you know, we are recording this webinar so that we can share it on our website later in case anyone wants to watch it at a later date and isn't able to come today. 00:12:39.000 --> 00:12:47.000 Liz McNeillie: We're just going to wait a few minutes for a few more people to join, so just please bear with us for a couple of minutes. 00:12:47.000 --> 00:12:58.000 Liz McNeillie: If you do want to, um, share in the chat, you know, why you've come today, and your, sort of, your background, you're very welcome to, but also no pressure at all to do so. 00:13:15.000 --> 00:13:27.000 Liz McNeillie: And please do let us know if there's any technical difficulties at all, if you're having any difficulties hearing us, or if you're not able to sort of see anything that's shared as the session goes on. 00:13:49.000 --> 00:13:57.000 Liz McNeillie: Hi, welcome. Welcome to the webinar today. We're just waiting for a couple more minutes to give time for people to arrive. 00:14:22.000 --> 00:14:36.000 Liz McNeillie: So, I'll just start with the introductions, which will give a little bit more time for anyone else to join over the next few minutes. So, hello everyone, welcome, and thank you so much for joining us today. 00:14:36.000 --> 00:14:43.000 Liz McNeillie: My name's Liz McNeely. I'm a speech and language therapist working for IMPACT and I'm introducing the webinar today. 00:14:43.000 --> 00:15:02.000 Liz McNeillie: So this webinar is about how we've implemented an early years care pathway in the UK, and it's a pathway designed to support neurodivergent infants and their families from age 11 months, so it's pre-diagnosis, and it includes the PACT and IBASIS programs as part of the pathway. 00:15:03.000 --> 00:15:18.000 Liz McNeillie: A key part of my role involves implementing the pathway with NHS partners. And from my perspective, it's been great to be able to provide that really early support to parents and babies at really critical period of the baby's brain development. 00:15:18.000 --> 00:15:27.000 Liz McNeillie: I really enjoy seeing the baby's communication develop over the course of the programme, and having the opportunity to work with families for up to 6 months. 00:15:27.000 --> 00:15:32.000 Liz McNeillie: And parents report feeling more bonded with their baby. 00:15:32.000 --> 00:15:41.000 Liz McNeillie: So the presentation today is pre-recorded as we really wanted to include the perspective of one of our NHS partners who couldn't be here today. 00:15:41.000 --> 00:15:55.000 Liz McNeillie: Her name is Jane Harris Waller, and she's the neurodevelopmental clinical lead in Coventry and Warwickshire, where this neurodevelopmental pathway is being piloted at the moment and implemented. 00:15:55.000 --> 00:16:05.000 Liz McNeillie: My colleague Sue Vosper is also presenting in the presentation today, and she is able to be with us, so she'll be available for questions at the end. 00:16:05.000 --> 00:16:10.000 Liz McNeillie: And I'll let her introduce herself when we get to the beginning of the presentation. 00:16:10.000 --> 00:16:13.000 Liz McNeillie: So, I believe we have a mixture of professionals. 00:16:13.000 --> 00:16:15.000 Liz McNeillie: parents and carers. 00:16:15.000 --> 00:16:22.000 Liz McNeillie: here today and sort of watching our webinars as they're recorded on the website. And you are all very welcome. 00:16:22.000 --> 00:16:27.000 Liz McNeillie: and we hope that the content will be accessible and useful to all of you. 00:16:27.000 --> 00:16:33.000 Liz McNeillie: And anyone who does want to share their background and why they're here in the chat is very welcome to do so. 00:16:33.000 --> 00:16:38.000 Liz McNeillie: So, before we begin, just a quick note that today's session is being recorded. 00:16:38.000 --> 00:16:50.000 Liz McNeillie: The recording will be shared with you afterwards, and will also be available on our website. So you'll be able to watch back anything you miss or share it with with any colleagues or friends who you think might find it useful and interesting. 00:16:51.000 --> 00:16:55.000 Liz McNeillie: We also have around 15 minutes at the end of the session for questions. 00:16:55.000 --> 00:17:05.000 Liz McNeillie: So please feel free to add questions into the chat as we go along, which will be answered at the end, or you can hold your questions and ask us at the end. 00:17:06.000 --> 00:17:11.000 Liz McNeillie: And questions from professionals or parents and carers are all very welcome. 00:17:11.000 --> 00:17:16.000 Liz McNeillie: And me and Sue will do our best to answer them as we come to the end of the. 00:17:16.000 --> 00:17:17.000 Liz McNeillie: presentation. 00:17:17.000 --> 00:17:22.000 Liz McNeillie: And can I ask everyone just to make sure that their microphone is muted? 00:17:22.000 --> 00:17:26.000 Liz McNeillie: as we go into the presentation, so that we don't have any noise disturbance. 00:17:27.000 --> 00:17:32.000 Liz McNeillie: So we're really pleased to have you here with us as part of this webinar series. 00:17:32.000 --> 00:17:42.000 Liz McNeillie: The next session in our series will be Growing Together, the PACT program and Related Therapies, and that will be delivered by one of our therapists, Wilson Mora. 00:17:42.000 --> 00:17:44.000 Liz McNeillie: And we'll share more details of this at the end. 00:17:45.000 --> 00:17:50.000 Liz McNeillie: And if you do want to see any of our upcoming or previous webinar. 00:17:50.000 --> 00:17:57.000 Liz McNeillie: webinars as part of this series. They are all recorded on our website. If you're not able to attend in person on the day. 00:17:57.000 --> 00:18:00.000 Liz McNeillie: So for now, we'll get started. 00:18:00.000 --> 00:18:04.000 Liz McNeillie: And please let me know if if anyone has any difficulties. 00:18:04.000 --> 00:18:06.000 Liz McNeillie: Hearing or seeing the presentation. 00:20:34.000 --> 00:20:59.000 Liz McNeillie: My name's Susanna Vosper. I work for Impact CIC. It's a voluntary sector organisation and we provide support to NHS partners as well as internationally around autism care. I'm a speech and language therapist by profession. I moved from Manchester Foundation Trust last year to solely work on this pathway work. 00:20:59.000 --> 00:21:11.000 Liz McNeillie: And I'll be presenting with Jane, who's the principal clinical psychologist for Coventry and Warwickshire Partnership Trust, and Liz is on hand to answer questions. So next slide please. 00:21:18.000 --> 00:21:35.000 Liz McNeillie: Is it okay to… oh, thank you. Bit of a… bit of a lag. Um, so we're here today to present on an evidence-based early years neurodevelopmental pathway, and it's been designed to provide, um, or reduce the detection gap. 00:21:35.000 --> 00:21:48.000 Liz McNeillie: And care gap between identifying children very young and then offering support at the earliest possible stage in order to improve developmental and life outcomes. 00:21:48.000 --> 00:22:06.000 Liz McNeillie: And we've shown from having implemented this for the last three to four years that it positively impacts the child's needs beyond the early years. So it reduces needs downstream and can impact, we hope, on autism assessment services as well. 00:22:06.000 --> 00:22:08.000 Liz McNeillie: Next slide, please. 