Support Staff – Training

Dedicated staff-members are necessary for creating a residence where the consumers and their parents know they are with people who care about them.  Dedicated and knowledgeable staff are critical for creating a residence where the consumers are engaged in a way that increases the likelihood that they will make progress, regardless of functional level, towards a greater degree of independence and personal competence.  The provision of effective staff training is an important element of the Foundation for Autism Support and Training (FAST) approach to the provision of residential care.  While FAST would always try to seek out and recruit staff who bring to their work a love of what they are doing and who they are helping, it is equally or more important that staff have the knowledge to interact with and respond to the consumer in a way that is therapeutically beneficial.  Towards this end, FAST would provide both an extensive initial training session with new staff and also a continuing series of trainings for more experienced staff.  These later training sessions would be more specialized and focused on specific techniques or on addressing particular issues or situations that are occurring in the residence. 

New staff would be trained to understand, recognize and address the diagnostic features that meet the criteria for a DSM diagnosis of Autistic Disorder and any other diagnostic category which are applicable to the consumers in residence.   They are trained to understand that individuals with autism frequently do not understand what they see, hear, and otherwise sense and must painstakingly learn normal patterns of speech and communication, and appropriate ways to relate to people, objects, and events, in a similar manner to those who have had a stroke.  They are trained to recognize and address typical autistic traits as stimming (i.e., stereotypic, self-stimulatory behaviors) and sensory integrative dysfunctions (i.e., over or under sensitivity in the processing or response to something that stimulates any one or all of the senses --visual, auditory, tactile, vestibular, taste, olfactory senses.)  Such training would provide staff with insight into the use of stimming by some consumers as a form of calming in some instances.  By being able to recognize these situations, staff are better able to understand how they might help the consumer adopt a more socially acceptable, calming-down, stress reduction technique when stimming is inappropriate or how, in certain contexts, stimming could be used as reinforcement for engaging in goal-related behavior.

For both the initial and continuing training sessions, curriculum for staff would cover topics like:

  • Ways of dealing with aggressive and self-injurious behaviors that may be exhibited by consumers with autism.  This would include recognizing the signs and stages of escalating agitation and the use de-escalation strategies to help calm a consumer down and help them regain control of themselves. Practical methods of defense would also be taught to staff to prevent injury to themselves and others.
  • Identifying and using positive reinforcers which can be a powerful motivator for the consumer and can elicit their cooperation in learning new skills.  Further, the provision of strong positive reinforcers when consumers demonstrate self-control and rein themselves in from a state of agitation can be an effective approach to minimizing instances of agitated behavior. 
  • How to review and use consumer life plans (Mapping/Person Centered Planning), clinical histories, behavioral assessments and behavior plans in order to provide the consumer with a quality of life that is responsive to his or her likes and  dislikes, needs, capabilities, deficits, and desires.
  • Staff are taught to assist and guide interacting consumers in the appropriate use of greetings, manners, and other social skills such as turn-taking, sharing, and acceptable hygiene-related behaviors (e.g., no belching) in the presence of others.  Staff are taught how to work with consumers to convey what the bounds are for acceptable or unacceptable behavior in such areas as displays of affection, respect for authority figures, sexuality, and stranger-danger.
  • How to design and implement a plan for enabling the consumer to acquire or master a daily living activity.  Staff learn how to break down a particular activity into a series of steps that are highly structured and progress from simplest to most complex.  Such deconstruction of the activity makes it easier for the consumer to learn.  Staff are taught skills in how to use, then fade, prompts for each step in the process so that the consumer can engage in the activity autonomously without staff assistance.  The importance of identifying ways to generalize a learned activity to a broader variety of settings and repetition of the mastered skill in order to offset its loss under conditions of stress or neurological regression is also taught.
  • How and when to apply supplemental visual communication techniques.   One of the more pervasive autism deficits is a limited ability to attend to and process verbal communications.  Staff are trained in the use visual communication devices such as Picture Communication Symbols, photo boards and low/high tech augmentative communications devices in order to facilitate interactions with residents so that directions and consumers’ preferences and choices can be more effectively and efficiently conveyed. Use of these methods can also minimize the frustration that consumers may experience in attempting to communicate verbally.

In all training sessions and in routine or special staff team meetings, FAST’s  reinforces its core objectives of providing a structured and supportive setting where consumers are treated with care and dignity and are encouraged to progress in the areas of independent living, self-determination and personal fulfillment.

Foundation for Autism Support and Training’s (FAST) Therapeutic Program

Because of the considerable variation that exists in persons on the autism spectrum, it is FAST’s view that no single therapeutic model or living arrangement is sufficient for effectively addressing all of the broad range of needs, wants, and challenges that adults with autism have.   This eclectic view is also based on FAST members’ successful experience working with children and adolescents ages 5 to 21 with full-syndrome autism who are participants in Maryland’s Autism Waiver Program.  These are clients who, without these services, run the risk of requiring ICF-MR (intermediate care facility) level of care. 

  • Person-Centered Planning/Mapping (A process of developing Life Plans)
  • TEACCH (use of visual supports)
  • Applied Behavior Analysis (prompting, prompt fading, modeling, reinforcement)
  • Natural Environment Teaching (make it real by learning in the natural setting as opposed to mostly table work)
  • Verbal Behavior (a comprehensive approach to promoting functional communications)

FAST’s selection of interventions evolve from the interplay of the needs and strengths of the individual consumer, through a Person-Centered Planning process and staff’s analysis of what techniques, methods or procedures have the greatest likelihood of success and can be viably applied to consumer’s current situation.

