What We Do

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We care for and support adults living with learning disabilities and/or autism spectrum disorder in specialist hospitals and residential services. Our aim is to deliver effective and outcome focused services within safe, sound and supportive environments.


At Danshell we specialise in two main areas:

  • Learning Disabilities
  • Autism Spectrum Disorder
       

Across the UK, over 1 million people have a learning disability. Learning disabilities may affect the way that a person learns new things, understands information and communicates with others. This means that they may have difficulties with things such as household activities, learning new skills, socialising or coping independently. People with a learning disability may also have a physical disability.

Learning disabilities vary in severity and people will need different levels of support depending on their needs. With the right support, individuals with a learning disability can lead full and independent lives.

A learning disability is caused by something affecting the brain during its development. This will be before, during or just after birth. Brain development can be affected by many different factors; however, in many cases there are no known causes for an individual to have a learning disability.

Our services have considerable experience and expertise in supporting people with a learning disability to develop independent skills and to live an active and happy life.

       

Autism is a developmental disorder that affects about 1% of the population, and is much more common in men. The diagnosis is a clinical one, with no blood tests or scans to provide confirmation. It affects how a person communicates with and relates to other people. It also affects how they make sense of the world around them.

Autism is a spectrum condition, which means that people living with autism may share certain difficulties, but the condition will affect each individual in a different way. The main difficulties that people on the spectrum share are trouble with social communication, social interaction and social imagination.

Some people with autism may also be living with learning disabilities as well as complex needs and behaviours, and therefore may need a lifetime of specialist support. This can be provided by expert care settings, such as our specialist autism services.

The main principle of care is behaviour management using Positive Behaviour Support (PBS). Individuals are also supported to communicate in effective ways to reduce frustration. Family contact is essential for both service users and relatives; we facilitate this through visits, phone calls and video calls.

  • Hospitals
  • Care Homes
       

Our hospitals provide treatment and rehabilitation in safe and structured environments to adults with learning disabilities and complex needs, with a diagnosis of autism and/or a mental health disorder. There is clinical and therapeutic input from the multi-disciplinary team of psychiatrists, psychologists, social workers, occupational therapists, nurses and support staff.

Many services offer an integrated or separate step down facility for service users, allowing them to move along their care pathway to more independent living.

Three of our hospitals provide specialist assessment and healthcare services for adults on the autistic spectrum with learning disabilities and associated complex needs.

We can accept referrals for people who may or may not be detained under the Mental Health Act.

       

Our care homes with nursing for adults with learning disabilities and complex needs offer care and support in a structured and therapeutic environment. Care is delivered by a team of specialist learning disability and mental health nurses, as well as clinical and therapeutic specialist support.

Care homes without nursing support people who have moved through their care pathway from more dependent services, and are being helped to progress to supported living.

Thornfield Grange is a care home with specialist nursing for people with autism, learning disabilities and complex needs. It is designed to meet the needs of those who may have been in more dependent services and who are on their journey to more independent living. The service provides a variety of opportunities to develop skills, confidence and self-esteem, leading towards a more independent lifestyle.

We care for people who may, in addition, have the following conditions:

  • Complex Needs and Behaviours
  • Mental Health Conditions
  • Forensic History
  • Personality Disorder
  • Physical Health Conditions
  • Dementia
  • Epilepsy
       

Complex needs and behaviours are, technically, behaviours that challenges services. Typically these include self-injurious behaviour, verbal and physical aggression, inappropriate sexual behaviour and destructiveness. It can have a variety of causes including biological (such as pain or medication), environmental causes (noise or change in the environment), psychiatric (mental disorder), psychological (anxiety or apprehension) or social (unwanted attention or demands). For most people with learning disabilities it is a way of communicating their feelings when they have compromised language skills.

How we support people with this diagnosis:

We use Positive Behaviour Support (PBS) to engage people in sociable tasks and skills so that any possible complex behaviours are minimised, as people do things they enjoy and do not need to communicate any discomfort or unhappiness. If there are problems, we first investigate any physical or mental health issues that can cause complex behaviours. We then analyse the difficulty to understand what the person is trying to tell us. We find ways of enabling effective communication in a sociable way so that the person does not need to display complex behaviours.

PBS is a core principle in how we work and all staff are trained in PBS during their induction.

       

People with learning disabilities can suffer from the same mental illnesses as the rest of the population. However, there are some important differences.

Most major mental illnesses are approximately three times as common in people with learning disabilities. This also applies to less serious mental disorders.

The manifestations and symptoms of mental disorders are generally similar in presentation, but can also be very different, especially in people with more severe levels of learning disability and fewer verbal skills, where diagnosis is guided more by changes in behaviour.

How we support people with this diagnosis:

Even in those with milder levels of disability, the person's description of his or her experiences can be more subtle due to the service user's cognitive and communication limitations. This means we must pay closer attention and place more importance on smaller changes.

One of the most important differences in management of mental disorder in people with a learning disability is that medication needs to be used more cautiously, as side-effects are often more common and can also be difficult for the service user to report.

