Table of Contents
The present paper is aimed at examining the concepts of disability, health, behavior and illness. Further specific needs extended by health & social care systems for individuals would be examined and strategies adopted by the health & social care for meeting these specific needs would be explored (Waterhouse, 2000). Further challenging behavior and strategies available for people working in the domain of specific needs would be examined in the present context. Below are the learning outcomes which would be attained through present paper:
LO1 Understand perceptions of health, disability illness and behavior
LO2 Understand how health and social care services and systems support individuals with specific needs
LO3 Understand approaches and intervention strategies that support individuals with specific needs
LO4 Understand strategies for coping with challenging behaviors associated with specific needs
There would be two case studies which would be adopted in the present paper which are “Baby Peter was failed by all agencies” and “The Bournewood case- Right for vulnerable people in the care system”.
Learning Outcome 1
Analysis of concept of disability, illness and behavior
Health can be defined as the overall status of mental, physical and social well being and does not merely confirm the absence of illness in a person. Ottawa Charter for health promotion in 1986 has stated the health as source for everyday life not the objective of living. Health is a positive concept which indicates social, personal and physical capacity. Health should be considered from holistic perspective and should consider all possible dimensions in it (Zarkowska and Clements, 1994). There are two models for health which are bio-medical model and socio-medical model. Bio-medical model confirms health as the absence of illness and emphasis on the curing & treatment with the specific needs. Socio-medical model of health would define health as the environmental & social factor impacting health with factors such as poverty & housing etc.
Illness and behavior: -what impact they have on health and how important is to understand them
Disability discrimination act 1995 defines a person as disabled in case the person has mental or physical impairment having long term effect on the ability of that person to carry out day to day activities. Disability in a person would impact on the mobility, understanding and learning activities for a person. There can be different impairments covered by disability such as physical impairment, communication impairment and sensory impairment. There are three disability models i.e. personal tragedy model, social model and medical model. In past people with disability were discriminated by family & their friends as well by making use of the words such as mentally retarded, imbeciles and handicapped etc. Disable people were not considered equivalent to other people and were considered to have specific needs for care. Behavior can be defined as any action which a person does and does not do and have negative impact on their lives and life of other people (Ritchel et al, 2003).
Explain medical and social model
Changes in perception of specific need over time
Perception of people on specific needs changes over time and from societies to cultures as well. People perception would be culturally & historically specific. In middle ages, Epilepsy was considered as the violent possession by divine forces or malevolent. Epilepsy in 20th century was linked with the insanity and it was believed that Holy Spirit is working fine for them (Squire, 2002). Epilepsy is considered in super natural terms and in Nigeria it was revealed that heredity is major cause of epilepsy and after that witch craft is cause of epilepsy. In Nigeria Epilepsy is considered as stigmatizing & hidden from others but medical advances suggests that epilepsy is caused by abnormal neurological activities occurring as a result of the damage caused to brain. Epilepsy is controlled through sodium valproate and carbamazepine to curb seizures. In present time new medical advances, technological developments and new ways for looking at functioning & structuring of body & brain can replace the current orthodox practice. Department of health (1999) introduced a new strategy according to which nurses & doctors have required skill set for making best possible use of technology as developed by NHS. Disability discrimination act 1995 gives right to disable people and enforces that employer provide suitable arrangement for the disable people to gain employment and makes use of the facilities provided in the community. According to legislation Valuing people 2001 complete support needs to be provided to the people with disabilities & their families and people with disability needs to control their lives as much as possible. Give example: Paralympic games explain
Impact of legislation, social policy, society and culture
Social policies ( details services available)prevailing in society can be considered as an important tool for encouraging ethical practice. Regulatory bodies do not only restrict themselves only to the code of ethics and disseminating policies (Sussex et al, 2008). Legislation act enforce the educational standards to meet specific need of people. Disability discrimination act 1995 protects individuals suffering from disabilities from any type of discrimination. This legislation extends disability from the individual medical problem to the community membership and participation in the societal activities such as employment and education etc. As per Disability discrimination act 1995, hospital and other service providers need to impart health related information to the disable person in a format which is suitable for them e.g. in large font to the visually impaired people. Most of the legislation under disability discrimination act 1995 has been replaced with the equality act from 1st October, 2010 in order to protect disable people from discrimination in education, healthcare services and other aspects (Hewitt, 1998). Data protection act 1998, ensure protection of data pertaining to service users so as to maintain them in separate file and not to be shared with other people to maintain confidentiality of data. Valuing people 2001 act protects people with learning disabilities and their families so as to make sure that these people have control for their lives and can access to the right job they need. Mental capacity act protects people with mental disabilities and decide who can take decisions for them. Health & social care act 2008 defines the quality commission being the regulator for health & adult social care services.
