A review of ‘A Mismatch of Salience: Explorations of the nature of autism from theory to practice’ by Dr. Damian E. Milton (2017) It was a real pleasure to read this illuminating book by Dr. Damian Milton. Damian is an esteemed colleague of Studio 3 and an expert in the autism field. He works for the National Autistic Society, is on the committee at Research Autism, and also teaches and lectures at the University of Kent. He is a committed advocate for the meaningful participation of autistic people within the field of autism research and activism, and is himself autistic. This publication is structured as a series of essays and writing that together provide a holistic and comprehensive overview of autism theory and practice, making it an invaluable guide and starting point from which to delve deeper using the extensive list of additional resources and references. The writing is engaging and of a high academic standard, and the topics discussed have been extensively researched. The knowledgeable academic voice is intermingled with deeply personal accounts from the author, including sections of poetry. Damian’s unique voice provides a real insight into his own lived experiences, and it is impossible not to empathise with Milton in a way that is very rare for an academic book of this standard. The book ranges from discussing the theories (or rather, lack of theories) that exist around autism, to what Damian describes as a mismatch of salience. Key to this view is what Damian describes as the double empathy problem, which demonstrates that empathy is a two-way street. The double empathy problem has greatly informed much of our own practice here at Studio 3 when it comes to understanding the perspectives of the individuals we are working with, and our own contribution to challenging situations. In his recent publication, ‘The Reflective Journey’, Professor Andrew McDonnell references Damian’s double empathy theory as a significant factor when it comes to supporting individuals with autism. Throughout the text, Milton emphasises the importance of understanding how stress can affect behaviour and emotion, and that autistic people in particular can be more sensitive to external stressors. This book is invaluable as a resource containing insider knowledge that challenges the assumptions made about autism by neurotypical people, and is essential reading for anyone working with or supporting an individual with autism. Damian emphasises how important it is to keep the perspective and experiences of the autistic individual at the centre of their support system: ‘For many philosophers, the way we talk about something is ‘more than just words’, but frames the way we think about ourselves and one another. By viewing the ‘autistic person’ as the ‘disordered other’, it can reduce an individual’s sense of self-worth and self-esteem.’ (p.15) Damian’s work as an advocate for the rights of people with autism is reminiscent of the work of Jim Sinclair, an Autism Rights advocate who famously stated: ‘Grant me the dignity of meeting me on my own terms--recognize that we are equally alien to each other, that my ways of being are not merely damaged versions of yours.’ (1992) For the non-autistic reader, this book provides a keen insight into the world of autism and the lived experiences of individuals with a diagnosis, as well as guidance on how to interact with and support those individuals in a meaningful way. Milton successfully weaves together academic research and personal experience in a highly sophisticated way that is at once engaging, informative, and deeply meaningful. We would recommend this book, not only to practitioners who work in the field, but also to a broader audience of individuals who want a useful insight into 'this thing we call autism'. Reviewed by Rachel McDermott, Studio 3 Digital Content Editor References McDonnell, A. (2019) The Reflective Journey: A Practitioner's Guide to the Low Arousal Approach. Available from: https://www.studio3.org/product-page Milton, D. E. (2017) A Mismatch of Salience: Explorations of the nature of autism from theory to practice, West Sussex: Pavillion Publishing and Media. Available from: https://www.pavpub.com/health-and-social-care/health-autism/a-mismatch-of-salience Sinclair, J. (1992) 'Bridging the Gaps: An Inside-Out View of Autism': http://www.aettraininghubs.org.uk/wp-content/uploads/2014/11/Bridging-the-Gaps-An-Inside-Out-View-of-Autism.pdf

Our Educational Adviser, Gareth D. Morewood, has been incredibly busy since starting full-time at Studio 3 in August. In conjunction with the Studio 3 team, Gareth has been involved in some exciting new projects in UK Education and abroad, with training packages and other projects underway, to be revealed soon. Gareth has been working to deliver high impact work with professionals, families, and young people themselves in the past few months, with excellent outcomes so far. In August, Gareth visited Emma Dibden at Jumeirah English Speaking School (JESS) in Dubai. Here, Gareth delivered training sessions on low arousal, stress, well-being and inclusive pedagogy, which were very well received by both staff members and families in attendance. JESS is an extremely progressive private school, which champions inclusion in every facet of school life for all children alike. Gareth will be returning in February to support Studio 3’s ongoing work with the faculty members here and continue to implement the inclusive vision across Dubai’s private and public schools. In addition, Gareth delivered a One Day Training course in Low Arousal, Inclusion and Emotional Regulation as the result of a BrewEd grass roots event earlier in the year, in which this training course was offered as a raffle prize donated by Studio 3. Read about Gareth's BrewEd experience here: https://blog.optimus-education.com/new-experiences-brewed. The raffle prize was won by Max Kelly of Dhoon & Laxey Schools on the Isle of Man, where Gareth delivered a training day in September. To hear more about the work Gareth did and the impact of this training, listen to the podcast below in which Gareth interviews colleagues Max Kelly and Craig Astin of Laxey school. Finally, for the last two weeks in September Gareth has embarked on the first leg of a long-term contract with St. Dominic’s International School in Portugal. In the initial two weeks of this fantastic opportunity, Gareth has met with over fifty families and worked with school psychologists and specialists to develop individual