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CHW60-Supporting Autistic People and People Living with Autism Policy

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Supporting Autistic People and People Living with Autism Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, lawful, inclusive, rights-based and person-centred care and support for autistic people and people living with autism. The service recognises that autism is a lifelong neurodevelopmental condition and that each person’s experience, strengths, communication, sensory profile, routines, preferences, risks and support needs will be different.

{{org_field_name}} will ensure that autistic residents are supported to achieve their personal outcomes, maintain their dignity, exercise choice and control, develop independence where possible, and participate in day-to-day life in a way that is meaningful to them. The service will make reasonable adjustments to reduce barriers and will ensure that care and support is planned, delivered, reviewed and recorded in accordance with the individual’s personal plan.

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016, The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, the Welsh Government statutory guidance for care home services, the Social Services and Well-being (Wales) Act 2014, the Equality Act 2010, the Human Rights Act 1998, the Mental Capacity Act 2005, Deprivation of Liberty Safeguards, the Wales Safeguarding Procedures, and the Welsh Government Code of Practice on the Delivery of Autism Services.

The service will have regard to Welsh Government and CIW expectations, including rights-based practice, well-being outcomes, safeguarding, positive behaviour support, lawful and proportionate use of restrictive practice, communication support, Welsh language needs, duty of candour, staff competence, and continuous improvement.

2. Scope

This policy applies to all staff, agency workers, volunteers, managers, the Responsible Individual, visiting professionals and any other person involved in the provision, management or oversight of care and support at {{org_field_name}}.

This policy applies to all autistic residents and residents who may have autism, whether formally diagnosed, awaiting assessment, self-identifying, or where autism-related needs are identified through assessment, care planning or professional advice. The policy also applies where autism occurs alongside other needs or conditions, including learning disability, dementia, mental health needs, sensory impairment, communication needs, physical disability, acquired brain injury, trauma, anxiety, epilepsy or other health conditions.

The policy covers admission and pre-admission assessment, provider assessment, personal planning, reviews, communication, Welsh language needs, sensory needs, environmental adjustments, daily routines, emotional well-being, positive behaviour support, safeguarding, restrictive practice, mental capacity, deprivation of liberty, staff training, involvement of families and representatives, access to healthcare and specialist advice, monitoring and quality assurance.

Where a resident has a representative, advocate, attorney, deputy, family member, placing authority, service commissioner or relevant health or social care professional involved in their care, staff will work collaboratively with them, subject to the resident’s consent, mental capacity, confidentiality and best interests requirements.

3. Principles of Support for Autistic Residents

Autistic residents will be supported through a rights-based and outcomes-focused approach. Staff must uphold the resident’s human rights, equality rights, privacy, dignity, autonomy, communication rights, cultural identity and Welsh language needs. Staff must not make assumptions about a resident’s abilities, wishes, capacity, behaviour, communication or quality of life because the person is autistic. Support must be based on individual assessment, the resident’s views, wishes and feelings, professional advice where required, and the resident’s personal outcomes.

Person-Centred Care and Personal Outcomes

Each autistic resident will have a personal plan that explains how their care and support needs will be met on a day-to-day basis and how they will be supported to achieve their personal outcomes. The plan will include the resident’s strengths, preferences, routines, communication needs, sensory profile, emotional well-being needs, cultural and spiritual needs, Welsh language needs, relationships, interests, risks, reasonable adjustments and support strategies.

The personal plan will be developed with the resident and, where appropriate, their representative, family, placing authority, service commissioner and relevant professionals. The resident’s views, wishes and feelings must be central to the plan. Where the resident has difficulty expressing their wishes verbally, staff will use appropriate communication methods and observations to support meaningful involvement.

Before agreeing to provide care and support, the service will consider whether it can meet the person’s assessed needs and support them to achieve their personal outcomes. This will include considering the person’s care and support plan, health assessments, autism-specific needs, risks to the resident, risks to others, reasonable adjustments and compatibility with the existing environment and resident group.

The provider assessment will be completed within 7 days of the commencement of care and support, or sooner where needed. The personal plan will be reviewed and updated following the provider assessment, whenever needs change, and at least every 3 months.

Staff must follow the resident’s personal plan consistently while remaining responsive to the resident’s changing needs, preferences, health, mood, communication and sensory presentation.

