Information factsheet for housing-related support services

Supporting people who may have a learning disability

This factsheet was developed by Housing Commissioning and the Westminster Learning Disability Partnership. It aims to support workers to recognise adult service users who may have a learning disabilityand therefore might benefit from either reasonableadjustment to their support or possibly from specialist assessmentand advice from the Westminster Learning Disability Partnership Team.

Why is this needed?

  • Under the Equality Act 2010, there is aduty for support services to make reasonable adjustments for a person with a learning disability, which might include assisted communication, adapteddaily living support orhelp with the learning of social and adaptive skills. See also What arereasonable adjustments?overleaf.
  • WestminsterCity Council have a responsibility to offer an assessment of a person’s health and social care needs, including those which may have arisen as a result of a learning disability. Such an assessment may lead to the provision of specialist housing, care or other support services.See also How do I seek furtheradvice or make a referral for assessment? overleaf.

What is a learning disability?

The following definition has been adapted from the British Psychological Society Document ‘Learning Disability: “Definitions and Context” (2000)’.

People with learning disabilities are an extremely varied group.However, in terms of diagnosis and classification there are a number of features of learning disability which have gained widespread acceptance across professional boundaries within the UK and America.

Each of the following criteria must be met for a diagnosis of learning disability:

  1. A significant impairment of intellectual functioning:this means having difficulties in most areas of cognitive functioning andconsequently having an IQ of less than 70.
  2. A significant impairment of social functioning in at least two areas: commonlyincluding areas such as functional academics, daily living skills and self-care.
  3. That the significant impairment of intellectual and social skills began before the age of 18.

Impairments that have only developed in adulthood (e.g. from acquired brain injury, neurological conditions or the effects of long-term alcohol/substance use are not considered to be a learning disability).

n.b. Having Autism does not always mean a person also has a learning disability. Approximately one third of people with a learning disability also have Autism.

Fictional examples of people who might have a learning disability?

How can I recognise if a person might have a learning disability?

If you notice the following issues it may indicate that a person has a learning disability:

Personal History: / Functional Academics / Cognitive skills
  • Has not stayed in a job / vocational course for at least 6 months
  • Has had special schooling or personal support at mainstream school
  • Has had previous contact with Learning Disability Services
  • Has had significant difficulty in living independently
/
  • Unable to read or write (except own name, address) or tell the time
  • Difficulty remembering or paying attention
  • Problems with understanding words or speaking complex sentences
  • Difficulties completing forms / dealing with letters

Activities of Daily Living / Social Relationships / Engagement/Communication
  • Difficulties in staying on task or following directions
  • Difficulties in basic living skills
  • Personal care/presentation may be poor
  • Problems with dealing with new things
  • Is socially vulnerable to exploitation
  • Finds difficulties in initiating social activities
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  • Difficulty engaging with the support offered
  • Difficulty in finding the right way to say something
  • Does not seem able to make sense of what is being said or difficulty in listening well
  • Repetitive behavior particularly around speech; limited verbal communication

What are reasonable adjustments?

Some ways in which you can support service users who may a learning disability:

  • Adapting documentation to meet specific needs; simpler forms and visual communication aids.
  • Ensuring that the language used is specific and not abstract; checking understanding.
  • Carefully planning work, breaking activities down into small manageable tasks
  • Givingclear instructions and carefullychecking that the service user knows what is expected of them
  • Where possible showing how things are done rather than just explaining.
  • Give encouragement and praise for positive behavior.

How do I seek further advice or make a referral for assessment?

If you feel that a person may have a learning disability and/or needs extra support because of intellectual and social difficulties, then please contact the Westminster Learning Disability Partnership (WLDP) to seek advice or to discuss making a referral for specialist learning disability assessment.

In the first instance call the WLDP Duty Worker on 0207 641 7411 or email:

Information factsheet for housing-related support services

Identifying and Supporting people who may have an autistic spectrum disorder

This factsheet was developed by Supporting People and the Westminster Adult Autism Assessment and Diagnosis Service (WAAADS). It aims to support workers to recognise adult service users who may have an autistic spectrum disorder and therefore might benefit from either reasonableadjustments to their support or possibly from specialist assessment and advice from the Westminster Adult Autism Assessment and Diagnosis Service.

Why is this needed?

  • Under the Autism Act 2009, there is a duty for support services to make reasonable adjustments for a person with an autistic spectrum disorder.This might include support with accessing and attending other services; support with communication; organising day to day “life admin” tasks; adjustments to the sensory environment. See also What arereasonable adjustments?overleaf.
  • Westminster City Council and the NHS have a responsibility to offer diagnostic assessments for people with a suspected autistic spectrum disorder. This assessment should also include care planning and signposting to appropriate services. Such an assessment may lead to a referral for a social services assessments or other support services. See also How do I seek furtheradvice or make a referral for assessment? overleaf.

