The assessment of people
with Learning Disabilities
under the CHC Framework
Susan Fitzgerald
CHC/FNC Team Leader:
Kingston
Introduction
• This presentation endeavours to cover some of
the practical aspects of assessing people with
Learning Disabilities under the CHC framework.
• Looks at some of the key domains and
challenges regarding assessment
• Discusses the role of the multi-disciplinary Team
in the assessment.
Should it or shouldn’t it even be
assessed?
• A question that is raised in all areas is
whether Learning Disabilities of varying
types should even be considered under
CHC?
• This comes up very often in Autism but is
not only in relation to this.
Social services seek health funding because the care
needs are more than they feel should be expected to
be provided from Social Services.
Health assesses and finds, often it is the behavioural
domain pivoting between Priority and severe that
make the judgement of CHC or not and this is
questioned by them as whether this should be the
deciding factor alone?
Families say they do not want CHC as they feel it will
reduce their or the person’s control and autonomy
and they say that Autism is not a health needs it’s a
social need.
Needs not Diagnosis
• CHC assessment is based on needs not diagnosis
• The Need is that the right Statutory Authority is
identified – and that there is clarity about funding
streams and responsibilities
• A CHC decision should not disempower the
individual or mean either increased or reduced care.
(However - yes it will affect funding arrangements,
and it could impact on the persons financial
arrangements)
CHC in Learning Disabilities
what do you need?
• A good knowledge of the CHC Framework
• A good knowledge / understanding of the DST
descriptors
And / or
• An in-depth knowledge of the individual.
Both is the ideal but rarely possible in such a small
field at this time – so utilise more people and
multiply the knowledge.
What’s the difference in LD
Assessment?
• Integrally it is the same as any complex
case assessment
• However there is an onus on the 4 initial
domains in both Learning Disabilities and
Mental Health Assessments. The
challenge here is that assessors find these
to be the most subjective and difficult
domains to accurately assess against.
So what does a CHC assessor need to
know about Learning Disabilities
• There are 4 key domains where the
presentation can be very different in this
group:
– Behaviour
– Cognition
– Psychology
– Communication
So what does a CHC assessor need to
know about Learning Disabilities
• People who work predominantly in the LD field have
a threshold of expectation that is higher than in the
general services population.
• Dependant on which field you originate from you will
also have a certain bias or leaning toward lower of
higher thresholds under those more subjective
domains.
• Keep referring to the DST and the framework for the
definition. Base everything on evidence
Behaviour Defined
Challenging behaviour is defined as
"culturally abnormal behaviours of
such intensity, frequency or duration
that the physical safety of the person or
others is placed in serious jeopardy, or
behaviour which is likely to seriously
limit or deny access to the use of
ordinary community facilities".
Emerson, E. 1995
Behaviour definition con’t:
• Frequency & Severity & Impact
• Is it or will it cause emotional or physical
harm to the person themselves, or others?
• How often and to what extent ?
Cognition Defined
Cognition is a term referring to the mental
processes involved in gaining knowledge and
comprehension, including thinking, knowing,
remembering, judging and problem-solving.
These are higher-level functions of the brain and
encompass language, imagination, perception
and planning.
Kendra Cherry Psychology Guide since 2005
Psychological & Emotional
Defined
Emotion is the complex psychophysiological
experience of an individual's state of mind....
Emotion fundamentally involves "physiological
arousal, expressive behaviours, and conscious
experience."
Emotion is associated with mood, temperament,
personality and disposition, and motivation.….
Emotions provide the affective component to
motivation, positive or negative.
Myers, David G. (2004) &
Gaulin, Steven J. C. and Donald H. McBurney. Evolutionary Psychology. Prentice Hall. 2003
Engagement of the Person
being assessed
• Firstly and as an integral part of the assessment
role assessors must have a good knowledge of
the Mental Capacity Act.
– Capacity in relation to the assessment
process
– Dignity and respect
– Enabling the person to have maximum control
– Best interest
– Deprivation of Liberty
Engagement of the Person
being assessed
• Engagement needs to be functional and useful
• It should not provoke anxiety or stress.
• Make the message as simple as it needs to be in
order to make sense.
• The message can come from whoever is best
placed to explain it.
• Arrive prepared – talk to the family and support staff
around the person to ensure understanding
Engaging the Person …….
• Bottom line :
- I am assessing what help you need
- This assessment is about who is going to work with you to
make sure you get the help you need .
- It is about who pays for your help
• If the people who know the person feel that he/she is
clearly not going to understand and that it will only cause
undue anxiety and distress then in the persons best
interest record that and don’t speak to them directly
about the assessment
Engaging the Family
•
•
•
•
•
•
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Talk to them first – this prevents misunderstanding
Invite them to be part of the process
Explain CHC to them and reassure them
Offer more information
Offer a pre-meet
Be clear about your role
Be clear about confidentiality issues and data protection – again
saves misunderstanding
• Make sure they know its not a one meeting only option – They can
have time to digest the information and support their relatives best
interests and that you are there to facilitate this
• Be clear about time frames and what they are there for – even if its
just because the process dictates it.
Case Coordination
Though the case coordination role can be held by
an individual from differing professional
backgrounds it is important to remember that
without a Multi Disciplinary team approach we do
not have:
a)A fully evidenced decision
b)A holistic assessment which can then lead to a
clearly defined package of care
c)Joined up working which reduces disputes
between statutory organization.
Reviews
• Need to have an agreed continued MDT
approach, otherwise we risk further
dispute or breakdown in communication.
The challenges that this poses:• MDT working
• Perceptions of patients and their families
• Communication