00:22:12.000 --> 00:22:30.000 Liz McNeillie: So, why are we thinking about this preemptively rather than reactively? Well, um, having worked on an autism assessment pathway for Manchester, um, traditionally, models of autism care have focused on providing support to autistic children and young people at the point of diagnosis. 00:22:30.000 --> 00:22:47.000 Liz McNeillie: This pathway moves away from solely relying on that. It's pre-emptive, so pre-diagnosis. It's needs-led, needs-based, so we're identifying the child's needs very early on and offering early support to the family to try and boost resilience. 00:22:48.000 --> 00:22:54.000 Liz McNeillie: And we hope also to reduce pressure on autism diagnostic services downstream. 00:22:54.000 --> 00:23:09.000 Liz McNeillie: So it's efficient. We know that we are reducing children's needs early on, and this also impacts on things like waiting lists within the NHS because we are offering this earlier support. 00:23:09.000 --> 00:23:27.000 Liz McNeillie: It's effective. We've got lots of evidence that families are very happy to get this earlier identification, earlier support. We know that the therapy programmes we offer boost bonding between parent and child, as well as actually supporting the child's development. 00:23:28.000 --> 00:23:41.000 Liz McNeillie: It's cost effective. We know from various research conducted by Professor Green, who I work for, that earlier support reduces costs downstream. 00:23:41.000 --> 00:23:55.000 Liz McNeillie: Because we're reducing the children's needs, it's proactive, we're getting in there early. We know that autism is developmental and enduring, so the support is starting at the earliest possible point. 00:23:55.000 --> 00:24:00.000 Liz McNeillie: We've mentioned that it's very linked detection and care, so as soon as we identify. 00:24:00.000 --> 00:24:08.000 Liz McNeillie: The children were offering immediate support and it's evidenced the identification tool and the. 00:24:08.000 --> 00:24:13.000 Liz McNeillie: therapy support, have strong evidence basis from research trials. 00:24:13.000 --> 00:24:30.000 Liz McNeillie: And it's flexible so we can, um, deliver this now with existing staff teams by redeploying them for maybe a day of their time a week, um, but also building it in dovetailing with existing service offers. 00:24:30.000 --> 00:24:32.000 Liz McNeillie: Next slide, please. 00:24:33.000 --> 00:24:43.000 Liz McNeillie: So the pathway elements include the SACS-R, um, which is the surveillance tool, so it's the Social Attention Communication Surveillance. 00:24:43.000 --> 00:25:02.000 Liz McNeillie: revised tool, and that's a detection tool that identifies children from as young as 11 months who may be at high likelihood of autism. In other words, they're showing early signs of autism. However, this is a surveillance tool, it's not a diagnosis, absolutely not. 00:25:02.000 --> 00:25:24.000 Liz McNeillie: But it shows likelihood and is very strongly evidence-based. What's nice about this tool as well is that it can be implemented at different time points up to the age of 6 years, so it can be delivered by frontline workers, health visitors, and early years workers to build up a picture of the child across time. 00:25:24.000 --> 00:25:29.000 Liz McNeillie: So, we use the SAXSAR to identify the babies from 11 months. 00:25:30.000 --> 00:25:40.000 Liz McNeillie: And then for children who are under 2, we offer Ibasis, which I'll talk about in just a moment, and for over 2, we offer PACT, um, again, I'll. 00:25:40.000 --> 00:25:51.000 Liz McNeillie: Talk about what both those things are. And again, this can link with existing services. So if a service is already offering other things, these can sit alongside that offer. 00:25:52.000 --> 00:25:53.000 Liz McNeillie: Next slide, please. 00:25:54.000 --> 00:26:09.000 Liz McNeillie: So the SACS I've mentioned is a brief monitoring tool. It identifies likelihood of neurodivergence and therefore can indicate need for referral. What we found on the ground with the implementation pathways we've been delivering. 00:26:09.000 --> 00:26:33.000 Liz McNeillie: Is that it's actually really effective in identifying children who aren't neurodivergent as well, so children who are showing perhaps more language needs will be diverted to the appropriate care sooner. SACSAR is also really applicable in a day-to-day scenario. It's a short play-based assessment. It takes about 15 minutes to deliver. 00:26:33.000 --> 00:26:45.000 Liz McNeillie: And it can be completed within usual mandated visits, so health visitors feed back to us that they really like it, because it can help with their decision-making, and is really easy to administer. 00:26:45.000 --> 00:26:47.000 Liz McNeillie: Next slide, please. 00:26:49.000 --> 00:26:58.000 Liz McNeillie: So, IBASIS and PACT are the therapy components, so it's the support once we have identified the neurodivergent children. 00:26:59.000 --> 00:27:00.000 Liz McNeillie: And babies. 00:27:00.000 --> 00:27:16.000 Liz McNeillie: Both IBASIS and PACT are video feedback based. So IBASIS stands for originally Intervention for the British Autism Study of Infant Siblings. So it was originally designed for infants who had an older sibling. 00:27:16.000 --> 00:27:31.000 Liz McNeillie: who had an autism diagnosis. But these days we don't rely on children having necessarily a sibling in order to access it. It's more whether they are showing those early neurodivergent signs. And PACT stands for Pediatric Autism Communication Therapy. 00:27:31.000 --> 00:27:34.000 Liz McNeillie: They both use video feedback. 00:27:34.000 --> 00:27:47.000 Liz McNeillie: To inform a discussion with parents to look at signals that the child might be giving, sort of when the child is making overtures to start an interaction. 00:27:47.000 --> 00:28:00.000 Liz McNeillie: and building those attuned caregiver responses. It's strength based and I just want to stress it's always based on what the child does first. So it's very neurodiversity affirming. 00:28:00.000 --> 00:28:04.000 Liz McNeillie: Totally accepting the child as they are, but building on their strengths. 00:28:04.000 --> 00:28:21.000 Liz McNeillie: They're both strongly evidence-based, um, both have had, had, uh, RCT trials and PACT actually followed up children up to 7 or 8 years. IBASIS followed the children up to 3 years and found that the, um, changes to their development. 00:28:21.000 --> 00:28:24.000 Liz McNeillie: development were long lasting. 00:28:24.000 --> 00:28:41.000 Liz McNeillie: In order to deliver IBASIS and PACT within this pathway, we identified teams of about five specialist practitioners who would accommodate this work by delivering it for a day to a day and a half per week. 00:28:41.000 --> 00:28:50.000 Liz McNeillie: So it might mean that they do slightly less of something else in order to accommodate this, but we're not trying to employ new staff teams. 