Role of LD Psychologist - Dr Alex Clark
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Transcript Role of LD Psychologist - Dr Alex Clark
The Role of the Learning Disability
Clinical Psychologist
Dr Alex Clark, Clinical Psychologist
West Cornwall Community Learning Disability Team &
Intensive Support Team
[email protected]
Aspects of the Role
Assessment
Formulation
Intervention
- Service Users
- Staff
- The MDT
Consultation & Training
Service Development
Assessment
What is a Learning Disability? & Eligibility assessments (NOT
just an IQ score!)
Functional Behavioural Analysis – observations, ABCs,
interviewing - supervision and training
Specialist Assessment e.g. capacity/risk assessment
(violence/sexual offending)/parenting.
Psychological assessment – e.g. neuropsychological,
systemic, attachment/relational history.
Historical Context to Learning
Disability
Many terms been used over the last 200
years (idiocy, feeblemindedness, mental
deficiency, mental disability, mental
handicap, mental subnormality, mental
retardation)
Now:
UK: Learning Disability
US: Intellectual Disability
World Health Organisation and American
Psychiatric Association definition of Learning
Disability
There are three core criteria:
Significant impairment of intellectual
functioning
Significant impairment of adaptive/social
functioning
Age of onset is before adulthood
Process of Learning Disability
Assessment
Referral
Clinical Interview
Consent
Ethical considerations including current context
Background information
Biological,
psychological and social contexts
Psychometric Assessment (order decided by the person)
Adaptive Behaviour Assessment System 2nd Edition
Weschler Adult Intelligence Scale- 4th edition (new)
Report or letter written ideally with the client as the
primary audience but considerations around other
audience members.
Defining ‘Significant Impairment’
Both Intelligence and Adaptive/Social functioning have standardised measures,
with a mean of 100 and 1 standard deviation of 15
Significant impairment = 2 standard deviations from the mean which equates to 70
or less, the lowest 2.2% of the general population
Working backwards this would mean that between 2% of the population have a
learning disability, actually worked out as 2-3% of population
100
70
85
115
130
Y axis
(% of
population)
2%
14%
34%
34%
14%
2%
X axis
(Scores)
WAIS - IVUK
13 subtests assessing different aspects
of the construct of ‘Intelligence’
Scores then compared with a general
population providing:
Full Scale IQ
Verbal Comprehension Index
Perceptual Organisation Index
Working Memory Index
Processing Speed Index
Significant impairment of
adaptive/social functioning
Definition of adaptive/social functioning relates to a
person’s performance in coping on a day to day basis
with the demands of their environment
American Association on Mental Retardation (1992)
further defined as impairments in at least two of the
following:
Communication
Community Use
Self care
Functional Academics
Home living
Work (if in a job)
Social Skills
Leisure
Health and Safety
Self direction
Adaptive Behaviour
Assessment System (ABAS II)
Scores then compared with a general population
providing:
General Adaptive Composite (GAC)
Conceptual Composite (Communication, Functional
Academics, Self Direction)
Social Composite (Leisure, Social)
Practical Composite (Community Use, Home Living,
Health and Safety, Self Care, Work)
Significant Impairment is:
a GAC of <70,
one of the other Composite scores <70,
or significant difficulty in 3 or more of the specific skill
areas
Age of Onset
It is important that any significant impairments of intellectual
and adaptive/social functioning occur before adulthood
Thus forming part of a developmental process (i.e.
developmental disability)
General consensus is that this is before the person turns 18
years old
Therefore important that a developmental history be taken to
provide context, including:
Birth and pre birth information
Developmental milestones and concerns about not achieving
milestones
Childhood diagnoses / illnesses
School experiences / Statement of Educational Need
Changes in ability during adulthood due to other events (e.g.
head injury, dementia, mental health problems, reactions to
medication etc)
Formulation
The 4 P’s –Predisposing, Precipitating,
Perpetuating, Protective factors
Models of formulation – psychodynamic
(Malan), systemic, CBT
Consulting to the system re: formulation
Intervention for Service UsersAims of psychotherapy
The therapeutic relationship –
establishing, maintaining and repairing
Meaning making – offering an explanatory
framework/narrative to help the client make
sense of their difficulties
Change promotion – acquiring new skills
and trying them out in therapy and real life (e.g.
how to repair relationship, experiencing oneself
as different)
Intervention – Service Users
Cognitive Behavioural - thoughts, feelings,
behaviour, beliefs and schemas (Stenfert Kroese,
Dagnan, Willner)
Psychoanalytic – unconscious, transference, tactical
defences, object relations (Beail, Sinason, Frankish)
Attachment – security and safety, exploration, internal
working models, loss & separation (Holmes)
Systemic/Family Therapy – circularity, curiosity,
homeostasis, family life cycle (Baum)
Social Constructionist – inequality, social structures,
community psychology
Adaptations of Psychotherapy for
people with Learning Disabilities
Pre-assessment re: cognitive level of
understanding, TBF assessment (Reed &
Clements), emotional awareness, labelling of
emotions
Language use - person centred approach
Use of visual supports (photos, pictures,
signing, availability of materials)
Level of directiveness (e.g. ASD)
Negotiation re: others’ presence
Communication with systems (family, staff
teams)
Interventions-Staff Team
Formulation-co-construction and discussion
Training and consultation re: behavioural
assessment/care planning/interventions (e.g.
ASD & communication)
Systemic working to encourage team’s
reflection around relationships with service
user(s) and conflicts, considering emotional
needs of staff
Interventions-The MDT
Reflective Practice sessions – “stuck”
situations, team difficulties, emotional support
MDT meetings - encouraging reflection on
service users’ relational and psychological
context in considering mood and behaviour
Consultation role
Any questions?