Guidance

Autism self-assessment exercise 2018: local innovations

Updated 20 June 2019

Local innovation questions

Three questions asked about specific areas of development in responding councils. This section reviews responses to them.

Question 103: Innovations for the Transforming Care programme

Full question:

Please outline any innovations you have put in place as part of the Transforming Care Programme which are helping provide homes in the community for autistic people who until recently were long-stay residents in psychiatric in-patient units.

136 local authorities responded to this question. Many mentioned innovations shared across a Transforming Care Partnership area encompassing more than 1 local authority, so some responses were duplicated across local authorities.

Thirteen local authorities stated that there were no or very small numbers of people from their area in inpatient units, which local authorities typically stated was due to previous work to reduce the number of people in inpatient services. Nine used this question to describe the journey of an individual in their area from an inpatient unit to being supported locally.

Most local authorities (93 local authorities; 68% of those answering the question) mentioned housing and/or residential support, usually relating to people moving out of in-patient units but also sometimes relating to housing options such that people would not be admitted to inpatient units. When specifically mentioned, these housing and residential support options were usually part of wider schemes for people with learning disabilities or autism, not exclusively for the latter, although they were often reportedly designed to be autism-friendly.

Forty-three local authorities (34% of those answering the question) briefly discussed broad housing strategies which did not report specific housing projects, many of which were in the early stages or not yet completed and were part of broader Transforming Care strategies.

Fifty-six local authorities (41% of those answering the question) mentioned more specific initiatives relating to housing and residential support, although more of these were in the planning or building phases than were ready for people to move into them. The nature of the houses or units being developed were not always specified by local authorities. These initiatives typically involved either new-build accommodation or properties converted in part to make the physical design more autism-friendly.

Supported living or supported accommodation initiatives were specifically mentioned by 19 local authorities, typically involving a number of people in separate accommodation (described as flats, flatlets or apartments) in the same building or site and sharing some communal facilities and staff. (Example 1).

These ranged from small numbers of people sharing a large converted property to 20 supported living apartments on a single site. Step-down units were specifically mentioned by 9 local authorities, ranging from bespoke units for between 3 and 8 people through to the provision of 27 step-down beds in residential care homes. Other initiatives were described as ‘units’ without further description.

The purpose of all these types of accommodation was sometimes described as being for people to stay for a limited time while they prepared for more independent living situations, and sometimes described as offering permanent homes.

Other types of accommodation mentioned by 3 or fewer local authorities included:

• extra care schemes for adults aged 18+ years
• crash pads for use in crisis situations
• a shared lives option
• a respite or short-term break scheme
• shared home ownership
• housing options where a person’s parents can move in with them

In addition to housing or residential initiatives, many local authorities mentioned various forms of community-based support, typically described as having the dual purposes of helping people move out of inpatient services into sustainable local places and supporting ‘at risk’ individuals (and their families) to prevent inpatient admissions.

Various types of specialist community team (intensive support teams, nurse-led teams, forensic outreach teams) were mentioned by 22 local authorities (16% of those answering the question).

Positive Behaviour Support (PBS), usually in the context of training paid support staff and family carers, was mentioned by 14 local authorities. (Example 2) Other initiatives mentioned by 3 or fewer local authorities included developing accessible information, an independent supporter or a social worker (working with a small number of ‘at risk’ people), and enhanced home care.

Example 1: Oldham

Alongside partners, the Council is currently developing a specialist supported housing scheme for adults with learning disabilities and/or complex behaviours such as autism. The scheme, which has been successful in attracting central government funding will include 20 supported apartments on one site.

It will provide individuals with their own front door with the ability to access care and support as and if required. The apartments have been designed in order to be flexible; to meet both current and projected future demands for accommodation in Oldham.

The strategic objective is to develop specialist supported living provision within the borough of Oldham in order to meet the needs of the individuals identified. The scheme is expected to be completed in 2019 and potential tenants are being identified.

Example 2: Hertfordshire

For people with a learning disability and autism, prior to discharge from long-stay hospitals a personalised approach to create a bespoke package for the individual has been used.

Working with proven ADS providers, packages have been tailored and will include working with the person before discharge delivered by either a creative group named Lomaskaski or Pioneer Approaches to prepare the person for living in the community.

