integrated mental health & learning disabilities cluster training second phase 2014-15
TRANSCRIPT
Integrated Mental Health & Learning Disabilities Cluster
Training
Second Phase 2014-15
Objectives
By the end of the session you should have an understanding of:•The rationale behind the updated MH & LD Clustering Tool (MHLDCT)•Who is responsible for clustering and when•Each item within the tool and additional guidance to accompany it•The content of the clusters•The decision tree for cluster allocation•How to score and cluster a case•Movement between clusters
History of Care Pathways & Packages
• Developed originally to increase use of evidence based practice and reduce inconsistent treatment.
• A number of Trusts as part of the Care Pathways & Packages Project Consortium have led this development nationally.
• The Mental Health Clustering Tool is now a recognised and mandated tool for all Working Age and Older Peoples Services.
• A list of relevant care packages and a quality & outcomes framework have been developed for Working Age Adult and Older Peoples Services.
Using the Integrated MHLDCT
• It is a summary of need not a clinical assessment.• It rates current problems in terms of impact on client.• It also rates historical problems.• The tool should be completed within two contacts.• It is seeks to identify the most significant presenting
need.• The cause of the problem and the interventions used
are NOT included in making a rating.• The more the MHLDCT is used the more reliable and
efficient it will be for users.
Responsibility for Clustering
• Lead Professional, Care Coordinator OR Delegated Professional are responsible for clustering.
• BUT at any given time a significant change may occur with a client’s presentation where the person normally responsible for clustering may not be available.
• E.g. if a client was admitted to an inpatient unit under Mental Health Act section or from out of area then professionals within that inpatient unit would cluster.
MHLDCT – Overview
• The first section in the tool contains a number of items to rate.
• There are Two Parts (Current and Historical) to this section: Part 1 Problems in the past two weeks
Items 1-13 are taken from the original MHCTItems 30-31 are LD specific
Part 2 Historical Issues (including the past two weeks)Items A-E are taken from the original MHCTItems I-K are LD specific
MHLDCT – Overview
Part 1 Problems in the past two weeks
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental-self injury
3 Problem drinking or drug taking
4 Cognitive problems
5 Physical illness or disability problems
6 Problems associated with hallucinations and delusions
7 Problems with depressed mood
8 Other mental and behavioural problems
9 Problems with relationships
10 Problems with activities of daily living
11 Problems with living conditions
12 Problems with occupation and activities
13 Strong unreasonable beliefs occurring in non-psychotic disorders only
30 Non accidental Self Injury (associated with cognitive impairment
31 Physical problems with eating and drinking
LD specific items
A Agitated behaviour / expansive mood
B Repeat self-harm
C Safeguarding children & vulnerable dependant adults
D Engagement
E Vulnerability
I Social Communication and interaction difficulties
J Problems with communication
K Seizures
LD specific items
MHLDCT – Overview
Part 2 Historical issues
MHLDCT – General scoring guidance
• Rate every item using the 0- 4 scale where
0-1 = sub clinical requiring ‘no action’2 = mild problem but definitely present3 = moderately severe problem4 = severe to very severe problem
• Also, Check Score Guide for examples and anchor points.
• Score each item in turn and don’t rate an aspect of a client’s presentation twice
• For Item 8 – choose and rate the most severe problem if relevant.
A. Agitated behaviour/ expansive mood (historical)
Rate agitation and overactive behaviour causing disruption to social role functioning. Behaviour causing concern or harm to others. Elevated mood that is out of proportion to circumstances.
Include such behaviour due to any cause (e.g. drugs, alcohol, dementia, psychosis, depression etc).
Excessive irritability, restlessness, intimidation, obscene behaviour and aggression to people animals or property.
Do not include odd or bizarre behaviour to be rated at Scale 6.
2 Makes verbal/gestural threats. Pushes/pesters but no evidence of intent to cause serious harm. Causes minor damage to property (e.g. glass or crockery). Is obviously over-active or agitated.
3 Agitation or threatening manner causing fear in others. Physical aggression to people or animals.
Property destruction. Serious levels of elevated mood, agitation, restlessness causing significant disruption to functioning.
4 Serious physical harm caused to persons/animals. Major destruction of property. Seriously intimidating others or exhibiting highly obscene behaviour.
