This case study is in relation to a 19 year old adult, Shaku who suffers from learning disability. Shakus heritage is East African/ Punjabi and both her parents are people who work full time. Shaku lives with her parents, bothers, sister and grand mother. The family of Shaku is not a devoted Muslim family but it has been observed that they value their traditions. Regarding Shaku’s learning disability, her speech is impaired and she is physically disabled and requires assistance with personal care tasks. Although she is disabled, but she is like a normal girl in many ways, who loves fashionable cloths, loves to watch movies and misses her friends from school. Shaku has a speech and language therapist, Jean who is working with her with computerized assistive technology.
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A learning disability affects the way someone learns, communicates or does some everyday things. Someone has a learning disability all through his or her life. There are many different types of learning disability. They can be mild, moderate or severe. Some people with a mild learning disability do not need a lot of support in their lives. But other people may need support with all sorts of things, like getting dressed, going shopping, or filling out forms. Some people with a learning disability also have a physical
disability. This can mean they need a lot of mental and physical support 24 hours a day.
Shaku has been attending a local authority ran day centre, Hopefield Road Resource Centre for people with learning disabilities three times a week for the last 12 months. In addition to this she has a care agency, Helpful hands visiting at home three times a day, for one and a half hours at a time to help her with simple everyday tasks. Shaku is getting more and more frustrated and angry everyday. There are many reasons for her verbally abusive out bursts. After interviewing her, this is what I came to know about her family back ground and the way things are going for Shaku. Shaku feels she is a burden on her parents, as both of them are working parents; they do not have the time to look after her. This also frustrated Shaku as she needs more time from people who love her and are close to her. Shaku does get some amount of support from her grandmother but that is not enough as she can not openly communicate with her in Punjabi. Shaku feels uncomfortable being left up to others. Even though she can not perform everyday tasks by herself, she still finds this inconvenient. For example, she does not like to go to bed early. Shaku is disturbed by the thought of the centre closing because then she would not have any activities to do. Although Shaku portrays a friendly attitude towards Kerry, she is not comfortable with her presence and is somewhat feeling being abused. Another important issue in Shaku’s life is about what will happen to her in future. She is unsure and uncertain. Her parents plan on marrying her, to which she does not give a favourable response.
Explain the likely policy and legislative framework which underpins the scenario as it is and that may assist this situation. Discuss the likely impact, usefulness and limitations of such policy and legislative framework.
â€¢ people with learning disabilities are citizens first and foremost, and public services,
together with the private sector, need to respond appropriately. This means that
the responsibility to ensure that all people can enter the workforce is a communitybased
responsibility – not one simply for health and social care;
â€¢ effective ‘person-centred planning’ is critical, as it ensures services fit the needs
of the individual, rather than fitting people into what is available;
â€¢ recognising the importance of employment whilst still at school is critical. Ensuring
effective individualised transition planning and implementation from education
to employment could have a dramatic and long lasting effect on the life
experiences of this group and other services;
Under the NHS and Community Care Act 1990 Section 47(1) Shaku is eligible for an assessment of need for community care services. Furthermore, according to The NHS and Community Care Act 1990 Section 47(2) Shaku has additional rights that are defined in this act because she suffers from learning and physical disabilities. Under Section 4 of the Disabled Persons (Services and Consultation and Representation) Act 1986, local authorities will need to come to a decision regarding the services that are necessary to be provided to Shaku.
The Carers and Disabled Children’s Act 2000 gives carers the right to ask for an assessment of their own needs to help them to continue to care, irrespective of whether the person they are caring for has had or is having their own needs assessment. The assessment is available to any carer who provides or is intending to provide regular and substantial care. The Carers and Disabled Act 2000 also allows, Social Service Departments to provide services directly to carers.
The Disability Discrimination Act 1995 (DDA) also applied to Shaku as she has a disability of both physical and mental impairment. As this law states, Shaku will have access to “reasonable adjustment” to fight with her disability. Shaku is encouraged to take part in public life as this Act has changed the law and extended the rights of disabled people in relation to using transport services, joining private clubs, strengthens rights in the areas of renting premises and discriminatory job advertisements. People like Shaku will receive full support from public bodies and will feel confidence in mingling with the public. Shaku is a “Vulnerable Adult”, according to the definition of “No Secrets” A person aged 18 years or over who is or maybe in need of community care services by reason of mental or other disability, age or illness.
