Community care assessments of adults with an autistic spectrum disorder (ASD) can prove complex for social workers not used to working with this client group for several reasons: the individual may have limited communication skills and understanding; may feel uncomfortable talking to a stranger; or may not engage with the process because of fear or anxiety.
Autism assessment case study
“My advice to social workers who aren’t used to doing this type of assessment would be to build the relationship slowly, do the assessment in several parts over a few weeks and then they may be more willing to give you information you need,” says Kirstie Guthrie, a care manager in Nottinghamshire Council’s Adults with Asperger’s Team.
“With one particular client it took me about six weeks to complete the assessment. When I started talking to him I had to be very open – you’re asking a lot of questions about them so it has to be a two-way relationship otherwise they may think why should they answer my questions if I won’t answer theirs.
“I would talk to him about generic subjects that related to the assessment. So, for example, when talking about mealtimes he said he had a favourite restaurant in Nottingham where he went for a curry. Talking about this revealed that he could travel to this restaurant on his own because he knew the route and the train he needed, so I learnt a bit about his social and travel skills.
“When talking about mealtimes at home he said he could cook a meal, but exploring it more all he could do was cook pasta and add sauce from a jar. He couldn’t prepare food and didn’t clean up after himself by wiping the surfaces or putting the dishes in the dishwasher. So he could make a hot meal that would be classed as a main meal but couldn’t do a lot of the tasks associated with making a meal.
“Writing down what we discussed in front of him was too formal so I had to remember as much as I could and get his permission to write it up when I was back in the office.”
For those with high-functioning autism or Asperger syndrome, impressive intellectual skills can make it hard for professionals to understand how they are struggling with day-to-day situations.
“They can be pigeonholed as able and not needing support but intellect and ability are not the same thing,” says Mari Saeki, co-author of a National Autistic Society (NAS) guide to carrying out assessments. “We need to train people to see beyond that mask of ability to what is really going on by asking the right questions in the right way.”
The following tips from the NAS guide should help social workers in carrying out these assessments.
1) Prepare, prepare, prepare
Thorough preparation before carrying out an assessment is vital. Gather as much information as you can before the assessment by speaking to the client’s family and support network.
Find out the best way of engaging with them so that they feel comfortable talking to a stranger, and gauge their communication skills.
2) Use unambiguous language
“How [adults with autism] use language is complex partly because of the difficulty they have with ambiguity of language and literal understanding,” says Andrew Powell, the other co-author of the NAS autism guide and a community autism officer at Bristol Autism Spectrum Service.
“Use words that mean something. Be as straightforward as possible and slow it down to give people time to process. Be patient, calm and clear and make sure they know what has been agreed.”
3) Allow plenty of time
An assessment of an adult with ASD is likely to take longer than for other client groups so allow plenty of time to build a relationship. “It might take several visits for a number of reasons, such as anxiety about meeting someone new, problems with concentration, and asking the right questions, which can take a tortuous route,” explains Powell.
“For example, if you ask someone whether they can wash on their own, they may say ‘yes'; but that can mean ‘yes, I did it once’, ‘yes I can but never do’ or ‘yes but with help from my parents’.
4) Break questions down
“So you have to break the question down into all its components: ‘do you have a bath or shower every day? do you have any help? who helps you? what do they do?’.”
Social workers must also be person-centred at all times, says Saeki, project officer at the NAS’s family services development project in Manchester.
5) Don’t make assumptions
“The way autism affects people is unique to each one, so it is essential that social workers don’t make any assumptions based on what they know about autism when doing an assessment,” she says.
“And remember that they will often have additional difficulties such as ADHD, dyslexia or dyspraxia, depression and anxiety that also need to be assessed.”
- Care managers who would like advice in assessing adults with autism can email Andrew Powell at the National Autistic Society.
Reflective practice for your continuing professional development
Chris Mitchell, manager of Nottinghamshire Council’s Adults with Asperger’s Team, makes some suggestions for reflective practice for social workers once they have carried out an assessment of an adult with ASD.
- Making sure your assessments are person-centred is vital, so take a step back to question whether you achieved that. Dr Lorna Wing [a leading expert in autism] said: “Once you have met one person with autism, you’ve met one person with autism.” That is the phrase to remember because everybody is so different in the way the elements of autism impact on them. You need a broad understanding of the experience of people on the spectrum, but you also need to understand how the individual is relating to other people and the world because that will influence how you adjust your assessment content.
- Have you recognised the significance of sensory issues for people with autism? You have to be sensitive to what the individual is receiving in terms of the stimulus you are giving them. For example, did you speak too loudly or too softly, or was the room too brightly lit or too dark? Anything that impacts negatively on the person you are assessing will be detrimental to the information you are given.
- Improve your knowledge of living with autism by reading books and autobiographies on the subject, many of which are published by Jessica Kingsley.
- Have you made links with your local autism partnership boards and others working with this client group? It’s important to network closely with colleagues doing the same sort of work to continue to learn.
- Are you thinking laterally and creatively enough with personal budgets? In Nottinghamshire one young man used part of his personal budget to buy an electric voice recorder which provides prompts for up to three months in advance. This assisted him to structure his days and saved the council £63 per week on what it might have cost to provide support to meet this outcome.
Chris Mitchell will be speaking on the role of social workers in supporting adults with autism at our forthcoming conference on supporting adults with autism, on 4 October. Register before 28 September for a discounted place.
More on CPD
The Health and Care Professions Council has produced an overview of the new system of continuing professional development (CPD) that has replaced post-registration training and learning for social workers in England, and a guide to completing your CPD profile and how this relates to registration.
Further resources on autism assessments