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Implementing UK Autism Policy & National Institute for Health and Care Excellence Guidance--Assessing the Impact of Autism Training for Frontline Staff in Community Learning Disabilities Teams

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Title: Implementing UK Autism Policy & National Institute for Health and Care Excellence Guidance--Assessing the Impact of Autism Training for Frontline Staff in Community Learning Disabilities Teams
Language: English
Authors: Clark, Alex, Browne, Sarah, Boardman, Liz, Hewitt, Lealah, Light, Sophie
Source: British Journal of Learning Disabilities. Jun 2016 44(2):103-110.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA
Peer Reviewed: Y
Page Count: 8
Publication Date: 2016
Document Type: Journal Articles
Reports - Research
Descriptors: Autism, Knowledge Level, Foreign Countries, Learning Disabilities, Questionnaires, Focus Groups, Feedback (Response), Outcomes of Education, Administrator Attitudes, Administrator Education, Futures (of Society), Interdisciplinary Approach, Community Services, Health Personnel
Geographic Terms: United Kingdom
DOI: 10.1111/bld.12116
ISSN: 1354-4187
Abstract: UK National Autism Strategy (Department of Health, 2010 and National Institute for Health and Care Excellence guidance (NICE, 2012) states that frontline staff should have a good understanding of Autism. Fifty-six clinical and administrative staff from a multidisciplinary community Learning Disability service completed an electronic questionnaire to evaluate levels of Autism knowledge. The results showed that, compared with clinical staff, administrative staff were more limited in their understanding of Autism and less able to access relevant Autism training. Autism training was provided for administrative staff. Focus group feedback about the training sessions and subsequent changes to practice concluded that the outcome of the training was positive. "Autism-friendly" changes to administrative practice included alterations to waiting environments, adapted communication for people with Autism and increased communication between clinical and administrative staff about the needs of people with Autism. Future Autism training for all frontline staff and ongoing evaluation of health professionals' Autism knowledge are discussed.
Abstractor: As Provided
Entry Date: 2016
Accession Number: EJ1097498
Database: ERIC
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  Value: <anid>AN0114539376;f0401jun.16;2018Jul06.10:17;v2.2.500</anid> <title id="AN0114539376-1">Implementing UK Autism policy & national institute for health and care excellence guidance- assessing the impact of Autism training for frontline staff in community learning disabilities teams. </title> <p>Accessible summary: Learning Disabilities staff were asked how much they know about Autism & people with Learning Disabilities.Doctors, nurses and other health staff knew quite a lot about Autism. Secretaries had not been offered any training about Autism for people with Learning Disabilities.Training about Autism was given to secretaries. We asked them to tell us what they thought of the training and how this had helped them do things differently.Secretaries felt that the training had helped with feeling valued and with understanding Autism. More help was needed to change the way they work with people with Autism. Summary: UK National Autism Strategy (Department of Health, 2010 and National Institute for Health and Care Excellence guidance (NICE, 2012) states that frontline staff should have a good understanding of Autism. Fifty‐six clinical and administrative staff from a multidisciplinary community Learning Disability service completed an electronic questionnaire to evaluate levels of Autism knowledge. The results showed that, compared with clinical staff, administrative staff were more limited in their understanding of Autism and less able to access relevant Autism training. Autism training was provided for administrative staff. Focus group feedback about the training sessions and subsequent changes to practice concluded that the outcome of the training was positive. ‘Autism‐friendly’ changes to administrative practice included alterations to waiting environments, adapted communication for people with Autism and increased communication between clinical and administrative staff about the needs of people with Autism. Future Autism training for all frontline staff and ongoing evaluation of health professionals’ Autism knowledge are discussed.