How can we make inter-agency work more effective ?

Dr Mostafa Ewees(Senior educational psychologist, Stanford University at

California)

… if you build your house on a busy highway you must expect many visitors … Kanner (quoted by Bennett and Billington, 2001)*

... Like ‘peace’ and ‘love’ everyone agrees multidisciplinary work is a good thing but there is no agreement on what it might look like … (paraphrasing Jordan, 2001)

*Lloyd-Bennett, P and Billington, T.(2001) editorial, Educational and Child Psychology 18(2)

To establish some principles to guide effective work

To look at practical examples to illustrate these principles.

To consider the range of skills and perspectives needed

my jobs and interestssome initial ideas - what are we

talking about ? - why ( are we talking

about it ) ?

- how ( can we improve the situation) ?

Task : ‘Listening to Kenneth ‘*

1. strengths 2. challenges 3. what needs to happen ?

* Extract from ‘Different for a reason’ BBC Radio 4 (23.9.01)

How to we achieve this ? Hearing the voices of people with autism …What we need to know can be learned from

the people themselves ….

‘ I have difficulty finding out what other people are feeling and thinking, its what people call mind reading. I also have difficulty making expressions and knowing what’s appropriate, like what kind of eye contact …’

‘When I ‘m In social situations I usually feel very nervous or anxious, especially if around people I don’t know well …I don’t know how to behave at all, I have to pick up cues from other people …’

‘Some emotions are more difficult than others: fear, anger, surprise because it can be very similar in the way people express them – especially if they are mild.There are very small cues (clues) between them …I’m not picking up…’

‘It’s really hard work to learn, it’s really difficult because no-one writes books about it. Everyone assumes it comes naturally to everyone…’ (Chris, student, from ‘The Face’ Channel 4, 2001).

Differences or difficulties ? (Donna Williams,1996; Kenneth Hall, 1998)

‘My world is not simply a damaged version of yours …’ (Jim Sinclair, 1992)

‘ these individuals are the experts on their autism and should be our future collaborators in our understanding of autism’ (Peeters, 2000)

‘…in the playground I always tried to find a quiet corner, in the classroom I tried to find a quiet corner to do nothing at all (Kenneth Hall, 1996)

‘… the sound of the children’s voices was like dynamite in my ears …its hard to know what’s expected of me, I like it when things are clearly explained and there are clear, fair rules…’

link to ‘understanding autism’sources of information (and overload !)know the person first and foremostreading, watching and thinking (from ‘Rainman’ to ‘Snowcake’ and What’s eating

Gilbert Grape, from Curious incident of the dog etc to ‘Somebody Somewhere’ and The Blue bottle Mystery)

Training and learning processes - collaboration and development - Autism-friendly schools initiative, (Autism

Cymru, 2004 - and LEAs); identity card initiative with the police service and

others; collaborative training processes in

schools (eg. Barrett, 2006)

Barrett,M. (2006) ‘Like dynamite going off in my ears’. Using autobiographical accounts of autism with teaching professionals. Educational Psychology in Practice, 22 (2) 95-110

Differences can be noticed in the following : Ways of being with other people (social

relationships)Ways of communicating and or speaking

(social communication)Fixed ways of thinking and doing things

(social imagination)These are known as the ‘triad of

impairment’(Wing, 1996).

Solution- focused approaches (eg. Ajmal and Rees, 2001)

individual workmeetingsways of hearing peoples’ stories and

perspectives ….

‘Our guard went up…’ never seen anything like it , ‘… told them the same thing a thousand times…’ ,’we are still waiting for the diagnosis…’ … these are severe impairments … ‘… differences not difficulties…’

Solution- focused thinking Helps people become aware of

the effects of own actions, thoughts, behaviours on themselves and environment

Helps people consider own knowledge about the situation and consider own skills and opportunities to do something about it to resolve own difficulties.

Promotes self-reliance but needs to be facilitated.

Focus on the positiveWhat is going right ?Look for exceptions ?ScalingPriorities for change not

problems to be sortedWhat would you see

happening ?Positive language leads to

solutions

Scaling Exceptions

Think about the times when what is troubling you wasn’t happening. What was happening then ? etc.

