Enabling individuals with additional needs to face daily challenges

Appendix 1-

Case study 1.  Rebecca Brown (Child Study)

Rebecca Brown is 8 years old and is a wheelchair user, following a road traffic accident when she was five years old.  Rebecca requires one to one personal care due to her physical disabilities, as she sustained a fractured spine in the accident, meaning that she has no movement below her cervical spine.

Rebecca attends a school for children with additional needs, where she has a designated teaching assistant and also a carer who provides her with personal care during the school day. Rebecca lives with her parents Sue and David and her older sibling Michael who is 12 years of age. The family live in an upstairs apartment provided by a housing association, which is small and not ‘wheelchair friendly’. Sue has a part time job at a local day nursery but has to stay at home during the school holidays, in order to care for Rebecca and Michael, reducing the family income. David works full-time at a local factory, working long hours for a low wage.

The neighbourhood where the Brown family live are not tolerant of Rebecca’s ‘difference’, and the family have received unpleasant comments as they pass neighbours in the street, causing them to avoid going out whenever possible. 

Appendix 2-

Case study 1.  Ben Grace (Adult Study)

Ben Grace is fifty two and has Down’s syndrome and type 2 diabetes. Ben has a learning age of 8 and requires support with all aspects of daily living. Ben lives in a group setting with five other adults who have learning difficulties and who also require additional support. Ben previously lived with his mother, but following her death last year, Ben moved to the residential setting.

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Ben has always enjoyed going shopping, but since he has moved into the residence, he prefers to stay in his room which is a concern for the staff, following an incident with some local youths who shouted at Ben when he went shopping with the residents and carers. Recently Ben was refused entry to a local funfair by the manager who stated that Ben’s appearance could prevent other people wanting to attend. Ben is refusing to keep to the special diet required to control his type 2 diabetes and staff have found bags of sweets under his pillow when making his bed. His blood glucose levels are unstable, resulting in Ben feeling unwell. Ben has become withdrawn.

Task 1

Introduction

This report with evaluate the significance of receiving a diagnosis of additional needs to both once child and one adult and their families and wider society. It will address their intellectual and learning needs; physical health needs and social and emotional needs

Adult case study

My adult case study is a fifty two year old man called Ben Grace, he has Down’s Syndrome and type 2 diabetes along with the learning age 8, meaning he requires support with all aspects of daily living, however with the death of his mother it meant he had to move into supported living where he lives with other people that also have learning difficulties and require support however he has not been getting on well there as it appears he has been discriminated by a local funfair manager and made fun of by some youths. This has lead to him becoming ‘with drawn’ and not wanting to stick to his special diet.

Child case study

My child case study is a 8 year old girl called Rebeca Brown, she is a wheelchair user  following a road accident in which she sustained a fractured spine meaning she has no movement below her cervical spine. Because of this she requires one to one personal care at all times therefor now goes to a specialist school where she can have a teaching assistant and carer. Due to her ‘differences’ she has received unpleasant comments from neighbours and her home doesn’t support her needs as it isn’t wheelchair friendly and is small.

Disability’s range from severe, moderate and mild. In Rebecca’s case she has a more severe physical disability and in Ben’s case he has a more profound learning disability. This means that both of these individuals additional needs would have different professionals involved in their diagnostics and care.

Ben Grace

Type 2 diabetes

It is a condition which causes the glucose in the blood to become to high (sugar levels).

It is diagnosed with a blood or urine test, but is often accidentally diagnosed as it shows up when being tested for other problems. Once the results come back, the doctor will put the patient on relevant medication and discuss what it is and the importance of life style choices. Patients will often have to monitor their sugar intake after a diagnosis. The most common causes of developing this is being overweight and inactive, however it can also be genetic.

Common symptoms:

•    peeing more than usual, particularly at night

•    feeling thirsty all the time

•    feeling very tired

•    losing weight without trying to

•    itching around your penis or vagina, or repeatedly getting thrush

•    cuts or wounds taking longer to heal

•    blurred vision (14)

In Ben’s case, as he is aged 52 he was at a risk of developing type 2 diabetes anyway as it becomes a higher risk the older the patient becomes, however it may also of been genetically passed to him or caused from being overweight and inactive. As stated in the case study, Ben has been refusing the special diet and eating sweets, which indicates he has been eating unhealthy for a while which may of been the cause of the development as it is harder for Ben to be more active due to struggles he has and has had in the past. To keep himself healthy he needs to stick to the diet and get plenty of exercise, he may need encouragement to exercise but he could attend exercise groups for people who have special needs as they have the right support their to help Ben make the most of what he does and understand the reasons for staying active, as going to a gym or for a run may be intimidating for Ben, especially as he has struggles with bullying in the past.

