Understanding Spesific Needs in Health and Social Care Essay Example for Free

Understanding Spesific Needs in Health and Social Care Essay The aim of this essay is to analyse the concepts of health, disability, illness and behaviour and also investigate how health and social care services and systems support individuals with specific needs and look at different approaches and intervention strategies available to support individuals with specific needs, lastly will explain what challenging behaviour is and explain strategies available for those working with people with specific needs LO1. 1 Health is defined as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (WHO, 1974). During the Ottawa Charter for Health Promotion in 1986, the World Health Organisation said that health is â€Å"a source for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities†. Health is traditionally equated to the absence of disease. A lack of fundamental pathology was thought to define ones health as good, whereas biological driven pathogens and conditions would render an individual with poor health and labelled diseased. However, Aggleton amp; Homans (1897), Ewles amp; Simnett (1999) argue that health is holistic and includes different dimensions and all needs to be considered. Bilingham (2010) explains health in two models which are the biomedical model and the socio-medical model. She said biomedical model is an approach to health and illness that identifies healthy as the ‘absence of disease’ and focuses on diagnosing and curing individuals with specific illnesses , the socio medial model is an approach to health and illness that focuses on the social and environmental factors that influence our health, including the impact of poverty and poor housing. The Disability Discrimination Act 1995 defines a disabled person as anyone with a physical or mental impairment which has a substantial and long term adverse effect upon his or her ability to carry out normal day to day activities. Disability can affect someone’s mobility, learning or understanding, and lack of understanding when it comes to danger. Disability covers a lot of impairments which include physical impairments, sensory impairments and communication difficulties. There are three models of disability which are the personal tragedy model, the medical model and the social model. In the past people with disabilities were discriminated by the families and the society. The language and terminology used were words such as imbeciles, handicapped and mental retarded. People with disabilities were called dangerous and scary and they were seen as not equal citizens, in need of special care. They were not seen as normal people. Behaviour is anything that a person does or does not do which has a negative effect on their lives or the lives of others. The negative effects can be emotional, physical and social. Also, one’s behaviour pleases and other’s infuriates. Some behaviour are socially acceptable here in the western world but not socially acceptable in African communities, for example kissing in public is not totally acceptable where I come from nevertheless, here in London (Europe) people can kiss in the public without any problem, people accept such behaviours in Europe . Illness is the partial experience of loss of health (Naidoo and Wills, 2000 p7). Illness is having poor health and is considered a synonym for disease; some have described it as a perception by a patient to define a disease. Illness indicates a condition causing harm and pain. Social constructionists argue that the following concepts illness, health, disease and behaviour are all relative concepts not universal but particular. Social concepts are learned and shared. Concepts often tell us more about the societies out of which they came than about the thing they are actually describing. LO1. 2 People’s perceptions on specific needs vary from cultures and societies. People’s perceptions Are also culturally and historically specific. Epilepsy in the Middle Ages was viewed as a violent possession by malevolent or even divine forces. Early part of the 20th century epilepsy was linked with insanity; people believed that the Holy Spirit was working them. In Third World cultures epilepsy continue to be defined in super natural terms. Recently a community study in Nigeria found that after heredity, witch craft was the cause of epilepsy amongst the lay populace (Awaritefe et al, 1985). Danesi (1984) has revealed that most Nigerians with epilepsy experience it as highly stigmatizing and something to be hidden from others but through medical discoveries and medical advances we know that epilepsy is caused by abnormal neurological activity that occurs as a result of damage or result to the brain. Epilepsy is now controlled by carbamazepine tablets and sodium valproate which controls the seizures however, what we all know is subject to reinterpretation. At any time new technological advances, new medical discoveries, new ways of looking at the structure and functioning of the body or brain could replace the current orthodoxy and epilepsy could come to be seen in a completely different light. Department of Health (1999) launched a strategy to ensure that doctors and nurses have the skills they need to use to make the best use of new technology introduced into the NHS. The right to freedom from discriminations for people with a range of disabilities, including those with a learning disability, has been enshrined in the 1995 Disability Discrimination Act which says employers should make reasonable adjustments to allow an individual with disability to gain employment and ramps to be provided so that wheel chair users can access t facilities in the facilities in the community. Also there is the Valuing People 2001 which state that support should be given to people with learning disabilities and their families and that people with disabilities should have control over their lives as much as possible (Department of Health, 2009). I have also done a small scale research and investigated the perceptions of people with specific needs which I carried at Shining Star Residential Care Home . LO1. 