</p> <p>Autism; health and social care policy; Learning (intellectual) disabilities; staff training</p> <p>Autism has been redefined within the Diagnostic and Statistical Manual of Mental Disorders 5th edition guidance (DSM‐5; American Psychiatric Association [<reflink idref="bib2" id="ref1">2</reflink>] ). The umbrella term ‘Autism Spectrum Disorder’ now encompasses the range of conditions including Autistic Disorder, Asperger's Disorder and Pervasive Developmental Disorder – not otherwise specified (DSM‐IV; American Psychiatric Association [<reflink idref="bib1" id="ref2">1</reflink>] ). In line with recent policy, the term ‘Autism’ will be used within this article to cover the range of Autistic Spectrum Disorders (Department of Health [<reflink idref="bib11" id="ref3">11</reflink>] ). The core difficulties for people with Autism include persistent impairments in social communication and social interaction, as well as restricted, repetitive behaviours, interests and activities (DSM‐5; American Psychiatric Association [<reflink idref="bib2" id="ref4">2</reflink>] ). Each of these impairments varies on a continuum. Individuals with Autism may have different levels of difficulty within each area.</p> <p>Estimated prevalence rates for Autism in the general population have increased over the last 50 years, with a more recent UK study suggesting a prevalence rate of 98 in 10 000 (Brugha et al. [<reflink idref="bib5" id="ref5">5</reflink>] ). Recent prevalence studies suggest that approximately 50% of people who have Autism also have a Learning Disability (NAS [<reflink idref="bib19" id="ref6">19</reflink>] ). This equates to approximately a third of the Learning Disability population within community‐care establishments and private households (Brugha et al. [<reflink idref="bib6" id="ref7">6</reflink>] ). Further, people with Learning Disabilities without a diagnosis of Autism may show an increased prevalence of ‘autistic traits’ even when diagnostic criteria are not met (Bhaumik et al. [<reflink idref="bib3" id="ref8">3</reflink>] ). Recent policy has highlighted major difficulties for people with Autism in accessing appropriate health services (NICE [<reflink idref="bib22" id="ref9">22</reflink>] ). This applies to people with Autism who do not have a Learning Disability but also includes the significant proportion of people with Autism who have a Learning Disability.</p> <hd id="AN0114539376-2">UK Autism policy & training for professionals and frontline staff</hd> <p>Policy output to support best practice in service provision for people with Autism has increased significantly over the last 10 years. ‘Better services for people with an Autistic Spectrum Disorder’ was aimed at clarifying existing policy and its application to service provision for people with Autism (Department of Health [<reflink idref="bib8" id="ref10">8</reflink>] ). It made recommendations on how to relate the eleven objectives of ‘Valuing People’ to people with Autism and Learning Disabilities (Department of Health [<reflink idref="bib7" id="ref11">7</reflink>] ). ‘Better services’ specifically highlighted the importance of staff training in person‐centred approaches to Autism and suggested that local specialists, such as clinical psychologists and community nurses, could promote and maintain this training (Department of Health [<reflink idref="bib8" id="ref12">8</reflink>] ).</p> <p>The Autism Act aimed to address social and economic exclusion and poorer health outcomes experienced by people diagnosed with Autism (Department of Health [<reflink idref="bib9" id="ref13">9</reflink>] ). One of the key issues highlighted by the Act was ‘the training of staff who provide relevant services to adults with such conditions’ (Department of Health [<reflink idref="bib9" id="ref14">9</reflink>] :p.2). The Act led to the development of the ‘Fulfilling and Rewarding Lives’ Autism strategy (Department of Health [<reflink idref="bib10" id="ref15">10</reflink>] ). The five core areas of the strategy include ‘increasing awareness and understanding of Autism among frontline professionals’ (Department of Health [<reflink idref="bib10" id="ref16">10</reflink>] :p.14).</p> <p>‘Fulfilling and Rewarding Lives’ states that Autism awareness training should be available to everyone working in health or social care (Department of Health [<reflink idref="bib10" id="ref17">10</reflink>] ). Training must lead not only to improved knowledge and understanding but also to changes in the behaviour and attitudes of health and social care staff. The strategy states that training should reflect the actual situations staff work in and that nonclinical staff must also be trained (e.g. administrative staff).