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.