The National Autism Centre in Sospiro: innovation, care and a new beginning

The Centre's purpose is not to provide a housing solution in the strict sense, but a service designed to enable people with autism and intellectual disabilities to receive essential support.

For more than a century, the Sospiro Foundation has been a point of reference in Italy's social and healthcare landscape. Founded at the end of the nineteenth century, in 1897, the organisation based in the Cremona area has gradually developed into a complex system of services for people with neurodevelopmental disorders, providing day, residential and outpatient services throughout Lombardy.

One of its most significant areas is the Disability Department, established in 2006 and developed over the years into a laboratory for research, innovation and clinical experimentation, as well as a centre for training and scientific dissemination in the field of disability. Its objective is to transform services and improve the quality of life of persons with disabilities through support designed around each person's Life Project and based on scientific evidence.

The project that best represents this vision is the new National Autism Centre, or CNA, inaugurated in May and regarded as a unique initiative in Italy. The Centre is headed by Dr Roberto Cavagnola, who emphasises its innovative nature. 'It is an original proposal because it organises support for the treatment of behavioural difficulties and protected discharge pathways that are still uncommon nationally. But it is not a service that operates in isolation. To succeed, it wants and needs to cooperate with a wider network of services, such as the national network for behavioural emergencies coordinated by the Italian National Institute of Health.'

The CNA accommodates, in two five-bed units, people with autism and intellectual disabilities who also present severe behavioural or psychopathological difficulties, such as self-injury, aggression, anxiety disorders or depression. These are particularly complex situations that often place families and local services under great strain.

The first challenge is diagnostic. 'We need to understand how the behaviour we observe arises from the interaction between the person's learning history and their neurobiological vulnerabilities, including health conditions such as unrecognised pain, without forcing a rigid separation between behavioural disorders and psychopathological manifestations, but without completely overlapping them either. Psychopathological manifestations express more of a trait dimension, in which complex neurobiological systems interact with learning history, while challenging behaviours are more an expression of state, although they too are shaped by a learning history,' Cavagnola explains. It is a delicate task requiring highly specialised expertise, especially when working with people who have limited communication skills.

The pathway then includes a temporary six-month residential treatment programme. During this period, an integrated programme is activated combining psychoeducational interventions based on the guidelines of the Italian National Institute of Health with healthcare and pharmacological treatments when necessary. 'We work simultaneously on the behavioural and health components, monitoring the person's progress every day,' Cavagnola explains.

The results achieved over the years of experimentation are significant. In most of the conditions treated, behavioural difficulties have been reduced by more than 70%, and, above all, people have been given greater opportunities for participation and wellbeing. But the most innovative aspect of the project concerns what happens afterwards. 'Our aim is to enable the person with a disability to return to living in their own community and within their own Life Project,' Cavagnola stresses. For this reason, the CNA has developed a 'protected discharge' model, regarded as one of the most original elements of the entire experience.

In the weeks before returning home, family members and caregivers stay in dedicated apartments within the facility and work alongside staff. They learn procedures, take part in interventions and acquire the skills needed to continue the pathway once the person returns home or moves to another living setting. Support also continues after discharge, with weekly counselling for the caregiver during the following six months.

'We want the wellbeing achieved to be maintained over time and for skills to spread throughout local communities,' Cavagnola says.

The pilot programme, launched in 2018 at the initiative of the Italian National Institute of Health, now has a new facility equipped with advanced technologies and home-automation solutions designed not only to improve the quality of interventions but, above all, to create an environment in which safety for both persons with disabilities and staff is central. Yet the greatest challenge remains cultural.

'The real challenge is discharge,' Cavagnola reiterates. 'It means supporting services and communities in changing, working together and welcoming the person in a new way. Only then can the Life Project become a concrete reality for people with complex needs as well.'