Tag Archives: adults

Autism-friendly cities: making a world of difference

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At this time of year, high streets and shops across the country are bustling, decked out with lights and colourful decorations, and of course, the familiar Christmas tunes.

For many, this is part and parcel of the exciting run up to Christmas.  However, for autistic people, the added crowds, lights and noise can turn an already challenging experience into a sensory nightmare.

Indeed, although more than 1 in 100 people in the UK are on the autism spectrum, many still struggle to access local shops and services.  Places that many neurotypical people may take for granted – shops, theatres, cinemas, cafes and restaurants, hairdressers, libraries and museums, public toilets, and public transport – can be particularly challenging environments for autistic people.

Unpredictable and unfamiliar noises, lights, smells, crowds, queues, and other events can be overwhelming, and may cause sensory distress – ultimately leading to a meltdown.  Meltdowns may present as crying, screaming, kicking, biting or lashing out.  A lack of understanding and awareness of autism among the public – including unfriendly looks, judgements and comments – can further enhance the distress experienced.

In 2015, a YouGov poll found that 99.5% of people in the UK had heard of autism. However, there remains a lack of public understanding about how it may present, and the associated challenges autistic people face.  This is perhaps best illustrated by the recent case of a young woman with Asperger’s being forcibly removed from a cinema for ‘laughing too loudly’.  Unfortunately, this experience is not unique.  Research has found that as many as 28% of people have been asked to leave a public space because of behaviour associated with autism.

Indeed, many autistic people and their families have changed their own behaviour to reduce the chance of experiencing intolerance from the public.

It’s perhaps not surprising, then, that social isolation is a common issue – 79% of autistic people and 70% of parents feel socially isolated.  Almost half (44%) sometimes don’t go out because they’re worried about how people will react.

Increasing public understanding

The recent Too Much Information (TMI) campaign, delivered by the National Autistic Society (NAS), aims to increase public understanding of the five core features of autism.

Those five core features are:

  • anxiety in social situations
  • anxiety with unexpected changes
  • sensory overload
  • meltdowns
  • processing time

Creating an autism friendly city

One response has been the drive towards the creation of ‘autism-friendly’ cities.

According to Autism Together and Autism Adventures, an autism-friendly city is one in which autistic people can ‘use public transport, shop for food and clothes, take part in sports and leisure activities, visit cultural and tourist institutions and eat in restaurants.’

The NAS have established an ‘Autism Friendly Award’, which aims to help businesses make the small changes that make the most difference to autistic people.  Their Autism Friendly Awards toolkit sets out a helpful five-point checklist:

  • customer information: providing appropriate information to help support autistic people and their families’ visitor or customer experience
  • staff understanding of autism: developing staff understanding
  • physical environment: making appropriate and reasonable adjustments within the limits of the physical environment
  • customer experience: a willingness to be flexible and providing a clear way for autistic people and their families to provide feedback
  • promoting understanding: committing to helping increase wider public understanding of autism

Examples of good practice

In Glasgow, the council have been working to make the city centre autism-friendly.  The plans have focused initially upon shopping centres, transport hubs, museums, cinemas and key operational staff across the city centre.

The Glasgow Film Theatre (GFT), Scotland’s oldest independent cinema, recently became the first cinema in the UK to achieve an Autism Friendly Award for their work with children and adults.  This includes monthly screenings for autistic adults and children, with the volume slightly lowered, stair lights remaining switched on, house lights dimmed and a chill out zone provided. Trained ‘autism facilitators’ also answer questions at the end of each film.

Other organisations have followed the GFT’s lead. Glasgow Science Centre, for example, has recently introduced autism friendly hours.

In the North East, Aberdeen has also announced its intention to work towards autism-friendly status.

As well as raising awareness and making key shopping locations more accessible for autistic people, Aberdeen also plans to introduce autism-friendly libraries, including pop up sensory sessions designed for autistic children.

Research has shown as many as 40% of people with autism never visit a library – however, 90% have said they would be more likely to visit their local library if some changes were made.