Miracle question Imagine the issue has gone

away. What is happening instead ?

1 105

Last year/month

today

1 5 10

6 months ?

Perspectives : autism and other learning and social profiles – the importance of a sense of perspective ?

Consultations, procedures and assessment frameworks - making guidance a reality …

Assessment: multi-agency (WAG Consultation paper 2006)

DfEE (Circular 10/99: Social Inclusion: Pupil Support) lack of coordination of services to families from

agencies and disciplines

Autism straddles different disciplines - for definitions, diagnosis, education and care a

multi disciplinary approach helpful.

Behavioural (biological) basis orNot a pathological state (part of normal biological variation, with

advantages and disadvantages – problems arise from social attitudes not disabilities)Way forward consider: - autism as a range of developmental characteristics in

social understanding, communication and flexibility of thinking and behaviour

- issues are around levels of adaptive functioning

- - this respects individuals but recognises major difficulties in coping with the world.

Autism affects: thinking, feeling and understanding but not same for everyone

understanding of the world comes from the social process of joint construction of meaning (Vygotsky, 1962)

How do we share the issues arising from this for people with autism with fellow professionals ?

No one approach will meet the needs of all people with autism (Jordan and Jones, 1999)

Key considerations; how does the child/young person learn best ? What barriers exist n? What support would mean a child would not fail in a local

setting ? What setting is the least restrictive way of meeting needs

and providing education ?

Multi-disciplinary input not just at crisis points

Time is a crucial resourceAutism outreach teams: multi-agencySee Cumine, Leach et al. (1997,2000);

Leicester City Council, Leicestershire County Council and Fosse Health Trust,

(1998)

Easier said than done: multi-agency work is a complex psycho – social process – no wonder its tricky !

Unique challenges for autism ? – impact of anxiety …

Differing professional positions and perspectives (social worker, clinical psychologist, nurse, paediatrician, psychiatrist, police, speech and language therapist, occupational therapist, teacher, teaching assistant, headteacher)

Unique perspective of the child/young person

Unique position of parents/carers

The National Autistic Society, City Rd, London, ECIU ING, tel 0171 833 2299. www.oneworld.org/autism.ukThe NAS in Wales, William Knox House, suite C1, Britannic Way, Llandarcy, Neath, West Glamorgan, SA 10 6EL, Tel: 01792 8159 815915

Autism Cymru, 6, Great Darkgate, St, Aberystystwyth, SY23 1 DE Tel: o1970 625256 www.awares.org

There are also many books on autism and the autistic spectrum. The following are among a growing number of accessible books.

Hall. K.(1998) Asperger Syndrome, the Universe and Everything. London: Doubleday

The National Autistic Society, City Rd, London, ECIU ING, tel 0171 833 2299. www.oneworld.org/autism.ukThe NAS in Wales, William Knox House, suite C1, Britannic Way, Llandarcy, Neath, West Glamorgan, SA 10 6EL, Tel: 01792 8159 815915Autism Cymru, 6, Great Darkgate, St, Aberystystwyth, SY23 1 DE Tel: o1970 625256 www.awares.orgAjmal,Y and Rees, I (eds)(2001) Solutions in Schools. London:BT Press:Jordan, R.(2001) Multidisciplinary work for children with autism, Educational and Child Psychology, 18(2)There are also many books on autism and the autistic spectrum. The following are among a growing number of accessible books.Hall. K.(1998) Asperger Syndrome, the Universe and Everything. London: Doubleday

Williams, D. (1996) Autism: and inside out approach. London: Jessica Kingsley.

This is one of several books by a woman who readilyacknowledges and describes her own autism.Haddon, M. (2003) The curious incident of the dog in the

night time. London: Johnathon Cape.An acclaimed novel written from the point of view of a young

person with an autism spectrum condition.Cummine, V., Leach, J. and Stephenson, G. (2000) Autism

in the Early Years, A Practical Guide. London: David Fulton.As above (1998) Asperger Syndrome, A Practical Guide for

Teachers. London: David Fulton.Jordan, R. and Jones, G. (1999) Meeting the Needs of

Children with Autism Spectrum Disorders. London: David Fulton.