Autism Strategy

Autism Strategy for Adults
who live and work in

Nottingham City
2014 - 2017
One Size Fits One

Ensuring autistic people live fulfilling and rewarding lives
Autism Strategy for Adults Nottingham City 2014 2017
Contents Page
Page No.
Forewords 2
Councillor Norris
Chair Co-Production Group

Introduction 4
Nottingham Citys Vision 6
The Challenges For Nottingham City And Priority Actions 6
Challenge 1: Understanding the Needs of Autistic People 7

Challenge 2: Awareness And Understanding Of Autism Is Increased 11
Challenge 3: Improving Transitions Support Pathways 14

Challenge 4: Accessible Pathway For Diagnosis And Assessment 17
Pathway Gap Analysis 22
Challenge 5: Access To Education And Employment Opportunities 23

Challenge 6: Living a Fulfilling and Rewarding Life in the Local 25
Community, with Access to Support Networks Increasing Health &
Wellbeing and Resilience
Support for Carers 29
Leadership Delivery And Implementation 32

Appendix 1: Acknowledgements 33
Appendix 2: The Journey 34

Appendix 3: National and Local Strategies 35
Appendix 4: ASD Pathway in Nottingham City (2011) 36

Appendix 5: SALT Case Study 37
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Forewords
When the Autism Act became law in 2009, it was a landmark that articulated the
governments commitment to transforming the way in which autism is addressed in
England.
Nottingham Citys 3 year Autism Strategy for Adults One Size Fits One summarises our
commitment and ambition to achieve Fulfilling and Rewarding lives for citizens with
autistic spectrum conditions.
The strategy has been developed by Nottingham Citys Autism Co-production Group and has
taken into account the views of autistic people, their families, professionals who work with
them including voluntary/ community, private and public organisations across Nottingham
City, to ensure individuals are enabled to live their lives with dignity, choice and
independence.
Thank you to everyone who has contributed to the development of the strategy. (See
Appendix 1 Acknowledgements)
The Strategy identifies the challenges for Nottingham as a city to raise awareness of autism
and implement changes for adults with autism, their families and carers. However it also
provides a framework for all partners including public, private, voluntary and community
services to work collaboratively across the city to achieve the shared vision.
In Nottingham, it is our ambition for autistic people to live fulfilling and rewarding lives and
for this to be achieved from childhood to adulthood. Whilst this strategy aims to improve
the lives of adults, we will take action to have a whole life strategy; we have therefore
begun the work to integrate the Childrens Pathway to support a holistic approach for
achieving quality of life outcomes.
I look forward to seeing the changes in attitudes and service delivery; ultimately improving
the lives of autistic people and their families in Nottingham City through the continued
collaborative approach of partners.
Councillor Norris
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Foreword by Co-Production group

We were thrilled when the Autism Act was introduced, and assigned Nottingham City
Council and the Clinical Commissioning Group with developing an autism strategy for adulits
who live in the city.
For many of us as Carers and parents we have been involved with campaigning for the rights
of our loved ones with autistic spectrum conditions over many years and thought it would
be a lifetime before we would see genuine commitment to understand their needs,
challenge attitudes, and have affective policy changes that required implementation.
Nottingham Citys approach to developing the strategy through a collaborative working

group has been important. As the Co Chair of the Autism Working group it has been a
refreshing opportunity to work through the Autism Act and the NICE guidance and not only
influence but be involved with shaping the Autism Strategy for adults who live and work in
Nottingham City.
Being involved with a real strategy to improve life outcomes occurred at the right time, as
our young people were moving from childrens to adults services.
The findings from both consultations supported the ethos of working co-productively and
provided an insight into the lives of autistic people and their carers living in Nottingham
City. The knowledge gathered has helped to inform and shape the strategy and identify the
priotiy actions required for improving mainstream and specialist services.
Working collaboratively to produce Nottingham Citys strategy for autistic people is a good
start; we have enjoyed the journey and we acknowledge there is some way to go. We are
committed to remaining involved and supporting implementation of the actions and
outcomes. As a minimum we want to see the following overarching outcomes:
1. Increased awareness and understanding resulting in empathy for a person with
autism recognising that one size really does fit one;
2. Quality training for providers of services, parents and carers;
3. Value and respect for parents and carers - we provide the scaffolding, and safety net
for coping with life, tools for managing change, we wear multiple hats as
counsellors, planners, advocates.........
Nottingham Citys Autism Strategy for Adults provides the reassurance that autistic people
and their families, will begin to receive more autism friendly services which are appropriate
and acknowledge that rather than one size fits all, there will be a shift to One Size Fits
One.
Co-Chair & Co-production Group
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1. Introduction
In response to the national strategy Fulfilling and Rewarding Lives Nottingham City
established a Co-production group in January 2012. The Co-production group brings
together autistic people, key partners and colleagues across Nottingham City to affirm that
there is commitment to tackle the inequalities that exist in relation to autism locally.
Our joint autism strategy One Size fits one describes the current experience autistic
people face, creates a shared vision with a set of aims and objectives to improve the lives of
autistic adults, including Aspergers and their families over the next 3 years 2014 2017.
One Size fits one believes autistic people who live and work in Nottingham should have
the right to be:
safe, healthy, happy and live longer lives in which they are able to fulfil their
aspirations;
have support, advice and information to live with choice, control and dignity, in a
place of residence which seeks to meet individual needs;
be protected from abuse and neglect;
are enabled to achieve their full potential as active partners in their own support and
as part of a community wide support system.
This might be through their social, family or employment circumstances, access to universal
services or more targeted services. (Adapted from the Vulnerable Adults Plan 2012-15)
The Autism strategy harnesses the views of people who live with autism their carers and
families, colleagues from the voluntary and community organisations, public and private
sector organisations through needs assessments, the Autism Self-Assessment and
consultations. (See Appendix 2 The Journey Developing Nottingham Citys Adult Autism
Strategy.....)
About Autism
In Nottingham City we recognise that each individual with autism is unique.
There are a number of definitions of autism; however in Nottingham the social model of
disability has been adopted. Nottingham Citys Autism Strategy Co-production Group
therefore want to promote an empowering aspirational definition, one which promotes
equal access and improves quality of life for autistic people.
Think Autism Fulfilling and Rewarding Lives, the strategy for adults with autism in
England 2014 states:
Autism is a lifelong condition it affects the way a person communicates with, and
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relates to, other people. It also affects how they make sense of the world around
them. It is a spectrum of different needs so it is essential to look at the individual.
Everyday life for people with autism can be confusing, frightening and lack meaning.
People with autism can often find understanding and communicating with others
particularly difficult, which can leave them feeling isolated. People with autism may
also experience some form of hypersensitivity or lack of sensitivity, for example to
sound, touch, taste, smell, lights or colours. Autism is a lifelong condition and people
may need to use services at any time in their life.
Autistic Nottingham and East Midlands
Autistic people are neurologically different to non-autistic people. They can

therefore have different areas of strength and challenge when compared to others.
As society is centred upon the skills and needs of the majority, Autistic people face
challenges fitting into society and further challenges to be understood and to
understand the general population.
"Sometimes Autistic people communicate or use language in a different manner to

non-Autistic people. This can be more direct and to the point, sometimes without
social nuance. There are both advantages and disadvantages to this different way of
communicating
Guidance by NICE describes some of the features experienced;

Autistic people also commonly experience difficulty with cognitive and behavioural
flexibility, altered sensory sensitivity, sensory processing difficulties and emotional
regulation difficulties. ..A significant proportion of adults with autism across the
whole autistic spectrum experience social and economic exclusion.
While many autistic people and their families will cope well with the additional
challenges autism brings, the emotional impact of autism is often difficult and
sometimes devastating for people with autism and their families. Autistica.org.uk
One Size Fits One....

