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Understand the legislation and policies that support the human rights and inclusion of individuals with learning disabilities Essay

 

The following legislations and policies is by no means an exhaustive list, but does outline some of the main areas of law which promote an individual with learning disabilities rights The Mental Capacity Act (MCA) 2005 – was introduced in England and Wales in 2007 and aims to protect the rights of people whose mental capacity is in doubt and people without mental capacity. It provides the framework for making decisions on behalf of others. It tells us what to do if we are involved in the care, treatment or support of people aged 16 and over who may lack capacity to make decisions.

The Act states that everyone is assumed to make decisions for themselves unless shown otherwise. If it is not clear whether someone has the capacity to make a decision concerning a specific issue an assessment of their capacity should be carried out. The Mental Health Act 1983 – The Court of Protection exists to safeguard the interests of anyone who is ‘incapable by reason of mental disorder of managing and administering his property and affairs’. Anyone found on medical evidence to meet these criteria is known as ‘a patient’. The Court’s duties are normally carried out by appointing a receiver for a patient.

The Mental Health Act 1983 gives the Court power to authorise virtually any transaction on behalf of a patient and to do whatever is necessary or expedient for the maintenance or benefit of the patient, his family and dependants. The NHS and Community Care Act 1990 – made all the legal changes necessary for the implementation of the Caring for people White Paper. Local authorities, in collaboration with health-service and independent-sector agencies, now became responsible for assessing need, designing care packages and ensuring their delivery.

Local authorities were made responsible, under the NHS and Community Care Act 1990, for the registration and inspection of homes and other community services either purchased or provided by them. The Equality Act 2010 – The act covers nine protected characteristics, which cannot be used as a reason to treat people unfairly. Every person has one or more of the protected characteristics, so the act protects everyone against unfair treatment. They protected characteristics are: •Age

•disability
•gender reassignment
•marriage and civil partnership
•pregnancy and maternity
•race
•religion or belief
•sex
•sexual orientation
The Equality Act sets out the different ways in which it is unlawful to treat someone, such as direct and indirect discrimination, harassment, victimisation and failing to make a reasonable adjustment for a disabled person. Human Rights Act 1998 – means that residents of the United Kingdom will now be able to seek help from the courts if they believe that their human rights have been infringed. It is likely that anyone working within health and social care will be working within the provision of the Human Rights Act. With the introduction of the Act, the Government had to show commitment to protecting the most vulnerable adults as well as children.

In the past some people had not always been able to access their rights, this will now be regarded as a violation of an individual’s human rights. Every Child Matters: Change for Children (2004) – outlines the government’s approach to the well-being of children and young people from birth to age 19. The aim is that every child, whatever their background or circumstances should have the support they need to:

•Be healthy
•Stay safe
•Enjoy and achieve
•Make a positive contribution
•Achieve economic well-being

The General Social Care Council (GSCC) Code of practice

Code of Practice for Social Care Workers Social care workers must:

1. Protect the rights and promote the interests of service users and carers 2. Strive to establish and maintain the trust and confidence of service users and carers 3. Promote the independence of service users whilst protecting them as far as possible from danger or harm 4. Respect the rights of service users whilst seeking to ensure that their behaviour does not harm themselves or other people 5. Uphold public trust and confidence in social care services; and 6. be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills

Care Quality Commission (CQC)
Are the independent regulator of health and social care in England. The Care Quality Commission is the independent regulator of health and adult social care services in England. It also protects the interests of people whose rights are restricted under the Mental Health Act. Whether services are provided by the NHS, local authorities, private companies or voluntary organisations, the CQC will make sure that people get better care by: •Driving improvement across health and adult social care. •Putting people first and championing their rights.

• Acting swiftly to remedy bad practice.
Gathering and using knowledge and expertise, and working with others

Essential standards for quality and safety – Compliance Criteria There is a relatively new law about regulating health and adult social care in England. It replaces the National minimum standards. From 1 October 2010, every health and adult social care service in England is legally responsible for making sure it meets new essential standards of quality and safety. Providers must show they are meeting essential standards as part of a new registration system which focuses on people rather than policies, on outcomes rather than systems. The essential standards relate to important aspects of care such as involvement and information for people, personalised care and treatment, safety and safeguarding.

The Community Care (Direct Payments) Act 1996 – gave local authority social services departments power to make direct cash payments to some individuals in lieu of the community care services they had been assessed as needing, to enable them to secure the relevant services for themselves.

NHS and Community Care Act 1990 – The act was brought in to promote community care. Local social service departments have an overall responsibility for community care and have to publish a regular plan about how this care will be delivered. The responsibility places a duty on authorities to assess people for social care and provide the support they require. The act established the familiar procedures of ‘care management’ (social services) or ‘care programme approach’ (NHS) which the statutory departments now operate to. A mixed economy of care is promoted with the independent, private and voluntary sectors being encouraged to provide resources. Valuing People (Department of Health, 2001)

stresses the important role that Person Centred Planning can play in helping people with learning difficulties take charge of their own lives. The Guidance (Department of Health, 2002) stressed that Person Centred Planning is not a professional activity done to people; instead people themselves and their friends, families or other allies, must lead it. However, professional services still have an enormous role to play in responding in a more person centred way to people with learning difficulties. “For 2009 -10 the key priorities include: to ensure that the Personalisation agenda is embedded within all local authority services and developments for people with learning disabilities and their family carers, and is underpinned by person centred planning.”

‘Valuing People Now’, is the ‘refresh’ of this white paper in 2009 and is a
new three-year strategy for people with learning disabilities (2009), DH; The new paper is a cross-government consultation which sets the agenda for people with learning disabilities across a range of key issues including health and well-being, housing, employment and inclusion in the community. It builds on the vision set out in Valuing People – A New Strategy for Learning Disability for the 21st Century, which was published in 2001 and outlined policy intended to improve the lives and chances for people with learning disabilities.

This new paper says what the Government thinks should happen for the next three years. It indicates that Valuing People was right but concedes that some areas need more attention and adds further policies. Valuing People Now focuses on the following key areas for the next three years: •Personalisation – having choice and control through individual budgets, direct payments and person centred planning •What people do in the daytime and evening – helping them to be more socially included with access to paid work •Better health care in mainstream NHS services

•Better access to housing especially real tenancies and home ownership •What should be done so that Valuing People becomes a reality for everyone 2. explain how this legislation and policies influence the day to day experiences of individuals with learning disabilities and their families.

These legislations and policies ensure that the individuals with learning disabilities and their families are treated, fairly and equally and not discriminated against. They are able to lead a fully inclusive life, take charge of their own lives and destiny and be involved in their care plan and how their care is delivered. They also ensure their voice is heard and they receive appropriate care, are able to make their own choices, are aware of their rights and entitlements, are not discriminated against and are protected from harm and abuse.

Outcome 2 Understand the nature and characteristics of learning disability
The learner can:
1. explain what is meant by ‘learning disability’

The World Health Organisation defines learning disabilities as:

“a state of arrested or incomplete development of mind”.

•Learning disability is a diagnosis, but it is not a disease, nor is it a physical or mental illness. Unlike the latter, so far as we know it is not treatable. Internationally three criteria are regarded as requiring to be met before learning disabilities can be identified: • Intellectual impairment

• Social or adaptive dysfunction
• Early onset
A learning disability is a lifelong condition of intellectual disability often starting at an early age. It results in a reduced ability to learn new skills, understand complex information or live independently. Because of these difficulties with learning, the person may have difficulties with a number of social tasks, for example communication, self-care, awareness of health and safety. Learning disabilities have a lasting effect on development socially and educationally, and can often be combined with physical conditions such as reduced functional skills. Individuals with a learning disability have an intellectual disability, which is generally associated with the following: •The condition causing the learning disability usually started at an early age, sometimes before the person was born. However, for most of the individuals who have a learning disability, the cause remains unknown •There is a lasting effect on development; socially and educationally

•There is often, but not always, a degree of brain damage associated with the condition and this may lead to other challenges for the individual such as epilepsy, cerebral palsy and sensory impairments relating to vision and hearing •There is a reduced ability to learn new skills and understand new ideas or complex information •There is a reduced ability to cope and manage independently PMLD Stands for profound and multiple learning difficulties (PMLD) (or MDVI – multiple disability and visually impaired). There is no accepted definition of profound and multiple learning disabilities, but it is commonly associated with pronounced Developmental Delay with significant physical and sensory impairments and Epilepsy.

Most people with profound and multiple disabilities will have physical disabilities and will be unable to walk and have to use a wheelchair. They may have hearing and sight problems. They will communicate non-verbally, that is, they will not speak or if they do, will use only a few words. Some may use signs and symbols or look and point to what they want. All children and adults with PMLD or MDVI will need a high level of support with most aspects of their daily lives •Difficulties with reading, writing and comprehension;

•Unable to understand and retain basic mathematical skills and concepts; •Limited vocabulary and communication skills
•Short attention span
•Under developed co-ordination skills
•Lack of logical reasoning;
•Inability to transfer and apply skills to different situations; •Have difficulty remembering what has been taught.

2. give examples of causes of learning disabilities

There is often no known cause of learning disabilities; where a cause can be identified it falls into the following categories:

Before birth
•Chromosome abnormalities such as Down’s Syndrome, Tuberous Sclerosis •Infection. e.g. Rubella
•Lack of oxygen to the foetus (Anoxia)
•Trauma (e.g. accident or injury in some way)
•Vaccine damage
•Poisons. e.g. drugs (legal or illicit), alcohol, smoking, and lead Birth Complications
•Asphyxia and anoxia
•Obstructed birth and extended labour
•Instrument birth and brain damage
•Extreme prematurity and very low birth weight
Postnatal reasons
•Infections e.g. Meningitis
•Trauma e.g. accident, injury, child abuse
•Metabolic or disorders of nutrition and growth e.g. Phenylketonuria •Social deprivation

3. describe the medical and social models of disability

Medical model of disability

Under the medical model, disabled people are defined by their illness or medical condition. They are disempowered: medical diagnoses are used to regulate and control access to social benefits, housing, education, leisure and employment.

The medical model promotes the view of a disabled person as dependent and needing to be cured or cared for, and it justifies the way in which disabled people have been systematically excluded from society. The disabled person is the problem, not society. Control resides firmly with professionals; choices for the individual are limited to the options provided and approved by the ‘helping’ expert.

The medical model is sometimes known as the ‘individual model’ because it promotes the notion that it is the individual disabled person who must adapt to the way in which society is constructed and organised.

The medical model is vigorously rejected by organisations of disabled people, but it still pervades many attitudes towards disabled people.

Social model of disability

The social model has been developed by disabled people in response to the medical model and the impact it has had on their lives.

Under the social model, disability is caused by the society in which we live and is not the ‘fault’ of an individual disabled person, or an inUnit 4222-245 Understand the context of supporting individuals with learning
disabilities (LD 201)

Outcome 1 Understand the legislation and policies that support the human rights and inclusion of individuals with learning
disabilities
The learner can:
1. identify legislation and policies that are designed to promote the human rights, inclusion, equal life chances and citizenship of individuals with learning disabilities

The following legislations and policies is by no means an exhaustive list, but does outline some of the main areas of law which promote an individual with learning disabilities rights The Mental Capacity Act (MCA) 2005 – was introduced in England and Wales in 2007 and aims to protect the rights of people whose mental capacity is in doubt and people without mental capacity. It provides the framework for making decisions on behalf of others. It tells us what to do if we are involved in the care, treatment or support of people aged 16 and over who may lack capacity to make decisions.

