SPACE: An Autism–informed framework
Today Lucy Gilbert, NdC’s Lived Experience Lead, is sharing the third blog of our latest campaign ‘Against PBS & ABA’.
Lucy discusses the use of SPACE framework inspired-practices that helped shape our new interactive toolkit.
At Neurodiverse Connection, we are advocates for our new interactive toolkit, inspired by the SPACE Framework. This novel framework was published in 2023 after being developed by a wonderful team of Autistic doctors, Dr Mary Doherty, Dr Sue McCowan and Dr Sebastian CK Shaw, all also on a mission to improve outcomes for Autistic folk in healthcare.
It is a delight to be able to end a training session on Autism-informed care by giving people something tangible to take away, something to structure or scaffold their thinking around. It’s a privilege to be able to use my lived experience to facilitate understanding and reflection on what Autism-informed care is. But, as we all know, there is no such thing as one ‘right’ way to do things when you are working in an Autism-informed, Neurodivergent-affirming way. We cannot provide a simple checklist of all the things to do, in order to deliver Autism-informed care. There is no one-size-fits-all approach. However, what we can do is invite reflection, gently dismantle misconceptions and kindle curiosity about and empathy for the Autistic experience. But this is just the start: to continue what we start in training, enter the SPACE Framework!
Just like Autism-informed care, there is no one way to use the SPACE Framework. I love it because it’s so adaptable, accessible and easy to remember. Having a five-letter mnemonic is also a great excuse for getting people up on their feet and energised during the post-lunch training day slump!
You can use the SPACE Framework to structure someone’s care plan, to support an idea generation session on how to do things differently within a team or to improve a particular aspect of care delivery – ward rounds would always get my vote to start with! You could use it to think about a more personalised approach to risk or even to structure a conversation with a patient about their needs.
This blog gives an outline of each of the five letters of SPACE and combines some of the ideas I’ve heard whilst speaking with staff about the SPACE Framework, with my own insights from what I’ve experienced, or wish I had experienced.
Sensory
How are you supporting sensory sensitivities or sensory seeking behaviour? How can you support sensory needs? Can you consider avoiding scented products, turning down lights, being mindful of noise? Does any sensory input support emotional regulation and can patients access any sensory tools they need easily? How soothing and well suited to the environment are the wall colours?
Predictability
How can you reduce the unexpected? Structure and routine, when co-created, can be calming for a Neurodivergent mind and knowing what’s happening and when, can provide an anchor in a storm of chaos. Hotels often do this well, what can you steal from this industry? Photos or video tours of wards, photos of staff, explanations of what the different uniforms mean. Who to ask for what. Specific times for appointments, with plan B if things need to change.
Acceptance
How can you indicate that everyone belongs and will be welcomed? We all want to feel a sense of belonging and connecting and being accepted for who we are. How can you indicate that you are a safe space? Language constructs our worlds and contributes to narratives – are we mindful enough of the language we use, avoiding overly medicalised labels or stigmatising language? Not calling attention to sensory aids, or perhaps having sensory aids available for everyone. Building connection by finding common interests or aspects of identity. Reminding people that it’s ok to come as you are.
Communication
How are you allowing people to use their preferred method of communication? Is there ability for people to use written word instead of spoken? Are people able to communicate distress that doesn’t rely on finding someone to speak to, or phoning someone? Can you use declarative language to avoid placing more demands on someone? What can you do to bridge that double empathy gap? Can you get someone external to check your communications are as plain English as possible.
Empathy
How are you supporting each other to maintain a sense of compassionate curiosity about each person’s unique experience of their world? How are you building in pauses, as a team, to reflect on your assumptions or biases about behaviour, reactions, or feelings? To what extent can you support someone to build self-compassion for themselves?
Physical space
Does the physical space enable people to maintain physical distance between themselves and others? Does the environment support wayfinding or does every corridor look the same? How is furniture laid out – does it feel cramped? Is the physical space conducive to an open and equal conversation or does it perpetuate power imbalances?
Temporal space
Neurodivergent folk often benefit from time to process information: how is this built into care and appointments? Are people given the opportunity to think about and write down what they may want to say before appointments? Do patients have prior notice of what may be discussed in an appointment? Is enough space left between questions to avoid the sense of needing to rush a reply or feel overwhelmed? Can a written summary of what was discussed be taken away before deciding if anything needs to be amended?
Emotional space
Neurodivergent folk may need more time to decompress after social interactions. We may also experience delayed emotional processing. How can space be created for people to decompress and process in a way that works for them? Are there ‘bolt holes’ patients can retreat to if they need to? Can we be sure we are not using time spent in communal areas as a marker of wellness?
There are plenty more ideas and things we at Neurodiverse Connection have seen ward teams put into action: hopefully this gives just a few examples of reflections, explorations and changes that the SPACE framework has inspired. I hope you can let it sit, then give it a go – download a copy of our new interactive toolkit ‘A practical approach to neurodiversity-affirming care and support’ to see what comes from using it to structure thinking on Autism-informed care. Even better, print out a copy and pop it in a staff room. Or even, even better, put a copy in a communal patient area and see what ideas staff, patients and carers alike come up with!
Download the toolkit now
References
Doherty, M., McCowan, S., & Shaw, S. C. K. (2023). Autistic SPACE: A novel framework for meeting the needs of autistic people in healthcare settings. British Journal of Hospital Medicine, 84(4). https://doi.org/10.12968/hmed.2023.0006
