Table of Contents Topic Name Page No. LO1 Understand perceptions of health, disability, illness and behaviour 1.1 Analyse concepts of health, disability, illness and behaviour in relation to users of health and social care services & assesses how perceptions of specific needs have changed over time 4 1.2 In health & social care analyse the impact of legislation, social policy, society and culture on the ways that services are made available for individuals with specific needs 5 LO2 understand how health and social care services and systems support individuals with specific needs 5 2.1 Using examples relating to your experience in health & social care mention & develop an analysis of need for in an organisation working with service users with specific needs 2.2 Evaluate current systems & services available to support patients with specific by providing significant examples of these services available locally or geographical area in your community to assist patients with specific needs 6 LO 3 understand approaches and intervention strategies that support individuals with specific needs
3.1 Explain the different approaches and interventions techniques that you have observed or used to support users with specific needs, discuss the limitations of advantages that these interventions have provided for individuals with specific needs. 7 3.2 Discuss the need for development and support for individuals with specific needs by emphasising the impact of this emerging development on the health & well-being of patients. 8 LO4 Understand strategies for copying with challenging behaviour associated 4.1 Explain the characteristics of two or more types of challenging behaviour service users you have come across with the aid of examples from your own experience working in health & social care. 10 4.2 Describe the potential impact of challenging behaviour on health & social care. 10 3
4.3 Analyse strategies like setting clear boundaries/targets time out reward & sanction, for working with challenging behaviour associated with specific needs. 10 Reference 12
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LO1 UNDERSTAND PERCEPTIONS OF HEALTH, DISABILITY, ILLNESS AND BEHAVIOUR
1.1 Analyse concepts of health, disability, illness and behaviour in relation to users of health and social care services & assesses how perceptions of specific needs have changed over time Concepts Disability is however either an 'impairment' as in problems in bodily structure or functions, a 'disability' or inability to perform certain activities or a 'handicap' which relate to problems with social participation. Disability of any form of permanent illness can have social, physical or psychological implications and forms a significant aspect of welfare considerations (Emersom & Einfeld, 2011) Public stigma is the reaction that the general population has to people with mental illness. Self- stigma is the prejudice which people with mental illness turn against them. Both public and self- stigma may be understood in terms of three components: stereotypes, prejudice, and discrimination. Social psychologists view stereotypes as especially efficient, social knowledge structures that are learned by most members of a social group. Stereotypes are considered "social" because they represent collectively agreed upon notions of groups of persons. They are "efficient" because people can quickly generate impressions and expectations of individuals who belong to a stereotyped group (Hewett, 2012). Changing Perceptions The challenge therefore is to identify and target patients' genuine needs. Mobilising resources to meet these needs would certainly avoid further expenses, keep patients satisfied with services, and lead to better quality of life. At the moment, there is no single definition of genuine health needs precisely within the context of public health policy, yet it makes sense to describe this inherently complex issue as 'what patients and the population as a whole- desire to receive from health care services to improve overall health'. Even this definition may leave practitioners 'open to making judgement based on implicit knowledge, rooted in professional training and values, office culture and assumptive world'. 5
1.2 In health & social care analyse the impact of legislation, social policy, society and culture on the ways that services are made available for individuals with specific needs The impact of legislation, social policy, society and culture Disabled people in the UK have historically suffered from discrimination and marginalisation. This was in no small part due to the earliest model of disability, the moral model, which has been prevalent throughout the history of religion. The moral model of disability regarded disability as retribution for the sins of an individual or in the case of a child, the sins of parents. Disabled people were seen as the deserving poor, eligible for support within their communities. It was only when the Poor Law was amended in 1834, during the Industrial Revolution, that relief for the deserving poor or unproductive defectives outside the workhouse was prohibited. The restriction of relief to the workhouse was to manage the escalatingcosts of outdoor relief by deterring able bodied people from claiming. However, institutional care for the defectives gained impetus during the Industrial Revolution as the change from peasantry to the birth of the factory, speed of machinery and wage labour made disabled people defunct. The Poor Law and philanthropists across the country continued to offer institutional provisions to disabled people until national concern due to the large numbers disabled ex-servicemen who served in the two world warsled to the passing of some legislation (Stokes, 1996).