The Act states that everyone is assumed to make decisions for themselves unless shown otherwise. If it is not clear whether someone has the capacity to make a decision concerning a specific issue an assessment of their capacity should be carried out. The Mental Health Act 1983 – The Court of Protection exists to safeguard the interests of anyone who is ‘incapable by reason of mental disorder of managing and administering his property and affairs’. Anyone found on medical evidence to meet these criteria is known as ‘a patient’. The Court’s duties are normally carried out by appointing a receiver for a patient.

The Mental Health Act 1983 gives the Court power to authorise virtually any transaction on behalf of a patient and to do whatever is necessary or expedient for the maintenance or benefit of the patient, his family and dependants. The NHS and Community Care Act 1990 – made all the legal changes necessary for the implementation of the Caring for people White Paper. Local authorities, in collaboration with health-service and independent-sector agencies, now became responsible for assessing need, designing care packages and ensuring their delivery.

Local authorities were made responsible, under the NHS and Community Care Act 1990, for the registration and inspection of homes and other community services either purchased or provided by them. The Equality Act 2010 – The act covers nine protected characteristics, which cannot be used as a reason to treat people unfairly. Every person has one or more of the protected characteristics, so the act protects everyone against unfair treatment. They protected characteristics are: •Age

•disability
•gender reassignment
•marriage and civil partnership
•pregnancy and maternity
•race
•religion or belief
•sex
•sexual orientation
The Equality Act sets out the different ways in which it is unlawful to treat someone, such as direct and indirect discrimination, harassment, victimisation and failing to make a reasonable adjustment for a disabled person. Human Rights Act 1998 – means that residents of the United Kingdom will now be able to seek help from the courts if they believe that their human rights have been infringed. It is likely that anyone working within health and social care will be working within the provision of the Human Rights Act. With the introduction of the Act, the Government had to show commitment to protecting the most vulnerable adults as well as children.

In the past some people had not always been able to access their rights, this will now be regarded as a violation of an individual’s human rights. Every Child Matters: Change for Children (2004) – outlines the government’s approach to the well-being of children and young people from birth to age 19. The aim is that every child, whatever their background or circumstances should have the support they need to:

•Be healthy
•Stay safe
•Enjoy and achieve
•Make a positive contribution
•Achieve economic well-being

The General Social Care Council (GSCC) Code of practice

Code of Practice for Social Care Workers Social care workers must:

1. Protect the rights and promote the interests of service users and carers 2. Strive to establish and maintain the trust and confidence of service users and carers 3. Promote the independence of service users whilst protecting them as far as possible from danger or harm 4. Respect the rights of service users whilst seeking to ensure that their behaviour does not harm themselves or other people 5. Uphold public trust and confidence in social care services; and 6. be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills

Care Quality Commission (CQC)
Are the independent regulator of health and social care in England. The Care Quality Commission is the independent regulator of health and adult social care services in England. It also protects the interests of people whose rights are restricted under the Mental Health Act. Whether services are provided by the NHS, local authorities, private companies or voluntary organisations, the CQC will make sure that people get better care by: •Driving improvement across health and adult social care. •Putting people first and championing their rights.

• Acting swiftly to remedy bad practice.
Gathering and using knowledge and expertise, and working with others

Essential standards for quality and safety – Compliance Criteria There is a relatively new law about regulating health and adult social care in England. It replaces the National minimum standards. From 1 October 2010, every health and adult social care service in England is legally responsible for making sure it meets new essential standards of quality and safety. Providers must show they are meeting essential standards as part of a new registration system which focuses on people rather than policies, on outcomes rather than systems. The essential standards relate to important aspects of care such as involvement and information for people, personalised care and treatment, safety and safeguarding.

The Community Care (Direct Payments) Act 1996 – gave local authority social services departments power to make direct cash payments to some individuals in lieu of the community care services they had been assessed as needing, to enable them to secure the relevant services for themselves.

NHS and Community Care Act 1990 – The act was brought in to promote community care. Local social service departments have an overall responsibility for community care and have to publish a regular plan about how this care will be delivered. The responsibility places a duty on authorities to assess people for social care and provide the support they require. The act established the familiar procedures of ‘care management’ (social services) or ‘care programme approach’ (NHS) which the statutory departments now operate to. A mixed economy of care is promoted with the independent, private and voluntary sectors being encouraged to provide resources. Valuing People (Department of Health, 2001)

stresses the important role that Person Centred Planning can play in helping people with learning difficulties take charge of their own lives. The Guidance (Department of Health, 2002) stressed that Person Centred Planning is not a professional activity done to people; instead people themselves and their friends, families or other allies, must lead it. However, professional services still have an enormous role to play in responding in a more person centred way to people with learning difficulties. “For 2009 -10 the key priorities include: to ensure that the Personalisation agenda is embedded within all local authority services and developments for people with learning disabilities and their family carers, and is underpinned by person centred planning.”

‘Valuing People Now’, is the ‘refresh’ of this white paper in 2009 and is a new three-year strategy for people with learning disabilities (2009), DH; The new paper is a cross-government consultation which sets the agenda for people with learning disabilities across a range of key issues including health and well-being, housing, employment and inclusion in the community. It builds on the vision set out in Valuing People – A New Strategy for Learning Disability for the 21st Century, which was published in 2001 and outlined policy intended to improve the lives and chances for people with learning disabilities. This new paper says what the Government thinks should happen for the next three years.

It indicates that Valuing People was right but concedes that some areas need more attention and adds further policies. Valuing People Now focuses on the following key areas for the next three years: •Personalisation – having choice and control through individual budgets, direct payments and person centred planning •What people do in the daytime and evening – helping them to be more socially included with access to paid work •Better health care in mainstream NHS services

•Better access to housing especially real tenancies and home ownership •What should be done so that Valuing People becomes a reality for everyone 2. explain how this legislation and policies influence the day to day experiences of individuals with learning disabilities and their families.

These legislations and policies ensure that the individuals with learning disabilities and their families are treated, fairly and equally and not discriminated against. They are able to lead a fully inclusive life, take charge of their own lives and destiny and be involved in their care plan and how their care is delivered. They also ensure their voice is heard and they receive appropriate care, are able to make their own choices, are aware of their rights and entitlements, are not discriminated against and are protected from harm and abuse.

Outcome 2 Understand the nature and characteristics of learning disability
The learner can:
1. explain what is meant by ‘learning disability’

The World Health Organisation defines learning disabilities as:

“a state of arrested or incomplete development of mind”.

•Learning disability is a diagnosis, but it is not a disease, nor is it a physical or mental illness. Unlike the latter, so far as we know it is not treatable. Internationally three criteria are regarded as requiring to be met before learning disabilities can be identified: • Intellectual impairment

• Social or adaptive dysfunction
• Early onset
A learning disability is a lifelong condition of intellectual disability often starting at an early age. It results in a reduced ability to learn new skills, understand complex information or live independently. Because of these difficulties with learning, the person may have difficulties with a number of social tasks, for example communication, self-care, awareness of health and safety. Learning disabilities have a lasting effect on development socially and educationally, and can often be combined with physical conditions such as reduced functional skills. Individuals with a learning disability have an intellectual disability, which is generally associated with the following:

•The condition causing the learning disability usually started at an early age, sometimes before the person was born. However, for most of the individuals who have a learning disability, the cause remains unknown •There is a lasting effect on development; socially and educationally •There is often, but not always, a degree of brain damage associated with the condition and this may lead to other challenges for the individual such as epilepsy, cerebral palsy and sensory impairments relating to vision and hearing •There is a reduced ability to learn new skills and understand new ideas or complex information •There is a reduced ability to cope and manage independently PMLD Stands for profound and multiple learning difficulties (PMLD) (or MDVI – multiple disability and visually impaired).

There is no accepted definition of profound and multiple learning disabilities, but it is commonly associated with pronounced Developmental Delay with significant physical and sensory impairments and Epilepsy. Most people with profound and multiple disabilities will have physical disabilities and will be unable to walk and have to use a
wheelchair. They may have hearing and sight problems. They will communicate non-verbally, that is, they will not speak or if they do, will use only a few words. Some may use signs and symbols or look and point to what they want. All children and adults with PMLD or MDVI will need a high level of support with most aspects of their daily lives •Difficulties with reading, writing and comprehension;

•Unable to understand and retain basic mathematical skills and concepts; •Limited vocabulary and communication skills
•Short attention span
•Under developed co-ordination skills
•Lack of logical reasoning;
•Inability to transfer and apply skills to different situations; •Have difficulty remembering what has been taught.

2. give examples of causes of learning disabilities

There is often no known cause of learning disabilities; where a cause can be identified it falls into the following categories:

Before birth
•Chromosome abnormalities such as Down’s Syndrome, Tuberous Sclerosis •Infection. e.g. Rubella
•Lack of oxygen to the foetus (Anoxia)
•Trauma (e.g. accident or injury in some way)
•Vaccine damage
•Poisons. e.g. drugs (legal or illicit), alcohol, smoking, and lead Birth Complications
•Asphyxia and anoxia
•Obstructed birth and extended labour
•Instrument birth and brain damage
•Extreme prematurity and very low birth weight
Postnatal reasons
•Infections e.g. Meningitis
•Trauma e.g. accident, injury, child abuse
•Metabolic or disorders of nutrition and growth e.g. Phenylketonuria •Social deprivation

3. describe the medical and social models of disability

Medical model of disability

Under the medical model, disabled people are defined by their illness or medical condition. They are disempowered: medical diagnoses are used to regulate and control access to social benefits, housing, education, leisure and employment.

The medical model promotes the view of a disabled person as dependent and needing to be cured or cared for, and it justifies the way in which disabled people have been systematically excluded from society. The disabled person is the problem, not society. Control resides firmly with professionals; choices for the individual are limited to the options provided and approved by the ‘helping’ expert.

The medical model is sometimes known as the ‘individual model’ because it promotes the notion that it is the individual disabled person who must adapt to the way in which society is constructed and organised.

The medical model is vigorously rejected by organisations of disabled people, but it still pervades many attitudes towards disabled people.

Social model of disability

The social model has been developed by disabled people in response to the medical model and the impact it has had on their lives.

Under the social model, disability is caused by the society in which we live and is not the ‘fault’ of an individual disabled person, or an inevitable consequence of their limitations. Disability is the product of the physical, organisational and attitudinal barriers present within society, which lead
to discrimination. The removal of discrimination requires a change of approach and thinking in the way in which society is organised.

The social model takes account of disabled people as part of our economic, environmental and cultural society. The barriers that prevent any individual playing a part in society are the problem, not the individual. Barriers still exist in education, information and communication systems, working environments, health and social support services, transport, housing, public buildings and amenities. The devaluing of disabled people through negative images in the media – films, television and newspapers – also act as a barrier.

The social model has been developed with the aim of removing barriers so that disabled people have the same opportunity as everyone else to determine their own life styles.

A simple example is that of a wheelchair user who has a mobility impairment. He is not actually disabled in an environment where he can use public transport and gain full access to buildings and their facilities in the same way that someone without his impairment would do.

The social model of disability has fundamentally changed the way in which disability is regarded and has had a major impact on anti-discriminatory legislation. However, some disabled people and academics are involved in a re-evaluation of the social model and they argue that the time has come to move beyond this basic position.

4. state the approximate proportion of individuals with a learning disability for whom the cause is ‘not known’

There is often no known factor or factors which are the cause of learning disabilities. According to the British Institute for learning disabilities (BILD) among people who have a mild learning disability, in about 50% of cases, no cause has been identified. A number of environmental and genetic factors are thought to be significant, although clearly diagnosed genetic
causes have been found in only 5% of people in this category

In people with severe or profound learning disabilities, chromosomal abnormalities cause about 40% of cases. Genetic factors account for 15%, prenatal and perinatal problems 10%, and postnatal issues a further 10%. Cases which are of unknown cause are fewer, but still high at around 25%.

