The assessment of people with Learning Disabilities under the CHC Framework Susan Fitzgerald

1. The assessment of people with Learning Disabilities under the CHC Framework Susan Fitzgerald CHC/FNC Team Leader: Kingston

2. Introduction • This presentation endeavours to cover some of the practical aspects of assessing people with Learning Disabilities under the CHC framework. • Looks at some of the key domains and challenges regarding assessment • Discusses the role of the multi-disciplinary Team in the assessment.

3. Should it or shouldn’t it even be assessed? • A question that is raised in all areas is whether Learning Disabilities of varying types should even be considered under CHC? • This comes up very often in Autism but is not only in relation to this.

4. Social services seek health funding because the care needs are more than they feel should be expected to be provided from Social Services. -Health assesses and finds, often it is the behavioural domain pivoting between Priority and severe that make the judgement of CHC or not and this is questioned by them as whether this should be the deciding factor alone? -Families say they do not want CHC as they feel it will reduce their or the person’s control and autonomy and they say that Autism is not a health needs it’s a social need.

5. Needs not Diagnosis • CHC assessment is based on needs not diagnosis • The Need is that the right Statutory Authority is identified – and that there is clarity about funding streams and responsibilities • A CHC decision should not disempower the individual or mean either increased or reduced care. (However - yes it will affect funding arrangements, and it could impact on the persons financial arrangements)

6. CHC in Learning Disabilities what do you need? • A good knowledge of the CHC Framework • A good knowledge / understanding of the DST descriptors And / or • An in-depth knowledge of the individual. Both is the ideal but rarely possible in such a small field at this time – so utilise more people and multiply the knowledge.

7. What’s the difference in LD Assessment? • Integrally it is the same as any complex case assessment • However there is an onus on the 4 initial domains in both Learning Disabilities and Mental Health Assessments. The challenge here is that assessors find these to be the most subjective and difficult domains to accurately assess against.

8. So what does a CHC assessor need to know about Learning Disabilities • There are 4 key domains where the presentation can be very different in this group: • Behaviour • Cognition • Psychology • Communication

9. So what does a CHC assessor need to know about Learning Disabilities • People who work predominantly in the LD field have a threshold of expectation that is higher than in the general services population. • Dependant on which field you originate from you will also have a certain bias or leaning toward lower of higher thresholds under those more subjective domains. • Keep referring to the DST and the framework for the definition. Base everything on evidence

10. Behaviour Defined Challenging behaviour is defined as "culturally abnormal behaviours of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities". Emerson, E. 1995

11. Behaviour definition con’t: • Frequency & Severity & Impact • Is it or will it cause emotional or physical harm to the person themselves, or others? • How often and to what extent ?

12. CognitionDefined Cognition is a term referring to the mental processes involved in gaining knowledge and comprehension, including thinking, knowing, remembering, judging and problem-solving. These are higher-level functions of the brain and encompass language, imagination, perception and planning. Kendra Cherry Psychology Guide since 2005

13. Psychological & Emotional Defined Emotion is the complex psychophysiological experience of an individual's state of mind.... Emotion fundamentally involves "physiological arousal, expressive behaviours, and conscious experience." Emotion is associated with mood, temperament, personality and disposition, and motivation.…. Emotions provide the affective component to motivation, positive or negative. Myers, David G. (2004) & Gaulin, Steven J. C. and Donald H. McBurney. Evolutionary Psychology. Prentice Hall. 2003

14. Engagement of the Person being assessed • Firstly and as an integral part of the assessment role assessors must have a good knowledge of the Mental Capacity Act. • Capacity in relation to the assessment process • Dignity and respect • Enabling the person to have maximum control • Best interest • Deprivation of Liberty

15. Engagement of the Person being assessed • Engagement needs to be functional and useful • It should not provoke anxiety or stress. • Make the message as simple as it needs to be in order to make sense. • The message can come from whoever is best placed to explain it. • Arrive prepared – talk to the family and support staff around the person to ensure understanding

16. Engaging the Person ……. • Bottom line : • I am assessing what help you need • This assessment is about who is going to work with you to make sure you get the help you need . • It is about who pays for your help • If the people who know the person feel that he/she is clearly not going to understand and that it will only cause undue anxiety and distress then in the persons best interest record that and don’t speak to them directly about the assessment

17. Engaging the Family • Talk to them first – this prevents misunderstanding • Invite them to be part of the process • Explain CHC to them and reassure them • Offer more information • Offer a pre-meet • Be clear about your role • Be clear about confidentiality issues and data protection – again saves misunderstanding • Make sure they know its not a one meeting only option – They can have time to digest the information and support their relatives best interests and that you are there to facilitate this • Be clear about time frames and what they are there for – even if its just because the process dictates it.

18. Case Coordination Though the case coordination role can be held by an individual from differing professional backgrounds it is important to remember that without a Multi Disciplinary team approach we do not have: • A fully evidenced decision • A holistic assessment which can then lead to a clearly defined package of care • Joined up working which reduces disputes between statutory organization.

19. Reviews • Need to have an agreed continued MDT approach, otherwise we risk further dispute or breakdown in communication.

20. The challenges that this poses:- • MDT working • Perceptions of patients and their families • Communication