Inclusive and Supportive Education Congress International Special Education Conference Inclusion: Celebrating Diversity? 1st - 4th August 2005. Glasgow, Scotland

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The impact of training on practice:
insights from postgraduate study of autism

Charlene Tait
National Centre for Autism Studies, University of Strathclyde, Jordanhill Campus, 76 Southbrae Drive, Glasgow, G13 1PP
charlene.tait@strath.ac.uk

Aline-Wendy Dunlop
National Centre for Autism Studies, University of Strathclyde, Jordanhill Campus, 76 Southbrae Drive, Glasgow, G13 1PP
a.w.a.dunlop@strath.ac.uk

Abstract

The Multi Professional postgraduate programme in autism (spectrum disorders) at the University of Strathclyde aims to promote development of professional practice in the field of autism through participation in the course. Assignments are designed to promote application of what is taught and learned through the programme and individual study. The programme started in May 1999, and was reviewed in December 2004.

Professionals studying on the Multi-professional postgraduate programme in autism (spectrum disorders) were surveyed to establish the extent to which they thought their studies had had an impact on their professional practice in the field of autism. Four groups of students participated in the study. The first group was a convenience sample of all professionals who have completed their studies on the autism programme (n=74). The second group comprised all professionals currently taking part in the programme (n=127) . The third group was a sub-group of the first two groups who were selected on the basis of participation in the multi-professional work and family support module (n=64), and the Independent Study module (n=54), both of which specifically require students to develop a plan of action and undertake an investigation based on their own practice. The final group was made up of all parents of a family member with ASD who have studied to date on the programme (n=24): this group were asked to reflect on the ways in which studying autism in general had had an impact on their individual family member in particular.

All sample students completed a questionnaire. 10% were followed up in structured interviews to further explore participants’ perceptions of the impact of their programme of study on practice. The third group were additionally asked to write a short reflective piece on the continuing impact (if any) of the particular module on their practice. The results from this group have been used as illustrative case studies.

The findings of the first survey have been used to inform course review. The findings from the current student group have been used in module revision, the development of programmes of study and the writing of assessment criteria for assignments undertaken. The findings of the parent survey have confirmed the importance of parent participation in the programme

Themes: curriculum, pedagogy

The impact of training on practice: insights from postgraduate study of autism.

Background to the study

The Multi-professional postgraduate certificate, diploma and masters in autism at the University of Strathclyde aims to promote professional practice in the field of autism spectrum disorders (ASD) and is the first   course of its kind in Scotland.

The purpose of this present paper is to report a study   which explored the extent to which course participants perceive their learning on the postgraduate programme in autism to be impacting on their practice. In the case of parent course members the focus was on the influences of the course on the approaches they use with family members. Additionally the study identified factors that are influential in affecting practice; the multi-professional ethos of the course will also be explored in terms of relevance and influence.

This programme of study has been available on a part-time basis from the University of Strathclyde since 1998. In this period students from a range of professional disciplines from the health, education, social work and voluntary sectors have studied alongside each other.   Individuals with ASD and parents of children and adults with ASD have also participated.

Embedded in the nature of this particular course and in postgraduate study generally is an expectation of self-evaluation and critical reflection on practice. Regular feedback is sought and given. Quantifying the effects of such a reflective approach promised to offer new insights into course development.

Insights from the Literature

Both multi-professional working and training to support such practice are relatively new concepts which are driven by the needs and rights of client groups. The need for such collaborative working has been driven mainly by day-to day needs and policy developments. Although there is currently limited research evidence to support either the value or challenges of working across disciplines, the literature does offer a number of key insights.

The National Training Framework for Autistic Spectrum Disorders (Mackay & Dunlop 2004) highlights the nature and range of training issues reported by professionals, parents and individuals with ASD. There are inconsistencies across disciplines and wide variation in both level and availability. The recommended framework seeks to address some of these issues and aims to enable practitioners and policy makers to consider the potential for a more consistent and structured approach that allows for broadening knowledge at a given level as well as identifying progressive pathways.

The presumption of mainstream education for children with additional support needs (Scottish Executive 2002) means that it is now more likely than ever that teachers in a wide range of educational settings will come into contact with children with ASD. For this group the implications for training are apparent however such issues cannot and should not be the concern of a single professional group. Florian (1998) highlights that whilst inclusion may be variously defined that it is an issue that extends beyond education and is pertinent in employment, recreation, the wider community and in the home. Consequently the potential exists for a vast range of professionals to be involved with individuals who have an ASD. It would therefore be infeasible to implement high level training to all. It is therefore more realistic and beneficial to consider training opportunities that range from basic awareness for those professions likely to be on the periphery of an individual’s life up to the highest level of training to those with daily, direct involvement (Mackay & Dunlop 2004)

It is the latter group that is attracted to undertake postgraduate study in autism.

