Learning Disability Awareness Training

Aims of session: What is a Learning Disability Barriers to health care for people with learning disabilities Reports Reasonable adjustments Case studies Evaluation

What is a learning disability

Learning Disability Cognitive impairment, which reduces the ability to understand new or complex information A reduced ability to cope independently. The limitation can show in many different ways; spoken, written, coordination, attention and self control. Which started before adulthood, with a lasting effect on development.

What is NOT a learning disability Difficulty reading, writing and numeracy Emotional difficulties which disrupt schooling, influencing achievement Attention deficit hyperactivity disorder Asperger’s syndrome and some individuals with autism

Barriers to health care COMMUNICATION: Abbreviations/jargon Difficulties with reading and writing Information not accessible None or limited verbal communication Different methods of communicating

Barriers to health care PHYSICAL: Examinations Equipment Reliance on additional support from carers Transport/parking Cognitive ability Sensory impairments

Barriers to health care Emotional: Alien world! unfamiliar Don’t understand what is happening Difficulty with waiting for long periods of time Difficulties with being around lots of people Difficulties with noise Frightened of procedures Bad past experiences

Barriers to healthcare Challenging behaviour: New situations can cause distress and stress May be a way to communicate pain May be a pleasure May be a way to gain control by attracting your attention This can challenge the health and safety of self and others

MARTIN “Martin was often smiling – he loved to go out, liked the movement of the coach and listening to the music. When he was young, he liked being in our car as well. He loved getting behind the wheel and turning it around” “Martin will always be the light of my life. He had a quirky sense of humour and oodles of charm”.

REPORTS These problems have been highlighted in a number of reports such as: Treat me right (Mencap 2004) Death by Indifference (Mencap 2007).

REPORTS The government responded in a number of ways such as: Health care for All (2008) This produced 10 important recommendations which concern the ‘reasonable adjustments’ that are needed to make healthcare services accessible for people with learning disabilities as they are to other people.

Reasonable Adjustments Hospitals have a clear ‘duty of equality’. This does not mean treating everybody the same but rather that hospitals must make ‘reasonable adjustments’ to meet the needs of people with a learning disability (Working Together 2006). Core standards for Better Health should be amended to reflect the requirement to make ‘ reasonable adjustments’ to services to ensure they are accessible to people with learning disabilities (Healthcare for All, 2008). You must make reasonable adjustments to ensure that each person has the same opportunity for health, whether they have a learning disability or not (Disability Discrimination Act 2005)

Group Work Split into two groups you will be provided with a description of a patient accessing your work setting. You will write down what “reasonable adjustments” you as staff supporting this patient could put in place.

Group Work GROUP 1 No verbal communication Wheel chair bound Has a moulded wheelchair therefore has a specialist sling Lives in residential home staff shortage they are unable to support The person is slapping themselves on their head GROUP 2 Has limited verbal communication Gets up from sitting or lying frequently to pace around Has severe epilepsy Is sensitive to loud noises Has an elderly mother supporting him who has back problems

Reasonable Adjustments Arrange pre-admission visits. Allow extra time or staff to support (use the risk dependency and support assessment). Consider appointments or surgery times. Appropriate equipment to hand (and know how to use it). Communicate in a way that the patient and carers can understand, are there accessible communication aids to be more effective.

Reasonable Adjustments Explain what is happening as a matter of routine. Link with local community learning disability team (CLDT) for advise, and support Always consider pain control Involve parents carers in handover to ensure they are aware fully what is happening or to explain support needs to ward staff

Reasonable Adjustments Encourage the family/paid carer to take regular breaks; provide use of staff kitchen. Identify if the family would like to stay over; can this be accommodated on your ward. Ask if there is a Hospital Traffic Light Assessment if so read it. (see next slide) Take all necessary steps needed to support the person to make decisions. Providing information in a format that they will understand (MCA).

Risk Dependency and support assessment tool Work with those who know the patient best to fill out the Risk, Dependency and Support Assessment so you can identify and agree what additional support may be required, and who is best to provide it. Carry out further hospital risk assessments on any areas of likely risk identified in the Risk, Dependency and Support Assessment. The senior member of hospital staff with responsibility for patients with a learning disability should be informed of the admission and the outcome of the Risk, Dependency and Support Assessment in order to authorise and secure appropriate funding. Paid support staff, with the help of families, are usually the best people to provide and additional support required during a hospital stay. The individual is used to them and they are familiar with the support the individual needs. Ensure all staff concerned understand this and accept their presence.

Hospital Traffic Light Assessment A tool to assist you support people with LD. Red Section – must know information. Amber – how to support me. Green – my likes and dislikes. 3 pages of very important information to help you to help others.

CASE EXAMPLE Without TLA Nurse administering tablets to patient in medicine pot Patient spitting them out Nurse tries several times and at different times Patient continues to spit them out Nurse documents “patient refused medication” Patient begins to have seizures due to no medication! With TLA Nurse READS TLA Nurse administers medication on a spoon one tablet at a time Nurse offers a drink from patients specialist cup and straw Patient takes all medication well Patient experiences no seizures!

GROUP WORK You are now aware of the TLA You have had examples of reasonable adjustments You are aware of the RDAT

Group Work Split into two groups you will be provided with a description of a patient accessing your work setting. You will write down what “reasonable adjustments” you as staff supporting this patient could put in place.

Group Work GROUP 1 No verbal communication Wheel chair bound Has a moulded wheelchair therefore has a specialist sling Lives in residential home staff shortage they are unable to support The person is slapping themselves on their head GROUP 2 Has limited verbal communication Gets up from sitting or lying frequently to pace around Has severe epilepsy Is sensitive to loud noises Has an elderly mother supporting him who has back problems

Contact Details Learning Disability Liaison Team Nottingham University Hospital Ext