Culture and society – social model – universal design - impact
Looking into the second case study of “The Bournewood case” it can be evident that mental capacity act was violated in the present case wherein Mr. and Mrs. E should have been given the right to take decision on behalf of HL. Further Valuing people act 2001 also gets violated wherein mentally disable people & their families should have been given right to take control of their lives (Naidoo and Willis, 2000). Implications of these legislations should have avoided any negative impact on the health of HL by keeping HL with Mr. and Mrs. E.
Emotional support details
Learning Outcome 2
Care need for individuals with specific needs
Care plan can be considered as the document which contains the strategy in order to meet specific needs targeted around the people with disabilities. This would help disable people to live healthy life as this plan fulfills special needs of the disable people instead of fitting them into the existing healthcare provisions. The care plan is for HL who was suffering from autism and was having learning disabilities (Department of Health, 2009). In order to analyze his needs Maslow hierarchy of needs as given in figure 1 can be used. HL was not able to talk and was also in need of help so as to complete day to day activities such as washing and dressing him. Care plan for HL was such that all his needs are met and at the same time he can make personal choices.
Figure 1: Showing Maslow Hierarchy of needs
Holistic needs of HL were met as per his choices so that he can spend healthy life at Mr. and Mrs. E’s house. Needs for HL can be related as per Maslow need hierarchy which has five levels with most basic need at the base of the pyramid. All the needs pertaining to meal and other aspects were met according to his religious and cultural needs. Health & safety of HL was maintained to make sure that there is no harm to HL as per Health & Safety act 1974. Environment at Mr. & Mrs. E’s home was safe and welcoming for other families coming to visit HL. He was supported socially to meet friends & families (Clements and Zarkowska, 2000). This helps him to gain sense of belongingness, friendship and trust. HL benefited from family setting which was boosting confidence for HL and was leading to self actualization growth. When all these needs are fulfilled for HL there were chances that service user feels more valued and it also promote independence.
Current system for supporting individuals with specific needs
Other current systems NGO
It is important to develop set of practice and processes while dealing with individuals with specific needs such as HL. Looking into the care plan for HL it was important to follow data protection act 1998 so that confidentiality of data can be maintained and data is not accessed by other people. HL was having little awareness for his safety so health and safety at work 1974 was followed in order to ensure safety of HL while living in house as well as going to health centre (Department of Health, 1999). HL was not able to talk and it was taken care that demands of HL are being fulfilled through sign language. He was taken at day centre on weekly basis through centre transport. For HL sign language and hand movement plan has been developed so that he can communicate his needs. By doing this independence of HL is being promoted.
Service available in chosen locality for people with specific needs
Mention the name of borough
Disabled persons are offered services at daily centre which is visited by HL weekly basis at free of cost. In locality there are institutes for the disable people wherein they can learn pottery lessons, art & craft and music through specialized learning tools. Large print keyboards and hearing loops are being used in order to meet special needs for the persons with disabilities (Butt et al, 2008). Day care service providers would help in social inclusion, respite cares for carers and living in community. This would help to extend emotional and physical support and enhances quality of life for people with specific needs. Dial a ride service can be provided to the people with specific needs who can’t travel through buses, train and other transportation medium. This helps people with disability to go for shopping, meeting friends and visit to doctor. Londontaxi card services helps people with disability to avail tax services door to door at subsidized rates for people who are having serious mobility impairment or visual impairment. Occupational health services are extended for the people requiring specific needs so that rehabilitation cares workers gets safe manual handling. These service providers help the carer for assessment of specific needs and impart training so that carer can use range of equipment for fulfilling needs of service users. STAAR (supporting those with autism and AspergersRedbridge) provides services related with swimming for people with specific needs. These service providers highlight the specific needs required by people suffering with autism and highlight the need of women and children requiring specific care and need (Bennett et al, 2009).