plans for the young people, and will be returning in December to continue supporting family’s needs and to offer further training and assessments. Additional to this work, Gareth was able to meet with Carolina Viana and Sofia Algeria to discuss future opportunities to work alongside Studio 3 in Education, including bilingual events and co-production with families. Looking forward, in October Gareth will be delivering a range of training and educational events in the U.K. and Ireland and also running a series of events with the Parenting Special Children Charity in Reading during November. Studio 3 will be working with them to delivering workshops and training for young people, families & professionals. You can see all of their events here: https://www.parentingspecialchildren.co.uk/events/2019-11/ Stress and Emotional Regulation Events in Reading from @studioiii in partnership with @PSCRuth & @MsJoBillington: 13 Nov 16:30 - 18:30 for Children & Young People - http://ow.ly/ykQ830pxO8S 14 Nov 09:30 - 14:30 for Parent/Carers - http://ow.ly/9sAf30pxOb9 14 Nov 16:30 - 19:00 - Twilight Session for Professionals - http://ow.ly/4KEL30pxOdq 15 Nov 09:30 - 16:00 - Stress & Emotional Regulation Full Day Training Course for Professionals & Practitioners - http://ow.ly/433X30pxOgz Finally, a new training package developed by Studio 3 in partnership with Optimus Education, will be available to purchase for your school or organisation shortly, and can be inquired about through our office by contacting info@studio3.org or calling 01225 334 111. As ever, there is plenty going on at Studio 3, and we will continue to ensure that Gareth is kept very busy in the months to come!

Dr. Daniel Rippon, a lecturer at the University of Northumbria, writes about his recent research into the effects of restrictive practice on the stress and well-being of frontline mental healthcare staff. There has been much debate about the use of restrictive practices to de-escalate the distress of care recipients in healthcare settings. In 2017, figures from 40 mental healthcare trusts were released showing that there were 59,808 reported incidences in which care recipients had been subjected to a restrictive practice. Restrictive practices can consist of manual restraint, mechanical restraint, pharmacological restraints or seclusion. There is a wealth of literature which suggests that the use of restrictive practices have the potential to elicit non-therapeutic outcomes in care recipients, such as physical harm and re-traumatisation. Thus, the use of restrictive practices could trigger or perpetuate traumas that have previously been experienced by care recipients. In 2017, the Department of Health and Social Care introduced an initiative which aimed to reduce the use of restrictive practices as a strategy to improve standards of inpatient mental healthcare. However, it must be noted that the use of restrictive practices can also implicate the well-being of frontline staff, who either witness or are involved in the application of restraints in a healthcare setting. The statistics released in 2017 also revealed that there were 1,847 reported injuries sustained by frontline mental healthcare staff who had been involved in administering a restrictive practice. The Health and Safety Executive has identified that frontline mental healthcare staff are an occupational group that could be vulnerable to the onset of work-related stress. We must therefore consider how reducing or negating the use of restrictive practices could also be beneficial in enhancing the occupational well-being of, as well as offsetting stress levels experienced by, frontline mental healthcare staff. According to medical ethics, healthcare professionals should ensure patient autonomy and justice, and act with beneficence and non-maleficence when providing care. Ultimately, and ideally, healthcare professionals should ensure that care recipients have a choice in the type of care they receive, and that they do not experience harm during their treatment. It goes without saying that most healthcare professionals who enter into this occupation have a genuine vocation to care for people. Therefore, it is often the case that the thought of manually restraining a care recipient against their will is at odds with the personal and professional ethics of some frontline mental healthcare staff. Such professionals can experience ethical dilemmas when encountering care recipients who self-harm, where non-invasive de-escalation strategies have been ineffective. Thus, cognitive dissonance can occur within healthcare professionals who apply a restraint in order to prevent a care recipient form experiencing further harm, but are ill at ease with the process of manually holding a person against their will within a care setting. When restrictive practices have been applied to prevent a care recipient from further self-harm, it is therefore necessary to consider how best to support frontline staff who may feel that they have breached their own professional ethics by applying a restraint. Unfortunately, there is some literature which suggests that many frontline staff receive inadequate or no offer of post-incident debriefing from suitably qualified professionals as a means to alleviate the stress which accompanies being involved in challenging situations where restrictive practices have been used. We must be mindful that some frontline healthcare staff may have experienced their own traumatic life events, which could be triggered by witnessing or being involved in the application of a restrictive practice. The process of witnessing care recipients self-harm can also be a traumatic experience in itself. However, the process of being involved in a restrictive practice has the potential to elicit re-traumatisation within frontline staff. Even in the event that a restrictive practice has been used as a last resort to prevent a care recipient from experiencing further harm, we cannot assume that members of frontline staff who were involved in the restraint walk away without any negative consequences to their well-being. Research has suggested that structured debriefing sessions, which provide emotional and educational support immediately following incidences of behaviours that challenge, can contribute to the reduced use of restrictive practices. However, there is also literature to suggest that the process of discussing incidences in which restrictive practices have been used can be traumatic for both care