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Occupational therapy can help people with learning disabilities live independently

NICE guidance says occupational therapy can be used to help people with learning disabilities with challenging behaviour live at home

Published on 30th October 2017

Occupational therapy should be utilised to enable people with learning disabilities and challenging behaviour to live at home, according to the National Institute for Health and Care Excellence.

NICE draft guidance states that people with learning disabilities and behaviour that challenges should be better cared for in the community. Local authorities and NHS bodies should provide specialist community care for people with learning disabilities who behave in a way that challenges to avoid admissions to psychiatric wards or residential homes, it adds.

Jonathan Senker, Chief Executive of VoiceAbility and chair of the guideline committee, said: “Our draft guideline recognises that some people with learning disabilities and behaviour that challenges are not receiving the care they deserve. Good, specialist support in the community is often lacking and this can make life for people and their families extremely difficult.

“They can find themselves in a crisis and admitted to hospital as an inpatient. We want services to provide better support in the community to break this disruptive pattern of care.”

According to NICE, there are 1.2 million people with a learning disability in England, and between 10-17% of those have behaviour that challenges.

Behaviour is challenging if it is harmful to the person or others around them, which can include hitting or kicking, and if it stops them from being able achieve things in their daily life, such as making friends.

The guidance states that people with learning disabilities should be supported to live where and how they want.

Services should aim to:

  • maximise people’s choice and control
  • promote person-centred care
  • help people take an active part in all aspects of daily life that they choose, based both on what they can do and what they want to do
  • respect people’s cultural, religious and sexual identity
  • help people as soon as problems emerge, not just when crisis has been reached
  • promote continuity of relationships.

The guideline aims to help local areas rebalance their services by shifting the focus towards enabling people to live in their communities and increasing support for families and carers. This should reduce the need for people to move away for care and treatment, says the guidance.

Local authorities should ensure that parents and carers of children, young people and adults with a learning disability and behaviour that challenges have support to care for that person from occupational therapy, psychology, speech and language therapy and behaviour analysis and positive behaviour support services.

The guideline makes a number of recommendations including:

Local authorities and clinical commissioning groups should jointly designate a single lead commissioner who is responsible for commissioning health, social care and education services for children, young people and adults with a learning disability, including for those whose behaviour is described as challenging.

Professionals should involve people and their family members and carers to enable person-centred care.

Local authorities should assign a single practitioner, such as a social worker in the community learning disability team, to be the person's ‘named worker’ and coordinate their support.

Local authorities and clinical commissioning groups, acting through the single lead commissioner, should ensure people can get support when needed through their team from OTs, psychologists, SLT’s, social workers and physiotherapists.

Commissioners should work with local housing providers to identify the specific housing needs of people with learning disabilities and challenging behaviour.

Children, young people and adults with a learning disability and behaviour that challenges should only be admitted to inpatient units if assessment and care planning show that their needs cannot be safely met in the community and all possibilities for doing so have been considered and exhausted.

Professor Gillian Leng, director of health and social care and deputy chief executive at NICE, said:“We know that services for people with learning disabilities, and their families, can be hugely difficult to navigate.

“Providing better and local support will ensure that someone who needs treatment doesn’t have to be away from home. Our advice, once final, will set out how services can deliver good care to meet their needs.”

The proposed recommendations are out for consultation until 20 November. Stakeholders and members of the public are invited to comment.

 

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