Increasing access to psychological therapies for people with a learning disability
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Increasing access to psychological therapies for people with a learning disability
- 1. Increasing access to psychological therapies for people with a learning disability Fleur-Michelle Coiffait University of Edinburgh & NHS Lothian Monday, 14 May 2012
- 2. Overview of presentation Monday, 14 May 2012
- 3. LD and mental health • MH problems and ψ distress more common in this group (Dosen & Day, 2001; Haddock & Jones, 2006; Brown & Marshall, 2006) • Estimated prevalence 30-50% (Smiley, 2005) • MH needs continue to be unrecognised and unmet • LD services need to follow mainstream mental health services (Hatton & Taylor, 2005) Monday, 14 May 2012
- 4. Key Scottish policy documents Monday, 14 May 2012
- 5. Key Scottish policy documents Monday, 14 May 2012
- 6. Key Scottish policy documents Monday, 14 May 2012
- 7. Key Scottish policy documents Monday, 14 May 2012
- 8. Key Scottish policy documents Monday, 14 May 2012
- 9. Key Scottish policy documents Monday, 14 May 2012
- 10. Key Scottish policy documents Monday, 14 May 2012
- 11. Key Scottish policy documents Monday, 14 May 2012
- 12. IAPT south of the border • £173 million invested 2007 - 2011 • IAPT primary care services • Low / high intensity therapists • Work at defined steps Monday, 14 May 2012
- 13. IAPT and learning disabilities Monday, 14 May 2012
- 14. IAPT and learning disabilities • Inclusion, improving access for minorities Monday, 14 May 2012
- 15. IAPT and learning disabilities • Inclusion, improving access for minorities • Service commissioning for whole community Monday, 14 May 2012
- 16. IAPT and learning disabilities • Inclusion, improving access for minorities • Service commissioning for whole community • Overcoming health inequality in NHS services Monday, 14 May 2012
- 17. IAPT and learning disabilities • Inclusion, improving access for minorities • Service commissioning for whole community • Overcoming health inequality in NHS services …the reality? Monday, 14 May 2012
- 18. Scottish policy context Delivering for Mental Health (2006) ‘The Matrix’ (2008) • Adults • Children, young people, families • Long-term conditions • Physical health Monday, 14 May 2012
- 19. Scottish policy context Delivering for Mental Health (2006) ‘The Matrix’ (2008) • Adults • Children, young people, families • Long-term conditions • Physical health …where is LD? Monday, 14 May 2012
- 20. Psychological therapies for people with LD • The ‘unoffered chair’ (Bender, 1993) • Growing evidence base for CBT (Beail, 2003) • Multidisciplinary biopsychosocial formulation (Ingham et al., 2008) • Behavioural family therapy Monday, 14 May 2012
- 21. Psychological therapies for people with LD • The ‘unoffered chair’ (Bender, 1993) • Growing evidence base for CBT (Beail, 2003) • Multidisciplinary biopsychosocial formulation (Ingham et al., 2008) • Behavioural family therapy …why not? Monday, 14 May 2012
- 22. Stepped care in LD services • Already used? • Feasible? • How would it work? • How would it look? • Skills gaps? • Training / supervision needs? • Alternatives? Monday, 14 May 2012
- 23. Methodology • 2 x 45 min focus groups • P’s – CLDT: psychiatrist, 4 x nurses, SLT, OT, physio, team secretary • Audio recorded and transcribed verbatim • Process notes • Stimulus material and topic guide Monday, 14 May 2012
- 24. Topic guide • Recognition/ assessment of MH / ψ needs • How these needs are met • Understanding / use of ψ approaches • Supervision, training • Stepped care Monday, 14 May 2012
- 25. Data and analysis • 90 mins discussion, >16,000 words • Transcribed in full • NVivo 8 used for coding and organising thoughts • Thematic analysis Monday, 14 May 2012
- 26. Thematic map Lack of Barriers to Varying levels standard recognising of knowledge Lack of assessment mental health and training standardised protocol / tool needs procedure / Lack of tool structured, Barriers to Time evidence- meeting constraints based mental health approaches needs Supervision Not enough Firefighting issues people to do it Monday, 14 May 2012
- 27. Conclusions • Differing levels of MH / ψ knowledge, training, experience and confidence • Lack of standardised assessment tools/ protocols • Limited evidence base → limited training/ guidelines/ policy available Monday, 14 May 2012
- 28. Acknowledgements North East Edinburgh CLDT Keith Marshall, CBT Therapist in LD Monday, 14 May 2012
- 29. Thanks for listening © Luc Coiffait Photography kindly provided by www.luccoiffait.com Monday, 14 May 2012