Such adjustments include staff training, increased tolerance of noise and understanding from the public.  Dimensions have released free online training and top tips for libraries looking to become autism-friendly. It notes that while many people with autism need a quiet environment, they may make noise themselves – for example, by talking to themselves or others, becoming excitable or moving around. They highlight the importance of making clear to the public that the library is autism-friendly, which includes a tolerance of certain levels of noise.

Other cities that have been working towards autism-friendly status include: Bristol –  whose airport has won an Autism Friendly Award; Liverpool – where autism champions are being supported to recognise and respond to autism; and Newcastle in Northern Ireland – which has been named as Northern Ireland’s first autism-friendly town. It is anticipated that being autism-friendly will help boost the local economy and tourism.

Other ways to make cities autism-friendly

As well as organisations themselves making adjustments and promoting autism understanding among staff and customers, there are a few other ways in which cities can be made more autism-friendly.

Making public transport more accessible is a key challenge.  More than half of autistic people avoid public transport due to fears of disruption.  There are many things that can be done to help make public transport less distressing for autistic people.

From an architecture and design perspective, there are also many other things that can help to make urban buildings and spaces more accessible, in regard to ventilation, acoustics, heating, lighting, layout and outdoor spaces.

From a town planning perspective – there is currently a lack of research and guidance on the design of places for autistic people per se, however, there may be some transferability of lessons from work on the creation of dementia-friendly and child-friendly spaces.

For example, the provision of clear signage and removal of street clutter may be beneficial for autistic people.  Edinburgh City Council has recently banned on-street advertising structures in order to make streets more accessible for people with disabilities.

There have also been concerns raised that shared spaces – including the removal of road signs, traffic crossings and delineation between roads/walkways – may negatively impact upon autistic people, who may struggle with the uncertainty such schemes deliberately create.  This is an area where more research and guidance is needed.

The way forward

Creating a city that is autism-friendly requires a multi-faceted approach that includes both raising public awareness and understanding, and creating towns and places that allow for the specific challenges that are faced by autistic people and their families.

Many steps that can be taken are low cost and easy to implement – and support is available from a range of national and local autism organisations, such as the NAS.

Even just reacting with kindness and compassion when witnessing a possible autistic meltdown – perhaps offering some solution such as a quiet space – is significant.  The sum of these small changes can make a world of difference to autistic people and their families.

“I wouldn’t change my son for the world but I will change the world for my son.” Julie Simpson, Founder of Autism Adventures

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Fighting the cold: working to reduce excess winter deaths

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Image from Flickr user FranTaylor under Creative Commons License

Image from Flickr user FranTaylor under Creative Commons License

We may have all breathed a sigh of relief when last week’s cold snap finally eased, but for those working in public health the consequences of the cold weather are still playing out.

Cold weather poses a significant risk to health. There is a notable rise in deaths, and also illnesses and injuries, during the winter period. Indeed, in England and Wales there were 11.6% (18,200) more deaths in 2013/14 during the winter period (December to March) compared with the non-winter period (known as “excess winter deaths”).

Older people, particularly those aged over 75 years old, are most vulnerable to cold weather-related illness. The majority of excess winter deaths occur within this age group and those living on their own or who are socially isolated are most at risk. Other groups at risk include those experiencing chronic or severe illnesses, particularly heart conditions or circulatory disease, children under the age of five, and homeless people /street sleepers.

The reasons why cold weather has such a negative impact on health are complex and interlinked with fuel poverty, poor housing and health inequalities. There can be an increase in circulating infectious diseases, particularly flu and norovirus, and snow and ice can cause falls. Cold weather has also been linked to increased cases of hypothermia, carbon monoxide poisoning (from faulty heating appliances), and mental health problems such as depression and anxiety.

However, there is evidence to suggest that many of these ill effects are preventable. In some northern European countries, such as Finland, the rate of winter deaths is far lower than that in England, despite experiencing much lower temperatures.

