No secrets: safeguarding vulnerable adults

January 2009

About us

The National Autistic Society (NAS) is the UKs leading charity for people affected by autism (1). We were founded in 1962 by a group of parents who were passionate about ensuring a better future for their children. Today we have over 18,000 members, 80 branches and provide:

• information, advice, advocacy, training and support for individuals and their families
• information and training for health, education and other professionals working with people with autism and their families
• specialist residential, supported living, outreach and day services for adults
• specialist schools and education outreach services for children
• out-of-school services for children and young people
• employment training support and social programmes for adults with autism.

A local charity with a national presence, we campaign and lobby for lasting positive change for those affected by autism in England, Wales, Scotland and Northern Ireland.

We welcome the opportunity to respond to this consultation.

About autism

Autism is a lifelong developmental disability that affects the way a person communicates with, and relates to, other people. It also affects how they make sense of the world around them. It is a spectrum condition, which means that, while all people with autism share three main areas of difficulty, their condition will affect them in different ways. The three main areas of difficulty are:

• Difficulty with social interaction
  This includes recognising and understanding other peoples feelings and managing their own. Not understanding how to interact with other people can make it hard to identify appropriate and inappropriate behaviour. Some people with autism can be perceived as naïve because of the low level of their social understanding.
• Difficulty with social communication
  This includes using and understanding verbal and non-verbal language, such as gestures, facial expressions and tone of voice. Some people with autism do not use language to communicate at all but instead may use picture symbols or sign language such as Makaton, while others may apparently use language well but in reality have a lower level of comprehension, for example taking language very literally.
• Difficulty with social imagination
  This includes the ability to understand and predict other peoples intentions and motivations and to imagine the implications of scenarios beyond their immediate experience. This can be accompanied by a narrow repetitive range of activities. Many people with autism have strong special interests.  In some cases a person may focus on these to the exclusion of all other considerations.

Some people with autism are able to live relatively independent lives but others may need a lifetime of specialist support. People with autism may also experience some form of sensory sensitivity or under-sensitivity, for example to sounds touch, tastes, smells, light or colours. 

Asperger syndrome is a form of autism. People with Asperger syndrome are often of average or above average, intelligence and generally have fewer problems with speech than other people on the spectrum. This can make them more vulnerable as while they might appear very able, this appearance can conceal their level of social naivety.

Research has shown that 1 in 100 children has autism. Very little is known about how many adults have autism, but by applying the 1 in 100 figure we estimate that over 300,000 adults in England have autism. Together with their families, they make up over one million people whose lives are touched by autism every single day.

Autism and safeguarding

Adults with autism can be extremely vulnerable both within a service setting and within the community. As outlined above, as a result of their difficulties with social imagination, people with autism are often unable to properly interpret other peoples intentions. They can take written and spoken words to be literal truth without discriminating or probing further and taken advantage of as a result.

Patricia Howlin, in her book Autism: preparing for adulthood, describes how people with autism can have profound problems in interpreting when someone is being unkind, leaving themselves open to abuse. The fear of displeasing people is also common among people with autism, meaning that often if someone with autism believes that someone is a friend then they may not seek to end the 'friendship' even where abuse is taking place or that they will go along with someones wishes even when it is harmful to their wellbeing (2).

It should also be highlighted that adults with autism can be very isolated as a result of their condition, leaving them more open to abuse. Three-quarters of adults with autism either do not have any friends or find it hard or very hard to make friends (3). Fifty-six per cent have been bullied or harassed as adults (4).

