Definition, diagnosis and legislative framework These resources give guidance on the definition of learning disability, the diagnosis of learning disabilities and the legislative framework that applies to the people with a learning disability. Definition, Guidance and Legislation applying to people with learning disability Learning disability read codes IHAL letter for parents and carers. Resources These guides present a range of external guidance and resources on learning disability.
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Follow us Facebook Twitter YouTube. Built by Spindogs. Communicate directly with the person with a disability rather than to a family member or caregiver who is with the patient. Although Ms. Since Ms. Determine what assistance is needed to transfer the patient safely from a wheelchair to an exam table so that a complete assessment, including pelvic or testicular and rectal exam, can be conducted if indicated.
In preparation for the physical exam that will be conducted by the nurse practitioner, it would be appropriate to ask Ms. Do you need assistance removing your coat and putting on a gown? The health history and physical assessment should address the same issues that would be addressed with a person without a disability. For example, the health history should include sexuality, sexual function, reproductive health issues, preventive health care practices, and lifestyle behaviors.
Assume that a person with a disability participates in the same activities and behaviors as those without a disability. When obtaining the health history and conducting the physical assessment, it is important to ask the same questions you would ask of any other patient. What kind of exercise do you do? How often do you exercise? When was your last GYN exam? When did you have your last mammogram? Were you able to stand for the mammogram? Have you had a colonoscopy?
Have you ever had a DEXA to assess your bone density? Are you sexually active? Although some disability groups [e. When referring to Ms. Do you have difficulty doing so? Many individuals with disabilities do not receive health care as often as is recommended because of transportation issues and other barriers, including failure of clinical facilities and staff to provide accommodations that enable them to participate in health care and screening, so it is important to ask about those issues.
How has it limited your ability to receive care? Questions should be asked privately when no one else, including family and care providers, is in the room or able to overhear the conversation. Questions specific to abuse of persons with disability include: Have they been prevented from using wheelchair, cane, respirator, or other assistive device; have they been refused help for important personal needs [taking medications, getting to bathroom, getting out of bed, getting dressed, getting food or drink].
After asking her daughter to leave the room for a few minutes, it is appropriate to ask Ms. Have you ever had any concerns about your safety? Has anyone prevented you from using your scooter or other assistive devices? Has anyone prevented you from receiving the help or care you need?
Ask about previous falls and injuries due to falls. Ask about impaired balance, muscle weakness, changes in gait, changes in vision, confusion. Ask if assistive devices are available and used to prevent falls. So questions about her risk for falls are very relevant and appropriate. Tell me about the times you have fallen and any injuries you have had as a result of a fall.
Do you have strategies to reduce your risk for falling and sustaining injury from falling? If a person with a disability has depression, treatment should be offered just as any other patient would have treatment offered. It is appropriate to ask Ms. Further, individuals with disabilities who are depressed should be evaluated and appropriate treatment for depression should be provided. Do you have days when your mood keeps you from wanting to get out of bed or leave the house or your room?
Have you ever been treated for depression? Secondary conditions are those conditions that result from having a disability or result from treatment of a disability [e.
Identify barriers to health care that may increase risk of secondary conditions [e. It is important to determine if she is at risk for other secondary conditions, such as pressure ulcers and other health problems that may be related to transportation barriers or non-participation in health promotion activities, such as lack of exercise weight gain, increased cardiovascular risks. What strategies have you used to reduce your risk for falling? What strategies do you use to reduce the risk of injury when you do fall?
Does anything hold you back from being able to do things you would like to do? Identify accommodations needed during hospital stay or when out of the home. Accommodations may range from use of assistive devices or simple rearrangement of the home to structural modifications that enable the person with a disability to remain in the home and to participate safely in his or her preferred setting.
Home care nurses and therapists [occupational or physical therapists] can be helpful in assessing the home environment and suggesting modifications that would increase the ability of individuals with a disability to function safely in their own home. Determine if patient has or requires a bladder or bowel management program, uses alternative approaches to eating and drinking fluids, or has had a procedure to make management of bowel, bladder, and nutrition possible [e.