Learning Outcome 3
Approaches and intervention for supporting people with specific needs
There is no cure for autism but there are several approaches and intervention which can be used in order to support people with specific needs. Approaches adopted for the specific need people would vary in terms of cost and availability in different areas. Further decision pertaining to the approach and intervention for supporting people with specific need would be taken by family and multi disciplinary teams (Borkowski, 2009). There are basically ten approaches from which decision can be taken and these are complementary therapy, behavioral intervention, medical interventions, diet & supplements, relationship based interventions, psychological interventions, service based intervention, technology, skill based and standard therapy etc. In present context two services based interventions and one technology based intervention would be explained as these are mainly used. TEACCH stands for treatment and education of autism and related communications handicapped children/adults. This is service based intervention and it is not technique or method. This is a complete program for people suffering from autism and aimed at providing suitable services to the people suffering from autism so that they can live healthy life. This would be helpful in order to deal with possible frustrations related with the non verbal or verbal communications. SPELL is another service based intervention. People with autism would not like the change and do not cope-up with the unfamiliar situations. Safe and predictable environment helps people suffering from autism to increase their independence and develop communication skills (Brindley & Reynolds, 2011).
Positive expectations and approaches help people to identify possible barriers and overcome these barriers in order to achieve their goals. Empathy explains that other people would see and understand world in similar way a person suffering from autism sees it. This focuses on people with their individual preference and interest level to understand their motivation level. In low arousal approach people would respond to their sensory needs by offering activities and surroundings that are calm and free from clutter (Bryan, 2009). This approach would be helpful in extending independence in all aspects of life. Link is another approach which link family and other society members with the people facing autism disorder so that they do not face difficulty. Speech and language therapy is standard intervention which is aimed at understanding the child/adult difficulties and helps in developing better communication process wherever possible.
Effectiveness of intervention strategies for people with specific needs
As evident through second case study that TEACCH approach is quite useful for people with autism and improvement has been observed in self help skills and social skills along with reduction in inappropriate behavior. Skill enhancement is one of the key principle among the seven principles for TEACCH and HL was able to maintain good behavior socially and was attaining self help skills in washing and dressing himself. Risk associated with the social skills and self help skills need to be evaluated and benefits also needs to be outlined for improvement in the skill set which basically would lead to independence for service users (Care Quality Commission, 2010). Previous researches have also highlighted that communication, independence and concentration has improved 80% through making use of the TEACCH. SPELL approach is also quite effective. Sensory room is a special room wherein intervention from outside world is absent and people with specific needs are present with music, different colors and pleasant environment so that people with specific need can’t miss and real building blocks of progress can be witnessed. This can be considered as a part of the low arousal approach. Language and speech therapy used for the autism treatment is major treatment tool. Speech therapy was quite useful wherein makaton sign and picture boards were used with the autism patients such as HL. This therapy is effective as service user can be communicated through verbal and non verbal mode so that they can make their personal choice (Collins et al, 2011). Many therapies and approaches spend high cost which is service dilemma and policies. It is important to ensure that Baby P gets the proper support through carers which is required for him but these services are quite costly as professional charges heavily for these services.