00:28:50.000 --> 00:29:06.000 Liz McNeillie: Um, we've based this on a population size of 300,000, so it would be adjusted for different localities, and it's delivered by specialist staff, so it's a very flexible model. IBASIS and PACT can be delivered by health visitors. 00:29:06.000 --> 00:29:15.000 Liz McNeillie: by speech and language therapists or assistants, by OT assistants, by neurodevelopmental practitioners. 00:29:15.000 --> 00:29:21.000 Liz McNeillie: There are lots of professionals who potentially, um, could deliver this, uh, therapy. 00:29:21.000 --> 00:29:23.000 Liz McNeillie: Next slide, please. 00:29:24.000 --> 00:29:43.000 Liz McNeillie: So, a brief bit about iBasis, I've mentioned that it's a video feedback program, it works through parents, and I've mentioned that it enhances the infant's communication potential through supporting parent-child interactions, as well as increasing parent bonding. 00:29:43.000 --> 00:29:45.000 Liz McNeillie: Next slide, please. 00:29:47.000 --> 00:30:08.000 Liz McNeillie: And here are a few outcomes from PACT, which works in a similar way. Some of the tools are different, and the way we feed back as therapists to the parent, however, we're still using video feedback as the main mechanism. So you can see from these quotes that parents really like it. 00:30:08.000 --> 00:30:14.000 Liz McNeillie: And they have have goals that they work for that they identify that it helps them to feel more tuned in. 00:30:14.000 --> 00:30:22.000 Liz McNeillie: to their child and to understand their child when it might be sometimes difficult to interpret their child's communication signals. 00:30:24.000 --> 00:30:25.000 Liz McNeillie: Next slide, please. 00:30:26.000 --> 00:30:33.000 Liz McNeillie: So outcomes, so once the child has traveled through the pathway, um, with their family. 00:30:33.000 --> 00:30:54.000 Liz McNeillie: The IBASIS and PAC therapist has really got to know the family over about 5 to 6 months of care, and in that time the therapist or practitioner has built up and captured a lot of detailed information and observations about that child, so that puts the therapist or practitioner in a very good position. 00:30:54.000 --> 00:30:59.000 Liz McNeillie: To make recommendations for the next stage and to consider whether there's a need. 00:30:59.000 --> 00:31:06.000 Liz McNeillie: three E's there, but need for autism assessment. So at the end of the therapy program. 00:31:06.000 --> 00:31:12.000 Liz McNeillie: the SAXSAR is repeated just to see the child's likelihood of autism. 00:31:12.000 --> 00:31:31.000 Liz McNeillie: Because for some children after IBASIS impact, even over six months, they may fluctuate in their score and their needs may already be reduced. Although we know from the control trials that it's generally over time that we see those developmental outcomes really shine through. 00:31:31.000 --> 00:31:49.000 Liz McNeillie: So at the end of the therapy input, there are different possible outcomes for the families. Some families are really happy with the progress their child's making. They feel in a good position to best support their child and they go to review and a diagnostic assessment is no longer required. 00:31:49.000 --> 00:31:50.000 Liz McNeillie: And… 00:31:50.000 --> 00:32:10.000 Liz McNeillie: Other children will be really well supported in terms of their social communication and their development overall, but may have other identified needs. For example, language is becoming more of a need, or they may have sensory needs, so they will be signposted to those needs accordingly. 00:32:10.000 --> 00:32:32.000 Liz McNeillie: A third group may still look as though they need an autism diagnostic assessment, but this hopefully will be a lighter touch assessment because we now have lots of information from the practitioner working with the child depending on the age of the child when they complete IBASIS or PACT. 00:32:32.000 --> 00:32:43.000 Liz McNeillie: So, for a baby who may be finishing at, sort of, two, two and a half years, some of that information can feed in if they are then going to be assessed at, say, three years. 00:32:44.000 --> 00:32:54.000 Liz McNeillie: Um, and then for the 4th group, they will still need a really full detailed MDT assessment and diagnosis because they may. 00:32:54.000 --> 00:33:07.000 Liz McNeillie: Either not be scoring consistently or they may be scoring more on the threshold, so showing some neurodivergent characteristics, but also lots of strengths as well. 00:33:08.000 --> 00:33:17.000 Liz McNeillie: So those are the different outcomes for the families, but it hopefully will reduce the burden on, um, the autism assessment teams. 00:33:18.000 --> 00:33:20.000 Liz McNeillie: Next slide, please. 00:33:21.000 --> 00:33:35.000 Liz McNeillie: So, we have carried out this pathway. The under-2s part has been carried out in Stockport in Greater Manchester, and other parts of Greater Manchester, um, Bury, um, is also adopting this pathway. 00:33:35.000 --> 00:33:45.000 Liz McNeillie: And here in Coventry and Warwickshire, the full pathway is currently preparing to mobilise, but it's actually mobilising now since writing these slides. 00:33:46.000 --> 00:34:01.000 Liz McNeillie: So, I'm going to hand over to Jane shortly, but just before I hand over, just to give you a couple of takeaways from what we found from Stockport and Bury. So, if you could move on to the next slide, please. 00:34:03.000 --> 00:34:18.000 Liz McNeillie: So we found that we were upskilling the workforce as a result of doing this pathway. Infants and children have been identified earlier and offered evidence-based support at a much earlier stage in their development, reducing needs. 00:34:18.000 --> 00:34:25.000 Liz McNeillie: We've got very positive feedback from families who've all… I think 99% of the families we. 00:34:25.000 --> 00:34:39.000 Liz McNeillie: spoke with said it was absolutely the right time for them to be getting that support. They don't want to wait longer, they're happy to get it then. And interestingly, comparing some families who had autistic. 00:34:39.000 --> 00:34:46.000 Liz McNeillie: older children who'd had to wait longer. They really sort of wax lyrical about this pathway. 00:34:46.000 --> 00:35:08.000 Liz McNeillie: So we get very positive parent feedback and we're obviously offering earlier support and we have seen a reduction in referrals to specialist services. So for example, in Stockport, in the child development unit, there's been a reduction of the amount of children who've been referred on and the next slide shows that. 00:35:10.000 --> 00:35:12.000 Liz McNeillie: If it's okay to move us on. 00:35:17.000 --> 00:35:25.000 Liz McNeillie: So this shows a reduction in the amount of referrals for 2024 than 2023. 00:35:25.000 --> 00:35:33.000 Liz McNeillie: And that was due to reducing the waiting list but also reduction of children who actually required. 00:35:33.000 --> 00:35:37.000 Liz McNeillie: The autism assessment having had the therapy. 00:35:37.000 --> 00:35:39.000 Liz McNeillie: Next slide, please. 