David a man with Asperger Syndrome and Psychosis has significant difficulties
processing and working out the gist of everyday situations. He described himself by
saying My life is like a game of hit and miss, sometimes I work sometimes I dont.
David is being supported by Speech and Language Therapy and Psychology Services
to develop his awareness of Autism and develop strategies to support himself. His
staff team are being supported by the health team to develop their awareness of
autism and the adaptations they need to make to their own communication, as well
as developing their knowledge of specific approaches such as Comic Strip
Conversations and Social Stories. (see www.thegraycenter.org)
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2. Nottingham Citys Vision

Nottingham Citys vision is for autistic people, including Aspergers, to be acknowledged, to
have equal opportunities regardless of their cultural background or age, to live fulfilling and
rewarding lives and for there to be recognition that for citizens with autistic spectrum
conditions One Size Fits One.
There are key principles we want to focus on in order to see autistic people empowered to
live fulfilling and rewarding lives and achieve their full potential.
Identification of needs
Assessment, Diagnosis and Support should be easy to access by individuals, their
carers and families;
Information, Advice and Support for citizens with autism and their families should be
easy to locate to enable empowerment to make informed choices;
Able to live fulfilling lives in their local community without fear of abuse or exclusion,
with support where appropriate;
Autism awareness and training for professionals incorporating providers of services
to encourage appropriate approaches for meeting individual needs, provision of
support and delivery of services;
Reasonable adjustments should be made to ensure mainstream services are
accessible;
Equal access to education /training and employment so autistic people can achieve
their potential and make a positive contribution to their communities and society;
Autistic people and their families are able to access a range of housing options and
live independently;
Services should be sensitive and responsive to spiritual, cultural and ethnic needs in
order to appropriately meet individual needs;
Families and Carers are able to access training and awareness about autism.
Health and well-being needs of people with autistic spectrum conditions are met.
3. The Challenges for Nottingham City and Priority Actions

The autism strategy for adults in Nottingham city aims to address the key gaps identified
from 3 key areas of work undertaken in Nottingham for improving the lives and potential of
autistic people and their families described below. There are Six Priority Actions being
proposed for achieving Fulfilling and Rewarding lives One Size Fits One:
1. Understanding the needs of autistic people by improving our data systems;
2. Challenge Stigma - Raising awareness of autism in society, through better provision
of appropriate training to identify, assess and support autistic people and their
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carers/families particularly for health and social care staff, providers of services,
incorporating the criminal justice system and universal services;
3. Improve Transitions support, from childhood to adulthood;
4. Develop an accessible pathway for diagnosis and assessment, with access to a
community care assessment and a carers assessment if required;
5. Enable equal access to education and employment opportunities;
6. Autistic people live fulfilling lives in the local community, with access to services and
support networks which facilitate health and wellbeing and resilience. Including
appropriate support for carers.
Whilst this strategy focuses on adults; we recognise the importance of connecting this
strategy to the work of our Childrens and Family Strategy and the work of the Multi-Agency
Children and Young Peoples Challenging Behaviour pathway which incorporates the autistic
spectrum conditions pathway.
This will ultimately result in a whole life autism strategy, incorporating robust transition
arrangements being in place.
4. National and Local Strategies

The following strategies support Nottingham Citys autism strategy for adults. (A full list of
strategies can be found at App 3)
Fulfilling and Rewarding Lives (2010)

The Equality Act 2010
The Nottingham Plan 2020: Safe, Clean, Ambitious, And Proud
The Vulnerable Adults Plan 2012 2015
Nottingham City Joint Health and Wellbeing Strategy 2013 - 2016
Multi-Agency pathway to support children and young people (0-19yrs) with
challenging behaviours (including ADHD/ASD), in Nottingham City This document
recommends the activities to implement a multi-agency pathway.
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Challenge 1
Understanding The Needs of Autistic People
The consultation confirmed:
Most people feel services need to get better at collecting information about people with
autism and understanding how to meet the needs of adults with autistic spectrum conditions
including Aspergers.
How Many People Have Autism Spectrum Conditions in Nottingham City?
Current estimates on the prevalence of autism in adults in England indicate that around
1.1% of people have autism. The rate is higher in men (2%) compared to women (0.3%).
It is estimated there are over 2,600 autistic adults in Nottingham city.
A number of methods have been used to estimate the number of autistic adults who live in
Nottingham City. Although awareness and access to diagnosis have improved in recent years
there will remain a number of people who are not aware that some of the challenges they
encounter may be due to autistic spectrum conditions (ASC).
PANSI (Projecting Adults needs and Service Information) provides the following estimates for
numbers of adults currently with ASC and projected to the future.
2012 2015 2020 2030

2,193 2,253 2,325 2,504
Adults 18-64 Source PANSI
However a more recent report into estimating levels of ASC in

populations has established an expected prevalence of 1.1% in the
adult population. Based on the 2012 Nottingham City adult population
this would mean that over 2,600 adults were currently affected.
As awareness and diagnosis has improved in recent years levels of ASC in children and
young people are better understood and can give an indication of the expected levels in
adult populations:
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School census information show that in the school census, Jan 2012,
1.13% of children had a primary SEN need of autistic spectrum
conditions. This accounted for 452 children (all school years).
Nottingham City has one of the highest rates of ASD in children on
the school census, and 37% of children with ASD are from a BME
community.
However there are limitations to this information as some children will attend school
outside of the city and only one type of Special Educational Need is reported per child in the
school census.
Autism and Learning Disability
It is estimated that 2% of the population will have a Learning Disability (LD) but that only a
quarter of these people are likely to be known to local services. In Nottingham 1 in 200 people is
known to their GP to have a Learning Disability. It is estimated that 30-35% of people with LD
also have an Autistic Spectrum Condition and that this rate increases with increasing severity of
LD.
Think Autism Fulfilling and Rewarding Lives 2014 states:

Autism is neither a learning disability or a mental health problem, although mental health
problems can be more common among people with autism and it is estimated that one in
three of adults with a learning disability also have autism.
(Estimating the Prevalence of Autism Spectrum Conditions in Adults: Extending the 2007 Adult
Psychiatric Morbidity Survey, The NHS Health and social Care Information Centre (2012)
http://www.hscic.gov.uk/ article/1733/New-study-estimates-autism-prevalence-among-adults-with-
learning-disability)
What can be known from health records about Autism prevalence?
Primary care (GP services) use Read codes. At practice level family doctors can identify
people with those read codes. The LD Health and social Care self-assessment framework
includes questions about ASC, and an electronic search to estimate levels of recording in
primary care is carried out annually to inform the self assessment. In April 2013 GPs
knew about 1,700 people with autism.
Secondary care (hospital services) uses ICD 10 codes to identify health needs. This
recording may improve as hospitals code complexity better.
o LD services have processes to identify ASC but it is not routinely reported so that the
group can be looked at further. There are no processes in place to identify people
with ASC who are using mental health or community forensic services
o Aspergers Service - Up to the end of 2012, 615 people have been in contact since
April 2009 with 246 people on current caseload and in receipt of a service.
How many people with ASC are known to local Nottingham services?
Few services in Nottingham City can describe how many people with ASC they have
supported.
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Autism is considered a disability under the Equality Duty, but recording and reporting for
equality purposes is very limited in Nottingham.
Specialist providers may record in individual notes autism diagnosis but there is no
systematic way of knowing how many autistic people they are in contact with.
Social care reporting systems do not have a facility to record ASC, and although changes
are planned it is unclear that this aspect will improve.
More work needs to be undertaken to establish what is recorded in housing and

employment. Homeless services have improved recording about LD but not autism.
Criminal Justice System
Research nationally shows that autistic people experience a number of problems once they
enter the criminal justice system; due to a lack of understanding. The number of autistic
people entering the criminal justice system is relatively unknown as little research has been
done in this area, although it is thought that this group is overrepresented (Cashin &
Newman, 2009).
Consultation Suggestions for Knowing about and understanding people with autism
Have an integrated counting process so all sources of information are combined to get
accurate statistics;
Get better at sharing information between different organisations;
Understand how people with autism might think, communicate and see the world
before you can consult. Find appropriate ways to build networks with, talk and engage
with people with autism;
Treat autism as a separate condition rather than an add on to mental health and/or
learning disability ;
People with autism should be involved at all stages of planning;
Ask people what they want as well as what they need;
Value the experience and insight of parents with autism when you are looking at the
support their children need for their autism.
Understanding The Needs of Autistic people

The aim of this recommendation is to get better at understanding the need of people
across the autism spectrum, in order to plan and develop appropriate services.
Recommended Actions
1. Improve knowledge of the numbers of autistic people using health services.

