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Services and Support for People with Learning Disability
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Prevention of learning disability
- Early intervention for those at risk of mild learning disability (low birth-weight babies, children from disadvantaged families).
- Better obstetric care & control of neonatal infections (but this has also led to an increase in survival of small-for-dates deliveries, which are at risk of learning disability).
- Prevention of drug/alcohol abuse in pregnancy (foetal alcohol syndrome, teratogenic effects of substance misuse, HIV).
- Screening for heterozygotes/carriers in families with affected member and counselling by geneticists (ethical dilemas as mostly no treatments available).
- Pre-natal diagnosis improving - but only ‘treatment' yet available is termination.
- Newborn screening for reversible disorders - Guthrie test for phenylketonuria & other metabolic disorders, congenital hypothyroidism.
- Other - e.g. rubella immunisation, folate supplements in pregnancy. .
Education and Social Care
In recent years, there has been an emphasis on inclusion and community integration of people with learning disability. This has been the principle underlying education, social care and health services. The closure programmes for the old large asylums are now largely complete. The previous ‘medical model' of care for people with learning disability has generally been rejected.
Health professionals need to be aware of a large, diverse network of carers, volunteers and professional organisations involved in the care and support of people with learning disability. These include:
- Family and friends.
- Early intervention programmed (e.g. ‘Sure Start')
- Voluntary befrienders.
- Advocates.
- Housing associations and agencies - from supported independent living to fully staffed residential accommodation.
- Teachers and allied professionals.
- Social workers - often coordinate ‘care packages' for individuals.
- Respite providers - special units or in providers' own homes.
- Adult training centres.
- Supported work placements.
Health Service Provision
- GPs and primary health care teams deal with the majority of health problems themselves.
- Generic secondary physical health care for adults, other than that provided by community learning disability teams. There are often special needs clinics run by paediatricians for children.
- Community learning disability teams consist of community learning disability nurses, psychiatrists and a variety of other professionals such as occupational therapists, speech and communication therapists, dieticians, physiotherapists, psychologists and social workers. Usually provide services to a geographic area.
- Specialist in-patient units are available for a small minority of people with learning disability. These are usually run by psychiatrists and multidisciplinary colleagues and provide assessment/treatment for mental health problems and challenging behaviour. Some areas also provide specialist learning disability units for people with forensic problems, autism, and children and adolescents. There are also some continuing care beds for those with severe multiple disabilities.
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