SAFE: Systemic Autism-related Family Enabling
 

SAFE is an intervention for families of a child/children with a diagnosis of autism developed by Professor Rudi Dallos and Dr Rebecca Stancer in collaboration with families of children with a diagnosis of autism. 

Systemic Autism-related Family Enabling (SAFE) is a manualised systemic intervention for families of children with a diagnosis of autism spectrum disorder. SAFE draws on evidence based principles of Family Therapy and what is known about the strengths and preferences of people with autism. SAFE is delivered by trained therapists and is a flexible toolkit of activities that can be used with families depending on their needs. The purpose of SAFE is to support families to build on their strengths and enhance their problem solving and coping strategies to deal with everyday challenges. 

The University of Plymouth and the Plymouth Autism Network supported the development of SAFE. See our news item.

We carried out a randomised controlled trial, funded by the National Institute for Health Research (NIHR), to assess the feasibility of SAFE. The results of the trial were very positive. Read a copy of the trial protocol paper.

Autistica funded a research project which focused on the experience of families receiving SAFE. You can read more about our research on the Autistica website.

The outcomes of the project showed that families receiving the intervention found it helpful in the following key areas:

Therapist as helping reflection

The therapists were seen as helping families to focus and encouraging reflective processes in the family which included a sense of helping them to slow down, pause and think and support the development of new solutions to their problems.

Increased understanding

This featured changes in understanding of each other, the autism and of family dynamics. This also included a sense that they understood each other better – increased empathy.

Feeling closer to each other and as a family

This contained a sense of the family members feeling less conflictual and blaming of each other. The focus on positive events and cycles assisted with this related to families generally feeling more hopeful, able to cope and to assist each other.

Feeling more confident to cope with problems

There was an overall sense that the sessions helped them to feel more able to cope with problems and important in this was a belief that they could better understand and manage the meltdowns in the future.

More able to reflect and problem solve

This included the families feeling more able to stand back, reflect and think about their dynamics and develop new ways to manage problems. This connected with the sense of being more able to solve problems but specifically contained the view that this was because they could reflect more clearly and constructively.

Improved communication

This contained the ideas that the session helped people to be able to communicate their thoughts and feelings and that the various activities helped with this. Especially for the children being able to express things visually helped them to communicate what would be difficult for them in words.

Feeling less alone and isolated

Particularly from the Multi Family Therapy sessions families expressed an important benefit and change in feeling less alone and isolated and a sense of sharing their difficulties with other families. This contained a powerful theme of feeling validated and not to blame for problems, especially with regard to meltdowns which they could experience as humiliating in public.

What do families say about SAFE?

“The best part of the sessions was hearing positive things. You rarely hear positive things about your parenting and how you are doing well as a family.” (Father)

“Talking about our family challenges and listening to your suggestions. Feeling understood, listened to…feeling supported.” (Mother)

“The part when we made playdoh figures and what we were like. I told my mum lots more about me.” (Autistic child)

“Learning about supporting the family as a whole. Wanting the family to find solutions together. Sitting with husband going through things. Understanding every family is different with ranges of approaches to situations.” (Mother)

“Looking at what went well and what didn’t. Because we got to see what can lead to/prevent a meltdown.” (Sister)

SAFE with Schools

Families receiving SAFE, commonly report interactions with schools as being problematic and their children often subject to informal exclusions. Discussions with teachers also identified concerns about how to manage difficult behaviour among children with autism and how to collaborate effectively with families. These findings led to the development of SAFE with Schools (SwiS).

Tara Vassallo is the lead investigator for SAFE with Schools, and is conducting a research project on SwiS as part of her Doctoral Studies, with teachers and families from nine schools across Plymouth and Devon. SwiS uses a systemic, attachment based approach, adopting the same principles and adapted activities from SAFE, to provide an intervention, which facilitates people around the child with autism, working together, problem solving, sharing strengths and resources, to support each other and the child by:

  • Creating a parent/teacher secure base by talking to each other and coming to a mutual appreciation of the problems faced. Identifying the difficulties, successes and beliefs associated with the child with autism and developing plans for working together.
  • Understanding the challenges by exploring the nature of key difficulties around meltdowns, anxiety and relationships.

  • Furthering understanding by discussing neurological information, attachment theories and models of intervention.
  • Developing solutions by using specific techniques such as tracking, sculpting and thinking about the interests of the child to develop ideas for change.
  • Increasing collaborative problem solving, trying out and adapting solutions by using techniques in context and discussing and sharing successes and challenges, and how things may change in the future.

We recently undertook a whole school pilot study for SAFE with Schools at Beechwood Primary Academy in Plymouth. If you would like to know more about the SAFE with Schools study, contact us through tara.vassallo@plymouth.ac.uk

Publications

Vassallo, T., Dallos, R. and Stancer, R., 2020. Parent and Teacher Understandings of the Needs of Autistic Children and the Processes of Communication between the Home and School Contexts. Autism-Open Access 10(4), No:262 doi.org/10.35248/2165-7890.20.10.262

McKenzie, R., Dallos, R., Stedmon, J., Hancocks, H., Vickery, P. J., Barton, A., Vassallo, T., Myhill, C., Chynoweth, J. and Ewings, P. (2020). SAFE, a new therapeutic intervention for families of children with autism: a feasibility trial. BMJ Open, 10(12), 1-11.

Vassallo, T., Dallos, R., McKenzie, R. (2020). Parent and teacher understandings of the needs of autistic children and the processes of communication between the home and school contexts. Autism-Open Access, 10(4), 1-10.

McKenzie, R., Dallos, R., Vassallo, T., Myhill, C., Gude, A., and Bond, N. (In Press). Family Experience of SAFE: a new intervention for families of children with a diagnosis of Autism Spectrum Disorder. Contemporary Family Therapy.

Gray, B., Dallos, R., Stancer, R. (In Press). Feeling “like you're on … a prison ship” – Understanding the Caregiving and Attachment Narratives of Parents of Autistic Children. Human Systems.

Dallos, R., McKenzie, R., & Bond, N. (2020). Doing things differently: Exploring attachment patterns and parental intentions in families where a child has a diagnosis of autism. Clinical Child Psychology and Psychiatry, 1359104520907141

Montague, I., Dallos, R., & McKenzie, R. (2018). “It feels like something difficult is coming back to haunt me”: The Association between a Child’s Autism Spectrum Disorder Meltdown and a Parent’s Adverse Childhood. Child Psychology and Psychiatry, 23(1), 125-139.

McKenzie, R., & Dallos, R. (2017). Autism and attachment difficulties: overlap of symptoms, implications and innovative solutions. Clinical Child Psychology and Psychiatry, 22(4), 632-648.

McKenzie, R., & Dallos, R. (2016).“I just like Lego!” Self-Autism Mapping as a non-totalizing approach. Context, 144, 21-23.

Researchers