Transcript Document

Learning Disabilities Awareness Training
for all SCH Staff
Introduction


This presentation offers a general overview of the needs of
people with a learning disability and supports staff working
with them to achieve better outcomes of care and
communication.
Staff working within Community Paediatric Services will be
involved with the assessment and care of children with learning
disabilities. This learning package supports this work and offers
further guidance with regard to communication strategies. Staff
should be directed to speak to their team lead if there are
particular concerns in responding to the needs of a particular
patient group, or if more in depth information or training is
needed.
Objective & Outline
 Objective- By the end of this session
you will be able to identify 3 areas
where you can further support
clients with a Learning Disability
(LD).
 It is hoped that following this course
you will feel more confident in
supporting people with LD using our
services
Contents
 Introduction to LD
 Communication
 Policy and Law
 Services
 Mental Health problems with LD
 Physical Health problems for people with LD
 Risk of Abuse
 Support (for them and you)
Introduction to Learning
Disabilities
A LD is usually caused by the way the brain develops - before, during or soon
after birth. It is lifelong and usually has a significant impact on a persons life.
People with a LD usually find it harder than others to learn, understand and
communicate. People with profound and multiple LD (PMLD) need full-time
help with every aspect of their lives - including eating, drinking, washing,
dressing and toileting.
There are 1.5 million (2% of the population) with a LD in the UK. Like all of us,
they are individuals who want different things in life and need different levels
of support.
LD is not a mental illness or dyslexia, but when a person has LD with another
condition this often makes their needs more complex… we will be looking at
this in more detail later on.
Introduction to Learning
Disabilities
Cont’d
The Department of Health (2001) in England defined LD as a combination of:
 A significantly reduced ability to understand new or complex information,
to learn new skills (impaired intelligence); with
 A reduced ability to cope independently (impaired social functioning);
which started before adulthood, with a lasting effect on development
It is important to remember that learning disability does not include all those who
have a 'learning difficulty', which is more broadly defined in education legislation.
Introduction to Learning
Disabilities
Cont’d
Most people with a LD are treated as 'different'. But they are individuals
like the rest of the population and have their own distinct personality,
characteristics, history, values and opinions. People with LD are a group of
people who in law have the same rights as any other citizen, though in the
past, and still today, they continue to be excluded and discriminated
against.
Discrimination can occur in the form of
"diagnostic overshadowing" where a
persons presenting problems are put
down to their LD rather than seeking
another potentially treatable cause.
Introduction to Learning
Disabilities
Cont’d
Some facts from MENCAP
 People with a LD are 58 times more likely to
die aged under 50 than other people.
 Just 1 in 3 people with a LD take part in some form of education or
training.
 Less than 1 in 5 people with a LD work (compared with 1 in 2
disabled people generally), but at least 65% of people with a LD
want to work.
 Half of all families with children with a LD live in poverty.
 At least half of all adults with a LD live in the family home -
meaning that many don't get the same chances as other people to
gain independence, learn key skills and make choices about their
own lives.
 Just 15% of people with a LD have a secure long-term tenancy or
own their own home.
Communication
The Government White Paper 'Valuing
People' (2001) followed by says that people
with LD should have: Independence, Choice,
Rights and Inclusion.
Valuing People Now