00:35:40.000 --> 00:36:10.000 Liz McNeillie: So we're now, I'm now going to pass you over to Jane, but this slide shows how it actually works on the ground. So the first sort of 6 months is the preparation stage. So in thinking about practicalities, if a locality is interested in this pathway, like we said, it's very flexible because it can be individually adapted to localities and can dovetail with what localities are already offering. We spend time in the first 6 months preparing. 00:36:10.000 --> 00:36:25.000 Liz McNeillie: preparing to mobilise. And that's what we did with Coventry and Warwickshire. So there's been a lot of, it's a collaborative process. So we've worked with Coventry and Warwickshire discussing the system, speaking with key stakeholders. 00:36:25.000 --> 00:36:42.000 Liz McNeillie: Completing a readiness tracker to find out who might be the best teams to deliver the therapy, who's going to use the SACSAR, and in Coventry and Warwickshire, it's mainly the community nursery nurses who identify the children. 00:36:42.000 --> 00:36:48.000 Liz McNeillie: There's lots of information governance, as we know, having worked in the NHS myself for a long time. 00:36:48.000 --> 00:36:55.000 Liz McNeillie: to complete at this stage and then identifying the staff for training and their capacity. 00:36:55.000 --> 00:37:18.000 Liz McNeillie: And then in the next 6 to 12 months that's where we start to implement the training and the staff teams begin to actually picking up working with their families and starting to mobilize and it's really from about 12 to 18 months onwards that it becomes part of routine delivery and we start to see the pathway really embedding. 00:37:18.000 --> 00:37:29.000 Liz McNeillie: So with Coventry and Warwickshire, we're really at the second stage. The training has just been completed and we started it all in September, so we sort of worked through the preparation stage then. 00:37:29.000 --> 00:37:44.000 Liz McNeillie: And staff are just starting to deliver SACSAR or the IBASIS or PAC teams are just starting to see their families. So I'm going to hand over now to Jane to talk through the sort of practicalities on the ground and to give her perspective. 00:37:44.000 --> 00:37:45.000 Liz McNeillie: Thank you. 00:37:46.000 --> 00:37:47.000 Liz McNeillie: Thanks, Sue. 00:37:48.000 --> 00:38:04.000 Liz McNeillie: Um, so as Sue said, we're, we're still in the midst of implementing this pathway, but I'm really pleased to be here to share some of our, um, learning to date, um, and, um, think about what we've done so far and where we're going. If we can go to the next slide, please. 00:38:05.000 --> 00:38:06.000 Liz McNeillie: I'm… 00:38:06.000 --> 00:38:21.000 Liz McNeillie: So, as Sue said, this real-world implementation in Coventry and Warwickshire is led by the Children's Neurodevelopmental Service within Coventry and Warwickshire Partnership NHS Trust, but it's very much a collaboration between three different organisations. As you can see here. 00:38:21.000 --> 00:38:36.000 Liz McNeillie: Um, so our kind of bigger collaborative team, we have our health visiting services, um, in our two areas, Coventry and Warwickshire, who are provided by different providers, and they have been implementing this XR, um. 00:38:36.000 --> 00:38:46.000 Liz McNeillie: Developmental surveillance tool, our IBASIS team across both localities, we've created 1 team and that's within our preschool autism services. 00:38:46.000 --> 00:38:53.000 Liz McNeillie: Which is provided by jointly by Coventry and Warwickshire Partnership Trust and South Warwickshire Foundation Trust. 00:38:53.000 --> 00:39:14.000 Liz McNeillie: And then PACT is being provided by our speech and language therapy services, which again have different providers across our two areas. So you can see within our locality there have been some complexities with working with three different providers, providing organisations and bringing everybody together to collaborate to provide this. 00:39:14.000 --> 00:39:15.000 Liz McNeillie: Fantastic new pathway. 00:39:15.000 --> 00:39:20.000 Liz McNeillie: So we'll talk a bit about how we got to this place. So if you can move to the next slide. 00:39:21.000 --> 00:39:26.000 Liz McNeillie: Um, so Sue was saying, um, there was quite a lot of preparation in the first. 00:39:26.000 --> 00:39:32.000 Liz McNeillie: six months, and before that, I'm preparing to bring in this new pilot model. 00:39:32.000 --> 00:39:52.000 Liz McNeillie: something that I think really helped us to succeed with setting this up that, um, was having in mind what the key benefits were for each service and each organization involved. Um, so as Sue's spoken about, um, us as clinicians, myself, um, as the psychology lead, and my colleague at the time, Helen Harbin, who was the speech and language lead for autism. 00:39:52.000 --> 00:39:57.000 Liz McNeillie: We were watching this research and really noticing, gosh, this sounds great. I wonder if it could work here. 00:39:57.000 --> 00:40:21.000 Liz McNeillie: And it was a clinically driven development with us approaching clinical leads within health visiting and within our community speech and language services first, and once everybody there was kind of on the same page that this looked like it could be beneficial for all of our organisations and services, we kind of, as clinicians behind that, then were able to start approaching other stakeholders to look at how we could. 00:40:21.000 --> 00:40:24.000 Liz McNeillie: Um, actually deliver this locally. 00:40:24.000 --> 00:40:30.000 Liz McNeillie: through that collaboration. So, that needed a lot of thinking about the capacity for the delivery, so… 00:40:30.000 --> 00:40:44.000 Liz McNeillie: Support from our commissioners and having a dialogue with them at an early stage was really important, particularly because, um, 1 of our health visiting services was transitioning between providers as 1 provider to another during. 00:40:44.000 --> 00:41:06.000 Liz McNeillie: This preparation phase, so that support from commissioning was really important in making sure that we could still implement whilst that change was going on, and support from senior leadership within each of the services was key as well. So us as clinicians really being clear about what the potential benefits were and how we could find ways of implementing, like Sue said, with our existing resource. 00:41:06.000 --> 00:41:17.000 Liz McNeillie: So that involved agreeing how much time, how much staffing resource would be able to be redirected towards this pilot, and how we would manage that, what the benefits would be. 00:41:17.000 --> 00:41:38.000 Liz McNeillie: So through those conversations together between clinical leads and operational leads, we came up with a plan of where and how it would best fit in with our existing services. So with the SACSAR, as Sue mentioned earlier, it's been really sensible for us to implement that alongside our existing Healthy Child programme offer across Coventry and Warwickshire. 