</p> <p>The strategy was followed up by the development of National Institute for Health and Care Excellence (NICE) clinical guidelines. An adult guideline concerns diagnosis and management of adults with Autism. Two further guidelines relate to the diagnosis and management of children and young people (NICE [<reflink idref="bib21" id="ref18">21</reflink>] , [<reflink idref="bib22" id="ref19">22</reflink>] , [<reflink idref="bib23" id="ref20">23</reflink>] ). The adult guidance outlines the need to ‘[ensure] the provision of multi‐agency training about signs and symptoms of Autism’ (NICE [<reflink idref="bib22" id="ref21">22</reflink>] :p.9). In terms of general principles of care, the adult guidance recommends that health and social care staff ‘have a broad understanding of the nature, development and course of Autism…its impact on, and interaction with, the social and physical environment and its impact on and interaction with other coexisting mental and physical disorders and their management’ (National Institute for Health & Care Excellence [<reflink idref="bib22" id="ref22">22</reflink>] :p.10). NICE have since issued a Quality Standard concerning aspects of diagnostic and other practice in Autism in 2014 (NICE [<reflink idref="bib24" id="ref23">24</reflink>] ).</p> <p>Finally, the Department of Health have issued ‘Think Autism’, an update to the Rewarding and Fulfilling Lives Strategy with 15 key areas for action including the need to include Autism within equality and diversity training (Department of Health [<reflink idref="bib11" id="ref24">11</reflink>] ). A summary of recent UK Policies related to people with Autism and Learning Disabilities is reported in Table [NaN] .</p> <p>UK Policies related to people with Autism and Learning Disabilities</p> <p> <ephtml> <table><tr><th align="left">Year of Publication</th><th align="left">UK Policy related to people with Autism and Learning Disabilities</th></tr><tr><td align="left">2006</td><td align="left">Better services for people with an autistic spectrum disorder: a note clarifying current government policy and describing good practice</td></tr><tr><td align="left">2009</td><td align="left">The Autism Act</td></tr><tr><td align="left">2010</td><td align="left">Fulfilling and rewarding lives: the strategy for adults with Autism in England</td></tr><tr><td align="left">2011</td><td align="left">NICE Guideline – Autism diagnosis in children and young people: Recognition, referral and diagnosis of children and young people on the autism spectrum</td></tr><tr><td align="left">2012</td><td align="left">NICE Guideline – Autism: recognition, referral, diagnosis and management of adults on the Autism spectrum</td></tr><tr><td align="left">2013</td><td align="left">NICE Guideline –Autism – the management and support of children and young people on the Autism spectrum</td></tr><tr><td align="left">2014</td><td align="left">NICE Quality Standard for Autism</td></tr><tr><td align="left">2014</td><td align="left">Think Autism – Fulfilling and rewarding lives, the strategy for adults with autism in England: an update</td></tr></table> </ephtml> </p> <p>This raft of policy development highlights the need to ensure that any community Learning Disabilities service is well equipped to meet the needs of individuals with Autism through increasing the understanding of frontline staff.</p> <hd id="AN0114539376-3">Autism training & knowledge of health and other professionals</hd> <p>Professionals' knowledge of Autism is key to the provision of sensitive person‐centred care for people with Autism. Peeters ([<reflink idref="bib25" id="ref25">25</reflink>] ) explains that a good theoretical understanding of Autism is essential in professionals' development of empathy with the person with Autism. He noted that imagining the world through the eyes of the person with Autism requires ‘an extraordinary…effort’ (Peeters [<reflink idref="bib25" id="ref26">25</reflink>] , p.49).</p> <p>Stone ([<reflink idref="bib28" id="ref27">28</reflink>] ) created the ‘Autism Survey’ to consider levels of knowledge amongst different groups of professionals involved in Autism diagnosis. The survey was completed by clinical and educational psychologists, speech and language therapists and paediatric staff. Their responses suggested that the professional groups held erroneous ideas about social and cognitive aspects of Autism. The professional groups also held different ideas about the diagnostic features of Autism. A further study found that mental health professionals and educational staff differed in their knowledge and beliefs about Autism (Helps et al. [<reflink idref="bib14" id="ref28">14</reflink>] ). Heidgerken et al. ([<reflink idref="bib13" id="ref29">13</reflink>] ) subsequently used the ‘Autism Survey’ to sample levels of knowledge across three professional groups – primary providers (including neurology, paediatric and general practice), specialists (including psychiatry, clinical psychology and speech and language therapists) and professionals working in an Autism specialist unit. The results suggested that, compared with those working in a centre for Autism, primary providers and even secondary care specialists tended to hold erroneous beliefs about Autism based on ‘out‐dated research’ (Heidgerken et al. [<reflink idref="bib13" id="ref30">13</reflink>] , p.328).