Donegal Autism Pilot Project HSE New Directions Learning

Donegal Autism Pilot Project - HSE New Directions Learning Event, Tullamore Court Hotel, May 18 th 2016.

Tobar Training Centre Click below to view the Tobar Training Centre location

Outline of the Change / Reconfiguration More complex referrals Challenges for both staff and service users No new staff Tobar Service Users with ID & Autism with behaviours that challenges Increased to 36 service users

Practical Steps Taken MDT Steering Group Three distinct phases APP Training Services Family Involvement Service within an existing service Ongoing training, supervision and support from APP 1 day per week Bespoke Staff Training Autism Project Psychology Psychiatry Social Work Occupational Guidance ID Services Rotation of staff

Practical Steps Taken A Phased Approach 1 • Assessment, ASD awareness/simulation activities Bespoke Training, Read the person- PBS plan, Sensory Training, ASD Environment, 2 • Skills / Capacity Building, • Centre Reintegration • All Staff working with trainees • Community Integration 3

Challenges Involved Service Users Families Staff Limited staff awareness of their individual needs No suitable service for their sons/daughters with behaviours that challenge No new staff/ more complex service users Autism UNFRIENDLY Environment Limited engagement with services High rate of absenteeism /sick leave High stress levels and burnout High Levels of Anxiety Poor communication Assault Low engagement/Isolation Negative previous experiences Limited Understanding of Autism

Challenges Overcome Service Users Autism Friendly Environment Families Tailored Formal daily communication system Individualised skill building plans Bespoke staff training regarding service users unique needs Intensive bespoke staff training Third party expertise 1 day a week 3/ 6 monthly Review meetings Individualized Positive Behavior Support plans (PBS) Peer Buddy System Staff Rotation of staff Specific protocols and procedures Monthly informal meetings with Social work Understanding of Autismsimulation activities

Overcoming the Challenges View the ASD Friendly Environment and Skills-Building

Overcoming Staff Challenges -High staff stress levels when working with ASD service users with behaviors that challenge -Frequent staff absenteeism -Staff burnout -Small group of ASD staff identified who received intensive bespoke training-ASD coordinator established -All staff received bespoke training, shadowing/mentoring provided from ASD staff group -ALL staff now working with service users -Staff report increase job satisfaction

Overcoming the Challenges Project- Collaborating with the Men’s Shed View the Sound Board Insulation

What do the changes mean for the Service User(s) Decrease in behaviours that challenge 10 9 8 7 6 Pre Intervention 5 Post Intervention 4 3 2 1 0 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec

What do the changes mean for the Service User(s) A brief case study- Service User A Before After • High levels of inappropriate touching and masturbation • Fatigue – sleeping within the centre • Staff avoidance of this service user • Peer avoidance • Significant rituals • Limited engagement in group activities • Antagonistic behaviour • No masturbation, appropriate interactions • Increased energy levels (no sleeping) • All staff working with this service user • Positive peer relationships, peer ‘buddies’ • Reduction in rituals • Engagement in all group activities • Reduction in antagonistic behaviour, increase in mischievous / playful interactions

What do the changes mean for the Service User(s) Individualised Behaviour Support Strategies View individualised behaviour supports documents

What do the changes mean for the Service User(s) Feedback from Service Users’ Families. Taken directly from monitoring report by Occupational Guidance Service *Names have been changed John is ‘more relaxed, calm at home’ since the project started • Brendan is ‘more relaxed’ staff are beginning to ‘tap into his potential’ ‘Excellent communication’ between staff and the family • The environmental changes, the effort and approach taken in the programme is benefitting C’

What do the changes mean for the Service Structures Staff • Highly Trained Staff • Flexible Staff Rotas • Formal Communication system between day and respite / residential services • Formal Communication system with families • Internal Service Policy, protocols and procedures in responding to behaviors that challenge • Autism friendly surroundings • Holistic behaviour support strategies and plans • Strength focused

Implementing New Directions in the ASD Pilot Project in Tobar Training Centre Before After Formal Communication system between day and respite / residential services