00:41:38.000 --> 00:41:54.000 Liz McNeillie: So the universal offer from Health Visiting involves key contacts across the child's first 5 years of life, and we've added in Saxar as a targeted offer within that programme, so some children who meet certain criteria will then be added. 00:41:54.000 --> 00:42:06.000 Liz McNeillie: In this extra opportunity for thinking with a community nursery nurse of whether or not autism is something to think about, whether they would benefit from a therapy like Ibasis or PACT. 00:42:06.000 --> 00:42:16.000 Liz McNeillie: And then similarly I basis we we found a way of of fitting that alongside our existing diagnostic service offer. So as a specialist autism service we thought it fitted quite well with us. 00:42:16.000 --> 00:42:17.000 Liz McNeillie: um… 00:42:17.000 --> 00:42:39.000 Liz McNeillie: To be able to come in a bit earlier and offer that early detection and care and it's our our neurodevelopmental practitioners primarily who have been we've had 8 practitioners trained in IBASIS and what the real advantage of us doing that is that we offer diagnostic assessments from age 2 plus as Sue was saying so if we've already been working with a family. 00:42:39.000 --> 00:42:44.000 Liz McNeillie: Providing eye basis, um, as the child is turning to, it enables a really. 00:42:44.000 --> 00:42:58.000 Liz McNeillie: Smooth seamless transition that the child can then be referred in by their IBASIS practitioner and they can liaise easily with our MDT and we can use that information to inform their diagnostic assessment and giving a better experience we hope to the families. 00:42:58.000 --> 00:43:08.000 Liz McNeillie: For PACT, that sits within our community speech and language therapy services, and again, that's been situated alongside existing therapy offers. 00:43:08.000 --> 00:43:30.000 Liz McNeillie: So they children can be referred to speech and language therapy to have an initial assessment and PACT is now an additional option for them alongside other existing offers, including things like the Hannon More Than Words programme. And we think it offers something new and different that allows us to serve for families who perhaps wouldn't have been able to access. 00:43:30.000 --> 00:43:39.000 Liz McNeillie: Things like more than words that include a group program that isn't suitable for everybody's needs. So having that individual therapy alongside is really beneficial. 00:43:39.000 --> 00:43:42.000 Liz McNeillie: Okay, so we move to the next slide. 00:43:42.000 --> 00:43:46.000 Liz McNeillie: And we'll just whiz through some aspects of the implementation. 00:43:50.000 --> 00:44:08.000 Liz McNeillie: So, um, a lot of our preparation work was moving towards this point where we had agreement from all of the organisations involved on our commissioning as well to implement, and we paid attention within that agreement to making sure that there was equity across our two areas, and that what we were offering. 00:44:08.000 --> 00:44:13.000 Liz McNeillie: Was similar and was a kind of coherent journey for people living across the areas. 00:44:13.000 --> 00:44:29.000 Liz McNeillie: And we also had to address some issues around sustainability. So as Sue said, the first 12 months is just part of the journey. What was that going to look like going forward? So some of the things we had to think about was after the training period had ended, could we cater for in house supervision for our therapists? 00:44:29.000 --> 00:44:34.000 Liz McNeillie: Could we manage that going forward and make sure it was sustainable within our organisations? 00:44:34.000 --> 00:44:55.000 Liz McNeillie: As Sue mentioned, we then had to seek information governance and digital security sign off for these projects. They use video feedback, so that comes with a whole host of questions about how we're going to manage the consent gaining for video, who's going to have the video, where's it going to be stored, how are we going to make sure that people's data and information is safe whilst accessing. 00:44:55.000 --> 00:45:04.000 Liz McNeillie: this therapy. So we needed to do a DPIA, a data protection impact assessment, and get advice from our digital security as well. 00:45:04.000 --> 00:45:10.000 Liz McNeillie: And it was really helpful to have support from impact in doing that with the previous experience in other areas. 00:45:10.000 --> 00:45:23.000 Liz McNeillie: Then we needed to look at our workforce development. So identifying for each part of the programme who would be best placed to offer that and how are we going to enable the staff that we had already to be able to do that. 00:45:23.000 --> 00:45:27.000 Liz McNeillie: So for the SACSAR training, our health visitors. 00:45:27.000 --> 00:45:38.000 Liz McNeillie: Identified their community nursery nurses as the best people to do the Saxar training, and that's because they are the people that are most likely to come into contact with the right people at the right time. 00:45:38.000 --> 00:45:44.000 Liz McNeillie: Um, and we had, I think it was 88 people in the end, staff members that, um, have access. 00:45:44.000 --> 00:45:55.000 Liz McNeillie: Saxar training, which is brilliant, I think kind of links with the themes that we heard earlier about upskilling the workforce, because then those people are across every locality now within Coventry and Warwickshire, and able to kind of share. 00:45:55.000 --> 00:46:05.000 Liz McNeillie: what they now know about making observations of early signs of autism with their teams. We also trained the clinical lead health visitors as well, in the interest of sustainability, for them to provide. 00:46:05.000 --> 00:46:07.000 Liz McNeillie: support and oversight. 00:46:07.000 --> 00:46:26.000 Liz McNeillie: Um, the workforce within iBasis and PACT, um, we… we had more staff who were interested in the training than we had, um, abilities to train them, so we offered it out as a development opportunity and took expressions of interest from staff. We trained eight, uh, neurodevelopmental practitioners or speech and language therapy assistants in iBasis. 00:46:26.000 --> 00:46:38.000 Liz McNeillie: Um, and they've each been released from other duties for half a day a week to do this. Um, and PACT, we've had 10 staff members from Community Speech and Language, um, trained in PACT. 00:46:38.000 --> 00:46:59.000 Liz McNeillie: Then there was a process of create, as for any new adventure within a service, is creating a standard operating procedure and all the supporting documents that you need, things like patient leaflets, referral forms, letters, all of that. I think it's very familiar to us that we use those documents a lot, but it did take a bit of time and thinking about what was going to be suitable for this pathway. 00:47:00.000 --> 00:47:14.000 Liz McNeillie: We also needed to think about gathering equipment, so I think we, as all of our organisations, work hybrid now, so we're quite used to working online, so luckily we had a lot of the equipment that we already needed for working with video. 00:47:14.000 --> 00:47:26.000 Liz McNeillie: Um, but we also needed to pull together some kits, like toys, that we needed to use for Saxar. And actually, we've managed to do that, fingers crossed so far, without purchasing much. We just needed to get some bags to put the Saxar. 