The Scottish Strategy for Autism - Menu of Interventions
Guide to Interventions and Supports for People on the Autism Spectrum
Appendix 2
Worked example re an individual adult on the autism spectrum
John Brown is 45 and lives in a small town in Scotland. He lives alone in the family house which he inherited on his mother's death last year. He has never worked since he left school but is under pressure from the benefits agency to find a job. An elderly neighbour contacted his GP with concerns about John. He has become dirty and unkempt. There has been a recent dramatic weight loss and she was worried to see him being brought home by police officers.
On discussion with the GP, it transpired that the recent negative changes in his appearance had drawn unwelcome attention to him from gangs of youths and his angry response to them had led to the Police being called. When the GP contacted the social work department, and a social worker called to the house, she found that it was in a very poor state. John had been hoarding newspapers and plastic bags and containers. He didn't appear to have any fresh food in the house. He told her that his mother had always done the cleaning, washing, shopping and food preparation. In addition to this he was being harried on money matters by other family members who appeared to resent his inheritance. He found it difficult to ask for help and didn't know who to contact. He has no friends.
John had not previously been known to services. He did not have a learning disability or a mental illness. He was referred for diagnostic assessment and found to have Asperger Syndrome. The menu of interventions was used to clarify his requirements and identify what services were currently available and which need to be developed in the area.
| ASD CHALLENGE |
WHAT NEEDS TO HAPPEN? |
WHO SHOULD DO IT? |
AVAILABILITY |
OUTCOMES |
| 1. Understanding the implications of an autism diagnosis |
John needs to have as many individual sessions as he requires from the diagnosing clinician to explain Autism and the implications of his condition to him and to respond to his questions. He may also benefit from a small group |
NHS Voluntary sector |
Yes Yes |
1,4, 5, 6 |
| 2. Development of effective means of communication |
Assessment of language comprehension to ascertain whether he needs further specific input |
NHS Speech and Language Therapist |
No |
2, 4, 5, 6 |
| 3. Social communication |
Specific work on practical aspects of social communication eg with neighbours. |
NHS Speech and Language Therapist Specialist ASD provider |
No To be commissioned |
2, 4, 5, 6 |
| 4. Developing and maintaining relationships |
Individual sessions to develop understanding of the skills required to develop relationships. Review of extent to which sexuality is an issue. Informal peer mentoring group |
NHS Psychologist/ Specialist provider |
Yes but limited time available To be commissioned |
4, 5, 6 |
| 5. Social isolation for individual with autism |
Informal social communication practice in small group setting |
Specialist ASD provider |
To be commissioned |
2, 4, 5, 6 |
| 6. Social isolation for family |
NA |
NA |
NA |
|
| 7. Learning to learn skills |
Assessment of cognitive abilities to ascertain whether he needs further specific input |
NHS Clinical Psychologist |
Yes but limited time available. |
1, 3, 4, 7, 8 |
| 8. Predicting and managing change |
Specific work on planning and managing what needs to be done on a practical basis in day to day life including preparation for appointments and meetings |
Voluntary sector specialist provider |
To be commissioned |
4, 5 |
| 9. Behaviour and emotional regulation protecting wellbeing |
Individual counselling focussed initially on bereavement and the transition to his new stage of life. Help with understanding how his behaviours may be seen by others and the implications. Ongoing support. Registration for Autism Alert card |
NHS Clinical Psychologist Voluntary sector specialist provider |
Yes but limited time available To be commissioned Yes |
4, 5, 6 |
| 10. Restricted and repetitive interests and behaviours |
Observation by care provider of the extent to which this is a problem. Referral on if it is found to be required |
Specialist Care provider NHS Psychologist |
To be commissioned Yes but limited time available |
8 |
| 11. Motivation issues |
Observation by care provider of the extent to which this is a problem. Referral on if it is found to be required |
Specialist Care provider |
To be commissioned |
1, 4 |
| 12. Sensory issues |
Sensory Assessment to find out the extent to which this is a problem for John |
NHS OT |
No |
8 |
| 13. Daily living skills |
Detailed assessment of John`s self care skills. Specific teaching regarding all aspects found to be problematic. Housing dept to carry out maintenance assessment as required. Training to be provided to Housing dept staff re AS and how it impacts on John |
SW OT Housing dept Specialist care provider |
Yes Yes To be implemented |
1, 3, 4, 7, 8 |
| 14. Co existing conditions-examples |
GP to monitor John`s mental and physical health on a regular basis. Referral as required to relevant specialists. John`s AS to be flagged on NHS system so that his requirements are understood in the event of emergency admissions |
GP CPN Psychiatrist |
Yes Yes Yes System to be implemented |
5, 8, |
What are the gaps?
- SLT
- Specialist care provider
- NHS OT
- Training for housing dept
- Clinical Psychology time
- System to flag up AS on medical notes
Contact
Email: Alison Taylor
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