</p> <p>Further studies have considered the level of training available to different professional groups. Brookman‐Frazee et al. ([<reflink idref="bib4" id="ref31">4</reflink>] ) surveyed secondary care community mental health professionals who reported working with many people with Autism but felt frustrated by their lack of training. Self et al. ([<reflink idref="bib27" id="ref32">27</reflink>] ) found that occupational and speech and language therapists had received a greater level of both pre‐professional and ongoing training in Autism in contrast to physiotherapists. Plumb & Plexico ([<reflink idref="bib26" id="ref33">26</reflink>] ) reported that speech and language therapists trained since 2006 received more training in Autism and felt more confident in their work with people with Autism compared to those trained before this. Khanna & Jariwala ([<reflink idref="bib15" id="ref34">15</reflink>] ) surveyed community pharmacists about their knowledge of Autism. They identified significant discrepancies and erroneous beliefs about the causes of Autism and a desire for further training.</p> <p>There is evidence that Autism training increases knowledge. In a recent study, Major et al. ([<reflink idref="bib17" id="ref35">17</reflink>] ) questioned trainee paediatricians about their Autism knowledge before and after receiving 7 case‐based teaching modules. They reported short‐term knowledge gains and increased self‐rated competence in working with people with Autism. Elmensdorp ([<reflink idref="bib12" id="ref36">12</reflink>] ) evaluated the effects of a 90‐min didactic training module on Autism knowledge and beliefs in medical physicians randomly assigned to training or wait‐list conditions. This study reported that trained physicians had increased confidence in recognising Autism and identifying diagnostic features. Kobak et al. ([<reflink idref="bib16" id="ref37">16</reflink>] ) evaluated an internet‐based training course in screening for Autism, which resulted in significant increases in knowledge of screening for Autism using a particular screening assessment. There is, however, little research evidence relating to the training needs and Autism knowledge of administrative staff. McMurray & Beebee ([<reflink idref="bib18" id="ref38">18</reflink>] ) describe a Learning Disability awareness training programme for acute hospital staff including secretaries but did not include Autism within their training programme. Webb & Stanton ([<reflink idref="bib29" id="ref39">29</reflink>] ) surveyed Learning Disability awareness of primary care practices including reception staff. Forty‐six percent of primary care staff surveyed (including administrative staff) identified Autism as an area where they required further training. A training module on Autism was then provided to primary care staff including administrative staff. This led to practice changes including visual aids in the waiting rooms and flexible appointment times for people with Autism and a Learning Disability.</p> <p>In summary, the evidence suggests that professionals in both primary and secondary care services cannot be assumed to have up to date knowledge of aspects of Autism including causes and key features. Despite the key role of administrative staff as the ‘face of an organisation’, there is a lack of research into the level of Autism knowledge of these staff and the training available to them as a staff group.</p> <hd id="AN0114539376-4">Aims of current study</hd> <p>The Adult Learning Disabilities service within Cornwall Partnership NHS Foundation Trust was audited against the National Autistic Society's (NAS) Autism Accreditation Standards in 2012/3. The service gained accredited status in March 2013 (NAS [<reflink idref="bib20" id="ref40">20</reflink>] ). This study took place in the context of this audit against the NAS Standards. The standards include the need for all staff to have a ‘Consistent Understanding of Autism’. Following the consideration of the research findings above and current UK policy, the aims of this study were as follows:</p> <p>To assess the level of Autism knowledge of community Learning Disabilities staff to inform the audit of understanding of Autism as part of the NAS Autism Accreditation process;</p> <p>To update and enhance the level of knowledge of Autism of community Learning Disabilities staff guided by current UK policy and research findings and</p> <p>To promote Autism‐friendly changes to everyday practice within the community Learning Disability teams.</p> <hd id="AN0114539376-5">Ethical statement</hd> <p>Those conducting the research have taken appropriate steps with regard to access, informed consent, confidentiality and anonymity. All those contributing to the focus group consented to the use of their comments within the article.