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Increasing access
      to psychological
      therapies for
      people with a
      learning disability


                      Fleur-Michelle Coiffait
                  University of Edinburgh & NHS Lothian
Monday, 14 May 2012
Overview of presentation




Monday, 14 May 2012
LD and mental health
                             MH problems and  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
Key Scottish policy documents
Monday, 14 May 2012
Key Scottish policy documents
Monday, 14 May 2012
Key Scottish policy documents
Monday, 14 May 2012
Key Scottish policy documents
Monday, 14 May 2012
Key Scottish policy documents
Monday, 14 May 2012
Key Scottish policy documents
Monday, 14 May 2012
Key Scottish policy documents
Monday, 14 May 2012
Key Scottish policy documents
Monday, 14 May 2012
IAPT south of the border
      贈173 million invested
       2007 - 2011
      IAPT primary care
       services
      Low / high intensity
       therapists
      Work at de鍖ned steps




Monday, 14 May 2012
IAPT and learning disabilities




Monday, 14 May 2012
IAPT and learning disabilities
                       Inclusion, improving
                        access for minorities




Monday, 14 May 2012
IAPT and learning disabilities
                       Inclusion, improving
                        access for minorities
                       Service
                        commissioning for
                        whole community




Monday, 14 May 2012
IAPT and learning disabilities
                       Inclusion, improving
                        access for minorities
                       Service
                        commissioning for
                        whole community
                       Overcoming health
                        inequality in NHS
                        services




Monday, 14 May 2012
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
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
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
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
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
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
Methodology
      2 x 45 min focus
       groups
      Ps  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
Topic guide
      Recognition/
       assessment
     
 of MH /  needs
      How these needs are
       met
      Understanding / use of
        approaches
      Supervision, training
      Stepped care


Monday, 14 May 2012
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
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
                                                Fire鍖ghting
                issues       people to do it




Monday, 14 May 2012
Conclusions
      Differing levels of MH /
        knowledge, training,
       experience and
       con鍖dence
      Lack of standardised
       assessment tools/
       protocols
      Limited evidence base 
       limited training/
       guidelines/ policy
       available
Monday, 14 May 2012
Acknowledgements

                            North East
                         Edinburgh CLDT

                          Keith Marshall,
                        CBT Therapist in LD




Monday, 14 May 2012
Thanks for
                                                       listening




                  息 Luc Coiffait Photography
             kindly provided by www.luccoiffait.com
Monday, 14 May 2012

More Related Content

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
  • 3. LD and mental health MH problems and 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 贈173 million invested 2007 - 2011 IAPT primary care services Low / high intensity therapists Work at de鍖ned 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 Ps 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 / needs How these needs are met Understanding / use of 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 Fire鍖ghting issues people to do it Monday, 14 May 2012
  • 27. Conclusions Differing levels of MH / knowledge, training, experience and con鍖dence 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 息 Luc Coiffait Photography kindly provided by www.luccoiffait.com Monday, 14 May 2012