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Able to work

first_imgPeople with learning disabilities have the right to live asequal citizens and that includes the opportunity to work. OH nurses can do muchto make this happen, By Susan Hart and Jane Pettingell The year 2001 was significant for people with learning disabilities. Thirtyyears since the last White Paper, called Better services for the mentallyhandicapped1 the much-heralded, Valuing people: A new strategy for learningdisability for the 21st Century, was launched2. Although published by the Department of Health, Valuing people is theproduct of several Government departments. Its parameters are wide, itsintentions clear. People with learning disabilities should live as equalcitizens enjoying the opportunities that everyone cherishes, such asrelationships, leisure, education and work, underpinned by basic values,rights, independence, choice and inclusion. The White Paper contains details of how the Government will achieve thesegoals. One objective is to “enable more people with learning disabilitiesto participate in all forms of employment, wherever possible in paid work, andto make a valued contribution to the world of work”2. It is apparent the Government believes entering paid work is achievable formany, although by no means all people with learning disabilities, and this willhelp lead to the goal of “social inclusion”. These developments will become increasingly relevant to occupational healthnurses. This article seeks to explain what is meant by the terms ‘learningdisabilities’ and ‘social inclusion’. It will also consider some of the wayspeople with learning disabilities are entering paid work and, based on theexperience of a ‘job coach’, consider how OH professionals may be best placedto offer effective support in the workplace. What is learning disability? In the early 1990s referring to people with ‘learning disability’ became theterm of choice when referring to those who had previously been labelled‘mentally handicapped’. As a descripton it is both time and culturallyspecific. In the 1980s ‘mental handicap’ replaced ‘mental sub-normality’ which in turnhad replaced the more stigmatising term ‘mental deficiency’. In Australia andNew Zealand ‘developmental disability’ is used, and, surprisingly in the USA,the term ‘mental retardation’ is still common. In the UK, the term ‘learningdisability’ is today largely interchangeable with ‘learning difficulties’. There is sometimes misunderstanding between the terms learning disabilityand dyslexia. Broadly speaking, a learning disability is sometimes said to be‘global’ and as such may affect any aspect of a person’s life fromcommunicating, reasoning and thinking things through to an ability toself-care, making relationships and handling money, etc. Dyslexia, by contrast,is a difficulty in learning, usually in one or more of the areas of reading,spelling and written language, commensurate with intellectual ability. Down’s syndrome is one of the better known causes of learning disability,but there are numerous other less frequently occurring conditions for which thecause often remains unknown3,4. However, it has long been felt that the actualcause of a learning disability tells us nothing of what is important about howwe can work with people effectively. Although categorising ability levels and assigning ‘labels’ to people is nolonger considered acceptable practice, occasionally it is expedient togeneralise. Broadly, learning disability can range from mild, to moderate, severeand profound5 although the ability of individuals varies enormously. The most disabled people today are described as having high support needs,with additional disabilities, such as motor impairment, sensory disabilities orepilepsy. But the majority of people with learning disabilities are able toachieve considerable if not total independence, and are able to communicate,care for themselves, enjoy relationships and manage practical and domesticskills. Some marry and successfully raise children6. Organisation of care and support Hundreds of people formerly resident in institutions now live in ‘ordinary’community houses7. In the new ‘mixed economy’ of care, people are supported in various ways –for example, by services provided by the NHS, local authorities, and housingassociations. Many people have always lived at home or independently. Social inclusion In the institutions care delivery was highly routine, with individualsmostly receiving the same basic care at the same time8. Now, increasingly thefocus is on user-centred services and the promotion of independence9. AsValuing people explains ‘social inclusion’ seeks to ensure that people withlearning disabilities become part of the main stream. “Inclusion means enabling people with learning disabilities to doordinary things, make use of mainstream services and be fully included in thelocal community,”2 it states These developments over the years have increasingly fuelled the belief thatpeople could enter paid work. In 1997 the Mental Health Foundation report,Building expectations, specifically stated that “many people with learningdisabilities would like to seek work É it increases their income, theirindependence, their sense of purpose and contribution, their status and theirself-respect”10. People with learning disability entering paid work It is anticipated that more people will be encouraged to seek paid workthrough ‘supported employment schemes’, often run by local authorities, as itis certain that existing day service provision is set to change2. Work can often be the most important aspect of life for a person with alearning disability, with many using the term work to describe the activitiesthey undertake in a day centre. Work is associated with able-bodied,independent people, and being ‘like them’ can be very important for somepeople. More significantly however, the enhanced self-esteem and financialrewards are as important to people with learning disabilities as they are toanyone else. “I like meeting people, getting to know people and working withdifferent people.” “I work at B&Q. I am what you call a customer adviser in gardening.I get paid monthly. I’ve been there about four years now. I had two interviewsand I get there on my pushbike.” “I stack shelves with two other ladies É I work nine to two three daysa week. I don’t get paid yet because I am on trial É I started eight months ago.”10.Supported employment schemes These services match a person to a job they would like and are able to do. A‘job coach’ learns the job and introduces the person to the work. This maystart with ‘travel training’ such as learning which bus route they will need touse to get to work, as well as other factors about the job itself, such aswhere to go for breaks and how to dress for work. Support in any aspect isongoing, fading only as the person’s ability and confidence grows. People with learning disabilities