Learning Disabilities Flashcards
Tell me about a case you have had recently?What went well?
What could you have done better?
REFLECTION:
Working with a client who was permanently excluded from college due too behaviours that can be described as challenging. The client has a moderate learning disability, autism and non-verbal.
My PBS informed intervention was to support his communication, particularly how he is feeling and if he is in any pain, destruction to property was hypothesised to be linked to headaches/migraines. I trialed a number of low tech AAC resources e.g. PECs, pain charts and choice boards, but these were unsuccessful. The client was unmotivated to use them, didn’t understand their purpose, and the shine laminated material was not suitable for his sensory needs, leading him to lick them and tear them.
On reflection, I had simply trialled the easiest and cheapest option first, but had not considered his specific needs, likes and dislikes in enough detail.
The main omission was his like of and skills using technology such as iPads and Youtube. Therefore, I trialled high tech AAC app Proloquo2go, with great success. I completed weekly intervention work for 10 weeks, using both the App supported with Makaton. A great success was Dad reporting to me that the client has started to use the Makaton sign for headache to request painkillers, and there had been no incidences of destruction to property. This also supported the reduction is his psychotropic medication.
To meet the criteria for ACS referral I wanted to ensure his developed skills were transferable to real-life setting. The client was due a physiotherapy assessment, so I arranged a joint visit with the physio, hoping to support the client to communicate his pain and feelings. I was optimistic as in a practice session with me, he was able to tell me wear the pain was, the severity, how it impacts his daily life, and how it makes him feel. I also prepared him for the physio appointment by showing him a picture and explaining the physio would come with me next week.
However, on reflection I did not appreciate how huge the change would be from his perspective, he had been seeing me every week for around 2 months, and didn’t account for how it might make him feel to suddenly change that. During the joint visit, the client was visibly confused and upset and he was not able to communicate to the physio all the aspects he had told me. I managed to end the session positively by completing some motivational activities to the client, nursery rhymes/transport/animals.
For the ACS referral I need to complete another joint visit in the future. To better prepare for this, I have written a social story for the client to support his understanding of what will happen and who will be there. I have asked his parents to read this with him frequently in the weeks leading up to the joint visit.
From this case I have learnt to always take the time to view all aspects of a situation from the clients’ perspective, and not to focus on the success of the intervention. To also check that a client has understood something, or if I need to explain in a different way, or if the information needs relaying consistently leading up to an event if there is a gap in-between.
How would you prepare to run a group for young people with a learning disability?
I have recently run a social communication group for 6 adults with mild to moderate learning disabilities. This involved an hour session for 6 weeks.
What went well:
- I had 1:1 practice session with each participant, to introduce myself, explain what to expect and introduce key resources e.g. prompt cards. Identify their goals for attending the group, and if there is anything they are worried about.
- We then had a week 0 session, which we held on MS Teams. The participants were selected for the group to support with the communication skills and confidence, so I felt it was important to ease them into this new/potentially scary situation, so they all met for the first time on MS Teams. Comfort of their own home, and free to easily leave at any time.
- First session is not content heavy, and focuses on getting to know each other.
- Prompt cards for participants to hold up; I do not understand, please slow down, can you say that again, I need to take a break. Re-introduced these every week for consistency, re-inforced every week that it’s OK to use any of the cards and it’s OK not to understand or to need to take a break. Made sure they were easy to reach, and pictures to support understanding.
- Responded to the needs of the clients and changed activities during a session; e.g. if too easy or stepping down as they did not understand.
What I would do differently next time:
- Learn more about the clients as individuals before attending, not just about the thing the group is focused on e.g. social communication. E.g. we did not know details about a participants past trauma and abuse, and did not realise that having a slightly older man in the group would be triggering for her.
- Intelligibility/clarity of speak of some clients made it difficult for both the clients and facilitators to understand them. Hard to find the balance of wanting to understanding them, but not want to cause any embarrassment in front of the group. We provided a 1:1 intensive session before the following session for 2 of the clients to work on intelligibility strategies. This is something I would try to assess and consider before the start of the group next time. e.g. if I felt someone may need further support to understand a concept, I would provide a 1:1 intensive session ahead of a session to promote understanding without causing embarrassment.
- Pre-judgements about who would get on..
Important factors to consider:
- Understand that it can be scary attending group, so tried to minimise all potential variables; meet before on MSTeams so they know who to expect, created detailed map so they know where to go, create resources to promote ease of communication e.g. if don’t understand/need a break.
- Although it’s a group setting, approach should still be person-centred, I have found this is made easier grouping people based on their needs, so everyone is at a similar level of understanding.
- Impact from previous experience/ Cultural factors: attending groups can make participants feel quite vulnerable, who do they feel comfortable communicating with? Women, men?