recipients and frontline staff involved in the restraint. This illustrates a conundrum as to how the aftermath of a restrictive practice can be effectively managed in order to prevent care recipients and staff from experiencing further trauma. In an ideal world, the simple answer would be to implement working practices that prevent challenging incidences from occurring in the first place. Some schools of thought actually advocate that the use of restrictive practices should never be used to reduce the distress of care recipients in healthcare settings. As my research interests concern the occupational welfare of frontline healthcare professionals, I am always keen to understand ways in which work-related stress can be alleviated in caring professions. It could be that healthcare environments which place an emphasis on reducing or negating the use of restrictive practices may help in ensuring not only the well-being of care recipients, but also of frontline staff. Some philosophies of care, such as Bloom’s Trauma Informed Sanctuary Model, advocate that mental health inpatient services comprised of therapeutic environments which are non-violent may help to ensure the biopsychosocial well-being of care recipients. Models of inpatient care that are underpinned by the principles of Trauma Informed Care, such as Safewards, have also been shown to reduce the use of restrictive practices and assist with harnessing therapeutic environments for care recipients. Studio 3’s Low Arousal approach also places a strong emphasis on diffusing the distress of care recipients without the use of aversive or restrictive interventions. My recent research has focused on ascertaining whether the application of such healthcare philosophies, encouraging the use of non-invasive techniques to reduce distress in care recipients, are also conducive to ameliorating stress levels in mental healthcare professionals. There is a plethora of research which suggests that providing frontline mental healthcare can be a stressful occupation. Witnessing or being directly involved in a restrictive practice could be one of a number of factors that contributes to the work-related stress experienced by frontline mental healthcare professionals. Trauma-informed care and Low Arousal approaches can provide guides as to how to avoid the use of restrictive practices as a means of ensuring the well-being of and preventing re-traumatisation in care recipients. It is also necessary to consider how avoiding the use of restrictive practices could be beneficial in enhancing the well-being of and reducing work-related stress in frontline staff with a vocation to provide care for vulnerable people. Dr. Daniel Rippon Lecturer in Psychology University of Northumbria, Newcastle

In this issue we review Pooky Knightsmith's 2017 publication, 'The Healthy Coping Colouring Book and Journal', illustrated by Emily Hamilton. ‘The Healthy Coping Colouring Book and Journal’ by Pooky Knightsmith is a busy, vibrant, joyful book, bursting with creative potential. Illustrated by Emily Hamilton, this book is far more than a simple colouring book for people who want to stay within the lines. The activities within encourage the reader to become the author – to be brave and bold in making this journal their own. Packed full of drawings, activities, inspirational quotes and advice, this journal provides practical methods of coping with stress, anxiety, anger, and other difficult feelings. With the concepts of Mindfulness and relaxation coming to the fore in recent years, we all know how important it is to ground ourselves in the moment, and to be mindful of stressors in our lives and how to manage them. Stress within the home, at school or in care settings can increase incidents of aggression, therefore methods of reducing stress, such as Mindfulness, are incredibly useful for both individuals and their parents or supporters (Singh et al, 2007). These simple but fun and effective activities are targeted towards making sense of confusing or overwhelming feelings. The illustrations throughout provide plenty of creative opportunities to engage one’s imagination by creating your own masterpiece. Activities like colouring in can induce a ‘flow’ state, such that a person can become so absorbed in an activity that they block out the world around them. Research into ‘flow’ states has shown that they can reduce stress, particularly in individuals with ASDs, and generally improve well-being (Csikszentmihalyi, 1990; McDonnell and Milton, 2014). Find out more about flow from autism expert Dr. Damian Milton here. ‘Whether you are stressed out at home or school, feeling anxious or simply in need of some relaxation, this workbook provides a place for you to express your emotions.’ This book is the perfect tool for anyone who struggles to identify and manage difficult emotions, providing a safe space to explore those emotions and consider helpful strategies for coping with them. The inspirational quotes and fun activities within are all geared towards encouraging positive reflection and productive thinking, asking the reader ‘what’ they are feeling but also ‘why’? Research has shown that some individuals struggle to identify their emotional states, and as a result have difficulty regulating their levels of arousal (Stichter, 2010). This difficulty to pin down big feelings such as anger and stress, coupled with feelings of helplessness in regards to coping with them, can be extremely distressing. Many of the people we support, from children with developmental differences to adults with Autism Spectrum Disorders (ASDs), struggle to manage their own stress, and, as a result, can become hyper-aroused easily. This failure to recognise, name and manage feelings of distress or discomfort can be extremely confusing. This is where tools such as ‘The Healthy Coping Colouring Book and Journal’ become integral towards supporting individuals to recognise their emotional and arousal state, and thereby gain more control over it. This light-hearted and fun book encourages positive thinking and optimism, with inspirational quotes throughout reminding us that ‘Every success starts with a decision to try’, and that ‘Kind words can be short and easy to speak, but their echoes are endless’. In addition, it is packed full of healthy coping mechanisms for when feelings become overwhelming, such as encouraging the reader to make lists of their favourite songs and books to listen to or read when they need to escape, calm down, or