Gheel Autism Services Caring for people with autism

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Gheel Autism ServicesCaring for people with
autism

• Implications for People within the Autistic
  Spectrum
• Peter Byrne
• CEO

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ASD and Mental Health Issues

• Many people with an ASD show behaviours which may
  be misinterpreted as mental illnesses
• Identifying if a person with an ASD has a mental
  health need is an incredibly difficult task.
• Autism is considered to be a risk marker for
  aggressive behaviours (McClintock et al., 2003).
• How do we best support a person with an ASD who
  has an identified mental health need?

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The enigma of the autistic spectrum

• People with an ASD cover the entire range of
  intellectual functioning.
• The social and communication impairments are
  often misinterpreted by professionals.
• Many people display a variety of special
  interests and repetitive behaviours.
• Sensory impairments are common triggers of
  challenging behaviours among people with ASD
  (Mills, 2006).
• Sensory overload is another common trigger

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Professional biases

• The philosopher Norwood Russell Hanson argued
  that
• PERCEPTION IS THEORY LADEN.
• I see the influence of this concept in my own
  experiences of people with an ASD.
• Professionals interpret behaviours often in terms
  of their own background
• we often see what we want to see.
• Power and decision making often resides with
  heads of multi-disciplinary teams.
• What is required is an psychiatric assessment
  using a mental health indicator tool.

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Medication based interventions

• Drug based treatments are not the first
  preference interventions of most professionals
  (Singh et al., 1996).
• In a survey of U.K. and Irish services
  anti-psychotic medication was more than 3 times
  more likely to be the treatment of choice than
  behavioural programmes (Emerson et al.,
  2000)
• It is difficult to distinguish whether medication
  approaches are behaviour management or behaviour
  treatment strategies (Gardner and Moffat, 1990).

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Medication based interventions

• Generally, the prescribing of medication for
  challenging behaviours without considering the
  functions of these behaviours is not best
  practice (Kroese, et al., 2001).
• Polypharmacy would appear to be a common practice
  (Lott et al., 2004 Spreat et al., 2004).
• PRN medication is a poorly understood process
  (Roberstson et al., 2000).
• Is it used prophylactically?
• Is it a staff issue?
• How often administered?
• Modes of administration?
• It it forcibly given?

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An ASD medication issue

• Sensitivity to psychotropic medication for people
  with an ASD
• Many people with disabilities have difficulties
  reporting side effects of medication such as
  nausea, dizziness and blurred vision (Fleming,
  et al, 1996). This would be relevant to a broad
  range of people on the spectrum who would have
  difficulties communicating their experiences.

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Specialised treatment units?

• Concerns raised about specialised assessment and
  treatment units as they tend to become bed
  blocked.
• People who go into crisis can lose their homes
  and acquire even more significant challenging
  reputations
• The practice of streaming individuals in crisis
  into the same unit has to be questioned.
• The issue of staff burnout / retention
• People with an ASD are removed from their
  familiar safe environments when they need it
  most.

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Specialised treatment units?

• There exists a paradox.
• You get admitted to a specialised unit because
  your behaviour is challenging.
• Once in the unit your reputation is enhanced.
• Who wants you now???

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Compliance based practices

• More likely to receive consequence based
  interventions within specialised treatment units
  (sanctions and other forms of coercion)
• Practices such as seclusion are more commonplace.
• Physical restraint practices often involve the
  application of pain to bring about compliance.
• Prone holds are far more likely to occur.
• All this points to a COMPLIANCE BASED CULTURE .

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What is needed for a person with an ASD is an
Outreach Model

• Recovery models imply that people recover more
  quickly in familiar environments.
• People with ASD need routine, predictability and
  stability in their living environments.
• People require specialised services not
  specialised units. services should follow
  people
• Learn to manage crises and take a long term view.

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Protocols

• Admission / Discharge
• Aftercare
• In-reach
• PRN medication
• Hands-on interventionist approaches
• Seclusion

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Understanding autism

• Educate all staff to understand the nature of
  an autism spectrum disorder
• If you think education is expensive
• 
  try ignorance
  (Derek Bok, Harvard University).