3 Social policy is the only one way of encouraging and promoting ethical practice. The functions of a regulatory body go much further than disseminating policies and code of ethics. Legislation acts have helped to set and enforce educational standards, which meet the needs of people, e. g. the Disability Discrimination Act 1995, which protect individuals with disabilities from discrimination (Rogers and Pilgrim, 1991). Legislation plays an important role in ways that services are made available for individuals with specific needs. Legislation modifies attitudes and practices. From the mid 1980’s some western countries e. g. Australia have enacted legislation which embraces a right based discourse rather than a custodial discourse and which seeks to address issue s of social justice and discrimination. The legislation also embraces the conceptual shift form disability being seen as individualised medical problem to rather being about community membership and participation and access to regular societal activities such as employment, education and recreation. Where access is inappropriate, inadequate, difficult or ignored, advocacy processes have been initiated to address situations and promote the people rights. Under the Disability Discrimination Act 1995 an individual has the right to get the information about health services in a format that is accessible to them where it is reasonable for the service provider to provide in the format, a hospital will have to provide forms and any literature in braille or large print to assist any blind person or anyone who have a visual impairment. Most of The Disability Discrimination Act 1995 has been replaced by the Equality act, this was changed on the 1st of October 2010 and is aimed to protect disabled people and prevent disability discrimination. Disabled people are protected in areas of employment, education, access to goods, service and facilities including larger private clubs and land based transport services buying and renting land. The Data Protection Act 1998 is the key legislation that governs the protection of data , when records for service users are kept for the purpose of sharing information to provide a well informed care service the details are kept in the individual service user file , they will have access to it but the information will not be shared with others The Valuing People 2001 was designed to improve support for people with learning disabilities and their families; to make sure people with disabilities are in control of their lives and that they have the job they want. The Mental Capacity Act aims to protect people with learning disabilities and metal health conditions. It provides clear guidelines for carers and professional about who can take decisions in which situations. The Health and Social Care Act 2008 established the Care Quality Commission as the regulator of all health and adult social care services. It is a single Act of Parliament that contains the commission’s powers and duties, and represents the modernisation and integration of health and social care. It contains some new powers of enforcement that were not held by any of the predecessor organisations. LO2. 1 A Care plan is a document that articulates a plan of care for and individual with specific need or disability. It helps individuals achieve valued fulfilling lifestyles, because it is build around the needs of the person rather than expecting them to fit into existing provision (Ritchel et al, 2003). The care plan is for Mr RN , who has autism and has learning disabilities. He is Jewish and is non verbal and he understands little English and uses makaton, sign language and pictures as a mode of communication. To analyse his care needs I will use the Maslow’s hierarchy of needs. See figure 1 for Maslow hierarchy of needs Figure 1 : Maslow hierarchy of needs Mr. RN had stroke and is unable to walk properly. He uses a walking stick to move around in the house and a wheel chair when out in the community. He does not hear properly and uses hearings aids. At the care home staff always checks if it is working properly, by changing the butteries and cleaning it for him. He also uses glasses to improve his vision. Mr RN’s care plan is person-centred to meet all his care needs at the same time he makes his own choices. His holistic needs are met according to his choice through assessment. He is from a Jewish background and sticks to his religious beliefs and culture seriously. RN is always supported to the synagogue every Friday to attend to his spiritual wellbeing. I respect his beliefs to avoid abuse, discrimination, oppression or prejudice. He is also provided with kosher meals. The organisation I work for has a Jewish calendar that recognises all the facts and festivals to highlight his religious rights. I relate this to Abraham Maslow’s (1908-1980) hierarchy of needs, ‘a theory of human Motivation’. It has five levels to it with the most basic needs at the bottom of the pyramid. I prepare meals for RN according to his cultural and religious needs. I ask him what he would like to eat from the variety of his kosher meal. I make sure RN’s safety and security or protection from harm and abuse according to Health and Safety Act 1974. I have to ensure that the environment around the care home is safe and welcoming for family members visiting. Socially, I support RN to visit family and friends. This gives him sense of belonging, love, friendship and trust. During the key working I encourage RN by reassuring him everything is fine. This builds his confidence thus leading to self actualisation growth. When these needs are successfully met chances are the service users feels more valued and respected, it also promotes independence. LO2. 