simply take time to enjoy the things they love. Alongside blank spaces that spark creativity, there are also practical suggestions for promoting mental, emotional and physical well-being, such as the importance of sleep, how to incorporate more activities into your life, how to ask for help and the importance of eating well. For people who are not struggling themselves but wish to become more mindful of how they can support others, there is plenty of advice for helping others, for example how to be a good listener and what to do if you’re worried about a friend. Overall, this is a fantastic book that would be helpful for any child or adult who is struggling with difficult feelings, and we highly recommend it as an essential tool for encouraging self-reflection and emotional regulation. Reviewed by Rachel McDermott, Studio 3 Digital Content Editor References Csikszentmihalyi, M. (1990) Flow: The Classic Work on How to Achieve Happiness. London: Rider. McDonnell, A. & Milton, D.E. (2014) Going with the Flow: Reconsidering 'Repetitive Behavior' Through the Concept of 'Flow States'. In: Jones, Glenys and Hurley, Elizabeth, eds. Good Autism Practice: Autism, Happiness and Well-being. BILD: Birmingham: 38-47. Singh, N.N., Lancioni, G.E., Winton, A.S., Singh, J., Curtis, W.J., Wahler, R.G. & McAleavey, K.M. (2007) Mindful Parenting Decreases Aggression and Increases Social Behaviour in Children with Developmental Disabilities. Behaviour Modification, 31(6): 749-771. Stichter, J.P., Herzog, M.J., Visovsky, K., Schmidt, C., Randolph, J., Schultz, T. & Gage, N. (2010) Social Competence Intervention for Youth with Asperger Syndrome and High-functioning Autism: An Initial Investigation. Journal of Autism and Developmental Disorders, 40(9): 1067-1079.

Studio 3 clinician Dr John McDermott discusses relationships and autism, and the role played by the emotional and relational world when supporting clients. The importance of relationship in the lives of people who have an autism diagnosis is a crucial part of our practice at Studio 3. When working therapeutically with clients, parents or caregivers, we aim to capture individual client meaning and what they might need from the people who support them. In psychology we refer to such approaches as systemic in the sense that rather than looking at just the individual, we recognise that the whole system around the person has impact on well-being. The professional literature talks of the problem of the “identified patient” in therapy, and how we must be careful not to focus on individuals while ignoring the other humans in their lives. Such systemic approaches also acknowledge that it can be unfair, unhelpful or even unethical to focus on behavioural approaches which attempt to change the behaviour of the person who has an autism diagnosis. When working one on one with clients in therapy, I am moved by the importance they and their families attach to their relational and emotional world, and the powerful grip that emotional experience has on their lives. Client stories have directed my professional focus towards the emotional and relational impact autism has on the lives of clients and their families, and the resulting distress or “trauma” held in family systems. Developmental perspectives on relationship and emotional development help create new ways to understand client experience for this group of people who have struggled to find ways to develop integrated relational and emotional selves. In this move from a medical model to one where emphasis shifts to emotional, relational and sensory development, I expect we will hear much more of the potential relevance of areas such as alexithymia, interception and relational trauma in autism - a view shared by my colleague Professor Andrew McDonnell. Developing relationships is therefore a critical part of any change process, and the practice of low arousal approaches requires a strong reflective process and framework to support caregivers so that they can examine their own contribution to challenging behaviours (McDonnell, 2010). With this in mind, I have developed a series of practitioner workshops, which have been piloted in Denmark, which aim to promote what could be called the “practitioner developmental agenda”. Such an approach acknowledges a shift away from medicalised ways of understanding client well-being, to approaches which help caregivers reflect on ways in which they can adjust their own ways of relating to support clients. Reflecting on practice can be a difficult and indeed emotionally challenging task. Crucial to the Studio III approach is cultivating a practitioner mindset of curiosity about self experience, and how the people we support might experience us. In many ways this is a framework for “relational mindfulness” (Dan Hughes) in the sense of emphasising awareness of the engagement between us and another people. Again, I stress that this is a model where the client is not the “patient”, but rather we are taking a hard look at ourselves in a non-defensive way. Our relational workshops aim to develop understanding of how people with an autism diagnosis or developmental disability experience relationship with other people, and explore practical skills which might help caregivers working in this field develop shared trust and understanding in their interactions with the people they support. The key theme is one of facilitating discussion around placing relationship and engagement at the heart of low arousal practice. We explore the value of developing caregiver awareness of unhelpful relational and emotional dynamics in autism and intellectual disability settings. The success of developing caregiver interventions suggests that mindful awareness and response to relational dynamics is a key change variable in the well-being of people supported in care settings. Attunement to client relational experience is the essence of most contemporary therapies (eg. Beck, Rogers, Hayes etc.) and we explore practical ways in which caregivers too can create warm relational interactions which reduce client distress and challenging behaviour. Some of the key themes we explore in our relational workshops are: Developmental perspectives on relationship and emotional growth; intersubjectivity, attachment styles and models of emotional development. The therapeutic value of promoting relational engagement and links between fulfilling relationship and client well-being. Styles of interaction which can be helpful in enabling this client group to successfully engage with caregivers and enable them to effectively communicate their needs and emotional experience. In particular, we explore the utility of techniques such as motivational interviewing (Miller & Rollnick) and pre-therapy (Prouty) when working with clients who have a qualitatively different relational world, or who may have detached or withdrawn from day to day experience. A central role for how we can use mindfulness (Kabat-Zinn) as a relational tool integral to the professional developmental agenda of caregivers who are part of the lives of this client group. Using group formulation rather than functional diagnosis as a tool to understand barriers to relational engagement and idiosyncratic client preferences around social interaction. For further information on the relational workshops Studio 3 will be running in the future, please contact our office at info@studio3.org or 01225 334 111.