The diverse composition of the student body enables opportunities for collaborative learning. Gokhale, (1995) advocates collaborative learning as a means of enabling students who have different levels of knowledge to work towards a common purpose. The approach engenders a responsibility for corporate as well as individual learning. The benefits of this approach are highlighted by Declute & Ladyshewsky (1993) who suggest that self-esteem increases as a result of improved and integrated skills and knowledge. Interest in and responsibility for learning also improves as does the level of critical thinking in which participants engage.

Hutchings & Feaver (2002) suggest that multi-professional education is not justified solely on the grounds of the requirement of a common body of knowledge but that it is concerned with the inter-relatedness of professional roles. Given the complex needs that result from the core impairments in communication, social interaction and flexible thinking that arise from the lifelong developmental disorder of autism (Wing 1996) it is both inevitable and desirable that a wide range of professionals will be involved.

The health sector has a well established ethos in relation to multi-professional training and development. The significant number of differing professions within this sector is likely to be a major contributory factor as is the fact that the health sector is the second largest purchaser of higher education in the United Kingdom (Sector Skills Development Agency 2005) Woolman, Banks & Wilson (2002) suggest that the attainment of effective multi-professional education is dependent on boundaries being crossed and new understandings being developed. This is supported by Dunlop & Mackay (2005) who cite The Royal College of Nursing (2003) when they identify that teamwork and shared understanding can be facilitated when professionals learn together in mixed groupings furthermore such advantages can potentially impact on future collaborative practice.

Wood (2000) raises the dilemma as to how to attain a balance between the need for professional socialization into a particular role and the benefits that can be derived from multi-professional education. Whilst this principally pertains to preferred methodology of training newly recruited health professionals it is of interest and relevance to the postgraduate programme. Consequently this raises issues for those managing and supporting continuing professional development (CPD) as it would suggest that there is a balance to be struck in order that individuals feel secure and established within a given role before they can benefit from shared learning. This is a view that can doubtless be debated depending on context. The nature and benefits of multi-professional learning and its impact on practice has, to date not been the focus of extensive enquiry. This is in itself interesting given that the current philosophical and legislative drive governing education, social care and health services is towards inter-agency collaboration and service delivery.

Methodology

Professionals who have previously or are currently studying on the multi-professional postgraduate programme in autism at The University of Strathclyde provide an ideal group through which to explore the challenges of multi-professional education and practice. A postal survey of 267 students was conducted. This sample comprised graduates at certificate and diploma level, current certificate, diploma and masters students, parents and individuals with ASD to establish the extent to which they thought their studies had had an impact on their practice. Additionally all graduates from the programme were surveyed.

A sub-group of respondents were followed up in structured interviews to further explore participant’s perceptions.

A further sub-group was selected on the basis of participation in the Multi-professional work and family support module and the Independent study module. Both modules specifically require students to develop a plan of action and undertake an investigation based on their own practice. This group were asked to write a short reflective piece on the continuing impact (if any) on their practice.

Results

Questionnaires, structured interviews and reflective statements were used in the study. The results reported are based on the 68 responses received.

It is acknowledged that a response rate of 25.5% is relatively low. This is felt to be as a result of the competing priorities on the time of professionals who sustained pressurised workloads whilst engaging in postgraduate study. Overall the trends and patterns emerging from the measures taken are felt to be illustrative of the potential impact multi-professional higher education can have on practice and professional development in the field of ASD.

Of the total number of respondents 5 were male and 63 were female. 41 were current students with the remainder comprising of 10 certificate graduates and 16 diploma graduates, 1 respondent omitted this information. Respondents were dispersed across professional disciplines as follows:

Table 1

It can be seen that the highest number of respondents were from education with 84% of these being teachers from both mainstream and special education provision. This reflects the actual course attendance with teaching and other education professionals forming the largest single group. Those students who were part of the “other” professional group represent a varied range of backgrounds e.g. a parent manager of home based intervention programme and project workers from voluntary agencies supporting a individuals within a specific service.

On average students who participated in the multi-professional postgraduate programme in autism had been involved in working with individuals with ASD for 6 years prior to participation. Whilst many had attended one day training events which were either in-service days or offered by specialist providers the postgraduate course represented the first sustained period of study in ASD.