00:47:26.000 --> 00:47:44.000 Liz McNeillie: kits into, but a lot of the toys overlap with things that we used for other assessments, like the SOGS kit and ADOS kits, things like that, that were kind of around already in our offices. So, um, yeah, it hasn't meant that we've had to purchase, kind of, lots of additional equipment. So we're now at the point where we are. 00:47:44.000 --> 00:47:54.000 Liz McNeillie: Our staff are trained, we've got all our equipment together, we've got the sign off that we need, and we're just about to open our pilot intervention pathways after Easter, which is very exciting. 00:47:55.000 --> 00:47:57.000 Liz McNeillie: If we can move to the next slide. 00:48:01.000 --> 00:48:12.000 Liz McNeillie: So just, um, a couple of, um, small challenges that we've had. So it just took time to set up our system. So the DPIA, for example, took 4 months, which might not sound like very long, but that was a lot of, kind of. 00:48:12.000 --> 00:48:19.000 Liz McNeillie: chasing and really wanting to move things forward, um, and as I said, it was helpful to have the previous experiences there. 00:48:19.000 --> 00:48:34.000 Liz McNeillie: There were pressures on existing systems, so we had a change of provider from one of our health visiting services. There were some teething problems as well with the new Saxar e-learning package, which just kind of added to their time and the challenges to kind of sort out those issues. 00:48:34.000 --> 00:48:49.000 Liz McNeillie: We're taking it one step at a time, so health visiting have wanted to focus on using Saxar with one particular age group, and then we're hoping to expand that as they gain confidence and get that embedded into their practice. I think having those shared clinical goals has really supported us to overcome those things. 00:48:49.000 --> 00:49:08.000 Liz McNeillie: The last thing I wanted to mention was just thinking about our language and how we're talking with parents and carers of very young children who are too young for our diagnostic pathway. So, something we did that was really helpful was liaise with our parent-carer organization to get their feedback on our leaflets and how we were going to talk about, um. 00:49:08.000 --> 00:49:14.000 Liz McNeillie: the SACSAR, what it means, what IBASIS is for, and how that links with our diagnostic pathway, which was really useful. 00:49:15.000 --> 00:49:44.000 Liz McNeillie: Now just final, our final slide, if we can go on to that, is our first feedback. So we haven't implemented our therapies yet, but the SAXSAR has gone live from the beginning of March. So we've already had a couple of positive feedbacks from our health visitors. So this was somebody who used the SAXSAR and just wanted to share that they were really impressed with the checklist. It was a good tool to reassure parents with, and they used it to assess whether a child would benefit from iBASIS and actually concluded that they were not showing significant. 00:49:44.000 --> 00:50:00.000 Liz McNeillie: significant signs of autism, which had been raised by a parent. So it just kind of gave the staff member the confidence to really look in detail about how is this child presenting and what's going to best fit their needs. And they ended up referring them elsewhere to our local Portage. 00:50:00.000 --> 00:50:12.000 Liz McNeillie: service. And this is exactly what we wanted to, um, to happen with Saxar, is to upskill the staff members to feel confident, to make sure that children are going to the right places for the needs that they have, um, at an early age. So, really good start. 00:50:17.000 --> 00:50:25.000 Liz McNeillie: So thank you, Sue, for that, and thanks to everyone who's joined us today, and thank you for bearing with us with those technical difficulties earlier. 00:50:25.000 --> 00:50:31.000 Liz McNeillie: So, as we mentioned, we're now going to move to the question and answer portion of the session. 00:50:31.000 --> 00:50:35.000 Liz McNeillie: and myself and Sue will do our best to answer as many of your questions. 00:50:36.000 --> 00:50:40.000 Liz McNeillie: And does anyone have any questions that they want to drop into the chat? 00:50:42.000 --> 00:50:44.000 Liz McNeillie: Or to ask. 00:50:44.000 --> 00:50:47.000 Liz McNeillie: And I've got Sue with me as well, to answer. 00:50:49.000 --> 00:50:50.000 Liz McNeillie: Hi, everybody. 00:50:53.000 --> 00:51:00.000 Liz McNeillie: And so, Sue, I don't know if you want to share anything else about your experience with the implementing the pathway. 00:51:00.000 --> 00:51:07.000 Liz McNeillie: Um, well, I just wondered, we've got… it's quite a nice, intimate group today, and I know no one has actually shared. 00:51:07.000 --> 00:51:18.000 Liz McNeillie: and whether they're a parent or practitioner or a lead. And so, if anyone would be willing to just share their roles in the chat, that would be really interesting for us to see. 00:51:18.000 --> 00:51:20.000 Liz McNeillie: And, um… 00:51:20.000 --> 00:51:26.000 Liz McNeillie: If you're a professional, we'd be interested to hear what your thoughts are about the pathway. 00:51:27.000 --> 00:51:31.000 Liz McNeillie: So again, either feel free to drop something in the chat. 00:51:31.000 --> 00:51:33.000 Liz McNeillie: Or to just ask us directly. 00:51:36.000 --> 00:51:44.000 Liz McNeillie: Oh, and I can see someone's asked why there were 2 images of myself, and that's because the presentation was pre-recorded. So you you could probably see as you're watching it. 00:51:44.000 --> 00:51:52.000 Liz McNeillie: that I was in the original meeting that Sue and Jane recorded the presentation, and then you could also see my. 00:51:52.000 --> 00:51:55.000 Liz McNeillie: and my my zoom icon from today. 00:51:55.000 --> 00:52:02.000 Liz McNeillie: We wanted Jane's voice to be heard, so she wasn't able to make today, so that's why we've had to use a pre-recorded. 00:52:02.000 --> 00:52:03.000 Liz McNeillie: session. 00:52:08.000 --> 00:52:13.000 Liz McNeillie: So Dr. Cicali, is that sorry? Oh, great! 00:52:13.000 --> 00:52:19.000 Liz McNeillie: Nice to see you. I don't know whether you fancy letting us know about sort of. 00:52:19.000 --> 00:52:23.000 Liz McNeillie: why you've joined us today, and your thoughts on hearing the pathway. 00:52:24.000 --> 00:52:31.000 Toyin Sokale: Thank you very much. I'm just delighted to be joining today. 00:52:31.000 --> 00:52:34.000 Toyin Sokale: Uh, I'm a community pediatrician. 00:52:34.000 --> 00:52:41.000 Toyin Sokale: Uh, retired quite a few years ago, but I'm still doing some part-time work on and off. 00:52:41.000 --> 00:52:45.000 Toyin Sokale: Uh, East, such as NHSL Care Trust. 00:52:45.000 --> 00:52:46.000 Toyin Sokale: Oh! 00:52:46.000 --> 00:52:50.000 Toyin Sokale: Supporting some clinical work, education. 00:52:47.000 --> 00:52:48.000 Liz McNeillie: Mmhm. 00:52:50.000 --> 00:52:55.000 Toyin Sokale: writing reports for the Escp process. 00:52:55.000 --> 00:53:00.000 Toyin Sokale: And other things, yes, uh, I mean, I find this very interesting, to be honest. 