This report will attempt to identify and analyse the child’s needs indicated in the case study (see appendix Case Study). These needs will be further discussed with supporting literature around the issues of self -injury and the ability of children with learning disabilities to communicate their needs although experiencing severe language impairments. In order to assess needs, a robust and holistic assessment needs to be undertaken.
Assessment is an activity that involves gathering data and interpreting the significance of that data and any further action that may need to be taken. Assessment is not static and should be continuous to account for the fluctuations and variations in the needs of the individual. There are varying levels of assessment from the more formal structural data to the less formal subconscious assessment. Casey (1988) provides a model of assessment that is holistic and family-centred to include the child and family’s need for support, information and teaching. In respect of patient confidentiality the child in the scenario will be referred to as Shelly to protect patient confidentiality and anonymity in accordance with the Nursing and Midwifery Council professional code of conduct: standards for conduct, performance and ethics (NMC 2004).
Shelly was statemented and attends a special school for children with learning disabilities. Shelly needs to enhance her communication strategies and social interactions, which in turn may reduce some of her disruptive self-injury behaviours. The family also need to be more involved in the use of alternative augmentative alternative communication systems (AAC). Shelly’s needs have been identified as the following:
1. Communication strategies to develop social interaction 2. Multi-disciplinary care planning/working holistically. 3. Need to reduce self-injury behaviour and need for restraint 4. Need for Family-centred care 5. One to one interventions/care/working 6. Medical interventions 7. Cultural needs 8. Need to increase mobility Issues raised The complexity of self-harming in learning disabled children and the effect of the environment. Cultural identity should form an integral part of an assessment of need. The importance of achieving an effective communication strategy to reduce frustrations.
The focus of this report allows the scope for three areas to be considered. The three identified areas this report will focus on will be Self-injury in disabled children, communication strategies and cultural needs. Communication/Self-Injury Shelly has limited communication and the frustrations she exhibits correlates with the literature in this area. Children who are unable to verbalise are more likely to feel frustrated and display challenging behaviours because of their inability to be understood. (Hernadez-Halton et al 2000) would suggest that verbal communication constitutes the most important instrument of change.
Communication can be divided into four main areas verbal, non-verbal, paralinguistic and written communication. However people with learning disabilities may not be able to utilise all aspects of communication and are encouraged to utilise strategies that best meet their needs. There are many factors that affect communication, verbal and non-verbal communication need to be congruent to be effective in relaying the appropriate assigned message.
Birdwhistell (1970) estimated that between 65% and 70% of social interactions are perceived non-verbally. It could be considered that all behaviours are a way of communicating and the key to understanding the individual would be achieved by acknowledging the subtle cues entwined within their individualised behaviours. This is particularly salient in Shelly’s case in which her behaviours are not fully understood, although her behaviour is different in different environments.
Manolson (1992) suggests that with patience and time it could be possible to discover what a child will respond to, or turn away from, and the unique way they articulate this should be observed and acted upon. The resource implications of Manolson’s suggestions would be vast and would require a lot of one to one working to establish patterns of behaviour although the idea is sound. The staffing ratios in special schools would not facilitate one to one working for all students, although research would suggest there would be a marked increase in the child’s communication systems. The use of augmentative and alternative communication (AAC) systems have long been recognised as important tools in aiding communication in children with learning disabilities, these include British Sign Language, Makaton, PECS, eye pointing and speech generating devices (see appendix AAC Tools.).