Transcript health action planning training

Cervical Screening of Women
with Learning Disabilities


Sandra Montisci (Head Nurse/Community Matron LD)
Sally Davis (Community Learning Disability Nurse)
Health of PLD
 Less likely to consult GP
 Less likely to tell anyone if feeling unwell
 Less likely to have access to health
education
 More likely to have difficulty cooperating with examinations
 More likely to be overlooked for regular
health screening
Background
Valuing People Now – a new three-year strategy
for people with learning disabilities
Department of Health, 2009
Healthcare For All – report of the independent
enquiry into access to healthcare
Department of Health, 2009
Ombudsman Report – Six Lives – the provision of
public services to people with learning
disabilities
House of Commons, 2009
Barriers to Healthcare
 What barriers do you think women with
learning disabilities might face in
accessing screening?
 The Three C’s – What are they?
Consent
 People with learning disabilities are often
excluded from making decisions about their own
health
 DO NOT judge someone as incapable to
consent until all practicable steps to help the
person to make their own decision have been
exhausted
 Decision about capacity to consent should be
multidisciplinary and to seek advice from the
carers or family who know the person well
Consent
 Adult without capacity?
- The person wholly responsible for the
intervention must decide if it is in the person’s
“best interests”
- Even if a person has not been able to consent,
it is important to help them understand what is
going to happen to whatever extent they can
- No-one can consent to or refuse treatment on
behalf of another adult who lacks the capacity
to consent
Consent
For screening to take place:
 Understand what is screening is and the
benefits
 If person agrees and consents – who
involved and where
 If unable to consent – “best interests”,
record
The Mental Capacity Act
 Enabling and supportive of people who
lack capacity
 Aims to protect people who lack capacity
and to maximise their ability and
participate in decision-making
The Mental Capacity Act
To ensure people with learning disabilities are not
denied care or treatment
5 Principles
1.
A person must be assumed to have capacity
2. A person is not to be treated as unable to make
a decision unless all practicable steps to help him
to do so have been taken without success
3. A person is not to be treated as unable to make
a decision because he makes an unwise decision
The Mental Capacity Act
4.
5
All decisions made on behalf of a person who lacks
capacity should be made in his best interests.
Must be achieved in a way that is the less restrictive of
person’s rights and freedom.
The Mental Capacity Act
A person is unable to make a decision if
she/he is unable to:
 Understand the information relevant to
the decision
 Retain that information
 Use or weigh that information as part of
the decision-making process
 Communicate his/her decision
The Mental Capacity Act
 Don’t make assumptions
 Consider the person’s own wishes,
feelings, beliefs and values
 Incapacity to consent only applies to
that decision at that particular time
 Listen to family carers and supporters in
obtaining a ‘best interests’ judgement
 Record Record Record!!!
Communication
For some PLD problems are obvious e.g. they can’t
speak or their speech is unclear. For some it
may be less obvious e.g. they may not
understand everything that is said or written
down. Can affect their ability to function fully
in everyday activities.
Making positive changes to our own
communication can help e.g. many PLD can
understand more easily if you point, gesture or
mime along with speaking, or use
pictures/photos
What slows down or stops
communication?
•Factors relating to the individual
•Factors relating to their facilitator
•Factors relating to the environment
•Factors relating to written information
Top tips for effective
communication
Tip One
Get to know the
person
• Spend time getting to know how the
person communicates;
•If the person doesn’t already have
one consider developing a
“COMMUNICATION PROFILE”
Top tips for effective
communication
Tip Two
Adapting your language
• Use short, simple sentences of common everyday
words;
• Use the person’s own vocabulary;
• Try using open questions or changing the question
around to check response.
• Avoid analogies as these may be taken literally.
Top tips for effective
communication
Tip Three
Be prepared to use
alternative
methods of
communication such
as signing, charts
or books
Top tips for effective
communication
Tip Four
Allowing time
• During a conversation some people will need
lots of time to understand and express
themselves;
• For some people you will need to go over
ideas on a number of occasions – understanding
may be a gradual process.
Top tips for effective
communication
Tip Five
Never assume understanding
Many people with learning disabilities will appear
as if they have understood and may be able to
repeat back what you’ve said. Always be cautious
and check this out. Ask them to explain it in
their own words.
Top tips for effective
communication
Tip Six
Preparation for
appointments
Help people to understand what is going to happen
and where by visiting GP Practice, Clinic etc.
before their appointment date.
Top tips for effective
communication
Tip Seven
Facilitating at appointments
• Try to speak to the person with learning
disabilities first. Only ask for assistance if
something is not clear.
• Be prepared to repeat, re-word or explain
in several different ways what has been said
and then allow the person to respond.
• Some people with learning disabilities are
not used to being asked their opinion and will
need encouragement.
Top tips for effective
communication
Tip Eight
Do not assume
the person will
understand the
link between an
event and their
illness.
•People with learning disabilities may not make
the connection between something that has
happened and them feeling ill.
VHS
Real object
Video information
Photos
Clip Art
150
140
130
120
110
100
Beyond Words
Books
90
80
Symbols
Change Pictures
REMEMBER:
There are always
ways of
increasing service
users’
understanding and
facilitating their
expression
IT’S UP TO US TO MAKE
THE CHANGES
Ceasing Guidance – Food for
Thought
 If unsure refer to the Best Practice
Guidance January 2009
 This should be a Multi-disciplinary decision
if the person cannot make it – is the family
history known, is there conflict as to
whether the person is sexually active etc
 No where does it indicate who will talk to
the lady about this. Even though she may
not have capacity, does that mean that noone should discuss the outcome with her?
Contact Details
 Sandra Montisci


[email protected]
Tel:- 01226 775663

Mob:- 07795305714
 Sally Davis & Community Learning Disability
Team (Birk House)


[email protected]
Tel:- 01226 775377
Thank You