Community Learning Disability Team Research Articles

Improving Communication Between the Community Learning Disability Team, Patients, Their Carers and Primary Care Services Within Aneurin Bevan University Health Board

Improving Communication Between the Community Learning Disability Team, Patients, Their Carers and Primary Care Services Within Aneurin Bevan University Health Board

Let's Talk About Sex: Breaking Down Barriers to Care in a Community Learning Disability Team

Let's Talk About Sex: Breaking Down Barriers to Care in a Community Learning Disability Team

Commentary on: an evaluation of a speech and language therapy eating, drinking, and swallowing service for adults with intellectual disability (Crocker et al., 2024)

PurposeThe purpose of this paper is to expand upon some of the issues raised in “An evaluation of a speech and language therapy eating, drinking and swallowing service for adults with intellectual disability” (Crocker et al., 2024).Design/methodology/approachThis commentary outlines considerations for multidisciplinary team working and professional roles both within and beyond the community learning disability team. It discusses models of service delivery and competency frameworks relating to eating, drinking and swallowing services.FindingsServices should be integrated, include a broad multidisciplinary team and aim to increase competency in all contexts supporting people with eating, drinking and swallowing needs. Outcomes of service provision need to be measured outside of individualised care.Originality/valueThis paper broadens the discussion of quality of eating, drinking and swallowing services beyond speech and language therapy and considers a whole systems approach.

Reflections of the experiences of people with and without learning disabilities conducting research together in a community learning disability team

Reflections of the experiences of people with and without learning disabilities conducting research together in a community learning disability team

A service evaluation exploring clients' experiences of being on a waiting list for individual psychological therapy with a community learning disability team

AbstractBackgroundService user involvement is imperative in the delivery of mental health services. However, a paucity of research has explored how individuals with a learning disability find waiting for therapy. Therefore, this project aimed to explore how service users accessing a community learning disability team experienced waiting for psychological therapy.MethodsTen adults on a waiting list for psychological therapy in Yorkshire, UK completed a semistructured interview, which explored their experiences of being on the waiting list. Interviews were transcribed and analysed using thematic analysis.FindingsFive superordinate themes were drawn from the analysis. Participants recalled long waits for therapy, struggled waiting and were unsure when therapy would start. Relief and hopefulness were common when they were put forward for therapy. Difficulties reading and/or remembering letters were prominent. Keeping busy and support from others helped participants cope while waiting. Participants would have valued additional support including having someone on call, regular check‐ins and information on other appropriate services.ConclusionsThis project led to a range of recommendations to inform a psychology waiting list standard operating procedure, service developments and improve the waiting list experience for service users. A future project exploring parent and carer experiences of the waiting list is warranted.

Adults with learning disabilities’ experiences of disclosing abuse, who access community learning disability teams, in Southeast England, UK

BackgroundThere is a high prevalence of abuse experienced by the learning disability (LD) population, with a clear impact of abuse on individuals. Several theoretical frameworks support the importance of disclosure in the recovery process, with regards to shifting self-blame and guilt and creating new narratives for these experiences. The key facilitators and barriers to disclosure and responses received have been studied for individuals without LDs, however there is a paucity of research in this topic area for the LD population.Rapid reviewA rapid review of the experiences health and social care professionals working with adults with LDs who have been abused highlighted variability in the care provided to this cohort. This was due to differences in the implementation of policy and procedures, the influence of relationships between professionals, service users and their families, perceptions of LDs, and clinicians’ own knowledge and thresholds, and confidence in their clinical expertise.Aim and methodThe aim of the empirical study was therefore to explore adults with LDs ‘ experiences of disclosing abuse. Semi structured interviews were conducted remotely, due to Covid-19, with five participants with LDs who had experienced historical abuse, and were open to Community Learning Disability Teams (CLDTs) in Southeast England, UK. A reflexive thematic analysis was used to analyse the data.Results and conclusionsFour themes were generated ‘Abuse is discovered not disclosed’, ‘Exposure of the abuse triggers a set response’, ‘Carrying the burden of what happened’ and ‘Finding a way out’, under the overarching theme of ‘The Journey of Disclosure’. The themes suggested disclosure occurred on a non-liner timeline, not at one timepoint, with abuse not being disclosed but identified by others, a lack of power and control over the process for participants and the importance of accessing the right support. Facilitators and barriers were identified, some unique to those with LDs, such as the influence of clinicians’ knowledge, or lack of, not only about abuse but also LD on the identification of abuse e.g. the role of diagnostic overshadowing, and the potential additional complexity of relationships for adults with LDs. Other facilitators and barriers were in line with previous research for those without LDs, such as trust, being listened to and believed. Several areas for future research are highlighted, such as the experiences of adults with LDs who may have different communication abilities e.g. use of augmented technology, adults with LDs from Black and Asian racialised communities who experiences of abuse and disclosure may be different, and further exploration of the experiences of disclosing specific types of abuse. The clinical and policy implications are discussed, such as reinforcing the need for professionals to receive training in the area of supporting individuals with LDs to disclose abuse and responding appropriately.

The use of a tree of life group to support community learning disability team staff wellbeing during Covid-19

During 2020 and early 2021 the Community Learning Disability staff team’s wellbeing was significantly impacted by Covid-19, national lockdowns and the changes to working practices. The psychology team ran a virtual team away day which included a Tree of Life session for staff. A follow up Forest of Life group was run to give staff more time to share and discuss their trees. The Forest of Life group feedback had three key themes; improved professional relationships, how the personal can impact the professional and increased confidence using the Tree of Life clinically (for psychologists within the group).

Fun & fitness: A community sport’s development programme for adults with learning disabilities

In the context of the significant health inequalities experienced by individuals with learning disabilities, Greenwich Community Learning Disability Team have worked in partnership with the Royal Borough of Greenwich’s (RBG) and leisure provider Better to offer bespoke exercise groups for people with learning disabilities in the borough. This programme, titled ‘Fun & Fitness’ was offered initially on Zoom from February 2021, in the context of Covid-19, before transferring to a community leisure centre in July 2021. The programme and approach have been developed with input from a range of professional disciplines and service user involvement and has been supported by multiple funding grants. A range of measures relating to physical and mental health, and quality of life have been repeated periodically through the programme. To date 108 group members have participated and a range of positive feedback has been received. Reflections of the process to date are offered, including in relation to the limitations of the approach and learning points, as well as ideas for further developing the project.Easy read summaryPeople with learning disabilities are not as healthy as most people.Part of this is because of difficulties accessing physical activities in the community.Exercise groups have been developed in Greenwich for people with learning disabilities. These groups are called ‘Fun & Fitness’.At first, they were on Zoom because of Covid-19. Now they are in a leisure centre.Over 100 people have attended at least one session and there are over 60 regular members.People say they like the groups. They like the fun and doing things with other people.We have been checking the health of people who come to the group.We want to see if the group improves people’s health.This is important because lots of people with learning disabilities have more health problems and this can cause them to die younger.We have plans to run more groups and help people do more sports and exercise.

Support staff liaising effectively with professionals for the rational use of psychotropics for behaviours that challenge in adults with intellectual disabilities: Findings from a co-design event.

Experience Based Co-Design (EBCD) and co-production are interdisciplinary collaborative approaches to improve health care services by involving all stakeholders. These approaches capture the experiences of all stakeholders who come in contact with services and use experiences as evidence to promote and implement service changes. The use of psychotropic medications for behaviours that challenge (BtC) in people with intellectual disabilities (ID) is a complex issue because of its off-licence use and use in combination with other medications for physical and psychiatric co-morbidities, which leads to overmedication of people with ID. As support staff plays a pivotal role in the prescribing for people with ID, we have developed a staff training programme, SPECTROM, to help reduce overmedication. A project team developed SPECTROM under the guidance of a Programme Development Group (PDG) consisting of 21 stakeholders. The PDG analysed data from a literature review, four focus groups and a co-design event day involving 26 stakeholders. In this paper, we have presented data based on the findings from the co-design event day, primarily on the issue of support staff effectively liaising with professionals such as doctors, nurses, and other community learning disability team members. In-depth information and recommendations were proposed at the co-design event, which helped develop the draft SPECTROM. The draft was finalised after receiving feedback from 56 stakeholders. Co-production and a modified EBCD can be successfully used to create training interventions and improve health care services. More research should utilise co-production and EBCD and use service users’ experiences to develop interventions and improve health care services.

Helicobacter pylori testing and treatment: experience and reflections of a community learning disability team

Helicobacter pylori testing and treatment: experience and reflections of a community learning disability team

A Quality Improvement Project (QIP) Within the Bolton Learning Disability (LD) Team (Greater Manchester Mental Health Trust) Aiming to Enhance Communication Among Multi-Disciplinary Team (MDT) Professionals and Wider Stakeholders, for the Purposes of Enhanced Care Delivery and Improved Patient Outcomes During COVID-19 pandemic. Project Lead: Dr Syeda Hasan

AimsThis QIP aims to improve communication and information sharing between the community LD team, administration team, service providers and wider stakeholders, to ensure patient safety. The primary objective is to evaluate local initiatives to improve communication between MDT professionals and wider stakeholders. The secondary objective is to improve patient safety and staff satisfaction.MethodsThe COVID-19 pandemic created unprecedented communication challenges within the workforce and highlighted areas requiring review; this included information sharing among internal and external teams, collaborative teamworking, support in absence of senior clinical leadership and transition pathways from Child and Adolescent Mental Health Services to adult LD services. The QIP was initiated in March 2021.The discovery process included an initial consultation exploring practitioners’ experiences, areas for development and to share ideas for good practice.We used QI methodology, following ‘plan-do-study-action’ cycles, to analyse change. Change ideas included a single point of contact for internal and external queries, regular complex case management meetings, development of a referral process and clinical review for complex cases along with teaching sessions.Qualitative feedback from the team pre- and post-intervention, at baseline and regular follow-up intervals, in the form of monthly team meetings, emails, focus-groups and semi-structured interviews.ResultsA full thematic map was created after initial consultation; themes included communication improvement between teams and external agencies, timely support for complex case management, improving transition processes and development of robust clinical review processes.Qualitative feedback has been collated, analysed and final recommendations to be shared with the MDT professionalsConclusionPreliminary results have shown improvements in communication among the MDT, stakeholders, and external agencies.The consultation process highlighted that there is a substantial need for standardisation and consistency within communicative practices to promote enhanced care delivery and improved patient outcomes.

Positive behaviour support training: developing skills in community services

Positive behaviour support (PBS) is considered an effective and ethical approach to supporting people with learning disabilities who are at risk of behaviour that challenges. Many people with learning disabilities are supported in the community by staff with varying levels of PBS skills and practice, and training is important to ensure PBS is used consistently. In 2019, a community learning disability team in Staffordshire, England, developed a PBS skills training programme and delivered it to 57 senior staff from 16 local community services. In an evaluation of the training programme, participants reported some improvements in their PBS knowledge and practice, as well as some benefits for service users, after the training. However, no follow-up data could be obtained from participants six months after the training. This article describes the training programme, reports the findings of its evaluation and discusses how the findings will inform a future PBS skills development project.

Long term outcome of Multi-Disciplinary Interventions within a Positive Behaviour Support Pathway in a Community Learning Disability Team

If you have a learning disability, Positive Behaviour Support (PBS) might be used to support you.PBS is intended to teach helpful behaviours in place of unhelpful ones, and increase your quality of life. It should be available for your whole life in everywhere you might be.We followed up on 16 people who had PBS intervention that ended in 2018.As a group, their scores on our main measure (HoNOS-LD) were still better than when we first met them.Two people had died (12 per cent), 10 people still showed challenging behaviours (62 per cent), and 4 (25 per cent) did not. The four that did not weren’t receiving PBS any more.

A Community Learning Disability Team (CLDT) and Improving Access to Psychological Therapies (IAPT) service working together to adapt, deliver and evaluate the effectiveness of a ‘Coping with My Feelings’ psychoeducational group for adults with learning disabilities or difficulties

Adults with learning disabilities (LD) experience higher rates of mental health difficulties and additional barriers to health care services compared with the general population. To address this, a CLDT and IAPT service collaborated to embed reasonable adjustments at a service level and adapted a ‘Stress and Mood Management’ group, renamed Coping with my Feelings. In this article, we will refer to this group as ‘Coping with my Feelings’. Findings are presented to encourage future collaborations.

The ‘Amber Consultation Service’: An audit of a systemic consultation service in a Community Learning Disability Team

This article describes an audit of ‘The Amber Consultation Service’; a systemic consultation service developed by the Psychology and Behaviour Support team in the Manchester Community Adult Learning Disability Service. We consider the feasibility and effectiveness of this service.

A new service model in East Lothian community learning disability team: evaluation of service with and without specialist positive behaviour support team

AimsTo evaluate the provision of services to patients with challenging behaviour in East Lothian Community Learning Disability population with and without specialist behaviour support team.BackgroundBehaviour that proves to be a challenge to manage (Challenging behaviour) is not uncommon in adults with intellectual disability and has a reported prevalence of 10–15%.1,2Positive behaviour support (PBS) is recommended as evidence-based intervention for adults with intellectual disability who have challenging behaviour. East Lothian community learning disability team (CLDT) underwent a change in service model for people with challenging behaviour. This change followed a Health and Social care partnership agreement that behaviour support and management could be provided by multidisciplinary CLDT rather than region-wide specialist team.MethodData collection was split into two cycles. First cycle looked retrospectively at six months prior to exit of Specialist Positive Behaviour Support Team (SPBST). Second cycle looked prospectively at 6 months after exit of SPBST.In first cycle, data were collected doing retrospective review of cases known and referred to SPBST. This included calculating time spent on each individual case by SPBST and by CLDT. SPBST provided information in the form of hours spent on each individual case for patients identified by them. For CLDT, electronic medical records system (TRAK) was used by looking at appointment entries on TRAK. For second cycle, newly developed Complex Behaviour pathway was used to identify the patients. Data were collected by using TRAK system as in the first cycle for CLDT.Data collected in both cycles was compared at the end of second cycle.ResultIn first cycle, 5 patients were managed jointly by SPBST and CLDT in 96.4 hours over six months and average clinical time spent on each patient was 19 hours. SPBST spent a total of 59 hours and CLDT spent 40 clinical hours. In second cycle, 12 patients were managed by CLDT alone in 130 hours over six months and average clinical time spent on each patient was nearly 11 hours.ConclusionResults of this evaluation suggest that SPBST had been providing significant contribution to East Lothian CLDT not only with their expertise but also with clinical time. More than 50 % of total clinical time spent on the patients with challenging behaviour in first cycle, was provided by SPBST. This is also evidenced in second cycle where there is an increase in clinical time of some professions when SPBST was withdrawn.

Transfer and transition referrals of patients with intellectual disability from children's services to adult community learning disability teams

AimsThe audit aimed to assess if patients under the care of children's services in Wessex were transferred at the appropriate age and whether transition referrals to Community Learning Disability teams (CTLD) occurred timely. It also aimed to look at how many patients underwent transitions in a three month period, and if their transition support plan (TSP) was completed. A transition support plan should include chronological information on psychopharmacology, psychotherapy, and social support measures. Patients should be referred between the ages of 17–19 but require a justification after 18 years of age.MethodThe BI team was contacted to provide all IDs for patients referred within a three month period between the ages of 17–19. The BI team provided 42 patients with their ID. Patients discharged from services within a short time span were excluded for the following reason: inappropriate referral (9pts), discharged after 1st assessment (6pts), internal discussion (6pts), only referred to Autism team (4pts), moved out of area (1pts). From the initial 42 patients, 16 patients were analysed using the collection tool.Result4/16 had a TSP, and only two had a complete TSP and transitioned in another trust and were inter-team referrals.CAMHS services referred 1/16 patients.Psychotropic medication was prescribed to 12/16 prior to or on time of referral, but only two patients had a complete psychotropic medication history.8/16 patients' referral was commenced prior to their 18th birthday, and no information was provided for delay in transfer.Health records did mention psychotherapy, but apart from 2/16 TSP records, no additional information was available on the modality.ConclusionPatients with Intellectual Disability face challenges when transferring from children to adult services. Insufficient referral information may have a detrimental impact on patients wellbeing and long-term care.Access to a patient's chronological journey through the different children's services allows Adult CTLD health professionals to provide effective care. Historical psycho-social and pharmacological interventions provide a reference point for future interventions.Concerns included: limited information on most TSP regarding psycho-social and psychotropic treatments, lack of access to CAMHS/CHYPS paperwork and ineffective inter-trust communication for transition patients.This project highlighted the average number of transition cases in 3 months. It led to changes to the transition pathway, as awareness was raised in trust and CCG meetings to improve patient outcome. CTLD created the new role of transition facilitators to support children's services. They sit in meetings before patients transition referrals.

Staff wellbeing and psychological support in a community learning disability team throughout the Covid-19 pandemic

Staff wellbeing and psychological support in a community learning disability team throughout the Covid-19 pandemic

Reflections from an audit examining differences in ethnicity groups access to community learning disability team

Reflections from an audit examining differences in ethnicity groups access to community learning disability team

How special interest groups can support safe sexual well-being in adults with learning disabilities

Special interest groups (SIGs) create a shared space in which healthcare professionals can network and collaborate on topics of mutual interest. These groups support the development of multiprofessional expertise and knowledge sharing by providing a forum in which healthcare professionals can hold collaborative discussions on methods that will improve practice and care quality, and how to translate these into practice. Research shows that people with learning disabilities are more at risk of sexual abuse or exploitation, therefore they require support in areas such as relationship safety, emotional and sexual well-being, and sexual rights. This article describes how the North Staffordshire community learning disability team developed a SIG to support and promote safe sexual well-being for adults with learning disabilities and explains how the forum benefits staff, the organisation and service users.