2. Improve recording of autism within disability monitoring by public services.
3. Raise awareness of the Equality Duty with regards to autistic people, particularly the
requirement to offer reasonable adjustments to services.
4. Public sector equality objectives to include actions relating to autistic people.
5. Nottingham Citys Partnership Board SPLAT (Speak, Listen, Act, Together) to
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incorporate autistic adults, their families and carers.
Challenge 2
Awareness And Understanding of Autism is Increased
Autistic people may appear to behave differently to the neurotypical population. There
will generally be a reason for this: it can be an attempt to communicate, or a way of
coping with a particular situation. A lack of understanding and awareness of autism
could lead to citizens being treated unfairly or responded to inappropriately.
Training and awareness of autism is a real

priority. It must involve people with autism in
the planning and delivery.
Training should reflect current good practice and

knowledge about autism. It should be consistent to
avoid contradictions and confusion across services.
However, it also needs to enable staff to feel confident
to adapt what they have learnt and respond to different
situations.
It is therefore essential that staff have the appropriate awareness, training and
understanding of autism to prevent inappropriate or stereotypical views/ responses.
Enabling individuals to live fulfilling and rewarding lives will require raising awareness
and a level of training across all partners. At the very least health and social care services
should have access to awareness and understanding of the needs and specialist training
for working with autistic people and ultimately for improving services.
The national strategy and guidance states unequivocally the need to ensure frontline
staff across all public services are trained appropriately to identify people with autistic
spectrum conditions early.
Autistic people should have the same human rights to feel safe and be treated with
respect. It has been recognised that within the Criminal Justice System there is a need
for police officers, like health and social care professionals to be able to identify the
behavioural clues that may indicate someone has autism; this will encourage
appropriate measures to be taken to ensure they are treated fairly.
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Training needs analysis carried out by Nottinghamshire Healthcare Trust found that
there were gaps in knowledge around autism in their community forensic teams. These
teams are being prioritised to receive training as part of an incentivised quality payment
scheme (CQUIN).
Autism Training Available in Nottingham
Autism Training is available to staff within Health and social care services
All Nottingham City Aspergers service staff who undertake assessments are trained
to use the tools training involves the correct behaviour and communication. The
service provides autism training to other health services and organisations
Community Learning Disability Teams have identified specific staff who access
autism training as part of their social work and continuing professional development;
A percentage of Consultant Psychiatrists, Clinical Psychologists and Speech and
Language Therapists have additional autism training, alongside training to diagnose
autism in Community Services and Assessment and Treatment Services.
The Speech and Language Therapy Service deliver training to partners.
NORSACA provides 3 tier training for schools and deli ver training for the East
Midlands Training Hub.
The Royal College of General Practitioners (2012) provide a free e-learning tool for
healthcare workers in general practice that may help organisations meet the
recommendations in this section of the guideline.
Multi-disciplinary services will also provide training around an individual focussed on
autism where the capacity and capability of the staff team forms part of the episode
of care.
The Learning Disability Services (Specialist Services Directorate) Challenging
Behaviour Care Pathway (in Draft) would identify and support the training needs of a
staff team working with a service user who has Autism, Learning Disability and
challenging behaviour.
The NHS Trust was set a CQUIN target for 2013-14 for the development of an e-
learning package focussed on Autistic Spectrum Conditions. This will have been
piloted, evaluated and further roll-out considered by end March 2014.
2 x one day course per year focussed on an introduction to Asperger Syndrome this
is open to Nottinghamshire Healthcare Trust employees run by the City Asperger
Service.
3 x one day course per year focussed on an introduction to Communication and
Autism this is open to anyone who supports someone on the autistic spectrum and
is run by the Speech and Language Therapy Service, Specialist Services Directorate.
Learning Disability Services are developing leaflets and a booklet of best practice for
those colleagues supporting autistic people, and a booklet for people with Aspergers
Syndrome as well as a DVD of best practice, to be produced by spring 2014.
As part of Nottingham City Councils Equality Strategy Autism Training will be made
available to raise awareness for all colleagues in health and local authority and partners
in Nottingham City.
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An autism training group, a sub group of the Co-production group are developing a
training plan harnessing the best approach for raising awareness and rolling out a
range/levels of training as required for Health and social care services and wider partners
within Nottingham City.
Autism Champions are being identified across Nottingham City services to raise
awareness, promote best practice for recognising and working with autistic people.
Consultation and Engagement told us.....

There are positive and negative experiences of awareness and knowledge of autism
among health, adult social care and universal services including housing, leisure services
and community services.
There appears to be a lack Autism teams need to

of understanding of autism understand that self-harm can
among health be part of autism not a mental
professionals. health issue. Mental health
teams need to understand this
too
Not to focus so much on the autism that they ignore or do not investigate potentially
significant mental or physical health issues
Training is really important if providers understand autism they can help put in the
scaffolding to enable people with autism to have fulfilling and rewarding lives social
not medical model
Reasonable adjustments should be the norm.
Challenging Stigma Raising Awareness and Understanding of

Autism
A key aim for this strategy is to increase awareness, develop Champions with knowledge
and understanding so we behave wisely and sophisticatedly when delivering services to
autistic people.
Recommended Actions
1. Establish and implement an Autism Training Programme for Nottingham city
incorporating voluntary/community private and public sector and the Criminal Justice
System.
2. Create Autism Champions to raise awareness, challenge stigma and promote good
practice to influence Nottingham city services.
3. Set targets and monitor the impact of incentivised quality payment scheme for
community forensic teams.
4. Coordinate a catalogue of Appropriate/Preferred Autism Trainers.
5. Generate opportunities to deliver Countywide training among voluntary/community,
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health and social care partners, and private organisations.

6. Develop a Charter/Quality Mark for organisations that are autism friendly.
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Challenge 3
Improve Transitions Support Pathways
The consultation showed Most people feel that the strategy if implemented fully and well
would help young people with autism as they go from using children's services to using adult
services.
Our school census information shows that currently 1.13% of children had a primary Special
Educational Need (SEN) of autistic spectrum conditions. This figure would seem to indicate
that the majority of people in Nottingham City in the future will potentially have received
their diagnosis as children as the national prevalence is 1%.
Nottingham City Childrens and Families Team have commissioned Futures (formerly
Connexions) an all age Careers advice and guidance service to deliver a service for targeted
youth support.
A multi-disciplinary Transitions Team is hosted within the Futures service, consisting of

specialist disability advisers and Transitions Social Workers. All staff are trained and
qualified in supporting people with a range of disabilities including Autism Spectrum
Conditions.
The team aims to support the transition pathway of young people from childrens services
into appropriate adult services. This includes:
o Accessing further education opportunities

o Transition of social care and health packages of support from Childrens services
to Adult Services
o Enabling access to work and training opportunities
Delivery is in a wide variety of settings. Universal teams are able to access support from the
Specialists in the Transitions team to enable them to have the skills to work with people
with autistic spectrum conditions.
Work with partners is widespread and in particular includes (though is not limited to):
Job Centre Plus
Remploy
Childrens and Adult Services, City Council
Health
Employer Hub
Apprenticeship Hub
Nottingham Jobs Fund
Training providers
Further Education colleges
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Nottingham Futures maintains the database providing information to Government office on