00:53:00.000 --> 00:53:04.000 Toyin Sokale: Ah, this is all new to me in these days, to be honest. 00:53:03.000 --> 00:53:03.000 Liz McNeillie: Oh. 00:53:04.000 --> 00:53:06.000 Toyin Sokale: But I will see. 00:53:06.000 --> 00:53:08.000 Toyin Sokale: right away the usefulness of. 00:53:08.000 --> 00:53:10.000 Toyin Sokale: the saps in the sense that. 00:53:11.000 --> 00:53:15.000 Toyin Sokale: Early detection will lead to better outcome for children, for their families. 00:53:15.000 --> 00:53:21.000 Toyin Sokale: Also, reduce the amount of unnecessary referrals, because actually, this is not. 00:53:21.000 --> 00:53:27.000 Toyin Sokale: Like the autism child is fine. So I think it's very useful. But to be honest, I'm just learning. 00:53:27.000 --> 00:53:33.000 Toyin Sokale: Like I said, I bought his… but it is a fantastic tool, as I can gather today. 00:53:28.000 --> 00:53:29.000 Liz McNeillie: Oh… 00:53:33.000 --> 00:53:38.000 Toyin Sokale: with regards to early detection, supporting families. 00:53:33.000 --> 00:53:34.000 Liz McNeillie: Okay. 00:53:37.000 --> 00:53:38.000 Liz McNeillie: Oh, wow. 00:53:38.000 --> 00:53:40.000 Toyin Sokale: And we, yeah, thank you. 00:53:39.000 --> 00:54:00.000 Liz McNeillie: That's, that's really interesting to hear. I mean, as a paediatrician, I, I imagine you were involved in quite a lot of autism assessments over your, in your career. Um, yeah, I mean, I think what's great about this pathway is that, as a paediatrician, you would have waited, like you said, you'd have had a long waiting list, I imagine, or lots of, lots of demand. 00:53:47.000 --> 00:53:48.000 Toyin Sokale: Yes, yes. 00:53:48.000 --> 00:53:49.000 Toyin Sokale: Okay. 00:53:58.000 --> 00:53:59.000 Toyin Sokale: Yeah, yeah. 00:54:00.000 --> 00:54:08.000 Liz McNeillie: And what's great about the pathway is that we're not waiting for an autism diagnosis to get support for the family. It is. 00:54:08.000 --> 00:54:17.000 Liz McNeillie: pre-diagnosis, so it's pre-emptive, but as a result of that early support, it can reduce the amount of demand on autism assessment services. 00:54:17.000 --> 00:54:22.000 Liz McNeillie: Obviously, it's not the complete solution, but it helps, but… and… 00:54:22.000 --> 00:54:27.000 Liz McNeillie: Morally, clinically, ethically, we're supporting families earlier on, and I think. 00:54:27.000 --> 00:54:38.000 Liz McNeillie: Certainly, I mean, I've been a speech therapist for over 20 years, and it's only recently that we have come across this tool that can identify children from such a young age. 00:54:38.000 --> 00:54:44.000 Liz McNeillie: And where we can feel pretty confident that, um, they are showing high likelihood of autism. 00:54:44.000 --> 00:54:45.000 Liz McNeillie: And. 00:54:45.000 --> 00:54:49.000 Liz McNeillie: Obviously, we're very careful with how we have those conversations with families, because. 00:54:49.000 --> 00:54:56.000 Liz McNeillie: The child can change and often does change once they've had IBASIS or PAC therapy support. 00:54:56.000 --> 00:54:57.000 Liz McNeillie: um… 00:54:57.000 --> 00:55:05.000 Liz McNeillie: But, so the conversations tend to be, we're noticing some developmental differences, but usually the parent has noticed that themselves, and. 00:55:05.000 --> 00:55:06.000 Toyin Sokale: Yep. 00:55:05.000 --> 00:55:11.000 Liz McNeillie: It's grateful, I think, that we're having a joined-up conversation so early on in the child's development. 00:55:11.000 --> 00:55:18.000 Liz McNeillie: Um, and kind of celebrating each unique child, what their strengths are, what might be more challenging for that child. 00:55:18.000 --> 00:55:19.000 Liz McNeillie: And… 00:55:19.000 --> 00:55:24.000 Liz McNeillie: So yeah, interesting to to hear your role as well. 00:55:25.000 --> 00:55:38.000 Liz McNeillie: and it's really helpful as well for those children who don't score on the sex who score below the threshold. Then we can make sure those children are getting the right support, and they can get that correct support earlier. So whether that's like language support. 00:55:38.000 --> 00:55:45.000 Liz McNeillie: And instead of sitting on a waiting list for a service that isn't appropriate for them, they're getting that early input as well that's correct for them. 00:55:45.000 --> 00:55:54.000 Liz McNeillie: And we know that the SACS is very accurate in terms of identifying those children who aren't showing high likelihood of autism. It's about 99% accurate. 00:55:54.000 --> 00:56:00.000 Liz McNeillie: If they're falling below that threshold, they wouldn't go on to get an autism diagnosis when they were older. 00:56:00.000 --> 00:56:00.000 Liz McNeillie: Mmhm. 00:56:00.000 --> 00:56:01.000 Liz McNeillie: Yeah, ma'am. 00:56:01.000 --> 00:56:04.000 Liz McNeillie: Thank you. Thanks a lot. Oh, yes. 00:56:02.000 --> 00:56:03.000 Toyin Sokale: Like, can I… 00:56:04.000 --> 00:56:11.000 Toyin Sokale: Okay, thank you so much. Just going back to some of one of the slides I you showed. There's a place, I say. 00:56:09.000 --> 00:56:10.000 Liz McNeillie: Mm-hmm. 00:56:11.000 --> 00:56:12.000 Toyin Sokale: Light touch. 00:56:12.000 --> 00:56:13.000 Liz McNeillie: Yes. 00:56:13.000 --> 00:56:18.000 Toyin Sokale: And I just wondered, just educate me, is it that when you look at some of these. 00:56:18.000 --> 00:56:21.000 Toyin Sokale: Every 1 to 3 years. 00:56:21.000 --> 00:56:26.000 Toyin Sokale: Uh, children, and you think it's clear as day, as we know that it can be. 00:56:26.000 --> 00:56:27.000 Liz McNeillie: Oh. 00:56:26.000 --> 00:56:29.000 Toyin Sokale: that they've got autism. Do you. 00:56:29.000 --> 00:56:31.000 Toyin Sokale: Are you able to make that diagnosis with us? 00:56:31.000 --> 00:56:35.000 Toyin Sokale: referring them to the MDT for formal assessment. 00:56:35.000 --> 00:56:46.000 Liz McNeillie: So, we still always go through the MDT process, but when we're saying about a light touch, because the practitioner has worked with the family and the child for 5 to 6 months. 00:56:46.000 --> 00:56:47.000 Toyin Sokale: You know. 00:56:46.000 --> 00:56:51.000 Liz McNeillie: That's often a longer time than… I know when I worked on autism assessment pathways. 00:56:51.000 --> 00:56:58.000 Liz McNeillie: I didn't get that much contact with the family through the autism assessment, so the practitioners built a lot of. 00:56:58.000 --> 00:57:17.000 Liz McNeillie: assessment information, it's very dynamic assessment from seeing and working with the family, but they can feed that into the MDT discussion, so there would be other… it would be part of an MDT, but when we say light touch, it might be that the paediatrician might only need to meet the family once, and that might be corroborated with that evidence. 00:57:17.000 --> 00:57:26.000 Liz McNeillie: And also, in stock put, certainly, a move away from necessarily having to do a full ADOS, because, like you said, if it's very clear, we've got very clear signals. 