At Apple House care homes we strive to support residents to lead a healthy lifestyle and to be as independent as possible. We provide access to a programme promoting healthy living and wellbeing, with home cooked fresh food, regular exercise, and creative activities. This article outlines why it is important to give people with autism the opportunity to take part in creative activities and regular exercise.

Challenges for people with Autism

For people with autism, you may notice that they can have challenges in interacting in social situations as it can be overwhelming at times with direct verbal communication. We may not get a direct response or eye contact and we can wonder if we have been understood. So it may also be a struggle to build a relationship with them through words alone.

At times people with autism can have rigid mindsets as this may be their way of making sense of the world around them. So, therefore, change can be difficult as they feel reassured by a routine that gives them a sense of control. They may not always understand that a change in routine may be something beyond their carer’s or parents’ control. Such as the illness of a friend or a change in who supports them due to outside factors.  They may need help in regulating their emotions in response to these situations.

Sensory experiences

Jackie Edwards (2017) describes how people with autism may have difficulty making connections between their tactile, vestibular and proprioceptive sensory systems where they may be overactive or not active enough with how they interact with their environment.  For example, they may have a hypersensitivity to loud noise or bright light, may also be de-sensitised to tactile experiences. So, therefore, they would benefit from a sensory diet to improve sensory integration.

She advocates giving people with autism access to different sensory experiences to help improve concentration and attention. This in turn may help them to be able to regulate awareness of their surroundings more effectively as well as to help them relax and not feel overwhelmed, leading to increased socialisation and interaction, promoting less rigid thinking, creativity, and motor skills.

Benefits of exercise

At Summerwood we recognise the importance of exercise by helping our residents access their community, take part in physical exercises such as the gym and swimming, and helping with gardening, tending the vegetable patch etc.

According to Healy S, et al. (2018) research shows that for people with autism exercise can have a number of benefits:

• Reducing stereotypical behaviours or self-stimulating behaviours
• Improving social skills with sports that promote teamwork
• Helps to reduce weight gain or obesity
• Can increase a person’s attention as repetitive behaviours can decrease
• Exercise can reduce anxiety and improve the ability to regulate emotions, build resilience to anxiety-triggering situations
• Exercise can improve motor skills and coordination for people with autism

Benefits of creative activities

The creative arts is another important activity and we support individuals to participate in regular arts and music classes in the community and within Summerwood, their home.

Art can give a person a sense of control as they learn to adapt to the task in their own way. Drawing and painting can also help to improve and maintain fine motor skills. Creative arts can be an effective way to engage with the person in a non-pressurised way. Tactile art forms such as paint and clay also provide a sensory experience to fulfill the needs of the person to be able to balance their sensory experiences more effectively. Music can elicit interactive emotional responses and melodic rhythms can help them engage.

Arts and wellbeing

People with disabilities can be more vulnerable to mental health issues so we are aware that it is important to provide a way for people to communicate their emotions appropriately. Behaviours on the surface may arise due to an inability to verbally communicate how they feel. Behaviours thus can have a function so this highlights the importance of non-verbal communication and communication aids to help people communicate their needs.

For further assistance, creative arts therapy with a trained art therapist can be a way for a person to be able to express and/or regulate their emotions when words are difficult. It can also help to improve cognition and emotional regulation where the aim is to use the art materials or creative activity to access emotional wellbeing and to help a person learn to regulate their emotions and understand themselves within a safe and facilitating environment.

— By Andrew Wright, Support Worker, Summerwood Care Home, Hants (Previously Rated ‘Outstanding’ by CQC).

References and further reading

Draycot, C. (2013) Educating Autism – Art and Creativity to Engage an Autistic Child in the Classroom. The Art of Autism: Connecting through the Arts. https://the-art-of-autism.com/educating-autism-art-and-creativity-to-engage-an-autistic-child-in-the-classroom/

Edwards, J. (2017) The benefits of multi-sensory environments. Autism Journey Blog.

Healy S (2018) The effect of physical activity interventions on youth with autism spectrum disorder: A meta-analysis. Review article. Autism Research. 11(2) · April 2018.

Rudy, L.J (2017) How Does Art Therapy Help People With Autism? Very Well Health. https://www.verywellhealth.com/art-therapy-for-autism-260054

What is Autism?

Autism is a lifelong developmental disability that affects an individual’s behaviour and communication. People with autism may lack social awareness, emotional reciprocity and the ability to sustain conversations. Autism Spectrum Disorder (ASD) is characterized by severe and persistent deficits in social communication and interaction (American Psychiatric Association 2013). In the UK the Autism Act (2009) led to the government producing statutory guidelines for autism. With a clear pathway of diagnosis, where everyone has a right to an assessment. 