What is anautistic spectrum disorder?

People with an autistic spectrum disorder are an extremely varied group of people. Some individuals with autism have severe learning disabilities, do not speak and are unable to complete basic self care activities. Others on the spectrum might have normal or even superior intellectual skills, hold down work, and are able to manage most of the activities needed to live independently.

Significant difficulty in the two following areas needs to be demonstrated for a person to receive a diagnosis:

  1. Social communication: this can mean many things – however what is commonly (though not always) seen is poor eye contact; unusually repetitive or overly formal speech; limited facial expression; few hand gestures; difficulty making and maintaining relationships of any kind; social isolation; social anxiety; finding it hard to keep a conversation going; making frequent faux pas and unintentionally offending people; difficulty seeing things from other people’s point of view.
  2. Repetitive and rigid patterns of behaviour and thinking: over-reliance on routine; finding it difficult to adapt to minor changes in routine or environment; presence of non-functional rituals; a preference for activities that are repetitive rather than creative; enjoying activities which are odd in their focus; enjoying activities with a single-minded intensity; black and white thinking; difficulty with negotiation and compromise.
  3. People with ASD can often have sensory over sensitivities. For example they might find specific types of sound extremely painful; find bright lights overwhelming, or be unable to cope with background noise.
  4. ASD’s by definition are “neuro-developmental”, which essentially means they developed in early childhood. If the difficulties started after childhood then this suggests there is another reason, such as brain injury, or social anxiety.

Fictional examples of people who might have an autistic spectrum disorder

How can I recognise if a person might have anautistic spectrum disorder?

If you notice the following issues it may indicate that a person has anautistic spectrum disorder:

Personal History: / Functional Academics / Cognitive skills
  • Has struggled to cope with work or schooling, despite apparent intellectual skill.
  • Has had special schooling or personal support at mainstream school
  • Has had previous contact with mental health, or children’s services, or had a statement at school.
  • Has had significant difficulty in coping with independence, even when intellectually able.
/
  • Can read and write but still finds it hard to understand and respond to letters and emails.
  • Has an uneven intellectual profile – e.g. extremely large vocabulary, but has a poor short term memory, and slow speed of processing.
  • May find it very challenging to “multi-task”
  • May find it hard to switch from one activity to another

Activities of Daily Living / Social Relationships / Engagement/Communication
  • Finds it difficult to start and maintain social relationships.
  • Very limited social network.
  • Avoids social contact where possible, or out of a sense of loneliness makes mistakes when trying to make friends.
  • Might fail to initiate activity without prompting.
  • Difficulty with organizing and sustaining activities of daily living, despite apparent ability to do so.
  • Preference for routine, or ritualized behaviour.
/
  • Avoids eye-contact, difficult to read facial expression.
  • Initiates little interaction, or is overly persistent in seeking interaction despite it being inappropriate.
  • During conversation may talk about his/her own interests, and not attempt to involve the other person.
  • May not notice unspoken cues – e.g. signs that the other person is bored, or wants to end the interaction.
  • May find it difficult to adjust behaviour to social circumstances

What are reasonable adjustments?

Some ways in which you can support service users who have an autistic spectrum disorder:

  • Be aware of the sensory environment – try to avoid places that are too bright, noisy or busy.
  • Be prepared to support the person with accessing or communicating with other organizations – phoning the DWP for instance can be extremely challenging for someone on the spectrum.
  • Be aware that social situations with more than one or two other people might be extremely testing for someone on the spectrum – e.g. large multi-professional meetings are notoriously upsetting
  • Don’t communicate in an abstract or overly nuanced way. Say what you mean. Expect your communication to be taken literally – e.g. “I’ll be there in a minute” could be taken to mean that exactly.
  • Be clear about what behaviour is and isn’t acceptable for you and your organization. At the same time offer alternative ways for this person to get their needs met.
  • All because the individual with ASD might be “pushing your buttons” don’t assume they are doing this on purpose or that it is personal.
  • If the person does not wish for any social interaction, then this might be something you have to accept. Adopting a “watchful” rather than assertive approach might be called for.
  • However, if the person is consenting, try and introduce new activities/ social opportunities at a gradual pace, with support where necessary.

How do I seek further advice or make a referral for assessment?

If you feel that a person may have anautistic spectrum disorder, then please contact the Westminster Adult Autism Assessment and Diagnosis Service to seek advice or to discuss making a referral for specialist autism assessment.

In the first instance call the serviceon 0207 641 7411 or email:

We work closely with the Westminster Learning Disability Partnership. If you are not sure whether the person you are concerned about has autism, a learning disability or both, it would be advisable to call the above number and have a discussion with a clinician at the service.