Have you ever fallen when using your assistive devices, or when not using the devices or when transferring from the scooter? For example, sexual risk assessment may be crucial to pre-sentence reports, parole assessments, community management plans such as MAPPA or community mental health teams, in-patient services managing restricted patients, tribunal reports — the list is endless! The RSVP is a sex offender risk assessment tool that follows the structured professional judgement approach to the assessment and management of sexual violence risk.
This structured professional judgement approach is similar in nature to that taken by the popular HCR v3. The RSVP guides the assessor in considering information, identifying risk factors that are present and relevant, formulating risk, generating potential future risk scenarios and creating appropriate risk management plans. The SVR version 2 is a similar tool, recently updated, and the training will provide an overview of this tool so that participants feel confident in applying both tools only RSVP manual will be provided and delegates will be signposted to where they can purchase the SVRv2 manual.
It is widely accepted in forensic risk assessment that structured professional judgement performs better than clinical judgement alone, and appropriate training is the key to thorough and defensible assessment. The primary aim of the workshop is to ensure that delegates feel confident when assessing clients using the RSVP and to develop awareness of how risk management plans can be formulated.
The training event does not aim to cover broad theories of sexual offending, as the focus is risk assessment. However, the majority of studies report poor agreement Akande ; Crawford ; Duker ; Durand ; Kearney ; Koritsas ; Newton ; Shogren ; Sigafoos ; Spreat ; Thompson ; Zarcone There have been mixed findings about the factor structure of the MAS.
Several studies have failed to replicate the original factor structure of the MAS Duker ; Kearney ; Joosten ; Koritsas and others have offered support for the structure in institutional but not school samples Bihm ; Singh Durand found that teachers' ratings on the MAS predicted their students' behaviour in experimental conditions. The QABF is a item report completed by unpaid and paid carers. It is designed to identify behavioural functions that are important in maintaining aberrant behaviour in children and adults.
The 5 subscales of the assessment relate to 5 possible variables influencing problem behaviour: Attention; Escape from Task Demands or Social Contact; Non-social Reinforcement; Physical Discomfort; and Tangible Reinforcement. Scores have been found to be stable over time indicating good test-retest reliability Paclawskyj ; Zaja Watkins also demonstrated that the QABF identified the same behavioural functions in participants when compared with a brief functional analysis.
Participants with treatments developed from functional assessment QABF results have been found to improve significantly when compared with controls receiving standard treatments not based on functional analysis Matson b. Paclawskyj replicated the original 5-factor solution. Nicholson also found 5 factors that corresponded to the 5 subscales of the QABF, however the analysis suggested the existence of a 6th factor with a high loading from only a single item, concerning the repetitive nature of the behaviour.
The proposed explanation for this was that respondents differentiated repetitiveness of behaviour from aspects suggesting sensory or other automatic reinforcement. No studies assessing the cost effectiveness of methods and tools for the assessment of behaviour that challenges displayed by people with a learning disability were identified by the systematic search of the literature undertaken for this guideline.
Details on the methods used for the systematic search of the economic literature are described in Chapter 3. No evidence on the cost effectiveness of methods and tools for the assessment of behaviour that challenges displayed by people with a learning disability is available. The recommendations that were developed from this section and the link to the evidence are at the end of the chapter see Section 8.
The GDG considered the review of the utility of methods and tools used to assess behaviour that challenges alongside the reviews of other instruments because they saw the benefit of developing an integrated approach to assessment. Clinical review protocol summary for the review of the utility of methods used to assess and monitor carers' capacity to support the person. The search for evidence supplemented by GDG advice identified 8 studies that met the eligibility criteria for this review: Chao Chao et al.
The evidence is organised by instrument and grouped within the following domains: carer burnout, carer needs and carer stress. The MBI is a self-report instrument with 22 items developed to assess burnout in professional paid carers.
Chao found that while a 3-factor solution suggested an acceptable fit for the data, a 4-factor solution provided a better fit than the original 3-factor solution. Items on the 3 subscales all had positive loadings greater than 0. Of the 22 items, 19 loaded above 0. The SWC-R a item self-report questionnaire for adults to represent thoughts and actions used to deal with the demands of a stressful encounter.