Since 2016, through the Specialist Learning Disability Community Assessment and Treatment Service (CATs) people can be referred to the Positive Partnership Team (PPT). This service gives support to help people who are living in the community and, having been discharged from long-stay hospital, solve problems as they arise. They also support carers to develop skills in Positive Behaviour Support and other Person Centred Approaches. It is run by Hertfordshire Partnership Foundation Trust (HPFT).

The team work across the county with 30 care providers delivering training to staff, parents and carers. The service will work with someone for as long as they require support and once closed an individual can re-enter the service without a re-referral. Since the beginning of the service approximately 100 referrals have been taken with 200 paid carers and family members receiving training. The service is offered countywide. The Offending Behaviour Intervention Service (OBIS) is a community-based service for high-risk adults with learning disabilities and LD & autism.

Question 104 (part 1): Providing care - supporting independence

Full question:

If you wish, describe briefly one initiative of your council, relating to the provision of care, support or development of independence for autistic people, which you think has been successful.

One hundred and ten local authorities responded to this, a few duplicating responses to the previous question.

The most common type of initiative regarded housing and housing policy (16 local authorities; 15% of those answering the question). These ranged in depth and scope from authorities at the stage of planning autism-friendly policies in their housing strategy, to authorities who had completed the building of specific housing developments.

Several authorities outlined housing developments based on sheltered housing with people living independently in clustered units with on-site support available in case it is required. In some cases, interiors were specified to help autistic people including features such as low-level lighting and safety features such as the ability to isolate electrics. These housing solutions are designed to keep people safe but as independent as possible. (Example 3)

Fifteen local authorities (14% of those answering the question) described specific individual packages of care that they had established for individuals leaving ATUs under the Transforming Care agenda. These were entirely person centred designed around the individual’s requirements and largely involved bespoke packages of care.

Work of an ablement team (or equivalent) was noted by 14 local authorities (13% of those answering the question). Access to this team is often not dependent on eligibility to other services, therefore anyone in need is able to access them. The purpose of these teams is to provide low-level support to help people within the community, with the aim of preventing small issues from escalating into larger problems which could lead to stays in hospital.

Eleven localities (10% of those answering the question) noted the use of drop-in centres, often called autism hubs. Hubs often provide low-level support and are open to everyone regardless of social care entitlement. One example outlined how the placement of the hub in a shopping centre has helped raise awareness of autism within the wider community. One shopping centre where an autism hub is based has now introduced a dedicated shopping lane for autistic people.

Support for training, volunteering and employment opportunities were noted by 10 local authorities (9% of those answering the question). Examples included employment readiness sessions focussing on workplace skills, development of internships for autistic people, supported employment staff actively seeking placements with employers and opportunities for job coaching and other in work support.

Technical innovations and apps were noted by 9 local authorities (8% of those answering the question). The most commonly specified was an app called ‘Brain in Hand’, which can be used on a smartphone or tablet. The app can be used to schedule events and to provide prompts and strategies if an individual is feeling anxious or worried. It can also be used to request assistance if required. (Example 4)

Other innovations included other assistive technologies such as SMART environment, sensors, local apps and activity trackers.

Nine areas (8% of those answering the question) noted attempts locally to raise awareness of autism within the wider community. This included support and training for staff to make local libraries more accessible for autistic people.

Drawing on the expertise of autistic people through initiatives like experts by experience was highlighted by 6 areas (5% of those answering the question). This included working with training within organisations and more strategically working on the autism strategy for the locality.

Other initiatives noted include a sex and relationship discussion group (2 local authorities) and improvements to day services (2 local authorities).

Example 3: Wigan

In partnership with Housing colleagues, a purpose-built accommodation scheme called Mayfield House has been developed in Orrell.

This comprises 12 apartments with communal areas for people with Autism and Severe Learning Disability. The building includes an immersive sensory room where people can spend time to relax but also can be used to desensitise people to different situations, specifically, can experience the sights and sounds of a visit to the hospital prior to going into an unfamiliar and anxious situation.

Environmental aspects built in include, low level lighting options, even temperature regulation, open corridor spaces and high ceilings. Practical factors include the ability to isolate utilities like electrics and water which can help to support risks in the least restrictive way.

The outside space has been designed so that people can have their own individual garden space but there is also a wider shared garden which is secure to enable people to enjoy time outside freely. The communal areas are warm and inviting with bright furniture and plenty of space for activities or just spending time together.

