understand the context of supporting individuals with learning disabilities (LD 201)
Unit 4222-245understand the context of supporting individuals with learning disabilities (LD 201)
Unit 4222-245 outcome 1: understand the legislation and policies that support the human rights and inclusion of individuals with learning disabilities:

Identify legislation and policies that are designed to promote the human rights, inclusion, equal life chances and citizenship of individuals with learning disabilities.
The Mental Capacity Act 2005: This act was introduced in England and Wales in 2007 and aims to protect the rights of people whose mental capacity is in doubt and people who do not have mental capacity. It provides a framework for making decisions on behalf of the individual. It tells us what to do if we are involved in the care, treatment, support of people aged 16 and over who lack mental 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 and 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 administrating their property and affair. Anyone found on medical evidence to meet these criteria is known as a patient. The courts 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 a patient, their family and dependants.
The Equality Act 2010: The Act covers nine protected characteristics, which cannot be used as a reason to treat people unfairly. Every person had one or more of the protected characteristics so the act protects everyone against unfair treatment, the protected characteristics are;
Age
Disability
Gender reassignment
Marriage and civil partnership
Pregnancy and maternity
Race
Religion or beliefs
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: This Act means that residents of the UK will 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.
The General Social Care Council (GSCC) Code of practice: The Code of practice for social worker’s 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.
6. Be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills.
Care Quality Commission (CQC): 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 service in England. It also protects the interests of people whose rights are restricted under the Mental Health Act. 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 1st 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 aspect 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 – This 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 access 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 stationary 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): Valuing people 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 them 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 the white paper in 2009 and is a new three-year strategy for people with learning difficulties (2009). The new paper is a cross-government consolation, 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 difficulties. This new paper says what the Government thinks should happen to 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

Explain how this legislation and policies influence the day to day experiences of individuals with learning disabilities and their families:
The 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 plans 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

2.1 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. Unlikely the letter so 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 adoptive 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 casing the learning disability usually started at an early age, sometimes before the person was born. 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 Development 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; 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

2.2 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, Down’s Syndrome, Tuberous Sclerosis
Infection e.g. Rubella
Lack of oxygen to the foetus
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 or child abuse
Metabolic or disorders of nutrition and growth
Socially deprivation
2.3 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 option provided and approved by the helping expert.
The medical model is rejected by organisations of disabled people but it still pervades many attitudes towards disabled people.

Social Model of Disability: The social model had 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 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 had 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 an anti-discriminatory legislation. 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.

2.4 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 50% of cases, no cause had 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%.

2.5 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 of the future and the individual’s 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 reduce opportunities and over dependence.

outcome 3 understand the historical context of learning disability

3.1 Explain the types of services that have been provided for individuals with learning disabilities over time:
The history of public and private attitudes to learning disability over the last three centuries had been one of intolerance and lack of understanding. In 1834 the poor laws were 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 and 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 certified as mental defective. The institutions were now renamed ‘colonies’ and their purpose was to separate their residents from society. In 1929, the Wood committee suggested 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 the 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.

3.2 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 inquires highlighting the inequalities and poor quality care individuals with learning disabilities have experienced.
SUMMARY OF KEY REPORTS AND ENQUIRIES Report Summary 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 in to the provision of services for people with learning disabilities at Cornwall Partnership NHS Trust, Commission for Social Care Inspection and the Health Care Commission (2006) This independent inquiry arose in response to serious concerns raised by the East Cornwall Mencap Society
The 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 on-going 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 detailing 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 healthcare 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 is 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.

3.3 identify some of the key changes in the following areas of individuals who have learning disabilities:
Where people live
Daytime activities
Employment
Sexual relationships and parenthood
The provision of healthcare
With the decline of the Medical model of learning disabilities that 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 expectation. The combined effect is that new opportunities are being opened up for people with learning disabilities in areas as employment, parenthood, lifelong learning and citizenship.

Where people live: People with learning disabilities are now encouraged to live 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 GP 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:

4.1 Explain the meaning of the term ‘social inclusion’:
‘Social exclusion is a complex and multi-dimensional process. It involves the lack/denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority or 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 p9). Therefore, social inclusion is the opposite and involves everyone having access to resources etc. and the ability to participate in normal relationships and activities.

4.2 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.