Communication, Information and Welsh Language Needs

Staff will identify, record and follow each resident’s preferred communication methods. This may include spoken language, written information, objects of reference, photographs, symbols, visual timetables, social stories, Picture Exchange Communication System (PECS), Makaton, British Sign Language, assistive technology, communication passports, pain tools, sensory cues, behaviour cues, or support from speech and language therapy.

Information must be provided in a format, style, pace and language that the resident can understand. Staff must allow additional processing time, avoid unnecessary ambiguity, avoid rushing the person, and check understanding in a respectful way.

The service will take reasonable steps to meet the resident’s language needs, including Welsh language needs. Where a resident’s first or preferred language is Welsh, the service will work towards actively offering care, support, information and communication in Welsh wherever reasonably practicable.

Communication needs will be recorded in the personal plan and communicated to staff, agency workers and relevant professionals. Staff must not interpret lack of speech, reduced eye contact, distress, withdrawal, repetitive movement or refusal as non-compliance without first considering communication need, sensory distress, pain, anxiety, trauma, unmet need, environmental triggers or changes to routine.

Where there are concerns about communication, swallowing, pain recognition, capacity, distress or behaviour, staff will seek appropriate professional advice, including from speech and language therapy, psychology, occupational therapy, GP, community learning disability team, mental health services or other relevant specialists.

Sensory Needs and Environmental Adjustments

The service will assess, record and respond to each autistic resident’s sensory needs. This will include identifying sensory sensitivities, sensory-seeking needs, preferred calming strategies, environmental triggers and situations that may cause distress.

Reasonable adjustments will be made where required. These may include reducing noise, reducing unnecessary touch, offering quieter spaces, supporting predictable routines, adapting lighting, minimising strong smells, adjusting mealtime environments, offering preferred clothing or bedding textures, providing ear defenders or sensory items, supporting access to outdoor space, and using visual information to support predictability.

Residents will be supported to access private, quiet and calming spaces when needed. Staff must respect the resident’s need for recovery time after distress, social interaction, appointments, personal care, visitors, noise, change or sensory overload.

The environment will be reviewed where a resident shows signs of distress, withdrawal, agitation, increased repetitive behaviour, sleep disruption, refusal of care, changes in eating or drinking, or other signs that may indicate unmet sensory or emotional need.

Environmental restrictions must not be used as a default response to autism-related distress. Any restriction must be lawful, necessary, proportionate, time-limited, recorded, reviewed and the least restrictive option available.

Emotional Well-being, Distress and Positive Behaviour Support

Staff will understand behaviour as a form of communication and will seek to identify the reason for distress before responding. Possible causes may include pain, illness, anxiety, trauma, bereavement, sensory overload, communication difficulty, change in routine, loneliness, hunger, thirst, fatigue, medication effects, unmet need, fear, environmental factors, or lack of meaningful activity.

Where a resident experiences distress or behaviours of concern, the service will use person-centred Positive Behaviour Support. Support plans will focus on prevention, communication, emotional regulation, meaningful occupation, environmental adjustment, consistency, de-escalation and quality of life.

Positive Behaviour Support plans will be based on assessment and, where required, specialist advice. They will identify known triggers, early warning signs, proactive strategies, preferred calming approaches, communication approaches, safe responses, post-incident support and actions to reduce recurrence.

Staff must use calm, respectful and non-punitive responses. Staff must not use shaming, punishment, threats, seclusion, intimidation, blanket restrictions, unnecessary confrontation or withdrawal of basic care as a response to distress.

Following any significant incident, staff will check the resident’s physical and emotional well-being, provide reassurance and recovery time, record the incident, consider whether safeguarding, medical review or professional advice is needed, and review whether the personal plan or Positive Behaviour Support plan requires updating.

Encouraging Independence and Social Inclusion

4. Mental Capacity, Consent and Deprivation of Liberty

Autistic residents must be presumed to have capacity to make their own decisions unless it is established that they lack capacity for a specific decision at the specific time the decision needs to be made. Staff must not assume that a resident lacks capacity because they are autistic, communicate differently, make an unwise decision, require additional processing time, or become distressed.

Staff will support residents to make decisions by providing information in an accessible format, allowing time to process information, reducing sensory distractions, involving trusted people where appropriate, and using the resident’s preferred communication methods.