Potential impacts of emerging developments
There are several emerging developments for the people with specific needs in current time. Looking into the case of HL, there is autism awareness card and this card can be used in order to create awareness among society so as to deal in emergency moments with the patient suffering from autism (Gillespie et al, 2010). One side of the car would contain all the needs which are required by person suffering from autism and strategies which would be helpful. Other side of the card would contain general information and these cards would be developed with person centric approach. There would be different approaches available for helping families whose children are suffering from autism disease. Organizations have mailing list so as to provide continuous information on autism to the families pertaining to the training. These service providers would offer key information and other resources to the key person handling patient of autism so that suitable strategies for treatment of autism patient can be developed by the key person handling patient. Further training is also imparted to the staff of primary health care or hospitals as well so that they can get proper training so as to help people suffering from autism such as HL. In the present case hospital trust was not having trained staff in order to fulfill specific needs of HL (Levinson et al, 2010). Hence these emerging developments can help people with specific needs to get treatment in proper way so as to allow them having healthy lifestyle.
Add same in medical field and in .................field = impact
Learning Outcome 4
Different concepts of challenging behavior
Challenging behavior can be defined as the culturally abnormally behavior of high frequency, intensity or duration that physical safety of other person is placed in serious jeopardy. This is a social label and person may not challenge but the behavior of the person would challenge our response and understanding level. Challenging behavior exhibited by a person can deny him for the access towards the community facilities. It has been observed through several researches that male patients are showing higher degree of challenging behavior as compared to the female patients (Pilnick et al, 2010). Challenging behavior of a person would be at peak level in the age range from 15 to 34 years and over represented in the age range of 14 to 24 years.
Prescientific concept define, describe, examples
Scientific concept define, describe, examples
Social concept define, describe, examples
In the present case study of HL challenging behavior is exhibited by him during travel from home to daily centre when driver took a different route and collected other passenger during the visit. There can be situations sometimes when service users can harm themselves and challenging behavior is generally exhibited by mental health factors. For example, considering the dual treatment patients getting treatment for Down syndrome and autism spectrum disorder would be developing repetitive behavior wherein they would not like to be touched and would not be comfortable under the loud voice.
Potential impacts of challenging behavior
Dealing with challenging behavior would require organizations to have suitable plan, policies and procedures to be followed. In general, BILD (British institute of learning disabilities) policy framework needs to be adopted which sets three broad physical categories of physical intervention and DoHDfes guideline for restrictive physical intervention should be followed (Reeves et al, 2011). Managers in the organization need to ensure that their employees get proper induction and training while starting for the employment so that they are aware of the policies and procedure for dealing with aggression, self harm and other challenging behavior traits among people suffering from autism.
Impact on staff – physical, wellbeing, emotional
Funds for NHS health departments
Health care professional shave duty of care against people suffering from autism and other disabilities and they should take any action which may harm these patients. At healthcare workplace General social care council and code of practice for the social care workers (code 4) should be followed which states that rights of service users should be respected by ensuring that their action should not harm them and people around them. Below are some of the actions which can be taken by the health care professionals:
· Service providers need to assess risk to the service users and people around them
· Risk assessment policies and procedure need to be adopted so as to know risk of harm
· Necessary steps needs to be taken by service providers so that service users can’t harm themselves
· Colleagues and relevant agencies should be informed about the outcomes of risk assessment
Entire staff of healthcare organization should ensure that care is extended without harming the people with specific needs as per “Mental capacity act 2005”.
Analyze working with challenging behavior
Every person is different from other and behavior of two people can’t be similar along with reasons to exhibit such behavior. For example, a person may shout as this would force other to do as he like and a person can hit as this may force others to leave him alone. Hence, it is important to consider that why a person is engaging himself in a particular kind of behavior and what are the circumstances (Rolnick et al, 2013). Non phamalogical interventions should be used for the challenging behavior instead of medication. Sometime challenging behavior may arise when needs of people suffering from particular disease do not gets fulfilled. It is important that positive, calming, preventing and problem solving skills should be used while dealing with people showing challenging behavior instead of restraining, holding and breakaway behavior. For example, HL shows agitation when he was put into uncertain situation by driver by following a different route and taking other passenger in the vehicle. It is important to deal with challenging behavior shown by HL through calming and problem solving ways.
Phychiatrist, behavior therapist, family involvement
Present paper has explored the context of understanding specific needs in social and health care with special context to two case studies i.e. Baby Peter and The Bournewood case. Present paper has evaluated the concept of health, disability, behavior and illness in context to the case studies referred in the context. Further ways through which health and social care systems helps the people with specific need was examined in the present context. Approaches and interventions used in context to people with specific needs was explored in this paper along with strategies for coping with challenging behavior exhibited by people with specific needs.
