Thinking about me?
Essential psychological care for people with learning disabilities
Model answers
Contents
Introduction 4
Model answers to Unit 1 5
Learning activity 1.1 5
Model answers to Unit 2 7
Learning activity 2.1 7
Learning activity 2.2 7
Learning activity 2.3a 8
Learning activity 2.3b 9
Learning activity 2.4 10
Learning activity 2.5 11
Learning activity 2.6 12
Learning activity 2.7 13
Model answers to Unit 3 15
Learning activity 3.1 15
Learning activity 3.2 15
Learning activity 3.3 16
Learning activity 3.4 17
Learning activity 3.5 17
Learning activity 3.6 17
Learning activity 3.7 18
Learning activity 3.8 19
Learning activity 3.9 20
Learning activity 3.10a 23
Learning activity 3.10b 23
Model answers to Unit 4 25
Learning activity 4.1 25
Learning activity 4.2 26
Learning activity 4.3 26
Learning activity 4.4 27
Learning activity 4.5 29
Learning activity 4.6 29
Learning activity 4.7 30
Learning activity 4.8 31
Learning activity 4.9 32
Learning activity 4.10 32
Learning activity 4.11 34
Learning activity 4.12 34
Model answers to Unit 5 37
Learning activity 5.1 37
Learning activity 5.2 38
Learning activity 5.3 40
Learning activity 5.4a 41
Learning activity 5.4b 42
Introduction
This guidance has been developed to accompany the Thinking about me?
Essential psychological care for people with learning disabilities learning resource commissioned by NHS Education for Scotland (NES) to support staff to deliver the best possible care for people with learning disabilities. The resource specifically aims to help staff understand psychological factors that may affect people with learning disabilities.
Thinking about me? includes a series of learning activities that learners are invited to work through with peers and/or a workplace mentor. The activities are designed to help them think about and understand the topics presented within the different units of the resource. Learners are invited to answer the questions in each activity and then discuss their responses with a peer and/or mentor.
The model answers provided in this publication set out examples of what learners may be expected to include in their answers to the activities. These can be used by:
· learners, to compare against their original answers and reflect on whether a further learning need is indicated
· mentors or mangers, supporting learners as they work through the resource to stimulate discussion around the learning activities.
Model answers to Unit 1
Learning activity 1.1
Do Robert, Christina, Michael and Patricia sound like people you have worked with?
It is expected that learners would be able to reflect on the range of demographics of individuals known to their service. The activity also provides an opportunity for reflection on the nature of their service and their experience of working with people with learning disabilities.
Have you had any training in psychological theories or therapies?
The response will be based on individuals’ experience, but they may make some reference to teaching on psychological theories during undergraduate degrees or other programmes. This offers an opportunity to establish their initial level of understanding.
If you have, what have you learnt?
The response will be based on individuals’ prior learning, but they may make some reference to theories that explain how people learn (such as classical conditioning) and those that explain behaviour, such as cognitive or psychodynamic (perhaps Freudian) theories. More experienced practitioners may have had formal training in delivering psychological therapies. Discussion during this learning activity will help learners to consider how they might best use the resource.
Do you use psychological theories or therapies in your everyday work?
If you have, how have you used these?
The response will be based on individuals’ experience, but may include some reference to the use of behavioural therapy, with awareness of terminology such as Positive Behavioural Support (PBS) and Cognitive Behavioural Therapy (CBT). If learners are not aware of these, it is expected that the mentor would expand the discussion to cover all practice, reflecting, for example, how medication compliance relies on some aspects of psychological theory.
The mentor may also wish to discuss exposure to overcome phobias and some fundamental skills such as the ability to listen, good observation, monitoring difficulties such as challenging behaviour and perhaps trying to identify factors that trigger or maintain such behaviours.
Write down what you would hope to gain from this resource.
The expected response will vary from individual to individual, but there should be some acknowledgement of the importance of psychological care in service provision for people with learning disabilities. Evidence of motivation to develop knowledge of this would also be expected. If learners are unclear on what they wish to gain or why they are undertaking this learning, the mentor should work with them to develop goals.
Model answers to Unit 2
Learning activity 2.1
Write down the different terms for learning disability they describe and define what they mean in different countries.
It is expected that learners will have identified some of the following terms.
· Learning disability in the UK, developmental or intellectual disability in Europe and Canada and mental retardation in the US. It is expected that learners will have an awareness that the term “mental retardation” is now being replaced and is not used in the UK. . It is also expected that they will be aware that the Royal College of Psychiatrists and British Psychological Society now use the term “intellectual disability” and that other disciplines may follow suit.
· Learners should have an awareness of the terms “learning difficulty” and “learning disability” and understand how they may be applied differently depending on the setting (“learning difficulty”, for instance, may be used within the education sector to describe a condition such as dyslexia). Learners should have an understanding of the potential confusion that can result from inconsistent use of terminology.
What, in your view, would be the best term, and why?
Learners should appreciate the need to consider the views of people labelled with the term and what best describes the condition. They should be mindful of how terminology can discriminate against people, even if unintentionally.
Learning activity 2.2
Case study: Robert
What emotions might Robert experience following this diagnosis?
Learners should:
· show appreciation that Robert may be upset by the diagnosis and may not accept it
· demonstrate awareness that he may view the diagnosis as a positive explanation for everyday difficulties he is experiencing that will help him to access support
· be aware that Robert may not understand the diagnosis and the terminology used.
