provide appropriate support to people with special needs

8/2/2019 Provide Appropriate Support to People With Special Needs

1/39


2/39

Special needs

In the United States, special needsis a term used in clinical diagnosticand functional development todescribe individuals who require

assistance for disabilities that may bemedical, mental, or psychological.

People with Autism, Down syndrome,dyslexia, blindness, or cystic fibrosis,for example, may be considered tohave special needs.


3/39

More narrowly, it is a legal term applying in

foster care in the United States. It is a diagnosis used to classify children

as needing "more" services than those

children without special needs who are inthe foster care system.

It is a diagnosis based on behavior,

childhood and family history, and is usuallymade by a health care professional.


4/39

In the United Kingdom, Specialneeds often refers to special

needs within an educationalcontext. This is also referred to asspecial educational needs (SEN).


5/39

Special Education Needs

The term Special Needs is a short form ofSpecial Education Needs and is a way to refer tostudents with disabilities.

The term Special Needs in the education settingcomes into play whenever a child's educationprogram is officially altered from what wouldnormally be provided to students through an

Individual Education Plan which is sometimesreferred to as an Individual Program plan.


6/39

Services and support

Today, support services are provided bygovernment agencies, non-governmentalorganizations and by private sectorproviders.

Support services address most aspects oflife for people with developmentaldisabilities, and are usually theoretically

based in community inclusion, usingconcepts such as social role valorizationand increased self-determination.


7/39

Support services are funded throughgovernment block funding (paid directly toservice providers by the government), throughindividualized funding packages (paid directly tothe individual by the government, specifically for

the purchase of services) or privately by theindividual (although they may receive certainsubsidies or discounts, paid by the government).

There also are a number of non-profit agencies

dedicated to enriching the lives of people livingwith developmental disabilities and erasing thebarriers they have to being included in theircommunity.


8/39

Education and training

Education and training opportunities forpeople with developmental disabilitieshave expanded greatly in recent times,

with many governments mandatinguniversal access to educational facilities,and more students moving out of specialschools and into mainstream classroomswith support.


9/39

Post-secondary education and vocationaltraining is also increasing for people withthese types of disabilities, although manyprograms offer only segregated "access"courses in areas such as literacy,

numeracy and other basic skills.


10/39

At-home and community support Many people with developmental disabilities live in the

general community, either with family members, insupervised-group homes or in their own homes.

At-home and community supports range from one-to-oneassistance from a support worker with identified aspectsof daily living to full 24-hour support (includingassistance with household tasks, such as cooking andcleaning, and personal care such as showering, dressingand the administration of medication).

The need for full 24-hour support is usually associated

with difficulties recognizing safety issues (such asresponding to a fire or using a telephone) or for peoplewith potentially dangerous medical conditions (such asasthma or diabetes) who are unable to manage theirconditions without assistance.


11/39

Residential accommodation

Some people with developmental disabilities livein residential accommodation (also known asgroup homes) with other people with similarassessed needs.

These homes are usually staffed around theclock, and usually house between 3 and 15residents. The prevalence of this type of supportis gradually decreasing, however, as residential

accommodation is replaced by at-home andcommunity support, which can offer increasedchoice and self-determination for individuals.


12/39

Employment support Employment support usually consists of two

types of support:1. Support to access or participate in integrated

employment, in a workplace in the generalcommunity. This may include specific programsto increase the skills needed for successfulemployment, one-to-one or small group supportfor on-the-job training, or one-to-one or small

group support after a transition period (such asadvocacy when dealing with an employer or abullying colleague, or assistance to complete anapplication for a promotion).


13/39

2. The provision of specific employmentopportunities within segregated business

services. Although these are designed as"transitional" services (teaching work skillsneeded to move into integrated employment),many people remain in such services for theduration of their working life. The types of workperformed in business services include mailingand packaging services, cleaning, gardening

and landscaping, timberwork, metal fabrication,farming and sewing.


14/39

Day services Non-vocational day services are usually known as day

centers, and are traditionally segregated services offeringtraining in life skills (such as meal preparation and basicliteracy), center-based activities (such as crafts, games andmusic classes) and external activities (such as day trips).Some more progressive day centers also support people to

access vocational training opportunities (such as collegecourses), and offer individualized outreach services (planningand undertaking activities with the individual, with supportoffered one-to-one or in small groups).

Traditional day centers were based on the principles of

occupational therapy, and were created as respite for familymembers caring for their loved ones with disabilities. This isslowly changing, however, as programs offered become moreskills-based and focused on increasing independence.


15/39

Advocacy

Advocacy is a burgeoning support field for people withdevelopmental disabilities.

Advocacy groups now exist in most jurisdictions, workingcollaboratively with people with disabilities for systemicchange (such as changes in policy and legislation) and

for changes for individuals (such as claiming welfarebenefits or when responding to abuse).

Most advocacy groups also work to support people,throughout the world, to increase their capacity for self-

advocacy, teaching the skills necessary for people toadvocate for their own needs.