The measure is scored on 2 subscales which represent distinct ways of coping: Practical Coping and Wishful Thinking.
Subscale scores were stable over time demonstrating good test-retest reliability: paired t-tests showing no significant differences between measurements over a month period Hatton b.
A significant association has been found between Wishful Thinking scores and distress scores Hatton b. It has 66 items and takes approximately 10 minutes to complete. As in the SWC-R, it is used to represent thoughts and actions that can be used to deal with the demands of a stressful encounter. For fathers, all except the Stoicism subscale showed adequate levels.
In a study that included participants with Down's syndrome only, subscales resulting from factor analysis were found to be similar to those reported in earlier studies, with differences attributable to variations of personal and situational variables Knussen The QRS-F is a item self-report questionnaire for families and carers, used widely with parents of children with disabilities.
It assesses 4 subcomponents of parental perceptions: parent and family problems stressful aspects of the impact of the child with disability on parents and the wider family , pessimism parents' pessimistic beliefs about the child's future , child characteristics features of the child that are associated with increased demands on parents , and physical incapacity the extent to which the child is able to perform a range of typical activities. The QRS-F is a free instrument. Scott successfully replicated the 4-factor solution found by Friedrich Scores have been found to vary reliably depending on the child's type of learning disability, which supports criterion validity Scott In a sample of participants with autism only, Honey did not find a 2- or 3-factor structure that had any resemblance to the existing QRS-F scales.
Rather, the majority of the items loaded significantly onto the first factor extracted in most analyses. No studies assessing the cost effectiveness of methods used to assess and monitor the capacity of carers to support a person with a learning disability and behaviour that challenges were identified by the systematic search of the literature undertaken for this guideline. No evidence on the cost effectiveness of methods used to assess and monitor the capacity of carers to support a person with a learning disability and behaviour that challenges is available.
View in own window. When assessing behaviour that challenges shown by children, young people and adults with a learning disability follow a phased approach, aiming to gain a functional understanding of why the behaviour occurs. Start with initial assessment and move on to further assessment if, for example, intervention has not been effective or the function of the behaviour is not clear see recommendations 24— Develop a behaviour support plan see recommendation 33 as soon as possible.
Explain to the person and their family members or carers how they will be told about the outcome of any assessment of behaviour that challenges. Ensure that feedback is personalised and involves a family member, carer or advocate to support the person and help them to understand the feedback if needed. If behaviour that challenges is emerging or apparent, or a family member, carer or member of staff such as a teacher or care worker , has concerns about behaviour, carry out initial assessment that includes:.
Consider using a formal rating scale for example, the Aberrant Behavior Checklist or Adaptive Behavior Scale to provide baseline levels for the behaviour and a scale such as the Functional Analysis Screening Tool to help understand its function.
As part of initial assessment of behaviour that challenges, take into account:. After initial assessment, develop a written statement formulation that sets out an understanding of what has led to the behaviour that challenges and the function of the behaviour.
Use this to develop a behaviour support plan see recommendation Assess and regularly review the following areas of risk during any assessment of behaviour that challenges:. If the behaviour that challenges is severe or complex, or does not respond to the behaviour support plan, review the plan and carry out further assessment that is multidisciplinary and draws on skills from specialist services see recommendation 15 , covering any areas not fully explored by initial assessment see recommendation Carry out a functional assessment see recommendations , identifying and evaluating any factors that may provoke or maintain the behaviour.
Consider using formal for example, the Adaptive Behavior Scale or the Aberrant Behavior Checklist and idiographic personalised measures to assess the severity of the behaviour and the progress of any intervention. Carry out a functional assessment of the behaviour that challenges to help inform decisions about interventions. This should include:. Vary the complexity and intensity of the functional assessment according to the complexity and intensity of behaviour that challenges, following a phased approach as set out below.
After further assessment, re-evaluate the written statement formulation and adjust the behaviour support plan if necessary. Develop a written behaviour support plan for children, young people and adults with a learning disability and behaviour that challenges that is based on a shared understanding about the function of the behaviour. This should:.
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