- That being said, ensuring I have graded activities for each session in case someone finds things easier/harder and needs it stepping up or stepping down.
- Don’t make prejudgements about the clients.
- Making sure location is accessible, and enough room for carers to attend if required.
Tell us about a piece of academic literature you have read recently.
- relevant to LD, peer reviewed, journal article.
Tell us about any research you have conducted.
- Reflect on the ups and downs of conducting research. AND HOW IT HAS INFORMED MY PRACTICE.
- PG Project: I carried out a qualitative research project, to better understand how universities can better support the mental health of students studying at UK universities. Semi-structured interviews, analysed using thematic analysis. I know qualitative research findings cannot be generalised to wider population, but the conversations and literature I read has informed my clinical practice.
Identified themes including; - Mental health support which reaches out to them (consistent with lit. that major barrier to getting MH support is asking for/seeking out help). Practice: making all interactions count, even if referral is not MH related, it should always be considered. Especially in LD, symptoms of MH problems are often attributed to their LD and therefore go unsupported.
- Preference for MH support from people they can relate to, feel that they are more likely to understand them. In LD setting, this shows the importance of experts by experience, and people participation. Also, asking for feedback from clients, and adapting the intervention to suit them. In addition, getting to know the client as a person e.g. their likes, dislikes etc. may lead to more successful intervention outcomes.
In my current role, I have been apart of a number of informal/service-based research projects and audits:
- Since all staff completed TOMs training, I am auditing the intervention scores for all disciplines, presenting the data in a meaningful way. The data can tell us % of clients who’s impairment, wellbeing, participation and activity scores have improved with intervention. Look at demographic/client factors which are associated with these changes e.g. age= improvement declines with age, sex= females more likely to improve, living in own home.
- Reliant on clinicians providing the data, difficulties motivating the team to collect the data/complete scoring, takes time from their busy schedule.
- PBS QoL measure: (LD self-rating scales) I adapted the Guernsey community participation and leisure assessment into easy read, making it easier for clients with LD to utilise. I combined this with an interest checklist. This is currently being piloted throughout the service, as a subsection of the PBS screening tool. The tools aims to identify any disparity between client interest in an activity and the frequency they take part in the activity. Providing insight for their family, carers and clinicians to support them to do activities they would like to do, which is commonly associated with an increased QoL.
- difficulty ensuring the scale is not too long for the population it is designed for, will identify by calculating internal reliability (chronbachs alpha), if scale items towards end lack IR, this suggests that the scale it too long- will identify after piloting.
- difficultly finding clinicians to complete with their clients, to work with people participation to get more participants.
- I am also about the begin research into the impact of clients not attending day centres has on their wellbeing, mental health and deskilling. Within 2 populations; PMLD and PBS pathway.
How do you demonstrate the ability work autonomously?
- How I manage my time: a daily to do list, outlook calendar (colour coded to keep a track of how I am spending my time; split across 2 disciplines.)
- Keep my clinical supervisor informed as to how I am managing my caseload/work, and give honest feedback if I am at full capacity.
- As I have worked longer in the team, especially once promoted to band 4, I have done more 1:1 client worked and been allocated a larger caseload. I ensure that I prioritise my time to meet the needs of the service and clients.
- Schedule visits which a closer together to save time on travel.
- Always complete notes within 24 hours of an appointment.
- If someone sets be a piece of work, I always ask how urgently it is needed for, and set at least a provisional deadline.
What is your understanding of ASD (Autism Spectrum Disorder)?
Autistic Spectrum Disorder is a complex neurodevelopmental disorder, where individuals do not express typical reciprocal social interactions, verbal and nonverbal communication, accompanied by restricted and repetitive behaviours and interests.
- Behaviours usually present in very early childhood (36 months).
- A large proportion of people with autism also have a learning disability (IQ below 70).
- Abilities and challenges of people with autism are largely varying e.g. some people have good language ability, whilst others are non-verbal.
Causes:
- Twin and family studies show us that autism is largely genetic, with multiple gene interactions, and neurobiological abnormalities are not confined to any one region of the brain.
What’s your understanding of Learning Disabilities?
The BPS follows the DSM’s definition of learning disability, with 3 core criteria:
- significant impairment of intellectual functioning (usually IQ less than 70).
- significant impairment of adaptive/social functioning.
- onset before adulthood.
This may impact someones communication, ability to learn new skills, carry out activities of daily living, and understand complex information e.g. risks.
People with learning disabilities have their own unique abilities, strengths and challenges, they are not defined by their disability, and all support should be person centred.
How do you plan on dealing with co morbidities?
