1. Early Intervention and Prevention relevant to people with learning disabilities and/or autism Cath Cameron-Jones Commissioning Manager

2. Causes of learning disability Information taken from “A Health Needs Assessment for Adults with a Learning Disability in Nottingham and Nottinghamshire 2010” genetic. Chemicals, drugs and diseases Oxygen deprivation traumatic birth, meningitis, head injury, brain damage causing cerebral palsy Low birth weight and prematurity are strongly correlated to the later development of learning disabilities.

3. HOWEVER…………………… The cause of learning disabilities cannot be determined in 40%-80% of cases. Gates and Barr (2009) Oxford handbook of Learning and Intellectual Disability Nursing, OUP

4. Causes of Autism “The causes of ASCs are multi-factorial, with the most likely explanation being an interaction between genetic and environmental factors. Current evidence appears to confirm a strong genetic link, whereas studies on environmental factors are not yet able to confirm specific environmental causes.” Needs Assessment for Adults and Young Peoplewith Autistic Spectrum Conditions in Nottingham, Nottinghamshire and Bassetlaw

5. Key problems for people with Autism 63% of adults with autism do not have the support to meet their needs 60% of parents say a lack of support has led to higher support needs in the long run 33% of adults with Autism have experienced severe mental health problems because of lack if support Only 15% of adults with autism have a full time paid job. »(National Autistic Society)

6. What type of support is required? Employment skills training Social skills training Befriending Social groups Travel training Advocacy Independent living skills training Speech and language therapy Theraputic interventions

7. Argument for specialist multi-disciplinary teams Autism Strategy NICE Guidance calling for these teams National Audit office found if local services identified and supported just 4% of those with high functioning Autism/Asperger’s it would be cost neutral Nottinghamshire’s Asperger’s team already know approximately 10% of the estimated population of people with Asperger’s.

8. Challenging Behaviour Evident in 10-15% of people with learning disabilities Terrible twos Escaping situations Other disabilities Deprivation and abuse Control LEADS TO HIGHER COST PACKAGES –Carer breakdown –Need more staff/hours of support –Higher staff turnover

9. What can be done? More support to carers – training and respite and also ‘someone to talk to and offer practical advice’ Better staff training Communication – speech and language Medical conditions identified and treated Promotion of independence early on Psychologist input – managing behaviours

10. Promoting independence INCREASING AN INDIVIDUALS INDEPENDENCE SHOULD REDUCE THEIR RELIANCE ON PAID SUPPORT Intensive short term work Community support Provider incentives Employment

11. Supported Living ASCH&PP have been undertaking a project to move people with a learning disability out of residential care into supported living Between April 2011 and end of September 2012 the project has moved 37 people from residential to supported living at a total saving of £443k to NCC and £150k to the PCTs IS SUPPORTED LIVING CHEAPER THAN RESIDENTIAL CARE?

12. Assistive technology Telecare Telehealth Limited use of AT for people with learning disabilities - therefore very little research Research into Older people AT services shows cost savings for health and social care

13. Assistive Technology – examples in Notts Local evaluation 2010-2011 – Savings of £375 on average pp, pa for social care and £100 for health. (based on 80 people) LD services – real examples Waking to sleeping night – saves £38,000 ‘Just checking sensors’ saves £40,000 Falls alarm saves £25,000

14. Care UK – carers survey 3,500 carers of which 750 used AT. Over 60% of carers surveyed said telecare/telehealth had given them peace of mind as a carer One in eight carers said telecare/telehealth had helped them stay in work or return to work alongside caring Almost two thirds of carers not using telecare/telehealth were unaware of the support available from technology Of carers not currently using telecare/telehealth one in four would like it but simply did not know where to find it Only 6% of carers said they would not want telecare/telehealth

15. The reason to support carers in Notts Nearly 50% of the people with a Learning Disability known to ASCH&PP live with carers 58% of the 37 people with a learning disability who moved into residential care in 2011/12 was as a result of carers no longer being able to cope A national survey showed 83% of carers felt caring had a negative impact on their physical health and 87% on their mental health