Policy leads practice - Why we have to get it right!

I picked up a tweet on
Friday 11 Jan https://twitter.com/suzannezeedyk/status/1083637607240744961.

The article Suzanne was commenting on was a blog by Mona Delahooke, PhD https://www.MONADELAHOOKE.COM. In her blog Mona tells a story about the experience of young boy who has autism. She says:

"Not long ago, at an autism treatment forum, I heard about a painful and frustrating episode a teenager recalled from his childhood. At five years old, the boy was 45 minutes into an autism treatment session when he ran to the window, pressed his nose against it, and stared intently at the family car. Unable to use spoken language or even point or gesture, he was simply trying to express to his behaviour therapist and his mother that he was weary of the incessant drills and ready to go home.

The therapist didn't get the message, dismissing his attempt to communicate as mere "stimming" - that is, a form of meaningless self-stimulation. "he's fixating on the care", she told the boy's mother. "Let's just ignore and try to get him back to the table". Now the boy recalls his great frustration trying to make himself understood.

The therapist wasn't being intentionally harsh. She was merely following an autism treatment protocol that uses reinforcement and other strategies such as "planned ignoring" to help children with autism learn and acquire new, adaptive behaviours."

Mona continues in her blog to discuss the hidden costs for this commonly used tool for the young person, however for me this is another example of how policy, guidelines and procedures lead practice.

I don't doubt for one moment that the therapist in this example felt she was doing absolutely the right thing for the family. I had never heard of planned ignoring, however as I have never worked directly with a child on the autistic spectrum, only supported families and staff through the nursery, it is not unusual that I would not have heard of it, Suzanne Zeedyk herself said the same. So a quick internet search revealed that "planned  or tactical ignoring is a strategy where you give no outward sign of recognising a behaviour (e.g. no eye contact, no verbal response, no physical response). However, you are aware of the behaviour occurring, and you monitor the child to ensure their safety and the safety of others. Often, you will be able to continue with a conversation with others without acknowledging the attention-seeking behaviour" http://www.autism-help.org/behavior-tactical-ignoring-autism.htm. For me this is as far from loving, caring practice as you could get. 

My limited experience working with children and adults with autism has taught me that their behaviours often represent communication. I worked with a young woman, who was on the autistic spectrum, who held a soft toy in class. When she would become uncomfortable or uneasy about something she would begin to pull quite vigorously at the limbs of this toy.  Her behaviour was distracting and often alarming for others in the class but to ignore this behaviour would have been wrong, she was telling me she was unhappy. To support her and to show I was listening to her and to maintain her sense of dignity, we arranged that I would simply go up to her and lay down a flower shaped eraser (we agreed this was her chosen signal). This signal told her silently, without fuss, that I understood she was uncomfortable and needed to leave this difficult situation. She would then leave my class and go to find her learning development tutor. Had I just ignored this behaviour, she probably would have quietened down, but she would have felt frustrated, not listened to and unloved. This was not written into any guidelines but I used my knowledge and experience to know that for this young woman this was the most loving thing I could do for her. 

Mona makes the point that one of the hidden costs of this practice are that it sends "the wrong emotional message to the child. In short, the adult is saying "I'm not interested in what you are trying to convey, and I'll pay attention only when you comply with my demands". As the young man in the example above shows he still recalls frustration at not being understood. The therapist was following guidelines, guidelines which will have been developed following policy created at a much higher level. There is nothing wrong with this process, however in order for the practice to not cause this kind of harm to young people as they grow and develop it is crucial that the policies reflects practice which is enabling rather than restricting. This therapist should have had the freedom to use their own knowledge, understanding, experience and learning to work with each child in a loving and individual way. While a child on the autistic spectrum may not be able to recognise or acknowledge love they will recognise when someone is working in a loving manner. 

Getting the language right in the initial policies will underpin practice guidelines and protocols in a way that allows the practitioner to work in a professional way which allows them freedom to work with integrity and know they have cared for the child, young person or adult in a way which represents their own values. 

That being said, as Mona points out this doesn't mean there won't be occasions where ignoring unwanted behaviours isn't the right thing to do however, ensuring the guidelines practitioners work with aren't restricting them to carry out practice that may not be right for the child is the key to good practice.