Down’s Syndrome

Ben has Down’s Syndrome which is caused by an extra chromosome in your cells. In the majority of cases it can not be inherited, it occurs by chance conception (4). Ben lives in a group setting of supported living, as he would require help with daily tasks such as personal hygiene, dressing, grocery shopping, leisure activities and also attending frequent appointments such as regular checkups which is common for adults with Down’s Syndrome. This support would typically come from a learning disability nurse/carer or support worker, which would also be Ben’s source of everyday encouragement and would also support him in other aspects such as finding employment and tidying. Ben may also require emotional support, in which case he may have a counsellor or a mental health nurse involved in his care. Ben may also need specific support to socialise and with his confidence as he has previously encountered bullying in the past which could majorly affect how he feels about himself. Living in the shared accommodation could feel scary and intimidating for Ben, especially at the beginning, so having someone check up on him regularly and keep in close contact with is important. Ben may find support groups effective, however may require encouragement to attend and wether there are any available to him. To monitor all of this, it would be useful to have a professional use a chart to measure everything and keep records, which would increase the importance of all of the professionals working closely together.

common facial features include:

•    Flattened face

•    Small head

•    Short neck

•    Protruding tongue

•    Upward slanting eye lids (palpebral fissures)

•    Unusually shaped or small ears

•    Poor muscle tone

•    Broad, short hands with a single crease in the palm

•    Relatively short fingers and small hands and feet

•    Excessive flexibility

•    Tiny white spots on the coloured part (iris) of the eye called Brushfield’s spots

•    Short height

What are the risks?

Having Down syndrome also increases the risk of developing Alzheimer’s disease and dementia from the age of forty five and onwards. Some health problems that are commonly associated are endocrine problems, dental problems, seizures, ear infections, and hearing and vision problems, however these don’t affect everyone. Most children are born with some type of congenital heart defect which can be life-threatening and may require surgery in early infancy (3).

How is Down’s Syndrome diagnosed?

The diagnosis for Down’s Syndrome can start during the pregnancy by a number of tests carried out at certain times. All pregnant women are offered a screening test between ten to fourteen weeks of their pregnancy. This test is called the ‘combined’ test as it tests for Down’s, Edward’s and Patau’s syndrome (however the women can choose what she tests for) and it involves a ultrasound and a bloods test, this causes no harm to the mother or the baby. Depending on wether the results show a higher or lower chance determines if other tests are offered. If the women appears at a higher chance, she will be offered a diagnostic test, such as amniocentesis or chorionic villus sampling (CVS) to tell her for certain whether or not the baby has Down’s Syndrome, however a diagnostic test does come with a risk of miscarriage (6). These tests don’t have to be taken if the mother wishes not to, in which case the diagnosis would be done after the birth. A diagnosis after birth is often based on physical the physical appearance and physical signs. However some baby’s may not have these symptoms, and some the of them are common in the general population, the health care provider would take a blood sample to check the number of chromosomes and confirm the diagnosis (7).

What is a learning disability?

A learning disability is a reduced intellectual ability and difficulty with everyday activities; for example household tasks, socialising or managing money which affects someone for their whole life.

People with a learning disability tend to take longer to learn and may need support to develop new skills, understand complicated information and interact with other people. 

The level of support someone needs depends on the individual. For example, someone with a mild learning disability may only need support with things like getting a job. However, someone with a more profound learning disability may need full­time care and support with every aspect of their life and they may also have physical disabilities (1).

People with Down’s syndrome will typically have some level of learning disability and characteristic physical features but the severity will be different for each individual (4). In Ben’s case his Down’s Syndrome has caused him to have quite a more severe learning disability, he has the learning age of 8 so therefore he requires support with all aspects of living.

Rebeca doesn’t have any learning disabilities.

What are the early signs of a learning disability?

•    Trouble feeding, sucking and digesting. (8)

•    Delayed learning to sit or stand. (8)

•    Difficulty pronouncing words and short sentences, or learning new words. (8)

•    School-aged children may find reading and writing difficult or have problems understanding information and instructions. (8)

How is a learning disability diagnosed?

GP usually makes a diagnosis of a learning disability, but it is often parents or teachers who first become aware that a child is having difficulties in certain areas. A learning disability may be diagnosed in various ways:

A learning disability may be diagnosed at a developmental check. All children have checks to monitor their growth rate and highlight any health problems. Health visitors and GPs will also look at what age the child is reaching their development milestones, such as learning to talk and developing physical skills.

