1. What if your next patient has a Learning Disability?

2. Session Objectives By the end of the session you should be able to: Identify what is and what is not a Learning Disability List historical terminology and degrees of LD Demonstrate an understanding of the causes of LD and the common health issues Be aware of the risk of diagnostic overshadowing Recognise communication barriers and what resources are available to support clinicians

3. What is a Learning Disability A significantly reduced ability to understand new or complex information and to learn new skills with a reduced ability to cope independently which started before adulthood, with a lasting effect on development. Learning Disability does not include all those with a learning difficulty.

4. Learning Disability is not..... Problems with reading, writing and numeracy only. Emotional difficulties that may have disrupted schooling. Conditions like ADHD Asperger’s Syndrome Autism Tutor please pause the DVD when a ? appears….

5. Through Barry’s Eyes 1.?nature of learning disability 2.?experience of carers 3.?fears 4.?barriers The aim of the DVD is to raise the consciousness of health personnel about the needs of adults with learning disabilities

6. Historical Terminology Subnormal & Severe Subnormality Mental Defective Mental Disorder, Mental Impairment Severe Mental Handicap Severely Mentally Impaired Mental Retardation Idiot

7. Degrees of Learning Disability MILD IQ 50-69 89% MODERATE IQ 35-49 6% SEVERE IQ 20-34 3.5% PROFOUND IQ <20 1.5% % of all people with a Learning Disability

8. Health Issues sample from the A-Z Poster… Coronary Heart Disease Diabetes Epilepsy Gastrointestinal Reflux Helicobacter Pylori Osteoporosis Respiratory Disease Schizophrenia

9. Diagnostic Overshadowing Diagnostic overshadowing refers to the tendency of health and social care professionals and others to interpret the reporting of symptoms, and symptoms themselves, to a learning disability or mental health problem. Patients are not therefore assessed for the new condition !

10. Other considerations… It must not be unreasonably difficult to access the service and service providers must make reasonable adjustments The outcomes should be the same for the person but some people need to be treated differently to get that outcome The practitioner needs to gather consent

11. Communication Check what is said and what is heard Use clear words and pictures Use body language to support words Make time to listen and understand Explain what is happening Check how people can communicat e

12. Caring for your patient Don’t assume they don’t understand Don’t assume that everything is linked to their LD Don’t give too much information in one go Stop Think Always Does the patient understand their health need How can existing experience help in their care Does the patient need someone to support them Listen to the patient using verbal & non verbal Involve the patient in all aspects of care Make reasonable adjustments to the way you work

13. Communication Lack of familiarity with patient Health Action Plan Need to communicate Health Action Plan Need medical history HAP or Grab Sheet Need carers and NOK details HAP or Grab Sheet SuggestibilityYieldingAcquiescenceAutomatic

14. Sources of Information Hospital Grab Sheet (Green Sheet) Health File (Blue Book) Personal Health Record (Yellow Book) Health Action Plan

15. Essential Information Example of a Hospital Grab Sheet in Northamptonshire Division

16. Page 7: Current Medical Conditions Page 6: My Communication Page 4: Personal Information Page 9: Supporting my Concerns Page 12: Supporting my Mobility Page 21: Contact Details Essential Information Example of a Health Action Plan in Lincolnshire Division

17. Essential Information Example of a Health File in Derbyshire Division

18. Grab Sheet HAP Any Questions

19. Conclusion It is key to effective treatment that we recognise a patient with a learning disability. It is beneficial if we have underpinning knowledge around LD health issues. It is essential for effective treatment and care that we can communicate. It is advantageous if we recognise the tools available to facilitate that communication.

20. References DSM4 (1994) The Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition American Psychiatric Association. Department of Health (1998) Signposts for Success in commissioning and Providing health services for people with learning disabilities. Department of Health (1995) Health of the Nation: a strategy for people with learning disabilities. Department of Health (2001) Valuing People a new strategy for learning disability in the 21st century. Hertfordshire Learning Disability Partnership Board (2005) Facilitators Guide Through Barry’s Eyes. Available from: www.hertsdirect.org/learningdisabilitywww.hertsdirect.org/learningdisability

21. Where to get more info…. Mencap campaigns for equal rights for children and adults with a learning disability and can offer information: www.mencap.org.uk www.mencap.org.uk British Institute of Learning Disabilities (BILD) works to improve the lives of people with learning disabilities across UK: www.bild.org.ukwww.bild.org.uk Foundation for People with Learning Disabilities supports people with learning disabilities and their families and works to improve services: www.learningdisability.org.uk www.learningdisability.org.uk