To help address this, the Government has published an annual ‘Cold Weather Plan’ (CWP) since 2011 aimed at local authorities, health and social care staff and any professionals working with vulnerable people. The plan operates a system of cold weather alerts, comprising five levels (Levels 0-4), from year-round planning for cold weather, through winter and severe cold weather action, to a major national emergency. Each alert level aims to trigger a series of appropriate actions, which are detailed in the plan. The latest CWP was published in October 2014.

It stresses the importance of year round planning and all-winter action for reducing excess winter deaths and relieving the additional pressures on the NHS and social care which occur during the winter months. Recommended all-year actions include:

  • addressing fuel poverty
  • improving housing and energy efficiency measures
  • raising awareness of preventative actions among staff.

All-winter actions (November to March) include:

  • communicating with the public about what they can do to reduce the risk of cold weather to their health
  • identifying vulnerable clients
  • supporting vulnerable clients to seek appropriate help.

There are also key public health messages which should be communicated with residents/patients, relating to flu vaccinations, keeping homes adequately heated and ventilated, available financial support, and looking after vulnerable older neighbours and relatives.

A guide to communicating effectively with the public during periods of extreme weather was published recently by the Local Government Association (LGA). The LGA have also provided guidance for local authorities on how they can help to reduce the negative effect of cold weather on health. It highlights examples of innovative schemes, including the installation of free temperature sensors and a volunteer ‘winter squad’ to care for vulnerable residents.

Investing in cold weather planning is important – although the media focuses on travel disruption during cold weather, for many of the most vulnerable in our society it can be a death sentence.

Further reading

The Information Service has a number of resources on cold weather planning – a selection are listed below.

Cold weather plan for England 2014: making the case – why long-term strategic planning for cold weather is essential to health and wellbeing

A turn for the better (Liverpool’s Healthy Homes Programme), IN Property Journal, Jul/Aug 2014, pp42-44 (Ref No. A51407)

Staying in touch (social media), IN Local Government News, Vol 36 No 2 Mar/Apr 2014, pp44-45 (Ref No. A49753)

Behind cold doors: the chilling reality for children in poverty

Reducing harm from cold weather: local government’s new public health role

N.B. Abstracts and access to journal articles are only available to members.

Can the Care Act really provide the transformation in adult social care needed for modern society?

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pregnant carer giving pills and medication to her patientBy Heather Cameron

The legislative framework for adult social care in England has been described as out-dated by the Department of Health (DH) as it is focused on crisis intervention rather than prevention and early intervention, and on the provision of services, rather than enabling the system to be centred around the health and wellbeing of people and carers. The DH has therefore highlighted the need for government intervention to reform the legal framework so it better fits the purpose of modern care and support.

The government’s objectives for adult social care are to improve people’s quality of life, delay and reduce the need for care, ensure positive care experiences and safeguard adults from harm. The Care Act 2014 was passed into law on 14th May 2014 with the aim of transforming adult social care in England to meet these objectives.  Although the Act is generally concerned with care and support matters in England, some provisions extend to the devolved nations.  The main focus of the Act is on promoting individual wellbeing and preventing the need for care and support. In particular, it makes provision:

  • to reform the law relating to care and support for adults and the law relating to support for carers;
  • about safeguarding adults from abuse or neglect;
  • about care standards;
  • about Health Education England;
  • about the Health Research Authority;
  • about integrating care and support with health services; and
  • for connected purposes.

According to Care and Support Minister, Norman Lamb: “the Care Act represents the most significant reform of care and support in more than 60 years, putting people and their carers in control of their care and support. For the first time, the Act will put a limit on the amount anyone will have to pay towards the costs of their care.”

Due to come into force in April 2015, with its provisions related to funding reform to be implemented a year later, the success, or otherwise, of the Care Act’s implementation is as yet unknown.

Nevertheless, there has been much discussion over the potential issues and challenges with regard to implementation. The College of Social Work (TCSW) argues that the implementation of the legislative reforms “will be challenging and demand significant cultural and attitudinal changes, both strategically and in professional practice”.