2 At my workplace we have a set of policies and procedures that we use when we work with clients with specific needs. Looking at Mr RN’s care plan I follow the Data Protection Act 1998 in maintaining his confidentiality and that only necessary people access his care plan. He has little awareness when it comes to safety and I follow the Health and Safety at Work 1974 to meet his safety needs, Mr RN cannot walk for long distance, he uses a wheelchair when out in the community and the wheel chair is checked every day before use to see if it’s not damaged. We have the dial a ride that comes to pick him up and take him to the day centre and he has the blue badge scheme that allows him to have free parking he goes to shopping malls. We use the visual communication systems such as Picture Exchange Communication to help him plan for activities; he is able to choose what he wants to eat with no problems. By doing this we are promoting independence as he is able to do things on his own. LO2. 3 The organisation I work for is located in the Redbridge Borough. The borough offers the Community Toilet Scheme which provides clean, safe and accessible public toilets in more convenient locations for residents. Disabled people can use the toilet free of charge during normal working hours. There is a Redbridge Institute of Adult Education that provides a range of courses for people with specific needs and offers pottery lesson, arts and crafts, music and dance lesson for people with learning disabilities . he college provides a range of specialised equipment or learning resources to meet specific needs for people with disability, this includes hearing loops and large print keyboards. Day care services provide  support  for  people living in the community, social inclusion and respite care  for carers. It offers  practical and emotional support by providing  a range of activities and facilities to  help  stay as independent as possible and improve and maintain  quality of life. Dial a ride provides offers door-to-door service for disabled people who cant use buses, trains or the London underground. It can be used for all sorts of journeys, making it easier to go shopping, visit friends and attend doctors appointments. Furthermore, there is London Taxi card, which provides subsidised door-to-door transport in taxis and private-hire vehicles for people who have serious mobility or visual impairment doo The Borough provides ambulances in case of emergencies. There is also Occupational Therapy Service which works with rehabilitation care workers to ensure carers practice safe manual handling. They carry our risk assessments and provide carers with specialised training to use a range of equipment. STAAR (supporting those with autism and Aspergers Redbridge) offers swimming for people with special needs. They organise activities to raise awareness and highlight the needs of children and adults with specific needs. LO3. 1 Autism has no cure and therefore there are a number of approaches and interventions available to help people with various difficulties they may have. Approaches vary in costs and availability in different areas. It also depends what suits an individual, the family, the multi –disciplinary team will decide what best intervention or approach is suitable for an individual. There are ten approaches /interventions for people to choose from, these are: the behavioural intervention, complementary therapies, diet and supplements, medical interventions, physiological intervention, relationship based intervention, service based intervention, and skills based intervention, standard therapies and technology. I will explain the two service based interventions and one standard therapy intervention because we use these at my workplace. TEACCH is a service based intervention/programme and stands for Treatment and Education of Autistic and Related Communications Handicapped Children/Adults. TEACCH is not a technique or a method. It is a complete programme based on the principle that the person with autism is the priority. It provides services for children and adults with autism and related developmental disorders. TEACCH works with people from all parts of the autistic spectrum and offers continuing support with the primary aim of enabling them to live as members of the community. TEACCH programme helps alleviate some possible frustrations associated with challenging behaviour for people who are non verbal or verbal and also assist in communication (Clements and Zarkowska 2000, Cumine at al 2000, Jordan and Jones 1999, Jordan and Powell 1998, Powell and Jordan 1997) SPELL approach is also a service based intervention and stands for : Structure: people with autism find change very frightening and they struggle to cope in new or unfamiliar situations. This safe, predictable and reassuring environments and activities give people with autism the opportunity to increase their independence, develop their communication skills and reduce their anxiety. Positive expectations and approaches: barriers of each person are identified and in this approach people work tom overcome these and achieve their goal and potential Empathy: people see and understand the world in the same way that a person with autism experiences it. They focus on individual interests and preferences, understanding what motivate distresses or preoccupies each person . sing these insights to help people deliver the best possible care and support. Low arousal: in this approach people respond to people’s sensory needs by providing surroundings and activities that are calm, focused and free from clutter and distraction. This approach helps to increase independence in all aspects of life Links: this is linking the family and the wider community and other support services and reducing the difficulties faced by people with autism, it is aimed to help them move together towards a world where they have the same opportunities Lastly the speech and language therapy is a standard intervention. It is aimed to understand the nature and extent of child/adults difficulties and facilitate better communication where possible. Through the speech and language therapy the service users I work with are able to have a say in the things they like to do. LO3. 