Oral Health Promotion for People with Learning Disabilities

1. Unit for Development in Intellectual Disabilities Developing a health promotion tool for people with a learning disability or their carers/family Louise Mellen March 04 Farrah Owen Sept 04 Venessa Thorpe Sept 04

2. Module assessment • Students are required to develop a health promotion tool for a group or individual with learning disabilities or their family/carers. • Identify a priority area for health promotion • Plan a strategy • Develop a tool (leaflet, game, poster, CDROM, etc.) • Evaluation of tool

3. Previous health promotion tools • Dementia • Testicular and breast cancer • Exercise • Healthy eating • Epilepsy • Positive image

4. TRAC - Service user group • TRAC is a service user group who advise, teach and work with students and staff at the University of Glamorgan.

5. Interventions to promote oral hygiene needs in people who have a learning disability. By Venessa Thorpe& Louise Mellen Student Learning Disability Nurses

6. Aims of the HP Tools • To improve the oral hygiene of people with learning disabilities • To improve the knowledge of clients, carers and family regarding oral hygiene

7. Background information • Good oral health is to be free from pain and disease (DoH, 1994) • Fulfilling the Promise (WAG, 2001) • Valuing people (DoH, 2001) • Oral Health Guidelines (BSDH, RCS, 2001) • Role of the LD nurse (DoH, 1996) • Why this topic?

8. Epidemiological data • Compared to the general population, people with learning disabilities have an higher incidence of unmet oral health needs. (Scott et al., 1998; Cumella et al., 2000) • Clinical pathways for oral health care of people with learning disabilities (BSDH, RCS, 2001)

9. Risk factors • Medication • Down Syndrome - dry mouth (BSDH & RCS, 2001; Gates, 2004) • Communication deficits • Lack of skills/knowledge (both client and carer) • Oral hygiene not viewed as a priority • Carers give oral health care a low priority (Cumella et al., 2000; Rawlinson, 2001; Tiller et al., 2001; and Stanfield et al., 2003)

10. Target population • Considering the barriers found. • Target group - carers. • Aim - raise awareness

11. Intervention • Educational approach • Secondary intervention (Tones and Green, 2004) • leaflets are suggested to be effective in raising awareness (Humphris et al., 1999; Andermann et al., 2002)

12. Producing a leaflet • Following the recommendations of the audit of health promotion leaflets (RPSGB, 1998) • Actively provided • Contain some pictures • SMOG readability test (Basic skills Agency) • Larger text for easier reading

13. Evaluation • Resources. • Evaluation team. • Action plan. • Questionnaires. • Ethics. • Recommendations for future.

14. References • Andermann AAJ, Austoker J, Watson EK. Lucassen AM and Mackay J (2002) Development and evaluation of a general information leaflet for women with a family history of breast cancer, Journal of cancer education, 17 (3) 155-60. • BSDH and RCS (2001) Clinical Guidelines and Integrated Care Pathways For The Oral Health care Of People With Learning Disabilities, British society For Disability and oral Health, The Royal College of Surgeons of England. • Cumella S, Ransford N, Lyons J, Burnham H (2000) Needs for oral care among people with intellectual disability not in contact with community dental services Journal of Intellectual Disabilities 44, 1, 45-52. • DoH (1996) Continuing the commitment: The report of the learning disability nursing project, London, HMSO. • DoH (2001) Valuing People: A New Strategy for Learning Disability in the 21st Century, Department of health. • DoH (2005) Oral Health strategy Group Department of Health. • Gates B (2004) Learning disabilities: Towards Inclusion 4th Ed London, Elsvier. • Humphris GM, Duncalf M, Holt D and Field EA (1999) The experimental evaluation of an oral cancer leaflet, Oral Oncology, 35 (6) 575-82. • RPSGB (1998) Audit of Health Promotion Leaflets The Royal Pharmaceutical Society of Great Britain, on line at www.rpsgb.org.uk/pds/leaflet.pdf accessed on 11.12.05. • Scott A, March L and Stokes ML (1998) A survey of oral health in a population of adults with developmental disabilities: Comparison with a National Health survey of the general population, Australian Dental Journal, 43 (4) 257-61.

15. Healthy eating and keeping fitin Children withLearning Disabilities By Farrah Owen

16. Objectives • Obesity • Explore the evidence that shows the need for my health tool • Aims of the health tool and how I will meet them • Limitations • Evaluating my health tool

17. Obesity Sharkey (1990) stated that: “Obesity is an excessive accumulation of fat beyond that considered normal for the age, sex and body type.”

