Adults with LD

Adults with LD

1. IMPAIRMENT

   • Specific diff / need
   • May not be able to change...
   • Means 'function'

2. DISABILITY

   • Soc / functional impact
   • How take part
   • Don't need to cure impairment to change how this impacts
   • Modify environment
   • COMMUNICATION
     • Receptive
       • Often over estimated
       • Acquiesence - often over agree 'yes' to everything
     • Expressive
       • People good at offering help - but removes opp to initiate
       • Articulation / co-ordination
       • Inconsistent use
       • Can't access device
       • Reduced topics?
         • Motivation?
       • Reduced partners?
     • Getting it Right Charter (MENCAP)
       • Diability Descriminatino Act (2005) Unlawful to fail to make reasonable adjustments / treat disabled p. less favourably
       • Liaison nurse
       • Annual health check
       • Training for all staff
     • INFORMATION STANDARD NHS (2015)
       • INFORMATION in format disabled person can access
       • Identify and document needs
       • Form an 'Alert' to enable other find info
       • Share info, within and between bodies
       • Meet identified needs: Bullet points, pictures, addressed to someone else?
   • Social model of disability sees disability as created by social barriers (WALMSLEY 2001)
     • Contrasts historical medical model
     • If a persons social role is valued then they are treated desirably, if negatively valued they become more subjected to rejection, low expectations and exclusion (WOLFENSBERGER,1983)
     • O'BRIEN (1987) 5 service accomplishments inc: valued social roles, community presence & choices
       • Confidential Inquiry (2013)
         • Men 13 years sooner
         • Women 20 years sooner
         • Respiratory infections
         • See Mazars report
         • Led to set up of IHAL; Improving Health and Lives
           • Raise awareness
           • Produce repeorts on health inequalities, for e.g.
           • Produce stats on health, housing, employment etc.
         • Hampshire Choking report (2012)
           • 5 deaths from choking
           • ALD at higher risk
           • Training - those at risk and 1st aid
             • Commissioning appropriate placements for training
           • Sufficient SLT for specialist assessment
           • Winterbourne DOH (2012) - now closed: exposed on Panorama
             • Too many in inpatient services and staying too long
             • Model of care goes against gov policy
             • 11 Prosecuted
               • Inc. emotional abuse
               • ttp://www.youtube.com/watch?v=hhCx3K8XJJM
             • Lack of meaningful activities
             • Too much reliance on restraint
               • 'Challenging Behavour' without finding out why
             • DoH, (2012)
         • into premature death of people with learning disabilities
     • MCA (2007) - People can make unwise choices: SLT enhance capacity
     • MICHAEL (2008) 'Healthcare for all'
       • See resource in folder
       • MENCAP (2007) 'Death by Indifference'
         • 'Valuing People Now' (2009) - 3 year plan: 1. Rights, 2. independence, 3. choice, 4. inclusion
           • See document in folder - this plan completed now
           • National objectives for public services
           • Targets & performance indicators
             • Workforce training to understand and impliment VPN ethos
           • e.g. housing, fulfilled lives and employment, support carers, improve health, provide quality services.
           • Some groups at greater risk social exclusion
           • Communicating CHOICE key SLT
         • "Institutional descrimination"
         • Human rights principles '- partic. dignity and equality' failed to live up to
         • 2012 = 74 deaths 'found wanting'
         • Recommended
           • 1. Hospital liaison nurses
           • 2. Hospital passports
           • 3. Annual health checks
           • 4. MCA training for all prof.
     • Equality act
       • Problems faced ALD
         • Route after school - transition to adult services
           • Choice: e.g. housing
             • No choice & little advice
           • Health care: comm how feeling
             • Soc. isolation & employment
               • 10% nationally are in work
       • (2010)

3. DEFINITIONS: ALD position paper RCSLT (2010)

   • Impaired intelligence: reduced ability to understand new /complex information
     • To learn new skills....
   • Impaired ability to cope independently
     • Inc. social functioning
   • Evident pre-18 & lasting effect on development
   • WHO (2005)* "A state of arrested, or incomplete development of mind."
     • MILD: IQ 50-70
     • MODERATE: 35 - 50
       • May be able to live in assisted care
     • SEVERE: 20-35
       • Full care - needs reminders etc.
     • PROFOUND: <20
       • Full time care
     • Diagnosis made by psychologist
   • SLT role......
     • Advocacy
     • Ass eating drinking swallowing & comm
       • Devising a plan, based on this
     • Advice, consultation, training others e.g. spec comm approach
       • Coaching
       • Resourcing
     • Writing accessible information
     • Improving overall comm env. Maximising paticipation, choice etc.
       • Help access services and employment
       • Promote health and well being
     • Tier 1: to improve awareness and knowledge of ways to overcome comm difficulties i.e. how best to support the ALD, work with police, emergency services, retail, leisure etc
       • Tier 3: improve the specialist services for PLD – the LD workforce re comm and dysphagia, focus on the receptive environment
       • Tier 4: Specialist interventions Specialists interventions to address communication and eating & drinking in all environments.
       • RCSLT POSITION PAPER (2010)
     • Tier 2: supporting mainstream services e.g. courts hospitals, primary care
   • 169,000 People over 20 in England

4. Important to consider what individual needs

   • May have co-morbidities: physical, sensory, mental health needs
   • All 7 senses potentially affected: Sight, smell, touch, taste, hearing, vestibular & proprioception
     • HYPO/HYPER sensitivities
       • Can be different in different areas
     • Hearing aids worn?
     • Hard to evaluate
     • Awareness of env.?
   • Physical needs:
     • Achieve and co-ordinate desired actions
       • Affects sign
     • consistant / vary?
     • Effort and fatigue
     • Postitional factors - key
     • Pain?
     • Switches/eyegaze alternatives

5. Aetiology

   • Maternal illness during peri-natal period
   • Genetic - chromosomal abnormalities
   • Post natal / early childhood illness
   • During childbirth (hypoxic ischemic encephalopathy)
   • Accident, e.g. in bath

6. Mental Health

   • Bi-polar
   • Depression
   • Schizophrenia
   • 30-40% comobidity
   • Demenita: can happen in Down's at 30!

7. Lots of ALD are not accessing local services

   • many with 'mild' LD do not access so prevelance figures may be greater
   • LD PUBLIC HEALTH OBSERVATORY 908,000 adults aged 18+ (2012) only 22% are known to GP’s.
     • 142,000 were accessing specialised services (2011)

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