Most parents notice some symptoms of autism when their child is two or three years old but these symptoms can change as the person gets older. The characteristics may be different in girls than in boys so diagnosis can be difficult. There is also a lack of a genetic or medical testing and the impairment may also be accompanied by other conditions such as epilepsy, ADHD and learning disabilities. People with autism may also have a co-morbid mental health condition such as anxiety or depression.

Features of Autism

Wing and Gould (1979) identified a Triad of Impairments with difficulties with social communication, difficulty with social interaction and difficulty with social imagination. People with autism may find it hard to keep eye contact due to an overload of speech, facial expression and body language data to process. They may also be unaware of personal space and may be unaware of non-verbal cues in communication.

They may also exhibit restricted or stereotypical patterns of behaviour and can be hyper (over) or hypo (under) stimulated by their environment. This can result in obsession with a particular topic, self-stimulating behaviours such as finger clicking, hand flapping, and an overload of emotional and sensory information, resulting in ‘stimming’.

According to Martin (2009) Baron-Cohen’s theory of mind can be considered as the fourth impairment for people with autism. As they will find it hard to imagine a world from someone else’s perspective and understand that other people have different thoughts and feelings independent from their own. This can be misinterpreted as a sign of rudeness as they may not be able to see things from another person’s perspective.

Working with autism

These difficulties can have the effect of preventing someone with autism feel the close bonds of relationships, and over compensatory rituals and routine can provide them with a feeling of safety and reassurance. So it makes sense that people with autism find routine very reassuring, although it is important to note that people with autism can adapt to change they just need support with time and preparation given to them so it is not just a sudden change that can make them feel overwhelmed.

Practitioners have advocated the importance of early intervention with environmental stimulation appropriate to a child’s needs is necessary for developing creative thinking in children. As many people with autism may need help with sensory processing to help them balance and regulate environmental stimuli. For instance some people may be sensitive to light or noise while they may need extra tactile stimulation. So in some cases it can be about thinking of the senses as a ‘graphic equaliser’ where people need help to balance their sensory input.

Strategies to encourage social interaction and communication can include the use of visual aids to help promote understanding and reduce anxiety. Carol Gray developed the use of ‘Social Stories’, while pictorial story boards can be useful. TEACCH promotes structured learning environments that encourage visual based engagement and communication. Also helpful is the use of a temperature gauge so they can communicate their feelings.

Creative strategies to help to attune and develop interaction and communication with people with autism. As often for two way verbal conversation can be too overwhelming due to the fact that they struggle to cope with verbal, nonverbal and body language, all at the same time. Arts Therapists encourage use creative mediums such as art, drama and music to engage and aid communication and interaction. Working together on an art object or creating a performance can be a less intrusive way of building a relationship for a person with autism. It may also meet their sensory needs and be a way of discharging emotion with directed movement and action.

Autism and Social Camouflaging

Hull, et al (2017) discusses social camouflaging, which is how people of all genders manage the way others perceive them in social situations. They suggest that people with ASD struggle with this have and it takes a lot of mental effort minimise their social soothing behaviours in public and this can cause stress and anxiety. A person who may seem to be functioning well in society may actually struggle to maintain this.

They also point out that this may account for less girls being under diagnosed with autism as boys will more likely to exhibit externalizing behaviours such as hyperactivity and conduct problems. While girls are more likely to internalise these difficulties leading to difficulties in emotional wellbeing.

This explains why often people with autism can struggle with mental wellbeing and emotional regulation, compared to the ‘neurotypical’ population. So it is useful to help them with coping strategies and when they do feel distress. Ccording to Connoer et al (2018) adaptive cognitive strategies can be successful with anxiety, but they are less successful at helping someone deal with destructive feeling and aggression. As over thinking and rumination can be a maladaptive response.

References

Conner, C. White, S. Beck, K. Goltx, J. Smith, I. Mazefsky, C.(2018)  Improving emotion regulation ability in autism: The Emotional Awareness and Skills Enhancement (EASE) program. Autism, 1–15. Sage Journals.