2 The TEACCH approach has been very effective to the service users I work with. It has enhanced their lives and we have seen an increased improvement in self help skills, social skills and there is reduction in appropriate behaviour. Through skill enhancement one of the TEACCH seven key principles, CA one of the service users can make tea on his own and all staff encourage him to keep on doing that on a daily basis, the risk assessment also highlighted the risk associated with him making the tea and the benefit of him making the tea, the benefit are increased independency. Also a research conducted by Ulster University has shown that communication, concentration and independence has improved by 80% for people with autism. TEACCH has helped our service users to introduce routine and stability in cases where they are hyper sensitive and confused (Cumine et al 2000). The SPELL approach is also effective. , we have a sensory room (it is a quite simple room, for a person with special needs, it is a pleasant environment where the distractions of the outside world are completely absent, present them with, music and attention grabbing moving colours and shapes and then add the ability for the person to actually make things happen that are so dramatic that they cannot be missed and you have the building blocks of real progress. This is a low arousal technique and it really works as the service users have gained a lot of independence. The Speech and Language Therapy is the key part of the autism treatment. This therapy has been effective to the service users I work with because the speech therapist has assisted us in working with the service users through the speech therapy technique. We use makaton, signs, and pictures boards with words to communicate with the service users. This approach is effective because now we are able to communicate with them both verbally and non verbal. Service users are able to make choices and preferences about their day to day lives. JW is able to ask who is sleeping over by showing us this sign (it means sleep). Without the intervention of the speech therapist JW was only saying few words and never learned any news words, this was also said by (Koegel and Koegel 1998) However, some of the approaches cost a lot of money and there has been many service dilemmas and polices. It a service user’s right that they get support to meet their communication needs and we had to wait a long time before a speech language therapist was assigned to our home. Our priority is to make sure service users get the right support they need at all times. In addition, it is costly for Social Services because they have to pay professionals who support families with autistic members. To support residential and day care cost extremely high, for adults who require ongoing support. There is cost of education for individuals with autism who require more level of support. More hours and attention is need for carers who have to go through national training strategy for Autism, to meet the needs of service users. LO3. 3 There are a lot of developments emerging in today’s world to support people with specific needs. As I work with people with autism, there is an Autism Awareness Card and this card is used to educate the general public in challenging moments while in the community. One side of the card contains information specific to the individual and strategies that are helpful to use. The other side of the card is the general information about autism, the card are developed using the person centred approach so that specific information about the individual is used. There are approaches available to help treat autism and organisations that offer advice to parents and organisations. There are services offered to organisations and people working with, or supporting someone who has an autistic spectrum disorder there organisation provide autism specific expertise to advise/help with future service planning and people on mailing list so that they are kept informed of developments or training in the area, they help key people access to resources for people with autism . There are training available for staff to enable them to work with people with specific needs. LO4. 1 Emerson (1995) defines challenging behaviour as â€Å"culturally abnormal behaviour(s) of such intensity , frequency or duration that the physical safety of that person or others is likely to be placed in serious jeopardy , or behaviour which is likely to seriously limit use of, or result in the person being denied access to , ordinary community facilities. Challenging behaviour is a social label and a person is not a challenge, the behaviour may challenge us in terms of our understanding and response Challenging behaviour can ‘result in the person being denied to access, to ordinary community facilities’ (Emerson, 1995). At my workplace service user TB has been banned from five pubs because he was spitting on other customers and urinating on the floor. Customers complained about his behaviour and pub managers had to ban him. Research has shown that males are more likely to display challenging behaviour than females and their behaviours tend to be more aggressive. Challenging behaviour tends to reach a peak between the ages of 15 and 34 years of age and is particularly over represented in the 14-24 year old age group. The service users I work with have autism and present a lot of challenging behaviour. They present a lot of challenging behaviour as an act of communication, environmental factors sometimes causes challenging behaviour for example JW exhibits challenging behaviour when we go to crowded noisy places. Also JW cry when he listens to certain music this is contributed by historical / emotional factors. Some service users self harm by lip and hand biting. Furthermore, challenging behaviour is caused by mental health factors for example a service user with dual diagnosis (Down syndrome and Autism Spectrum Disorder); they develop repetitive behaviour and don’t like to be touched and loud noises. 