Nottingham Citys 16-18 year old - Not in Employment, Education or Training (NEET)
statistics.
They have a duty to support young people into education, employment or training. In
support of this they deliver on a number of projects, for example in Summer 2013 there was
a Raising the participation age project targeting a small number of disabled young
people and care leavers in looking at the options available to them to engage them in future
meaningful activity. This cohort included a number of young autistic people.
The Childrens and Families Act comes into force in September 2014. This brings major
changes to the Special Educational Needs and Disabilities (SEND) Code of Practice including;
Statements being replaced by the Education, Health and Care plan
An offer of personal budgets being available to meet education, health and social
care needs
Development of a Local Offer which will tell Nottingham citizens about services
they can access
A joint commissioning strategy
Preparing for Adulthood pathway
The Preparing for Adulthood workstream is chaired by Futures and will be the forum for
ensuring that we include the needs of autistic children and young people who are due to
transition. The first phase is focussing on employment, family leadership and an improved
Further Education transition pathway.
We will ensure that the implementation of this Act works in conjunction with the Care Act
(2014) developments and in partnership with strategic commissioning reviews.
The Multi-Agency pathway to support children and young people (0-19yrs) with
challenging behaviours (including ADHD/ASD) in Nottingham City, has been developed by
commissioners, public health directorate, social care and education, service providers and
the Clinical lead consultant Paediatrician (NUH). Additionally NHS Nottingham City and NHS
Nottinghamshire County worked jointly with an externally commissioned consultant to
develop a pathway and toolkit, webpage, training and support resources.
The proposed pathway is in line with and supports NICE recommendations and facilitates
early intervention and prevention approaches including multi-agency assessment and
diagnosis and on-going care planning for Children, Young Person and family/carers.
Nottingham Citys Adult Autism Co-production group are working with the Clinical
Commissioning (CCG) led multi-agency group to link the pathway with the adults pathway,
facilitating smooth transitions from childhood to adulthood.
Our Local Consultation and Engagement told us.....
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Autistic adults felt the change between childrens and adults services was equally poorly
planned and well panned, suggesting inconsistent experiences. The main thing they felt
would help this transition was having one person to speak to about the change, followed
secondly by better communication between childrens and adults services.
My mum is not sure of my future. She is so

worried when I change to adult services. She does Remember that the transition
not want me to spend my time in a secure unit. from primary to secondary school
Mum knows my needs, and with the threat of can also be really difficult.
cuts, no one is sure what is there in the future.
Childrens and adult services should link up because many people with autism have
children who have autism also
Childrens services and adult services should be the same - it should start from a young
age then there would be no cross over
Improving Transitions Support Pathways is key.

Autistic people can find change difficult and are often unable to visualise what life might be
like in the future. Transition from children's to adult services is a particularly challenging
time for young autistic people and is often associated with high levels of anxiety.
Recommended Actions:
1. In partnership with the Clinical Commissioning Group (CCG) led multi-agency group
develop an Information and Advice Hub to support children, young people, adults and
their families to ensure a coherent approach.
2. Nottingham Futures to improve the recording and sharing of information to support
better understanding and knowledge regarding autism needs.
3. Nottingham Futures Frontline staff to receive Autism training, including how to support
and signpost Carers.
4. Raise the concerns about the numbers of young autistic people accessing the criminal
justice system.
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Challenge 4
Accessible Pathway for Diagnosis and Assessment
The criteria for services will be set too

high so most people will not get a Assessments will be pointless
service and will be pushed out and left unless funding is available to help
to deal with it themselves families
Fulfilling and Rewarding lives states that: For many adults, receiving a clinical diagnosis of
autism is an important step towards living a fulfilling life. Think Autism 2014 priority action
states:
I want a timely diagnosis from a trained professional. I want relevant

information and support throughout the diagnostic process.
A significant proportion of adults across the autistic spectrum experience social and
economic exclusion. Their condition is often overlooked by healthcare, education and a
social care professional, which creates barriers to accessing the support and services they
need to live independently. In addition, autistic people are more likely to have coexisting
mental and physical disorders, and other developmental disorders (National Collaborating
Centre for Mental Health 2012). 1
Central to our vision for autistic adults living with the spectrum of conditions is to have
access to diagnosis and contact with the appropriate support, when and if they require it.
An accessible pathway is a key element of this strategy with a clear aim of increasing social
and economic inclusion of adults with autism. Nottingham Citys Vulnerable Adult Plan
(VAP) has a vision of preventative services in Nottingham promoting early intervention by
ensuring the right mix of support and information is available.
Following the work of the Needs Assessment for Adults and Young People with Autistic
Spectrum Conditions in Nottingham, Nottinghamshire and Bassetlaw, which provided an
understanding of the clinical pathway (see Appendix 4) the co-production team and partners
did a further mapping exercise in line with the NICE guidance for Developing a Pathway, to
show our current structures for the organisation and delivery of care and interventions and
support in Nottingham city; including understanding the roles in the delivery and
coordination of the pathway. (See Gap Analysis below)
Based on the NICE guidance the gap analysis reveals the following:
1
National costing report: Autism in adults initial recognition, referral, diagnosis and management (June 2012)
18
Nottingham city provides a range of autism services, including providing information,

signposting to support, provision that takes account of how autism affects the whole
family by public, private and community organisations;
There are multiple points for identification and access to specialist diagnostic and
assessment services available for adults with, or suspected of having autism including
Asperger in Nottingham City.
Nottingham City is in a unique and positive position as we have a multidisciplinary

diagnostic and support service, Nottingham City Aspergers Service commissioned by
NHS Nottingham City. The City Asperger Service offers a specialist service that
undertakes formal assessment and diagnosis, develops and supports coordinated
packages of support and enablement for people who would otherwise not receive a
comprehensive service including the meeting of mental health needs as they arise. The
service operates creatively and imaginatively across pre-existing service boundaries
whilst growing local expertise and harnessing existing expert knowledge.
The Learning Disability Services, Specialist Services Directorate of Nottinghamshire

Healthcare Trust have developed a diagnostic care pathway for people with learning
disability and autism. Professionals from Consultant Psychiatry, Clinical Psychology and
Speech and Language Therapy contribute directly to this pathway. 24 professionals
have recently been trained to use diagnostic assessments.
Speech and Language Therapy (A case study of best practice is available at App 5)
Services work with service users and those who support them around communication
and eating and drinking. The main aims of the service are to reduce risks, support the
development of inclusive relationships and develop the capacity and capability of those
who support autistic people. Speech and Language Therapy have a key role to play
around supporting the social communication needs of people on the Autism Spectrum.
Clinical Psychology Psychologists work with the individual and systems around the
person to understand psychological distress. Assessment approaches can include
behavioural observation, interviews and psychometric tests, which can then be used to
formulate an understanding of the persons behaviour and facilitate change
We have a number of autism

services in Nottingham but they do
not shake hands or say Good
morning.comment May 2013.
Support to families, partners and carers is available from a range of points on the
pathway, providing they are in contact or are aware of the providers
offering/delivering support;
19
Independent Living Support Service (ILSS) is a defined service for adults with autism
commissioned by Nottingham Citys Children and Families services. (ILSS previously
known as Floating Support namely the Include Service).
Additional areas for Nottingham City to focus their attention on:
Maintaining Contact with, housing, education and employment services requires
attention Reasonable adjustments should be a focal point of improvements;
Training, support and consultation for staff who care for adults with autism in
residential and community settings is the starting point for change, support is
required in all organisations to develop a culture of thinking differently.
The gap analysis similar to the needs assessment highlighted the need for a
definitive link and connection between the diagnosis and social care assessment
team to improve the accessibility and flow of the pathway for individuals their
families and carers.
Further analysis revealed that the process by which citizens with autism and their
carers/parents may access a social care assessment is clear and concise; however we cannot
rest on our laurels, we need to test whether the access to assessment requires a reasonable
adjustment? This needs to be further explored.
Individuals will receive services from a local Community Learning Disability Team (CLDT) if
they have a learning disability as their primary need.
Why Are Autism Diagnostic Services Important To Commissioners?
Failure to deliver services that meet the needs of autistic adults not only has a devastating
effect on the individual with autism, it also has a serious cost implication on a wider level.
Nationally, the estimated cost of autism is 28 billion per annum (25.5 billion for adults,
and 2.7 billion for children).This averages out at 500 each year for every man, woman and
child in the country. It has been estimated that if we include the cumulative impact of
service use, the need for accommodation assistance and low employment rates:
Someone with Aspergers the lifetime cost is 3.1m;
Someone with autism and a learning disability the cost was 50% higher at 4.6m.
This cost can be reduced by making sure autism diagnostic and post-diagnostic support
services are accessible in a timely and appropriate way.
When the National Audit Office (NAO) investigated public spending into adults with autism;
they found that failing to invest in autism provision is a huge false economy. They also found
that if local services identified, through autism specialist teams, and supported just 4% of
adults with Aspergers and AS the outlay would become cost neutral over time.
20
Proposed Adult Autism Pathway for Nottingham City

