Early Intervention and Prevention

relevant to people with learning disabilities and/or

autism

Cath Cameron-Jones

Commissioning Manager

Causes of learning disabilityInformation taken from “A Health Needs Assessment for Adults with a Learning

Disability in Nottingham and Nottinghamshire 2010”

• genetic.

• Chemicals, drugs and diseases

• Oxygen deprivation traumatic birth, meningitis, head injury, brain damage causing cerebral palsy

• Low birth weight and prematurity are strongly correlated to the later development of learning disabilities.

HOWEVER……………………

• The cause of learning disabilities cannot be determined in 40%-80% of cases. Gates and Barr (2009) Oxford handbook of Learning and Intellectual

Disability Nursing, OUP

Causes of Autism

• “The causes of ASCs are multi-factorial, with the most likely explanation being an interaction between genetic and environmental factors. Current evidence appears to confirm a strong genetic link, whereas studies on environmental factors are not yet able to confirm specific environmental causes.” Needs Assessment for

Adults and Young Peoplewith Autistic Spectrum Conditions in Nottingham, Nottinghamshire and Bassetlaw

Key problems for people with Autism

• 63% of adults with autism do not have the support to meet their needs

• 60% of parents say a lack of support has led to higher support needs in the long run

• 33% of adults with Autism have experienced severe mental health problems because of lack if support

• Only 15% of adults with autism have a full time paid job.

» (National Autistic Society)

What type of support is required?

• Employment skills training• Social skills training• Befriending• Social groups• Travel training• Advocacy• Independent living skills training• Speech and language therapy• Theraputic interventions

Argument for specialist multi-disciplinary teams

• Autism Strategy• NICE Guidance calling for these teams• National Audit office found if local services

identified and supported just 4% of those with high functioning Autism/Asperger’s it would be cost neutral

• Nottinghamshire’s Asperger’s team already know approximately 10% of the estimated population of people with Asperger’s.

Challenging Behaviour• Evident in 10-15% of people with learning disabilities• Terrible twos• Escaping situations• Other disabilities• Deprivation and abuse• Control

• LEADS TO HIGHER COST PACKAGES– Carer breakdown– Need more staff/hours of support – Higher staff turnover

What can be done?

• More support to carers – training and respite and also ‘someone to talk to and offer practical advice’

• Better staff training• Communication – speech and language• Medical conditions identified and treated• Promotion of independence early on• Psychologist input – managing behaviours

Promoting independence

• INCREASING AN INDIVIDUALS INDEPENDENCE SHOULD REDUCE THEIR RELIANCE ON PAID SUPPORT

• Intensive short term work• Community support• Provider incentives• Employment

Supported Living

• ASCH&PP have been undertaking a project to move people with a learning disability out of residential care into supported living

• Between April 2011 and end of September 2012 the project has moved 37 people from residential to supported living at a total saving of £443k to NCC and £150k to the PCTs

• IS SUPPORTED LIVING CHEAPER THAN RESIDENTIAL CARE?

Assistive technology

• Telecare

• Telehealth

• Limited use of AT for people with learning disabilities - therefore very little research

• Research into Older people AT services shows cost savings for health and social care

Assistive Technology – examples in Notts

• Local evaluation 2010-2011 – Savings of £375 on average pp, pa for social care and £100 for health. (based on 80 people)

• LD services – real examples

• Waking to sleeping night – saves £38,000

• ‘Just checking sensors’ saves £40,000

• Falls alarm saves £25,000

Care UK – carers survey• 3,500 carers of which 750 used AT.• Over 60% of carers surveyed said telecare/telehealth

had given them peace of mind as a carer• One in eight carers said telecare/telehealth had helped

them stay in work or return to work alongside caring• Almost two thirds of carers not using telecare/telehealth

were unaware of the support available from technology• Of carers not currently using telecare/telehealth one in

four would like it but simply did not know where to find it• Only 6% of carers said they would not want

telecare/telehealth

The reason to support carers in Notts

• Nearly 50% of the people with a Learning Disability known to ASCH&PP live with carers

• 58% of the 37 people with a learning disability who moved into residential care in 2011/12 was as a result of carers no longer being able to cope

• A national survey showed 83% of carers felt caring had a negative impact on their physical health and 87% on their mental health