in work All people are different, with varying needs and abilities to communicate tomake their needs known. This equally includes people with learning disabilitieswho may present some out of the ordinary challenges in the work environment. It has been noted, for example, that some people may be reluctant to taketime off when they are ill, as they fear losing their job. It is not rare forpeople to like their work so much they do not even notice that they are ill.Routine activity is often important in their lives, and they may try tocontinue working regardless of other circumstances. Stress may present in unexpected ways, for example through ‘difficult’behaviour, or behaviour which is out of the ordinary. In one instance a personsuddenly resigned from a job he enjoyed. It was found that he was becomingunhappy about an aspect of his work, but did not know how to talk about it.Once understood, this situation was addressed and the problem was resolved. Social isolation can be a problem in the workplace. Although many people areaccepted as work colleagues, others may struggle to fit in, especially if theyare not particularly welcomed. In such a situation, a person with learningdisabilities may not have the skills and confidence to break down the barriers.Bullying of a person with learning disabilities can be a problem, just asfor anyone else. This may not be by close colleagues or managers who get toknow the person, like them and value their work. But it could be the ‘lads’from the packing department making comments or mimicking. People with learningdisabilities may not have the confidence to report the behaviour, which if leftunchecked can lead to them, like others, experiencing considerable distress. Use your imagination Supporting people who have learning disabilities often requires imaginativeapproaches. An otherwise excellent employee with a learning disability alwaystook too long for her tea break. It was eventually established that she couldnot tell the time. With her agreement she is reminded of the time by hercolleagues and she now promptly returns to her duties. A man was supported to become a dishwasher in a Chinese restaurant. He coulddo the job well. However, he became distressed because he could not understandwhat the waiters were saying and began to believe they were talking about him.In fact, they were speaking Chinese. It helped when the job coach intervenedand admitted she did not understand them either. As outlined above many people with learning disabilities often haveadditional needs, for example, because of epilepsy or sensory or physicaldisabilities. Understanding idiosyncratic behaviour can be helpful (forexample, a person we know benefits from drinking Coca-Cola following aseizure). The job coach is likely to have such information and be a usefulresource. It is important to consider the person’s support network. Flexible workingtimes may be helpful where an individual relies on other people for transportto work. Although willing, people may be unable to volunteer for extra hours atbusy times, unless they can be supported. Processes reliant on the written word can be problematic for some people.Confirming an appointment by letter or following up a meeting with notes maynot be helpful if the employee is unable to read. Some people may ask a carerfor help, but others may just put the letter in a drawer or throw it away. It is important that occupational health assessments do not over-compensatefor people’s needs. It is helpful to remember that the person has lived withthe disability for a long time. If for example, they hold a piece of paper veryclose to their face when reading, they have probably always done it like that,and although ill advised under normal circumstances, it may be as well toacknowledge this with them and resist any well-intentioned suggestions tochange the behaviour. People with learning disabilities have life crises like everyone else(relationship breakdown, bereavement, etc). However, some may find workparticularly difficult at such times, but may still keep coming for the reasonsoutlined above. It is useful to take note of non-verbal cues when working withthe person and consider their behaviour. Poor grooming, looking unwell, achange in regular routines, for example, may indicate a person is unwell orunhappy, although they may not have said anything. Sensitivity is vital when discussing the job with the person. A good exampleof this concerns absence monitoring. A woman who had not had a day off sick inher entire six years of paid work, was very unwell with ‘flu and was forced totake a week off. By chance, her name appeared in an absence monitoringexercise. Her manager took account of her record and knowledge of theindividual to understand that she would be distressed to be ‘spoken to’ abouther absence (which was known to be genuine) and bypassed the procedure. Conclusion Undoubtedly more people with learning disabilities will be likely to enteremployment in the years to come. Hopefully, most will settle well and becomevalued members of staff. In many workplaces, the understanding, sensitivity andsupport from occupational health professionals may well be central to suchsuccesses. The most frequently occurring reasons for the job not being successful arethe dislike of someone, journey difficulties or the job being too difficult. References 1 DHSS (1971) Better Services for the Mentally Handicapped, Cmnd 4683, HMSO,London 2 Department of Health, March 2001, Valuing People: A new strategy forlearning disability for the 21st Century (Cm 5086) White paper 3 Gates B (1997) Understanding Learning Disability, in Gates B ed LearningDisabilities (3rd Edition) Churchill Livingstone, London 4 Watson D (1997) Causes and Manifestations, in Gates B ed LearningDisabilities (3rd Edition) Churchill Livingstone, London 5APA (1995) Diagnostic and Statistical Manual of Mental Disorders (DSM111)4th Edition, APA, Washington 6 Booth T, Booth W (1997) Exceptional Childhood, Unexceptional Children:Growing up with parents who have a learning disability 7 Korman N, Glennester H (1990) Hospital Closure. Open University Press,Milton Keynes, UK 8 Goffman E (1961) Asylum: Essays on the social situation of mental patientsand other inmates. Doubleday, New York 9 Kings Fund (1980) An Ordinary Life. King Edwards Hospital Fund for London 10 Mental Health Foundation (1997) Building Expectations 1997: Opportunitiesand services for people with a learning disability. The Mental HealthFoundation, London Susan Hart is a clinical lecturer in learning disability at the EuropeanInstitute of Health and Medical Sciences, University of Surrey. Jane Pettingell is principal manager, day services, with the LondonBorough of Richmond upon Thames. Able to workOn 1 Feb 2002 in Personnel Today Comments are closed. Previous Article Next Article Related posts:No related photos.last_img read more

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