Dr Dina Berkeley Public Health Lead, East Riding of Yorkshire PCT 23 April 2008 Promoting health and wellbeing for people with a learning disability in East Riding of Yorkshire

Context Estimates: 1 – 2.5% of population (only 0.25% registered) Definitions vary (Disability? Difficulty? IQ<70) From “Valuing People” (DoH, 2001) Learning Disability includes the presence 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.”

Health needs/Health inequalities Health needs are similar to all other people BUT they also have Additional needs as they are especially prone to some health problems including Obesity, heart disease, hypertension/stroke, musculoskeletal problems, sensory impairment, epilepsy, problems associated with the endocrine system, psychiatric morbidity, dental problems, osteoporosis, skin problems, etc. Comparative research findings indicate that they have 2.5 times the health problems of people without a learning disability

Health inequalities They are also facing Challenges in identifying own health needs Barriers to timely and appropriate access to services (both outside and within health services) Negative and unhelpful attitudes of staff Lack of collaboration between specialist and primary care services Diagnostic overshadowing Stigma

Addressing health inequalities experienced by people with a Learning Disability in East Riding of Yorkshire Commissioning Strategy Partnership working (partners included ERY Council, Primary Care Trust, Humber Mental Health Trust, Hospital Trust, MENCAP, etc.) “Roadshows” aiming to Introduce /familiarise clients with a variety of health, health promotion and social issues Familiarise professionals with this client group Bring different professionals together

Issues to take into account Huge geographical area – including both urban and rural population – how can we cover all needs? Some members of the client group reside at home while spending time at Day Care Centres; others reside in residential homes – how can we bring all people on board? Needs of visiting clients (e.g., varied difficulties in comprehending information) Types of presenters/material (e.g., some with experience of working with the client group, others with none) Numbers of roadshows (e.g., splitting number of potential visitors, demanding much effort/time from presenters).

Evolution of Roadshows Pilot: Roadshows 2005, carried out in 4 localities (Beverley, Goole, Withernsea, Bridlington) Roadshows 2006 and 2007 carried out in a central locality Forthcoming Roadshow 2008 carried out in a central locality Planned dvd of the 2008 Roadshow (plus complementary info) for distribution across East Riding

Examples of topic areas covered Direct paymentsPhysical activity Health Action PlanningNutrition Active AdvocacySmoking ConsentDental Health Carers’ support servicesFalls Patient PassportSun awareness Speak UpSexual health Fire safetyDrugs EpilepsyPrimary Care Nursing ContinenceSecondary Care Nursing Community Team for Learning Disabilities

Visiting staff’s expectations For themselves: gain information & material for group work and client reference For clients: gain information at a level they understand be offered opportunity to discuss health topics All expectations realised. Also they were happy to see clients enjoying themselves realised that clients were interested in health

Visiting staff: other comments “Very informative, a good selection of services represented. Roadshow information was brought into services and used with clients. This would provide better interaction for service users and other staff teams.” “They seemed happy – especially because they were made to feel included by the approachable presenters.”

Comments from participating staff “Opportunity to catch up on what is happening in the LD area” “I have been asked to visit a residential unit to discuss a possible stop smoking group - I now have a slightly better understanding of the issues” “Identified key workers in other agencies” “Was able to find out about other things that were going on” “Links with community dental service enhanced; possibility of increased stop smoking referrals” “Invitation for attendance at team meetings” “My awareness of LD issues was raised. In particular I am more aware when purchasing reading materials, resources” “Highlighted need to encourage access to training by staff working with LD clients” “Provision of resources more suited to clients with LD”

Information from clients They want to be talked to (rather than through family/staff) be listened to be explained about procedures, fill forms, etc. look after themselves Family and staff can help them Professionals can help them understand more about their bodies

Achievements Gains for Participating staff Briefing sessions - much learning Taking opportunity to reflect on practice Learning from one Roadshow to the next Learning for future means of approaching LD clients Improving on communication skills Gaining confidence and better understanding of the target group Gains for Visiting staff Gain info and contacts they did not have Opportunities to discuss with clients on related issues

Achievements Gains from interactions between staff Linkages fostered between Day Centre staff and other mainstream services Linkages between participating staff for other work of common interest Enhanced understanding of all participants concerning what is available within the community Gains for Clients Feeling included and having seen their needs being addressed as an issue of concern Relevant knowledge for themselves and others

General recommendations Encourage/facilitate interaction between staff working with this client group and that of mainstream services Familiarise mainstream service providers with this client group Familiarise clients with mainstream service providers Train and support staff who work with this client group to deliver relevant messages Train and support clients to deliver relevant messages to their peers Identify/develop health awareness material which can be taken directly to clients (not only to Day Centres) Encourage the development of suitable relevant material for this client group