Effective communication is fundamental in
achieving these principles. People with LD
may have difficulties with spoken and
written language, coordination, attention, or
self control. Some people with LD find it
difficult to communicate pain or
distress in an understandable way and
may express this by changes in
behaviour or personality.
Resources and information about the strategy available at:
Link to National Archives.gov.uk
Communication
Cont’d
Communication difficulties occur to varying degrees,
depending upon the type and extent of LD and the presence of
an associated physical disability such as cleft palate, cerebral
palsy or hearing impairment.
There is an increasing recognition that difficulties with
communicating over a lifetime often contribute to low self
esteem, social isolation and loneliness, lack of trust, frustration
and anger.
Finding ways in which people with LD can communicate, and
ways other people can communicate with them, can make a big
difference to their quality of life. Click here to read more Bild
Information and Factsheets
Communication
Cont’d
So how can we help people with LD using our services to communicate
what they are thinking and feeling?
 help them to feel secure and safe from harm
 spend time to develop a rapport with them
 ensure they have as much choice and control over their
treatment as possible
 encourage and support them to build social networks
 support them to improve their physical health
Communication
Cont’d
 People with LD do not have one recognised tool for communication, and
are often dependent on professional intervention to develop an
individually tailored communication plan.
 There are a variety of communication aids which can help communication
for people with LD, e.g. from organisations such as those below (click on
the links to learn more).
Change Bank – provides accessible information
Makaton - language programme using signs and
symbols
Widgit software (symbols for writing)
Policy and Law
In 2008 the Joint Committee on
Human Rights stated it is still
necessary to emphasise that adults
with LD have the same rights as
everyone else. Since 1995 it has
been unlawful to discriminate
against people with a disability,
including those with a LD.
The Equality Act 2010 requires information to be provided in an accessible
format about treatment options, complaints procedures and appointments.
'Reasonable adjustments' must be made to the way that services are
delivered in order to meet the needs of disabled users.
Policy and Law
The Mental Capacity Act
(2007) introduced a new
criminal offence of ill treatment
or neglect of a person lacking
capacity. It put into statute the
principle that everything must
be done in the best interest of
the patient.
Cont’d
Policy and Law
Cont’d
The English policy for people with LD is the Department of Health (2001)
Valuing People; a new strategy for learning disability for the 21st
century. Click here http://www.archive.officialdocuments.co.uk/document/cm50/5086/5086.pdf
The Green Light Toolkit (GLTK)
(2004) is one way in which this
policy is being implemented. The
GLTK is an audit tool used to
measure how the National Service
Framework for Mental Health
(1999) is being implemented for
people with LD. It offers a traffic
light scoring system and provides
guidance on how services can be
improved.
www.workingwithwords.org/PDF/gr
eenlight_toolkit.ppt
The Trust's Green Light Strategy
Group
This is a partnership meeting with the providers of specialist
LD services, who are Hertfordshire Partnership Foundation
Trust.
This group discuss and take forward improvements in mental
health services in the Trust. To find out more about the Green
Light Strategy Group please contact Nicola Armstrong,
Advanced Clinical Specialist (LD), or the Chair of the
group…see i-connect page for LD (Teams and Services;
Learning Disability Pages)
Services
People with LD have the same rights of
access to mainstream statutory services
as any other citizen, such as using their
GP, dentist and secondary services.
Other services are provided by a range of nonstatutory organisations. The following links may