4.3 Describe different types of advocacy:
Citizen advocacy – This is one-to-one ongoing partnership between a volunteer Advocate and a person. This person may not know their rights, be vulnerable and maybe at risk of being mistreated or excluded.
Independent (issue-based) Advocacy – Can also be called crisis or case advocacy. A one to one partnership between two people, often provided by paid advocates. Independent advocacy shares the same principles as Citizen Advocacy but is usually a short-term, one off involvement, dealing with a sceptic issue in a person’s life. The relationship is normally time limited but may last for several months. When this has been done the advocacy partnership is terminated until it is required again.
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).
Group Advocacy – Where people come together to represent shared interests or goals and works by offering mutual support, skill development and a common call for change with the intention of developing or changing services.
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.
Statutory Advocacy – Where there is a statutory duty to provide advocacy following government legislation as Independent Mental Health Advocacy (IMHA) and Independent Mental Capacity Advocacy (IMCA).
Family and friend advocacy – Where a person’s family member or members or friends play a part in advocating on their behalf. Most of us will have used or provided this support at some time in our lives whether we realised it or not.

4.4 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 sills 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 received. Empowerment is 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 this 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

5.1 Explain how attitudes are changing in relation to individuals with learning disabilities:
Society’s attitude 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 had 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 what’s 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 can’t. Now instead of being expected to fit in society is finding ways to adapt to their needs

5.2 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, and prejudices 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 “label” are undesirable and often misleading as no two people are alike and 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 an adult’s view, being labelled as LD can provide them with many advantages as extra instruction and help at college. It can help the individual and others to focus on their abilities rather than weakness.

5.3 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 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.
Encouraging the individual’s 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 disabilities have average to above average intelligence. In studies as many as 33% of students with LD are gifted (Baum, 1985)
Dyslexia and LD is 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 as social skills, motor conditions, and memory.

5.4 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 basic. 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 contract 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 service, 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 learning difficulties individual’s 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

6.1 Identify ways of adapting each of the following when communicating with individuals who have learning disabilities:
Verbal communication
Non-verbal communication
The communication skills of individuals with learning difficulties can vary greatly. Communication between all people is very complex, miscommunication leading to misunderstandings, confusion and conflict. 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 learning difficulties 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 it’s 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 had 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 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 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 meaning interaction. Non-verbal communication could include,
Use gestures to emphasise your communication: point to the part of the body you are talking about.
Use the 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 e.g. 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

6.2 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 necessary 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 individuals. 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 years old individual with learning disabilities will have the same needs and preferences as any other 20 years old and would most definitely not want to be treated like a 5 years 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.

6.3 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 had 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 as
Medical terms – “I will send you for an x-ray” it may be better to say “we will take a picture of your arm”
Metaphors – “How’s the plumbing working?” It’s better to ask, “Have you had a wee?
Avoid abstract concepts 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 a time on the clock for example 8.00am as breakfast time or 10.00pm as bedtime.

outcome 1: understand the legislation and policies that support the human rights and inclusion of individuals with learning disabilities:

Identify legislation and policies that are designed to promote the human rights, inclusion, equal life chances and citizenship of individuals with learning disabilities.
The Mental Capacity Act 2005: This act was introduced in England and Wales in 2007 and aims to protect the rights of people whose mental capacity is in doubt and people who do not have mental capacity. It provides a framework for making decisions on behalf of the individual. It tells us what to do if we are involved in the care, treatment, support of people aged 16 and over who lack mental 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 and 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 administrating their property and affair. Anyone found on medical evidence to meet these criteria is known as a patient. The courts 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 a patient, their family and dependants.
The Equality Act 2010: The Act covers nine protected characteristics, which cannot be used as a reason to treat people unfairly. Every person had one or more of the protected characteristics so the act protects everyone against unfair treatment, the protected characteristics are;
Age
Disability
Gender reassignment
Marriage and civil partnership
Pregnancy and maternity
Race
Religion or beliefs
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: This Act means that residents of the UK will 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.
The General Social Care Council (GSCC) Code of practice: The Code of practice for social worker’s 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.
6. Be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills.
Care Quality Commission (CQC): 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 service in England. It also protects the interests of people whose rights are restricted under the Mental Health Act. 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 1st 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 aspect 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 – This 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 access 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 stationary 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): Valuing people 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 them 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 the white paper in 2009 and is a new three-year strategy for people with learning difficulties (2009). The new paper is a cross-government consolation, 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 difficulties. This new paper says what the Government thinks should happen to 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

Explain how this legislation and policies influence the day to day experiences of individuals with learning disabilities and their families:
The 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 plans 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

2.1 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. Unlikely the letter so 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 adoptive 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 casing the learning disability usually started at an early age, sometimes before the person was born. 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 Development 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; 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

2.2 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, Down’s Syndrome, Tuberous Sclerosis
Infection e.g. Rubella
Lack of oxygen to the foetus
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 or child abuse
Metabolic or disorders of nutrition and growth
Socially deprivation
2.3 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 option provided and approved by the helping expert.
The medical model is rejected by organisations of disabled people but it still pervades many attitudes towards disabled people.

Social Model of Disability: The social model had 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 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 had 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 an anti-discriminatory legislation. 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.

