Working with Intellectual Disabilities Flashcards
What is an ID?
Called learning disability as well
Department of health defined it as having 3 aspects (not just IQ)
reduced ability to understand info and learn skills
reduced ability to cope independently
condition that started before adulthood and is long term
How can we measure IQ?
It is a mili-faceted concept so it hard to apply it
Psychometrics - neuropsychological assessments
The Wechsler Adult Intelligence Scale - full scare IQ - determined by a number of different assessments done with a person:
Verbal IQ
Performance IQ
How is IQ reported?
Average = 100
When should IQ tests be used?
If they are designed for individuals not groups
They are constructed on the basis of the normal distribution of general intelligence
Reliable and valid
Based on multidimensional, hierachical model of intelligence - not just one score, lots of scores
How can ID be characterised?
Mild
Moderate
Severe
Profoundc
should be doing IQ tests, assessments, home and school assessments et
Why is physical and psychological health important for these people?
People with an ID are more likely to develop physical and psychological health difficulties
but they are less likely to access services:
less than 55% of eligible adults with an intellectual disability received a health check in 2010
increased need but less likely to accept the services
Why are mental health services important for ID?
People with an intellectual disability are more at risk of:
Vulnerability to abuse
Higher social deprivation
Poor communication skills so less able to communicate when feeling anxious/low in mood
All of which are risk factors for poor metal health
How did they used to be treated?
Hospitalisation was the dominant model till 1980’s - Bedlam hospital
1953 - nearly half of NHS beds were more mental illness or ID - concerns about the level of spending were likely to be a factor in changing towards community care
1961 - mental health hospitals to close in 15 years
1980’90’s - shift to care in the community model, client focussed mental health therapy
What are the psychological approaches for this group?
British Psychological Society suggest that ‘‘to promote valued, inclusive lives for people with learning disabilities. Much of our work is with those with complex needs and this value base guides our clinical interventions’’ - should be promoting and enabling them to get access to therapies
What should be focussed on when working with these?
Assessment of capacity
Behaviours that challenge services
People with mental health difficulties
People with Autistic Spectrum conditions
People with dementia or who are at risk of developing dementia
Offenders and those at risk of offending
People with profound and multiple intellectual disability
People with physical health needs
Supporting parents who have an intellectual disability
Who are the community learning disability teams?
Community learning disability nurses Speech and Language Therapists Clinical Psychologists Occupational Therapists Physiotherapists Psychiatrists Social workers/care managers
Who do they work with?
Individuals Groups Families Staff teams Services Multidisciplinary
How might clinical work be different?
Focus on behavioural work - challenging behaviour or behaviour that challenges - puts others at risk, or prevent the use of community facilities or a normal home life
Could be in the form of aggression, self-injury, stereotyped behaviour, disruptive behaviour
Why don’t you use the label challenging behaviour anymore?
Stereotypes - lead to stigma
It is normal - in people with LD it can be seen as an appropriate response to the forces affected them in lives - serves a purpose
What are the NICE guidelines for working with ID on a behavioural level?
Positive behavioural support
What is positive behavioural support? PBS
Using positive behavioural support to manage that challenges
Aim: Understand the meaning of behaviour for an individual and the context in which the behaviours occur
Start to deconstruct the behaviour and what is causing it, can lead to teaching them another way of behaviour
What are key elements of PBS?
Functional analysis to understand what purpose the behaviour serves
Inclusion of stakeholder perspective/involvement
Use of ecological strategies to ensure environment meets the persons needs
Support strategies to manage environment and reduce need to reactive behaviour
Enhance quality of life outcomes for people
What is a functional analysis?
A tool used as part of a wider assessment which examines behaviour that is challenging at three stages
ABC
A - antecedent (what happens before, trigger)
B - behaviour (what does the person do)
C - consequences (what does the person do as a result)
ABC chart - build up a rich picture of what is happening to this person
What function does challenging behaviour serve?
Social attention
Tangibles - something that can be touched, real
Escape
Sensory
What are the behavioural interventions?
Address antecedents - triggers Address consequences (reinforces) - remove if making someone do something Address function
therapist is directive and work is done through others
What are CBT interventions?
CBT is effective for people with an ID but adaptations need to be made to ensure the client can engage with the model - evidence it works for people with mild-moderate LD
What are the requirements for CBT?
Emotional recognition Naming and reporting emotions Linking situation to mood Identifying and reporting thoughts - thoughts linked to behaviour, so if you can change thoughts, can change behaviour Memory - hold in mind information from one session to the next Oriented in time/space Sequencing Understanding cause and effect Rating moods and beliefs Recording- writing, reading Evaluating
What modifications need to be made to CBT?
Consider alterations to though records/diaries e.g. Dictaphones (record session to remember what happened in the session) or images during discussion
Structure during sessions is important
Allow more time (more sessions) and consider more behavioral work
For homework use more visual aids/supportive strategies
Consider engaging the system family/carers around the individual in therapy/homework if you have permission from your client
What did Shankland and Dagnan find?
Online survey of IAPT practitioners in 4 IAPT services - problems of adapting theories to people with ID
Found:
Most people reported having worked with people with intellectual disabilities and identify the need to adapt therapy, but believe it should be offered within mainstream services
Those who report more positive outcomes and more barriers are more confident in therapy and more positive attitudes
Most people said that therapy can be provided to these people (84.6%), however a few said it couldn’t (15.4%)
Why should / shouldn’t therapy be offered to these people? Shankland and Dagnan
Equality (adapting to meet needs)
Therapists negative expectations (hard without more training, not possible with severe impairment)
Specific problems with mainstream set up (time constraints, difficulties with understanding and communication, engagement) Positive solutions (specialist training for therapists, adapted material, flexibility in sessions)