The Sexual Offences Act 1956 gives Shaku the protection and rights as any other girl. She has rights to:
a) To have and enjoy a fulfilling personal relationship;
b) The right to express sexual need in an appropriate way if they wish to;
c) To privacy;
d) To be sexually active;
e) To have sexual education, including counselling on personal relationships, sex and sexuality, HIV and other sexually transmitted diseases;
f) To contraceptive advice and support services;
g) To marry or cohabit;
h) To make an informed choice about whether or not to have children;
i) To be free from exploitation, abuse and degrading treatment;
In Shaku’s case, Kerry is not having a sexual relationship with her but she is being abused to the extent of calling names and touching parts of the body. Section 128 of the Mental Health Act 1959,states that it is an offence for a male member of staff or manager of a hospital or mental nursing home to have unlawful sexual intercourse with a woman “who is for the time being receiving treatment for mental disorder or is an out patient at the hospital or home”. It is also an offence for a guardian to have unlawful sexual intercourse with a person in his custody/care (Mental Health Act 1948) or in Part 111 accommodation (National Assistance Act 1948). The Sexual Offences Act 1967 also makes it an offence for a male member of staff to commit acts of gross indecency on male patients. All prosecutions require the Director of Public Prosecution’s consent.
According to the Human Rights Act, rights of people with learning disabilities are the same as of their fellow citizens. In March 2008 the Joint Committee on Human Right declared that the HRA “provides a legal framework for service providers to abide by, and for service users to demand that they are treated with respect for their dignity”. According to the Human Rights Act, Shaku has the right to marry or refuse at her own free will. Shaku is over 18 years old and if she understands the nature of the marriage, she can get married without her parent’s consent. Otherwise, she would have to have permission of her parents.
The Mental Capacity Act 2005 (the Act) provides the legal framework for acting and making decisions on behalf of Shaku as she lacks the mental capacity to make particular decisions for herself. The person that makes the decision for Shaku will have to adhere with this Act. The five statutory principles are:
1. A person must be assumed to have capacity unless it is established that they lack capacity.
2. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
4. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.
The deputy should keep a few things in mind when making decisions; they should only make those decisions they are authorized by the court. They should let the person make the decisions whenever they can, always put they person’s best interests first.
The Disability Discrimination Act 1995 banned the ill treatment of disabled people. The Disability Discrimination Act 2005 and the Disability Equality Duty Act promotes disability equality, takes steps to eradicate discrimination and harassment. These laws make the world an easier place to live in for Shaku.
Shaku comes from a minority ethnic background which is why she is subject to discrimination and needs a high level of support. According to the Learning Disability Task Force; people belonging from minority ethnic groups experience poverty, racism, discrimination in employment, education, health and social services. There are a few services which adhere to hold sufficient skills which are needed to work with people with learning disabilities from minority ethnic communities. To prtoct people suffereing from learning disabilities Government departments and local statutory providers are expected to act in accordance with the Race
Relations (Amendment) Act 2000. 
As mentioned in the Department of Health document; Valuing People Now, a strategy has been set out where all the basic rights in relation to health, inclusion in all the aspects of community, housing education, work, having a family, advocacy, transport, leisure services and social activities, safety in the community and at home, access to justice rights of people with learning disabilities.
According to the Government’s White Paper ‘Valuing People: A New Strategy for Learning Disability for the 21st Century ‘ Shaku has the rights to be educated and have access to employment opportunities. Having an education and earning forherself can make Shaku more independent and confident about her self as time goes by and even diminish the disabilities she has. From these benefits she can also achieve inclusion and visibility in the community. The Working Group research shows the objectives of people with learning disabilities are not different from those of the 6.9 million disabled people of working age in Great Britain. The Working Group also possesses evidence unemployment is damaging to both mental and physical health.
