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. 2025 May 28;7(3):293-302.
doi: 10.1089/aut.2023.0124. eCollection 2025 Jun.

Adapting Safety Plans for Autistic Adults with Involvement from the Autism Community

Jane Goodwin  1 , Isabel Gordon  2 , Sally O'Keeffe  1 , Scarlett Carling  3 , Anya Berresford  3 , Nawaraj Bhattarai  1 , Phil Heslop  4 , Emma Nielsen  2 , Rory C O'Connor  5 , Emmanuel Ogundimu  6 , Mirabel Pelton  1   7   8 , Sheena E Ramsay  1 , Jacqui Rodgers  1 , Ellen Townsend  2 , Luke Vale  1 , Colin Wilson  1 , Sarah Cassidy  2
Affiliations

Adapting Safety Plans for Autistic Adults with Involvement from the Autism Community

Jane Goodwin et al. Autism Adulthood. .

Abstract

Background: Autistic adults are at greater risk of self-harm and suicide than the general population. One promising intervention in the general population is safety planning. We aimed to seek advice from autistic adults and others in the autism community on how to adapt safety plans for autistic adults.

Methods: We conducted focus groups with autistic adults (n = 15), family members (n = 5), and service providers (n = 10), about their views of the Autism Adapted Safety Plan (AASP). We also conducted interviews about the acceptability of the AASP with autistic adults who had developed an AASP (n = 8) and with service providers who had supported them (n = 8). We analyzed the focus group and interview transcripts using thematic analysis.

Results: Theme 1 highlights conditions needed to make the process of creating the AASP acceptable for autistic adults. This included creating the AASP with someone they could trust and at the right place and time, when they were not in distress or in crisis. Theme 2 describes how safety planning needed to be a creative, flexible, and iterative process. Autistic adults may need help in expressing their emotions and identifying coping strategies, which can be supported through visual resources and suggestions from the service provider. To ensure that the AASP is accessible in times of crisis, it needs to meet the autistic adults' preferences in terms of formatting and how it is stored (i.e., hard copy or electronic).

Conclusions: The AASP is a potentially valuable intervention for autistic adults, provided that the process of creating it is flexible and sensitive to individual needs. Further testing of the AASP to assess its clinical effectiveness in reducing suicidal behavior could provide a life-saving intervention for autistic adults.

Clinical trial registration number: ISRCTN70594445, Protocol v4: 8/2/22.

Keywords: autism; qualitative research; safety plan; self-harm; suicide; thematic analysis.

Plain language summary

Community brief Why is this an important issue? Autistic adults are at risk of self-harm and suicide, yet there are no approaches specifically for autistic adults to reduce their risk of self-harm and suicide. What was the purpose of this study? We wanted to explore how developing a document called a safety plan might be useful for autistic people if it was designed with advice from autistic adults and others in the autism community. A person creates their own safety plan document. This safety plan includes a person's own list of steps that can be used when they are in distress or crisis. The steps are: (1) Warning Signs that a crisis may be about to occur; (2) Coping Strategies that might help; (3) Social Contacts and Locations that might help; (4) Family Members or Friends that might help; (5) Professional support that might help; and (6) How to Keep the Environment Safe. What did the researchers do? We conducted interviews and group discussions with autistic adults, family members, and service providers about what they thought of an Autism Adapted Safety Plan and how it could be improved to make it more helpful for autistic people. What were the results of the study? We learnt that it was important that autistic adults had a supporter they felt able to trust to help them to develop their safety plan. The safety plan needed to be done at the right time, when they were not in distress or in crisis. The safety plan also needed to be flexible based on the autistic adult's needs and preferences. Autistic adults told us they sometimes needed help identifying things that they could do that they could include in their plan to help them to feel less distressed. They told us that using pictures and symbols might help them express their needs and that people supporting them could make suggestions to help them identify things that might help. It was important for the safety plan to fit the person's preferences for layout, color, text and images, and options for either paper or electronic format to make the safety plan accessible in times of crisis. What do these findings add to what was already known? Before this study, we knew that autistic people are more likely to experience self-harm, suicidal thoughts, and behaviors than non-autistic people. However, no studies had yet explored whether approaches developed to reduce self-harm and suicide in non-autistic people could also be useful for autistic people. Ours is the first study to ever explore whether safety plans could be useful for autistic adults, and how they could be adapted to meet the unique needs of autistic adults. Our findings suggest that Autism Adapted Safety Plans may help autistic adults who are experiencing self-harm and suicidal thoughts. What are potential weaknesses in the study? We do not know whether the views of participants in this study are the same as the views of other autistic people. This means further work will be needed with more autistic people to see whether these views are shared. How will these findings help autistic adults now or in the future? These findings will allow the Autism Adapted Safety Plan to be further refined based on the feedback provided by participants in this study. Then, the plan could be used in future studies to find out if it helps autistic adults who are experiencing distress.

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