Screening for people with learning disabilities and people with literacy and numeracy difficulties in IAPT in Cumbria: The argument and initial data. Professor Dave Dagnan Consultant Clinical Psychologist

How does diagnosis/identification work in adult services?

1. Some people do not need assessment.

• Transitions/severe disabilities 2. Assessment needed: a. General Screen (McKenzie & Paxton, 2005)/local screen/Age of onset of difficulties.

• If diagnosis still possible then 1.

b. Adaptive Behaviour assessment.

1.

If diagnosis still possible then 2.

c. Intellectual functioning (IQ) assessment.

The Monitor Compliance Framework – Governance Indicator for NHS Foundation Trusts: Access to Healthcare for People with Learning Disabilities 1. There is a mechanism in place to identify and flag patients with learning disabilities, and protocols that ensure that pathways of care are reasonably adjusted to meet their needs.

2. There is readily available and comprehensible information for patients with learning disabilities about treatment options, complaints procedures and appointments.

3. Protocols are in place to provide suitable support to family carers.

4. Protocols are in place to routinely include training on providing healthcare to patients with learning disabilities for all staff.

5. Protocols are in place to encourage representation of people with learning disabilities and their family carers.

6. Protocols are in place to regularly audit practices for patients with learning disabilities and to demonstrate the findings in routine public reports.

There is a mechanism in place to identify and flag patients with learning disabilities, and protocols that ensure that pathways of care are reasonably adjusted to meet their needs: Challenges

•Multiple software (community health/mental health/inpatients). •Different organisation have different criteria for including on their data-sets.

• LD flag using data from our own services ASC data base, routine updating to ensure accuracy.

ASC NHS

Numbers of People with a Learning Disability

• About 985,000 people in England have a learning disability (about 2% of the population); 796,000 of them are aged 20 or over • Cumbria population c 500,000 • 2.5% population IQ below 70 = 12,500

Numbers of people in services?

• Only about 20% of adults with learning disabilities are known to learning disability services (about 1750 people), therefore about 10,000 people in community with IQ below 70.

• Cumbria population c 500,000 15.5% (1 in 6) population IQ below 85 = 77,500 • At least 1 in 6 of caseloads in the trust have IQs below 85…. probably1in 5 or above.

Social inequalities in mental health

Supporting adjustments in IAPT

• Training for staff specific to their roles and the types of intervention supported by their part of the pathway.

• Pathway adaptation, based on lower ability: • • Easy read medication and self-help guides Allowing extra time for reading core questionnaires • Emphasising less cognitively demanding techniques • Emphasising smaller set of techniques • Enabling supporters in therapy

Screening tool

Screening tool

Trust flag and IAPT Screening:

What does it give us?

• Ability to monitor people with learning disabilities’ and people with lower abilities’ access to the service.

• Ability to compare outcomes for people with learning disabilities’ and people with lower abilities’ • Ability to test outcomes of adjustments

Conclusions

• The reasonable adjustments we apply to people with learning disabilities may also help a significant number of people without learning disabilities.