Developed by Director Dave Walker, the Studio 3 'Good Life' Foster Care Project uses the Safety, Stability, Repair and Resilience Model (SSRR) to help children with complex behaviours stay with their foster carers. Stopping Foster Care Placements Breaking Down All children in care deserve the opportunity to experience a family setting, and to feel safe and happy and able to achieve their aims and hopes for the future. No child should feel ashamed of their past, and every child can be helped to overcome trauma and negative life experiences with the help of kind and skilled carers. The majority of children in care are in foster care. It is not generally recognised that foster carers often have to manage the same level of complexities and challenges as carers in residential children’s services, without anything like the same level of backup. Unlike residential carers, foster carers are not allowed the opportunity to go home after one of the children they care for has been particularly anxious, stressed or aggressive, and, unlike residential carers foster carers, they often only get one chance to get their foster caring ‘right’. The facts are stark - almost 1 in 4 foster care placements breakdown, and it is not at all unusual for children in foster care to have been in more than 15 placements before they even reach their 12th birthday. The reasons for this are often complicated, and generally not down to ‘bad’ foster carers. In fact, the foster carers are often doing the best they can in very difficult circumstances, which they have often been poorly prepared for. For some children who have experienced a life of chaos and trauma, the experience of foster care can be overwhelming and placements breakdown quickly unless their complex needs are quickly understood and supported by highly resilient foster carers. Yet at the same time, foster carers also need high levels of support in order to help them deal with high levels of concerning behaviour and to prevent ‘burn out’ that can contribute towards the continuing pattern of placement breakdowns. Studio 3 have been providing practical low arousal behaviour and clinical support to residential children’s services working with complex children since 1998. In 2011, Studio 3 started work on a ground-breaking partnership between a residential children’s service and an independent foster care agency who were attempting to prevent foster care breakdowns for children who had previously been in residential care. What became quickly apparent was that, although foster carers often received high levels of training, little thought had gone into considering how theoretical models of attachment and the effects of trauma and abuse could be turned into kind, practical approaches. Whilst knowing about dyadic developmental therapy, Neurosequential development and Mary Ainsworth’s theory of attachment is important, this theoretical knowledge is not of great use to a foster carer who has just realised that the child they are fostering is about to run upstairs and break all of their wedding photos. This partnership between the residential children’s service and the foster care agency did not last, but Studio 3’s interest in the experiences of foster carers did. The Practical Application of Theoretical Models Over the last five years, Studio 3 have been talking to a large number of foster carers to try and understand the unique and daily challenges that they face in caring for the children living with them, focusing particularly on children who had either been in residential children’s homes previously, or were in danger of being moved into a residential children’s home. Our research has led us to the development of the integrated and practical ‘Good Life’ Foster Care Project alongside the Safety, Stability, Repair and Resilience Foster Care Model (or SSRR for short). This approach incorporates Studio 3’s mainstays of creating low-stress environments, practicing trauma-informed care and using low arousal approaches to provide a kind, child-friendly, respectful and developmentally appropriate attitude to caring for vulnerable children. This unique training is delivered to foster carers in a practical and engaging way, avoiding ‘death by PowerPoint’ or bombarding foster carers with ‘theoretical’ knowledge. The model has been taken up by leading independent foster care agencies in England, Wales and Ireland and, as with all Studio 3 work, each step of the model is being rigorously researched and evaluated. Our first peer-reviewed papers on the research will be submitted later this year. Initial outcome studies with statistics provided by the foster care agencies are very positive, with placement breakdown being reduced to only 1 in 8 for even the most complex foster care placements, as well as foster carers reporting less stress and more satisfaction within themselves. Whilst these outcomes are still sad for some children, they are a clear improvement on the general situation for most children in foster carer. As the ‘Good Life’ Foster Care approach and SSRR model continues to be applied to more foster care placements throughout the UK, Studio 3 will continue to share our findings from the outcome studies and the informed learning that we will receive from talking to children within the foster care system, as well as the wonderful people who care for them. More information can be found here. If you would like to know more about the ‘Good Life’ Foster Care Approach and the SSRR model please contact Director David Walker at dave@studio3.org or Clinical Manager Carl Benton at carlb@studio3.org.