Under the Government policy, Shaku is eligible for higher education rights. She can access vocational educational training courses. To get Shaku ready for employment, Entry to Employment (E2E) is a flexible work-based learning programme established across England. E2E concentrates many concerns about the accessibility of work towards young people with learning disabilities. It is an entry/level 1 programme which is proposed to help young people to conquer obstacles that confine their advancement to higher levels. Each programme covers three core areas; basic and key skills, vocational development, and personal and social development.
Part C Recommendations
Discuss the social work interventions which would be required in this scenario: what would you need to do and how you would approach the scenario? Critically evaluate different options you could consider.
First of all, Shaku and her problems need to be understood properly. Everything that is to be done should be in the best interests of Shaku. Better communication methods than speech need to be used when communicating with Shaku, such as pictures, simple text, tapes and videos. When communicating with Shaku, she should be addressed directly giving her a self of confidence in herself and being patient with her whenever needed. Shaku’s family will be included in her care up to the extent which is comfortable for them with their daily life routine. Shaku’s family would be trained to help them understand interpret and manage situations that Shaku finds challenging. Shaku should have access to a community service for people with learning disabilities. Small-scale alternative day services provide supported employment or innovative leisure or educational pursuits.
A range of Occupational Therapy models will be used to gather relevant information about the individual and to help plan appropriate treatment and intervention.
The model of Human Occupation
The basis of this model has three elements:-
o Performance Capacity
Volition refers to the process by which persons are motivated toward and choose what they do. Habituation analyses the person’s habits and routines. Performance Capacity analyses the person’s mental, physical & sensory capabilities
“Volition, habituation, performance capacity and environmental conditions always resonate together, creating conditions out of which our thoughts, feelings and behaviour emerge”
The model is very useful and can be applied to both very able and less able individuals. It guides us to ask the right clinical questions in order to build a picture with the person, of their life and what they can and want to achieve
The Sensory Integration Model
This model addresses problems of sensory organisation in the brain.
A number of people with learning disabilities have a problem processing sensory information which impacts on their ability to do everyday tasks. By
process of assessment and specially designed programmes Occupational Therapists help to adapt the person’s responses to sensory information in order for them to become more adaptive in their ability to interact with their environment.
The Canadian Model of Operation
The theoretical basis of CMOP focuses on the dynamic relationship between the
Person – spirituality, cognitive, affective and physical
Occupation – self care, leisure and productivity
Environment – physical, institutional, cultural, social
The person is connected to the environment, and occupation occurs as a result of the interaction between the person and their environment. Another component to the model is Spirituality which is at the core of a person, is influenced by the environment and gives meaning to occupation. There are two main areas of focus in this model:
Occupational performance i.e. the result of the interaction between a person, their environment and occupation .€ Client-centred practice i.e. the collaboration and partnership formed in the therapeutic process.
As Shaku’s therapies are taking place, Shaku has the issue of marriage she is not comfortable with. As a social worker I would be thinking about what Shaku wants and what her best interests are in. Shaku’s parents may want the best for her in their opinion by an arrange marriage. Even before anything like this takes place, Shaku should be given knowledge about all the aspects of marriage and the relation ship. In Shaku’s condition, it will take a considerable amount of time for her to understand everything properly; there is a need for Shaku’s parents to understand what her condition is and how much she can take in when it comes to issues like marriage. It should be made sure that Shaku’s parents do give her a considerable amount of time everyday as this can help a great deal in her recovery, If Shaku is to be married she needs to be educated in special programs for parents with learning disabilities. These programs will help Shaku and her parents understand the issues that affect parents who have learning disabilities, what kind of help is out there for parents with learning disabilities.
Learning Disability Services
An in-house care plan is needed for Shaku. The care plan will feature the information about her daily living, health, medication, personal care, likes, dislikes, wishes, choices and other aspects. The plan will be updated regularly to act in accordance with her changing needs and will be reviewed at an anuual basis.
person centred planning is advised to be undertaken by Shaku and her family. This will help them to choose what ever is best suited for them. A care plan will be written down what Shaku transport, social, educational, health and other community-based services can be linked up. Contacting Social Care Direct will the first step towards getting a social care service.
The Care Quality Commission (CQC), takes assessments and follow-up reviews on care homes and services throughout the UK. Their website lists all the assessments which can help Shaku and her family to choose the right care home and to locate one near their residence as well.