General comments and overview

• We support the calls from Action on Elder Abuse for legislation on safeguarding.
• We believe that this legislation should put safeguarding boards on a statutory footing; a new database should be set up to share information locally about vulnerable adults who are potentially open to abuse; a national database should support the sharing of best practice and lessons learnt; and a duty should be put on local relevant agencies to collaborate on safeguarding issues in their area.
• Any legislation about intervening and going into someones home needs to be considered with care. However, we would support legislation in this area, as long as robust safeguards are in place.
• The needs of the individual concerned must be paramount in any investigation of an incidence of abuse.
• All adults with autism should be entitled to a person-centred plan. This will ensure not only that they are better understood by their supporters and social workers, but also that they are supported to develop their own skills to keep healthy and safe.
• Local authorities need to ensure that they are meeting statutory obligations, such as ensuring that people are placed in placements appropriate to their need to help prevent abuse.
• Timely and appropriate support for adults with autism (including social skills training, befriending and social groups) needs to be developed to help prevent isolation.

1. Leadership

Q1a. Where should leadership for safeguarding adults lie nationally, and how should the various national organisations work together?
There would be real benefit in appointing one national body to lead on safeguarding. This body could help share best practice examples, oversee the working of safeguarding practice and ensure proper implementation of guidance and/or legislation, as well as investigating safeguarding issues that have been unresolved locally.

The Care Quality Commission (CQC), as the new regulator responsible for health and social care is uniquely placed to fill this role. It would be beneficial for the CQC to set up a national safeguarding board to co-ordinate national work on safeguarding. This board should include representation from the Public Guardian, ADASS, the police, the Official Solicitor, the Independent Safeguarding Authority (ISA), and the Local Government Association (LGA) as well as service user groups. The CQC would need to be given adequate resources to do this properly.

Q1b. Where should it lie locally? If within local government, then where in local government?
Local authority social services are the obvious section of local government to take a lead on safeguarding, as they currently do. To date, they have faced particular challenges in trying to implement No Secrets, due to a lack of willingness to collaborate on the part of other local agencies. We are therefore supportive of calls from Action on Elder Abuse and the Safeguarding Adults Alliance for a statutory duty for all the relevant local agencies to collaborate on safeguarding issues. This would help local authorities to bring everyone round the table on safeguarding, making the procedures more effective.

However, we would also like to note that we have some concerns about the ability of local social services to be able to act independently when investigating safeguarding issues.

For example, one of our members of staff recently raised the alarm on a safeguarding issue in relation to the way an individual living at home was being treated by their family. Social services listened to our concerns, but when it came to the safeguarding meeting, we realised that all of the people from the local authority who were present worked together. In fact the team involved with the individual's care were managed by the safeguarding lead at the local authority. They appeared far more defensive of the family and dismissive of what was alleged. The meeting felt to be more about the local authority safeguarding itself rather than the individual, to ensure that it did not look like the local authority had been neglectful in not having picked up on the alleged abuse.

There are also a number of cases where the local authorities themselves have been the root cause of abuse or neglect. For example, they may continue to contract services out to care providers despite concerns being raised around the quality of care delivered by that provider (5).

There is therefore an argument for appointing an independent lead on safeguarding. We suggest that if adequately resourced, the local Care Quality Commission inspectors could take on this role.

However, if leadership on safeguarding remains with local authority social services, measures should be put in place to ensure independence. Moreover, the Care Quality Commission would still need to take a strong national lead to ensure that poor local authority practices (such as contracting out services to providers of questionable quality) are dealt with swiftly. It is essential that they are given adequate resources to do that.

Q1d. How do we know if a safeguarding board is working effectively? To whom should it be accountable?
As a national lead on safeguarding, the Care Quality Commission should have representation on local safeguarding boards and the Boards should report back to the CQC on their work, through annual reports. The CQC could also take a role as an external investigator in safeguarding cases that have not resolved locally. 

A complaint we hear from adults with autism and their families about the Commission for Social Care Inspection (CSCI) is that they do not investigate individual cases, meaning that where they believe local investigations have not been completed satisfactorily there are few options for taking this any further.

Local user-led organisations and patient groups should also be involved in overseeing the work of the safeguarding board. They should report back to the board itself, the lead local organisation as well as the CQC.

