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
(*Schalock's)

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.
Informal social communication practice in small group setting

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/
counsellor

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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