00:57:26.000 --> 00:57:32.000 Liz McNeillie: that reduces time and input that way. But for children, as we mentioned earlier, who are. 00:57:32.000 --> 00:57:40.000 Liz McNeillie: maybe more on the threshold, or where it's less clear, they would still go through that that longer assessment which could involve aidos or or other. 00:57:40.000 --> 00:57:42.000 Liz McNeillie: other assessments. Yeah. 00:57:44.000 --> 00:57:48.000 Liz McNeillie: Thanks. Thanks. It's Toyin or Towin, so I don't know whether. 00:57:45.000 --> 00:57:46.000 Toyin Sokale: Okay. 00:57:47.000 --> 00:57:51.000 Toyin Sokale: No, sorry, my name is Shola, S-O-L-A, Shola Shukale. 00:57:50.000 --> 00:57:54.000 Liz McNeillie: Shawla, ah, you've got a different name that's come up, Shawla, right. 00:57:53.000 --> 00:57:55.000 Toyin Sokale: Yeah, that's my wife's name. 00:57:54.000 --> 00:58:00.000 Liz McNeillie: Oh, right! Okay, brilliant, thanks, Shola. Um, okay. 00:57:55.000 --> 00:57:56.000 Toyin Sokale: Thank you for having me. 00:57:56.000 --> 00:57:57.000 Toyin Sokale: Yep. 00:57:57.000 --> 00:57:58.000 Toyin Sokale: Yes, what? 00:57:58.000 --> 00:58:02.000 Toyin Sokale: Yeah. Well, you actually said last, actually… 00:58:02.000 --> 00:58:06.000 Toyin Sokale: similar to what I used to say that you know. Yes. 00:58:05.000 --> 00:58:06.000 Liz McNeillie: No. 00:58:07.000 --> 00:58:12.000 Toyin Sokale: Every child autism needs multidisciplinary support. 00:58:08.000 --> 00:58:09.000 Liz McNeillie: Oh. 00:58:12.000 --> 00:58:13.000 Toyin Sokale: But. 00:58:13.000 --> 00:58:19.000 Toyin Sokale: Making an assessment does not always have to be, because you've got a lot of information, like you said. 00:58:19.000 --> 00:58:26.000 Toyin Sokale: A pediatrician-only clinic will suffice because, look, it's clear as day. The child walks in your room. You've got all this information. 00:58:19.000 --> 00:58:20.000 Liz McNeillie: Oh. 00:58:23.000 --> 00:58:24.000 Liz McNeillie: Mmhm. 00:58:26.000 --> 00:58:29.000 Toyin Sokale: He's looking around, not showing you any awareness. 00:58:29.000 --> 00:58:37.000 Toyin Sokale: doing all sorts of things, not interested in the choice, you can actually make the diagnosis without going to Formal Aid or ZDIR and all that. 00:58:37.000 --> 00:58:37.000 Liz McNeillie: Oh. 00:58:37.000 --> 00:58:41.000 Toyin Sokale: That's always been one of my themes that I used to say, yeah. 00:58:41.000 --> 00:58:42.000 Liz McNeillie: Um, yeah. 00:58:41.000 --> 00:58:42.000 Toyin Sokale: Well, thank you. 00:58:42.000 --> 00:58:50.000 Liz McNeillie: Absolutely. I totally agree. And it's better for families as well because they're not having to go through that process and go through all the same questions with with with. 00:58:49.000 --> 00:58:50.000 Toyin Sokale: you know. 00:58:51.000 --> 00:58:58.000 Liz McNeillie: And with new people, when there's already someone who knows them really well, who who has that information. And yes, I definitely agree with that. 00:58:58.000 --> 00:58:59.000 Liz McNeillie: In. 00:58:59.000 --> 00:59:00.000 Toyin Sokale: Thank you so much. 00:59:00.000 --> 00:59:04.000 Liz McNeillie: Thank you, Charlotte. We've got another comment in the in the chat. 00:59:04.000 --> 00:59:09.000 Liz McNeillie: and from Erica, just saying that you're a non-medical prescriber. 00:59:09.000 --> 00:59:14.000 Liz McNeillie: I'm about to start a children, young person, ADHD service in the NHS. 00:59:14.000 --> 00:59:16.000 Liz McNeillie: And you'll be, um… 00:59:16.000 --> 00:59:20.000 Liz McNeillie: that you you're interested in in sort of finding out more about this. 00:59:20.000 --> 00:59:26.000 Liz McNeillie: And yeah, it can sort of, it fits really well with existing services if you have existing pathways in place. 00:59:26.000 --> 00:59:35.000 Liz McNeillie: And the pathway that we have is is very flexible, and we can adapt it to to fit with with what your service already offers alongside what the new things you might want to offer. 00:59:36.000 --> 00:59:37.000 Liz McNeillie: Yes, yeah. 00:59:37.000 --> 00:59:42.000 Liz McNeillie: And I don't know whether, Erica, you want to add any comments. Don't want to, or. 00:59:44.000 --> 00:59:57.000 erikamurphy: Oh, no, I'm just to share. Uh how interesting this was. Um! It's it's new for me. I have not heard of this before. So, and I'm just kind of delving into the world of neurodiversity and adHD and autism so. 00:59:48.000 --> 00:59:49.000 Liz McNeillie: Okay. 00:59:57.000 --> 01:00:00.000 erikamurphy: This is this is quite interesting, so thank you. 01:00:00.000 --> 01:00:03.000 Liz McNeillie: Oh, no, you're welcome. You're welcome. Great to hear from you. 01:00:04.000 --> 01:00:08.000 Liz McNeillie: So I don't know whether we have any other questions today. 01:00:08.000 --> 01:00:09.000 Liz McNeillie: And. 01:00:09.000 --> 01:00:21.000 Liz McNeillie: I think that might draw us to a close. I don't know. Do you have a closing statement? Yeah, just and just again to thank everyone for coming. And just a reminder that the session's been recorded. 01:00:21.000 --> 01:00:28.000 Liz McNeillie: So you will receive the recording after the webinar and it will also be available on the website if you want to look again or share it with anyone. 01:00:29.000 --> 01:00:38.000 Liz McNeillie: and we we know that there's a mixture of people from who've joined us from different backgrounds, and we hope that everyone has been able to find this session helpful and accessible. 01:00:38.000 --> 01:00:40.000 Liz McNeillie: and including any parents or carers. 01:00:40.000 --> 01:00:53.000 Liz McNeillie: We'll be sending a short feedback survey after the session and we'd really value your input as it really helps how we deliver and develop future webinars and helps us ensure that our content is useful and relevant. 01:00:54.000 --> 01:01:04.000 Liz McNeillie: Your feedback also really helps us demonstrate the the value and impact of what we're doing, which is really vital in supporting wider awareness and implementation of these programmes. 01:01:04.000 --> 01:01:06.000 Liz McNeillie: and pathways, and it should only take. 01:01:06.000 --> 01:01:10.000 Liz McNeillie: a couple of minutes to complete. So we would be really grateful for your time with that. 01:01:10.000 --> 01:01:13.000 Liz McNeillie: So so this is part of our ongoing webinar series. 01:01:13.000 --> 01:01:21.000 Liz McNeillie: Our next webinar will be growing together the pact program and related therapies, and that will be delivered by Wilson Mora. 01:01:21.000 --> 01:01:28.000 Liz McNeillie: who's a PACT practitioner and trainer, and someone who's very passionate about the PACT programme, so we'd really encourage you to join us. 01:01:28.000 --> 01:01:33.000 Liz McNeillie: for that session, either in person or by having a look back on our website to access the recording. 01:01:33.000 --> 01:01:37.000 Liz McNeillie: So thanks again for being here. Thanks for your interest. 01:01:37.000 --> 01:01:39.000 Liz McNeillie: And we hope to see you at the next webinar. 01:01:39.000 --> 01:01:40.000 Liz McNeillie: Thanks. 01:01:40.000 --> 01:01:42.000 Liz McNeillie: Thanks, everybody. 01:01:42.000 --> 01:01:43.000 Liz McNeillie: Well, best. 01:01:43.000 --> 01:01:43.000 Liz McNeillie: Bye!