Q1e. Where should leadership for NHS safeguarding issues lie? Do we want national procedures for the NHS?
Under the new Care Quality Commission, NHS settings will undergo the same process of registration and inspection as social care settings. It would make sense for the CQC to help in the development of and oversee the implementation of national standards for the NHS and for local authorities. PCTs should appoint local leads on safeguarding to sit on the Safeguarding Boards.

Q1f. Where should leadership for safeguarding in the care home sector lie? What can be done to strengthen this?
Again an adequately resourced CQC could take a leadership role in the care home sector.

2. Prevention

Q2a. Should we be doing more work on prevention? If so, where should we concentrate our efforts? If you are doing effective preventive work, please tell us what it involves.

Q2b. Should we develop a national prevention strategy for adult safeguarding which includes, for example, links with neighbourhood policing, with a human rights agenda, and with health and well-being?

The key issues we would like to raise in relation to prevention are as follows:

• A. The importance of ensuring that local authorities fulfil their statutory obligations and properly support adults with autism
• B. Person-centred planning
• C. Local area co-ordination and tackling social exclusion
• D. Advocacy.

A) The importance of ensuring that local authorities fulfil their statutory obligations and properly support adults with autism
As highlighted above, it is sometimes the case that the local authority itself has contributed in cases of abuse and neglect for failing to adequately fulfil its statutory obligations. The ombudsmen have been duly scathing in a number of cases relating to young people with autism whom local authorities have refused to adequately provide support for. These cases resulted in people being inappropriately locked up in secure psychiatric units and sedated without cause. In one case, someone was forgotten about in hospital for ten years and suffered abuse while there (6).

These serious cases demonstrate the worst possible outcomes of the underlying challenges for adults with autism as they try and access services, which we identified in our I Exist report published last year. The report found that 63 per cent of adults with autism do not have enough support to meet their needs. This was due to an underlying lack of information about adults with autism and their needs; a lack of understanding of autism and training amongst professionals; the structure of local social services which mean that pathways to assessment and support are unclear or non-existent; a lack of appropriate services; and a lack of leadership (locally and nationally) on autism (7).

Raising awareness of autism and increasing the number of professionals trained in autism would be particularly helpful in preventing inappropriate and harmful placements like the ones highlighted above. It would help ensure that community care assessments take better account of what the needs of someone with autism might be. It would also ensure that adult with autism could be supported by people who understand their needs.

The wider development of appropriate supports that could help adults with autism to become more independent and more included in the local community is also essential. This would include befriending, social skills training and social groups. Our research shows that these are the top three supports that parents of adults with autism believe would be of benefit to their son or daughter (8). These kinds of supports could help in tackling isolation and in the development of self-advocacy skills: both of which are central to preventing abuse.

B) Person-centred plans
We would also like to stress the importance of person-centred plans in preventing abuse. Person-centred planning is a set of approaches which enables a person to plan for their lives, take part in the community, be supported in a way which is meaningful to them and to enable them to keep healthy and safe. The process of developing person centred plans is about empowering people to lead change themselves, and to speak out when things are not right in their lives. This has obvious benefits for supporting people to stay safe and learn how to advocate for themselves.

C) Local area co-ordination and tackling social exclusion
The Government may also like to consider the use of models such as local area co-ordination, an approach developed in Western Australia, as a potential means to prevent abuse. This would be particularly useful for those who do not meet the ever tightening eligibility criteria for community care services.

The idea of local area co-ordination is that anybody that has a need (regardless of whether it meets eligibility criteria) can go to their local area co-ordinator, who will discuss their needs with them, give them advice about what support they can access and look at low level support that they can offer. There is also an emphasis in the model on advocacy, provision of information in a variety of ways (in particular from other people and families with similar experiences) to enable choice and decision making. Part of the ethos of local area co-ordination is to support people to develop a range of personal networks and supports, helping to tackle social exclusion, which could help prevent abuse or help with the early identification of abuse.