LO2 UNDERSTAND HOW HEALTH AND SOCIAL CARE SERVICES AND SYSTEMS SUPPORT INDIVIDUALS WITH SPECIFIC NEEDS
2.1 Using examples relating to your experience in health & social care mention & develop an analysis of need for in an organisation working with service users with specific needs Time and workload pressures which impeded them from exercising leadership. Organisations responses to regulatory demands led at times to tighter, more controlling cultures which eroded rather than encouraged personal leadership. Resources to support the development of leadership capacity were diminishing. This included the time for reflection and work based learning as well 6
as financial resources for formal courses. These constraints are real and need to be taken seriously. But there was a further issue which begged questions about how well organisational cultures were supporting staff at every level to believe in and to exercise their own leadership potential. Example Nulsen is a not-for-profit organisation founded 58 years ago in Perth by a group of parents of children with profound intellectual and physical disabilities. Currently, Nulsen provides accommodation services for 112 people with severe and profound disabilities or acquired brain injury. The residents are women and men who are between 13 and 69 years old. Nulsen also provides Clinical Services, Positive Behaviour Support and Community Services through an Alternative to Employment Program. In addition, Nulsen has a Culture and Creative Development Program which explores and support number of musical, cultural and arts related talents of Nulsen residents. Nulsen has its own Education Unit that it is used to promote awareness in schools and wider community. Additionally, Nulsen provides Business Management and Clinical Services support to other organisations.
2.2 Evaluate current systems & services available to support patients with specific by providing significant examples of these services available locally or geographical area in your community to assist patients with specific needs Attitudes mean the positive or negative approach towards a view of a person, place, thing or event. Thus people posses an objective towards the introduced thing and a question arises within them whether to acquire or not. Thus in the case of local areas or villages, there are many clans and beliefs and ideas that each of these groups posses. Thus they too have their own views and ideas on their health conditions. In many rural areas the conditions of health and sanitation lies at a very poor standard, and there are people who dont want to change their views. 7
Most people living in rural areas dont want to change their ways of medication and though the world is moving forward with new techniques and information, there is a set of people who wants to be in the olden times. Who has a strong belief, on orals and witch crafty. So with this the effect, the spreading of sicknesses and diseases are more. How much NGOS and many organizations integrate towards the rural village, the in habitants dont want to change their ways of thinking. It is not with all but a few who want to live within their idea frame. This is all due to the illiterates people. Thus to overcome this scenario the people have to be liberated on the ways of taking medicine and facing situations. Also the social care units are seen as something bad. They dont believe in the benefits of these units. Also they believe that it is a social come down to keep an aged person in a social care unit, thus little noticing the care there is sometimes much better what they provide at home. Evaluate current thinking on the chosen issues and its likely influence on the development of health and social care
LO3 UNDERSTAND APPROACHES AND INTERVENTION STRATEGIES THAT SUPPORT INDIVIDUALS WITH SPECIFIC NEEDS Case Scenario: In health & social care; we often say that it is vast service sector undergoing rapid change, with new government initiatives giving it a higher profile that ever. Priorities in the health care agenda include being more responsive to patient needs, and preventing illness by promoting a healthy lifestyle. The focus in frontline health & social care is on giving services-users more independence, choice & control. a) Explain the different approaches and interventions techniques that you have observed or used to support users with specific needs, discuss the limitations of advantages that these interventions have provided for individuals with specific needs. The medical model defined disability as a medical condition, hence viewing disabled people as disempowered, dependent and needing care. If disabled people cooperate with doctors, they 8
