NURS 1465 - Managing complex Needs in People with Learning Disabilities:

Assessment guidance:

A 20-minute graded individual presentation of an evidence-based comprehensive

assessment, formulation, and recommended interventions within a multi-element
framework of a service-user with complex needs identified through practice,
identifying own strengths and limitations.

The student will be required to:

1. Identify a service-user from practice who has complex needs and carry out an
evidence based comprehensive assessment of the individual’s needs.
2. Critically analyse the data from the assessment to create a formulation that
identifies how the individual’s needs developed and the impact this has on the
individual’s physical health, mental health, behaviours, and psychosocial
functioning
3. Recommend evidence-based interventions using recognised multi-element
frameworks
4. Identify their own strengths and limitations when carrying out this process

Medium - Use PowerPoint or equivalent e.g. Prezi or other presentation software.

Structure -
Slide One:
Title slide, this will be straightforward – Module code and name, student number,
Presentation of Evidence Based Comprehensive Assessment, Formulation and
Recommended Interventions within a Multi-Element Framework of a Service User
with Complex Needs. Include observation of confidentiality (reference), the
pseudonym applied to the individual. Pseudonyms - do not use Mr X or Ms Z – these
sound like superheroes, use Mr Smith/Ms Smith, Robert/Sarah/Steve - something
average or culturally appropriate.

Slide Two:
Agenda/contents/introduction slide – bullet points stating the contents/structure of
the presentation.
e.g.
 Background to individual
 Assessments and results
o physical health needs
o mental health needs
o challenging behaviours
o social needs
o risk
 Formulation
 Recommended interventions/multi-element framework
o physical health
o mental health
o challenging behaviour
o social needs
o risk
  Reflection / Identification of strengths and limitations
If the individual does not have challenging behaviours, this will not be included. All
other assessments and interventions will be included.

Talk briefly through this slide e.g. “Firstly the background to the individual will be
discussed and will explore their upbringing, schooling, employment history (and
anything else you discuss as background). A range of assessments were carried out
on the individual and these will be examined. Next, the data from these assessments
will be critically analysed and results presented. A formulation that identifies how the
individual’s needs arose will be presented. From this several interventions designed
to meet their physical health, mental well-being, challenging behaviours, social
needs, and risk be considered within a multi-element framework. Finally, own
strengths and limitations in this process will be analysed and discussed.”

Slide three:
Provide the background to the individual. Factors to discuss are the individual’s birth,
development, schooling/education, family, employment history, medical history,
mental health, housing/living, daytime activities etc.

Only have a bullet point on each but talk at greater length about this. The slide may
read:
 Birth (age, level of LD, diagnoses)
 Early development (level of LD, diagnoses)
 Family
 Education
 Medical history and presenting conditions
 Mental health and psychological and emotional well-being
 Social circumstances

It does not have to be in this order, this could be presented as a timeline to the
present date.

When discussing this slide the verbal account may be: “David was born in Kent in
1978 his birth was described as unremarkable, and no complications were reported.
He reached his developmental milestones within normal ranges, although his speech
was described as delayed, and he did not say his first words until 23 months. His
parents separated two years after he was born leaving him in the care of his mother
along with his two older sisters. He has not seen his father since. His mother
remarried when he was aged ten, but he has been described as having a ‘strained’
relationship with his stepfather. He remained at the family home until he was twenty-
five when he moved into semi-independent provision. He went to his local primary
school and went to mainstream secondary school. In secondary school he struggled
with his schoolwork and was seen by an educational psychologist and was identified
as having a learning disability with an IQ of 66. His mother was offered the option of
moving David to a special school, but this was declined, and he left school at 16 with
no qualifications. His schooling was described as ‘typical’ although it was felt he did
not fit in and there were reports of bullying. His childhood medical history did not
identify anything out of the ordinary. He was diagnosed with asthma at the age of
nine and was prescribed a salbutamol inhaler prn and beclomethasone 100mcg BD.
By the time he left school he was overweight and by the time he left the family home
he was described as obese and at present has a BMI of 33. As he has gained weight
his health has declined and he now has ……… David has had periods of anxiety and
at the age of twenty a query of depression was suggested by his GP when he
became withdrawn, refused to go to college, along with disturbed sleep. This lasted
two months and then David spontaneously returned to college as did his sleep
pattern and other behaviours. He has expressed concerns about his weight, being
ugly, not having a girlfriend and ……… At present he lives in a three-bedroom flat
with two other men with mild learning disabilities and receives support from an
outreach worker for two hours a day which is shared with his two flatmates…….”.

This should take about two–four minutes or so to go through. Expand on the

important information or minimise information that is not so relevant to the presenting
factors for the individual. For example, it is mentioned he had two siblings – if there
were issues with these siblings or they were important in his life then this information
could be expanded on. If his stepfather was abusive and violent and this has
affected him throughout his life, then this could be expanded on too. If the asthma is
a major issue expand on this talk about the different treatments, problems with
concordance with medication and so on. If there are challenging behaviours go into
this in greater detail.