In a similar way to the local area co-ordination approach, one of the Cabinet Office adults facing social exclusion (ACE) pilot sites provides low level support for adults who do not receive support and are isolated from the local community. A large number of people on their books are adults with autism. The team work alongside the individual to give them the confidence to be more involved in the community (9). This has obvious benefits in relation to tackling isolation. The service also helps people to feel more empowered and raises self-esteem.

D) Advocacy
We would also like to highlight the importance of having trained advocates available to support vulnerable adults when they are needed. It is particularly important that there are advocates available who have had autism training, who understand the communication needs of adults with autism.

Q2c. Are whistle-blowing policies effective? What can we do to strengthen them?
There is an essential role for whistle-blowing in safeguarding cases. Current policies have helped to develop a culture where openness and transparency are more common, which is to be welcomed.

3. Outcomes

Q3a. Would an outcomes framework for safeguarding adults be useful? If so, which indicators should we use within the wider responsibilities of local government, the NHS and the police force?
Setting clear outcomes for what any new safeguarding policy would seek to achieve is absolutely essential. These outcomes should be consulted upon widely with people who use services, patient groups as well as relevant agencies with responsibility for safeguarding issues. The Care Quality Commission should ensure that a new outcomes framework forms part of the inspection process.

Q3c. How can we learn from people's experiences of harm and their experiences of the safeguarding process in order to improve safeguarding?
A national database on best practice and lessons learnt that all safeguarding boards can access would help raise the bar on safeguarding practice. Action on Elder Abuse has been developing such a database. This could be built upon and shared more widely.

Q3d. Should we review current arrangements for delivery of safeguarding adults training? Should we have national occupational training standards across all agencies?
In a report we published last year, we found that 71% of local authorities do not think that care managers receive sufficient training in autism in their initial professional training, 67% do not believe that care managers receive sufficient training in their ongoing professional training and 76% of local authorities do not have an autism training strategy at all (10).

Those who are members of Safeguarding Boards need to have training in autism in order to have a full understanding of a situation where abuse of a person with autism has taken place. They will also need to have an understanding of the communication needs of the individual concerned to ensure that they can be involved as fully as possible in the process.  The Board should also help the individual concerned with support from a trained advocate, if the person needs one. This advocate would need to have a clear understanding of autism and the communication needs of the individual concerned if they are to support them fully.

Q3e. Should we have a national database of recommendations from serious case reviews at a national level? Should we review the effectiveness of serious case reviews as learning tools? What should trigger a serious case review, and how should the conclusions be disseminated?
A national database of recommendations from serious case reviews would be an extremely useful learning tool. The confidentiality around serious case reviews needs to be carefully revisited. For individuals subjected to abuse and their families, carers and supporters it is unsatisfactory that they are not able to see the full review, which would help them get a complete picture of what happened in order to help the person they support or care for to move forward.

There is also merit in sharing information about cases that did not escalate to the point where a serious case review was needed, as this would help aide learning about more common abuse cases. 

Q3g. What are the desired outcomes of safeguarding work?
A framework of outcomes for safeguarding work needs to be developed in collaboration with people who use services and all agencies involved in implementing the policy.

Any outcomes based approach to safeguarding must take into account the seven outcomes that the Government is already promoting, developed from the 2006 White Paper on community care Our health, our care, our say. The White Paper stated that social care should achieve the following for all adults:

• improved health and emotional well-being
• improved quality of life
• making a positive contribution
• choice and control
• freedom from discrimination
• economic well-being
• personal dignity.

These seven outcomes should underpin the development of an outcomes framework for safeguarding. 

Safeguarding work should therefore look at developing a framework to support vulnerable individuals to become more independent and to have more choice and control over their own lives. It should stress the importance of tackling social exclusion and should help people to build up a network of support, both informal and formal. This should include ensuring that people can have access to independent advocates. This will help to prevent abuse occurring. Making sure that support plans are person-centred will also help.