Diagnosis may be made through psychological checks. These tests look at the child’s ability and compare it with what is considered typical for a child of that age.

A learning disability may be identified by your child’s teacher.

A clinical psychologist may be able to diagnose an adult’s learning disability, by assessing their level of understanding.

What is an IQ and how does it help to define learning disabilities?

An ‘IQ’ stands for intelligence quotient and it is several tests that are designed to assess a humans intelligence (2).

IQ less than 20 – described as ‘profound learning disability’ (5)

IQ of 20-35 describes as ‘severe learning disability’ (5)

IQ of 35-49 described as ‘moderate learning disability’ (5)

IQ of 50-70 described as ‘mild learning disability’ (5)

Rebeca Brown

Physical disabilities

‘’A physical disability is a limitation on a person’s physical functioning, mobility, dexterity or stamina. Other physical disabilities include impairments which limit other facets of daily living, such as respiratory disorders, blindness, epilepsy and sleep disorders.’’ (9) In Rebecca’s case, her injuries caused her to have a fractured spine meaning she has no movement below her cervical spine, because of this she would have been given physical examinations and radio-graphical screenings to determine what injuries she had and the severity of it. With Rebecca having a fractured spine it means she will need a lot of one to one help with personal care which is why she was placed in a school for additional needs so that she can get the appropriate help and support she needs which would be a teaching assistant and carer which she has, stated in the case study. However Rebecca may need emotional support which she can get from her peers and family, but a specialist councillor or mental health nurse may be more beneficial as she may struggle to comprehend the extent her injuries have effected her and her family’s life, and may have encountered mental health issues. Rebecca may find socialising difficult so she may need encouragement to do so, especially if she has previously had issues with bullying or confidence. Rebecca might find support groups beneficial, but might need some encouragement to attend any if they are available. It is important to help Rebecca be independent where she can as this can help her to increase mobility and ability to do things for herself.

How is a fractured spine diagnosed?

Firstly the patients breathing is assessed as this can show signs of damage to the diaphragm, secondly a physical exam of the spine will be performed, during these processes the spine is kept in a neck or back brace to protect any injuries until the diagnostics are completed (10). There are scans that can be done to confirm if a patient has any damage such as MRI, CT scans and X-Rays.

What are MRI, CT scans and X-Rays?

MRI (magnetic resonance imaging), is a process that uses strong magnetic fields and radio waves to create detailed images of the inside of the body. It can almost examine any part of the body, including the brain and spinal cord, bones and joints, breasts, heart and blood vessels, internal organs, such as the liver and womb or prostate gland. The patient will lie on a flat bed that’s moved into the scanner, either head or feet first depending on the part of the body being scanned. The scan is more longer than the others, lasting anywhere from 15 to 90 minutes, depending on the size of the area being scanned and how many images are taken. Extensive research has been carried out into whether the magnetic fields and radio waves used during MRI scans could pose a risk to the human body which no evidence has been found to suggest there’s a risk, which means MRI scans are one of the safest medical procedures available. MRI scans may not be recommended  for patients with a metal implant fitted, such as a pacemaker or artificial joint.

CT (computed tomography), is a process that uses X-rays and the use of a computer to produce detailed images of the inside of the body. CT scans are different to MRI scans because they use radiation. They can be used to diagnose conditions including damage to bones, injuries to internal organs, problems with blood flow, stroke, and cancer. They are used to gather information on tumours, including monitoring treatments and allow a doctor to take a accurate biopsy. These scans are not used for screening. CT scans are a small risk of developing cancer in the future (less than 1 in 2,000). During the scan, the patient will lie on a bed that passes into the CT scanner which is a ring that rotates around a small section of the body as they pass through it. Unlike an MRI, it doesn’t surround the whole body which can commonly cause people to feel claustrophobic. These can last 10-20 minutes (12).

X-Rays are a radiation called electromagnetic waves which is also used to create a image, these are typically used to detect broken bones. They can detect bone fractures and breaks, tooth problems (loose teeth and dental abscesses), scoliosis (abnormal curvature of the spine), non-cancerous and cancerous bone tumours, lung problems, such as

pneumonia and lung cancer, dysphagia (swallowing problems), heart problems, such as heart failure and breast cancer. They are quick usually only lasting a few minutes), easy as the patient will either lie on a table or stand against a flat surface so that the part of the body being examined can be positioned in the right place and it is painless.

Being exposed to X-rays does carry a risk of causing cancer many years or decades later, but this risk is thought to be very small, with it being less than a 1 in 1,000,000 chance of causing cancer (13).

