Falling through the gaps? Investigating the experiences of autistic young people within Care and Education Treatment Reviews

尽管NICE指南中具体提到了自闭症和有学习障碍的精神疾病（LD）的管理，但一个关键的挑战是为有学习障碍和自闭症的人获得适当的精神卫生服务。服务的发展总是受到研究的影响，英国皇家精神科医学院（RoyalCollege of Psychiatrists）最近的指导（2020年3月）表明，“在所有文献中，都缺乏关于精神健康问题和轻度ID患者的高质量证据。”（第13页）因此，并非所有地方都为自闭症患者提供专门服务，因此使用者必须依靠一般心理健康服务来支持他们，这并不奇怪。上述列出的研究项目认识到，在健康和保健系统中，有复杂需求的自闭症年轻人持续存在困难，它将试图更好地理解，根据年轻人自己的直接观点和经验，定制服务提供（从而改善结果）对自闭症服务使用者来说可能是什么样子。通过在地方政府的SEND服务部门工作，我对患有自闭症和学习障碍（或缺乏这些障碍）的年轻人的心理健康和教育支持服务有了直接的经验，更具体地说，对护理、教育和治疗审查（CETRs）和更广泛的NHS转型护理议程有了直接的经验。因此，我对“实地”实践有深刻的理解，这些实践与识别有入学风险的儿童和青少年有关，并且能够胜任地识别和探索中心设计、获取和影响方面存在的许多挑战。收集有学习障碍的自闭症青少年的意见是这项计划的核心，而我与自闭症青少年的工作经验（作为社会福利工作者、教育福利主任和特殊需要主任）使我能够利用一系列的沟通方法（包括使用视觉支持）来有效地获取他们的意见。此外，我通过利益相关者咨询和服务重新设计的合作制作经验将以一种真正参与式的方式支持该项目的发展。该项目将探讨以下研究问题：1。护理及教育治疗检讨小组（CETR）对儿童及青少年的服务提供有何意见及经验？当地服务提供者如何发展一种基于优势的方法来支持ctr团队职权范围内的自闭症年轻人，从而改善他们的结果？如何才能真实地、尊重地获取和分享有学习障碍的自闭症年轻人的观点？这将是一种跨学科的、以社区为基础的参与性研究方法，旨在解决这些具体的地方需求，这些需求也将具有更广泛的全国适用性和兴趣。我将带来一个独特的，现实世界的视角来发展研究设计，我很高兴有机会传播这些发现，以一种可能影响地方和国家层面实践的方式。

Despite specific reference to the management of autism and mental illness with learning disabilities (LD)within NICE Guidelines, a key challenge is access to suitable mental health services for those with LD andautism. Invariably, service development is influenced by research and recent guidance from the RoyalCollege of Psychiatrists (March 2020) suggests there is a "lack of high-quality evidence on people withmental health problems and mild ID echoed throughout the literature." (pg.13) It is thereforeunsurprising that not all local areas provide specialist services for those with LD and autism andconsequently users must rely on general mental health services to support them.The above listed research project recognises the continuing difficulties of autistic young people withcomplex needs within health and care systems and it will attempt to develop a better understanding ofwhat bespoke service provision (and thus improved outcomes) could look like for autistic service users,based on the direct views and experiences of young people themselves.Through working across local authority SEND services, I have direct experience of mental health andeducational support services for young people with autism and learning disabilities (or lack thereof) andmore specifically, of Care, Education and Treatment Reviews (CETRs) and the wider NHS TransformingCare agenda. Consequently, I have a strong understanding of 'on the ground' practice relating to theidentifyication of children and young people at risk of admission and will be able to competently identifyand explore many of the challenges that exist with the design, access and impact of CETRs.Capturing the views of autistic young people with learning disabilities is central to this project and myexperience working with autistic young people (as an LSA, Education Welfare Officer and Special NeedsOfficer) will enable me to utilise a range of communication approaches (including the use of visual14 / 16supports) to effectively secure their views. Further, my experience of co-production through stakeholderconsultation and service re-design will support the development of this project in a way that is trulyparticipatory.The project will explore the following research questions:1. What are the views and experiences of service provision of children and young people being supportedby the Care and Education Treatment Review (CETR) Team?2. How can local service providers develop a strengths-based approach to supporting autistic youngpeople under the remit of the CETR team, thereby improving their outcomes?3. How can the views of autistic young people with learning disabilities be authentically and respectfullyaccessed and shared?This will be an interdisciplinary, community-based participatory research approach designed to addressthese specific local needs that will also have much wider national applicability and interest. I will bring aunique, real-world perspective to developing the research design and I am greatly excited by theopporunity to disseminate the findings in a way that may influence practice at both a local and nationallevel.