could get better. Disability is a deviation from the norm or expectations by which men live and considered it the fault of the individual. The medical model, that barriers faced by disabled people are not a result of their medical condition but that they are constructed by society. The medical model is oppressive and excludes people with disabilities from the mainstream especially due to capitalisms quest for profits. The medical model of disability led to systematic prejudice, marginalisation and discrimination of disabled people, calling this Disablism Disabilism occurs at three levels of oppression; personal, cultural and structural. The personal level, preconception displayed through attitudes and actions of repulsion, dismissiveness pity and belittling are rife. At the cultural level, society views the disabled as misfits, pathetic victims of tragedy and subjects them to abusive and derogatory treatment at the structural level, one only has to look at how public services and the built environment have historically overlooked their suitability for the disabled. A common critique of quality of life tools in clinical research is that data are 'soft' and less reliable than traditional clinical assessment or physiological measurement. Nevertheless, both generic and disease-specific tools can detect subtle clinical changes quite precisely, especially in cardiac disease. Some are concerned that HRQL tools may not precisely identify the most important problems yet, from an economic and existential point of view, it is conceded that patients' perception has equal validity and legitimacy to that of physicians. English language- based quality of life tools have been tested in a wide range of diseases; overall in clinical practice and in health service research, they have proven so useful that both generic and disease-specific tools have been translated into a variety of other languages for wider application. Basing health care needs on quality of life scores, however, necessarily incorporates several sources of uncertainty due to factors such as age, sex, social class and individual patient's health status. In addition, quality of life tools may fail to distinguish between health problems and the desire to get professional attention.
b) Discuss the need for development and support for individuals with specific needs by emphasising the impact of this emerging development on the health & well-being of patients. 9
Unavailability of an experience interpreter in the healthcare settings can be barrier. It can affect the sensitivity of patients values and attitudes. To use a professional interpreter can reassure patients to communicate and feel freer when describing their religious beliefs and unsatisfactory environment conditions but to healthcare professionals may feel disempowerment and may depend on interpreters in order to carry out their roles. A review in development in tackling health inequalities of Acheson, recommended the improvement of living standards of people with lower income than average. Among the people in this group are people living in a deprived area and depend on social housing. Also people with learning disability may fail to get the necessary services because of lack of understanding about health issues articulating their needs based on their poor experiences of education system (Fisher, 2006). LO4 UNDERSTAND STRATEGIES FOR COPYING WITH CHALLENGING BEHAVIOUR ASSOCIATED 4.1 Explain the characteristics of two or more types of challenging behaviour service users you have come across with the aid of examples from your own experience working in health & social care. Anil represents a small and vulnerable group in a society who find difficulty in accessing and using health and social care because of the greater health care needs they have than general population. Motor and sensory disabilities, Epilepsy, hypertension and Alzheimers disease are some of the conditions that are common in this group. The MENCAP report states that people with learning disability are being treated wrongly in all part of healthcare provision and they are not equally valued in the health services. The government also revealed that people with learning disabilities are poorer particularly uptake of invitations on primary care and hospital provisions such as access screening services. Because of their greater needs of healthcare, they are more prone to a wide variety of additional physical and mental health problems as it shows to Anil. There is an increasing in evidence of an inverse care law where those who needs are greatest get the least (Altenbaugh & Richard, 1997).
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4.2 Describe the potential impact of challenging behaviour on health & social care. Impact of challenging behaviour on health The correlation between health needs and health-related quality of life scores might have potential benefits in routine clinical investigation, too, where comprehensive care is targeted. Administration of appropriate HRQL tools in clinics, surgeries or health centres may detect areas of health care needs worthy of health professionals' closer scrutiny. For example, a patient with an impaired Short Form Physical Component Score or physical dimension (SAQ-Phys) may perhaps be distinguished not only as being at high risk in terms of clinical end points [48], but also as a vulnerable patient who might have difficulty accessing health care services, for which extra care (such as afterhours services or ambulance transport) may be required. Similarly where the satisfaction component in the SAQ yields a lower score, cardiac care teams must be aware of potential shortcomings in the delivery of care and investigate reasons for any dissatisfaction; even provision of information about the nature of cardiovascular disease or its treatment may improve the satisfaction score.