Where there is reason to believe that a resident may lack capacity for a specific decision, a mental capacity assessment must be completed in accordance with the Mental Capacity Act 2005. Any best interests decision must be recorded and must consider the resident’s wishes, feelings, beliefs, values, rights, least restrictive options, and the views of relevant people where appropriate.

Where care arrangements may amount to a deprivation of liberty, the service will ensure that lawful authority is in place through the appropriate Deprivation of Liberty Safeguards process. The service must not deprive a resident of their liberty without lawful authority.

Any restrictive practice, continuous supervision, locked doors, restrictions on leaving, restrictions on contact, use of monitoring equipment, or limitations on movement must be considered in line with mental capacity, consent, human rights, safeguarding and deprivation of liberty requirements.

4.1 Restrictive Practice, Control and Restraint

The service will avoid restrictive practice wherever possible and will promote proactive, preventative and person-centred support. Restrictive practice must only be used where it is necessary to prevent harm, proportionate to the risk, the least restrictive option available, and in accordance with the resident’s assessed needs, personal plan, Positive Behaviour Support plan, Mental Capacity Act requirements and the service’s Control and Restraint Policy.

Restrictive practice includes any act that restricts a resident’s movement, liberty, choice or normal access to care and support. This may include physical restraint, mechanical restraint, environmental restriction, chemical restraint, locked doors, constant supervision, restrictions on possessions, restrictions on food or drink, restrictions on contact, or preventing a resident from leaving an area.

Control or restraint must only be used by staff who have received appropriate training in the method used. Any incident involving control, restraint or restrictive practice must be recorded within 24 hours and reviewed by the manager. The review must consider the resident’s well-being, whether the intervention was lawful, necessary and proportionate, whether less restrictive alternatives were available, whether medical or safeguarding action is required, and whether the personal plan or Positive Behaviour Support plan needs to be updated.

The use of restrictive practice will be monitored through audits, incident analysis, safeguarding reviews, staff supervision and the quality-of-care review process.

4.2 Safeguarding Autistic Residents

Autistic residents may be at increased risk of abuse, neglect, exploitation, bullying, discrimination, restraint, institutional practice, communication-related harm, financial abuse or inappropriate assumptions about behaviour. Staff must remain alert to these risks and must act promptly where there is any concern.

The service will follow the Wales Safeguarding Procedures and the Safeguarding Adults from Abuse and Improper Treatment Policy. Staff must report any concern about abuse, neglect, improper treatment, discriminatory practice, unexplained injury, distress, inappropriate restraint, medication misuse, financial abuse, sexual abuse, psychological abuse, self-neglect or organisational abuse.

Residents will be supported to understand how to raise concerns in a way that is accessible to them. This may include easy-read information, visual information, communication aids, advocacy, trusted staff support, family support where appropriate, or referral to independent advocacy.

Where a safeguarding concern involves an autistic resident, the service will ensure that communication needs, sensory needs, mental capacity, advocacy needs and emotional support needs are considered throughout the safeguarding process.

5. Staff Training and Responsibilities

All staff will receive autism awareness training appropriate to their role. Staff working directly with autistic residents must receive additional training and guidance relevant to the resident’s assessed needs and personal plan.

Training will include autism understanding, sensory processing, communication differences, reasonable adjustments, Welsh language needs, anxiety and distress, trauma-informed support, Positive Behaviour Support, prevention and de-escalation, safeguarding, Mental Capacity Act, Deprivation of Liberty Safeguards, consent, restrictive practice, equality and human rights, duty of candour, documentation and incident reporting.

Staff must be able to demonstrate that they understand the resident’s personal plan, communication profile, sensory needs, risks, routines, preferences, support strategies and actions to take if the resident becomes distressed.

The manager will ensure that autism-related training needs are identified through induction, supervision, appraisal, incident review, care plan review, quality assurance and changes in residents’ needs. Refresher training will be provided at intervals determined by the service and sooner where practice concerns, incidents, complaints, safeguarding concerns, regulatory changes or changes in resident needs indicate this is required.

Agency staff and temporary staff must receive relevant information before supporting an autistic resident. This must include essential communication needs, risks, sensory needs, distress indicators, routines, personal care preferences, restrictive practice requirements and emergency support arrangements.

The service will identify a named Autism Lead or, where a separate Autism Lead is not appointed, the Registered Manager will hold responsibility for ensuring autism-related good practice is implemented, monitored and reviewed. The Autism Lead or Registered Manager will support staff practice, promote reasonable adjustments, liaise with professionals, review incidents and ensure learning is embedded.