16/39

Other types of support

therapeutic services, such as speech therapy,occupational therapy, physical therapy, massage,aromatherapy, art, dance/movement or music therapy

supported holidays

short-stay respite services (for people who live withfamily members or other unpaid carers)

transport services, such as dial-a-ride or free bus passes

specialist behavior support services, such as high-security services for people with high-level, high-riskchallenging behaviors

specialist relationships and sex education services


17/39

Comprehensive health care services forpeople with learning disabilities

Comprehensive health care services respond effectively tothe needs of their patients not just in terms of treatment ofhealth problems but also by addressing overall well-being byunderstanding, informing, involving, counselling andrespecting the individual.

By contrast, the history of health care for people with learningdisabilities has been characterised by a lack ofcommunication and poor understanding of their ordinary andspecial needs.

There have been many barriers to access to health servicesthat most members of the population take for granted. In

addition, people with learning disabilities have many specialhealth care needs that also have to be addressed. Therefore,person-centred services must be aware of the wide range ofneeds to which they must be able to respond while treatingeach person as an individual.


18/39

Requirements for meeting the health careneeds of people with learning disabilities

Equal access to all health services

Sufficient support to enable access tothese services

Disability awareness as an integral part ofstaff training

Access to specialist health services forthose with more complex and specialneeds


19/39


20/39

Health care needs of people with learning disabilitiesOrdinary health care needs

People with learning disabilities have ordinaryhealth care needs similar to those of the rest ofthe population and the same rights of access tohealth care services.

However, barriers to access arise from two mainsources: the learning and communicationdifficulties of people with learning disabilities andthe knowledge, attitudes and beliefs of carers,clinicians and managers of services.


21/39

Learning and communication difficulties

The individual with a learning disability may not

understand the significance of a healthy lifestyle andthe importance of health screening or recognizesymptoms or signs of ill health.

This can lead to failure to cooperate with carers in

following a healthy lifestyle or in participating in healthscreening activities.

When the person has ill health he or she may notdraw this to the attention of others in the usual waysbecause of failure to realize the significance ofsymptoms or because of communication difficulties.


22/39

There are several ways of addressing this.

First, services should ensure that people with

learning disabilities have opportunities tolearn about their health and that information isprovided in ways that take communicationdifficulties into account. Picture-based booksare available aimed at people with learningdifficulties and their carers. Some communitylearning disability teams have found that well-

woman and well-man groups have beensuccessful in raising awareness of healthissues.


23/39

Second, people with severe learning andcommunication difficulties may not be able toexpress discomfort or pain in usual ways. Carersmust be aware of this and sensitive to changesin behaviour or well-being that indicate pain,

illness or unhappiness.

Third, regular health (including dental andsensory) checks are needed to detect problemsby symptom screening and physicalexamination.


24/39


25/39

Discrimination

Carers and professionals may

undervalue people with learningdisabilities and may not consider theirhealth needs to be important.

Most often, however, it leads to moresubtle discrimination and neglect ofhealth care needs. This can be

addressed in various ways.


26/39

First, the training of carers and professionals shouldinclude examination of their own and society's attitudes

and beliefs and the ways that these shape services andservice responses. Positive changes in attitudes andbeliefs can most readily be achieved by direct contactand discussion with self-advocates and with familycarers.

Second, organisations should have explicit policiesabout disability discrimination based on discriminationlegislation and also whistle-blowing policies;involvement and consultation with service users and

carers should be a priority. Professional organisationsshould make these explicit in their codes of conduct.


27/39

Physical and administrative barriers

Physical barriers to access may be present and theseinclude not only unsuitable buildings but also unsuitable

signs, support, information about appointments, timing ofappointments and information about treatment. Sometimespeople with learning disabilities need careful preparationfor hospital appointments or admissions and opportunitiesto familiarize themselves with places and procedures.

Issues of consent also need to be understood andaddressed in order to avoid this becoming another barrierto access.

Services should be aware of the potential needs of people

with learning disabilities by listening to them and tospecialist learning disability services and should thenundertake the adaptations that are needed. Flexibleservices are necessary in order to accommodate theparticular needs of people with learning disabilities.


28/39

Social factors

Finally, barriers to access will be greaterif services are insensitive to the social,ethnic, cultural and economic

backgrounds of individuals and theirfamilies: these should be bothrecognised and understood.


29/39

Developmental disorders

Many people with learning disabilities have autistic

spectrum, hyperactivity and other developmentaldisorders, even if not formally recognized.

This involves many factors. First, there must be gooddiagnostic services, to detect in early childhood any

developmental disorder additional to a learning disability.The diagnosis depends on a full and competentassessment by a child and adolescent psychiatric,paediatric or learning disability service that specializes inthis area. This will include a detailed developmentalhistory as well as direct observation of the child andfamily.


30/39

Second, treatment is important. There is some evidencethat early intervention for children with autistic spectrumdisorders may result in significant improvements in skillsand behaviour.