</p> <hd id="AN0114539376-6">Method</hd> <hd id="AN0114539376-7">Participants</hd> <p>Fifty‐six members of community Learning Disability teams in Cornwall responded to an electronic survey of Autism knowledge (n = 56). Of the 56 participants, 43 were clinical staff and 13 were administrative staff. The administrative staff group included community team administrative leads, team secretaries, medical secretaries and receptionists. Two of the administrative staff working in the service at that time had a Learning Disability. The 13 administrative staff then received an Autism training session. A subgroup of eight trained administrative staff later attended a focus group to reflect on their experience of the training and to plan improvements to administrative practices for people with Autism.</p> <hd id="AN0114539376-8">Procedure</hd> <p>An online questionnaire was created, aiming to highlight any gaps in staff knowledge of Autism and to enable targeted training for staff with lower levels of knowledge. The questionnaire asked participants whether they had previously received Autism training, whether they would like future Autism training and nine further questions about their knowledge of Autism. The questions were presented as statements requiring a True, False or Don't Know response. The questionnaire link was emailed to all staff within the community Learning Disability service (see [NaN] for Questionnaire Statements). The results revealed a lower level of Autism knowledge within the administrative staff group compared with the clinical staff group. The administrative staff also reported receiving less previous Autism training (see below).</p> <p>An ‘Introduction to Autism’ training session was therefore planned for the 13 administrative staff. This was run by Psychology, Speech and Language Therapy and Occupational Therapy staff. The session took the format of a didactic teaching session followed by a discussion focused on improving and adapting future administrative practice. The didactic session covered the following topics: social interaction; communication; sensory processing issues; repetitive behaviours; cognitive aspects and ways to support people with Autism. The discussion was used to generate goals for changing administrative practice with people with Autism. This was achieved through discussion of a set of case vignettes, based on actual experiences of people with Autism accessing the service and reflecting their face‐to‐face or telephone contact with administrative staff. The potential changes to practice required to deal with these situations were discussed, and goals were set for changes to administrative practice. The goals were as follows:</p> <p>To adapt staff communication with people with Autism to ensure a consistent approach using simplified language.</p> <p>To adapt staff communication by considering the time required to process language by some people with Autism.</p> <p>Administrative staff to think about the words and phrases they used, particularly in relation to the fact that some people with Autism may interpret language literally.</p> <p>To consider changes to the waiting rooms making them less cluttered and potentially overstimulating for people with Autism.</p> <p>To consider how to provide a space as an alternative to the waiting area if people with Autism become uncomfortable, anxious or overstimulated.</p> <p>Three months after the training, a focus group was held with eight administrative staff who had received the training. This involved a review of the training session and considered whether planned changes to practice had been implemented. The session was facilitated by Occupational Therapy and Psychology staff. Participants were given questions, one at a time, on slips of paper. They were asked to write one thing they liked about the Autism training and one thing they did not like. Participants were also asked to write what they had learned from the training, one thing they had changed about their practice as a result of the training and what barriers they had experienced in changing how they worked. Lastly, they were asked to write down a further change to practice. Written responses were handed back to the facilitators and comments were noted down on flipchart paper. All comments were then collated. Comments concerning the same areas of practice were grouped into themes by Psychology staff after the focus group. Summary statements were generated to reflect each theme. Comments exemplifying each theme were highlighted.</p> <hd id="AN0114539376-9">Results</hd> <hd id="AN0114539376-10">Questionnaire survey of Autism knowledge</hd> <p>The results from the questionnaire found that the majority of staff within the adult Community Learning Disabilities service had a good basic understanding and knowledge of Autism (see Fig. [NaN] ).