5. describe the possible impact on a family of having a member with a learning disability.

Life in the family of an individual with LD is complex and challenging, involving practical and emotional issues. There are medical and educational decisions, financial pressures, and time constraints — all likely to represent additional responsibilities for parents. And the inherent concern, disappointment, anger, self-recrimination and blame — typical emotions in response to a child’s problem — also contribute to the pressures frequently disruptive to the family equilibrium and divisive to a marriage. While some may think parental bonds are strengthened in the face of adversity, unfortunately, the opposite is true. Many parents have a difficult time accepting their child’s problems and reconciling their own differences in response to them, while trying to manage daily life at home and in their respective careers.

Parenting a child is never easy, but a strong relationship is required to withstand the additional stress of raising a child with special needs. The family can go through a stage of grief for the ‘perfect child’ it can cause tension between parent and parent, parent and sibling, sibling and sibling, worry for the future and the individuals capacity for independence. It can also cause financial problems, having to have time off work to attend hospitals and doctors and can also lead to social exclusion for the family because the child is disruptive and the invitations dry up. It can also cause some family members to become over protective of the individual leading to reduced opportunities and over dependence.

Outcome 3 Understand the historical context of learning disability

1. explain the types of services that have been provided for individuals with learning disabilities over time

Sadly, the history of public and private attitudes to learning disability over the last three centuries has been one of intolerance and lack of understanding. In 1834 the ‘Poor Laws’ was created and the building of asylums began. These purpose-built institutions were to house people described as ‘mad’ or ‘feeble minded’. They soon became overcrowded and a harsh place to live where the ‘inmates’ had little choice and were not valued as people. Soon residents began to be regarded to be dangerous and a drain on society.

In the early 20th century the building of institutions continued but the purpose moving people to institutions changed. Reforming educationalists got laws passed that encouraged the building of schools for ‘feeble minded’ children, and in 1908 the Radner Commission stated that: ‘Feeble-mindedness is largely inherited.’ They suggested that such people were genetically inferior and needed to be segregated from the rest of society. The Mental Deficiency Act 1913 states that anyone admitted to the institutions had to be certified as a mental defective. The institutions were now renamed ‘colonies’, and their purpose was to separate their residents from society. In 1929, the Wood committee suggested such people were a threat to society.

In 1946 the National Health Service was introduced, the term ‘mentally handicapped’ came into use and the institutions were turned into hospitals overnight and the emphasis turned to caring for people. They remained segregated and isolated and the standard of care was poor.

In 1971 the government published a paper ‘Better services for the mentally handicapped’ which laid the foundation for ‘Care in the community’ which aimed to achieve half the people living in hospitals were living in the community by 1990.

‘Normalisation’ began to influence the delivery of care during the 1980’s. The theory emphasises the unique value of the individual their right to
choice and opportunity, and the right to any extra support they need to fulfil their potential. At this time there was also recognition that institutions were a major barrier to inclusion. The idea that everyone in society has the right to a life with choice, opportunity and respect, with extra support according to their needs, helped to change the way services were planned and delivered. The National Health Service and Community Care Act 1990 recognised the right of disabled people to be an equal part of society, with access to the necessary support.

Today’s services aim to enable people and promote equal treatment and inclusion. This brings with it new challenges and responsibilities, the greatest of which is to change public attitudes towards people with a learning disability and raise understanding.

2. describe how past ways of working may affect present services

Past ways of working greatly affect present services. The health of people with learning disabilities has been at the forefront of policy and service development over recent years, but sadly this has often been in reaction to damning reports and inquiries highlighting the inequalities and poor quality care individuals with learning disabilities have experienced.

SUMMARY OF KEY REPORTS AND ENQUIRIES

ReportSummary of the main findings or recommendations
Equal treatment:
closing the gap,
Disability Rights
Commission (2006)Government should seek to close health inequality gaps by: • improving primary care access and health checks
• enabling equitable treatment
• targeting people with learning disabilities in national health inequalities programmes • working in partnership with people with learning disabilities to educate and improve services. Joint investigation into

the provision of
services for people
with learning
disabilities at Cornwall
Partnership NHS Trust, Commission for Social Care Inspection and the Healthcare Commission (2006)
This independent inquiry arose in response to serious concerns raised by the East Cornwall Mencap SocietyThe independent enquiry found: • institutional abuse was widespread, preventing people from exercising their rights to choice, independence and inclusion • multiple instances of unacceptable restrictions on the lives of service users • poor assessment, care planning and record keeping, especially in relation to people whose behaviour was described as ‘challenging’ • limited training, policies and procedures.

Its recommendations included:
• immediate action with regards to vulnerable adults, including processes, training and identified responsibilities • a plan to improve the skills and knowledge of staff
• immediate community care assessments and ongoing health care assessments for service users • the redesign of the service reflecting a person-centred culture. Six Lives: the provision
of public services to
people with learning
disabilities,
Parliamentary and
Public Health Service
Ombudsman (2009)
A report detilailing the
investigation into the deaths
of six people with learning
disabilities whilst in local
authority or NHS care• Effectiveness systems should be in place to enable services to understand and plan to meet the full range of needs of people with learning disabilities in their areas. • Services should have the
capacity and capability to provide and/or commission for their local populations to meet the additional and often complex needs of people with learning disabilities

Investigation into the
service for people with
learning disabilities
provided by Sutton
and Merton Primary
Care Trust, Healthcare
Commission (2007)
(now called the Care
Commission)A request from the trust’s chief executive initiated this independent inquiry, which found: • care models based on the needs of the service rather than individuals • limited activities for service users

• inappropriate use of restraint
• lack of staff experience in supporting people with behaviour described as challenging • a number of serious incidents of sexual and physical abuse • poor living environments
• lack of service user involvement
• limited arrangements for governance.
The Care Commission’s recommendations included:
• services should be based on the principles of person-centred care plans and health action plans
• a range of activities for service users
• develop a policy on and train staff in the use of restrictive physical interventions • develop the skills, experience and training opportunities for the workforce • provide appropriate advocacy services.

Healthcare for all:
report of the
independent inquiry
into access to health
care for people with
learning disabilities,
Sir Jonathon Michael
(2008)The report recognised examples of good practice but found a range of appalling examples of discrimination, abuse and neglect across the range of health services. The report recommendations include:

• the Department of Health should adjust its Core standards for better health to reflect the ‘reasonable adjustments’ service are required to make for vulnerable groups • clinical training must include mandatory training in learning disabilities • inspectors and regulators of health services should develop and extend their monitoring of general health services provided to people with learning disabilities • family and other carers should be involved as a matter of course as partners in the provision of care, unless good reason is given.

3. identify some of the key changes in the following areas of the lives of individuals who have learning disabilities:

With the decline of the ‘Medical model’ of learning disabilities the focus of support has shifted to health and social care and to education. The emphasis is now on the inclusion approach and community integration. Because of the ‘Direct payments’ individuals are able to purchase the services they want, which gives the individual more choice and changing expectations. The combined effect is that new opportunities are being opened up for people with learning disabilities in areas such as employment, parenthood, lifelong learning and citizenship.

Where people live
People with learning disabilities are now encouraged to live in the community rather than in residential or nursing homes

Daytime activities
Individuals have access to day centres which carry out stimulating activities and excursions whilst offering support and care

Employment
The Equality act ensures individuals with learning disabilities are not discriminated against in the workplace.

Sexual relationships and parenthood
A person with a learning disability has the freedom to choose a partner and get married. They also have the right to become parents. They have the right to use contraception or not.

The provision of healthcare.
A detailed health assessment plan is now used, to provide a holistic service for their medical, mental, and emotional needs. They have the right to choose their own G.P, and be informed of what their medical records contain, and see their medical notes.

Outcome 4 Understand the basic principles and practice of advocacy, empowerment and active participation in relation to
supporting individuals with learning disabilities and their
families
The learner can:
1. explain the meaning of the term ‘social inclusion’

‘Social exclusion is a complex and multi-dimensional process. It involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas. It affects both the quality of life of individuals and the equity and cohesion of society as a whole’ (Levitas et al 2007, p.9). Therefore ‘Social inclusion’ is the opposite and involves everyone having access to resources etc and the ability to participate in normal relationships and activities.

2. explain the meaning of the term advocacy

Advocacy is about helping you to speak up for yourself, to make sure that
your views and opinions are heard and understood. If you find it hard, or you are unable to speak for yourself then you may find an ‘Advocate’ who can help you. An advocate should be free from conflicts of interest with those providing services to the person they are working with and should represent the other person’s interests as if they were the Advocate’s own.

3. describe different types of advocacy

Citizen advocacy
This is a one-to-one ongoing partnership between a volunteer Advocate and a person. This person may not know their rights, be vulnerable and may be at risk of being mistreated or excluded.

Self-advocacy
This means “speaking up for yourself”. Self-advocacy is about expressing your own needs and concerns and giving your own views.

Peer advocacy.
Peer advocacy is when one person talks for another who has experienced or is experiencing similar difficulties or has similar life experiences (e.g. service users in a residential facility).

Professional advocacy
This is when people are paid to provide an advocacy service. It is issue led, focusing on particular issues.

Legal advocacy
This is when a solicitor works on your behalf.

4. describe ways to build empowerment and active participation into everyday support with individuals with learning disabilities.

Empowerment for people with learning disabilities is the process by which they develop increased skills to take control of their lives. This will help them achieve goals and aspirations, maximising their quality of life. A key feature in empowering people is giving them a voice and actively listening to what they have to say. By using person centred thinking and person centred planning, and listening to what the individual wants, you can ensure the individuals support plan allows them more choice and control over their lives and the support they receive.

Empowerment is, therefore, closely linked to the concept of advocacy. Empowerment in learning disability can be described as a social process, whereby people who are considered as belonging to a stigmatised social group can be assisted to develop increased skills to take control of their lives. This increased control will help them to achieve their goals and aspirations and thus potentially maximise the quality of their lives. You can empower the individuals you work with by offering them choices, ensuring they are aware of their rights and entitlements, allowing them to make informed choices, speaking up for them if they wish you to or encourage them to speak up for themselves, if they have a problem or request. and ensuring they know their rights and you safeguard them for the individual.

You should allow and encourage the individual to actively participation in every aspect of their life to encourage their independence and actively involve them in their care. You should only assist them with tasks they are unable to do themselves and always encourage them to try new things. Outcome 5 Understand how views and attitudes impact on the lives of individuals with learning disabilities and their family carers The learner can:

1. explain how attitudes are changing in relation to individuals with learning disabilities

Society’s attitudes and behaviour towards people with learning disabilities have had a major impact on their lives and continue to do so. Many people still label people with learning disabilities which has led to a negative attitude towards them. One of the biggest changes is a move away from the medical model and a move towards the social model. Now instead of focussing on ‘whats wrong’ with the individual the focus has shifted to removing barriers which prevent an individual with learning disabilities from having the same opportunities as everyone else.

This move has also impacted on changes in the law regards anti-discrimination legislation and equal rights. The focus is now on what an individual can do rather than what they cant. Now instead of being expected to ‘fit in’ society is finding ways to adapt to their needs.

2. give examples of positive and negative aspects of being labelled as having a learning Disability

From a negative aspect, any type of label can lead others to have a stereotypical view and make stereotypical assumptions of what a person or group of people are like and also assumptions about their capabilities. A label can cause others to act or treat individuals differently, without knowing the person as an individual.