In order to gain a postgraduate certificate in autism students are required to undertake 3 core modules and 1 optional module. To advance to diploma 4 core modules and 4 option modules are required. At the time of writing 2 of the core modules are integrated and offered as a double module and this is known as “Theory into Practice”

Participants were asked to grade the modules they had undertaken or were currently undertaking to ascertain the degree to which they felt participation was impacting on their practice. They were asked to apply the following scale:

1 –        has had no impact on my practice

2 –       has had minimal effect on my practice

3 –       has impacted on some aspects of my practice

4 –        has significantly impacted on many aspects of my practice

It can be seen from the following table that in all modules the majority of participants recognise an impact on practice.

Table 2 : distribution of student ratings.

Students were then asked to provide an overall rating on a   four point scale to indicate the extent of the impact of their course of study on their practice.

Table 3: ratings of the impact of the course on practice

Further they were asked   to identify 3 factors that influenced this overall rating.

Responses were distributed as follows:

Table 4: factors that contributed to the overall rating given

The factors identified fell into broad categories that related to the development of confidence, professional development, the enabling of service development or the development of knowledge and the opportunity to engage with other professionals from different disciplines.

Some typical responses cited as factors are:

“I feel I am more confident in my job as I am more familiar with autism”

(Learning support worker)

“I am confident in discussions with colleagues from various disciplines, with regards to my knowledge about ASD and in suggesting various strategies”

(Learning Disabilities Nurse)

“Increased knowledge and a more balanced view”

(Teacher)

“Multi-professional opportunities enhance greater understanding of support in different contexts”

(Speech & Language Therapist)

Students were presented with a list of indicators and were asked to rate them using the following scale in relation to what they considered to be the impact of their learning on practice.

1 – Not Relevant

2 – Relevant

3 – Very Relevant

Results are shown in table 5. Some statements were designed to be directed towards parents i.e. those that ask about developments in relation to a child or family member. The distribution of responses shows that these have been responded to by professionals. This highlights a flaw in the format of the questionnaire however results are none the less encouraging as they show that professionals feel there have been developments presumably for the children and adults they work with.

The responses to these statements again reflect development in areas such as confidence, practice and professional development. The postgraduate programme has recently undergone review. It will be interesting to revisit these statements about course relevance with future cohorts studying on the revised programme, for example students note a low relationship between their studies and changes in negative behaviours: the   module originally entitled Challenging Behaviour has been revised under a new module title of   Emotional Well-being in Autism: a more pro-active and positive ethos and approach thus being indicated.

Table 5 Ratings of relevance statements

Examples were sought from participants of scenarios or statements which they felt best illustrated the impact of their course of study on their practice. Examples given were categorised by six themes: an increase in confidence, professional development, development of practice in relation to individuals,   developments to the service e.g. the graduate or current student becoming involved in training other staff or other developmental work such as having an advisory role within their school or service. Changes in knowledge, and changes in attitude or participation in multi-professional support networks were also noted. It is an embedded aim of the course to promote communication and effective practice and partnership working between all the disciplines involved with people with ASD and their families. (NCAS 2005) The following table shows the number of examples given in relation to these six categories.

Table 6: frequency of examples by category

Some illustrative comments are as follows:

“I am far more conscious of sensory integration difficulties. As a result I build in activities to my science curriculum which encourages practice in understanding sensory information”

(Teacher)

“Increased confidence to run the training for other staff members. The course has provided the “validity” to do so. My knowledge is current and based in research findings. I have shifted my attitude, successful intervention requires a consistent, team approach not individuals working in isolation”

(Teacher)

 “Successful inclusion of a pupil with severe autism. This year the pupil is more confident and relaxed at home and at school than she has been in the last 2 years”

(Teacher)

“It has had a particular impact on my relationship with parents who value this degree of knowledge, understanding and empathy (and validation of a university degree!)”

(Teacher)

“Theoretical and practical knowledge allows me to work with pupils with ASD in mainstream schools and support their parents, families and school staff who are often very stressed”

(Teacher)

These themes were echoed in structured interviews that were conducted with ten respondents. These are illustrated and discussed in an integrated way in the following section:
Structured Interviews.