be of interest:
 http://www.suffolk.gov.uk/care-andsupport/adult-social-care/learning-disabilities
 http://www.suffolk.nhs.uk/Home/Getinvolved/Co
nsultationsandEngagement/Closedconsultations/
LearningDisabilitiesConsultation/tabid/2930/Item
Id/4276/Default.aspx
Services
Cont’d
NHS East of England plan to improve access to health services across the region for patients
with learning disabilities and are working with PCTs, CCGs and Local Authorities
https://www.eoe.nhs.uk/page.php?page_id=2123
Services
Cont’d (click on the links)
 https://www.eoe.nhs.uk/page.php?page_id=2123
 Local Disability Teams
http://www.smhp.nhs.uk/OurServices/LearningDisabilityServi
ces/tabid/204/Default.aspx
 http://www.smhp.nhs.uk/OurServices/LearningDisabilityServi
ces/Stourmeadlearningdisabilitiesservices.aspx
 http://www.smhp.nhs.uk/OurServices/LearningDisabilityServi
ces/WestSuffolkDisABILITYresourcecentre.aspx
 http://suffolkcarers.org.uk/index.php?option=com_content&task=blogcateg
ory&id=26&Itemid=178
 MENCAP services
 Advocacy
Mental Health Problems
with LD
Most people with LD live in the community and have the right to equal
access to mainstream health services. However, specialist services are
sometimes needed to provide additional support.
It is important that you feel confident in supporting these vulnerable
people to ensure they get the best service possible.
People with LD are:
 More likely than others to suffer mental ill health
 Experience the same range of mental health problems but have a
higher prevalence than the general population
 Are more likely to have undetected and untreated mental health needs
Mental Health Problems with LD Cont’d
It is estimated that 16-25% of the population are likely to have a mental
health problem at some point in their lives. This compares with an
estimated 25-40% of people with LD who experience more of the risk
factors associated with mental ill health.
There seem to be 4 key reasons for this…..
1. Many LD syndromes of genetic origin are associated
with psychiatric disorders
2. Brain trauma often results in psychiatric problems
3. People with LD are much more likely to encounter
traumatic life events that make them more vulnerable
to mental health problems
4. Social restrictions experienced by people with LD may
endanger their mental health
Mental Health Problems with LD … detection
Generally the signs and symptoms of psychiatric disorders presented by adults
with mild learning disability and reasonable verbal communication are similar
to those presented by adults in the general population.
It is more difficult to detect psychiatric disorders in adults with moderate to
severe LD or autism. These individuals are likely to exhibit disturbed and
regressive behaviours as presentations of psychiatric disorder.
How do we detect mental health problems?
 What people say they are experiencing
 What others say about them
 How they are seen to behave
 History of the complaint
 Family history
 Recent trauma/traumatic events
Mental Health Problems with LD…Detection cont’d
Carers play a central role in the
identification and assessment of
mental health problems in
individuals with LD.
Some problems can be very
difficult to diagnose in people
with LD and so it is important to
ask and talk to the carers about
the persons background and
experiences, as this will give you
vital clues to any diagnosis.
Mental Health Problems with LD…Detection Cont’d
A comparison of those adults in the general population with people
with LD
PSYCHIATRIC
DISORDER
PRESENTATION IN
MILD LD
PRESENTATION IN
SEVERE LD
Dementia
Similar
Different/
difficult to diagnose
Schizophrenic
psychoses
Similar/may be overdiagnosed
Very different/
difficult to diagnose
Anxiety and related
disorders
Similar/underdiagnosed
Very different/
difficult to diagnose
Eating disorders
Similar/ underdiagnosed
Different/
difficult to diagnose
Personality disorders
Similar
Different/
difficult to diagnose
Mental Health Detection in People with LD – Some
Possible Symptoms
 Social isolation or marked withdrawal (unusual