The label will create an expectation of what that person is like Labels can cause stigmatization, rejection, prejudice’s and also cause victimisation of those with the label. It can lead to the person with the label experiencing physical and emotional isolation and the label can become their defining characteristic. Medical “labels” are undesirable and often misleading, as no two people are alike and such labels merely reinforce stereotyping of disabled people as “patients”.

From a positive aspect, being diagnosed with learning disabilities can create a feeling of relief and understanding for the individual and their families. Under the law in order for a person to receive special services they have to be diagnosed as having LD. From a child’s point of view, being labelled as LD can provide them with many advantages such as extra instruction and help at school. It can help the individual and others to focus on their abilities rather than weakness.

3. describe steps that can be taken to promote positive attitudes towards individuals with learning disabilities and their family carers In a research report carried out by the Department of Works and pensions, the conclusion reached on how to promote a more positive attitude towards individuals with learning disabilities and their family, carers was to make several changes. The key strategies included: improved education about disability; improved media representation and publicity; improved physical access, transport and
financial support; strengthened legislation; and increased integration of disabled and non-disabled people. From a carers point of view the ways in which you can follow this strategy is by •encouraging the service user to join in local community activities, clubs and social events to enable more interaction between them and members of the public •Ensure you treat the individual in the same way as you treat other individuals you care for •Focus on the individuals abilities rather than their disabilities •Encourage the individual to reach their full potential through empowerment and independence. •Educate others and raise their awareness regards LD and the different types of LD there are. •Encourage the individuals family to join support groups – , research has found a strong association between supportive social networks and the positive psychological well-being of individuals caring for LD individual •Dispel myths attached to LD

MYTHS
•People with learning disabilities have below average intelligence and cannot learn – the fact is people with learning difficulties have average to above average intelligence. In studies as many as 33% of students with LD are gifted (Baum, 1985) •Dyslexia and LD are the same thing – Dyslexia is a type of LD not another term for LD. It is a specific language based disorder •LD only affects an individual’s academic skills – Most people with LD usually have other areas of difficulty such as social skills, motor conditions, memory.

4. explain the roles of external agencies and others in changing attitudes, policy and practice.

Many people are involved in the day to day lives of individuals with learning disabilities. They are more aware than anyone else of the problems and attitudes they face on a day to day basis. Sometimes it may be necessary to speak up on their behalf when they feel a policy or practice is not right. These individuals may be people the LD person works with, their family, friends, other professional they come into contact with, or it could be you as their carer. If you ever feel that your workplace policy or practice is incorrect you should report this and discuss it with your manager. If you still felt the situation had not improved you should take the matter further, even as far as the CQC depending on the severity of the issue.

There are also many external agencies and others who are involved in the life of an individual with learning difficulties. The external agencies could include advocacy services, parent/carer support groups and campaign groups. These people are the collective voice of the individuals and as groups are able to put forward and campaign for the LD individuals rights, if they are not being met and also put forward. This is the way in which attitudes and laws are changed and individual’s rights are upheld.

Outcome 6 Know how to promote communication with individuals with learning disabilities
The learner can:
1. identify ways of adapting each of the following when communicating with individuals who have learning disabilities

The communication skills of individuals with LD can vary greatly. Communication between all people is very complex; miscommunication leading to misunderstandings, confusion and indeed conflict. The potential for this is exacerbated when the issue of Learning Disabilities is also included. In order to avoid misunderstandings it is necessary to establish an effective means of communicating, whether it is verbal, non-verbal or a combination of both. An individual with LD may be less able to understand and retain new and complex information and may require you to use simple language and explain things which are unfamiliar. Also its important to remember that not all disabilities may be visible or immediately evident

verbal communication

•Ensure that your communication is clear. Use simple language and keep your sentences short •Explain any difficult or unfamiliar words. For example: “I will send you for an x‐ray” it may be better to say; “we will need to take a picture of your arm” •Check that the individual has understood: “Can you please tell me in your own words what I have just said” • Give the person time to respond

•Be aware of any additional disabilities such as hearing or visual impairment •Speak to the person, in a relaxed and natural way, using facial expressions and keep eye contact with them. •Be clear about what you want to say and why.

•Be sure that the information is relevant
•Speak directly to the person rather than to a support worker, though carers and support workers may be useful sources of additional information.

non-verbal communication

Communication is not just verbal. It also includes body language, gestures, pictures and symbols, and facial expressions. This adds up to a more complete picture, helping us and the ‘message receiver’ to undertake a meaningful interaction. Non verbal communication could include,

•Use gestures to emphasise your communication: point to the part of the body you are talking about •Use pictures, photos diagrams or objects to demonstrate what you are going to do before you do it •Pointing to objects

•Facial expressions
•Miming
•Makaton
•Signing – British sign language
•Using their Communication Passport (A detailed booklet which might include photos, drawings and text which individuals can use to let you know things about themselves eg what they like to eat, wear, do, their achievements etc. •Using their communication dictionary (A detailed book advising how the individual communicates yes, no, bored, happy etc) •Active listening

2. explain why it is important to use language that is both ‘age appropriate’ and ‘ability appropriate’ when communicating with individuals with learning disabilities Communicating with people with disability is no different to communicating with people without disability. The most important thing is
the ability to listen to an individual’s needs and not prejudge their requirements. Talk to people using an age-appropriate tone of voice and language. Simplifying the language you use does not necessarily mean treating adults like children. Use short and simple sentence structure. If you spoke to an adult like a child, this can be very patronising and degrading for the individual. An adult with learning disabilities may have the same interest and feelings as any other person of the same age.

They may need things explaining slower and take a little longer to understand what you are communicating, but this does not mean they do not understand. A 20 year old individual with learning disabilities will have the same needs and preferences as any other 20 year old and would most definitely not want to be treated like a 5 year old. Treat adults as adults. Also you should not make assumptions of someone’s abilities based solely on their physical age, or our perception of their age. Individuals with learning disabilities communication abilities will vary from person to person so it is important to establish the abilities of the individual you are communicating with. 3. describe ways of checking whether an individual has understood a communication, and how to address any misunderstandings.

The best way to establish if an individual has understood a communication is to ask them to repeat the details back to you in their own words. You could also word a question in a different way to see if you get the same response, which would indicate their understanding. Give them time to respond and ask questions. Be clear about what you want to say and why. Be sure the information is relevant. The best way to ensure understanding is to keep communications simple and jargon free This means avoiding things such as

•medical terms – “I will send you for an x‐ray” it may be better to say; “we will need to take a picture of your arm” •Metaphors – ‘Hows the plumbing working?’ it’s better to ask ‘Have you had a wee?’ •Avoid abstract concepts such as “later” or “somewhere”, or analogies. Instead, be as specific as possible. Unit 4222-245 Understand the context of supporting

individuals with learning disabilities (LD 201)

Outcome 1 Understand the legislation and policies that support the human rights and inclusion of individuals with learning
disabilities
The learner can:
1. identify legislation and policies that are designed to promote the human rights, inclusion, equal life chances and citizenship of individuals with learning disabilities

The following legislations and policies is by no means an exhaustive list, but does outline some of the main areas of law which promote an individual with learning disabilities rights The Mental Capacity Act (MCA) 2005 – was introduced in England and Wales in 2007 and aims to protect the rights of people whose mental capacity is in doubt and people without mental capacity. It provides the framework for making decisions on behalf of others. It tells us what to do if we are involved in the care, treatment or support of people aged 16 and over who may lack capacity to make decisions. The Act states that everyone is assumed to make decisions for themselves unless shown otherwise. If it is not clear whether someone has the capacity to make a decision concerning a specific issue an assessment of their capacity should be carried out.

The Mental Health Act 1983 – The Court of Protection exists to safeguard the interests of anyone who is ‘incapable by reason of mental disorder of managing and administering his property and affairs’. Anyone found on medical evidence to meet these criteria is known as ‘a patient’. The Court’s duties are normally carried out by appointing a receiver for a patient. The Mental Health Act 1983 gives the Court power to authorise virtually any transaction on behalf of a patient and to do whatever is necessary or expedient for the maintenance or benefit of the patient, his family and dependants. The NHS and Community Care Act 1990 – made all the legal changes necessary for the implementation of the Caring for people White Paper.

Local authorities, in collaboration with health-service and independent-sector agencies, now became responsible for assessing need, designing care packages and ensuring their delivery. Local authorities were made responsible, under the NHS and Community Care Act 1990, for the registration and inspection of homes and other community services either purchased or provided by them. The Equality Act 2010 – The act covers nine protected characteristics, which cannot be used as a reason to treat people unfairly. Every person has one or more of the protected characteristics, so the act protects everyone against unfair treatment. They protected characteristics are: •Age

•disability
•gender reassignment
•marriage and civil partnership
•pregnancy and maternity
•race
•religion or belief
•sex
•sexual orientation
The Equality Act sets out the different ways in which it is unlawful to treat someone, such as direct and indirect discrimination, harassment, victimisation and failing to make a reasonable adjustment for a disabled person. Human Rights Act 1998 – means that residents of the United Kingdom will now be able to seek help from the courts if they believe that their human rights have been infringed. It is likely that anyone working within health and social care will be working within the provision of the Human Rights Act. With the introduction of the Act, the Government had to show commitment to protecting the most vulnerable adults as well as children.

In the past some people had not always been able to access their rights, this will now be regarded as a violation of an individual’s human rights. Every Child Matters: Change for Children (2004) – outlines the government’s approach to the well-being of children and young people from birth to age 19. The aim is that every child, whatever their background or circumstances should have the support they need to:

•Be healthy
•Stay safe
•Enjoy and achieve
•Make a positive contribution
•Achieve economic well-being

The General Social Care Council (GSCC) Code of practice

Code of Practice for Social Care Workers Social care workers must:

1. Protect the rights and promote the interests of service users and carers 2. Strive to establish and maintain the trust and confidence of service users and carers 3. Promote the independence of service users whilst protecting them as far as possible from danger or harm 4. Respect the rights of service users whilst seeking to ensure that their behaviour does not harm themselves or other people 5. Uphold public trust and confidence in social care services; and 6. be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills

Care Quality Commission (CQC)
Are the independent regulator of health and social care in England. The Care Quality Commission is the independent regulator of health and adult social care services in England. It also protects the interests of people whose rights are restricted under the Mental Health Act. Whether services are provided by the NHS, local authorities, private companies or voluntary organisations, the CQC will make sure that people get better care by: •Driving improvement across health and adult social care. •Putting people first and championing their rights.

• Acting swiftly to remedy bad practice.
Gathering and using knowledge and expertise, and working with others

Essential standards for quality and safety – Compliance Criteria There is a relatively new law about regulating health and adult social care in England. It replaces the National minimum standards. From 1 October 2010, every health and adult social care service in England is legally responsible for making sure it meets new essential standards of quality and safety. Providers must show they are meeting essential standards as part of a new registration system which focuses on people rather than policies, on outcomes rather than systems. The essential standards relate to important aspects of care such as involvement and information for people, personalised care and treatment, safety and safeguarding.

The Community Care (Direct Payments) Act 1996 – gave local authority social services departments power to make direct cash payments to some individuals in lieu of the community care services they had been assessed as needing, to enable them to secure the relevant services for themselves.