Pre Diagnosis Diagnosis Assessment Post Diagnosis
Information and Housing &

Advice Nottingham City Enablement Community Services
o Multi-Agency Aspergers Service Gateway o Autism
(Childrens) o Referral process o Signposting/ Champion
Webpage/Toolkit to Adult Social o Self Care/ o ILSS
o Nottingham City Care Community
LDPB website o If a person has and local Voluntary and
o NORSACA LD, doagnosis will networks. Community services
(external be through the
contacts with LD CLDT Specialist Services
SLT Service.) Adult Social Care o SALT
Assessment o Psychologist
Training Programme o CLDT Autism
o Approved/Preferr Champion Employment &
ed Trainers o MH Autism Education
o E-Training Champion o Nottingham
o Suite of Training o Carers Futures
and Information Assessment o Jobcentre Plus
o Nottingham Hub
Transitions o Remploy
o Nottingham
Futures
Key:
LDPB = Learning Disability CLDT = Community Learning ILSS = Independent Living
Partnership Board Disability Team Support Services
SALT = Speech & Language MH = Mental Health
Therapist
The majority of service users (2 in 3) felt it was difficult to get a diagnosis of autism, and
only half who had received a diagnosis thought it had made a positive difference to their
life.
Helped me understand Diagnosis changed [life] in a

why I'm different. Helped bad way. Get treated
me get help from the differently. Everyone talks
right people. about the negatives and
problems.
21
Social Care Support
There were fewer citizens receiving social care support compared to those diagnosed,
with 70% diagnosed compared to 45% receiving social care support.
Four out of five citizens did not know what personal budgets were.
People need access to a diagnosis in

Assessments should ask about the
good time and practical support
practical support people with
post-diagnosis - but we then need
Aspergers need everyday not just
more staff and more staff hours to
focus on whether you can complete a
support people
task
Accessible Pathway for Diagnosis and Assessment

It is crucial to develop a clear and easily accessible process which is effective before, during
and after diagnosis; with the primary aim of enabling individuals to remain independent,
make choices that empower individuals to live fulfilling and rewarding lives.
Recommended Action:
1. The Health & Wellbeing Board know how many people are diagnosed with autism and
how services are planned to meet need.
2. A clear and concise diagnosis and assessment pathway is clearly communicated and
known by professionals, autistic people and Carers.
3. Key partners delivering services for autistic people are actively linking services and
establishing levers to enable smooth transitions along the autism pathway.
4. Connect the Multi-Agency pathway to support children and young people with
challenging behaviours (including ADHD/ASD), in Nottingham city with the Adults
pathway to ensure a coherent approach in partnership with the CCG led multi-agency
group.
22
23
1 2 3 4 5 6 7 8 The Specialist Autism Team should

Norsaca x x x x have:
City Asperger team x x x x x
Specialist Diagnostic and Assessment
Homeless Health Team
CLDT x x x x Services
Mental Health Team- x x x x Specialist Care and Interventions
Nottingham Mencap x
NAS x x Support in Accessing with, Housing,
Education and Employment Services
Rainbows (Carers Org) x x
Employment and Maintaining Contact with, Housing,
Educational Services
Education and Employment Services
x if
Speech and Language accesing
Therapists x CLDT Advice and Training to other Health
and social Care Professionals on the
Housing Specialist Team
Jobcentre + x
Diagnosis, Assessment, Care and
Interventions for Adults with Autism

Nottingham Futures x x (as not all may be in the care of a
Specialist Residential specialist team.)
Providers
Support to Families, Partners and
Independent Living
Support (Floating Support) x x Carers
Independent Voices for
Care and Interventions for adults with
Engagement x
Autism Living in Specialist Residential
Accommodation
Nottingham City - Adults Autism Pathway - Gap Analysis Training, Support and Consultation for
Staff who care for Adults with Autism
in residential and Community settings.
24
Challenge 5
Access To Education And Employment Opportunities
During consultation
Most people feel the strategy would help people with autism
have the chance to learn and get a job but this would need
commitment and involvement from other organisations beyond
statutory services.
A number of people with autism talked about their negative

experiences of work and the types of support that could help
them get and keep a job.
Nottingham City Councils Employment and Skills Team aims to reduce worklessness,
increase the percentage of citizens in employment and, through strategic partnerships,
improve equality of opportunity for residents.
They work with the Invest in Nottingham and Business Growth teams to provide a
comprehensive support package for economic growth activity in Nottingham.
Objectives and projects include:
developing an Employer Hub for all sectors, providing a single port of call for citizens
and employers, including supporting contractors committed to the delivery of social
clauses in public sector contracts;
working to ensure that employment and skills is a priority within social clauses;
creating 80 job placement opportunities on an annual basis for 3 years through the
Nottingham Jobs Fund, targeting the 18-24 age group;
delivering an annual Keep Nottingham Working campaign including a jobs fair and
community events;
working to increase the uptake of apprenticeships across the city through the
Apprenticeship Hub;
developing and implementing the Working Nottingham Local Jobs strategy for
Nottingham city;
Engaging with Job Centre Plus and Work Programme prime contractors to influence
the delivery of mainstream provision to ensure that the needs of Nottingham
citizens are met.
Job Centre Plus
Jobcentre Plus Disability Employment Advisers work in partnership with Remploy to

deliver Work Choice. This offers support with job finding and job keeping. This can also
include supporting someone starting work and settling into a new routine. It can also
offer on-going in work support;
25
An Occupational Psychologist to help establish what type of work will be most

appropriate and the support a person may need to succeed in the work place.
Training opportunities designed to offer a supportive environment to people
with special learning needs.
Local Consultation and Engagement told us.....
More than half of respondents were unemployed, with 10% in part-time work and over
a third in education. (March 2013)
Respondents were positive about their experiences of employers and tutors with the
majority stating employers/ tutors understand Autism, and provide extra help when
needed, communicate in a way they understand and listens to them.
However, less than half stated employers/ tutors make Reasonable adjustments for
them.
Move away from the idea

A lot of jobs or interviews are that having academic
based on good communication qualifications means you
skills many people with autism do not need any support
find this stage difficult so cannot
show their skills and strengths.
Access to Education and Employment Opportunities;
Recommended Actions:
1. Accessible information and advice to be made available about education, employment,

training and benefits.
2. Provide Transitions support to enable access to work placements, apprenticeships and

volunteering.
3. Employment Partners to be encouraged to sponsor the adults strategy for autistic

people, and raise awareness and promote equality of opportunity.
4. Ensure Nottingham City Councils employment initiatives are able to accommodate and
include autistic people.
5. Reasonable adjustments to be promoted among employers by Jobcentre Plus, the