Attention-deficit and hyperactivity disorders may benefitfrom the use of psychostimulant medication, whichrequires specialist assessment and monitoring.

Communication disorders are often associated withchallenging behaviour. Speech and language disordersrequire access to skilled speech and language therapyand carers and teachers who can apply such specialistadvice in day-to-day care. Coordination disorders

(dyspraxia) require skilled occupational therapy input. Ticdisorders may improve with the use of medication butare often undiagnosed.


31/39

Epilepsy

Access to specialist services for epilepsy is

important because 1324% of people with alearning disability are affected by the disorder.

Modern diagnosis includes referral to a

specialist with expertise in epilepsy for detailedexamination and investigation, followed byeffective monitoring of seizure control andmedication. Expert knowledge is required of the

many anti-epileptic drugs available and of theindications and risks associated with their use.


32/39

Sensory impairments

Sensory impairments must be detected and remedied to

minimize the consequent disability, and a specializedand sensitive approach is usually needed. About 30% ofpeople with learning disabilities have a significant sightimpairment and 40% have significant hearing problems.Sometimes both are present, resulting in a complexdisability. The prevalence of these problems increaseswith age, and professionals should be aware of this as apossible explanation for changes in behaviour andawareness. Sensory disabilities are often associated

with challenging behaviour. There is a very high rate ofunderdetection of sensory impairments, most of whichcan be treated.


33/39

Physical disabilities

Up to 30% of people with learning disabilities also have

physical disabilities, most often owing to cerebral palsy,and they need input from a range of specialist services.

A large number of serious health problems aresecondary to these physical disabilities (e.g. gastro-

oesophageal reflux, aspiration pneumonias, risk ofchoking, joint pains and muscle spasms). The chronicdiscomfort caused by such problems may present as abehavioural problem and this can lead to misdiagnosis.

Pain management is particularly important for peoplewho cannot easily communicate their discomfort.


34/39

Changes in health care services

Previous patterns of service delivery

It is evident from the range of needs that no singleservice can effectively meet them all.

In the past, large hospitals were established mainly forcare and segregation rather than with a therapeuticpurpose, and the staff attempted to address all thephysical and mental health needs of their long-staypatients. As these hospitals became overcrowded, carestandards became poor and the problems ofinstitutionalization were increasingly recognized. Pilot

projects in the 1980s showed that even people with highhealth care needs could be cared for by communityservices if the various agencies worked togethereffectively.


35/39

As the hospitals closed, the professional staff shifted theirspecialist work to community settings and specialist

community learning disability teams have become the norm inmost areas. The knowledge and skill base has steadilyimproved so that more effective interventions are nowavailable to help people with learning disabilities and theirfamilies and carers.

However, the majority of those with learning disabilities havealways lived in the community and have had to compete withthe general population for health care. There is evidence thatthe health needs of these people have for many years goneunderrecognised or undertreated in the ordinary primary,community and hospital health services. This is less likely tohappen if specialist services are involved in drawing attentionto the barriers to access and in meeting the special needsoutlined above.


36/39

Present and future trends Patterns of health service provision for people with learning

disabilities are shifting.

The residual hospital provision is mainly for specialist psychiatricassessment and treatment and also for some continuing care ofpeople with severe and complex health problems.

Social care is no longer the responsibility of health services andthe emphasis is much less on the disability and much more onsupport to the individual to build on strengths and respond to

needs. There is a risk that this change of emphasis could lead to neglect

of health care needs, and there has been a recent resurgence ofinterest and concern in this area.

The difficulty in separating health from social care, particularlyfor people with long-term and complex needs, has led to an

increasing emphasis on partnerships between organizations. Also, there has been an increasing awareness that the problems

of institutionalization and poor-quality care can arise in any caresetting and that organizations that commission, provide andmonitor services must work together to ensure that servicedelivery is optimal in terms of quality and effectiveness.

T d i h f h l h i


37/39

Trends in the pattern of health serviceprovision for people with learning disabilities

Shift from institutional to personalized community care,leading to greater use of community health servicesand reduction of the barriers to access

Increasing service-user and carer consultation and

involvement in improving services Changes in health needs as more children with

complex disabilities live into adulthood and mostpeople with learning disabilities reach old age

Identification of physical and behavioural phenotypes Development of specialist out-patient and in-patient

mental health services for people with learningdisabilities with complex needs


38/39

Improved understanding of developmental disorders andspecialist interventions for these

Increasing awareness of the need to develop mental

health services for children and adolescents withlearning disabilities and emphasis on early intervention

Increasing awareness of the needs of older people withlearning disabilities

Improved understanding of seizure disorders and newtreatment approaches, leading to higher expectations ofservices

As a result of international and national changes inservices for people with learning disabilities and changes

in the attitudes of society towards them, there have beenmajor policy reviews at government level, withconsiderable implications for future provision of healthcare services.


39/39

provide appropriate support to people with special needs

Documents