NHS and Community Care Act 1990 – The act was brought in to promote community care. Local social service departments have an overall responsibility for community care and have to publish a regular plan about how this care will be delivered. The responsibility places a duty on authorities to assess people for social care and provide the support they require. The act established the familiar procedures of ‘care management’ (social services) or ‘care programme approach’ (NHS) which the statutory departments now operate to. A mixed economy of care is promoted with the independent, private and voluntary sectors being encouraged to provide resources. Valuing People (Department of Health, 2001)

stresses the important role that Person Centred Planning can play in helping people with learning difficulties take charge of their own lives. The Guidance (Department of Health, 2002) stressed that Person Centred Planning is not a professional activity done to people; instead people themselves and their friends, families or other allies, must lead it. However, professional services still have an enormous role to play in responding in a more person centred way to people with learning difficulties. “For 2009 -10 the key priorities include: to ensure that the Personalisation agenda is embedded within all local authority services and developments for people with learning disabilities and their family carers, and is underpinned by person centred planning.”

‘Valuing People Now’, is the ‘refresh’ of this white paper in 2009 and is a new three-year strategy for people with learning disabilities (2009), DH; The new paper is a cross-government consultation which sets the agenda for people with learning disabilities across a range of key issues including health and well-being, housing, employment and inclusion in the community. It builds on the vision set out in Valuing People – A New Strategy for Learning Disability for the 21st Century, which was published in 2001 and outlined policy intended to improve the lives and chances for people with learning disabilities.

This new paper says what the Government thinks should happen for the next three years. It indicates that Valuing People was right but concedes that some areas need more attention and adds further policies. Valuing People Now focuses on the following key areas for the next three years: •Personalisation – having choice and control through individual budgets, direct payments and person centred planning •What people do in the daytime and evening – helping them to be more socially included with access to paid work •Better health care in mainstream NHS services

•Better access to housing especially real tenancies and home ownership •What should be done so that Valuing People becomes a reality for everyone 2. explain how this legislation and policies influence the day to day experiences of individuals with learning disabilities and their families.

These legislations and policies ensure that the individuals with learning disabilities and their families are treated, fairly and equally and not discriminated against. They are able to lead a fully inclusive life, take charge of their own lives and destiny and be involved in their care plan and how their care is delivered. They also ensure their voice is heard and they receive appropriate care, are able to make their own choices, are aware of their rights and entitlements, are not discriminated against and are protected from harm and abuse.

Outcome 2 Understand the nature and characteristics of learning disability
The learner can:
1. explain what is meant by ‘learning disability’

The World Health Organisation defines learning disabilities as:

“a state of arrested or incomplete development of mind”.

•Learning disability is a diagnosis, but it is not a disease, nor is it a physical or mental illness. Unlike the latter, so far as we know it is not treatable. Internationally three criteria are regarded as requiring to be met before learning disabilities can be identified: • Intellectual impairment

• Social or adaptive dysfunction
• Early onset
A learning disability is a lifelong condition of intellectual disability often starting at an early age. It results in a reduced ability to learn new skills, understand complex information or live independently. Because of these difficulties with learning, the person may have difficulties with a number of social tasks, for example communication, self-care, awareness of health and safety. Learning disabilities have a lasting effect on development socially and educationally, and can often be combined with physical conditions such as reduced functional skills. Individuals with a learning disability have an intellectual disability, which is generally associated with the following:

•The condition causing the learning disability usually started at an early age, sometimes before the person was born. However, for most of the individuals who have a learning disability, the cause remains unknown •There is a lasting effect on development; socially and educationally •There is often, but not always, a degree of brain damage associated with the condition and this may lead to other challenges for the individual such as epilepsy, cerebral palsy and sensory impairments relating to vision and hearing •There is a reduced ability to learn new skills and understand new ideas or complex information •There is a reduced ability to cope and manage independently PMLD Stands for profound and multiple learning difficulties (PMLD) (or MDVI – multiple disability and visually impaired).

There is no accepted definition of profound and multiple learning disabilities, but it is commonly associated with pronounced Developmental Delay with significant physical and sensory impairments and Epilepsy. Most people with profound and multiple disabilities will have physical disabilities and will be unable to walk and have to use a wheelchair.

They may have hearing and sight problems. They will communicate non-verbally, that is, they will not speak or if they do, will use only a few words. Some may use signs and symbols or look and point to what they want. All children and adults with PMLD or MDVI will need a high level of support with most aspects of their daily lives •Difficulties with reading, writing and comprehension;

•Unable to understand and retain basic mathematical skills and concepts; •Limited vocabulary and communication skills
•Short attention span
•Under developed co-ordination skills
•Lack of logical reasoning;
•Inability to transfer and apply skills to different situations; •Have difficulty remembering what has been taught.

2. give examples of causes of learning disabilities

There is often no known cause of learning disabilities; where a cause can be identified it falls into the following categories:

Before birth
•Chromosome abnormalities such as Down’s Syndrome, Tuberous Sclerosis •Infection. e.g. Rubella
•Lack of oxygen to the foetus (Anoxia)
•Trauma (e.g. accident or injury in some way)
•Vaccine damage
•Poisons. e.g. drugs (legal or illicit), alcohol, smoking, and lead Birth Complications
•Asphyxia and anoxia
•Obstructed birth and extended labour
•Instrument birth and brain damage
•Extreme prematurity and very low birth weight
Postnatal reasons
•Infections e.g. Meningitis
•Trauma e.g. accident, injury, child abuse
•Metabolic or disorders of nutrition and growth e.g. Phenylketonuria •Social deprivation

3. describe the medical and social models of disability

Medical model of disability

Under the medical model, disabled people are defined by their illness or medical condition. They are disempowered: medical diagnoses are used to regulate and control access to social benefits, housing, education, leisure and employment.

The medical model promotes the view of a disabled person as dependent and needing to be cured or cared for, and it justifies the way in which disabled people have been systematically excluded from society. The disabled person is the problem, not society. Control resides firmly with professionals; choices for the individual are limited to the options provided and approved by the ‘helping’ expert.

The medical model is sometimes known as the ‘individual model’ because it promotes the notion that it is the individual disabled person who must adapt to the way in which society is constructed and organised.

The medical model is vigorously rejected by organisations of disabled people, but it still pervades many attitudes towards disabled people.

Social model of disability

The social model has been developed by disabled people in response to the medical model and the impact it has had on their lives.

Under the social model, disability is caused by the society in which we live and is not the ‘fault’ of an individual disabled person, or an inevitable consequence of their limitations. Disability is the product of the physical, organisational and attitudinal barriers present within society, which lead to discrimination. The removal of discrimination requires a change of approach and thinking in the way in which society is organised.

The social model takes account of disabled people as part of our economic, environmental and cultural society. The barriers that prevent any individual playing a part in society are the problem, not the individual. Barriers still exist in education, information and communication systems, working environments, health and social support services, transport, housing, public buildings and amenities. The devaluing of disabled people through negative images in the media – films, television and newspapers – also act as a barrier.

The social model has been developed with the aim of removing barriers so that disabled people have the same opportunity as everyone else to determine their own life styles.

A simple example is that of a wheelchair user who has a mobility impairment. He is not actually disabled in an environment where he can use public transport and gain full access to buildings and their facilities in the same way that someone without his impairment would do.

The social model of disability has fundamentally changed the way in which disability is regarded and has had a major impact on anti-discriminatory legislation. However, some disabled people and academics are involved in a re-evaluation of the social model and they argue that the time has come to move beyond this basic position.

4. state the approximate proportion of individuals with a learning disability for whom the cause is ‘not known’

There is often no known factor or factors which are the cause of learning disabilities. According to the British Institute for learning disabilities (BILD) among people who have a mild learning disability, in about 50% of cases, no cause has been identified. A number of environmental and genetic factors are thought to be significant, although clearly diagnosed genetic causes have been found in only 5% of people in this category

In people with severe or profound learning disabilities, chromosomal abnormalities cause about 40% of cases. Genetic factors account for 15%, prenatal and perinatal problems 10%, and postnatal issues a further 10%. Cases which are of unknown cause are fewer, but still high at around 25%.

5. describe the possible impact on a family of having a member with a learning disability.

Life in the family of an individual with LD is complex and challenging, involving practical and emotional issues. There are medical and educational decisions, financial pressures, and time constraints — all likely to represent additional responsibilities for parents. And the inherent concern, disappointment, anger, self-recrimination and blame — typical emotions in response to a child’s problem — also contribute to the pressures frequently disruptive to the family equilibrium and divisive to a marriage. While some may think parental bonds are strengthened in the face of adversity, unfortunately, the opposite is true. Many parents have a difficult time accepting their child’s problems and reconciling their own differences in response to them, while trying to manage daily life at home and in their respective careers.

Parenting a child is never easy, but a strong relationship is required to withstand the additional stress of raising a child with special needs. The family can go through a stage of grief for the ‘perfect child’ it can cause tension between parent and parent, parent and sibling, sibling and sibling, worry for the future and the individuals capacity for independence. It can also cause financial problems, having to have time off work to attend hospitals and doctors and can also lead to social exclusion for the family because the child is disruptive and the invitations dry up. It can also cause some family members to become over protective of the individual leading to reduced opportunities and over dependence.

Outcome 3 Understand the historical context of learning disability

1. explain the types of services that have been provided for individuals with learning disabilities over time

Sadly, the history of public and private attitudes to learning disability over the last three centuries has been one of intolerance and lack of understanding. In 1834 the ‘Poor Laws’ was created and the building of asylums began. These purpose-built institutions were to house people described as ‘mad’ or ‘feeble minded’. They soon became overcrowded and a harsh place to live where the ‘inmates’ had little choice and were not valued as people. Soon residents began to be regarded to be dangerous and a drain on society.

In the early 20th century the building of institutions continued but the purpose moving people to institutions changed. Reforming educationalists got laws passed that encouraged the building of schools for ‘feeble minded’ children, and in 1908 the Radner Commission stated that: ‘Feeble-mindedness is largely inherited.’ They suggested that such people were genetically inferior and needed to be segregated from the rest of society. The Mental Deficiency Act 1913 states that anyone admitted to the institutions had to be certified as a mental defective. The institutions were now renamed ‘colonies’, and their purpose was to separate their residents from society. In 1929, the Wood committee suggested such people were a threat to society.

In 1946 the National Health Service was introduced, the term ‘mentally handicapped’ came into use and the institutions were turned into hospitals overnight and the emphasis turned to caring for people. They remained segregated and isolated and the standard of care was poor.

In 1971 the government published a paper ‘Better services for the mentally handicapped’ which laid the foundation for ‘Care in the community’ which aimed to achieve half the people living in hospitals were living in the community by 1990.

‘Normalisation’ began to influence the delivery of care during the 1980’s. The theory emphasises the unique value of the individual their right to choice and opportunity, and the right to any extra support they need to fulfil their potential. At this time there was also recognition that
institutions were a major barrier to inclusion. The idea that everyone in society has the right to a life with choice, opportunity and respect, with extra support according to their needs, helped to change the way services were planned and delivered. The National Health Service and Community Care Act 1990 recognised the right of disabled people to be an equal part of society, with access to the necessary support.

Today’s services aim to enable people and promote equal treatment and inclusion. This brings with it new challenges and responsibilities, the greatest of which is to change public attitudes towards people with a learning disability and raise understanding.

2. describe how past ways of working may affect present services

Past ways of working greatly affect present services. The health of people with learning disabilities has been at the forefront of policy and service development over recent years, but sadly this has often been in reaction to damning reports and inquiries highlighting the inequalities and poor quality care individuals with learning disabilities have experienced.