- aware that those with LD are more likely to have a mental health problem compared to the general population, but their symptoms are often attributed to their LD. Support communication to help them to communicate how they are feeling and educate families and carers.
- Dysphagia; know signs of dysphagia and refer to SLT if any concerns e.g. coughing, horse sounds voice suggests dysphagia/reflux which can cause a lot of pain if untreated (may be cause of behaviours that challenge). Know risk, and raise urgently and can cause aspiration pneumonia which can be fatal.
- Mobility problems: ensure that location of appointments and recommended activities etc. is always accessible. Check if there is wheelchair access/ accessible toilet/ hoist if needed.
What is your knowledge about risk assessment tools?
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Name a situation when you have used formulation, and what was the outcome of the formulation?
Using the 5Ps Model of Case formulation: (MSS)
Presenting problems: Referred to SLT through PBS pathway for support to implement communication strategies. Presented with behaviours that can be described as challenging; destruction of property, self-harm, shouting/screaming. Joint visit due to red alert on file, could be heard audibly upset from outside the property, decided it was not the right time to start communication intervention. Therefore used the time to gather information with family/carers to better inform intervention.
Predisposing factors:
- Not attended day centre since before Covid-19 pandemic.
- Adults with LD more likely to have dysphagia
- Culture which views LD’s negatively, so Mum does not have lots of support
- Mum getting older and finding it harder to provide support
Precipitating variables:
- Pain from reflux
- Loss of sleep
- Hungry at night time due to lack of routine
Protective factors:
- enjoys sensory games e.g. bubbles, water play
- enjoys spending time with his family
- likes to watch Mum cooking tea
- enjoys going for walks to local park with his carers
- responds well to routine
Perpetuating factors:
- carers only take him to same park, no where new.
- untreated reflux, causing pain that he cannot communicate in a way his family/carers understand
- Out of routine he was used to and previously enjoyed/not attending day centre; causing meals to be eaten sporadically and waking up in the night hungry, also causing reflux and pain.
- Possible nightmares
- Unable to communicate how he is feeling.
What is your understanding of the role of an assistant psychologist?
An assistant psychologist aims to work holistically to improve the lives and promote health and independence for people with learning disabilities.
They do this by:
Support with psychological assessments of individuals referred to CLDS Psychological therapies psychometric tests, self-report measures, rating scales, direct and indirect structured observations and semi-structured interviews.
formulation, and therapeutic interventions, under the supervision of a qualified clinical psychologist.
- Run groups for service users, and their carers/families.
- Support with Positive Behaviour Support Pathway; PBS plans,
- Clinical Audits, research.
- To support with clinical admin work.
- Attend team meetings, and work within a MDT to provide holistic support to service users with a bio psychosocial approach.
- To receive regular supervision, to focus on CPD and self-reflection to constantly learn and improve clinical work.
What is the difference between a psychologist and psychiatrist?
Psychologist: Psychologists study people, how they think, act, react and interact. It’s concerned with all aspects of behaviour, thoughts, and feelings. Takes a bio psychosocial approach to mental health. Provide talking therapy. Get to know clients in great detail.
Psychiatrist: A psychchiatrist has studied a branch of medicine focused on diagnosing and treating mental health conditions, but from a largely biomedical perspective. Although psychiatrists do use psychotherapy to support the patients.
Prescribe medications. Normally have a much larger caseload.
Name a theoretical model you have used in your work.
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What do you expect from a supervisor?
- Check in with my wellbeing.
- Allocate work to me that the believe is within my abilities.
- Able to turn to for support, if I’m unsure or stuck with a case.
- Learn from them; provide constructive feedback and guidance so I can improve my clinical practice.
- Support with my CPD.
- Provide a space for reflection, discussing cases, research, theories and how I might use these going forward.
What are you like as a supervisee?
- Supervision was something that took me a while to understand and use well. When I first started I thought that it was just about making sure I was doing my work.
- However with experience, I have learnt how to utilise supervision to improve my practice, learn and reflect.
- I am open and honest with my supervisor, and always ensure I am prepared for our meetings.
- Open to receiving guidance and constructive feedback.
- I have described as efficient and diligent by my current supervisors.
- I have also been told I am nice to supervise as I present a problem, but also multiple potential ways to resolve the issue.
A time I have used supervision well: I was anticipating a difficult conversation with the key worker at my client’s day centre. They were not implementing any of our recommendations, and had previously been very dismissive on the phone. Although I felt a little embarrassed, I brought this to my clinical supervision, and we discussed how to approach the conversation and role played it so I felt more confident. This allowed me to remain professional whilst advocating for my client.
We reflected that the key worker may feel criticised by the recommendations, and I should recognise all the great work they are doing to support the client at the day centre, so he is more likely to take on board new techniques.