Staff must work in accordance with the Social Care Wales Code of Professional Practice and the service’s policies and procedures. Staff must seek advice where they are unsure how to support a resident safely, lawfully or effectively.

5.1 Access to Healthcare and Specialist Advice

The service will support autistic residents to access healthcare and specialist advice in a timely way. This includes support to access GP, dental, optometry, pharmacy, community nursing, speech and language therapy, occupational therapy, psychology, psychiatry, learning disability services, mental health services, neurology, dietetics, physiotherapy, podiatry, palliative care and other relevant services.

Staff will recognise that autistic residents may communicate pain, illness, anxiety or distress differently. Changes in behaviour, sleep, eating, drinking, continence, mobility, communication, personal care tolerance, social engagement or emotional regulation must prompt consideration of physical or mental health needs.

Where a resident requires appointments, staff will make reasonable adjustments to support access. This may include preparing the resident using visual information or social stories, arranging quieter appointment times where possible, sharing communication passports with professionals, allowing additional time, supporting a trusted person to attend, and planning sensory or recovery needs after the appointment.

Advice from healthcare and specialist professionals will be recorded and reflected in the resident’s personal plan.

5.2 Duty of Candour and Openness

{{org_field_name}} will act in an open and transparent way with residents, representatives, placing authorities and service commissioners where relevant. Where something goes wrong, staff and managers will communicate honestly, provide appropriate information, explain actions being taken, offer an apology where appropriate, and support the resident in a way that meets their communication and emotional needs.

Where an autistic resident is affected by an incident, complaint, safeguarding concern, use of restraint, medication error, injury or other adverse event, communication must be adapted to the resident’s level of understanding, preferred communication method, sensory needs and emotional state.

The manager will ensure that incidents are recorded, investigated, reported where required, and used to improve care and support. Learning from incidents will be shared with staff through supervision, team meetings, training and updates to personal plans or policies.

6. Related Policies

7. Equality, Rights and Reasonable Adjustments

Autistic residents have the same rights as all other residents, including the right to dignity, privacy, safety, respect, family life, autonomy, communication, participation, cultural identity, Welsh language, protection from discrimination, and support to achieve personal outcomes.

The service will make reasonable adjustments where autistic residents experience barriers to care, communication, activities, healthcare, meals, personal care, relationships, visitors, complaints, safeguarding processes or involvement in decisions.

Reasonable adjustments will be individualised and recorded in the personal plan. They may include adjustments to communication, staffing approach, routines, environment, sensory input, appointment planning, personal care, mealtimes, activities, risk management and involvement in reviews.

Staff must challenge discriminatory, dismissive or institutional practice. Autism must never be used as a reason to deny choice, restrict liberty, ignore distress, exclude a resident from meaningful activity, or fail to investigate health, safeguarding or emotional well-being concerns.

8. Documentation and Records

Records relating to autistic residents must be accurate, respectful, factual, timely and person-centred. Staff must avoid judgemental language and must describe what was observed, what the resident communicated, possible triggers, support provided, outcomes, follow-up actions and whether the personal plan requires review.

The following information must be recorded where relevant:

Records must be available to relevant staff while respecting confidentiality and data protection requirements.

9. Monitoring and Review

This policy will be reviewed annually or sooner where there are changes in legislation, Welsh Government guidance, CIW requirements, Social Care Wales guidance, safeguarding procedures, best practice, the statement of purpose, resident needs, incidents, complaints, safeguarding concerns or organisational learning.

The manager will monitor implementation of this policy through care plan audits, provider assessment reviews, personal plan reviews, incident analysis, restraint and restrictive practice audits, safeguarding audits, complaints and compliments, medication reviews, staff supervision, training records, feedback from residents and representatives, and feedback from professionals and commissioners.

The service will use information from monitoring to improve outcomes for autistic residents. Where audits identify gaps, the manager will create an action plan with clear timescales, responsible persons and evidence of completion.

The Responsible Individual will maintain oversight of how the service supports autistic residents as part of governance, quality assurance and quality-of-care review arrangements.

The service will also consider CIW inspection themes and ratings, including well-being, care and support, leadership and management, and environment. From April 2025, CIW ratings apply to care home and domiciliary support services and are awarded across these key themes.

Any changes to this policy that directly affect residents or their representatives will be communicated in an accessible format.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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