An effective safeguarding strategy should also develop a framework that can respond quickly to incidences of abuse to prevent it escalating. Action to tackle and stop abuse must consider the best interests of the individual concerned. This principle has to be paramount.

The individual must be fully involved in the decision-making process as to what happens next after incidents of abuse have been identified. An advocate should be made available to them to support them in communicating their view if they need that support. 

4. Managing risks

Q4. In an environment where an increasing number of people will be taking responsibility for arranging their own support, we need to have a debate on how their interests can be safeguarded. What aspects of safeguarding do we need to build into personalisation? What training, risk assessment and risk management should we use? Please tell us what you are doing locally and what more needs to be done.

5. Managing choice

Q5. What aspects of personalisation greater independence, choice and control can we build into safeguarding? How do we better reflect service users informed choices? How do we facilitate informed self-determination in risky situations and in the safeguarding process? How can we move forward on this agenda?

Safeguarding has been used as a reason in the past to prevent some people from accessing self-directed support. This is something that we would caution against and safeguarding must not be used to prevent people with disabilities from having autonomy and control over their lives. However, robust measures do need to be developed to ensure that vulnerable people are not put at unnecessary risk.

We have substantive concerns about the way that services bought by individual/personal budgets are to be inspected. There is a real risk that vulnerable individuals could be open to abuse if adequate safeguards are not put in place to ensure that personal assistants are properly trained and that the services they provide are properly assessed. Local authorities may want to consider setting up local training hubs for all of those who work in the care and support system in their area to ensure that employers (the local authority itself, individuals accessing support and local care agencies) can access training for their employees.

Equally, local authorities should set up support for individuals to advise them on employment issues as well as providing an enhanced CRB check service for personal assistants who are to be employed directly by the service user. It seems perverse that CRB checks are needed in a group setting, but that personal assistants are able to go into someones home without that vital check.

Clarity is also needed about the lines of responsibility, when something goes wrong with a personal assistant, paid for through a direct payment. We were recently in contact through our email helpline service with a woman with high functioning autism who had a safeguarding complaint in relation to the behaviour of her personal assistants. She had contacted her local Safeguarding Adults Board, but they refused to get involved or give her any support because she paid the personal assistants through a direct payment. The police have not been of help either and she is therefore trying to pursue civil action against them.

This case is particularly demonstrative as it seems that this individual is able: she understands that there has been wrong doing and is pursuing the case as best she can. However, she is unable to use the telephone because of her condition; meaning in practice pursuing the case is even more challenging. Moreover, the incident has been very distressing for her, particularly as it happened in her own home and there has been no recourse for those involved. Yet those with statutory obligations to provide her with services have turned their back on her.

It is therefore essential that Safeguarding Boards support those who pay for services through Direct Payments. This must be made clear to the Boards and to local authorities.

It should also be highlighted that there are risks of abuse from carers and families who help individuals to manage their individual/personal budget. A large number of adult protection lead officers within local authorities, who were interviewed as part of the Evaluation of the Individual Budgets (IBs) Pilot had anecdotal evidence of users of direct payments and possibly IBs being subject to financial abuse from family members or paid carers (11). A team manager interviewed as part of the evaluation said: We identified within the last four months about three or four cases where the PAs (personal assistants) financially abused the service user (12).

To tackle this, measures need to be developed to help enable people to develop robust circles of support consisting of people from a range of backgrounds.

For instance, if someone needs help and support to manage their personal finances they may wish to employ an accountant for x number of hours per year. Clauses around auditing accounts could be built into the accountants contract, thus safeguarding against financial abuse. Similarly for other types of abuse a strong and robust circle of support made up of people who have a real interest and regard for the person supported is likely to reduce the risk of abuse occurring. Advocacy would have a central role to play here. Funding for an accountants time or support from an advocate will have to be built into a persons individual/personal budget. Otherwise, the most vulnerable people who need the most support in managing their own care will be penalised for having higher support needs.