The care and support is delivered by Wigan Council Provider service who are positioning themselves to be the expert provider for the Transforming Care cohort. The scheme is part of a wider housing development of social housing surrounding the building. This ensures a neighbourhood model where people are at the heart of their communities.

Example 4: Salford

Smartphone app ‘Brain in Hand’ has been commissioned as a digital innovation and is being trialled with 50 school leavers (and some older) on the spectrum to look at whether this is a useful tool in increasing independence.

The app builds strategies that can be easily followed when a situation occurs; acting as a prompt for the individual to work through familiar strategies to solve the issue, but with access to support should this not be effective.

Question 104 (part 2): Improving access to private sector employment

Full question:

What initiatives have been taken in your area to encourage private sector organisations to improve accessibility, employment opportunities or address other important issues for autistic people?

One hundred and thirty-eight local authorities provided details of an initiative to encourage private sector organisations to improve accessibility, employment opportunities or address other important issues for autistic people.

Fifty-nine local authorities (43% of those answering the question) highlighted the work of supported employment schemes and initiatives. These included:

• improving the employment prospects of individuals
• working on job skills and workplace protocols
• working with employers to help widen engagement and participation of autistic people in the workplace

Work with individuals included looking at strengths that would be valued by employers, conducting travel training to promote independence, and helping the person to settle into a workplace. Sessions with employers, run by local supported employment agencies or in conjunction with the DWP, helped to break down any myths or concerns about employing people with autism.

In some areas the employers then go on to become autism ambassadors and help run future events. (Example 5) Specific schemes included Project Search, work with young people not in education, employment or training (‘NEETS’), and ‘Let’s get working’.

Encouraging and improving community accessibility for autistic people was noted by 24 areas (17% of those answering the question). Ideas included introducing a quiet hour at local supermarkets to assist autistic people to shop in a more comfortable environment. Accessible cinema screenings have the lights left on low, lower sound, good disabled access and non-reserved seating so people can sit where they like. Autism training and the setting up of safe spaces within a community was also mentioned.

It helps raise awareness of the issues autistic people may face in daily life to the wider community and enables autistic people to feel safer when out and about. Four of these areas noted the work of local autism ambassadors, often experts by experience, who help to run training with employers and other groups such as library and leisure centre staff. (Example 6)

12 areas (9% of those answering the question) outlined future plans currently in development. These focussed on working towards implementing work with employers around supported employment schemes, events aimed at raising awareness of autism and issues which impact upon the lives of autistic people within the wider community, and work on strategic developments such as autism plans.

Other areas highlighted by a single area include an innovation grant, assistive technology and a befriending service.

Example 5: South Yorkshire

The Supported Employment team hold sessions around the county aimed at encouraging local business to come together to break down the barriers and myths around employing a person who may have additional needs. These sessions often have a guest speaker who will share their experience of employing a person with autism.

At one event this year, over 20 employers attended an ‘Employment Breakfast’. The speaker talked about their positive experience of employing a person with additional needs and gave a first-hand account of the support they had been provided with to make the necessary adjustments to meet the person’s needs.

These are very informal sessions which help reduce stigma and ensure that employers are confident to know that they have the right support so the person can become a valued member of their workforce.

Example 6: Hampshire

Hampshire Autism Partnership board have established an Autism Ambassador Scheme. This is delivered by representatives of the local authority alongside local autism charities, experts by experience as well as family members and carers of people with Autism.

To date, it has trained over 600 ambassadors. This includes:

• schools (over 130)
• colleges and universities
• Hampshire Constabulary
• council,
• libraries
• private companies, such as IBM and Proctor and Gamble
• shopping centres
• theatres
• youth organisations

We are currently offering free training to GP surgeries. The scheme is free to join and members who remain as active ambassadors are asked to attend an annual conference where we are joined by national guest speakers such as Sarah Hendrickx, Jamie and the Lion, and so on.

We have heard success stories from Ambassadors where HR recruitment processes have been changed to make reasonable adjustments which have led to successful employment for people with Autism. Greater inclusion at clubs where small changes have enabled a member to stay for an overnight event which had not been previously achievable. We have many examples like these where the ethos of the scheme ‘the smallest change can make the biggest difference’ has been realised.