Hull, L. Petrides K.V. Allison, C. Smith, S. Baron-Cohen, S. Lai, Meng-Chuan Mandy, W. (2017) “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions.  Journal of Autism and Developmental Disorders. DOI 10.1007/s10803-017-3166-5

Martin, N. (2009) Art as an Early Intervention Tool for Children with Autism. Jesssica Kinsgley Publishers

Wing L. and Gould J. (1979) Severe Impairments of Social Interaction and Associated Abnormalities in Children: Epidemiology and Classification. Journal of Autism and Developmental Disorders 9 (1) 11-29

A postscript from Apple House HQ:

Huge thanks go to Andrew Wright, qualified art psychotherapist and valued member of the Summerwood staff team, for kindly sharing this detailed and interesting article he has written for our blog. We are incredibly fortunate to have such a talented and creative team member. We have Andrew’s full permission to share the above article but Andrew remains the copyright holder of the work and no sharing or use of his work is permitted without authorisation from the copyright holder: Copyright: Andrew Wright 2020.

Our teams are working hard to ensure a safe and peaceful Christmas can and will be enjoyed for all the people we support.

We have seen the introduction of Lateral Flow Device tests (LFD) and our staff are busy attending the webinars and training to ensure that these can be delivered in a timely manner. You can see more information regarding these tests here https://www.gov.uk/government/publications/coronavirus-covid-19-lateral-flow-testing-of-visitors-in-care-homes

Our teams have gone over and above this year in their commitment to our company and we can’t thank everyone enough for the extra effort we know the pandemic has made everyone make. We have all had to adapt how we think, what we do and how we see our family and friends. Frontline workers have been recognised for the work they do and this is long overdue. We want to see the celebration of our wonderful carers and managers applauded by the country as much as we do each and every day.

We have been keeping our readers up to date with the latest Governement guidance where possible. Please bear in mind that this is fluid and changes to meet the latest decisions taken centrally. For the latest guidance please go to the gov.uk site.

— Romaine Lawson, Director of Operations, Apple House Care Homes.

Historically, care homes and nursing homes followed the hospital model of rigid visiting times.  This in turn meant that families may not have been considered to be intrinsic in the planning of care pathways or, in fact, in the individual’s life inside a care environment.  Today, things are changing for the better but there is always more work to be done.

Apple House care homes embrace an ethos of inclusion.  Families and loved ones have a hugely crucial role to play and, as such, are our partners and never an inconvenience.

Apple House are proud to have signed up to John’s Campaign who champion family inclusion in care settings, and to have been featured in their blog. These are just some of the ways in which we include families of the individuals entrusted to our care:

• Decision making: From the moment that we receive a referral for a placement at our homes we establish communication with the individual’s family unless they do not wish to be involved in the assessment process.  This means that we invite the family and the individual to the home for an initial look at the facilities offered and to meet our team.  An open line of dialogue is created so that families feel empowered to ask any questions and to express concerns or wishes.  Often close family members advocate on behalf of their loved one or have worries about how the individual will adapt to their new home environment.  After all, change is scary for all of us and we understand that.  Only by being fully informed can families and their loved one make a decision that is right for them.
• Partnerships: We believe that families and friends are an invaluable source of information.  No-one knows an individual as well as those closest to them.  Insights and preferences, life history, hobbies and matters that are important to the individual can sometimes be shared with us more fully by family members, especially if their loved one finds verbal communication to be a challenge or if their memory is poor.  Memories are precious and we would like to learn about the memorable moments that are important to the person – all of this makes the individual who they are today. Working in partnership with families as well as the individual in care planning produces a more holistic and comprehensive pathway.
• Approachable: Communication is key.  Three words that summarise the entire partnership between ourselves and the loved ones of the individuals we support.  It is essential that strong communication is in place to form a bridge between families and staff teams.  That bridge helps to avoid rocky roads where anxiety and disharmony could take hold.  After all, it can be stressful and emotional entrusting the care and support of someone you love into the hands of others.  By us being approachable–letting families know that we are there to support them, that they can talk to us at any time–we hope to alleviate concerns, discuss expectations and to be friendly and flexible.
• Flexible: The people who live at Apple House homes are not living in our workplace.  We are working in their home.  They are free to invite their families and friends into their home for a cuppa or to enjoy their gardens with them.  We minimise rules about visiting to, for example,  the need to sign in which is a legal requirement, and to the consideration of others living alongside the individual.  There will always be a warm, genuine welcome from staff.  We have an ‘open door’ approach to visiting, just as we all expect within our own homes outside of care.
• Homely:  We work hard to ensure that Apple House homes are exactly that – homely!  To achieve this, we choose furnishings for our public areas such as lounges that are not clinical or generic in style.  We encourage the displaying of items and pictures that have meaning to the individuals who live there.  Our gardens are created and maintained with the help of those individuals who are able and wish to, for example our chickens are cared for by residents who collect the eggs and bake with them.  There are sensory areas and places to simply sit and be.  Where we are required to display certificates of registration, fire, health and safety etc, we endeavour to do so discretely.  Individuals are encouraged and empowered to decide how they wish their bedroom to look (and we’ve certainly painted some wild and varied colours!).
• Communication: We understand that it is not always possible to visit and so we ensure that alternative means of communication are accessible.  These include Skype video calls, email and telephone calls between individuals and their loved ones.
• Participation: Invitations are extended to families to events within the homes that are varied and regular.  These include invitations to birthday celebrations, BBQs, seasonal parties, special activities such as visiting owls and birds of prey and charity fund-raiser coffee mornings.