What advantages to Robert could you foresee as a result of this diagnosis?
Learners should make some reference to potential access to services that may be more experienced at meeting the needs of people with similar diagnoses. Additionally, the diagnosis may allow Robert access to more support, benefits and specific educational and social opportunities in his local area.
What disadvantages to Robert could you foresee as a result of this diagnosis?
Learners should make some reference to potential stigma and the possibility that Robert may perceive himself in a negative light following the diagnosis, affecting his self-esteem and expectations for the future. He may also become confused by the diagnosis, signalling a need for him to understand its meaning. Learners should also be aware that Robert may now find it more difficult to access mainstream services. If extra support, benefits and access to appropriate services are not in place, the diagnosis has been of no benefit to him.
Learning activity 2.3a
Case study: Christina
Reflect on what Christina’s feelings might have been when she was admitted.
How might these have affected her behaviour at the time?
Learners should acknowledge the feelings that Christina may have had at that point in her life. She may have felt abandoned, scared, lonely and without support. She is likely to have been grieving for the loss of her mother and other significant losses/life events that she had to cope with, including the loss of her family.
If she is not familiar with the people and practices at the institution, she may start to behave in ways that are associated with low mood and hopelessness. She may stop eating, struggle to sleep and become aggressive if she feels angry at her current situation (anger being a very common emotion in the grieving process). The anger may be directed at members of staff or her family, including her father.
How might that experience continue to affect her in later life?
Learners should show awareness of potential ongoing effects, including a lack of trust and fear that she will be moved again. This may mean that Christina refuses to go out or becomes unwilling to do so without others in case she is being taken somewhere else, which in turn may affect her ability to bond with others and jeopardise the security of her future relationships. Depending on level of experience, learners may reflect on clients they have worked with who have had similar experiences.
Christina’s father was told that it would be better for him not to visit her after she was admitted.
How might that have affected him and his family?
Christina’s father may believe he is to blame for some of the issues. If professionals are telling him he should not visit her, he may question whether some of the other decisions regarding Christina in the past have been in her best interests. Learners should be aware that Christina’s father may experience significant guilt and that her admission to hospital may cause conflict among family members if others (such as her sisters) do not agree with it. Feelings of guilt may re-emerge at the point Christina is discharged, as institutions have been portrayed as inappropriate living places that had to be closed. Again, depending on level of experience, learners may reflect on clients’ families they have worked with who have had similar experiences.
Learning activity 2.3b
“Community care is a good thing.” Reflect on this statement and write down what might be the benefits of the move to community care for someone like Christina. Also note any disadvantages you can think of.
Learners should be able to discuss some of the following points.
Benefits of community living
· People aren’t isolated or removed from society because of their needs or diagnosis.
· If segregation no longer occurs, generations growing up will not automatically expect problems with people with learning disabilities or assume they are different from other people. They are more likely to be accepted as members of society, reducing the likelihood of stigma and prejudice.
· People can access activities, education and social support opportunities more easily.
· People are not principally defined by their learning disability.
· Institutional patterns of behaviour can become less of an issue.
Disadvantages of community living
· People can still be isolated within communities.
· People may be more vulnerable to others and may be exploited in various ways.
· Benefits changes and changes to support may leave people worse off financially than when they were when they lived in institutions.
Learning activity 2.4
Models of care
Identify what models of care are offered in the area in which you work.
Responses will vary depending on the geographic area in which learners work, but may include:
· individual tenancies in which carers or support workers provide help with tasks of daily living such as personal hygiene, personal care, meal preparation and access to community activities
· supported living, where the person has his or her own flat or house but staff are available on site in another flat or house
· specialist units, such as those provided by health or private organisations
· day provision at a specific base to allow the person to access activities or educational opportunities
· shared living situations, either with others with a learning disability with staff available or in “adult fostering”, family placement or live-in support arrangements.
Establish why these models are used. You may need to search for social work information to help you with this activity.
Reponses will vary depending on local circumstances, but learners may find that government policies, interpreted by local authorities, have influenced the models of care offered.
What effects (positive and negative) on psychological well-being do you think these models have?
It is expected that learners will be able to identify some of the following points.
· Individuals may have freedom and choice regarding day-to-day issues such as what they eat or wear, but not necessarily about where to live and with whom. For example, people who were discharged from long-stay hospitals tended to return to the local authority areas in which they had resided before admission to hospital, rather than moving with people with whom they had developed friendships and had perhaps expressed a preference to live with or near.
· When responding to this question, learners should show awareness of the roles control, social support and opportunities (for friendship, occupation and recreation) may play in psychological well-being.
Learning activity 2.5
Case study: Robert
Consider what you have learned about stigma and answer the following questions. Does the behaviour of the group of men and the manager reflect stigmatisation in society? List the reasons why or why not.
Learners should be able to recognize that the behaviour of the men does reflect stigmatization for the following reasons:
· one of the men knows Robert received support at school
· the group assumes he is not that able
· they financially exploit him
· they draw him out as “different”
· this extends to the manager of the establishment taking sides with the group rather than listening to Robert’s side of the argument.
How else might the manager have dealt with this situation?
Learners should suggest that the manager could listen to Robert – maybe doing this away from the group. He could ensure that the group know he is aware of what they are doing, not accept bets they put on with Robert’s money and encourage others in the shop to support, rather than tease, Robert. Literature on bullying and stigma could be brought into the shop and the manager could try to get advice from local social work or voluntary agencies on how he could manage the situation.