References

1-      Mencap. (Date). What is a learning disability? [online] Available at https://www.mencap.org.uk/learning-disability-explained/what-learning-disability Assessed on 25/03/2019

2-      Wikipedia. (29 April 2019). Intelligence quotient [online] Available at https://en.wikipedia.org/wiki/Intelligence_quotient Assessed on 30/04/2019

3-      Mayo Clinic. (8 March 2018). What are the health problems of Down’s Syndrome? (8 March 2018). [online] Available at https://www.mayoclinic.org/diseases-conditions/down-syndrome/symptoms-causes/syc-20355977 Assessed on 30/04/2019

4-      Mencap. (date?). Down’s Syndrome [online] Available at https://www.mencap.org.uk/learning-disability-explained/conditions/downs-syndrome?gclid=CjwKCAjwqqrmBRAAEiwAdpDXtNg0cffSHgwxKsFmospzanAlkpxPSmNsOb4T9ZSiOwL4v7QEr3ruaRoCUPkQAvD_BwE Assessed on: 30/04/2019

5-      Patient. (11 August 2016). General learning disabilities [online] Available at https://patient.info/doctor/general-learning-disability Assessed on: 30/04/2019

6-      NHS. (22 February 2018). Your pregnancy and baby guide [online] Available at https://www.nhs.uk/conditions/pregnancy-and-baby/screening-amniocentesis-downs-syndrome/ Assessed on 30/04/2019

7-      National Human Genome Research Institute. (2010). Learning about Down syndrome. [online] Available at http://www.genome.gov/19517824#3 Assessed on 30/04/2019

8-      Mencap. (date?). Spotting the signs [online] Available at https://www.mencap.org.uk/advice-and-support/diagnosis/getting-diagnosis-after-your-child-born Assessed on: 30/04/2019

9-      Wikipedia. (4 may 2019). Physical disabilities [online] Available at https://en.wikipedia.org/wiki/Physical_disability Assessed on 6/05/2019

10- Mayfield Brain & Spine (September 2018). Spinal fractures [online] Available at https://mayfieldclinic.com/pe-spinefract.htm Assessed on 6/05/2019

11- NHS (9 August 2018) MRI scan [online] Available at https://www.nhs.uk/conditions/mri-scan/ Assessed on: 8/5/2019

12- NHS (8 June 2018) CT scan [online] Available at https://www.nhs.uk/conditions/ct-scan/ Assessed on 8/5/2019

13- NHS (13 July 2018) X-Ray [online] Available at https://www.nhs.uk/conditions/x-ray/ Assessed on 8/5/2018

14- NHS (8 July 2017) Type 2 diabetes [online] Available at https://www.nhs.uk/conditions/type-2-diabetes/understanding-medication/ Assessed on: 9/5/2018

Task 2

Introduction

For this task I will reduce a report, this report will justify the support and adaptions provided by the setting and other agencies in the support of my selected child and adult case study in the tasks of daily living.

What is a social construct?

A social construct is an idea that has been created which appears natural and obvious and is accepted by the people of society (1). An example of a worldwide social construct is money. We think that the money does exist because we touch it and see it however, unless we agree on what the paper or the coins mean and do, the paper money is just paper and the coins are just round shaped metal (2).

How disability can be viewed as a social construct

Disability is often looked upon as a negative thing, with use of the social construct it makes it easier to have a positive outlook on it and challenges the stigma stuck around disability by creating the idea that a person is disabled by barriers and surroundings, not their impairment or difference. The barriers can be physical, such as not being wheelchair friendly. However they can also be caused by peoples negative attitudes and opinions towards disabled people, such as saying disabled people can’t do certain tasks. These negative attitudes and opinions are usually based on prejudice or stereotype views and can stop disabled people from having equal opportunities. Examples of these views are that they are unable to… work, live independently, have sex and have children, which if they are limited to opportunities because of their disability then they are being discriminated against. By recognising the barriers that are making life harder for disabled people, it makes it possible to remove them and creates equality and offers disabled people more choice, control and independence. A good example of the social model is a disabled person who can’t use stairs and wants to get into a building that has a step at the entrance, this is a common issue and which using the social model it would recognise that this is a problem with the building, not the person, and would suggest adding a ramp to the entrance. (3).

How is the social model used in my case study/s?