All the latest staff news from Studio 3, including new team members, exciting training developments, and recent publications. Our first exciting piece of news is that we will be hosting an international conference in Kerry, Ireland in October 2020! To be the first to know all the details of this event, register your interest now at neart2020.org to join our exclusive mailing list for the conference. The name 'NEART' is derived from the Irish word meaning strength, and is the theme of this conference. Stay tuned for more information in the coming month such as speakers, venue and more! Secondly, we would like to offer a warm welcome to our new colleagues in Kerry and Scotland! We are joined by a team of new assistant psychologists whose work in the coming months will be invaluable as our work in Ireland and Scotland continues to grow and develop. In addition, Gemma Holdsworth will be joining us in the main office in Alcester, Birmingham full-time from this month as our admin extraordinaire! She will be on hand to answer any queries you may have about our services, and to assist our trainers and clinical teams! We also welcome Elly Chapple, founder of #CanDoELLA, as an adviser, who will be working closely with our educational lead Gareth D. Morewood in the coming months. With Elly's motivation and expertise we hope to have a meaningful impact on the lives of young people and their families, and #flipthenarrative when it comes to restraint and seclusion in schools. Additionally, Gareth Morewood and Professor Andrew McDonnell have been working on developing a new training programme for schools, titled the LASER Programme (Low Arousal Supports Emotional Resilience). This programme is due to launch in October, and will be available throughout the UK and Ireland. Subscribe to our mailing list to keep up to date with the most recent developments and offers: https://www.studio3.biz/studio3/. Mary Maher of the Maynooth office in Ireland is now the clincal co-ordinator for all our work in the Republic of Ireland, and will be liasing closely with Carl Benton, our clinical manager in the UK. Mary has been a valuable member of our team for many years and we know that she will thrive in this new role! In other news, our Train the Trainer courses in Vancouver, Canada are going from strength to strength thanks to lead trainer Rob Whiskens. In addition, our work in Breton Ability Centre in Nova Scotia continues to flourish, with Director Andrew McDonnell visiting there this week! Our project with Pindstrup Skole in Denmark is gathering momentum, focusing on applying the stress and well-being model to children with special needs. Our associate Signe Lo Scott Larsen has just had a publication regarding an Atlass programme in Denmark accepted, which should be appearing in an upcoming issue of Good Autism Practice. In addition, a new publication by Professor McDonnell, Paul Dickinson and the late Dr. Michael McCreadie is now available in The SAGE Handbook of Autism and Education. This chapter discusses Behavioural Issues and Supports, and is part of a collection of articles on Barriers to Education. This academic text is highly informative and shares the positive psychological framework we adopt in our work, and we are honoured to be associated with it. There is also a rumour that Professor McDonnell is in the process of writing another book on gastric operations... Stay tuned for more Studio 3 news in the next few months!

We are delighted to announce that Elly Chapple, founder of CanDoELLA, will be joining Professor Andrew McDonnell and the Studio 3 team as a Specialist Consultant as of this month. Elly will be working closely with our Educational Advisor, Gareth D. Morewood, developing new training and support for teams working within schools, for family members and working with young people themselves. Elly’s recent TEDx talk powerfully highlights how her traumatic personal experience has allowed for a unique perspective and level of expertise in reducing stress, applying low arousal approaches and reducing restrictive practices. More details about the new training and projects Elly will be involved in will be announced in the coming weeks. Follow Elly on twitter @elly_chapple and join her cause to #flipthenarrative

Our education project is now well and truly off the ground with Educational Adviser Gareth Morewood joining us full-time! We are delighted to announce that our Educational Adviser, Gareth Morewood will be joining the Studio3 team full-time from August 2019. Since January Gareth has combined his role as SENCo at Priestnall School in Stockport with his role as an Adviser to Studio3. He has already had significant impact, developing and delivering training and support for schools, other educational settings and families. We have exciting plans for the years ahead, and you can find out more about our ongoing Education Project here. We look forward to continuing to develop high impact, low cost training and support for schools and families as we further develop our educational support in the year ahead. Follow Gareth on Twitter to keep up to date with his recent work by clicking this link!