Waterhouse, S. (2000) A Positive Approach to Autism. London: Jessica Kingsley.
Zarkowska, E. and Clements, J. (1994) Problem Behaviour and People with Severe Learning Disabilities. London: Chapman and Hall.
Ritchel, L. Dick, D. and Lingham, R. (2003) The report of Inquiry into Care and Treatment. London: HMSO.
Squire A, (2002) Health and Well Being for Older People: Foundation for practice. London: BailliereTindall
Sussex, F. Herne, D. Scourfield, P. (2008) Advanced Health and Social care, London: Heinemann. The Challenging Behaviour Foundation Website http://www.thecbf.org.uk/chall-behaviour/physic-inter.htm WHO
Hewitt, D. (1998) Challenging Behaviour .Principles and Practises, London: David Fulton. Moonie N, Bates A, Spencer Perkins D. (2004) Diversity and Rights in Care, Oxford: Heinemann, pp164-192
Naidoo J, Willis J (2000) Health Promotion: Foundation For Practise, London: Bailliere Tindal
Department of Health (2009) Valuing people now: a new three-year strategy for people with learning disabilities (Online). Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093377 (Accessed: 01 December 2014).
Clements J, and Zarkowska E (2000) Behavioural Concerns and Autistic and Spectrum Disorders, Explanations and Strategies, London: Jessica Kingsley.
Department of Health (1999). Working Together With Health Information (Online). Available at: http://www.dh.gov.uk/assetRoot/04/06/22/14/04062214.pdf (Accessed: 1 December 2014).
Butt,G; Reis, M. M; Browne, G (2008) Inter-professional Partnerships In Chronic Illness Care: A Conceptual Model For Measuring Partnership Effectiveness. Int J Integr Care. P. n.d. data retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2387190/ on Nov 30, 2014
Bennett, P., Calman, K., & Curtis, S. (2009). Risk communication and public health. OxfordUniversity Press
Borkowski, N. (2009). Organizational behavior in health care. Jones & Bartlett Publishers
Brindley, P. G., & Reynolds, S. F. (2011). Improving verbal communication in critical care medicine. Journal of critical care, 26(2), 155-159, retrieved from http://www.sciencedirect.com/science/article/pii/S0883944111001511
Bryan, K. (2009). Communication in Healthcare (Vol. 1). Lang, Peter, AG, InternationalerVerlag Der Wissenschaften
Care Quality Commission. (2010). The State of Health Care and Adult Social Care in England: Key themes and quality of services in 2009 (Vol. 343). The Stationery Office,
Collins, L. G., Schrimmer, A., Diamond, J., & Burke, J. (2011). Evaluating verbal and non-verbal communication skills, in an ethnogeriatric OSCE. Patient education andcounseling, 83(2), 158-162
Gillespie, S. M., Gleason, L. J., Karuza, J., & Shah, M. N. (2010). Health care providers’ opinions on communication between nursing homes and emergency Specific Needs 18departments. Journal of the American Medical Directors Association, 11(3), 204-210,
Levinson, W., Lesser, C. S., & Epstein, R. M. (2010). Developing physician communication skills for patient-centered care. Health Affairs, 29(7), 1310-1318, retrieved from http://content.healthaffairs.org/content/29/7/1310.short
Pilnick, A., Hindmarsh, J., & Gill, V. T. (Eds.). (2010). Communication in healthcare settings: Policy, participation and new technologies. Wiley-Blackwell
Reeves, S., Lewin, S., Espin, S., &Zwarenstein, M. (2011). Interprofessional teamwork forhealth and social care (Vol. 8). Wiley-Blackwell
Rolnick, S., Bliss, D. Z., Jackson, J. M., Arntson, C., Mullins, J., & Hepburn, K. (2013). Healthcare providers’ perspectives on communicating incontinence and skin damage information with patients with dementia and their family caregivers: a descriptive study.