Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting

Abstract

The guidance available for tailoring mental health services for autistic people is limited and dispersed. Practitioners attempting to appropriately adapt mental healthcare and therapy provision report low confidence and inconsistency in their approach. This study contributes to the guidance by providing a shortlist of usable and priority adaptations for diagnostic and therapy services as described by multidisciplinary staff members responsible for the design and delivery of a specialist autism service in the UK. Individual freelisting interviews were conducted with 15 staff, who were asked to list the ways that they adapt their practice individually, within therapy, and collectively as a service. Salience and cultural consensus analyses demonstrated the following agreed priority service adaptations: ensuring the suitability of the service environment with consideration of sensory demands, adapting communication, knowing individual gender identity preferences and minimising client uncertainty. Detailed examples are given for flexibly adapting therapy to individual needs to inform general and specialist services. The findings require replication and evaluation.

Approaches to improving mental health care for autistic people: a systematic review

“…Seven articles described studies investigating service adaptations, largely related to autism-specific training of staff and environmental adjustments. These studies examined clinical pathways (48), models (46), networks (47) and general adaptations (39,44) to improve quality of mental health care for autistic people, and initiatives to improve the detection of autism (40,41).…”

“…Overall, strategies to improve clinicians’ knowledge of autism and provide environmental adjustments in services were evaluated as acceptable and feasible (46–48). Several service adaptations were reported as frequently implemented in services by staff (39,44). Additionally, self-report tools were found to discriminate autistic and non-autistic people (40,41).…”

“…Of the 29 articles, two were RCTs (30,31), three were pilot RCTs (32)(33)(34), three were nonrandomised controlled trials (35)(36)(37), two were qualitative (38,39), one was retrospective analytical cross-sectional (40), four were surveys (41)(42)(43)(44), four were service evaluations (45)(46)(47)(48), and 10 were before-after comparison studies (49)(50)(51)(52)(53)(54)(55)(56)(57)(58). Two of these articles were from the same trial (33,38).…”

“…Sixteen papers reported on adults (31,33,34,(36)(37)(38)40,45,48,(51)(52)(53)(54)(55)(56)(57) seven papers reported on both CYP and adults (30,32,35,47,49,50,58). Five papers reported on staff perspectives of how to adapt and deliver better care for autistic people across the lifespan (39,(42)(43)(44)46). Sample characteristics are described in detail in Table S6.…”

A Blog-Based Study of Autistic Adults' Experiences of Aloneness and Connection and the Interplay with Well-Being: Corpus-Based and Thematic Analyses

“…Second, it should be assumed that autistic adults likely desire social connection, under personally meaningful conditions. Within clinical practice it will be important to explore where there are expectations for autistic people to take responsibility for social communication differences, both within therapy, 74 and in narratives throughout their lives.…”