We would also like to stress the importance of ensuring that person-centred plans are available to all adults with autism. Person-centred plans not only help ensure that risks of abuse can be picked up earlier, as working in a person-centred way, supporters and social workers will have a better understanding of the individual concerned, but also help support individuals to develop the skills they need to keep healthy and safe. Unfortunately however, current research shows that only 27 per cent of adults with autism have a person-centred plan (13). This needs to be urgently addressed.

6. Health services and safeguarding

Our only substantive comment on health services and safeguarding is that every effort should be made to ensure that health services are involved in safeguarding boards. There should be a statutory obligation to ensure that this is the case.

7. Safeguarding, housing and community empowerment

Q7a. Do we need stronger policy links between safeguarding and community development and empowerment? How can this be achieved at the national and the local levels?
There is some important work to be done on developing community links with vulnerable adults. The local area co-ordination approach outlined above has a focus on community development and could be a useful model.

8. Access to the criminal justice system

Q8f. Should information about the safety of a person be passed between health and social care organisations, the ambulance service, GPs, the CSCI and the police? If so, can it happen now or does it need legislation? Should such information include incidents not amounting to abuse, but which may provide early indicators of the likelihood of abuse?
Information sharing between different agencies is essential to help support early intervention in abuse cases. Information which could amount to an early indicator of the likelihood of abuse should also be gathered. This would help local authorities and other agencies to assess what measures need to be put in place to prevent any potential abuse.

Q8h. Should we look at ways of making it easier for people who may be vulnerable to report abuse?
As autism is a communication disability, it should be ensured that any information on who to contact if you experience abuse is in an accessible format, eg easy read. Moreover, police working in public protection units should be given awareness training in autism, which will help them to communicate with people with autism who may wish to report abuse.

Support also needs to be developed for adults with autism to help them understand what is acceptable and non acceptable behaviour, as well as how to identify when someone is or is not a friend. Improving access to trained advocates is also essential.

Q8j. Financial abuse appears to have increased steadily and to have diversified. Is there a need to explore the most common types and most effective responses? Should this include preventive strategies in consultation with the Financial Services Authority and the British Bankers Association? Should banks, building societies and the Financial Services Authority be encouraged to share information that suggests financial abuse of vulnerable adults?
The NAS Autism Helpline receives around 3,000 calls annually on financial issues (out of an average of 40,000 calls per year), demonstrating a real need for work to be done to first develop financial capability among adults with autism.

Of particular concern, we are aware of a number of incidents where people with high-functioning autism or Asperger syndrome take on credit cards following sales calls from credit card companies. As a result of the nature their condition and their difficulty with social imagination (outlined above), people with autism often do not understand the consequences of using a credit card and have therefore totted up huge debts, without the means to service this debt. Yet the credit card companies will not have realised their vulnerability, as they will sound very able on the phone, hiding their naivety.

We have been doing some work with the Financial Services Authority on developing financial capability training and are looking to extend this work further. Part of this work could also involve training for financial institutions.

9. Guidance and legislation

We support calls for legislation on safeguarding. At the bare minimum, this legislation should put safeguarding boards on a statutory footing; a new database should be set up to share information locally about vulnerable adults who are potentially open to abuse and; a national database should support the sharing of best practice and lessons learnt and a duty should put on local relevant agencies to collaborate on safeguarding issues in their area.

Any legislation about intervening and going into someones home needs to be considered with care. Access to a private home should be only be authorised by a warrant from a magistrate. If this warrant is granted, a social worker should accompany the police into the home, as he or she will be better placed to understand the circumstances the individual is in and assess the next steps around what can and should happen. If the adult concerned has autism, the social worker must have an understanding of autism and how to communicate with people with autism.

