Learning Disabilities Flashcards
what is a learning disability
- reduced ability to learn new skills
- reduced ability to cope independantly
- started before adulthood
IQ= Below 70
7 casues of LD and examples of each
What is important when taking a hx
Mood
sleep
Bowels
Have they had annual health check
Mild moderate severe LD - differences
Difference between LD and learning difficulty
a learning disability constitutes a condition which affects learning and intelligence across all areas of life. a learning difficulty constitutes a condition which creates an obstacle to a specific form of learning, but does not affect the overall IQ of an individual
what is Diagnostic overshadowing
give examples
Assuming the behavious is down to the learning difficulty and not suspecting an organic cause
3 main physcial causes = constipation, pain, reflux
social = change in carers, berevement, abuse
How to approach a patient with challenging behaviour?
- Ddx: organic cause thats been missed (! OP: dementia in OP, dental pain, eyesight hearing)
- Ddx: mental health (mania, depression, anxiety, OCD, psychosis)
- Focus on Behaviour:
A- Focus on environment
B- Behaviour management plan (triggers, consequences, rewards)
C- Intensive support team LD nurses, antipsychotics
Who is involved in care for LD? How do we refer?
what adjustments can we make?
Order of referral:
- Annual LD health check with GP
- generic services - refer to normal secondry care
- Specialist if needed… Psych review ~ every 3 months
other members of mdt:
- Specialised LD nurses: anger management courses, relationship teaching, intensive support team for behaviour, desensatisation (help with phobias)
- Salt team
- PT if in wheelchairs
Reasonable Adjustments:
- longer apptm
- quiet waiting area, book them first in clinic
- accompanied by carer
- communication aids and easy read leaflets
Important LD reports enquiries
Cipold report 2013 - conficential inquiry into death of LD: 20y sooner death = women
30y sooner death = men
Winterborn view scandal 2010 reports were ignored of care staff abusing residents –> Time for Change Report 2014
How are we addressing LD Inequalities
+ reduce overmedication
NHS England Learning Disabilities Mortality Review Programme
- Green Light Toolkit for Mental Health- access to generic teams
- Death by Indifference Agenda- addressing health inequalities
- Transforming Care Agenda- same rights as you and I
STOMP / STAMP – reducing overmedication;
The Transforming care agenda
The Transforming care agenda:
- reduce people living in LD hospitals (more living at home and with carers)
- prevent admission if poss
- if admitted discharge asap
It is driven by NHS England, national requirement, monitored through weekly reports, partnership approach
Key Legislation (3 acts) and what they mean
Legislation:
- Mental capacity act
different levels of capacity for different things, treat with ‘Best Interest’
- Human rights act
- Equality act
How to communicate with LD? 10 Tips from SALT team
- communication passport = guide as to how they prefer to be communicated with
- Use pics/ sign language (nhs website easy on the eye)
- Low distractions
- Get to same level - (eye contact may be stressful)
- simple language
- dont rush
- get them to summarise
- ‘easy read’ leaflets
- Adapt to the pt needs
- Be nice
Assessment of mental state for learning disabilities :
Developmental Behavior Checklist - dx children
Glasgow Depression Scale - monitor change over time
Dementia questionaires for people with LD:
DLD, DSDS, DSQIID
Test for Severe Impairment (TSI) - monitor change over time
risk assess (7 things to consider)
risk to self
risk to others (including sexual offending)
risk of self-neglect
vulnerability to exploitation
likelihood and severity of any particular risk
potential triggers, causal or maintaining factors
whether safeguarding protocols should be implemented.
