How can you ensure that a first meeting or appointment goes well for an autistic person and why is it important?
“SEVEN HELPFUL ADJUSTMENTS.”
First appointments may represent a change from existing routines for an autistic person. Additionally, they will be meeting a new person, in a strange place with a new journey – so a lot of changes! This uncertainty can be experienced as a series of micro-stressors or a pressure that may lead overwhelm, shut down and not being able to get to the appointment, if adjustments aren’t made.
Why is it important to think about making adjustments?
Lack of adjustments to the way in which services are provided is one of the biggest barriers to access for autistic people.
For one autistic man, going to new places always increased anxiety. He experienced something he called, “anticipatory anxiety,” which meant that whenever an appointment was coming up, he would find it difficult to sleep the night before. This often meant that he struggled to wake in time for a morning appointment.
When he requested afternoon appointments from his local mental health team (when seeking support for suicidal thoughts and low mood), these were often not accommodated, which meant the appointments were missed. Eventually he was discharged from the mental health team for nonattendance, even though he desperately needed support.
This experience only exacerbated this young man’s low mood and self-esteem – he said, “the appointment system was just set up to make me fail.” The hidden messages that this young man internalised were that his own experiences were not understood or validated, it made him feel less than good enough and lacking. Overall, this whole experience was extremely damaging for this young man, and it took some time with an independent practitioner to build trust again for much needed mental health support.
First do no harm
Many professionals work to ethical frameworks that always seek to, “first do no harm.” If we can’t make those adjustments that demonstrate a real understanding and respect for an autistic person’s inside out lived experience, then there is a real risk that we could be making things worse when thinking about an autistic person’s mental health and well-being. Given the experience of the young man above it isn’t surprising that autistic people are at higher risk of experience both trauma and suicidal ideation as they battle to get access to much needed mental health support.
Seven adjustments that autistic people have said are helpful
There is a lot we can do as practitioners when preparing for first appointments with autistic and neurodivergent people. Here are seven adjustments that can make a big difference:
- Offering an initial phone or zoom call ahead of a visit to a new place so that they can put a face to a name and to begin to build the relationship with you before attending for a first appointment.
- Offering afternoon or early evening appointments for those autistic people who may experience sleep difficulties or anxiety ahead of first appointments. This will increase the chances of being able to make the appointment and allow for navigating to a new place.
- Taking the uncertainty out of the appointment by providing as much supporting information and detail as possible ahead of a first appointment will help to reduce anxiety.
- Building the relationship through inviting them to bring those things that matter to them (their special interest/supports and questions) will support the autistic person in using these resources as transition objects (both in their mind as an alternative to possibly worrying about the changes ahead, and at a sensory/practical level as they begin to prepare their bag, supports and questions).
- Providing a picture of yourself will help to reduce uncertainty as will providing a picture of the building, location and related maps and transport links.
- Asking about what supports will be helpful will help to reduce anxiety as you will be affirming that you will take care of adjustments and aim to make the environment as comfortable as possible for them.
- Providing a point of contact throughout via phone will mean that any uncertainty about the appointment can be reduced through asking questions or seeking clarity. Offering to meet them at the front of the building on arrival will also make getting into the building feel less overwhelming as the person will help them navigate their way through a new building, hopefully via a route that is quieter and not over stimulating.
If you want to learn more about what skills and adjustments are helpful when supporting autistic people, please take a closer look at our, “Core Skills and Adjustments to Practice,” 3 Day On-Line Training Course. On this course we share with you a comprehensive framework that guides you through those adjustments that are helpful for autistic people.
We also share many other tools, resources and strategies that you can use in your practice, including a, “Spotting the Signs of Autism amongst Girls and Women tool,” and, “Good Practice Checklist when Preparing for First Contacts.”
Please click here to find out more about the course.