We would also like to stress the problems associated with the identification of those adults with autism who are particularly vulnerable and should be included on any at risk database. There is currently a dearth of information on the numbers of adults with autism at both national and local levels. Indeed, a recent report undertaken for the Government's Social Exclusion Task Force highlighted the impact that a lack of information on people with autism had on policy design:

We have insufficient epidemiological information reliably to estimate the prevalence of adult neuro-developmental disorders in the UK population. This is a major gap in the evidence needed to estimate the prevalence of chronic exclusion and the most effective responses to the needs of the people affected (14).

The Department of Health has committed to carry out some national research on prevalence of autism among adults (15). This is to be welcomed, but data also needs to be collected on a local level and this would help identify potentially vulnerable adults. Yet, 67% of local authorities do not keep a record of how many adults with autism there are in their area. Of those that do keep a record, people with Asperger syndrome or high-functioning autism are often excluded. Indeed, they are only included in the data collected by 19% of local authorities (16). 

The core dataset for the new Joint Strategic Needs Assessments (JSNAs) that Local Authorities and Primary Care Trusts (PCTs) have to produce advises including data on the number of vulnerable adults in a local area and the number receiving services. While this is to be welcomed, given the lack of available data on adults with autism as outlined above, they will almost certainly be excluded from this process.

Improving local data on adults with autism is something that needs to be urgently addressed, to ensure that their needs are properly accounted for in all policy development, including safeguarding procedures and all potential prevention measures as outlined in answers to questions 4 and 5.

10. Definitions

Q10a. Should the No secrets definition of a vulnerable adult be revised? If so should the revised definition do the following, and if so, how?
In looking to revise the definition of vulnerable adult, we would like to ensure that it is made clear that not only those adults in receipt of community care are potentially vulnerable. The increasing restriction of eligibility criteria combined with a lack of understanding among community care assessors about the needs of someone with autism means that large numbers of people with autism are deemed ineligible for support.

Our fear is that without clarification the definition will only apply to vulnerable service users which may exclude some people with autism who are vulnerable but either choose not to or are unable to access community services.

Other comments

In developing new safeguarding policy or legislation, the needs of people across the whole autism spectrum must be taken into account. Those with Asperger syndrome or high functioning do not have accompanying learning disabilities, and can appear very able. Structures of local services often prevent this group from accessing services, as they fall through the gap between learning disability and mental health services. Nevertheless, the nature of their disability and the fact that the disability is not always obvious may make them particularly vulnerable to abuse.

The needs of those with autism who are less able also should be recognised. They may be more easily identified, but it is absolutely essential that their communication needs are taken into account and that they can be supported by people who understand the nature of their condition.

References

(1) The term autism is used throughout this document to refer to all people on the autism spectrum including Kanner autism, Asperger Syndrome and high-functioning autism.
(2) Howlin, P. (1997). Autism: preparing for adulthood. London: Routledge. Page 64-65
(3) Rosenblatt, M. (2008). I Exist: the message from adults with autism in England. London: The National Autistic Society. Page 5
(4) Ibid.
(5) Mandelstam, M. (2009). Community care and practice. London: Jessica Kingsley Publishers. Page: 229
(6) Ibid. Pages 175-176
(7) Rosenblatt, M. Ibid.
(8) Rosenblatt, M. Ibid. Page 31
(9) See: www.cabinetoffice.gov.uk/social_exclusion_task_force/adults/pilots/potm_pathways.aspx for more details
(10) Rosenblatt, M. Ibid. Page 21
(11) Ibid. Page 173
(12) Ibid. Page 173
(13) Ibid. Page 33 
(14) Schneider, J. (2007). Better outcomes for the most excluded. The Institute of Mental Health, The University of Nottingham and Nottinghamshire Healthcare NHS Trust, Nottingham
(15) http://nds.coi.gov.uk/Content/Detail.asp?ReleaseID=366876&NewsAreaID=2 Accessed Monday 17 October
(16) Rosenblatt, M. Ibid. Page 12