To make sure the needs of adults with a learning disability are met in the best way, health and social worker should work together. Shaku’s community learning disability nurse will fulfil common and special health needs which include challenging behaviour. Shaku’s Occupational therapy treatment programme will be designed based according to her exclusive life style, environment and choices. Clinical psychology provides evidence based assessment and intervention to individuals with a learning disability who may have a wide range of psychological problems, which are often complex and multiple. We undertake Cognitive Assessment, for example, to support service provision in relation to capacity issues. Music therapy is another communication tool which will be used for Shaku which will help her to express herself. The Physiotherapists provide assessment, advice and treatment to people with a musculo-skeletal problem associated to their learning disability, and any training their carers/family need to help them with this. Specifically, we support mobility, posture, eating and drinking and health living, including walking and exercise groups. As necessary, we liaise with other health professionals and non-health professionals in a variety of settings. Shaku experiences difficulty expressing her self verbally, she can be encouraged to communicate through art therapy which uses art materials. Speech and language therapists put emphasis on developing communication, which is vital to good health and social care. In co ordination with her speech therapist Jean, Shaku can also attend regular ‘inclusive communication’ training courses. The dietician can counsel on healthy eating, special diets or assist with eating and drinking problems. Mental health problems are very common in people who suffer from a learning disability. The psychiatrist is responsible for assessment and treatment of mental health problems and challenging behaviour.
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Person centred planning is developed by Learning Disability Partnership Boards which is done according to the White Paper, Valuing People. Partnership boards help people with learning difficulties fulfil their desire to live an ordinary life through person centred planning. The following is taken from the meeting that was arranged with Shaku and sets out what she wants to do and the things she is not happy about.
Shaku seems very unhappy with her life. She misses school and her friends there. She is bored at home and bored in the day centre. She is angry that she cannot come and go as she pleases either at home or in Hopefield and school was better at this. She says that she find it ‘depressing’ that the centre is now closing and is ‘scared’ about what this means. Will she be at home more? More bored? Helpful Hands are ‘rubbish’ and the leisure activities are watching telly together or going for a walk and they arrive too late. Shaku says that she would really like to see her friends more. She says that she hadn’t thought much about marriage.
As Shaku experience learning disabilitied, sometimes she can not explain what she wants so she will need support to make decisions. The Framework for person centred planning for Shaku will need be discussed with her parents, her therapists and her social worker. The person centred planning implementation group will follow the action plan on a daily basis. Shaku’s family, friends and comuunity services like care management, health professionals, services ( organisations that provide services for people with learning disabilities).
Mental Capacity Act 2005.PDF
British Institute of Learning Disabilities. PDF
ADULTS WITH A LEARNING DISABILITY – INTERPERSONAL RELATIONSHIPS AND SEXUAL DEVELOPMENT. PDF
Occupational Therapy Models and Learning Disability. PDF
Supporting the needs of parents with learning disabilities
Making life better for people with a learning disability and people with mental health problems who live in Northern Ireland
our lives, our choices
Learning Disability Services, Wakefield Council, viewed 10 June, 2010 http://www.wakefield.gov.uk/HealthAndSocialCare/AdultsAndOlderPeople/LearningDisabilities/default.htm
Choosing the Right Care, AboutLearningDisabilities, viewed, 9 June, 2010
Department of Health, Valuing People Now: a new three year strategy for people with learning Disabilities 2003, viewed 7 June, 2010
Improving work opportunities for people with a learning disability 2006, Department of Health, viewed on June 6, 2010
Mansell, J (2010) “Raising our sights: services for adults with profound intellectual and multiple disabilities” available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_114347.pdf
“Rights, independence, choice and inclusion” Learning Disability Task Force.
Available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4074727.pdf
VALuInG PEOPLE nOw: A nEw THREE-YEAR STRATEGY FOR PEOPLE wITH LEARnInG DISAbILITIES 2009, Department of Health
There are some components that are essential for a good social care service. These include designing and delivering arrangements that are adapted to the individual person’s requirements and choices. As in Shaku’s case, she is living with her family, the service should be family-centered, and a care plan which is prepared for her should be what is most suitable for her and her family. 
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