2.4 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 50% of cases, no cause had 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%.

2.5 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 of the future and the individual’s 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 reduce opportunities and over dependence.

outcome 3 understand the historical context of learning disability

3.1 Explain the types of services that have been provided for individuals with learning disabilities over time:
The history of public and private attitudes to learning disability over the last three centuries had been one of intolerance and lack of understanding. In 1834 the poor laws were 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 and 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 certified as mental defective. The institutions were now renamed ‘colonies’ and their purpose was to separate their residents from society. In 1929, the Wood committee suggested 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 the 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.

3.2 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 inquires highlighting the inequalities and poor quality care individuals with learning disabilities have experienced.
SUMMARY OF KEY REPORTS AND ENQUIRIES Report Summary 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 in to the provision of services for people with learning disabilities at Cornwall Partnership NHS Trust, Commission for Social Care Inspection and the Health Care Commission (2006) This independent inquiry arose in response to serious concerns raised by the East Cornwall Mencap Society
The 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 on-going 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 detailing 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 healthcare 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 is 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.

3.3 identify some of the key changes in the following areas of individuals who have learning disabilities:
Where people live
Daytime activities
Employment
Sexual relationships and parenthood
The provision of healthcare
With the decline of the Medical model of learning disabilities that 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 expectation. The combined effect is that new opportunities are being opened up for people with learning disabilities in areas as employment, parenthood, lifelong learning and citizenship.

Where people live: People with learning disabilities are now encouraged to live 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 GP 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:

4.1 Explain the meaning of the term ‘social inclusion’:
‘Social exclusion is a complex and multi-dimensional process. It involves the lack/denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority or 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 p9). Therefore, social inclusion is the opposite and involves everyone having access to resources etc. and the ability to participate in normal relationships and activities.

4.2 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.

4.3 Describe different types of advocacy:
Citizen advocacy – This is one-to-one ongoing partnership between a volunteer Advocate and a person. This person may not know their rights, be vulnerable and maybe at risk of being mistreated or excluded.
Independent (issue-based) Advocacy – Can also be called crisis or case advocacy. A one to one partnership between two people, often provided by paid advocates. Independent advocacy shares the same principles as Citizen Advocacy but is usually a short-term, one off involvement, dealing with a sceptic issue in a person’s life. The relationship is normally time limited but may last for several months. When this has been done the advocacy partnership is terminated until it is required again.
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).
Group Advocacy – Where people come together to represent shared interests or goals and works by offering mutual support, skill development and a common call for change with the intention of developing or changing services.
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.
Statutory Advocacy – Where there is a statutory duty to provide advocacy following government legislation as Independent Mental Health Advocacy (IMHA) and Independent Mental Capacity Advocacy (IMCA).
Family and friend advocacy – Where a person’s family member or members or friends play a part in advocating on their behalf. Most of us will have used or provided this support at some time in our lives whether we realised it or not.

4.4 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 sills 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 received. Empowerment is 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 this 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

5.1 Explain how attitudes are changing in relation to individuals with learning disabilities:
Society’s attitude 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 had 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 what’s 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 can’t. Now instead of being expected to fit in society is finding ways to adapt to their needs

5.2 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, and prejudices 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 “label” are undesirable and often misleading as no two people are alike and 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 an adult’s view, being labelled as LD can provide them with many advantages as extra instruction and help at college. It can help the individual and others to focus on their abilities rather than weakness.

5.3 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 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.
Encouraging the individual’s 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 disabilities have average to above average intelligence. In studies as many as 33% of students with LD are gifted (Baum, 1985)
Dyslexia and LD is 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 as social skills, motor conditions, and memory.

5.4 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 basic. 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 contract 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 service, 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 learning difficulties individual’s 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

6.1 Identify ways of adapting each of the following when communicating with individuals who have learning disabilities:
Verbal communication
Non-verbal communication
The communication skills of individuals with learning difficulties can vary greatly. Communication between all people is very complex, miscommunication leading to misunderstandings, confusion and conflict. 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 learning difficulties 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 it’s 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 had 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 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 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 meaning interaction. Non-verbal communication could include,
Use gestures to emphasise your communication: point to the part of the body you are talking about.
Use the 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 e.g. 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

6.2 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 necessary 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 individuals. 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 years old individual with learning disabilities will have the same needs and preferences as any other 20 years old and would most definitely not want to be treated like a 5 years 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.

6.3 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 had 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 as
Medical terms – “I will send you for an x-ray” it may be better to say “we will take a picture of your arm”
Metaphors – “How’s the plumbing working?” It’s better to ask, “Have you had a wee?
Avoid abstract concepts 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 a time on the clock for example 8.00am as breakfast time or 10.00pm as bedtime.