       

There are a range of forensic difficulties for people with learning disabilities. These include offences related to violence, inappropriate sexual behaviour, and fire setting. These problems are often associated with mental health problems, personality disorders, alcohol and substance abuse and disorders with poor impulse control. Generally such problems are confined to people with moderate/mild learning disability.

How we support people with this diagnosis:

Forensic difficulties in people with learning disabilities require a range of specialist input including:

  • Risk assessments for violent and sexual offending
  • An understanding of the issues associated with poor impulse control
  • Knowledge of how to deal with people who suffer from personality disorder and the accurate assessment of associated difficulties, such as anxiety, depression, poor self-esteem and substance abuse.

This requires experienced clinicians who have knowledge of the assessment and treatment of associated mental illness. Our clinical and nursing staff are extremely highly skilled in dealing with forensic issues. Our clinicians have vast expertise in assessing and treating people with learning disabilities and forensic problems. Treatment includes medical and psychological interventions for impulse control, treatment for violence and alcohol-related violence, treatment for inappropriate sexual behaviour and promotion of healthy social networks. As with all interventions, quality of life, community engagement and "a good life" are uppermost in treatment provision.

       

Personality disorder is a condition that disrupts all of the relationships in the person's life across work, home and leisure situations. People with personality disorders experience high levels of anxiety, depression and interpersonal sensitivity. The condition is often associated with underlying mental illness, such as bipolar disorder.

How we support people with this diagnosis:

Our clinical and nursing staff have been trained to a high standard in the assessment, diagnosis and treatment of people with learning disabilities and personality disorder. We use the most up-to-date methods of assessment and treatment, which have been recently been adjusted to accommodate changes in diagnosis and the legal framework. Assessment is likely to include not only categorisation of the personality disorder, but also an assessment of the underlying personality traits that may cause the personal and interpersonal conflict. Our management of service users with personality disorder and learning disabilities has been successful, often outstandingly so, with several individuals moving on to more independent living with support from local services.

       

People with learning disabilities have a much greater chance of developing physical health problems compared to the non-learning disabled population. In some cases, the cause of learning disability also leads to specific physical health conditions, e.g. Down syndrome has a link with heart problems.

In addition, they are likely to find it more difficult than others to describe their symptoms. As a result it is more difficult for healthcare workers to identify health needs among people with learning disabilities, which can leave some problems unrecognised.

It has also been found that people also have reduced access to generic preventative screening and health promotion campaigns, such as breast or cervical screening.

As a result of higher frequency of illness and later diagnosis, people with a learning disability often die many years sooner than their non-disabled peers.

How we support people with this diagnosis:

We ensure optimum physical healthcare for all of our service users and facilitate active health promotion in all of our services, including an annual health check by a General Practitioner for all service users.

We use the Health Equalities Framework to ensure service users receive the same access to physical health care as their non-learning disabled peers. This tool looks at the risks that exist to cause health inequalities for people with learning disabilities. It makes us aware of the health inequalities our service users may face, enabling us to minimise them.

       

Dementia is a degenerative brain disease often seen in the elderly and affecting 1 in 4 people by the age of 80. People with a learning disability, especially Down syndrome, have an increased risk of developing dementia.

Diagnosis of dementia in people who have a learning disability, autism or Down syndrome poses a challenge, as the presentation can be similar to their pre-existing symptoms. It can also be harder for service users to explain their symptoms, which means that the standard assessment tests cannot be easily used. We utilise recognised assessment tool to aid diagnosis, such as the Dementia in Learning Disability (DLD) test.

How we support people with this diagnosis:

Diagnosing dementia, and which type of dementia someone has, is important. It will ensure that people with dementia can get the right support, treatments and plan for the future.

Our support for service users with dementia is similar to how non-learning disabled people would be cared for. We focus on medication, behaviour management plans using Positive Behaviour Support (PBS), psychotherapy such as reality orientation, reminiscence and cognitive stimulation, and also giving personal support as well as supporting service users to continue with activities they enjoy.

       

Epilepsy is a condition that affects the brain and causes repeated seizures. These usually begin in childhood, however they can start at any age. Epilepsy is more common in people with a learning disability than in the general population. Around 22% of people with a learning disability will also have epilepsy. The more severe the learning disability, the more likely it is that they will have epilepsy.

Epileptic seizures can take many different forms, and they affect awareness, movement or behaviour. For example, complex focal (partial) seizures can include symptoms such as repetitive movements without purpose like fiddling with clothing and lip smacking. Confusion additionally is also seen in seizures, and many people have periods of confusion following seizures.

Because having a difficulty communicating or sometimes appearing confused, can be part of a learning disability, it can sometimes be hard to tell if a person with a learning disability is having a seizure.

How we support people with this diagnosis:

Many of our professionals have a specialist interest in epilepsy and are experts in how to treat this condition in someone with a learning disability. They also treat the symptoms that come before, during and after a seizure, to ensure service users are supported during what can be a very disorientating and confusing experience.