</p> <p>Staff generally had good knowledge about the difficulties people with Autism can experience with sensory issues, understanding emotions, repetitive speech, seeing ‘the big picture’ and language processing. The majority of staff also understood that people with Autism commonly seek routine and structure in their lives. Staff were less clear about the likelihood that people with Autism might interpret language literally and that people with Autism can make eye contact. Staff were also unclear about the prevalence of people with both a Learning Disability and Autism.</p> <p>Only 1 of the 13 administrative staff had received previous training in comparison with 40 of the 43 clinical staff (see Fig. [NaN] ). This was reflected in lower levels of correct responses on the questionnaire. This indicated the need to implement training for administrative staff as the frontline of the organisation.</p> <hd id="AN0114539376-11">Focus group themes</hd> <p>The following themes emerged from the focus group discussion:</p> <p>Feedback on Autism Training</p> <p>1. Administrative staff reported that ‘the case studies relevant to my job highlighted ways which I can make a difference’ and that ‘the training was delivered by staff able to provide knowledgeable and practical advice on real situations’. Staff noted that improvements to training could be made by the trainers using ‘more simplistic Language’.</p> <p>2. Communication between administrative staff and clinicians</p> <p>A lack of ‘consistent information from clinicians’ was identified as being a barrier to changing administrative practice. Administrative staff wished to know which people using the service were diagnosed with Autism. They asked for more information about how to communicate with particular people, both in person and on the telephone, and how best to inform people about appointment times. Staff also wanted to know more about particular people's sensory needs and environmental preferences. Lastly, administrative staff also wanted ‘clinicians to have an idea of what administrative staff do’ in order to change the way they work.</p> <p>3. Making waiting environments more ‘Autism friendly’</p> <p>Administrative staff reported that the training had taught them about ‘the importance of ensuring we provide the best sensory environment we can to meet the person's needs at the time’ as ‘people with Autism can be hypersensitive to noise, smells, touch and light’. Administrative staff reported wishing to ‘redesign and reorder the waiting areas (to make them) less cluttered with a calmer colour scheme’. They reported changing their practice by ‘keeping on top of clutter in the clinic rooms and reception areas’ and ‘offer(ing) alternative spaces, for example, a smaller room if the person would feel more comfortable’.</p> <p>4. Communication with people with Autism</p> <p>One administrative staff member identified that, as a result of the training, they are ‘more aware of simplifying language during telephone contacts’. Another commented that they had learned ‘to speak to (people with Autism) in a clear and consistent way, ensuring they know how things are done in a step by step way’. Staff also noted that the importance of ‘giving the person time to respond’. The need to be flexible about appointment times was also noted.</p> <p>5. Future training</p> <p>Administrative staff noted the importance of including medical secretaries in future training, as well as offering ongoing training to newly recruited staff.</p> <p>In summary, the administrative staff's comments were very positive about the training and provided some helpful tips for future training in terms of use of jargon and complex language. Staff reported that the vignettes helped to make the training relevant and led to changes in practice. Staff spoke about positive changes to administrative practice in the main areas of communication and changes to the waiting areas. Administrative staff wished to increase levels of communication between themselves and clinicians about the needs of each individual with Autism.</p> <hd id="AN0114539376-12">Discussion</hd> <hd id="AN0114539376-13">Autism knowledge & future training amongst adult community learning disabilities teams</hd> <p>The questionnaire survey ascertained that the community Learning Disability team clinical staff had a good basic understanding of Autism. Previous research indicates that, even for secondary care staff, knowledge may require frequent updating to ensure high levels over time (Heidgerken et al. [<reflink idref="bib13" id="ref41">13</reflink>] ). Helpfully, both clinical and nonclinical staff expressed a desire for more Autism training. In seeking to implement UK Autism policy and NICE guidance, the service's training programme has been extended and adapted to meet the needs of staff working in the wider local mental health and Learning Disabilities NHS Trust. This has included compiling a brief module on Autism which is included