Seven teachers including principal teachers, support for learning teachers and mainstream teachers were involved, additionally one learning disability nurse, an Applied Behaviour Analysis (ABA) instructor and a Speech and Language Therapist participated. All have daily ongoing contact with individuals with ASD with the exception of two participants who have minimal contact at the present time. There reasons for selecting an ASD specific course were consistent with all interviewees citing the need for more knowledge and understanding of the needs of individuals. Three interviewees also stated that participation in the course was an opportunity that had presented itself and the fact that it was being funded by their authority encouraged them to participate, all three also stated an existing interest in gaining greater knowledge and understanding.

Interviewees were asked to identify aspects of their knowledge that were lacking prior to undertaking study and to identify ways in which the course had impacted on these. All participants identified a lack in both theoretical and practical aspects of their knowledge and conveyed a particularly strong desire to improve practice. Illustrative comments highlighted match the categories used in structured interviews.

“All aspects (of knowledge and practice) needed developed. I had a little knowledge of Asperger’s syndrome from reading. It was vital that I did the course; I needed an understanding of ASD. It has all had an impact…the biggest thing is working with parents, listening to their point of view. It made me review the way I dealt with parents.”

The increase in theoretical knowledge was also valued by respondents with all able to cite examples of broader and deeper knowledge as exemplified below:

“… I needed general knowledge of ASD. The course helped me keep up with current research, I gained from the multi-professional dimension. It has changed aspects of my practice, I have developed as a professional… I have realised what kind of professional I want to be, there is not just one methodology, you need to look at the bigger picture”

Interviewees reported a feeling of increased confidence in both their knowledge base and in their practice.

“I am 150% more confident in my practice. Parents knew I was on the course, it has increased my status with them”

This individual had also produced an information booklet for her establishment and was able to take a more active role in the assessment and review of individuals in her setting.

“Yes, my confidence has increased. People come to me, even psychiatrists will come because they don’t know. I have referred people on for diagnosis, I recognise people coming in who have ASD”

This individual conveyed a strong enthusiasm for working with and advocating for the needs of individuals with ASD. There was also an element of frustration as she had undertaken the course at her own initiative and was therefore the only person trained in her setting and felt that this affected her ability to have greater influence and impact.

All participants were able to provide examples of situations involving their care, support or education of individuals with ASD where their learning had had a direct and positive impact on the situation. The following are indicative of the direct impact of the course on practice.

“There is a child who is very able, he doesn’t quite fit in. He is often described by others as “at it” I can see his behaviour is due to a lack of social understanding. He was really stressed during a test; I was able to give advice to help him and the staff through it.

“I can think of situations where colleagues are sceptical about ASD, I feel better able to demonstrate why problems are not behaviourally based”

 “There is a young girl who is cognitively more able than some of the other children but she has great difficulty with her emotions. I introduced social stories, we have been using the approach for 2 years. She is now expressing herself more easily; she can cope with more unknown environments. The staff arranged for a group to entertain some senior citizens, this child performed songs for them and was able to speak with them with just a verbal prompt. I used information and knowledge form the course and translated it into practice. I saw the worth of social stories in real life. We have had a number of success stories using this approach.”

“We have a client who has been with us a long time because she has so many challenges. The way I work with her and talk to her has been influenced by what I have learned about sensory issues. I have incorporated aspects into her care plan.”

This selection of examples illustrates how knowledge is being used to influence practice and to bring about change and development in the individuals with whom interviewees work.

A central aim of the postgraduate programme is that students continue to develop and use their learning well beyond their period of study. The development of professional identity and competence are as important as growing knowledge and affecting practice. The following case study illustrates the perceptions of one individuals as to how this is happening for her.

Susan is a teacher in a special school who commenced study in 2000.

I had gained a generic qualification in special needs but was aware that the knowledge base relating to autism was fast developing I also felt I needed to build my own understanding to better support pupils with ASD within the school.

The need to keep abreast of latest developments, strategies for good practice, and widening of my knowledge base, were sufficient incentives for me to consider undergoing new training. Whilst it remains imperative to up-date thinking as a professional, the CPD element was of less importance perhaps, than the need to have an opportunity to be part of a University Course, where new thinking would be highlighted. The aims at the time were to try to obtain my P.G. Certificate in Autism, through the University of Strathclyde. It was later, that I realised that it may not be beyond my reach to take my studies further.

Working alongside other professionals, e.g. Doctors, Psychologists and Social Service Personnel offered a fresh approach to breaking down Multi-professional barriers, and added to the development of how other professionals committed to the area of ASD. The nature of the Course, in that it made one reflect on one’s own practice, helped build on how one analyzed the job itself, the wider context of ASD and how liaising with others added to best practice.