Partnership Board and voluntary/community organisations.
26
Challenge 6
Living a Fulfilling and Rewarding Life in the Local Community, with
Access to Support Networks Increasing Health & Wellbeing and
Resilience
Due to the nature of autism people living with the range of conditions may easily fall into
the category of being socially excluded and isolated, as there could be difficulty engaging
with services, also they could be hard to reach.
Nottingham Citys Autism strategy will promote social inclusion utilising the Disability
Discrimination Act (DDA) a key piece of legislation put in place to promote equality for
people with a disability. It placed a Disability Equality Duty (DED) on public authorities to
promote equality for disabled people, including making Reasonable adjustments to enable
them to access services. The autism strategy makes it clear that this duty applies to adults
on the autism spectrum.
Nottingham City will work to promote this duty as it is our role, but more importantly we
are driven to improve independence, by supporting informed choices for citizens with
autistic spectrum conditions and providing access to preventative services namely Health,
Housing and community services.
Health
Autistic people will experience a wide range health needs at different stages of life in the
same way as the wider community and may have higher needs. Currently we are aware
that health professionals in primary care services such as General Practitioners, dentists,
opticians, chiropodists or audiologists do not receive training around autism spectrum
conditions (ASC). This lack of awareness and knowledge makes it difficult to meet needs and
may delay diagnosis and treatment leading to higher levels of need.
Within Nottingham it has been found that people with a learning disability have a greater
incidence of also having autism. Because of this, health staff working in specialist learning
disability services, have a greater awareness of autism. Nottinghamshire Healthcare Trust
has stated that there is a gap in knowledge in adult mental health services and in
community forensic services. During 2013-14 staff working in these services received
training on autism, as part of an incentivised payment scheme (CQUIN).
It is helpful to note that there have been similar issues around the knowledge and
awareness of learning disability. In the City Primary Care Health Facilitators, commissioned
by NHS Nottingham City Clinical Commissioning Group (CCG) provide awareness training
across the health community and assist services to make Reasonable adjustments.
Healthcare in acute hospitals
27
Health professionals in hospitals do not routinely receive training on autism. This means
that staff are not always aware of the specific needs of people with this condition. From
2009 hospital staff at Nottingham University Hospital Trust have been receiving mandatory
learning disability awareness training.
NHS Nottingham City CCG commission an acute learning disability liaison service. The team
have identified that there is growing need to support autistic people.
It appears autistic people may be receiving an inconsistent service from health

professionals, particularly due to a lack of understanding about what it means to have
an autistic spectrum condition and inappropriate methods of communicating.
There is an over-representation of autistic people who use mental health services, 27%
of respondents compared to 17% of the population experiencing mental health
problems nationally. The reasons for this are not known.
Dental Experience
After a traumatic incident in children's day case dental services, when no staff
appeared to have any understanding of autism I vowed to complain loudly so
that other children and their parents/carers would not have to go through a
similar ordeal.
After a referral from my son's school at 16yrs to specialist dental services I finally
found something I could recommend without hesitation to other parents and
carers.
Accessing a service where all the staff have an understanding of learning

disabilities and ASC meant that for the first time in his life my son was able to
undergo procedures. The dental therapist worked tirelessly in allowing him to
experience on his hand anything that was to be placed in his mouth.
In the past 2 years he has had his teeth cleaned, scaled and polished and has
also had to small fillings. He has undergone 360degree X-rays and most
importantly allows a dental check! His oral hygiene is still below par, but we
would never have achieved this much without their input.

What have we learnt from family carers and people with ASC?
There may be scope for health professionals to improve the way they work with autistic
adults, as a third of respondents thought health professionals did not listen to them or
explain their health choices clearly.
28
Housing
The Housing Nottingham Plan (2013-2015) sets out the collaborative approach to the
housing market over the next three years. It doesn't describe every action or intervention
we will undertake - instead it shows how we will respond to changes in the city, changes
brought about by national policy and changes to the way we do things in order to achieve
the housing outcomes we want for our citizens.
We dont want this plan to just be about responding to new policies or changing housing
market circumstances. We want it to demonstrate the ambition we have for Nottingham
and the role housing and housing related services have to play in achieving it.
Our challenge for Housing in line with local priorities; support should be available for adults
with autism who want to, or have to live independently; and adults with autism and their
carers should be given help to understand the options available to them, including the
financial help they may be entitled to.
Our approach to access to housing is in keeping with the national strategy and underpinned
by the following plans: The Vulnerable Adults Plan for Nottingham City (2012-15) and The
Housing Nottingham Plan (2013-15), which is the plan of Nottinghams Housing Strategic
Partnership. Both plans have a focus on preventative services and early intervention;
building and supporting community capacity; personalisation and citizen choice; and co-
productive partnerships and collaborative working.
The Vulnerable Adults Plan for Nottingham City has as one of its three primary outcomes
those vulnerable adults have support, advice and information to live with choice, control
and dignity, in a place of residence which seeks to meet individual needs. Addressing
specialist housing needs and support, one of four key themes of The Housing Nottingham
Plan aims to help achieve this outcome of providing access to suitable accommodation for
vulnerable adults in Nottingham city. The plans links with the Autism Strategy will help
address the housing needs of adults with Autism Spectrum Conditions (ASC) more
specifically.
Homelink, Nottinghams partnership and choice based lettings system for accessing social
housing through Nottingham City Homes or registered housing providers, does not currently
identify autistic at application stage unless they already have support services or are
referred by Adult Services. Children or young people would be identified if the reason for
application is around their needs. Colleagues currently receive training on disability and
mental health awareness, but this does not specifically include Autism.
Information from Housing Aid on those who present as homeless identifies citizens with a
learning disability and autism, however does not identify autistic people.
Data to indicate numbers of adults accessing assistive technology similarly record learning
disability as primary condition, whilst medical notes alongside this may then also record an
autitic spectrum condition.
29

What have we learnt from family carers and people with ASC?
Nottingham Citys autism consultation in 2013 with carers of, and adults with autism, gained
information about peoples experience of accommodation, and housing options available to
them. Although the number of responses was not large enough to draw strong conclusions,
it provides information on the views of those who took part.
Almost 80% of autistic adults lived with their family. This is backed up by what we know
anecdotally. Other situations include various types of supported living, living with others
and residential accommodation.
Of those who lived with family, almost one fifth (19%) stated they would like to live on
their own. A similar number of carers thought the person they cared for would like to
live on their own.
Gap analysis carried out for the strategy illustrated that whilst some organisations and
teams, such as NORSACA, The Nottingham City Asperger Team and Community Learning
Disability Teams provide support in accessing housing services, far fewer organisations
and teams maintain contact with housing services.
Community Life and access to Leisure Services (Social Inclusion)

Nottingham is a vibrant city with many opportunities for citizens. Within the Nottingham
Plan there are a number of strengths outlined regarding the City including Nottingham is a
world class city; Nottingham is its people; and it states:
Nottingham is home. The city has one of the UKs largest and most successful retail
centres, excellent public transport, parks and green spaces and unrivalled leisure and
cultural opportunities. (Nottingham Plan)
Fulfilling and Rewarding Lives states they [adults with autism] can depend on mainstream
public services to treat them fairly as individuals.
All public service delivery is currently underpinned by the Equality Act 2010, which requires
all organisations that provide a service to the public to make Reasonable adjustments to
those services to ensure they are accessible for disabled people. This includes making
Reasonable adjustments for autistic people.
Nottingham city acknowledges that enabling adults with autism to access mainstream
services is important in terms of social inclusion and are striving to ensure they have more
choice and control.
Nottingham City Council has commissioned services to support autistic people learn to cope
with many everyday situations in the community.
30
Independent Living Support Services
The aim of the service is to offer a flexible service that enables and encourages individuals
to manage their tenancies and sustain their accommodation independently. The service also
aims to prevent isolation and provide support people to have meaningful relationships, and
build a life in the community for themselves and their families.
Advocacy
POhWER in partnership with Age UK Nottingham and Nottinghamshire currently provide an

