Improving access to social care for adults with autism
Making services accessible and acceptable - commissioners
I asked why they did not contact me on the phone I had explicitly told them about - we can't do that we don't have the staff - so, what do you do for blind people? - we have a bill reading service - so you ring them - yes - so why don't you provide for the mentally ill?Adult with autism (7)
Enabling effective access to social care for people with autism involves an in-depth knowledge of what an individual needs. It is therefore difficult to set out in detail what commissioners should do for everyone with autism, but enough is known about what generally makes services accessible to people with autism to give some pointers. Some of them will also be of benefit in healthcare, education and employment settings, as well as in mainstream services such as leisure centres and libraries.
Commissioners should try to ensure that (29):
- there are local options for people with autism about where to live, how to spend their time and by whom they are supported
- specialist services are available for those who need them, offering structure, routine and continuity
- mainstream services are competent to support people with autism, with trained staff, low-arousal areas and flexible processes
- outreach provision is in place to support people with autism in their own homes; outreach should be flexible, such as being able to provide short, intensive work during a crisis
- provision reflects the need of some people with autism for predictable, reliable services
- services are flexible enough to meet fluctuating support needs that can change from day to day
- effective joint working exists between these services, and with health services.
In addition, commissioners should:
- engage people with autism and their family carers in service design and delivery
- explicitly include autism within key documents such as equalities policies, Joint Strategic Needs Assessments* and local housing plans, as examples
- use the Disability Discrimination Act 2005 requirements to ensure that reasonable adjustments are made to local processes and services
- ensure that there is local competence in using the Mental Capacity Act 2005 (or equivalent legislation in other parts of the UK) to support people with autism to make decisions
- make use of the Mental Health and Learning Disability Standard Contract*, which explicitly covers autism. This is a legally binding document covering all NHS-commissioned services for the named client groups, and can help ensure that services are meeting their obligations to people with autism.
One approach is to provide services in a local, or regional, centre of excellence (30), a 'one-stop shop' for people with autism, offering:
- training and employment support
- diagnosis services
- consultancy and advice
- outreach to prevent family breakdown
- social groups and skills training
- accommodation advice
- brokerage and advocacy
- support with practical tasks, paperwork and forms (65).
The provision of good-quality housing underpins many of the other things that people with autism need to enjoy a good quality of life. Again, each person with autism will have highly individualised needs, so commissioners should provide flexible options:
- specialist provision for people with highly complex needs
- good-quality residential options, considering factors such as low-arousal settings, noisy activities like vacuuming taking place when people are out, spacious, uncluttered rooms in muted tones, and fixtures and fittings that can withstand damage
- good-quality supported living and independent living options with similar adjustments, bearing in mind some people with autism will be parents or carers, and will need sufficient space for family members
- housing options that are not 'move-on' or time-limited (66)
- additional security measures or telecare if people are deemed vulnerable or have high levels of anxiety
- all backed with well-trained and well-motivated staff, offering a mixed package of practical and emotional support, as and when people need it. 67
With specialist provision, regional cooperation may be needed. More locally, though, the focus should be on ensuring that mainstream services adapt to people with autism, including those with behaviour that challenges services, rather than excluding and marginalising them (22).
People looking to provide services to black and minority ethnic people with autism, or people with autism from the lesbian, gay, bisexual and transgender community, will need to ensure that services can meet all the needs of the people they support.
* Not applicable in Northern Ireland.