This list is not exhaustive – there are so many diverse ways of ensuring that we are family friendly.

–– Jane Montrose, Managing Director.

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At the most basic level, stress is our body’s response to pressures from a situation or life event. Some common features of things that can make us feel stress include experiencing something new or unexpected, something that threatens your feeling of self, or feeling you have little control over a situation. [Mental Health Foundation]

In the following article, Jayne Jackson, registered manager at Apple House care home, writes an open and very insightful reflection on how stress plans can and do have a profoundly positive impact for a gentleman she supports:

Our care plans are person centred and very individual to each of the people we support.
I was looking at environmental risk assessments & policies for stress. This centred around how we could look after staff’s health and what they/we could do to help in their day-to-day working environment, which we know at times can be stressful.This prompted me to look at the people we support [in relation to stresss]. We looked at easy read documents and set up a meeting.

The easy read document comprised general things to help lower stress/anxieties. We wanted our support plans to be personalised to suit the needs of the individual.

We worked with each person individually and discussed what we could do to help them stay settled and reduce their stress levels.

For one individual this was a massive achievement as in the past just discussing and writing information could cause him to experience high levels of stress.

We worked very closely over many years with the gentleman to help him learn to trust us. We use the phrase ‘it’s good to talk’ and this person now quotes this phrase.

This plan would not have worked for this person if they did not sign up to it.

He spent time with us, we listened to him, we built ‘his’ support plan. It is important that the person has ownership over ‘their’ plan. When he is feeling stressed we refer to the plan and this keeps it fresh in his mind. We all stick to the plan; this is key in keeping his well-being stable.

This plan cannot work without the individual being involved, it is not a paper exercise, it is a live tool.

The stress support plan runs alongside others that all interlink. He is now beginning to recognise when he is feeling troubled, or finding things difficult and, with our support, he is starting to work them out.
The individual works with us. We ensure he has time to reflect, to identify what is worrying him.

Breathing exercises, conversation and space are used; usually after 10 minutes he feels able to talk about what is happening. We must ensure that the person and staff have clarification that they have settled as this prevents further stress. A physical change can be seen within him – his body language and speech will return to pre-stressed levels, and he appears calmer. This is not just a one-off thing as this may happen a few times a day, or weeks may pass without presentation of stress.

Because of the trust we have built, continuity of the team and knowing and respecting the individual it could be said that he has a better quality of life. Sure, there are stressful days for him, we all have those, but learning to cope with them is what we support him to do.

I cannot tell you how proud I feel of him and the team; it is lovely to see the person more involved in day to day things, and by doing this it also helps him to have a renewed sense of purpose and to feel valued, staying focused forming part of his routine.

This individual wrote an additional support plan with staff which was linked to additional stress; he took it to a meeting with his psychiatric team and asked them to sign up to it which they did.

He then wrote to his link mental health team and asked to be discharged. We supported him in writing a letter and discussed the benefits, including self-esteem, that he would feel. His mental health team told us they never thought they would see they day this gentleman would be signed off [from their care].

This is a massive achievement for him!

Due to the hard work and commitment of my staff, their link team and the individual himself, he has stayed settled for over a year following years of mental health decline.

In our compliment folder, the person’s mental health team praised Apple House. They commented how well we had supported the person when they had deteriorated in their mental health and suffered episodes of depression and mania, they had never see this person doing so well. This was signed by the person’s community nurse. This person was told if they remained stable for the next year they would be signed off.

Jumping forwards a year, well its happened, he has been discharged!

We look forward to maintaining his wellbeing and will continue to encourage him to further develop and reach his personal goals.

— Jayne Jackson, registered manager, Apple House care home, Bournemouth.

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But, wait a minute! 

Cookery should be accessible to all who love it, shouldn’t it?  We think so!  Which is why, when ‘L’ (who is registered blind) showed a culinary passion, we decided to set out and find a way to make all our cookery books accessible to her in the format she knew best.