The Independent Study Module was exciting in that it offered scope for investigation, testing ideas, and recording findings in a broader field. The impact of the feedback from this study definitely allowed me to consider how a research module would be useful as a background to further study.

As a result of broadening horizons and experiences through the Course, I feel more comfortable in tracking down relevant material to support colleagues, families, and for my own development. Working on my MSc research is vastly different from my earlier studies, indeed I feel more self-critical.   Hopefully I’m able to identify, analyze and foster new learning, and be more specific in how I learn and teach.

The learning process for me is still ongoing. The courses I have completed have certainly been invaluable for how I reflect on my own practice, and contributed to my overall personal professional ethos. I continue to keep my ideas, hopefully in focus. I try to be organized in my learning and teaching. Maybe I have influenced other staff as well as parents, and perhaps gone some way to raise awareness by other agencies. Meeting with others is a vital element of the Course. Undertaking MSc studies is a little more solitary, however, I feel more able to cope with this due to the foundations built on during my earlier studies.   Contacts have been made, techniques for self-study honed, and links with University well established.

As previously stated the active involvement of parents as students and teachers is highly valued. Two of the six parents who responded to the study were interviewed in order to gain some insight into their perspective of how their learning impacted on their situation.

Whilst both were motivate to undertake study to better support their family members it is interesting to note that for one individual participation principally resulted because an opportunity to participate in an outreach cohort presented itself. She describes being actively encouraged to participate by a member of staff from a voluntary agency. The local authority in which she lives were prepared to fund parent places and she took up the offer. This raises a significant point that authorities also have to value parent participation and truly consider them part of the team to enable access to learning opportunities.

Each expressed diverse experiences of participating in the course. One describes an initial feeling of vulnerability due to her personal connection with ASD whilst the other describes that she felt she had “spent too much time on parent stuff” feeling she had concentrated her reading on parental accounts and autobiographical literature, the course offered an opportunity to look more widely for information.

Just as it is intended that professionals will become more insightful regarding parental issues when learning alongside them it is equally important that parents become more aware of the challenges and constraints faced by professionals. Interviewees were asked if they felt they had gained a greater understanding. Both felt they had benefited:

“I have increased my understanding of professional perspectives. The idea of a multi-professional, multi-agency team; you don’t really feel part of that as a parent. Now I feel I could be, I am more confident. I didn’t think I lacked confidence but now that it has increased I see that I did”

As with the professional group it was important to establish if parents felt that learning had had an impact on practice. Both respondents felt that it was difficult to pinpoint specific examples but expressed an overall change in terms of being able to apply knowledge and have more empathy and understanding towards their child. One stated:

“I am not taking it personally anymore…I can see where he is coming from. I understand the psychology of it more”

The parents were asked to identify what they felt they had been able to contribute to the learning of their professional colleagues. This was very powerfully described by the following:

“…I feel what I have to say is said with emotion, I am not just saying something that happens, there is a lot of feeling…there is a family, it is quite involved, there is pain, there is hurt…”

Interviewees were also asked to identify what they felt were the main advantages to parent participation. Both could see benefits to them in terms of how they now perceive their child and how they can support them both identified factors that had influenced their increased acceptance.

“…I see other parents fighting professionals all the time and I want to say, don’t do that. I know this is part of the guilt, I can see that process. Because I have been in the team with all the professionals I feel I can see the bigger picture. I can see it from both sides not just as a parent.”

Whilst those interviewed are too small in number to be representative there are commonalities between these two illustrative interviews. Both made very strong comments regarding their development and their evolving perception of the range of professionals.

Reflections

It is interesting to note that participants have an average period of involvement of 6 years prior to sustained study in ASD. Whilst it could be argued that this enables them to feel secure in their specific professional role this is a considerable period to be responsible for the care, health or education of an individual with insufficient knowledge and understanding of the wide range of differences and abilities common in individuals with ASD (Fombonne 1999)

The distribution of professions represented in the study reflects that a majority of students in both campus and outreach cohorts are from education and are mainly teaching staff. It is felt that the compulsory nature of education is a factor in this however as previously highlighted individuals with ASD are everyone’s concern. CPD developments are heralded for allied health professionals as a result of a recently commissioned scoping exercise. (Dunlop & Mackay 2005) Other professional groups need to be encouraged to consider formal and sustained CPD in this area as a priority.