The social model is used in my child case study, Rebecca Brown. As stated, ‘the family live in an upstairs apartment provided by a housing association, which is small and not ‘wheelchair friendly.’ With use of the social model, professionals would realise the apartment is restraining Rebecca and not her wheelchair, and to remove the barrier they should move Rebecca and her family to a more suitable apartment, although in many situations this would not be possible due to many reasons such as availability and funding therefor the time should be taken to remove as many of the barriers in the apartment as possible, ideally all of them though. With these adaptations, it would mean that Rebecca would have more independence and freedom in her environment. Not only is the apartment a barrier, but also the people around them as ‘The neighbourhood where the Brown family live are not tolerant of Rebecca’s ‘difference’, and the family have received unpleasant comments as they pass neighbours in the street, causing them to avoid going out whenever possible.’, this is a good example of other types of barriers according to the social model, however this is a harder one to remove as some people are stuck in their own thoughts and opinions, one thing the family could try is talking to the people nicely and making them realise they’re normal, just like anyone else. This issue is also seen in my adult case study, Ben Grace which states ‘Ben was refused entry to a local funfair by the manager who stated that Ben’s appearance could prevent other people wanting to attend’, and ‘following an incident with some local youths who shouted at Ben when he went shopping with the residents and carers’ this is another example where the barrier is the people around him as the manager is discriminating against Ben for the way he looks and the youths are being abusive.

Support

Ben and Rebecca both require support from healthcare professionals to be able to live and function easily, positively and happily. The support that they receive will have a positive impact on them, their wellbeing and their life.

As stated in the case study, Rebecca attends a school for children with additional needs, this will mean that she can get the support she needs to attend a full day at school, at the school she has a designated teaching assistant and a carer. Because the school she attends is especially for children with additional needs, it means the school will be wheelchair friendly and will have little to none barriers, meaning when Rebecca goes to school she will not be restrained by anything, this is a good as a regular school could have lots of limitations.

•    A teaching assistant supports pupils inside the classroom with their education, sometimes working one-to-one, in small groups or helps the whole class. The duties can vary from different schools but usually gave similar underlying tasks.

•    A carer is trained to look after people, they help with daily needs and activities like personal care, moving and handling and administering medications. People who are fairly independent but require support may have a carer to keep an eye on them, or help them with tasks like banking, transport, shopping and housework. The job will vary depending the environment and the tasks (4).

Her teaching assistant will help her to be on task, making sure she understands what she’s learning and help her if she doesn’t, this is good as it will ensure that Rebecca doesn’t fall behind on her education. Her carer will provide personal care whilst she is in school which is good as it means she doesn’t have to go home, she doesn’t have to be uncomfortable or embarrassed.

Ben’s case study doesn’t state which health professionals he gets support from, other than it mentioning staff which are concerned, which I would assume are support workers or carers which work within the residence. As stated that Ben required support with all aspects of living, having a carer regularly visit him during the day to help him with his personal care and daily tasks, also encouragement to prepare healthy meals and snacks to control his blood glucose as Ben won’t stick to the diet, which he may just need reminding of the importance of it. Ben may find seeing a learning disability nurse helpful so that he can get specialist support. With Ben moving into the residential setting, because there are other people there with learning difficulties the accommodation is most likely been adapted so that there aren’t any limitations or any barriers, and he might find it comforting knowing there people around him.

•    A support worker assists individuals who are unable to live independently by offering them the practical help they need as well as emotional support (5).

•    A learning disability nurse provides specialist healthcare and support to people with a learning disability, as well as their families and staff teams, to help them live a fulfilling life. The main roles and areas as a learning disability nurse involve…improving or maintaining a person’s physical and mental health, reducing barriers to them living an independent life (exmaple of social model) and supporting the person in living a fulfilling life (6).

References

1-      Merriam Webster (no date) Definition of Social Construct  [online] Available at https://www.merriam-webster.com/dictionary/social%20construct Assessed on 12/05/2019

2-      Very well family (October 25 2018) Why does social construct exist? [online] Available  https://www.verywellfamily.com/definition-of-social-construct-1448922Assessed on 12/05/2019

3-      Scope (no date) The social model of disability [online] Available at https://www.scope.org.uk/about-us/social-model-of-disability Assessed on 12/05/2019

4-      Carers NSW (no date) Who are carers? [online] Available at https://www.carersnsw.org.au/facts/who-are-carers Assessed on 12/05/2019

5-      Prestige Nursing (14 November 2018) What do support workers do? [online] Available at https://www.prestige-nursing.co.uk/carers/what-does-a-support-worker-do/ Assessed on 12/05/2019

6-      Health careers (no date) Learning disability nurses [online] Available at https://www.healthcareers.nhs.uk/explore-roles/nursing/roles-nursing/learning-disability-nurse Assessed on 12/05/2019