Introduction to Learning Disabilities
What is a learning Disability?
Our Learning Disability services work with individuals who have a learning Disability. Learning Disability is defined as people experiencing global and life long cognitive impairments impacting on all aspects of their lives. The onset of these impairments occur at birth or early in childhood. The old term used to refer to this group is mental retardation, which is a term still being used in the US and internationally but no longer used in the UK. In the UK the term Learning Disability or intellectual Disability is used.
People with Learning Disabilities can range in their abilities from Mild, Moderate to Severe Learning Disabilities. Global levels of cognitive impairments mean that they are less likely to be able to communicate their needs. Those with severe levels of LD may not be able to communicate verbally at all and may rely on vocalisations of sounds and utterances. Developmentally they are likely to be operating at 0-6 months of age.. They are likely to experience a wide range of additional physical health , sensory (hearing loss, poor eyesight etc) , and neurological (i.e. epilepsy) difficulties. In addition to this they are more likely than the general population to experience, behavioural, psychological, emotional and other mental health difficulties.
The range of cognitive, behavioural, physical, communicative and mental health difficulties can make this group to be one of society’s most vulnerable groups. As such they are also more likely to be vulnerable to a range of physical, sexual, financial and emotional abuse. Although Life expectancy for this client group has increased over the years, it is still over 20 years behind that of the general population.
Introduction to our NELFT Adult Learning Disability Services
Our Trust Wide Adult LD services consist of four Locality Community LD teams as well as our inpatient assessment and treatment Unit.
Our community LD teams are integrated with social care and health providers. All four locality teams are co-located with Local Authority providers of LD services, The teams are Multi-Disciplinary consisting of health, social care staff including Physiotherapists, Occupational therapists, Psychiatrists, Nurses, Clinical Psychologists, behavioural specialists, at therapists, Speech & Language therapists, social workers etc.
Our inpatient assessment & treatment unit for people with LD is Moore Ward at Goodmayes Hospital. A dedicated MDT team works with LD clients admitted.
- Reflective Practice groups- Facilitating staff teams to be effective by creating a safe, supportive and non-judgemental space to allow staff to reflect together as a team. Reflective practice groups are facilitated by clinical psychologists within both community teams and in our LD inpatient settings. Reflective practice with teams helps create a more safer, effective staff groups, helping to enhance staff wellbeing. (Linda Batty, Dr. Sidrah Muntaha, Dr. Sarah Gorniak).
- Cognitive Stimulation group therapy - This approach has been known to be effective in working with older adults with dementia, however, we know little about its efficacy for older adults with LD. This group programme has been delivered with adults with LD and Dementia. It was delivered by our LD psychological therapy teams in B&D & Havering ( Dr. Sarah Gorniak & Sarah Hoare)
- Carers Group- Supporting carers of people with LD has been vital in achieving positive outcomes for PwLD. Our Waltham Forest LD Psychological Therapies team have been running support groups for carers with a focus on enabling and equipping carers in managing and supporting PwLD.. This was delivered and supervised by – Nirupama Rao- Clinical Psychologist & care Pathway lead & Saba Hassan- Assistant Psychologists.
- CBT anxiety management group- This was a 10 week group programme for staff & carers of PwLD presenting with anxiety. The programme aims to equip staff & carers with the skills and expertise to help better manage the high levels of anxiety experienced by PwLD they support. It utilises a lay therapist model of Cognitive Behavioural approach in managing anxiety in PwLD. A mixture of didactic and experiential methods were used to help carers/staff work through the application of the model with their LD relative’s clinical presentation. The outcomes of the group programme were evaluated. This group programme was delivered by Dr. Sabiha Azmi & trainee Clinical psychologists.
- Challenging behaviour- A range of training and group programmes have been delivered to help staff & carers better manage behavioural challenges presented by PwLD. Using a Positive Behavioural Support model our behavioural analysts and clinical psychologists have been working with teams, staff and carers to achieve better outcomes for PwLD presenting with behavioural challenges. Our Behavioural analysts Kate Blamires, Ray Nambiar have been at the forefront in delivering these programmes.
Tree of life: This is a Narrative based approach that has been used with both LD service users and LD staff groups. This was used with groups of LD service users who are frequent users of A&E services. The outcomes of the programme using this model have been very positive. The approach has been also used with MDT staff groups as part of an away day to help facilitate the development of an effective LD Strategy. Dr. Lisa Monaghan and colleagues have led on this work).