4. 2. When dealing with challenging behaviour health care organisations need intervention plans, policies and procedures to follow as this is best practice. At my workplace we follow the BILD (British Institute of Learning Disabilities) policy framework for physical interventions which sets out three broad categories of physical intervention and the DoH Dfes guidance on restrictive physical intervention. My manager makes sure staff get proper induction when they start their employment and clear guidelines are written in the employees handbook, all staff attend training to deal with challenging behaviour and this include training challenging behaviour, managing violence and aggression, self harm and Caring for People on the Autistic Spectrum. Also the manager makes sure that policies and procedures are written and all times followed under the BILD policy framework. As professionals in the health care sector we have a duty of care towards the vulnerable people we look after, we need to avoid action that will or may harm others and we should always work in the best interest of the service user. At my workplace we follow the General Social Care Council, Codes of Practice for Social Care Workers (Code 4) which states that as a social worker you must respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people. This includes: * Recognising that service users have the right to take risks and helping them to identify and manage potential and actual risks to themselves and others * Following risks assessments , policies and procedures to access whether the behaviour of service users presents a risk of harm to themselves or others * Taking necessary steps to minimise the risks of service user from doing actual or potential harm to themselves or others and * Ensuring that relevant colleagues and agencies are informed about the outcomes and implications of risk assessment. My organisation’s policy is to make sure all staffs are trained in managing challenging behaviours without causing any harm to individuals. This is done in accordance with the Mental Capacity Act 2005, which states that: someone is using restraint if they: use force – or threaten to use force – to make someone do something they are resisting, or restrict a person’s freedom of movement, whether they are resisting or not’. At my care home we use safe practices like the team teach training. LO4. 3 â€Å"Each person is different and each behaviour needs to be considered in its own right. In addition the reasons behind one’s behaviour may not be the same as the reasons behind another behaviour which the person shows. A person may shout because this makes others do as he asks. He may hit because this makes others leave him alone. There is therefore a need to build a detailed understanding of why a particular person is engaging in a particular behaviour and why he is likely to engage in that behaviour more under some circumstances than under others. † (Clement and Zarkowska 2000) p. 38 The NICE (2006) states that non-phamalogical interventions should be used first before medication in cases of challenging behaviours. Some of the challenging behaviours are caused when service users are expressing their unmet needs . At my workplace all staff have been trained in communication as effective communication plays important role managing behaviours. We use body language, signs and pictures to communicate with service users who are non verbal. At my workplace we use different strategies to deal with challenging behaviour for service users. We try to use positive, preventative, calming, defusing and problems solving skills instead of holding, restraining and breakaway when dealing with challenging behaviour and in most cases it works well. For example service user JW likes to know who is sleeping over at the end of the shift, when he is presenting challenging behaviour staff calm him down by saying ‘JW do you want me to do sleep over tonight,’ he answers yes and staff will tell him that what he is doing in not nice and because of that no one is sleeping over ,we encourage him to do something like emptying the dishwasher , and remind him that someone will sleep over if he continues to be good, JW calms downs apologises to staff and the other service user for his behaviour . He continues to sign sleep in makaton to show that he is happy. Also we always try to remind JW of his behaviour at calm moments of the day (Attwood 1998, Clements and Zarkowska 2000, Gray 1995). Also we have a change in setting strategy to manage DC’s challenging behaviour. DC has Autistic Spectrum Disorder and finds any change difficult to tolerate. We support DC to the day centre every Monday we do group activities and DC is disruptive at all times. An assessment was done and it showed that DC did not like crowds and noisy environment. He is encouraged to work in a small quiet room with few other people and once she is settled we give her a small task which means she only visits the larger room for a short time and return. After sometime we reintroduced her to the larger group but we seated her at a table near the door with only two people near her. To manage her behaviour she is asked to deliver things to different rooms. This strategy has worked well and it means DC does not have to spend the whole day in the larger room and the gradual reintroduction resulted in significant reduction of disruptive behaviour.