A comment on the BBC Panorama 'Undercover Hospital Abuse Scandal' Documentary aired 22nd May 2019 Background The BBC Panorama documentary, which reported abusive practices in a hospital for people with intellectual disabilities and autism, has highlighted a broken system of support for society’s most vulnerable. The earlier 2012 Winterbourne View documentary was the first of many to expose a pervasive model of support that both is damaging and not therapeutic. What Do We Know? The children’s commissioner Anne Longfield identified that there were 1,465 children in England securely detained in 2018, of whom 873 were in held in youth justice settings, 505 were in mental health wards and 87 were in secure children’s homes for their own welfare. The cost of these placements was over a staggering £300 million per year. The situation in our adult mental health services is also concerning. Staff in NHS mental health hospitals deployed restraint on patients 22,000 times last year, almost 50% more than the 15,000 occasions in 2016. A File on Four investigation identified the number of such patients living in inpatient units in England has only fallen from 2,600 to 2,400, while the number of under-18s being cared for has almost doubled. We are spending huge sums of money supporting people with very complex behaviours quite literally miles from their homes and communities. Human Costs These are just the financial costs. The human cost of managing people in highly medicalised environments is also incalculable. I do acknowledge that the vast majority of this poorly trained and underpaid workforce are trying their best to deliver optimum care. However, in my opinion, our current system is flawed. We criticise people for the large number of individuals in this type of care, yet we do not adequately resource specialist community resources to support these people. In my opinion, there needs to be both a top-down and bottom-up approach to changing these services. Deeds Not Words The challenge for us is to have real and honest dialogue about how we begin to fix these problems. The usual sweeping statements from politicians and officials after such documentaries can be both full of vigour and quickly forgotten. We must begin to follow a simple message. My old school motto, ‘Facta Non Verba’, means ‘Deeds Not Words’. So, what are we going to do about it? I am very aware that complex issues such as these need to be reduced to basic principles. Let’s move away from targets and start to figure out who these people are and how we return them to their homes and communities. In the spirit of keeping things simple, the following short list should be seen as a ‘snapshot’ guide: 1) When people require support, it should be close to their homes Sending people hundreds of miles away from their family and supports places them in a form of isolation. This reduces the likelihood of visits, which is an important factor in the external monitoring of abusive practices. Local services can help to reduce the lengths of stays in specialist placements, and also encourage continuity of care. The mantra should be to 'keep people in their communities'. 2) We need to change our crisis training models to reflect an approach that genuinely makes restraint a last resort. Restraint may be required to keep people safe. On the other hand, when it is repeatedly used, it just demonstrates a traumatising approach which is a by-product of a larger failure to understand and meet a person’s needs. It is too easy to train people in narrow crisis management responses that often contain limited de-escalation strategies. Surely a better use of these pre-crisis skills would reduce the need for repeated use of restraint methods? 3) Commissioners of services must be held more accountable Placements are expensive, and often long in duration. The level of scrutiny needs to be much higher. Authorities that place individuals must move towards a system of visits which do not give prior warning to services. There should also be a mandatory funding threshold of one year in any placement. After this period, funding should only be extended by six-month periods, with commissioners’ agreement. The emphasis needs to be on returning people locally. Where a stay is determined to be long-term in nature (likelihood of greater than 2 years), the individuals should be moved to services locally. 4) Create a new national clinical audit team Greater scrutiny of placements should occur after 1 year. A national therapeutic, multidisciplinary team should assess all individuals in placements for their therapeutic needs, goals and outcomes. They should consider the therapeutic pathway for individuals and consider the following three areas: · What supports and resources are needed to return home? · A service specification for an individualised service for those individuals deemed to need long-term supports. · Individuals that remain in placements must have a clear therapeutic pathway that is reviewed by this team. All individuals with monthly or greater levels of physical restraint or seclusion must have an agreed and binding restraint reduction plan. 5) Increase therapeutic resources to local community resources. Critical to returning people home is the need for local supports from specialist practitioners and agencies. The emphasis should be on strengthening these resources. Increased community supports should also prevent the need for specialist placements. Conclusion It is our considered view that the core driver of change must be returning people to their local communities wherever possible, and developing local services to support these individuals. There needs to be a mindset change which emphasises that 'local is best'. What we are to learn from this documentary and Winterbourne View is that we need to ‘bring people home’. Professor Andy McDonnell, Studio 3, CEO