as part of staff induction training and an e‐Learning introduction available to all staff. Staff also have access to a more intensive e‐learning training package including case studies and self‐assessments of knowledge. In response to the questionnaire, bespoke face‐to‐face refresher training sessions have been provided for staff working in the adult community Learning Disability teams. Adapted training has also been provided to local community mental health teams, a mental health rehabilitation unit, a psychiatric intensive care ward and a forensic low secure setting. A quarterly special interest group focused on Autism practice, and research has been set up locally. This promotes good Autism practice and provides a communication channel between secondary care community Learning Disabilities and mental health teams and primary and acute care liaison nurses for people with Learning Disabilities and Autism.</p> <p>In future, this training programme would benefit from developing the involvement of people with Autism, both with and without Learning Disabilities. At the time of planning the above training, links with local people with Autism who could assist in running training were not well developed. This has been remedied by developing links with local facilitators of ASD training who work with the NAS to offer training to health and social care staff across the county. This training programme complements that offered to secondary Learning Disability community teams. It is run through the local Autism partnership board which holds a remit to ensure that general hospital staff, GP practices and other nonspecialist services also receive training in Autism.</p> <p>In terms of future research, the development of more rigorous measures to assess the impact of Autism training on clinical and nonclinical staff's knowledge, attitudes and practice would also be highly beneficial, given the evidence that knowledge and training levels differ between professions and can become out‐dated (Heidgerken et al. [<reflink idref="bib13" id="ref42">13</reflink>] ; Helps et al. [<reflink idref="bib14" id="ref43">14</reflink>] ; Self et al. [<reflink idref="bib27" id="ref44">27</reflink>] ).</p> <hd id="AN0114539376-14">The impact of Autism training on administrative practice</hd> <p>Qualitative feedback from administrative staff who attended Autism training was very positive. Staff engaged well with the training session. They were keen to relate the information they learned to the real‐life scenarios they experienced working daily with people with Autism. The focus group discussion highlighted the positive changes that staff had made immediately following the training to help them adjust their practice to suit individuals with Autism. This entailed positive changes to waiting areas and communication practices with people with Autism. It was noted that training about the needs of people with Autism is not generally offered to this group of staff, despite their frontline role. An unexpected but pleasing outcome of the training was that administrative staff reported feeling more valued by the organisation and by clinical staff. Given this outcome, there is a need to implement an ongoing rolling programme of training for new administrative staff.</p> <p>However, feedback from one member of staff with a Learning Disability indicated that the training had not been adequately adapted. Future training would need to be planned with stronger consideration of the communication needs of all attendees. This could be achieved by adjusting the language used in the training, considering the conceptual content and booking smaller sessions.</p> <p>The study demonstrates some low level evidence for behaviour change on the part of administrative staff when training is directly linked with day to day practice. In order to consider the impact of longer‐term changes to administrative practice within the community Learning Disabilities teams, it would also be helpful to regularly interview administrative leads and monitor the changes to practice noted above. Such interviews could be used as a mechanism for identifying any future barriers to practice changes.</p> <p>Administrative staff indicated that they need clearer communication with clinicians about the needs of particular service users with Autism. With the consent of people with Autism, clinicians could share additional information with administrative staff about their needs. This would helpfully include sharing information about a person's preferred communication style, levels of understanding of language and any environmental and sensory processing needs with administrative staff ahead of clinic appointments. Clinicians should also inform administrative staff of any likely triggers to anxiety or behaviour that challenges for particular people with Autism.