Learning Disability - Research & Development
Research, innovation and development is an important of our work in LD services. Continuously aiming to improve our services by contributing to R&D activities. This is a sample of some of our R&D activities.
- Feasibility study -Lay therapist CBT Anxiety management group programme for people with Learning Disability. Dr. Sabiha Azmi. Consultant Clinical Psychologist. LD Psychological Services.
There has been much research evidence to suggest that People with LD are more likely to experience higher levels of anxiety and mental health difficulties than the general adult population.
The effectiveness of CTBT approaches in managing anxiety and depression has been well documented for the general adult population, however the evidence base on its effectiveness for PwLD is less clear. A literature review of the evidence base was undertaken to assess the effectiveness of this approach for PwL. The review highlighted clearly the sustained effectiveness is determined by staff and carers ability to help support PwLD to use the approach on a consistent basis over a prolonged period of time. PwLD often require support in the form of prompts, reminders and cues to help reinforce the implementation of the model on a day to day basis in managing their anxiety. However, staff and carers were only able to do this if they themselves were taught and supported on how to utilise this approach in supporting PwLD. As part of the study, staff & carers were trained and supervised to deliver a 12 week CBT anxiety management group programme for PwLD. Pre, during and post measures were used help evaluate the effectiveness of this approach in helping PwLD manage their day to day anxiety.
- A feasibility randomised controlled trial of Individual Cognitive Stimulation Therapy in People with Dementia and Learning Disabilities- Dr. Afia Ali- Consultant Psychiatriasts. Waltham Forest CTLD
Individual Cognitive Stimulation Therapy (CST) is a treatment for dementia that involves the individual with dementia taking part in activities such as a life story, discussion of current affairs, puzzles and being creative, which is designed to be mentally stimulating. There is evidence that group CST is effective in improving cognition in people with dementia in the general population. CST is now widely available for people with dementia in the general population but it is not used in people with dementia who have learning disabilities.
There is also some evidence that individual CST may be beneficial when it is given by carers to people with dementia in the general population.
In the research study the intervention will involve carers delivering the activities, based on a manual, to the service user with dementia and Learning disabilities. Each session will last 30 minutes and carers and service users with dementia will take part in two sessions each week for 20 weeks (a total of 40 sessions).
The outcomes of the intervention will be evaluated as part of the study programme.
Older Adult & LD Dementia Strategy and Care Pathway - LD Psychological Services for older adults with LD & Dementia
People with Learning Disabilities are now living longer than the past. It is predicted that the proportion of people with LD (PwLD) over 65 years of age will have doubled by 2020, with over a third of all people with intellectual disabilities being over 50 years of age by that time (Janicki & Dalton, 2000). This has resulted in a growing population of older adults with Down’s syndrome.
People with LD are four times more likely to develop dementia at an earlier age than the general population. This rate is even higher for people with Downs Syndrome.
Now more than ever consideration needs to be given to age-related illnesses that most commonly occur in later life.
NELFT LD Psychological services have been working on developing an Older adults with LD dementia Strategy and Care pathway to provide specialist psychological assessments, interventions and support for both older adults with LD and younger people with LD who may be presenting with age related emotional, psychological and mental health difficulties.
Our services work along both specialist and mainstream services, such as social care, old age and memory services, voluntary services and LD multi-disciplinary teams across the Trust Wide NELFT Localities. The care Pathway aims to provide specialist psychological assessments and interventions for older adults with learning disabilities who may be experiencing difficulties as they age such as: Dementia, anxiety, challenging behaviours, relationship issues, loss and bereavement.
Providing Psychological assessments for older people with LD enables a greater understanding of the difficulties that the individual may be experiencing. A range of therapeutic interventions may be offered to the individual to facilitate them to overcome these difficulties and continue to have valued lives in their community. This Trust Wide service also works with individuals, carers, teams and services that support people with LD. This is to offer practical and emotional supports for family and formal carers as well as education and training opportunities for individuals, teams and services that work alongside people with LD. These specialist interventions are offered to both raise awareness of and meet the changing needs of people with LD as they age.
“Somethings are good about getting older, but some things are harder… for us and our families. It’s good to know we can get support when we need it”.