Keynote speaker Professor Andy McDonnell on understanding stress, arousal and emotional regulation in context. #CoPro19 is an event organised by Gareth Morewood of Priestnall School, Stockport, and Elly Chapple, founder of CanDoELLA. This event, which took place on 21st January 2019 at the Stockport Conference Centre, featured several speakers on the topic of co-production in education, discussing the ways in which educators can #flipthenarrative in schools for children with developmental differences by working together to effect change. Keynote speaker Andy McDonnell kicked off proceedings with a presentation on understanding stress, arousal and emotional regulation in context, and how low arousal can be applied in classroom settings. Firstly, Andy acknowledged that fear is sometimes part of our work as educators and carers, and that recognising how fear impacts our responses is key. Sometimes, people are scared of the person they are supporting – worried that they might behave in an aggressive manner, or react badly to suggestions. In these circumstances, Andy argued, low arousal approaches are essential. The first step to overcoming fear is to acknowledge that it exists, and secondly, examine how to support carers when they are fearful. ‘It’s a mindset in education, it’s not about resources.’ (Elly Chapple via Twitter @elly_chapple) Andy went on to say that having a fearful response to someone we are supporting’s behaviour does not make us ‘bad’ people or ‘bad’ carers. In stressful situations, it is natural to panic and act irrationally. The key to helping someone, Andy says, is to manage your own stress first. To step back and be mindful. To stop being adversarial, and start being reflective. In a recent collaboration with Northumbria University and PhD student Daniel Rippon, research has shown that stress has a significant impact on carers. The high levels of the stress hormone cortisol found in the hair of carers for dementia patients demonstrates a larger, sector-wide prevalence of carer stress. Even when a person does not feel stressed, this study shows that stress leaves physical markers which can affect overall well-being. In short, we are working with highly stressed individuals when we ourselves are highly stressed, meaning that stress reduction and coping skills should be implemented, not only in the lives of the people we are supporting, but should also be practiced in our own daily lives. ‘Frightened and highly stressed people make poorer decisions’ - Andy McDonnell Andy goes on to share Studio 3’s mantra; that you can not talk about stress without also talking about coping. He says, ‘Lazarus & Folkman (1991) linked stress and coping. Coping strategies are a critical variable in this model. In this model, individuals with high levels of stress but with high levels of coping responses do OK.’ This is why it is important not to resort to restraining challenging individuals, but teaching them healthy coping mechanisms in order to approach stressful situations differently. However, Andy explained that trying to talk to people mid-crisis is not necessarily helpful. This is when de-escalation skills such as low arousal become incredibly useful; learning to diffuse crisis situations without the use of physical restraint. ‘When a person is drowning that is not the best time to teach them how to swim’ (David Pitonyak) Furthermore, Andy also discussed the importance of having an emphatic, understanding and forgiving mindset when working with children, young people and adults who can be challenging. It is important to learn to forgive when individuals react aggressively, and also to recognise that they are not always responsible or in control of their behaviour. By learning to forgive, and not respond in kind with anger and distrust, there is a higher chance of changing outcomes. In addition, Andy discussed clinical terms such as ‘client, case and service user’, which dehumanise individuals and portray them as ‘problems’ to be ‘fixed’. Andy concluded by emphasising that we need to listen to the children and young people we support, and be open to adapting to their needs and preferences. ‘We are not trying to fix people who are broken’ (Gareth Morewood via Twitter @gdmorewood) Other speakers from the event included Barney Angliss, who discussed being a regular hospital inpatient with diagnosed Asperger's, and why we should avoid doing things to people and focus on helping them. Jo Billington of the University of Reading discussed autism and education, and how we can make a difference to primary-school aged children by examining the barriers and facilitators to inclusion. The full event programme can be viewed here: http://www.gdmorewood.com/wp-content/uploads/2019/01/Copro-Programme-Jan-19-1.pdf For more information on Studio 3’s work in education, see the new one-day low arousal course in conjunction with Gareth Morewood here: http://www.gdmorewood.com/wp-content/uploads/2019/01/Autism-Emot-Reg-Flyer-2019-one-day-training.pdf.

What the recent investigation into The Priory Healthcare group has taught us about increasing pressures upon systems of care in the UK. On Thursday 18th January, before the Easter break, we witnessed another undercover documentary from ITV that focused on children with mental health issues being mistreated by staff. We at Studio 3 do accept that the vast majority of staff are trying to do their best in the face of resourcing issues and increased pressures upon systems of care. However, to quote Ghandi, a society is judged by how it cares for the vulnerable. In the UK, we have had the Winterbourne View documentary (2012), and the Aras Attracta documentary in the Republic of Ireland (2015), both of which highlighted abuses in care environments. How is it that we seem to struggle to learn from previous exposure documentaries? Understanding that we appear to be in a situation where staffing resources, especially staffing turnover, is becoming more and more of an issue for service providers. Surely training and coaching is even more necessary in such a climate? It also strikes us that the very basics of support and compassion sometimes seem to be lacking in environments. We understand from social psychological research that when practices become the acceptable norm, good people can start to conform to very poor practices. This case is a sad example of organisations putting profit before care, and overlooking the very basic needs of the people they care for. What is important, first and foremost, is the physical and emotional well-being of vulnerable individuals. That is why funding staff training and ensuring appropriate levels of staffing in facilities such as these should be the first priority, not an afterthought.