for the person)
Odd/bizarre behaviour
Biological changes - sleep disturbance/poor
appetite/weight loss
Anxious, worried, preoccupied, agitated or
perplexed mood
Talk content preoccupied
Conversation bizarre and disjoined/disorganised
Speech changes i.e. rapid, slurred
Loss of usual interpersonal skill, social skills &
ability to learn new skills
Paranoia/unusually very suspicious
Avoidance of situations & people
Mental Health Detection in People with LD – Some
Possible Symptoms Cont’d












Aggressive/argumentative/non-compliant
Destructive to property
Low impulse control, compulsive/impulsive
Mood Swings
Feeling stressed/cannot cope/feels different
Personal hygiene poor/self neglect
Feelings of severe anxiety, despair, loneliness,
unworthiness & rejection
Delusions - false belief
Self injury or increase in usual self harming behaviour
Evidence of suicidal ideas/intent/acts
Compulsion or rituals
Hallucinations (visual/auditory) & evidence
of responding to these
Physical Health Problems
for People with LD
People with LD often do not seek out
healthcare, and when they do they frequently
face difficulties, but ironically they are more
prone to a range of physical problems than
others. People with LD are less likely to
receive health checks and access to routine
screening, e.g. cervical screening.
Risk of Abuse
Individuals with a LD are at an increased risk
of being abused and neglected. Research has
indicated that between 8% and 58% of adults
with LD have experienced sexual violence.
Adults with LD are less likely to report crimes of abuse perpetrated against
them, and if they do they are less likely to achieve justice. For many, the
violation of their human rights is seen as a normal part of their everyday lives.
As part of our roles as healthcare professionals we need to be actively aware of
this and you should know what to do if you are suspicious that abuse may be
occurring.
Risk of Abuse
Cont’d
 For adult referrals follow the link:
 http://www.onesuffolk.co.uk/safeguardingadults/referralform/
 Staff must report the referral to their line manager and complete an SCH incident
form
 For childrens referrals, staff should follow the flowchart at:
 http://nww.suffolkch.nhs.uk/LinkClick.aspx?fileticket=F8c7UO7QS3Y%3d&tabid=2
21&mid=1003
 We have a capacity assessment for patients with learning disabilities within the
dental department:
 http://nww.suffolkch.nhs.uk/LinkClick.aspx?fileticket=ukanLQ1_47s%3d&tabid=24
4&mid=1057
 and SCH procedure (multiagency) is at:
 http://nww.suffolkch.nhs.uk/LinkClick.aspx?fileticket=o22liHfEvh0%3d&tabid=160
&mid=506
What you can do to Support
People with LD
There are many ways you can help people with LD, particularly when
they are using our services. Just taking more time and being more
observant can make a big difference in helping the person feel more
relaxed and comfortable. Also to think about the diagnosis carefully,
taking into account the LD factors that can skew the information.
Things to remember:
 Be aware of any special needs, such as sensory impairment
 Put information in an accessible format
 Carry out assessments in familiar settings
 Minimise distractions
 Be aware of the persons attention span and act accordingly
 Use open ended questions
 Ensure your conversations are jargon/terminology free
 Use concrete terms
Did you Know?
The foundation for people with learning disabilities
 http://www.learningdisabilities.org.uk/help-information/forums/
Has forums dedicated to connecting people who work with those
with learning disabilities
Further Support/Information for You
 The following link gives guidance on the formatting of written info for
learning disabilities:
http://www.brightpart.org/documents/communicate/Devon%20%20total_communication_literature_-_guidelines-2.pdf
 The East of England SHA plan to improve access to health services
across the region for patients with learning disabilities and are
working with PCTs/CCGs and Local Authorities.
https://www.eoe.nhs.uk/page.php?page_id=2123
External Resources
(Documents)
 Valuing People - A New Strategy for LD for the 21st century.
Department of health (2001) http://www.archive.officialdocuments.co.uk/document/cm50/5086/5086.pdf
 Valuing People Now - A three-year strategy for people with
learning disabilities - Department of health
(2009)http://www.dh.gov.uk/en/Publicationsandstatistics/Publica
tions/PublicationsPolicyAndGuidance/DH_093377
 Equality & Human Rights Commission. Call 0845 604 6610 or
visit: www.equalityhumanrights.com
 MENCAP. Call 020 7454 0454, email: www.mencap.org.uk
 Foundation for people with LD. Visit:
www.learningdisabilities.org.uk
 LD email network - for anyone interested in the mental health
needs of people with LD. Free to join, go to
http://www.learningdisabilities.org.uk/ldhn/
 British Institute of LD. Call: 01562 723010 or visit
http://www.bild.org.uk/
 Clear Thoughts http://www.clearthoughts.info/
USEFUL LINKS

http://www.nhs.uk/livewell/childrenwithalearningdisability/pages/childrenwithalea
rningdisabilityhome.aspx

http://www.nhs.uk/Livewell/Childrenwithalearningdisability/Pages/Whatislearning
disability.aspx

http://www.nhs.uk/Livewell/Childrenwithalearningdisability/Pages/Copingwithdiag
nosis.aspx

http://www.nhs.uk/Livewell/Childrenwithalearningdisability/Pages/reallifesinead.as
px

http://www.nhs.uk/Livewell/Childrenwithalearningdisability/Pages/Reallifemichael.
aspx

http://www.mencap.org.uk/all-about-learning-disability/information-professionals