ESCAP 2015 - Anna van Spanje: autism clinical guidelines

1. Dr. Anna van Spanje
Dutch Knowledge Center for Child and Adolescent Psychiatry
ESCAP 2015 congress – Madrid, June 22nd 2015
Clinical autism guidelines in the
Netherlands and Belgium
Small distance, small differences?

2. None
Conflicts of interest

3. Small distance…

4. • Include the latest findings from the best
studies (both inspired by NICE guideline)
• Include input from researchers, clinicians
and patient organizations
• Several feedback moments
• Similar recommendations
Similarities in guideline development

5. • Belgian guideline only aimed at
treatment; Dutch guideline also covers
diagnosis
• Netherlands: multiple guidelines for
different professionals (prevention vs.
diagnosis and treatment)
• Belgian guideline also includes negative
recommendations (“what not to do”)
Differences per country

6. • Scotland:
• Diagnosis and intervention
• England:
National Institute for Clinical Excellence
(NICE)
• One for recognition, referral and diagnosis
• One for intervention
UK guidelines for children

7. • No research into implementation
• However, clinicians tell us: There are
problems with implementation in spite of
thorough developmental process
Guideline implementation

8. • General: little effort into implementation
• Who receives guideline training?
• Is the guideline binding?
• Policy changes vs. budget cuts
• Differences between departments
• Multiple ways to interpret guideline
And…
• No cooperation between countries!
Implementation issues

9. • Netherlands: new system for youth
mental health care, recent changes
• Belgium: bilingualism
 Practical issues that slow down
implementation
Influencing factors per country

10. “There is an imperfect evidence base to
support decisions about which guideline
dissemination and implementation
strategies are likely to be efficient under
different circumstances.”
Grimshaw, J.M., Thomas, R.E., MacLennan, G. et al. (2004). Effectiveness and
efficiency of guideline dissemination and implementation strategies. Health
Technology Assessment, 8(6), 1-72.
What to do?

11. • Make autism guidelines more hands-on
• Avoid ambiguity, include examples and
“what not to do”
• Cooperate and actively exchange
knowledge
• Include an implementation plan, plus
follow-up (cf. NICE implementation support)
• Work bottom up rather than top down
Recommendations

12. • Is it possible to make an autism clinical
guideline for all clinical settings?
• Is it possible to make a European autism
clinical guideline?
The future

13. • Dr. Annelies de Bildt
(Research Psychologist, Accare University Medical Center Groningen)
• Penny Williams
(Consultant Speech & Language Therapist, Children’s Neurosciences
Centre at Evelina London Children’s Hospital)
Special thanks to:

14. Contact
a.vanspanje@kenniscentrum-kjp.nl

15. • How are guidelines developed and used
in your organization?
• How do you see the future of autism
clinical guidelines?
General discussion