SUMMARY OF KEY REPORTS AND ENQUIRIES

ReportSummary of the main findings or recommendations
Equal treatment:
closing the gap,
Disability Rights
Commission (2006)Government should seek to close health inequality gaps by: • improving primary care access and health checks
• enabling equitable treatment
• targeting people with learning disabilities in national health inequalities programmes • working in partnership with people with learning disabilities to educate and improve services. Joint investigation into

the provision of
services for people
with learning
disabilities at Cornwall
Partnership NHS Trust, Commission for Social Care Inspection and the Healthcare Commission (2006)
This independent inquiry arose in response to serious
concerns raised by the East Cornwall Mencap SocietyThe independent enquiry found: • institutional abuse was widespread, preventing people from exercising their rights to choice, independence and inclusion • multiple instances of unacceptable restrictions on the lives of service users • poor assessment, care planning and record keeping, especially in relation to people whose behaviour was described as ‘challenging’ • limited training, policies and procedures.

Its recommendations included:
• immediate action with regards to vulnerable adults, including processes, training and identified responsibilities • a plan to improve the skills and knowledge of staff
• immediate community care assessments and ongoing health care assessments for service users • the redesign of the service reflecting a person-centred culture. Six Lives: the provision
of public services to
people with learning
disabilities,
Parliamentary and
Public Health Service
Ombudsman (2009)
A report detilailing the
investigation into the deaths
of six people with learning
disabilities whilst in local
authority or NHS care• Effectiveness systems should be in place to enable services to understand and plan to meet the full range of needs of people with learning disabilities in their areas. • Services should have the capacity and capability to provide and/or commission for their local populations to meet the additional and often complex needs of people with
learning disabilities

Investigation into the
service for people with
learning disabilities
provided by Sutton
and Merton Primary
Care Trust, Healthcare
Commission (2007)
(now called the Care
Commission)A request from the trust’s chief executive initiated this independent inquiry, which found: • care models based on the needs of the service rather than individuals • limited activities for service users

• inappropriate use of restraint
• lack of staff experience in supporting people with behaviour described as challenging • a number of serious incidents of sexual and physical abuse • poor living environments
• lack of service user involvement
• limited arrangements for governance.
The Care Commission’s recommendations included:
• services should be based on the principles of person-centred care plans and health action plans
• a range of activities for service users
• develop a policy on and train staff in the use of restrictive physical interventions • develop the skills, experience and training opportunities for the workforce • provide appropriate advocacy services.

Healthcare for all:
report of the
independent inquiry
into access to health
care for people with
learning disabilities,
Sir Jonathon Michael
(2008)The report recognised examples of good practice but found a range of appalling examples of discrimination, abuse and neglect across the range of health services. The report recommendations include:

• the Department of Health should adjust its Core standards for better health to reflect the ‘reasonable adjustments’ service are required to make for vulnerable groups • clinical training must include mandatory training in learning disabilities • inspectors and regulators of health services should develop and extend their monitoring of general health services provided to people with learning disabilities • family and other carers should be involved as a matter of course as partners in the provision of care, unless good reason is given.

3. identify some of the key changes in the following areas of the lives of individuals who have learning disabilities:

With the decline of the ‘Medical model’ of learning disabilities the focus of support has shifted to health and social care and to education. The emphasis is now on the inclusion approach and community integration. Because of the ‘Direct payments’ individuals are able to purchase the services they want, which gives the individual more choice and changing expectations. The combined effect is that new opportunities are being opened up for people with learning disabilities in areas such as employment, parenthood, lifelong learning and citizenship.

Where people live
People with learning disabilities are now encouraged to live in the community rather than in residential or nursing homes

Daytime activities
Individuals have access to day centres which carry out stimulating activities and excursions whilst offering support and care

Employment
The Equality act ensures individuals with learning disabilities are not
discriminated against in the workplace.

Sexual relationships and parenthood
A person with a learning disability has the freedom to choose a partner and get married. They also have the right to become parents. They have the right to use contraception or not.

The provision of healthcare.
A detailed health assessment plan is now used, to provide a holistic service for their medical, mental, and emotional needs. They have the right to choose their own G.P, and be informed of what their medical records contain, and see their medical notes.

Outcome 4 Understand the basic principles and practice of advocacy, empowerment and active participation in relation to
supporting individuals with learning disabilities and their
families
The learner can:
1. explain the meaning of the term ‘social inclusion’

‘Social exclusion is a complex and multi-dimensional process. It involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas. It affects both the quality of life of individuals and the equity and cohesion of society as a whole’ (Levitas et al 2007, p.9). Therefore ‘Social inclusion’ is the opposite and involves everyone having access to resources etc and the ability to participate in normal relationships and activities.

2. explain the meaning of the term advocacy

Advocacy is about helping you to speak up for yourself, to make sure that your views and opinions are heard and understood. If you find it hard, or you are unable to speak for yourself then you may find an ‘Advocate’ who can
help you. An advocate should be free from conflicts of interest with those providing services to the person they are working with and should represent the other person’s interests as if they were the Advocate’s own.

3. describe different types of advocacy

Citizen advocacy
This is a one-to-one ongoing partnership between a volunteer Advocate and a person. This person may not know their rights, be vulnerable and may be at risk of being mistreated or excluded.

Self-advocacy
This means “speaking up for yourself”. Self-advocacy is about expressing your own needs and concerns and giving your own views.

Peer advocacy.
Peer advocacy is when one person talks for another who has experienced or is experiencing similar difficulties or has similar life experiences (e.g. service users in a residential facility).

Professional advocacy
This is when people are paid to provide an advocacy service. It is issue led, focusing on particular issues.

Legal advocacy
This is when a solicitor works on your behalf.

4. describe ways to build empowerment and active participation into everyday support with individuals with learning disabilities.

Empowerment for people with learning disabilities is the process by which they develop increased skills to take control of their lives. This will help them achieve goals and aspirations, maximising their quality of life. A key feature in empowering people is giving them a voice and actively listening to what they have to say. By using person centred thinking and person centred planning, and listening to what the individual wants, you can ensure the individuals support plan allows them more choice and control over their lives and the support they receive. Empowerment is, therefore, closely linked to the concept of advocacy. Empowerment in learning disability can be described as a social process, whereby people who are considered as belonging to a stigmatised social group can be assisted to develop increased skills to take control of their lives.

This increased control will help them to achieve their goals and aspirations and thus potentially maximise the quality of their lives. You can empower the individuals you work with by offering them choices, ensuring they are aware of their rights and entitlements, allowing them to make informed choices, speaking up for them if they wish you to or encourage them to speak up for themselves, if they have a problem or request. and ensuring they know their rights and you safeguard them for the individual. You should allow and encourage the individual to actively participation in every aspect of their life to encourage their independence and actively involve them in their care.

You should only assist them with tasks they are unable to do themselves and always encourage them to try new things. Outcome 5 Understand how views and attitudes impact on the lives of individuals with learning disabilities and their family carers The learner can:

1. explain how attitudes are changing in relation to individuals with learning disabilities

Society’s attitudes and behaviour towards people with learning disabilities have had a major impact on their lives and continue to do so. Many people still label people with learning disabilities which has led to a negative attitude towards them. One of the biggest changes is a move away from the medical model and a move towards the social model. Now instead of focussing on ‘whats wrong’ with the individual the focus has shifted to removing barriers which prevent an individual with learning disabilities from having the same opportunities as everyone else.

This move has also impacted on changes in the law regards anti-discrimination legislation and equal rights. The focus is now on what an individual can do rather than what they cant. Now instead of being expected to ‘fit in’ society is finding ways to adapt
to their needs.

2. give examples of positive and negative aspects of being labelled as having a learning Disability

From a negative aspect, any type of label can lead others to have a stereotypical view and make stereotypical assumptions of what a person or group of people are like and also assumptions about their capabilities. A label can cause others to act or treat individuals differently, without knowing the person as an individual. The label will create an expectation of what that person is like Labels can cause stigmatization, rejection, prejudice’s and also cause victimisation of those with the label. It can lead to the person with the label experiencing physical and emotional isolation and the label can become their defining characteristic. Medical “labels” are undesirable and often misleading, as no two people are alike and such labels merely reinforce stereotyping of disabled people as “patients”.

From a positive aspect, being diagnosed with learning disabilities can create a feeling of relief and understanding for the individual and their families. Under the law in order for a person to receive special services they have to be diagnosed as having LD. From a child’s point of view, being labelled as LD can provide them with many advantages such as extra instruction and help at school. It can help the individual and others to focus on their abilities rather than weakness.

3. describe steps that can be taken to promote positive attitudes towards individuals with learning disabilities and their family carers In a research report carried out by the Department of Works and pensions, the conclusion reached on how to promote a more positive attitude towards individuals with learning disabilities and their family, carers was to make several changes. The key strategies included: improved education about disability; improved media representation and publicity; improved physical access, transport and financial support; strengthened legislation; and increased integration of disabled and non-disabled people.

From a carers point of view the ways in which you can follow this strategy is by •encouraging the service user to join in local community activities, clubs and social events to enable more interaction between them and members of the public •Ensure you treat the individual in the same way as you treat other individuals you care for •Focus on the individuals abilities rather than their disabilities •Encourage the individual to reach their full potential through empowerment and independence. •Educate others and raise their awareness regards LD and the different types of LD there are. •Encourage the individuals family to join support groups – , research has found a strong association between supportive social networks and the positive psychological well-being of individuals caring for LD individual •Dispel myths attached to LD

MYTHS
•People with learning disabilities have below average intelligence and cannot learn – the fact is people with learning difficulties have average to above average intelligence. In studies as many as 33% of students with LD are gifted (Baum, 1985) •Dyslexia and LD are the same thing – Dyslexia is a type of LD not another term for LD. It is a specific language based disorder •LD only affects an individual’s academic skills – Most people with LD usually have other areas of difficulty such as social skills, motor conditions, memory.

4. explain the roles of external agencies and others in changing attitudes, policy and practice.

Many people are involved in the day to day lives of individuals with learning disabilities. They are more aware than anyone else of the problems and attitudes they face on a day to day basis. Sometimes it may be necessary to speak up on their behalf when they feel a policy or practice is not right. These individuals may be people the LD person works with, their family, friends, other professional they come into contact with, or it could be you as their carer. If you ever feel that your workplace policy or practice is incorrect you should report this and discuss it with your manager. If you still felt the situation had not improved you should take the matter further, even as far as the CQC depending on the severity of the issue.

There are also many external agencies and others who are involved in the life of an individual with learning difficulties. The external agencies could include advocacy services, parent/carer support groups and campaign groups. These people are the collective voice of the individuals and as groups are able to put forward and campaign for the LD individuals rights, if they are not being met and also put forward. This is the way in which attitudes and laws are changed and individual’s rights are upheld.

Outcome 6 Know how to promote communication with individuals with learning disabilities
The learner can:
1. identify ways of adapting each of the following when communicating with individuals who have learning disabilities

The communication skills of individuals with LD can vary greatly. Communication between all people is very complex; miscommunication leading to misunderstandings, confusion and indeed conflict. The potential for this is exacerbated when the issue of Learning Disabilities is also included. In order to avoid misunderstandings it is necessary to establish an effective means of communicating, whether it is verbal, non-verbal or a combination of both. An individual with LD may be less able to understand and retain new and complex information and may require you to use simple language and explain things which are unfamiliar. Also its important to remember that not all disabilities may be visible or immediately evident

verbal communication

•Ensure that your communication is clear. Use simple language and keep your sentences short •Explain any difficult or unfamiliar words. For example: “I will send you for an x‐ray” it may be better to say; “we will need to take a picture of your arm” •Check that the individual has understood: “Can you please tell me in your own words what I have just said” • Give the person time to respond

•Be aware of any additional disabilities such as hearing or visual
impairment •Speak to the person, in a relaxed and natural way, using facial expressions and keep eye contact with them. •Be clear about what you want to say and why.

