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Occupational Therapy (OT) a role in health liasion acute service for people with a learning disabili

As far as I am aware there are no occupational therapists working with our nursing colleagues in health liaison teams for people with learning disabilities. And it could be argued that this might creates a gap in the services we offer. Please do email if you are an occupational therapist working in a health liaison team....!

This blog aims to argue how occupational therapy staff might enhance the hospital experience for people with learning disabilities. This is very important in light of the Mencap Campaign - Treat Me Well

Role of Occupational Therapists:

We promote health and well-being though the use of occupation. The primary goal of occupational therapy is to enable PwLD to participate safely in the activities of everyday life. OTs achieve this outcome by working with PwLD and their communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do; or by modifying the occupation or the environment to better support their occupational engagement (DoH, 2012). Families caring for a son or daughter with profound intellectual and multiple disabilities face an exceptionally heavy responsibility of care (Mansell, 2010). Recent research (Emerson, 2009) estimates that there are just over 16,000 adults with profound intellectual and multiple disabilities in England, a figure which is rising.

Those with high levels of disability require support with most aspects of daily life and may have additional sensory or physical disabilities, complex health needs or mental health difficulties including challenging behaviours.

More specifically OT tailors the service around PwLD by:

- Assess and recommend support levels for individuals and develop / maintain the individual in their daily independent living skills (Lillywhite and Haines, 2010)

- Provide skills training to decrease support needs

- Support carers and colleagues – advice on equipment and adaptation for home, school or short term care

- Address behavioural needs through use of specialist approaches such as sensory integration (Urwin and Ballinger,2005) and intensive interaction to promote quality of life in the most profoundly disabled

- Support communication needs through environment controls and other aids

- Support mainstream OT colleagues in the provision of services to the individual.

There are two areas to consider then thinking about the role of OT in health liaison teams; acute health services and health liaison.

For this blog I will be concentration on the acute health service role.

Acute Health Services is when people with learning disabilities are in hospital and upon leaving hospital.

OTs have a unique role by:

- Helping to made reasonable adaptations and educating healthcare providers, in typically AHPs in order to enable someone to access primary healthcare effectively

- .Working with the client prior to hospital appointments to overcome barriers preventing them from going to hospital – e.g. anxiety management techniques, relaxation, sensory integration, physical and postural support.

- Empowering individuals with an learning disabilities by educating them/families/carers on how to advocate for themselves whilst in hospital, especially when accessing AHP services.

- Discharge planning to ensure that those with an LD do not stay in hospital longer than they need to; using specialised LD knowledge and skills to assess individuals in hospital, help with allocation of appropriate package of care / equipment / adaptions / environmental changes / occupational demands, ready for a safe discharge.

- Ensuring that individuals with an LD get the appropriate adjustments if they have to stay in hospital – e.g. what equipment they may need for washing, eating etc

- .Linking with community learning disabilities service including social service and health teams.

Key Facts and Drivers

Why does their need to be an OT in acute health liaison teams?Currently, there is no active role for this work in the community / acute services. OTs working in the hospital are not commissioned to work with people with an learning disability. BUT occupational therapists play a key role in determining whether a patient is safe to be discharged or needs a hospital admission (COT, 2008). OTs working in the hospitals (primary care) have not had formal training to work with people with an LD, although they can assess occupational performance, primary care OT do not always have the understanding or knowledge in order to make reasonable adjustments (hence why we have specialist LD OT services).

Key Documents:

- Death by Indifference, 2007

- Six lives, 2009Healthcare for All, 2008

- Valuing People, 2001 and Valuing people Now, 2007

- Occupational Therapy Service for Adults with Learning Disabilities: Principles for education and practice, Whitehead, 2010

- The importance of occupational therapy to people with Learning Disabilities, COT, 2013

- Improving Health and Well-being Through Positive Partnerships, 2012

- Confidential Inquiry into premature death of people with learning disabilities (CIPOLD), 2013

- Equality Act, 2010

- Mental Capacity Act, 2005

- Francis Report, 2013

- People with Learning Disabilities in England 2012

- Getting It Right from the Start Campaign, 2011

Better health care is everyone business

There are over 80,000 AHPs working across the NHS, local government, education, private and voluntary sector organisations in England. This is equivalent to at least a million contacts with the public each week. Considering that 2 out of every 100 people have an learning disability (DoH, 2012), this means AHP will have contact with 20,000 with people with learning disability each week.

This is a significant number of opportunities to impact on health inequalities. Yet, AHP are not actively supported by local community services to ensure safe, effective, timely primary care service for people with learning disabilities.

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