Therapeutic programs that adhere too strongly to a specific model, such as Applied Behavior Analysis or a particular position, such as non-use of psychotropic drugs, are less likely to meaningfully address the broad range of clients and types of behavioral issues encountered with autism.

For example, while an ABA approach with its discreet trial paradigm can be quite effective for developing certain skills in certain consumers, there is often a failure of the acquired skill to generalize from the discreet trial situation to daily routines and interactions.  Other techniques must be added to the intervention mix to promote such generalization.  Likewise, some obsessive-compulsive behaviors that consumers with autism may demonstrate that are extremely difficult to address with behavioral/operant interventions become quite manageable with the consumer’s use of appropriate medication.

FAST does espouse a few guiding principles in which an eclectic approach should operate. One guiding principle is that residential programs and daily living interventions should be designed to have a modest to high degree of structure and goal-orientation. There is a consensus by professionals in the autism field that consistent, predictable, reliable structures and schedules are helpful for people with autism, since these structures help them make sense of life.

The degree of structure should be determined based on the collective capabilities of the residents in the facility and then modified for the needs, capabilities, and goals of each individual resident.  Free time should be built into the structure. Goals should be established in a collaborative and pragmatic way, based on input from the consumer, the consumer’s family, and program staff.

Consumers with autism may not be able to express what they want to do or accomplish but, when any such expression does occur, it is a significant input to goal specification since the consumer is likely to be more motivated and engaged in accomplishing the expressed goal. The consumer’s family may provide valuable insights and clinical history as to the skills and capabilities that are most in need of being developed or strengthened. Goal development is also informed by cognitive, psychological, and adaptive skills assessments with attention to the consumer’s needs and with careful consideration of appropriate developmental expectations. FAST subscribes to the overarching goals of increasing consumer independence and self-initiation, diminishing dependency through active participation in a broad range of activities and exercise of choice.

Another core principal is that the residential program and related programs provide consumers with a safe and healthy environment where there is respect for the dignity of each consumer.  Simply put, FAST seeks to establish a place where the parent or parents of a consumer with autism can feel reasonably assured about the “quality of life” that their child will experience as they grow older – that their  loved one will live in a in a structured and supportive setting where they are treated with care and encouraged to progress.

And as the participants at the New Jersey Center for Outreach and Services for the Autism Community conference concluded: The support needs of an adult with autism are subject to change during the lifespan so the level of public fiscal support must periodically be reassessed.

This issue of appropriate supports primarily hinges on the availability of appropriate funding, which definitely must be emphasized as key to any comprehensive national policy to address the needs of adults with autism.  People who are at the lower end of the spectrum need a staff/consumer ratio of 1:1 (at least while they are awake). This ratio may apply to adults with ASD who are on the mid range of the spectrum for period of time until they acclimate and get used to the routines and demand of a new setting.  Once routines are familiar, they may do fine with a staffing ratio of 1:2.

Those functioning on the higher end of the spectrum, may only need a staff ratio of 1: 3 or some higher partial support pattern such as  Supported Living or Supervised Living.  for a definition of Supported Living, Supervised Living, Group Homes, and Farmsteads  see:
Types of Community Living Options and Residential Models

Depending on the needs of each resident, supported employment, customized employment, day programs, volunteer positions and continuing education will be offered.  Vacation and supported travel opportunities will also be offered.  Opportunities for involvement in communities of faith will be offered.

Most residential programs and group homes currently do not include training in the use of augmentative and alternative communication as this is not a priority to group home providers and they are ill equipped to train support staff to serve as appropriate communication partners.  In contrast, FAST’s therapeutic approach will ensure that every resident that requires communication supports will receive them, including both low and high tech augmentative communication devices and the proper training to use such devices.

Group homes have recently come under some criticism for their supposed lack of individualized programming, limited access to the community and a lack of resident participation in programming and service decisions.  As a result, there has been a move away from the development of larger group homes and toward the development of smaller residences with 2-3 people with more emphasis on self determination and resident home ownership.  While it is true that with fewer numbers of residents, there is much less chance of a multiplier effect (for example) when one client tantrums, it sets up a chain reaction of tantrums by other residents), that does not mean a structured program should be abandoned.  Best practices for people with autism still support the notion of a reliable, predictable structure, schedule and routine for people with autism so they can continue to learn, grow and thrive.  The emphasis of any structure and schedule must be geared toward creating a productive, rich, and meaningful future for each individual.  The focus is on integrating the individual’s capabilities, abilities and interests through meaningful activities in the places they spend the most time, i.e., home, work and community.

There is a definite quality of life benefit to resident home ownership over the lifespan, because if the residents do not like or approve of their service provider, (with the help of a guardian who keeps an eye out for quality of life issues) they could have the option of firing a specific provider and replacing them with a provider more to their liking.  This notion supports the value of a model that relies on a public/private partnership, where the consumer owns his own private suite, but a public entity provides funding for the communal areas of the residence. The public entity be it federal, state or local funding entities (or non-profits) oversees or pays for residential services providers and monitors and ensures that service providers deliver therapeutic models and training to staff that encompasses best practices in the field of autism.

Provided there are sufficient appropriate supports (usually referred to as appropriate staffing ratio) any conventional housing type could conceivably work (i.e. single family home, duplex, apartment, and townhouse) but some situations may need adaptations for sound insulation, safety/security issues and other issues.  Experts such as George Braddock of Creative Housing Solutions can provide consultation services on how to build, adapt or renovate nearly any community setting to address the modifications and adaptations needed to house anyone on any part of the autism spectrum.

While no one-size-fits-all model will work, neither will an unwieldy, long list or confusing array of options serve to simplify the confusion for families and service providers.