•Be sure that the information is relevant
•Speak directly to the person rather than to a support worker, though carers and support workers may be useful sources of additional information.

non-verbal communication

Communication is not just verbal. It also includes body language, gestures, pictures and symbols, and facial expressions. This adds up to a more complete picture, helping us and the ‘message receiver’ to undertake a meaningful interaction. Non verbal communication could include,

•Use gestures to emphasise your communication: point to the part of the body you are talking about •Use pictures, photos diagrams or objects to demonstrate what you are going to do before you do it •Pointing to objects

•Facial expressions
•Miming
•Makaton
•Signing – British sign language
•Using their Communication Passport (A detailed booklet which might include photos, drawings and text which individuals can use to let you know things about themselves eg what they like to eat, wear, do, their achievements etc. •Using their communication dictionary (A detailed book advising how the individual communicates yes, no, bored, happy etc) •Active listening

2. explain why it is important to use language that is both ‘age appropriate’ and ‘ability appropriate’ when communicating with individuals with learning disabilities Communicating with people with disability is no different to communicating with people without disability. The most important thing is the ability to listen to an individual’s needs and not prejudge their requirements. Talk to people using an age-appropriate tone of voice and language. Simplifying the language you use does not necessarily mean treating adults like children. Use short and simple sentence structure.

If you spoke to an adult like a child, this can be very patronising and degrading for the individual. An adult with learning disabilities may have the same interest and feelings as any other person of the same age. They may need things explaining slower and take a little longer to understand what you are communicating, but this does not mean they do not understand. A 20 year old individual with learning disabilities will have the same needs and preferences as any other 20 year old and would most definitely not want to be treated like a 5 year old.

Treat adults as adults. Also you should not make assumptions of someone’s abilities based solely on their physical age, or our perception of their age. Individuals with learning disabilities communication abilities will vary from person to person so it is important to establish the abilities of the individual you are communicating with. 3. describe ways of checking whether an individual has understood a communication, and how to address any misunderstandings.

The best way to establish if an individual has understood a communication is to ask them to repeat the details back to you in their own words. You could also word a question in a different way to see if you get the same response, which would indicate their understanding. Give them time to respond and ask questions. Be clear about what you want to say and why. Be sure the information is relevant. The best way to ensure understanding is to keep communications simple and jargon free This means avoiding things such as

•medical terms – “I will send you for an x‐ray” it may be better to say; “we will need to take a picture of your arm” •Metaphors – ‘Hows the plumbing working?’ it’s better to ask ‘Have you had a wee?’ •Avoid abstract concepts such as “later” or “somewhere”, or analogies. Instead, be as specific as possible.

Sometimes it is best to keep it simple by asking closed questions which only require a yes or no answer. People with learning disabilities sometimes have little or no concept or understanding of time. To aid understanding with regards times, it is better to describe it in terms of events rather than a
time on the clock for example 8.00am as breakfast time or 10.00pm as bedtime

Sometimes it is best to keep it simple by asking closed questions which only require a yes or no answer. People with learning disabilities sometimes have little or no concept or understanding of time. To aid understanding with regards times, it is better to describe it in terms of events rather than a time on the clock for example 8.00am as breakfast time or 10.00pm as bedtime

evitable consequence of their limitations. Disability is the product of the physical, organisational and attitudinal barriers present within society, which lead to discrimination. The removal of discrimination requires a change of approach and thinking in the way in which society is organised.

The social model takes account of disabled people as part of our economic, environmental and cultural society. The barriers that prevent any individual playing a part in society are the problem, not the individual. Barriers still exist in education, information and communication systems, working environments, health and social support services, transport, housing, public buildings and amenities. The devaluing of disabled people through negative images in the media – films, television and newspapers – also act as a barrier.

The social model has been developed with the aim of removing barriers so that disabled people have the same opportunity as everyone else to determine their own life styles.

A simple example is that of a wheelchair user who has a mobility impairment. He is not actually disabled in an environment where he can use public transport and gain full access to buildings and their facilities in the same way that someone without his impairment would do.

The social model of disability has fundamentally changed the way in which disability is regarded and has had a major impact on anti-discriminatory legislation. However, some disabled people and academics are involved in a re-evaluation of the social model and they argue that the time has come to
move beyond this basic position.

4. state the approximate proportion of individuals with a learning disability for whom the cause is ‘not known’

There is often no known factor or factors which are the cause of learning disabilities. According to the British Institute for learning disabilities (BILD) among people who have a mild learning disability, in about 50% of cases, no cause has been identified. A number of environmental and genetic factors are thought to be significant, although clearly diagnosed genetic causes have been found in only 5% of people in this category

In people with severe or profound learning disabilities, chromosomal abnormalities cause about 40% of cases. Genetic factors account for 15%, prenatal and perinatal problems 10%, and postnatal issues a further 10%. Cases which are of unknown cause are fewer, but still high at around 25%.

5. describe the possible impact on a family of having a member with a learning disability.

Life in the family of an individual with LD is complex and challenging, involving practical and emotional issues. There are medical and educational decisions, financial pressures, and time constraints — all likely to represent additional responsibilities for parents. And the inherent concern, disappointment, anger, self-recrimination and blame — typical emotions in response to a child’s problem — also contribute to the pressures frequently disruptive to the family equilibrium and divisive to a marriage. While some may think parental bonds are strengthened in the face of adversity, unfortunately, the opposite is true. Many parents have a difficult time accepting their child’s problems and reconciling their own differences in response to them, while trying to manage daily life at home and in their respective careers.

Parenting a child is never easy, but a strong relationship is required to withstand the additional stress of raising a child with special needs. The family can go through a stage of grief for the ‘perfect child’ it can cause tension between parent and parent, parent and sibling, sibling and sibling, worry for the future and the individuals capacity for independence. It can also cause financial problems, having to have time off work to attend hospitals and doctors and can also lead to social exclusion for the family because the child is disruptive and the invitations dry up. It can also cause some family members to become over protective of the individual leading to reduced opportunities and over dependence.

Outcome 3 Understand the historical context of learning disability

1. explain the types of services that have been provided for individuals with learning disabilities over time

Sadly, the history of public and private attitudes to learning disability over the last three centuries has been one of intolerance and lack of understanding. In 1834 the ‘Poor Laws’ was created and the building of asylums began. These purpose-built institutions were to house people described as ‘mad’ or ‘feeble minded’. They soon became overcrowded and a harsh place to live where the ‘inmates’ had little choice and were not valued as people. Soon residents began to be regarded to be dangerous and a drain on society.

In the early 20th century the building of institutions continued but the purpose moving people to institutions changed. Reforming educationalists got laws passed that encouraged the building of schools for ‘feeble minded’ children, and in 1908 the Radner Commission stated that: ‘Feeble-mindedness is largely inherited.’ They suggested that such people were genetically inferior and needed to be segregated from the rest of society. The Mental Deficiency Act 1913 states that anyone admitted to the institutions had to be certified as a mental defective. The institutions were now renamed ‘colonies’, and their purpose was to separate their residents from society. In 1929, the Wood committee suggested such people were a threat to society.

In 1946 the National Health Service was introduced, the term ‘mentally handicapped’ came into use and the institutions were turned into hospitals overnight and the emphasis turned to caring for people. They remained segregated and isolated and the standard of care was poor.

In 1971 the government published a paper ‘Better services for the mentally handicapped’ which laid the foundation for ‘Care in the community’ which aimed to achieve half the people living in hospitals were living in the community by 1990.

‘Normalisation’ began to influence the delivery of care during the 1980’s. The theory emphasises the unique value of the individual their right to choice and opportunity, and the right to any extra support they need to fulfil their potential. At this time there was also recognition that institutions were a major barrier to inclusion. The idea that everyone in society has the right to a life with choice, opportunity and respect, with extra support according to their needs, helped to change the way services were planned and delivered. The National Health Service and Community Care Act 1990 recognised the right of disabled people to be an equal part of society, with access to the necessary support.

Today’s services aim to enable people and promote equal treatment and inclusion. This brings with it new challenges and responsibilities, the greatest of which is to change public attitudes towards people with a learning disability and raise understanding.

2. describe how past ways of working may affect present services

Past ways of working greatly affect present services. The health of people with learning disabilities has been at the forefront of policy and service development over recent years, but sadly this has often been in reaction to damning reports and inquiries highlighting the inequalities and poor quality care individuals with learning disabilities have experienced.

SUMMARY OF KEY REPORTS AND ENQUIRIES

ReportSummary of the main findings or recommendations
Equal treatment:
closing the gap,
Disability Rights
Commission (2006)Government should seek to close health inequality gaps by: • improving primary care access and health checks
• enabling equitable treatment
• targeting people with learning disabilities in national health inequalities programmes • working in partnership with people with learning disabilities to educate and improve services. Joint investigation into

the provision of
services for people
with learning
disabilities at Cornwall
Partnership NHS Trust, Commission for Social Care Inspection and the Healthcare Commission (2006)
This independent inquiry arose in response to serious concerns raised by the East Cornwall Mencap SocietyThe independent enquiry found: • institutional abuse was widespread, preventing people from exercising their rights to choice, independence and inclusion • multiple instances of unacceptable restrictions on the lives of service users • poor assessment, care planning and record keeping, especially in relation to people whose behaviour was described as ‘challenging’ • limited training, policies and procedures.

Its recommendations included:
• immediate action with regards to vulnerable adults, including processes, training and identified responsibilities • a plan to improve the skills and knowledge of staff
• immediate community care assessments and ongoing health care assessments for service users • the redesign of the service reflecting a person-centred culture. Six Lives: the provision
of public services to
people with learning
disabilities,
Parliamentary and
Public Health Service
Ombudsman (2009)
A report detilailing the
investigation into the deaths
of six people with learning
disabilities whilst in local
authority or NHS care• Effectiveness systems should be in place to enable services to understand and plan to meet the full range of needs of people with learning disabilities in their areas. • Services should have the capacity and capability to provide and/or commission for their local populations to meet the additional and often complex needs of people with learning disabilities

Investigation into the
service for people with
learning disabilities
provided by Sutton
and Merton Primary
Care Trust, Healthcare
Commission (2007)
(now called the Care
Commission)A request from the trust’s chief executive initiated this independent inquiry, which found: • care models based on the needs of the service rather than individuals • limited activities for service users

• inappropriate use of restraint
• lack of staff experience in supporting people with behaviour described as challenging • a number of serious incidents of sexual and physical abuse • poor living environments
• lack of service user involvement
• limited arrangements for governance.
The Care Commission’s recommendations included:
• services should be based on the principles of person-centred care plans and health action plans
• a range of activities for service users
• develop a policy on and train staff in the use of restrictive physical interventions • develop the skills, experience and training opportunities for the workforce • provide appropriate advocacy services.

Healthcare for all:
report of the
independent inquiry
into access to health
care for people with
learning disabilities,
Sir Jonathon Michael
(2008)The report recognised examples of good practice but found a range of appalling examples of discrimination, abuse and neglect across the range of health services. The report recommendations include:

• the Department of Health should adjust its Core standards for better health to reflect the ‘reasonable adjustments’ service are required to make for vulnerable groups • clinical training must include mandatory training in learning disabilities • inspectors and regulators of health services should develop and extend their monitoring of general health services provided to people with learning disabilities • family and other carers should be involved as a matter of course as partners in the provision of care, unless good reason is given.

3. identify some of the key changes in the following areas of the lives of individuals who have learning disabilities:

With the decline of the ‘Medical model’ of learning disabilities the focus of support has shifted to health and social care and to education. The emphasis is now on the inclusion approach and community integration. Because of the ‘Direct payments’ individuals are able to purchase the services they want, which gives the individual more choice and changing expectations. The combined effect is that new opportunities are being opened up for people with learning disabilities in areas such as employment, parenthood, lifelong
learning and citizenship.