18. Obesity 2 The main reasons for an Increase in obesity are documented by Drummond (2002)- • a high fat diet and a lack of habitual physical activity • A diet high in fat and energy combined with low levels of physical activity promote a positive energy balance (energy intake exceeds energy expenditure); RESULTING IN WEIGHT GAIN.

19. Evidence behind the health need. • People with learning disabilities are at a high risk of obesity and consequent health risks. • Adults with learning disabilities are more likely to be inactive for a variety of reasons, including barriers to leisure and exercise facilities, and the impact of physical and intellectual impairments on their ability to take part in traditional exercise. Chapman et al. (2005)

20. Primary barriers: unclear policy guidelines in residential and day service provision Leisure opportunities Resourcing Transport Staffing constraints Income Expenditure Secondary barriers: individuals motivation Support and encouragement Overprotection Underestimating persons ability Staffs interpretations of ‘ordinary living principles’ Barriers Chapman et al. (2005)

21. My aims • To give children with Learning disabilities a knowledge of healthy eating. • To produce a video that will not only help reduce weight and help with cardiovascular fitness, but will be enjoyable. • To make children more aware of the reasons why its important to eat healthy.

22. Who am I aiming my health tool towards? I aimed my tool towards children with mild learning disabilities from around the age of 12 to 15. I did this because: • Children are our future (please don’t sing) • Children are becoming more obese • Children eat a lot of junk food • “Overweight kids usually grow up to be overweight adults with high risk of heart disease, diabetes and cancer”. (www.healthyeating.net/he_4-01.htm)

23. Also… • During my school placement, I took part in the P.E. classes, and found that the children were bored of the same type of exercise every week. When I spoke to some of them about the dance classes that I teach, they were very interested. • Also I feel that children with learning disabilities have more knowledge and potential than people give them credit for.

24. How to meet the need. Leaflet • The leaflet shows good food and bad food to eat with clear diagrams and words. • It also explains why we need to eat healthy, again with diagrams and simple words. • The leaflet is bright and colourful to catch their eye and some words are in bright colours too, to help exaggerate important points.

25. Video • 20 minutes long • consists of a warm up, main dance and a cool down • pictures to show what they should wear • and to insure that the children remember it’s important to wash and drink plenty of water after exercise there are pictures at the end • The music was chosen after spending a lot of time with the children in my school placement, and listening to the types of music they liked.

26. Warm up increases body temperature Increase respiration and heart rate Guard against muscle, tendon and ligament strains Cool down just as important Abrupt cessation of vigorous activity leads to pooling of blood, sluggish circulation and slow removal of waste products To stop cramping, soreness or more serious problems Lowers body temperature Why it’s important to warm up and cool down Sharkey (1990)

27. Why I chose a leaflet and a video • The video can be played over and over • The leaflet gives just enough information • I felt that to meet the health need I could not do one without the other as if you don’t eat the right diet, physical activity will not be effective and vice versa. • You need to balance energy input and energy output.

28. Fact! “300 Kcals in a chocolate bar take only 30 seconds to consume but 30 minutes to exercise away” Carr and Decheemaeker (2002)

29. Limitations Leaflet • Limited on the information I could give • Making them aware without scaring them Video • Background noise • Room- lighting and background • Not an expert on making video’s and editing them • Teaching a camera how to dance!

30. Evaluation and Recommendations • The tool is yet to be evaluated but I intend to: • Send out the leaflet and video to schools to either do in P.E. lessons or for the children to take home • Also send out a simple evaluation form to gain feedback from the teachers and the pupils.

31. References • Chapman M.J. Craven M.J. and Chadwick D.D. (2005) Fighting fit? An evaluation of health practitioner input to improve healthy living and reduce obesity for adults with learning disabilities, Journal of intellectual disabilities, 9 (2), pp131-144. • Drummond S. (2002) The management of obesity, Nursing Standard, 16 (48), pp 47-52 • Fox K.R. (2002) Physical activity, exercise and weight control: movement for management? In: Carr T. Descheemaeker K. (2002) Nutrition and Health, London, Blackwell science, p 55. • Lllingworth K. Moore K.A. McGillivray J. (2003) The development of the nutrition and activity knowledge scale for use with people with an intellectual disability, Journal of applied research in intellectual disabilities, Australia, BILD publications, vol.16, pp 159-166. • Sharkey B.J. (1990) Physiology of fitness, 3rd Ed., Leeds, Human Kinetics. • BILD (1998) Worcestershire, BILD publications. • www.healthyeating.net/he_4-01.htm

32. Thank you for listening, now dance your way out!! Any Questions????