‘The state of social work knowledge on autism must improve – the law requires it’

By Yo Dunn

Taken together, the Care Act 2014 and the 2015 revision of the statutory guidance under the Autism Act 2009 mean councils risk questions about the validity of their assessments of autistic adults if they fail to ensure assessors have sufficient autism-specific skills and access to ongoing specialist training.

Regulations under the Care Act require councils to ensure that any practitioner conducting an assessment has the skills, knowledge and competence to carry out the assessment and is appropriately trained. The statutory guidance under the Autism Act states that councils should ensure that people carrying out assessments of autistic adults have a good understanding of key aspects of autism, including how it presents across the lifespan and levels of ability. They should also receive specialist training.

Poor-quality, generic courses

However, at present, social workers are often expected to rely on whatever autism knowledge they picked up when qualifying (no matter how limited and dated). Any ongoing training on offer is generally limited to poor-quality, generic ‘awareness’ courses which focus on basic ‘textbook’ autism knowledge and don’t provide practitioners with the key practical skills needed to actually adapt assessment practice appropriately.

Nearly all social workers can tell me that autistic people have social difficulties and many can describe the triad of impairments.

But far fewer know that they could greatly help a new autistic client they are planning to visit by: sending a photograph of themselves and specific information about the purpose of their visit and the questions they plan to ask in advance; turning up on time; avoiding the use of strong fragrances and not touching or moving too close to the client (at least until they know them well enough to know their personal sensory preferences).

Beyond those (and other) practical basics, assessors also need access to more in-depth training to meet the legal requirements now in place.

Required knowledge

Where are the courses which provide meaningful knowledge in the areas set out in the Autism Act statutory guidance and how to apply it to Care Act assessment and care planning? For example:

• Types of reasonable adjustments to the assessment process an autistic client might need.
• Communication challenges in involving autistic clients in the assessment process, strategies for overcoming them and understanding when these challenges constitute ‘substantial difficulty’ and potentially trigger the duty to arrange independent advocacy under the Care Act.
• Where and how to access appropriate communication support to involve less verbal autistic clients in social care assessments.
• Ways in which the 10 Care Act eligibility ‘outcomes’, a person’s inability to achieve two of which may lead to them having eligible needs, might apply to individuals with profiles from across the autistic spectrum and at different stages of life
• How to gather evidence from observation without drawing inferences or making assumptions which may not apply (such as that a physically able person who is able to study for a degree must be able to dress themselves without assistance).
• Reflecting on assessment decision making to challenge assumptions about the relationship between intellectual, social and functional abilities which may not apply in autism. Essential to good-quality assessments is avoiding the tendency to underestimate functioning in the less verbal population and overestimate it in the more verbal population.
• What ‘wellbeing’ – which the Care Act requires local authorities to promote through their care and support functions – might look like from an autistic perspective (reflecting on the risks of making neurotypical assumptions which might not be valid, such as assuming that social interaction is necessarily positive).
• Autism-specific issues around safeguarding such as ability to assess risks and developmental differences in the area of sex and relationships.
• Improving the quality of capacity assessments and how to support decision making effectively for autistic clients.

Social workers deserve more

Publication this month of the Department of Health’s CPD curriculum guide and good practice manual for social workers on autism provides a useful, though somewhat limited, overview of autism specific knowledge that social workers need. There are some other helpful resources out there, such as the National Autistic Society’s guide to carrying out social care assessments. But the majority of social workers working outside of specialist autism teams need and deserve much more face-to-face training and support to develop skills in applying theoretical knowledge to the actual scenarios they are working with day to day.

Where, as in most areas, there is no specialist autism team to assess clients from across the spectrum, more verbal autistic adults and those without a formal diagnosis continue to be at risk of being denied social care assessments altogether because they don’t meet the criteria for either mental health or learning disabilities teams. This was always legally dubious but the Care Act has made it even clearer by creating a unified assessment and eligibility system for all client groups and setting a low threshold for triggering the requirement to assess. Some councils solve the legal problem by using generic adult social care teams. However assessors on these teams are even less likely to be able to access the specialist training those assessing autistic adults are now required to have.

Without access to specialist training, understandably many social workers fall back on the sources of knowledge available to them, such as having supported autistic clients previously or having an autistic family member. The trouble with this is that, as Dr Stephen Shore said: “If you’ve met one person with autism, you’ve met one person with autism”.

This sort of personal experience is no substitute for knowledge drawn from the research evidence base and the collective knowledge of the adult autistic community. Sooner rather than later councils need to change their learning and development commissioning to reflect the new legal requirements. Change is needed to ensure that in future all those assessing autistic clients have access to high quality ongoing specialist training.

Yo Dunn is an autism trainer, consultant and researcher, who has delivered training on the Care Act 2014. She is autistic and has two autistic children.