Improving access to social care for adults with autism
Early intervention and eligibility
Some of the difficulties faced by people with autism could be addressed or reduced if low-level, often relatively inexpensive services were provided promptly (30). This notion of early intervention* is, however, often hampered by what people with autism sometimes experience as inflexible and reactive services. This inflexibility is often linked to people's experience of Fair Access to Care Services (FACS) or DHSSPS 'Care management, provision of care and charging guidance' eligibility criteria (9, 49). FACS criteria measure whether the risk to a person's independence would be at low, moderate, substantial or critical risk if services were not provided (9). Most local authorities only provide services to people whose needs are in the substantial or critical bands (9), which tends to militate against the provision of early intervention services.
However, skilled commissioning of preventative services** and effective use of the provisions within FACS (or the DHSSPS 'Care management, provision of care and charging guidance') that promote preventative support can be used. The revised guidance on applying FACS makes it clear that staff should:
- have prevention and early intervention at the front of their minds when carrying out their work
- work with individuals and their support networks whose situation may deteriorate, and where early intervention could prevent or delay the need for social care support
- provide interventions to address specific barriers preventing individuals achieving their goals
- help people to access short-term health or technological support or re-ablement services, to promote independence and reduce risks
- use predictive tools that can identify and target individuals who could benefit from signposting and early decision making
- identify sources of support for individuals and carers on the edge of needing social care, or who have low or moderate social care needs, to help them retain control over their lives and achieve the outcomes they want (50).
The focus in Fulfilling and Rewarding Lives(10) and the'Autism strategic action plan for Northern Ireland' (24) on diagnosis has an early intervention aspect, as the sooner people are accurately identified as having autism, the sooner appropriate, well-informed support can be provided. The insistence in Fulfilling and Rewarding Livesthat a diagnosis of any form of autism must be a reason to offer an assessment, rather than deny one, does mean that people with high-functioning autism or Asperger's Syndrome have at least overcome one hurdle to getting the support they need, even if they still have to have eligible needs under FACS. The expectations under 'Putting people first' that local areas will provide a universal information and advice service (42) should also mean that people with autism can be pointed in the right direction for accessing help.
* We are taking early intervention here to mean the timely provision of services to people with autism. We do not mean interventions that aim to militate or remove the effects of the condition.
** Again, by preventative, we do not mean services that aim to prevent autism. We mean services that aim to prevent social care needs from escalating.