Bolton Learning Disability Audiology Services and Challenging Behaviour.
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Transcript of Bolton Learning Disability Audiology Services and Challenging Behaviour.
Bolton Learning Disability Audiology Services and Challenging Behaviour
LD Audiology Adult Services in Bolton
Audiology dept. is based in the Acute Trust, but sees clients in a wide variety of settings
Introduced LD hearing screening over 12 years ago- initially not universal screening
Also provides diagnostic audiology and rehabilitation
Strengths of Bolton Team Only staff interested in working with LD
adults on the team Working in partnership with other
professionals Treat everyone as an individual, trying to
understand their needs and what motives them
Provision of high quality aids that best meet clients needs
Dedicated transition team
What is Challenging Behaviour?Emerson et al (1987) suggested that;
“Severely challenging behaviour refers to behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit or delay access to and use of ordinary community facilities.”
Challenging Behaviour Foundation
Some children and adults with severe learning disabilities typically display behaviour which may put themselves or others at risk, or which may prevent the use of ordinary community facilities or a normal home life.
This behaviour may be in the form of aggression, self injury, stereotyped behaviour or disruptive and destructive behaviours. These behaviours are not under the control of the individual concerned and are largely due to the individual’s lack of ability to communicate.
Why audiological assessment and screening is so important for LD adults with challenging behaviour?
Possible self harm or foreign bodies Progressive hearing loss may go undiagnosed if
alongside other progressive condition e.g. dementia Effects of hearing loss compounded by poor
communication tactics and other disabilities Often no continuity of carer Difficult to spot early signs of infection/discomfort Examination/testing can be difficult Ear pain/hearing loss may compound challenging
behaviour LD increases probability of having hearing difficulties
and higher incidence of premature aging
Incidence of Hearing Loss in Adults with LD
Research Evidence on the Health of People with Learning [Intellectual] Disabilities
First published by the Valuing People Support Team in 2002
“Around 40% are reported to have a hearing impairment”
Incidence of Hearing Loss in Adults with Downs Syndrome
Effects of Hearing Impairment on Adaptive Behaviour in Adults with Downs Syndrome
Prasher V.P. 1995 studied Adults with DS and looked at the effects of hearing loss
“Hearing impairment leads to a loss of adaptive skills and to an increase in maladaptive behaviour for individuals below the age of 40 years.”
“Deterioration in adaptive functioning cannot be assumed
to be due to dementia in people with DS unless the presence of hearing impairment has been excluded.”
Mean age for each group between 40 and 48 years201 Adults with DS, living a range of environments took part in the study
Meet the team that allows us to work with this client groupAudiologistsLD assistant practitionersSocial Care StaffTrust Specialist LD Nurse Audio-vestibular MedicineENTSALTAdvanced Practitioners in Audiology Advanced ENT Nurse Practitioner
Screening and review sessions
This involves:
•Co-ordinating availability of staff, clients, transport and facilities•Monitoring review and referral lists- chasing DNA’s•Understanding and allowing for clients preferences and dislikes•Obtaining consent and generating appointment schedule•Conditioning of clients with challenging behaviour and briefing carers•Being a familiar face supporting Audiologists during investigations•Recording and communicating results and recommendations in appropriate format
These sessions are arranged with audiology, care homes, day centres etc by the LD assistant practitioners.
Audiology Screening and assessment appointments
oBriefed on clients preferences and dislikes- documented for future appointmentsoVenue is safe and a place where client is relaxedoStaff don’t wear uniformsoStaff present are those the client is likely to respond well to and are able to provide insight into clients behaviouroMore than just a hearing assessment- ears checked and aural care issues addressed
Audiology Screening and assessment appointments
oAdequate time given, several visits if necessaryoFlexible approach to testing- being creative and making use of behavioural changes oBe prepared for the unexpected-assume nothingoTreat clients with respect e.g. “Toys” are not childishoClinical governance guidance followed
Appointments
•Alerts on clients in audiology booking system•Those requiring 2 of LD staff or other special requirements noted•Variable lengths of appointment with most appropriate member of staff, dependent on patients needs•Encourage regular carers to attend with clients•Fast track appointments when possible to minimise time in waiting room•Use large test room and friendly facilities
Working with other professionals in the hospital
•Close relationship with Trust LD nurse•Co-ordinate hospital appointments to minimise disruption•If GA or sedation being use opportunity to check ears, take impressions, perform objective tests etc.•Share experiences and personal development opportunities•Collate any concerns regarding an individuals care
Rehabilitation
oTake time to build a relationship with client and carers
oMild losses may not require aiding as good communication tactics are employed by carers in a consistently good listening environment
oA realistic rehabilitation plan needs to be developed and agreed in partnership with stakeholders
oEnsure the care plan is communicated to all staff working with the client and a consistent approach is maintained
Hearing DevicesoAgree benefits and care plan, build in checking aid is functioning and ear is not soreoMay be unable to communicate if aid uncomfortable or too loud, set conservative output limits. Remember client may be in very noisy environmentsoUse quality products that best meet clients needs- consider using high end products with additional features e.g. water resistantoMalformation of pinnae and narrow ear canals can present additional challengesoMotivation- Find ways to reward cooperationoConsider and minimise risks
Transition Team
3 of the audiology staff are members of both the LD adult and the team that works with clients moving from paediatric to adult hearing services.
One of the Audio-vestibular Medicine Doctors has a keen interest in this client group and works across both services.
Pressures we still face
• LD Children that have not accessed local audiology services could be missed•How to consult effectively with these clients and their carers when developing services• Ensuring equality and access with new financial pressures and management structures•Monitor quality of services across UK, when no detailed standards available and introduction of individual care budgets•Access to high quality training and development for all professionals
Example of local Audit
findings in 208 clients screened-2008/9
020406080
100
Excessivewax
Earinfection
Referral toENT
Hearingloss
pe
rce
nta
ge
Use information to drive service improvement
•Research and audit data•Record referrals and activity •Data that allows us demonstrate collated outcomes•Need to document and share evidence of practices e.g. risk assessments
Final point to take away
No BIG answer and Bolton still has a long way to go.
However, working together, focusing on and trying to meet each clients needs, is a must when providing services for LD adults with challenging behaviour.
Thank you and remember;
The most valuable lessons are often learnt when facing adversity.