Where people live
People with learning disabilities are now encouraged to live in the community rather than in residential or nursing homes

Daytime activities
Individuals have access to day centres which carry out stimulating activities and excursions whilst offering support and care

Employment
The Equality act ensures individuals with learning disabilities are not discriminated against in the workplace.

Sexual relationships and parenthood
A person with a learning disability has the freedom to choose a partner and get married. They also have the right to become parents. They have the right to use contraception or not.

The provision of healthcare.
A detailed health assessment plan is now used, to provide a holistic service for their medical, mental, and emotional needs. They have the right to choose their own G.P, and be informed of what their medical records contain, and see their medical notes.

Outcome 4 Understand the basic principles and practice of advocacy, empowerment and active participation in relation to
supporting individuals with learning disabilities and their
families
The learner can:
1. explain the meaning of the term ‘social inclusion’

‘Social exclusion is a complex and multi-dimensional process. It involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities,
available to the majority of people in a society, whether in economic, social, cultural or political arenas. It affects both the quality of life of individuals and the equity and cohesion of society as a whole’ (Levitas et al 2007, p.9). Therefore ‘Social inclusion’ is the opposite and involves everyone having access to resources etc and the ability to participate in normal relationships and activities.

2. explain the meaning of the term advocacy

Advocacy is about helping you to speak up for yourself, to make sure that your views and opinions are heard and understood. If you find it hard, or you are unable to speak for yourself then you may find an ‘Advocate’ who can help you. An advocate should be free from conflicts of interest with those providing services to the person they are working with and should represent the other person’s interests as if they were the Advocate’s own.

3. describe different types of advocacy

Citizen advocacy
This is a one-to-one ongoing partnership between a volunteer Advocate and a person. This person may not know their rights, be vulnerable and may be at risk of being mistreated or excluded.

Self-advocacy
This means “speaking up for yourself”. Self-advocacy is about expressing your own needs and concerns and giving your own views.

Peer advocacy.
Peer advocacy is when one person talks for another who has experienced or is experiencing similar difficulties or has similar life experiences (e.g. service users in a residential facility).

Professional advocacy
This is when people are paid to provide an advocacy service. It is issue led, focusing on particular issues.

Legal advocacy
This is when a solicitor works on your behalf.

4. describe ways to build empowerment and active participation into everyday support with individuals with learning disabilities.

Empowerment for people with learning disabilities is the process by which they develop increased skills to take control of their lives. This will help them achieve goals and aspirations, maximising their quality of life. A key feature in empowering people is giving them a voice and actively listening to what they have to say. By using person centred thinking and person centred planning, and listening to what the individual wants, you can ensure the individuals support plan allows them more choice and control over their lives and the support they receive.

Empowerment is, therefore, closely linked to the concept of advocacy. Empowerment in learning disability can be described as a social process, whereby people who are considered as belonging to a stigmatised social group can be assisted to develop increased skills to take control of their lives.

This increased control will help them to achieve their goals and aspirations and thus potentially maximise the quality of their lives. You can empower the individuals you work with by offering them choices, ensuring they are aware of their rights and entitlements, allowing them to make informed choices, speaking up for them if they wish you to or encourage them to speak up for themselves, if they have a problem or request. and ensuring they know their rights and you safeguard them for the individual. You should allow and encourage the individual to actively participation in every aspect of their life to encourage their independence and actively involve them in their care.

You should only assist them with tasks they are unable to do themselves and always encourage them to try new things. Outcome 5 Understand how views and attitudes impact on the lives of individuals with learning disabilities and their family carers The learner can:

1. explain how attitudes are changing in relation to individuals with learning disabilities

Society’s attitudes and behaviour towards people with learning disabilities have had a major impact on their lives and continue to do so. Many people still label people with learning disabilities which has led to a negative attitude towards them. One of the biggest changes is a move away from the medical model and a move towards the social model. Now instead of focussing on ‘whats wrong’ with the individual the focus has shifted to removing barriers which prevent an individual with learning disabilities from having the same opportunities as everyone else. This move has also impacted on changes in the law regards anti-discrimination legislation and equal rights. The focus is now on what an individual can do rather than what they cant. Now instead of being expected to ‘fit in’ society is finding ways to adapt to their needs.

2. give examples of positive and negative aspects of being labelled as having a learning Disability

From a negative aspect, any type of label can lead others to have a stereotypical view and make stereotypical assumptions of what a person or group of people are like and also assumptions about their capabilities. A label can cause others to act or treat individuals differently, without knowing the person as an individual. The label will create an expectation of what that person is like Labels can cause stigmatization, rejection, prejudice’s and also cause victimisation of those with the label. It can lead to the person with the label experiencing physical and emotional isolation and the label can become their defining characteristic. Medical “labels” are undesirable and often misleading, as no two people are alike and such labels merely reinforce stereotyping of disabled people as “patients”.

From a positive aspect, being diagnosed with learning disabilities can create a feeling of relief and understanding for the individual and their families. Under the law in order for a person to receive special services they have to be diagnosed as having LD. From a child’s point of view, being labelled as LD can provide them with many advantages such as extra instruction and help
at school. It can help the individual and others to focus on their abilities rather than weakness.

3. describe steps that can be taken to promote positive attitudes towards individuals with learning disabilities and their family carers In a research report carried out by the Department of Works and pensions, the conclusion reached on how to promote a more positive attitude towards individuals with learning disabilities and their family, carers was to make several changes.

The key strategies included: improved education about disability; improved media representation and publicity; improved physical access, transport and financial support; strengthened legislation; and increased integration of disabled and non-disabled people. From a carers point of view the ways in which you can follow this strategy is by •encouraging the service user to join in local community activities, clubs and social events to enable more interaction between them and members of the public •Ensure you treat the individual in the same way as you treat other individuals you care for

•Focus on the individuals abilities rather than their disabilities •Encourage the individual to reach their full potential through empowerment and independence. •Educate others and raise their awareness regards LD and the different types of LD there are. •Encourage the individuals family to join support groups – , research has found a strong association between supportive social networks and the positive psychological well-being of individuals caring for LD individual •Dispel myths attached to LD

MYTHS
•People with learning disabilities have below average intelligence and cannot learn – the fact is people with learning difficulties have average to above average intelligence. In studies as many as 33% of students with LD are gifted (Baum, 1985) •Dyslexia and LD are the same thing – Dyslexia is a type of LD not another term for LD. It is a specific language based disorder •LD only affects an individual’s academic skills – Most people with LD usually have other areas of difficulty such as social skills, motor conditions, memory.

4. explain the roles of external agencies and others in changing attitudes,
policy and practice.

Many people are involved in the day to day lives of individuals with learning disabilities. They are more aware than anyone else of the problems and attitudes they face on a day to day basis. Sometimes it may be necessary to speak up on their behalf when they feel a policy or practice is not right. These individuals may be people the LD person works with, their family, friends, other professional they come into contact with, or it could be you as their carer. If you ever feel that your workplace policy or practice is incorrect you should report this and discuss it with your manager. If you still felt the situation had not improved you should take the matter further, even as far as the CQC depending on the severity of the issue.

There are also many external agencies and others who are involved in the life of an individual with learning difficulties. The external agencies could include advocacy services, parent/carer support groups and campaign groups. These people are the collective voice of the individuals and as groups are able to put forward and campaign for the LD individuals rights, if they are not being met and also put forward. This is the way in which attitudes and laws are changed and individual’s rights are upheld.

Outcome 6 Know how to promote communication with individuals with learning disabilities
The learner can:
1. identify ways of adapting each of the following when communicating with individuals who have learning disabilities

The communication skills of individuals with LD can vary greatly. Communication between all people is very complex; miscommunication leading to misunderstandings, confusion and indeed conflict. The potential for this is exacerbated when the issue of Learning Disabilities is also included. In order to avoid misunderstandings it is necessary to establish an effective means of communicating, whether it is verbal, non-verbal or a combination of both. An individual with LD may be less able to understand and retain new and complex information and may require you to use simple language and explain things which are unfamiliar. Also its important to remember that not
all disabilities may be visible or immediately evident

verbal communication

•Ensure that your communication is clear. Use simple language and keep your sentences short •Explain any difficult or unfamiliar words. For example: “I will send you for an x‐ray” it may be better to say; “we will need to take a picture of your arm” •Check that the individual has understood: “Can you please tell me in your own words what I have just said” • Give the person time to respond

•Be aware of any additional disabilities such as hearing or visual impairment •Speak to the person, in a relaxed and natural way, using facial expressions and keep eye contact with them. •Be clear about what you want to say and why.

•Be sure that the information is relevant
•Speak directly to the person rather than to a support worker, though carers and support workers may be useful sources of additional information.

non-verbal communication

Communication is not just verbal. It also includes body language, gestures, pictures and symbols, and facial expressions. This adds up to a more complete picture, helping us and the ‘message receiver’ to undertake a meaningful interaction. Non verbal communication could include,

•Use gestures to emphasise your communication: point to the part of the body you are talking about •Use pictures, photos diagrams or objects to demonstrate what you are going to do before you do it •Pointing to objects

•Facial expressions
•Miming
•Makaton
•Signing – British sign language
•Using their Communication Passport (A detailed booklet which might include photos, drawings and text which individuals can use to let you know things about themselves eg what they like to eat, wear, do, their achievements etc. •Using their communication dictionary (A detailed book advising how the individual communicates yes, no, bored, happy etc) •Active listening

2. explain why it is important to use language that is both ‘age appropriate’ and ‘ability appropriate’ when communicating with individuals with learning disabilities Communicating with people with disability is no different to communicating with people without disability. The most important thing is the ability to listen to an individual’s needs and not prejudge their requirements. Talk to people using an age-appropriate tone of voice and language. Simplifying the language you use does not necessarily mean treating adults like children. Use short and simple sentence structure.

If you spoke to an adult like a child, this can be very patronising and degrading for the individual. An adult with learning disabilities may have the same interest and feelings as any other person of the same age. They may need things explaining slower and take a little longer to understand what you are communicating, but this does not mean they do not understand. A 20 year old individual with learning disabilities will have the same needs and preferences as any other 20 year old and would most definitely not want to be treated like a 5 year old.

Treat adults as adults. Also you should not make assumptions of someone’s abilities based solely on their physical age, or our perception of their age. Individuals with learning disabilities communication abilities will vary from person to person so it is important to establish the abilities of the individual you are communicating with. 3. describe ways of checking whether an individual has understood a communication, and how to address any misunderstandings.

The best way to establish if an individual has understood a communication is to ask them to repeat the details back to you in their own words. You could also word a question in a different way to see if you get the same response, which would indicate their understanding. Give them time to respond and ask questions. Be clear about what you want to say and why. Be sure the information is relevant. The best way to ensure understanding is to keep
communications simple and jargon free This means avoiding things such as

•medical terms – “I will send you for an x‐ray” it may be better to say; “we will need to take a picture of your arm” •Metaphors – ‘Hows the plumbing working?’ it’s better to ask ‘Have you had a wee?’ •Avoid abstract concepts such as “later” or “somewhere”, or analogies. Instead, be as specific as possible.

Sometimes it is best to keep it simple by asking closed questions which only require a yes or no answer. People with learning disabilities sometimes have little or no concept or understanding of time. To aid understanding with regards times, it is better to describe it in terms of events rather than a time on the clock for example 8.00am as breakfast time or 10.00pm as bedtime


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