Redcroft contacted RNIB and began working with them to create an entire library of cookery books in braille just for ‘L’

Six volumes so far! ‘L’ is thrilled and enjoying the challenge of discovering new recipes and tasting her own wonderful and complex creations in the kitchen.

This got us thinking…

‘L’ already has a braille machine, already prepares an agenda, chairs house meetings. But, if we can produce SIX entire volumes of cookery books, can’t we do more?

New mission: Create an entire library in braille right here at Redcroft! Watch this space!

Choice, we all need it and deserve it. Choice in reading and recreation should also be accessible to all. It underpins what we do and who we are.

— Jane Montrose, Managing Director

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No two days are the same working in our homes and a career in care can be both rewarding and motivating.

We are supporting Bournemouth, Christchurch, and Poole Councils #proudtocare Twitter week from the 9th^th to the 15th^th of September 2019 in support of the great people who work with us. Keen to find out more? You can follow us on Twitter: @AppleHouseLtd

You can also see our details in the BCP ‘Proud to Care’ list of Care Home Providers here:

https://www.bournemouth.gov.uk/AdultSocialCare/AboutAdultSocialCare/proud-to-care/care-home-providers.aspx

And you can find out more from the ‘Proud to Care’ team here:

 https://www.bournemouth.gov.uk/AdultSocialCare/AboutAdultSocialCare/proud-to-care/ProudToCare.aspx

— Romaine Lawson, Director of Operations, Apple House care homes.

John’s Campaign was founded by Julia Jones, daughter of June who lived with Alzheimer’s and vascular dementia, and Nicci Gerrard, daughter of Alzheimer’s sufferer Doctor John Gerrard who sadly passed in 2014 after a prolonged hospital admission. Doctor Gerrard’s health deteriorated during a five week hospital stay during which time he was detached from the care and support of family members by a system that did not historically facilitate such external input into daily hospital routines.

From this experience Nicci and Julia founded John’s Campaign, with the hope that family and carer support could and should be accepted and welcomed in the hospital setting. The Campaign has taken off exponentially, with TV coverage, MP support, and over a thousand wards, hospitals and other environments pledging their support.

‘We need to embrace a new era of of family-centred care in which family carers are treated as equals in the delivery of care.’ — The Benefits and Drawbacks of Open Visiting, Nursing Times, November 2018.

On seeing John’s Campaign on social media, Apple House care homes reached out to Julia and were delighted to pledge our support. It was clear to us that family involvement was key to underpinning the wellbeing of individuals we support.

The archaic practice of restricted visiting has never been an ethos we have condoned or participated in. Family members and loved ones are an extension of us just as we are an extension of them. Together with the individual we collectively form a team, a family, a group co-working towards a common goal: support and care underpinned by a sound knowledge base garnered not from one source or from paperwork, but via a deep and thorough understanding of an individual’s network of family and friends and, most importantly, what matters to them in their life. What makes them ‘them.’ What their hopes and aspirations are, their fears, their interests and so many other threads of their life which simply cannot be gathered together in isolation.

‘There are good reasons to support the notion that friends and family play a huge role in the person’s emotional wellbeing.’ –From Families as ‘Visitors’ to Families as Partners, Dokken DL et al, 2015.

To this end, Romaine spoke at the steering group and you can listen to what she said by clicking the YouTube link in this post.

— Jane Montrose, Managing Director, Apple House Ltd.

Joined by CQC and leading representatives of the sector, presentations and discussion will centre on what is already being achieved and what work can be done to take John’s Campaign’s ethos even further forward.

John’s Campaign was founded in 2014. Since then, overwhelming support has been shown from across the UK. Over 1000 wards, hospitals and other institutions have pledged their support. 58 MPs from across political parties signed an Early Day Motion in December 2014. Following this, the then PM, David Cameron, voiced support on the Andrew Marr show. A year later, NHS England officially endorsed the campaign, including it in their 2016/17 Commissioning for Quality and Innovation payment framework.

Apple House proudly adopted the core principles of John’s Campaign in 2017 and were commended for this by CQC as part of their inspection which led to a rating of our Hampshire care home, Summerwood, as ‘Outstanding,’ achieved by only 1% of care and nursing homes in the UK.

On Thursday we will be discussing how we greatly value the excellent inclusive relationships we work hard to establish and maintain with family and friends of people we support.  

Our team extends beyond ourselves in reaching out to the people outside our organization for their ideas, input and involvement.  We do this by whatever means are appropriate to the individual and can include social media, Skype, our Open-Door policy and regular face-to-face meetings.

— Jane Montrose, Managing Director, Apple House Care Homes.