</p> <p>Administrative staff also indicated that they could better meet the needs of service users with Autism if clinicians had a greater understanding of administrative duties and pressures. For example, clinicians would helpfully schedule time with administrative staff to discuss service users' needs, rather than attempting to do so just prior to a busy clinic session. Increased information sharing between clinicians and administrative staff in both directions would help facilitate Autism‐friendly adjustments to practice in future.</p> <p>This study would helpfully be extended to include follow‐up measures of administrative staff knowledge, attitudes and changes in practice within both primary and secondary care services. Perhaps most importantly, people with Autism and their parents and carers, could helpfully be asked for specific feedback on administrative changes to practice within primary and secondary care settings. The findings serve as a further reminder of the need to include all frontline health staff in the planning of Autism training, including those groups who, traditionally, have not been offered such opportunities, such as administrative staff in both primary and secondary health services.</p> <hd id="AN0114539376-15">Acknowledgements</hd> <p>The authors would like to thank all of the administrative staff for their input and support to the training and focus group as well as their willingness to share ideas and change practice to assist people with Autism.</p> <hd id="AN0114539376-16">Appendix</hd> <hd id="AN0114539376-17">Autism online survey questionnaire & true/false statements</hd> <p></p> <p> <ephtml> <table><tr><td align="left" /><td align="left" /></tr><tr><td align="left">1.</td><td align="left">Have you previously attended Autism training?</td></tr><tr><td align="left">2.</td><td align="left">Would you like to receive Autism training in future?</td></tr><tr><td align="left">3.</td><td align="left">People with Autism need time to think about and process language. T/F</td></tr><tr><td align="left">4.</td><td align="left">People with Autism find it easy to see the big picture. T/F</td></tr><tr><td align="left">5.</td><td align="left">People with Autism do not take things literally. T/F</td></tr><tr><td align="left">6.</td><td align="left">People with Autism may repeat words or phrases that other people use. T/F</td></tr><tr><td align="left">7.</td><td align="left">People with Autism never make eye contact. T/F</td></tr><tr><td align="left">8.</td><td align="left">People with Autism dislike structure and routine. T/F</td></tr><tr><td align="left">9.</td><td align="left">Some people with Autism may be over sensitive to noise, smell or touch. T/F</td></tr><tr><td align="left">10.</td><td align="left">People with Autism may have difficulties understanding their own and other people's emotions. T/F</td></tr><tr><td align="left">11.</td><td align="left">50% of people with Autism have a learning disability. 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J Pediatr Psychol, 21 : 615 – 30. </bibtext> </blist> <blist> <bibl id="bib29" idref="ref39" type="bt">29</bibl> <bibtext>Webb J. & Stanton M. ( 2009 ) Working with primary care practices to improve service delivery for people with Learning Disabilities – a pilot study. Br J Learn Disabil, 37 : 221 – 7. </bibtext> </blist> </ref> <p>Graph: Questionnaire responses according to staff group.</p> <p>Graph: image%5ft/bld12116-fig-0001-t.gif</p> <p>Graph: Respondents' previous Autism training.</p> <p>Graph: image%5ft/bld12116-fig-0002-t.gif</p> <aug> <p>By Alex Clark; Sarah Browne; Liz Boardman; Lealah Hewitt and Sophie Light</p> </aug>
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  Data: UK National Autism Strategy (Department of Health, 2010 and National Institute for Health and Care Excellence guidance (NICE, 2012) states that frontline staff should have a good understanding of Autism. Fifty-six clinical and administrative staff from a multidisciplinary community Learning Disability service completed an electronic questionnaire to evaluate levels of Autism knowledge. The results showed that, compared with clinical staff, administrative staff were more limited in their understanding of Autism and less able to access relevant Autism training. Autism training was provided for administrative staff. Focus group feedback about the training sessions and subsequent changes to practice concluded that the outcome of the training was positive. "Autism-friendly" changes to administrative practice included alterations to waiting environments, adapted communication for people with Autism and increased communication between clinical and administrative staff about the needs of people with Autism. Future Autism training for all frontline staff and ongoing evaluation of health professionals' Autism knowledge are discussed.
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