accessible advocacy service across Nottingham City and Nottinghamshire, a jointly
commissioned service from Health and social care partners Nottinghamshire County
Council, Nottingham City Council, NHS Nottingham City CCG, NHS Bassetlaw and NHS
Nottinghamshire County. The service is delivered by skilled and trained advocates work with
children and adults who need advocacy support to enable them to have their voices heard,
to ensure their wishes are respected and their rights are upheld. Advocates working with
autistic people and/or learning disabilities all receive training and guidance in how to work
and communicate effectively.
Autism Champions will be trained and developed to raise awareness among their
colleagues, promote best practice and model the attitudes required for supporting citizens
with autism to access services. It is hoped the Champions will form a network in order to
support each other.
Both adults with autism and carers felt help with correspondence e.g. with utilities
companies budgeting, life skills and finding a house would help adults with autism to
live alone. Consultation for the national strategy provides backing for these findings, as
many of those responses indicated the benefits of low level support e.g. administrative
or domestic tasks, and that such support can make a difference to the choice and
control autistic people can have over where and how they live.
In the Nottingham consultation half of respondents stated that they would need help
with personal care, although this was the least identified option to help citizens to live
alone. Whilst consultation for the national strategy indicated the benefits of low level
support, this also showed that support might range between this type of support and
assistance with personal care.
Support for Carers and Families of autistic people
In Nottingham we recognize the important role that Carers and families play in supporting
autistic people to have and live fulfilling and rewarding lives, and that citizens would have
difficulty managing their life without the emotional and convenient hands on support. This
strategy endeavours to Listen to the voice of carers and involve them in planning and
monitoring services.
31
Carers Assessment
More than two thirds of carers either hadnt had a carers assessment (38%) or did not know
what one was (31%).
The most commonly identified support providers were voluntary organisations/ charities
(40% of carers receive support from these organisations), family members than
Nottingham City Council.
Of those who stated they received other support the most commonly identified
support providers were rainbows parent/ carers forum and schools2.
Carers stated the thing that would help them most in their caring role was better
information about services (41%), followed by a support worker and then respite.

What we learnt about services from the consultation:
When asked to describe what else would help in their caring role, carers mainly
identified
o More Information about support available to them
o Prompt Respite.
o a support worker
I do not know what is

As a parent I too have an available and don't know
autistic way of life how to apply. No one has
ever come round and made
me aware of the available
options. I can't believe it. I
only just found out about the
carers allowance that I could
The majority of carers are not receiving any support in their caring role3. Carers also feel
the support they receive is not meeting their needs.
Almost all carers (90%) cared for someone with a diagnosis, however only 4 in 10
respondents cared for someone receiving social care support. This may indicate a lack of
access to social care services. Of those who were receiving services 70% had a personal
budget.
There appears to be a lack of information given at the point of leaving school about
employment, as well as a lack of information about adult services when autistic young
adults turn 18 years.
2
However this group was very small at 7 people.
3
Two thirds stated they received no support however later in the survey some identified they received support
from family and friends, at which point the figure dropped to 29% who receive no support. This may be
attributed to carers perceptions of what support is.
32
Living a Fulfilling and Rewarding Life in the Local Community, with

Access to Support Networks Increasing Health & Wellbeing and
Resilience
Nottinghams focus is to enable autistic people to equally access the opportunities to live
fulfilling lives. This will be achieved by
Recognising One size fits one and providing the ability to make informed choices.
Recognising the pivotal role natural and community support networks provide, also by
Effective and appropriate access to information and advice and mainstream public
services.
Recommended Action:
1. Recognising and supporting the pivotal role of natural and community support
networks, by linking them into SPLAT.
2. Raise awareness of the Equality Duty and Reasonable Adjustments to ensure services
are accessible, e.g. the Choice Based Letting service for housing; Leisure centres and the
City card.
3. Autism Training and Awareness to include adapting processes, design for potential
sensitivities e.g. lighting and layout of space, information.
4. Create Autism Champions to raise awareness, challenge stigma and promote good
practice to influence Nottingham city services.
5. Enable access to mainstream services by providing a suite of Information and Advice
available at Nottingham City services and locations including Service centres, Health
centres.
6. Building on the consultation, gain further information on the types of housing options
autistic people would prefer.
Health Support
7. Acquire an autism health facilitator or assign a team member as a Champion.
8. Expand the Acute Learning Disability Liaison Team to include an autism lead/
Champion.
Carers Support
9. Carers to be offered quality Carers assessments with a focus on empowerment,
signposting to community and voluntary support services and group support.
10. Establish support mechanisms for Carers and families of autistic people.
33
Leadership
Delivery and Implementation
Nottingham Citys Health and Wellbeing Board is ultimately responsible for ensuring the
governance mechanism is in place and functions effectively to achieve Fulfilling and
Rewarding Lives.
The Autism Co-production group which includes autistic people across the spectrum,
Carers, and family members, Providers from private, public, community and voluntary
sector have worked together to develop the strategy and recommended actions. The co-
production group will form a strand of Nottingham Citys Partnership Board SPLAT.
Nottingham Citys Partnership Board SPLAT (Speak Listen Act Together) brings together
council departments and health services, providers of services in the private, community
and voluntary sector share information about what is happening in the local area and find
creative solutions to ensure individuals can live fulfilling and rewarding lives. This process
gives the opportunity for citizens with Autism and/ or learning disability to agree what
needs to be done and can check that the work they are doing fits in with what everyone else
is doing and ultimately measure the extent and progress of this strategy.
SPLAT are currently accountable to the Learning Disability Joint Commissioning Group
(LDJCG) who set direction, oversee delivery and monitor progress; who in turn are
accountable to the Health and Wellbeing Board.
Fulfilling and Rewarding Lives states that:
1. Change needs to be driven locally, through strong local leadership.
2. The key is that local partners come together in one place to discuss
priorities and challenges together: how that might be done will need to be
determined locally.
34
Appendix 1
Acknowledgments:
Nottingham Citys Adult Autism Co-Production Group

Sue Hopkinson (Co- Chair) Parent Carer
Aysha Subedar Parent Carer
Julie Walters Parent Carer
Peter Harris Service User/Parent Carer
Danny & Aleks Jackowski Jigsaw Youth Club
Nikki Autistic Nottingham
Liz Pierce Public Health Nottingham City Council
Phil Carpenter NORSACA
Amanda Payne Futures Nottingham
Sarah Andrews Housing Strategy
Jake Jacobs Community Learning Disability Team (CLDT) Manager
Annette Todd Social Worker
Oliver Bolam Operational Lead
Karen Archer Independent Voices for Engagement
Jackie Dziewanowska Nottingham City Aspergers service
Della Money - Speech and Language Nottinghamshire Healthcare Trust
Vicky Romily Speech and Language Therapist
Della Sewell Speech and Language Therapist
Phil Sharpe Jobcentre Plus /DWP
Ester Vickers - National Autistic society
Tracie Baker Participation & Engagement Lead NHS Nottingham City
Jon Rea Participation & Engagement Lead Nottingham City Council
Trevor Clower LDPB Representative -Nottingham City LA
Charlotte Reading Head of Commissioning (LD Mental Health)
NHS Nottingham City CCG
Sharon Bramwell Commissioning Manager Nottingham City Council
Other contributors included;

Nottingham City Council Employment Team
Deborah Hooton CAMHS NHS Nottingham City CCG
35
Appendix 2
The Journey Developing Nottingham Citys Adult Autism Strategy

The autism strategy builds on the knowledge of 3 key areas of work
1. Needs Assessment for Adults and Young People with Autistic Spectrum Conditions in
Nottingham, Nottinghamshire and Bassetlaw. (2010)
2. Local Authority Autism Self-Assessment 2010 - 2011

The new outcomes-focused policy framework; Implementing Fulfilling and
rewarding lives. Statutory guidance for local authorities and NHS organisations to
support implementation of the autism strategy (2010) provided a set of seven
outcome goals and three service ambitions.
Nottingham City completed their self-assessment in February 2012, to ascertain
where progress was required.
3. Local Consultation and Engagement What you told us.....
Following the completion of the Autism self-assessment, consultation was undertaken

by Rainbow Parents Carers Forum as the lead and voluntary sector partners,
Independent Voices for Engagement, Jigsaw Youth Club and NORSACA during December
2012 and February 2013 to:
a) Quality assure the position established within the self-assessment

b) Find out what autistic people and their families views and thoughts were about
services they could access and desired to access
c) Determine what improvements we should focus on for improving the lives of autistic
people spectrum conditions.
The findings were used to draft the initial strategy.
January 2014 June 2014 Consultation on the Draft strategy

