In the drive towards supported living for autistic adults, the layout of the accommodation can be overlooked, but good design can be crucial in enhancing a person's quality of life.
Article updated 04/10/21
For autistic adults, the environment in which they live can have a profound impact on their wellbeing. If it does not suit their needs, it can exacerbate behaviours that may inhibit their progress and diminish motivation and confidence.
But housing that is designed around them and their condition has been shown to have a positive effect, helping them to feel more settled, enhancing their confidence and motivation to take part in their community.
It was with this in mind that the 'Living in the Community' project was launched to explore how design might improve residential accommodation for adults with autism. The project was a collaboration between autism charity The Kingwood Trust and the Royal College of Art Helen Hamlyn Centre for Design, an inclusive design and research centre.
The research involved visits to supported living residences, workshops with autistic people, interviews with support workers and clinical professionals. To provide guidance and support for the project, an expert reference group of scientists, parents, architects and designers was established.
Kingwood supports adults with a range of abilities to live in domestic-sized properties, close to local shops and services, as individuals or in small groups. The research team were invited into some people's homes to observe how the location, layout and interior design of the buildings affected their quality of life.
Researchers started by shadowing service staff and observing how people are supported in their homes. Staff members talked openly about their experiences and the people they support and from their stories and firsthand observations, insights were drawn that would be used later to develop a set of design themes
Many of the people whose homes were visited are wary of strangers so the researchers tried to build rapport with individuals by joining them in daily activities such as cooking, cleaning, gardening, going grocery shopping and to the bank, as well as social events in people's homes and in their local communities.
To get feedback on specific accommodation issues, two workshops were run with autistic adults. In these sessions, participants were invited to comment on and design their ideal home environments. Participants expressed needs for access to outdoor spaces and a connection to other people, but in spaces that enable the individual to control the level of social interaction.
Many participants also described their sensory perceptual differences and how they were affected in their daily lives by these unusual responses to stimulation such as colour, patterns, noise and odours.
One theme that came through strongly was that participants wanted freedom to personalise their spaces and in particular their bedrooms. As one participant remarked; "If you've got autism, in my experience, you're likely to spend a lot of time in your bedroom because that's where you feel safest, so what's in your bedroom and what you can see through the window is your world."
Key findings from the autism housing research
There was overwhelming evidence to show that the design of residential accommodation can profoundly impact the health and wellbeing of adults with autism. In buildings that had been specifically designed or adapted for their residents, people displayed higher levels of confidence and independence and fewer accounts of challenging or complex behaviour.
In the right settings, individuals' motivation and willingness to engage in daily tasks and social activities had been increased. And in all cases, good buildings had been achieved by involving service providers, support workers, parents and individuals with autism in all stages of the design and build process.
A shift from institutional care to community-focused, social models of support, with emphasis on the needs and wishes of individuals, was seen throughout the research visits. But in aiming to provide normal home-like environments, the requirements of staff had been often overlooked and this affected their ability to provide appropriate levels of care and support. It was noted that residential buildings are foremost people's homes, but they are also places of work.
Homes in which people cohabitated alongside others with similar needs, routines and complementary sensory differences were more successful in enhancing the residents' quality of life.
Invariably the design of residential buildings make a difference to the quality of life of adults with autism, but it cannot be considered in isolation. A holistic approach needs be taken that includes the design of people-centred support plans, models for financing accommodation, inclusion in the community, as well as meaningful employment and help in developing friendships, relationships and interests that bring meaning and purpose to everyday life.
Design themes and recommendations
From an analysis of what had been observed and recorded during the research, key project findings and a set of four design themes were defined.
The design themes are expressed in terms of qualities and performance criteria that are critical to improving housing for adults with autism. The themes are intended to be comprehensive and exclusive from one another, and a represented in a way that aims to inspire creative responses rather than providing prescriptive rules. Like all good people-centred design, some of these qualities are specific to autism, but most would benefit the wider population.
In summary, the design themes are:
- If home environments are designed to help residents grow and develop interests and life skills, their confidence and self-esteem can be enhanced
- By providing consistent, low arousal environments in which stimulation can be adjusted by residents, triggers of agitation and anxiety might be reduced
- Robust environments help to protect residents and staff and lessen the physical and emotional impact of unintended use
- Providing appropriate tools for staff can help them to deliver quality, people-centred care and support.
These themes were used as a springboard for developing recommendations and concepts for designing or refurbishing residential accommodation. Recommendations included seemingly obvious but, as the research showed, potentially overlooked measures such as to beware of locating buildings next to busy roadways or airports - especially for individuals with over-sensitive hearing.
More insightful recommendations included how the layout of a building might aid understanding and help residents to engage in social activities on their own terms.
'Living in the Community' also contains number of design concepts for supportive living environments. Interventions for main living spaces such as a kitchen, bedroom and communal room are suggested alongside facilities such as bathrooms and toilets. One of the more intriguing behaviours observed during visits to people's homes was how individuals would often reside or withdraw to corridors or non-functional spaces and how staff also used these spaces for de-escalating and managing certain behaviours.
It appeared these spaces are as important as functional rooms so the design concepts are presented as part of a single conceptual building to demonstrate how travel routes and connecting spaces might be designed to accommodate these behaviours.
A large number of unmet design challenges emerged from the first year of the project, particularly how communication, sensory differences and control of environments in domestic settings might be fulfilled. More research needs to be done to understand ways in which people with autism perceive spatial relationships and connect contextual information with detailed information.
Researchers are looking at how to identify, map and design for individual sensory preferences of adults with autism. The aim is to generate methods that will help people to manage their relationships with their home environments more effectively and enhance social interaction and communication.
Lucy was 29 years old at the time of the project. Seven years previously, she moved into a three-bedroom house acquired through a housing association's shared ownership scheme. The house was selected because it had three bedrooms; one to accommodate guests, one for staff, and a bedroom for Lucy. It also had a straight staircase for her physical disability.
The location was perfect for Lucy, providing proximity to shops, a pub she likes, a railway centre and plenty of space.
Lucy is a talented filmmaker. Using a computer for video editing, she made a film about her moving house, which was shown at her service provider's AGM and at a Valuing People conference in London.
"I've got lots of colours in my house, and my stuff and all my lights, a notice board and a picture of Thomas the Tank Engine," she says. "This place makes me happiest." Lucy likes to go out and is interested in railways. She has model trains and railway illustrations in her room. She is very sensitive to sound and has perfect pitch. She may decide to wait outside a shop if it is noisy. Car engines left running and fans are a source of stress but she can manage her own vacuum cleaner and uses this daily to clean the house.
Lee was 32 at time of the project and lived with a foster family for most of his life. His foster parents became adult placement carers when Lee turned 18 enabling him to remain in the family. But as they entered their 70s, Lee's foster parents became concerned for his future welfare and sought alternative accommodation and support services. In 2008, Lee took on his own tenancy and moved into an individual flat in a new supported living residence.
The transition to Lee's new home was managed carefully. Discussions about what Lee was going to take with him and and furnishings he would like were started several months before the move. Closer to the move, Lee visited the new development with members of the support team. Together they agreed a care plan and enjoyed planning for the future. Lee makes sure that his support workers take him out for food, especially lasagne.
He enjoys going to the local pubs and watching football with his foster dad. Lee experienced periods of anxiety, leading to challenging behaviour at times. But in his new home, Lee is relaxed and settled and has shown a growing independence. He regularly attends a local horticultural group, taking pride in ensuring the plants are watered, and has recently opened a bank account.
About the author
Andrew Brand is a design engineer
This article was first appeared in Learning Disability Today in July 2011 issue. It was updated in October 2021