The Act presents significant changes for local authorities which will be challenging to implement in the proposed timescale. Concerns have been raised by both local authorities and charities over the funding of the Act’s provisions and the sustainability of adult social care services. A recent article published in Community Care highlights such concerns among councils, noting that nine out of 10 councils believe key parts of the Act will be jeopardised if the government fails to provide local authorities with adequate funding for implementing the reforms.

According to London Councils, London is facing double the shortfall in funding to prepare for the Care Act than previously thought with proposed new funding arrangements unveiled by the government to leave the capital with a £36 million gap.

Moreover, a subsequent article in Community Care suggests that local authorities need to consider the training challenge now in order to negotiate the issues raised by the new funding reforms.

The main costs of the Act relate to improved legal rights for carers (rising to £175 million per annum). However, there may be additional costs, for example where local authorities face increased demand for services due to improved information. Greater clarification on the support available to carers could potentially increase the workload for social care professionals as the number of carers’ assessments could also increase.

The additional requirements of providing support to self-funders as well as carers could also take its toll on councils. Caroline May, business partner in finance at Havering LBC noted at a recent roundtable that:

“There are a lot of unknowns out there that will present us with financial challenges. I think culture shift is going to be huge across the board.”

The Association of Directors of Adult Social Care (ADASS), which represents local authorities, is unconvinced that local authorities can implement the changes required in the proposed timescale. In a joint report with the Local Government Association, they highlight the financial challenges local authorities face, particularly at a time of budget cuts and increasing demand for services. A recent inquiry into adult social care in England has highlighted that there was an 8% real terms cut in spending between 2010/11 and 2012/13; and demand for care provided by adults is projected to rise by over 50% between 2007 and 2032, while the supply of this care is projected to rise by only 20%, according to Carers UK.

Despite these funding issues, however, cost savings have also been identified in relation to public expenditure savings of improved support for carers, according to the DH’s recent impact assessment, which also states that these cost savings outweigh other new costs overall. The potential benefits of the Act for people with care and support needs which could also lead to savings were identified as: “improved wellbeing, better prevention of care and support need, greater clarity, consistency and equality of access to care and support and reduction of unmet need.”

It will undoubtedly be challenging to implement the provisions of the Care Act and it remains to be seen whether the funding provided will be adequate.

Only time will tell whether the proposed reforms will truly transform the currently outdated adult social care system.

 

Further reading

The Idox Information Service has a wealth of research reports, articles and case studies on a range of adult social care issues. Items we’ve recently summarised for our database include:

The Care Act and the care market: conference summary

Adult social care in England: sixth report of session 2014-15 (HC 518)

Using technology to deliver social care, IN Local Government Chronicle, No 7598 17 Jul 2014

Carers’ quality of life and experiences of adult social care support in England, IN Health and Social Care in the Community, Vol 22 No 4 Jul 2014

Transforming adult social care (improving efficiency in council social care services), IN Local Government Chronicle, 5 Jun 2014

Care Act 2014

Understanding personalisation: implications for social work, IN Journal of Social Work, Vol 14 No 3 May 2014

State of caring 2014

Care home top-up fees: research with local authorities

Making our health and care systems fit for an ageing population

N.B. Abstracts and full text access to subscription journal articles are only available to members of the Idox Information Service.

Literacy matters … and we’re still not doing enough to improve it

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Image by Elke Wetzig under Creative Commons License, via Wikimedia Commons

Image by Elke Wetzig under Creative Commons License, via Wikimedia Commons

By James Carson

Three new reports published in September have highlighted the significance of literacy in our lives.

The first report, from the National Literacy Trust (NLT), discusses how low levels of literacy can contribute to health inequalities, poverty and crime. Among the findings, the NLT notes that:

  • Those with lower levels of literacy are more likely to be obese, smoke, and drink heavily;
  • Those with low literacy are more likely to live in disadvantaged housing conditions and more deprived areas;
  • Young people who are not in education, employment or training (NEET) are 20 times more likely to commit a criminal offence.

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