The draft Autism strategy underwent intensive consultation lead by VOX (UK) to confirm
if Will One Size Fit One?
The consultation and engagement sessions confirmed the challenges we proposed were
all important and included recommendations of other important issues, ie having a
family and having children, incorporating schools and the other transitions points
separating the needs of Carers, being honest about what we can deliver and quality
assurance with autistic people.
Subsequently the Autism Strategy for Adults has been developed through consultation
with autistic people, parents/carers; service providers and professionals across
voluntary/community sector, the public and private sector.
36
Appendix 3
National and Local Key Strategic Policy Drivers
The Autism Act 2009 was passed in response to an identified gap in provision of services for
adults with autism. The strategy was published as:
Fulfilling and Rewarding Lives: the strategy for adults with autism in England
published on 3rd March 2010. The strategy sets a clear framework for all mainstream
services across the public sector to work together for adults with autism.
Towards Fulfilling and rewarding lives: The first year delivery plan for adults with
autism in England (April 2010);
Implementing Fulfilling and Rewarding Lives: Statutory guidance for local authorities
and NHS organisations to support implementation of the autism strategy (December
2010).
Think Autism- Fulfilling and Rewarding Lives, the straegy for adults with autismin
England: an update (April 2014)
The Equality Act 2010 provides a cross-cutting legislative framework to protect the rights of
individuals and advance equality of opportunity for all.
NICE Guidance CG 142, Autism: recognition, referral, diagnosis and management of adults
on the autism spectrum, June 2012 summarises evidence-based advice on the diagnosis
and management of autism in adults.
The Nottingham Plan 2020: Safe, Clean, Ambitious and Proud

and the underpinning twenty year vision for the city is an ambitious and fundamental driver
for all our activity and delivery of services by partners (including providers) in Nottingham.
The Vulnerable Adults Plan 2012-15 sets out a vision of preventative services in Nottingham
that:
Reduce needs and dependency and lowers future costs
Develop innovative and new ways in which to mobilise and make use of all the resources
of the community; and
Enables vulnerable citizens to remain independent for longer and have real choice
regarding how their needs are met
Nottingham City Joint Health and Wellbeing Strategy 2013 2016 - sets out four priorities
on which the Health and Wellbeing Board will focus its efforts to improve quality of life and
tackle health inequalities in Nottingham.
Multi-Agency pathway to support children and young people (0-19yrs) with challenging
behaviours (including ADHD/ASD), in Nottingham City This document recommends the
activities to implement a multi-agency pathway.
37
38
Appendix 4
ASD Pathway in Nottingham City (2011)
Needs Assessment for Adults and Young People with Autistic Spectrum Conditions in Nottingham, Nottinghamshire and Bassetlaw.
39
Appendix 5
SALT Case Study:
Supporting Barry and his staff team to Communicate effectively together
Barry is a 23 year old man with autism and learning disabilities. He has lived in his residential
home for 2 years. Staff have different styles of communicating and interacting with Barry
some of these styles seem to suit him better. There is no specific guidance or
communication passport that the team use or add to in order to develop shared
communication systems.
The Speech and Language Therapy service were requested to support Barry, his team and
his work placement work. They spend time directly with Barry, observing Barry at home and
at his work placement a charity shop and they spend time working with different staff
members.
The Specialist SLT Service worked with Barry and the team to develop some communication
guidelines. This information supported the staff team to consider how Barry understood
information around him, - how he understood language and how he understood intention.
It also supported other people to think about how Barry processed information that he
needed more time (sometimes up to 20 seconds) to process what had been said to him. The
guidelines also highlighted how Barry might not seem to respond to questions or comments
made by others and explained the difference between other people might perceive this
behaviour and how from Barrys point of view he has difficulties coping with the demands of
interaction.
A significant part of communication guidelines highlighted how other people need to adapt
their own communication or interaction to meet Barrys need. Below are some examples
from this:
Barry needs people to be mindful of whether he has understood a situation or not as

he will not indicate if he has not understood. Barry needs other people to be aware that
his understanding and processing of language can change. Therefore people need to be
able to change and be flexible in how they give him information.
Barry responds to people who use a non direct approach with him. This means being
low key in your own interaction style, and not directing conversations directly at Barry
but still being structured or firm in a interaction when necessary.
Other people need to be aware that Barrys tone of voice can unintentionally change
how people perceive what he is saying try and work out is he asking me a question
here or not?
Barry needs staff to be autism specific in their thinking so they do not interpret his style
of conversation as being impolite more that he is being direct and giving clear
information
40
Barry needs specific support to understand social rules around interaction. Comic Strip
Conversations and Social Stories could offer a structured approach to this.
The outcome of this work:
The staff team recognised the key issues highlighted in the communication guidance as
significant and it brought together staff views on how to spend time with and
communicate with Barry. The staff team worked with the SLT Service to use socially
accurate information approaches to support Barry to predict and plan for social situations.
How did this work reduce risks around communication and relationships?
Staff were able to consider predicting more risky situations where Barry misinterpreted
social situations which previously could lead to difficult misunderstandings. Barry was
able to learn about other peoples points of view and adapt his own communication and
interaction in different situations.
41

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Autism Strategy

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Autism Strategy for Adults

who live and work in

One Size Fits One

Chair Co-Production Group

Challenge 1: Understanding the Needs of Autistic People 7

Challenge 3: Improving Transitions Support Pathways 14

Challenge 5: Access To Education And Employment Opportunities 23

Leadership Delivery And Implementation 32

Appendix 2: The Journey 34

Appendix 4: ASD Pathway in Nottingham City (2011) 36

Foreword by Co-Production group

Nottingham Citys approach to developing the strategy through a collaborative working

Co-Chair & Co-production Group

Autistic Nottingham and East Midlands

Autistic people are neurologically different to non-autistic people. They can

"Sometimes Autistic people communicate or use language in a different manner to

Guidance by NICE describes some of the features experienced;

One Size Fits One....

2. Nottingham Citys Vision

3. The Challenges for Nottingham City and Priority Actions

4. National and Local Strategies

Fulfilling and Rewarding Lives (2010)

How Many People Have Autism Spectrum Conditions in Nottingham City?

It is estimated there are over 2,600 autistic adults in Nottingham city.

2012 2015 2020 2030

However a more recent report into estimating levels of ASC in

Autism and Learning Disability

Think Autism Fulfilling and Rewarding Lives 2014 states:

What can be known from health records about Autism prevalence?

More work needs to be undertaken to establish what is recorded in housing and

Criminal Justice System

Understanding The Needs of Autistic people

1. Improve knowledge of the numbers of autistic people using health services.

incorporate autistic adults, their families and carers.

Training and awareness of autism is a real

Training should reflect current good practice and

Autism Training Available in Nottingham

Consultation and Engagement told us.....

There appears to be a lack Autism teams need to

Challenging Stigma Raising Awareness and Understanding of

health and social care partners, and private organisations.

A multi-disciplinary Transitions Team is hosted within the Futures service, consisting of

o Accessing further education opportunities

Nottingham Futures maintains the database providing information to Government office on

Our Local Consultation and Engagement told us.....

My mum is not sure of my future. She is so

Improving Transitions Support Pathways is key.

The criteria for services will be set too

I want a timely diagnosis from a trained professional. I want relevant

Nottingham city provides a range of autism services, including providing information,

Nottingham City is in a unique and positive position as we have a multidisciplinary

The Learning Disability Services, Specialist Services Directorate of Nottinghamshire

We have a number of autism

Why Are Autism Diagnostic Services Important To Commissioners?

Proposed Adult Autism Pathway for Nottingham City

Information and Housing &

Our Local Consultation and Engagement told us.....

Helped me understand Diagnosis changed [life] in a

Social Care Support

People need access to a diagnosis in

Accessible Pathway for Diagnosis and Assessment

1 2 3 4 5 6 7 8 The Specialist Autism Team should

A number of people with autism talked about their negative

Objectives and projects include: