Transcript Angela Mack Audiology Service Manager

Bolton Learning Disability
Audiology Services and
Challenging Behaviour
LD Audiology Adult Services in
Bolton
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Audiology dept. is based in the Acute
Trust, but sees clients in a wide
variety of settings
Introduced LD hearing screening
over 12 years ago- initially not
universal screening
Also provides diagnostic audiology
and rehabilitation
Strengths of Bolton Team
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Only staff interested in working with
LD adults on the team
Working in partnership with other
professionals
Treat everyone as an individual,
trying to understand their needs and
what motives them
Provision of high quality aids that
best meet clients needs
Dedicated transition team
What is Challenging Behaviour?
Emerson et al (1987) suggested that;
“Severely challenging behaviour refers to behaviour of such
an intensity, frequency or duration that the physical
safety of the person or others is likely to be placed in
serious jeopardy, or behaviour which is likely to
seriously limit or delay access to and use of ordinary
community facilities.”
Challenging Behaviour Foundation
Some children and adults with severe learning
disabilities typically display behaviour which may put
themselves or others at risk, or which may prevent
the use of ordinary community facilities or a normal
home life.
This behaviour may be in the form of aggression, self
injury, stereotyped behaviour or disruptive and
destructive behaviours. These behaviours are not
under the control of the individual concerned and are
largely due to the individual’s lack of ability to
communicate.
Why audiological assessment and screening is so
important for LD adults with challenging
behaviour?
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Possible self harm or foreign bodies
Progressive hearing loss may go undiagnosed if
alongside other progressive condition e.g. dementia
Effects of hearing loss compounded by poor
communication tactics and other disabilities
Often no continuity of carer
Difficult to spot early signs of infection/discomfort
Examination/testing can be difficult
Ear pain/hearing loss may compound challenging
behaviour
LD increases probability of having hearing difficulties
and higher incidence of premature aging
Incidence of Hearing Loss in Adults with LD
Research Evidence on the Health of People with
Learning [Intellectual] Disabilities
First published by the Valuing People Support
Team in 2002
“Around 40% are reported to have a
hearing impairment”
Incidence of Hearing Loss in Adults with Downs
Syndrome
Effects of Hearing Impairment on Adaptive
Behaviour in Adults with Downs Syndrome
Prasher V.P. 1995 studied Adults with DS and looked at
the effects of hearing loss
“Hearing impairment leads to a loss of adaptive skills and
to an increase in maladaptive behaviour for individuals
below the age of 40 years.”
“Deterioration in adaptive functioning cannot be assumed
to be due to dementia in people with DS unless the
presence of hearing impairment has been excluded.”
Mean age for each group between 40 and 48 years
201 Adults with DS, living a range of environments took part in the study
Meet the team that allows us to
work with this client group
Audiologists
LD assistant practitioners
Social Care Staff
Trust Specialist LD Nurse
Audio-vestibular Medicine
ENT
SALT
Advanced Practitioners in Audiology
Advanced ENT Nurse Practitioner
Screening and review sessions
These sessions are arranged with audiology, care homes, day
centres etc by the LD assistant practitioners.
This involves:
•Co-ordinating availability of staff, clients, transport and
facilities
•Monitoring review and referral lists- chasing DNA’s
•Understanding and allowing for clients preferences and
dislikes
•Obtaining consent and generating appointment
schedule
•Conditioning of clients with challenging behaviour and
briefing carers
•Being a familiar face supporting Audiologists during
investigations
•Recording and communicating results and
recommendations in appropriate format
Audiology Screening and assessment
appointments
oBriefed
on clients preferences and dislikesdocumented for future appointments
oVenue is safe and a place where client is relaxed
oStaff don’t wear uniforms
oStaff present are those the client is likely to
respond well to and are able to provide insight into
clients behaviour
oMore than just a hearing assessment- ears
checked and aural care issues addressed
Audiology Screening
and assessment
appointments
oAdequate
time given, several visits if
necessary
oFlexible approach to testing- being creative
and making use of behavioural changes
oBe prepared for the unexpected-assume
nothing
oTreat clients with respect e.g. “Toys” are not
childish
oClinical governance guidance followed
Appointments
•Alerts
on clients in audiology booking system
•Those requiring 2 of LD staff or other special
requirements noted
•Variable lengths of appointment with most
appropriate member of staff, dependent on
patients needs
•Encourage regular carers to attend with clients
•Fast track appointments when possible to
minimise time in waiting room
•Use large test room and friendly facilities
Working with other
professionals in the hospital
•Close
relationship with Trust LD nurse
•Co-ordinate hospital appointments to minimise
disruption
•If GA or sedation being use opportunity to
check ears, take impressions, perform
objective tests etc.
•Share experiences and personal development
opportunities
•Collate any concerns regarding an individuals
care
Rehabilitation
oTake
time to build a relationship with client and carers
oMild
losses may not require aiding as good
communication tactics are employed by carers in a
consistently good listening environment
oA
realistic rehabilitation plan needs to be developed and
agreed in partnership with stakeholders
oEnsure
the care plan is communicated to all staff
working with the client and a consistent approach is
maintained
Hearing Devices
oAgree
benefits and care plan, build in checking aid is
functioning and ear is not sore
oMay be unable to communicate if aid uncomfortable or
too loud, set conservative output limits. Remember client
may be in very noisy environments
oUse quality products that best meet clients needsconsider using high end products with additional features
e.g. water resistant
oMalformation of pinnae and narrow ear canals can
present additional challenges
oMotivation- Find ways to reward cooperation
oConsider and minimise risks
Transition Team
3 of the audiology staff are members of both
the LD adult and the team that works with
clients moving from paediatric to adult
hearing services.
One of the Audio-vestibular Medicine Doctors
has a keen interest in this client group and
works across both services.
Pressures we still face
• LD Children that have not accessed local audiology
services could be missed
•How to consult effectively with these clients and their
carers when developing services
• Ensuring equality and access with new financial
pressures and management structures
•Monitor quality of services across UK, when no detailed
standards available and introduction of individual care
budgets
•Access to high quality training and development for all
professionals
Example of local Audit
percentage
findings in 208 clients screened2008/9
100
80
60
40
20
0
Excessive
Ear
Referral to
wax
infection
ENT
Hearing
loss
Use information to
drive service
improvement
•Research
and audit data
•Record referrals and activity
•Data that allows us demonstrate
collated outcomes
•Need to document and share
evidence of practices e.g. risk
assessments
Final point to take away
No BIG answer and Bolton still has a
long way to go.
However, working together, focusing
on and trying to meet each clients
needs, is a must when providing
services for LD adults with challenging
behaviour.
Thank you and remember;
The most valuable lessons are often learnt
when facing adversity.