Building communication skills and self-reliance

Background

Charlie (not their real name) is autistic and has a learning disability. He lived in a supported living service outside London for a long period and his  mother expressed concerns that his needs were not fully met. Staffing shortages and high turnover limited Charlie’s access to community activities.

Charlie lost confidence and interest in activities he had enjoyed. There was no structured routine and he spent most of his time indoors unoccupied. The environment was institutional, with limited meal choice and often unhealthy food. Charlie showed distress through property damage, self-injury, physical aggression, tearing clothes and shoes, and refusing to wear clothes indoors. He was prescribed a high dose of medication, but this did not address the environmental factors contributing to his distress. With limited activity and an unhealthy diet, Charlie became obese, reaching 101 kg.

Charlie had a history of trauma, including neglect and abuse in previous placements. His parents felt he needed consistent support from a team with strong autism knowledge, able to build trust, promote engagement, and help him regain confidence.

We began shadowing Charlie in late 2021 to build rapport and understand his needs. In 2022, Charlie moved to our supported living service, providing a stable home using person-centred and Positive Behaviour Support (PBS), proactive strategies, skill development, inclusion and meaningful activity to improve quality of life and reduce restrictive practice.

Our Approach

Charlie’s support centred on Person-Centred Active Support and Good Autism Practice, improving quality of life, autonomy, predictability and routine, while reducing distress.

Key elements introduced included:

• Consistent structure and routines: visual written schedules, a monthly calendar, daily staff rota, and visitor board to reduce anxiety and increase predictability.
• Skill development: including structured teaching in shopping, cooking, and domestic activities.
• Active Support: graded assistance and opportunities to participate in activities at his own pace, increasing engagement and independence.
• Health and well-being support: healthier meal choices and increased physical activity, leading to weight loss.
• Weekly schedule: tailored to Charlie’s interests, with opportunities for community participation and social engagement.

These approaches were delivered by a consistent staff team, supporting trust, stability and progress.

Outcomes:

A key priority during transition was predictability. Written and visual supports, including a daily schedule, monthly calendar, and staff and visitor rotas, helped R understand what was happening each day and who would support or visit him.

This reduced anxiety linked to unpredictability. Charlie became more confident and settled, and now uses his schedule independently to organise activities.

When the environment is consistent and predictable, Charlie is far less likely to experience behaviours of concern.

Social skills, relationships, and confidence

Charlie’s social skills and confidence have improved significantly. He can order food and communicate directly in restaurants, pubs and cafés. As trust with his support team has grown, his personality, humour and enjoyment of light-hearted interaction have become more visible.

Self-reliance; independent problem-solving

Charlie has developed strong self-reliance and problem-solving skills. He understands his weekly schedule, prepares for activities, and independently completes household tasks including dishes, rubbish, shopping, cooking and serving meals, with very minimal support.

Emotional self-regulation and well-being

Charlie is now noticeably more settled. Emotional distress has stopped, and he appears calmer, more cheerful, and more comfortable at home. His parents have observed clear improvements in his well-being.

Achievements, successes and quality of life outcomes

• Since transition, incidents have remained consistently low, reflecting how calm and settled R has been.
• No incidents of physical aggression towards staff.
• Increased participation in meaningful and enjoyable activities.
• Weight reduced from 101 kg to 70 kg through improved diet and regular physical activities.
• Good rapport with staff and trusting relationships developed with a consistent support team.

Charlie’s outcomes show how person-centred, autism-informed practice can reduce distress, build independence and improve wellbeing when support is consistent, responsive and genuinely centred around the individual.