Have cue cards to use – do not read from them exactly just have a card with a few
key words e.g. birth unremarkable, normal milestones, delayed speech, divorce age
2, remarried age 10, normal schooling, Ed Psychologist at 13 years, IQ 66.

This can be spread this over several slides if this helps, have a slide with the
presenting conditions/issues that are going to be a focus (the individual’s current
needs) e.g.
 Asthma
 Anxiety
 Lack of daytime activity
 Housing
 Support form staff
 Obesity and diabetes
 Anything else

Slide Four (or slide 5, 6, 7, 8 – if more have been used):

Assessment of physical health needs – these should be evidence based so require
references, and discuss why using a particular tool e.g. ‘it is valid/ reliable’ etc. This
is straightforward – how was this assessed/what tools or methods were
used/rationale for this e.g. The OK Health Check 3rd edition (Mathews, 2003) was
used – this is a standardised tool for people with learning disabilities that……… Then
cover all other physical health assessment methods/tools.

Present the results – the key findings, scores, outcomes of the assessments.
Present graphs, data, tables as required.

Slide Five etc:

Assessment of mental health or emotional and psychological needs – if they have a
mental health issue – tools and methods that were used e.g. Mini PAS-ADD 3rd ed.
(Moss, 2016), why tool was selected. Then all other mental health assessment
methods/tools.

Present the results – the key findings, scores, outcomes of the assessments.
Present graphs, data, tables as required.

Slide five/ six/ seven etc:

Assessment of challenging behaviours – tools, methods and rational for use.

Assessment of social skills – tool, rationale.

Assessment of risk – tool, rationale.

Present the results – the key findings, scores, outcomes of the assessments.
Present graphs, data, tables as required.

Next slide(s):
Formulation – present and discuss how the individual became ill/used challenging
behaviours or how their condition got worse or what is wrong in their life/what their
needs are. Present this as a flowchart or with pictures and images e.g. like a
formulation diagram for challenging behaviour.

See the example at the bottom of the last page. Each student’s formulation may be
more complicated – a diagram for other aspects of the individual’s life or a large
inter-connecting diagram where they all interplay with each other. Identify any proven
link between a cause and an illness and this can be referenced too e.g. smoking
exacerbates asthma (Smith, 2008) or unemployment predisposes to depression
(Smith, 2009) – put it in the box on the flow chart.

Next slide(s):
Recommended Interventions - Use a recognised multi-element framework e.g. Multi-
Element Model (LaVigna and Willis 1995), Bio-Psycho-Social (Engell 1977).

Interventions - a slide or two for each intervention for each area of need e.g. physical
health, mental health, challenging behaviours, social needs, risk.

If the individual has physical health problems identify the interventions for this e.g.
Obesity – exercise regime, weight reducing diet, activity – reference this e.g. Smith
(2009). Have a rationale for the interventions used.

If the individual has mental health problems identify some biological, psychological,
or social interventions to help with this (reference them).

Socially – are there issues around their housing, work, activities, education, skills,
benefits, being allowed to take risks, family, peer group, staff, DoLS, MCA – what
needs to change for them socially.

Risk management – reduce risks.

Next slide:
Identify your own strengths and limitations when carrying out this process – reflect
on where what you believe your strengths and limitations of carrying out this process
were, and how limitations can be rectified. How can you apply your strengths to your
limitations, how can you improve etc? This should just a couple of minutes at the
end.

Other requirements:
You will need a reference list at the end – you may have to spread this over several
slides, or it will be too small to read. Equivalent to 4000-word assignment!

You need to bring two copies of your slides printed out – 6 slides per page as a
handout should be fine.

The main aspects of this are the assessment, formulation, interventions – if you take
4-6 minutes on each of these that will leave you with 5 minutes or so for the rest.
You have 20 minutes, and there is a tolerance of 10% if you go slightly over (2
minutes).

Importantly rehearse – many times, to yourself or to colleagues (preserve

confidentiality). Do not read it in your head, read it out loud as you would on the day.
Remember you will talk faster, at least initially, if you are stressed/have increased
adrenaline on the day.

You can send me draft slides with notes and questions regarding them. Tutorials are
available for formative feedback regarding your work/presentation.

You are being assessed on the 14th June 2022, time slots will be provided, two
assessors will be present.
 Example formulation for asthma – this is a very rough example

Poor housing / Cold

damp. Housemates Anxious about
Poor concordance
smoke (shown to having an asthma
to medication
exacerbate asthma: attack
Jones, 2001, Willis, (Smith, 2009)
2004 etc)

Over weight
When he is anxious When he becomes
he comfort eats anxious increases
amount he smokes

(Smoking and
asthma: McCall,
Reluctant to 2006)
exercise due to
being over weight

(exercise & Asthma:

Jones, 2004) Poor understanding
Asthma
about medication
and difference
between
preventative and
reactive
medications