145 Beyond the usual referrers: Improving equity of access to a national tier 4 second-opinion autism assessment service

Background The Social Communication & Autism Spectrum Service (SCASS) is a Tier 4 national second opinion diagnostic service for children with a suspected Autism Spectrum condition. Our multi-disciplinary team provides comprehensive assessments of children in mainstream education where there is diagnostic uncertainty in local services. Since the COVID-19 pandemic, SCASS has observed a shift in referral patterns. While case complexity has risen, necessitating additional assessment appointments to enable us to reach diagnostic conclusions, overall referral numbers have declined. In addition, referrals now appear to come from a smaller, familiar pool of professionals. This narrowing of referrer diversity risks reducing equity of access, potentially excluding children and young people who meet referral criteria but are not linked to these established networks. This contrasts with the hospital’s commitment to reducing health inequalities, as referrals may be influenced by socio-demographic factors such as where a child lives, the local service they access, or parental capacity to request a second opinion assessment. This project aims to identify barriers to referral and assess awareness of our service, with a longer-term aim to improve equity of access to SCASS.Methods An online survey (Smart Survey) was sent to community paediatric and child and adolescent mental health neurodevelopmental assessment services across London and the surrounding areas. The survey explored referrers’ awareness of our service, understanding of referral criteria, availability of local second-opinion pathways, and perceived barriers to referral.Results Variation in awareness of SCASS, second-opinion pathways, and perceived barriers and facilitators to referrals were identified across local teams.Conclusion Findings highlight the need for SCASS to strengthen collaboration with local teams and widen awareness of the service. These improvements will support equity in referrals and reduce health inequalities, ensuring all eligible children can access timely, high-quality second-opinion autism assessments. Future evaluation will help monitor progress and impact.