4.3 Analyse strategies like setting clear boundaries/targets time out reward & sanction, for working with challenging behaviour associated with specific needs. Health education as a part of health promotion is defined as a planned communication activities designed to attract well being and ill health in individuals and group through influencing the knowledge, belief, attitudes and behaviour of those in power of the community at large. For people with learning disabilities, health education might promote social inclusion through decreasing negative stereotyping by valuing and respecting their needs. On a more individual level, people who receive health education messages have a choice to decide whether to follow or not the message given.. Building partnerships between nurses, careers, other professional and people with learning disabilities is essential in order to promote and educating health by identifying their physical and mental health condition. A partnership is not only the way to bring up to date statutory services 11
but also is about developing and acknowledging the collective responsibility for the health and wellbeing of the community which they belong. Having the opportunity to make choice about their healthcare is critical to their sense of inclusion in society. It is also a key factor in allowing individual like Anil to feel in control of his life. The NMC (National Midwifery Council) code of 2008sets out number of responsibilities on nurses to promote choice and respect the decisions of those they care. Nurses need to help them making their choice by making some simple adaptations. The first step can be taking a little more time to explain something and giving the person with learning disability more time to understand what is being said. Other approach could be the involvement of relative or paid career not to make choice on behalf of the person with learning disability but to use their knowledge of the person to help the care professional interpret or to explain treatment options. In all this processes, nurses need to ensure that they obtain consent before they begin assessment and treatment. Any decision to be taken by the staff must be in the interests of the person and must regard to his or her human rights (Michie, 2007). The UK has over 10 million disabled adults and 770,000 disabled children. Despite these statistics, disabled people have historically suffered from widespread discrimination and marginalisation. The earliest model of disability, the moral model of disability viewed disability asretribution for sin of an individual or of parents. This affected the way disabled people were treated, mocked and patronised. The Poor Laws of the 17 th Century qualified disabled people for support within their communities, but later amended the support to be confined to the workhouses. This was the conception of institutionalisation and segregation of disabled people. Laws to deal with disabled people gained the attention of legislators as a result of the number of disabled ex-servicemen from the two world wars. Consequently, the Disabled Persons (Employment) Act 1944 and the Education Act 1944 were enacted to deal with disabled people. From 1951, the medical and social models of disability have been dominant and influenced legislation.
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Reference 1. Basingstoke: Palgrave Altenbaugh, Richard J. Where are the disabled in the History of Education? The Impact of Polio on Sites of Learning. History of Education 35, no. 6 (2006) 70530.Bagilhole, B. (1997) 2. Emersom E, Einfeld S, Challenging Behaviour, 3rd Edition Cambridge University Press, 2011. ISBN: 978- 1- 13949-453-3 3. Equal Opportunities and Social Policy. London: LongmanBarnard, H. C. (1947) 4. Fisher A, et al Applied A2 Health & Social Care for OCR (Folens,2006) ISBN : 9781850082484 5. Hewett D, Challenging Behaviour: Principles and Practices. Routledge, 2012. ISBN: 978- 1-13661-248-0 6. London: University of London Press Barnes, C. (1991), Disabled People in Britain and Discrimination: A Case for Anti-discrimination Legislation, London: Hurst/BCODP.Birkett, K. and Woman, D (eds.) (1988) 7. London: Institute of Personnel ManagementBorsay, A. (2005) 8. Michie V, Working in Care Settings: Common Induction Standards 2nd Edition (Nelson Thornes 2007) ISBN100748781587 9. Stokes G, Challenging Behaviour in Dementia, A Person-centred Approach, Speechmark Publishing Ltd, 2000. ISBN: 978-0-86388-397-2 Alcock, P. (1996) 10. Social Policy in Britain: Themes and Issues.