The positive impact of learning on practice has been highlighted by all measures taken. It can bee seen from table 4 that the 3 most significant factors influencing this are increase in knowledge, developments in practice and the multi-professional nature of the course. This is echoed in table 5 where increasing confidence is also cited as significant. This is an interesting outcome given the average of 6 years experience professionals have in their own field. This is perhaps indicative of the de-skilling nature of ASD. (Dunlop & Mackay 2005) and why there has been an urgent call for training of all professionals involved with persons with an ASD (National Initiative for Autism: Screening and Assessment 2003) the following highlights the potential impact of increased practitioner confidence.

“There is a recently diagnosed child, the staff are very anxious, they find him challenging. I can be more assertive with them; I have got the confidence to be more directive…to ask people to stick with the things we are doing. I feel the staff are more reassured by my approach”

Participants also highlight that their colleagues are aware of growth in confidence and knowledge and this has positive implications for capacity building within services. It is important that if students engage in training or advising colleagues as a result of participation in postgraduate study in autism that there is a perception of confidence among those who will be recipients. It is encouraging to see the direct impact on practice with respondents feeling that developments in the individuals they work with can be assigned to their learning on the course. Table 6 shows that participants gave the majority of examples in relation to practice development. The following comment from a care worker is illustrative of this and is especially significant as they make a clear connection between what has been learned and how they perceive the person in their care.

“Reduction in client’s negative behaviour as a result of me having greater insight into the triggers that upset my individual clients and how to overcome these”

It is also interesting to note how influential these practitioners are becoming in terms of disseminating knowledge and sharing good practice principles with colleagues. There is also a strong echo of the sense of empowerment and confidence they feel they have developed as a result of their learning.

It is felt important that course participants engage in a process of reflective learning and as such are encouraged to review and evaluate their professional attitude and practice throughout their period of study. Central to this is developing a sense of empathy for individuals with ASD and their families. 2 participants felt they already had a strong sense of empathy with all others reporting developments. This was largely related to increased empathy for parents. It is reasonable to conclude that this is in part due to parents participating as students as well as those who are invited to speak with the students at various points throughout their course of study.

One person sums this up by saying:

“…we who are teachers have learned from parents who have been on the course. This is due to the shared experience of doing the course together”

Both questionnaire and interview responses indicate that parental participation is valued by students and statements such as that above demonstrate what an important part of the overall ethos of the postgraduate programme the shared learning experience is.

Many respondents also valued the opportunity to read and reflect on practice and saw this as a positive opportunity to build knowledge. Interestingly one respondent felt that her already extensive knowledge, experience and approaches to practice were confirmed by the course but was also anticipating that her knowledge could develop further. This rationale was given as a context to her current overall rating of the course being low i.e. she was already quite experienced as a practitioner.

Conclusions

T his study has been of value in terms of reviewing the development of the postgraduate course in autism. It has however highlighted a number of factors that are of relevance when considering the wider issues of CPD and education. Confidence is a critical factor in relation to practice. This is relevant in terms of confidence in knowledge and in dealing with colleagues in a multi-professional context. There is a strong link between knowledge and confidence in that deeper understanding on a practical and theoretical knowledge enables professionals to make adjustments to practice and to challenge their own thinking and that of others.

For organizations and local authorities investment in a programme of education of this kind enables capacity building and more sustained development at both individual and organizational level. This has been exemplified by respondents who cite they now deliver training to other staff or those who have become involved at a strategic level within their service or authority. It can therefore be seen that broader development occurs when individuals engage with learning at the appropriate level. It is also essential that those involved in strategic planning in organizations and local authorities consider the benefits of parents and professionals learning alongside each other and create opportunities for this in a planned and strategic way.

The value of multi-professional training and education will doubtless continue to be debated however this was noted to be highly valued by respondents in this study particularly as parents were included. There can be little doubt that people with autism have complex needs that frequently require a multi-agency, multi-disciplinary response over a prolonged and sustained period of time. It is there fore important that as far as possible such professionals are equipped with a common body of knowledge and understanding so that individuals and families gain maximum benefit from their collective expertise. Further more it is critical that parents and individuals are an integral part of that team.

“The same as you?” (2000) resulted from a review of learning disability services in Scotland. This highlighted the lack of ASD knowledge among professionals who come into contact with people with ASD it is essential that developing such knowledge remains the focus of effort for involved professionals, agencies and local authorities.

It is clear form this investigation that for the 68 who responded the multi-professional programme in autism has had a strong impact on their workplace practice. Given that over 500 people have studied in some capacity on this programme since 1998 it is reasonable to conclude that it is having a direct and positive impact on the lives of people with ASD in Scotland.

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