Screening for people with learning
disabilities and people with literacy and
numeracy difficulties in IAPT in Cumbria:
The argument and initial data.
Professor Dave Dagnan
Consultant Clinical Psychologist
How does diagnosis/identification
work in adult services?
1. Some people do not need assessment.
•Transitions/severe disabilities
2. Assessment needed:
a. General Screen (McKenzie & Paxton, 2005)/local
screen/Age of onset of difficulties.
• If diagnosis still possible then
1.b. Adaptive Behaviour assessment.
1.If diagnosis still possible then
2.c. Intellectual functioning (IQ) assessment.
The Monitor Compliance Framework – Governance
Indicator for NHS Foundation Trusts: Access to
Healthcare for People with Learning Disabilities
1. There is a mechanism in place to identify and flag patients with
learning disabilities, and protocols that ensure that pathways of
care are reasonably adjusted to meet their needs.
2. There is readily available and comprehensible information for patients
with learning disabilities about treatment options, complaints procedures
and appointments.
3. Protocols are in place to provide suitable support to family carers.
4. Protocols are in place to routinely include training on providing
healthcare to patients with learning disabilities for all staff.
5. Protocols are in place to encourage representation of people with
learning disabilities and their family carers.
6. Protocols are in place to regularly audit practices for patients with
learning disabilities and to demonstrate the findings in routine public
reports.
There is a mechanism in place to identify and flag patients with
learning disabilities, and protocols that ensure that
pathways of care are reasonably adjusted to meet their
needs: Challenges
•Multiple software (community
health/mental health/inpatients).
•Different organisation have different
criteria for including on their data-sets.
• LD flag using data from
- our own services
- ASC data base,
- routine updating to ensure
accuracy.
ASC NHS
Numbers of People with a Learning Disability
• About 985,000 people
in England have a
learning disability
(about 2% of the
population); 796,000 of
them are aged 20 or
over
• Cumbria population c
500,000
• 2.5% population IQ
below 70 = 12,500
Numbers of people in services?
• Only about 20% of adults with
learning disabilities are known
to learning disability services
(about 1750 people), therefore
about 10,000 people in
community with IQ below 70.
• Cumbria population c 500,000
- 15.5% (1 in 6) population
IQ below 85 = 77,500
• At least 1 in 6 of caseloads in
the trust have IQs below 85….
probably1in 5 or above.
Social inequalities in mental health
Supporting adjustments in IAPT
• Training for staff specific to their roles and the
types of intervention supported by their part of
the pathway.
• Pathway adaptation, based on lower ability:
• Easy read medication and self-help guides
• Allowing extra time for reading core questionnaires
• Emphasising less cognitively demanding techniques
• Emphasising smaller set of techniques
• Enabling supporters in therapy
Screening tool
Screening tool
Trust flag and IAPT Screening:
What does it give us?
• Ability to monitor people with learning
disabilities’ and people with lower abilities’
access to the service.
• Ability to compare outcomes for people
with learning disabilities’ and people with
lower abilities’
• Ability to test outcomes of adjustments
Conclusions
• The reasonable adjustments we apply to
people with learning disabilities may also help
a significant number of people without
learning disabilities.