Elevated mood, agitation, restlessnesscausing complete disruption.
Rate 9 if not known
Exampleof Need for Accurate Rating:
MHLDCT - Additional Guidance
- Additional guidance has been put together to provide clarity on certain items and to explain how some of the Mental Health examples apply in Learning Disabilities
- Guidance was derived from the first pilot with clinicians
Eg. Scale 4: Cognitive Problems• Please be aware that the anchor points in this question
may not be helpful for learning disabilities clients, it may be easier to revert to the generic scale for this item.
• In this context, 0 = no learning disabilities; 1= borderline learning disabilities; 2= mild learning disabilities; 3=moderate learning disabilities; 4=severe to profound learning disabilities.
• Where the person is experiencing dementia or other additional difficulties that may impact on cognitive impairment, score the most severe impairment for the person.
MHLDCT – Using the Decision Tree
The Decision Tree helps to reduce the range of potential clusters for allocation. To do this:
1.Firstly you need to identify the ‘super class’ (Non-psychosis, Psychosis or Organic) that the client may fit best with.
2.Then consider the particular need/level of complexity/severity relevant to the client within that super class.
3.You should then be able to reduce the list of potential clusters for allocation.
DECISON TREE(RELATIONSHIP OF CLUSTERS TO EACH OTHER)
Acuity
New Learning Disability Specific Clusters
9A Maintenance, engagement and minor support needs, complicated by LD
9B Risk to self, complicated by LD
9C Risk to others complicated by LD
9D Risk to others, complicated by mild LD & ASD
9E Risk to others, complicated by moderate - profound LD & ASD
9F Risk to others & self, complicated by moderate - profound LD & ASD
22 Physical health complicated by mild LD
23 Physical health complicated by moderate - profound LD
24 Physical health with dysphagia complicated by moderate - profound LD
Care Cluster 9d Risk to others, complicated by mild LD & ASD
Description: This group will be displaying physical and/or verbal aggression towards others but not self-injurious behaviour. They will be experiencing social and communication difficulties and have relatively mild: cognitive impairment; problems with adaptive functioning; social communication and interaction difficulties; self-regulation (emotional and/or behavioural).
Likely primary diagnosis: Significant challenging behaviour. F70 Mild Learning Disabilities. F84 Pervasive Development al Disorders.
Unlikely primary diagnosis: Minimal or no challenging behaviour. F71-73 Moderate – Profound Learning Disabilities. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30-39 Mood (affective) disorders, F40-48 Neurotic, stress-related and somatoform disorders, F50 Eating disorders, F60-69 Personality disorders
Impairment: ADLs and/or role functioning are likely to be significantly affected. Risk: Risk of injury to others. Course: Episodic. Unlikely to improve without intervention. Life-long vulnerability. Likely NICE Guidance: Adults with Autism CG142, Challenging behaviour and Learning Disabilities due 2015. Drawing on existing NICE guidance as appropriate Service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Common mental health disorders CG123.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury
3 Problem drinking or drug taking
4 Cognitive Problems
5 Physical Illness or disability problems 6 Hallucinations and Delusions
7 Depressed mood *
8 Other mental and behavioural problems * 9 Relationships
10 Activities of daily living
11 Living conditions 12 Occupation & Activities
13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood
B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement
E Vulnerability
F Social communication difficulties G Communication problems
H Seizures
Must score Unlikely to score
Expected to score No data available
May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
Example Cluster Profile
Using the scoring profile
Make sure the scoring fits in with the Must Scores (‘Red rules’)
If they don’t fit but the cluster profile is a good match then go back and check your scoring to see if you under/overscored.
Use the Expected to score (orange) and May score (yellow) to help decide between different clusters, check that you’ve got a reasonable match with the profile and check you’re not under/overscoring.
Using the Variance Cluster
There may be times when the client’s needs do not readily fit an existing cluster profile. On these occasions the Variance Cluster may be used (Cluster 0).
However, this is likely to happen less than 10% of the time and it’s important that the Variance Cluster is only used as a last resort.
It is much more helpful in terms of understanding needs to have a cluster profile allocated but with concerns noted in ‘Additional Information’.
Retrospective clustering
The current scores might not reflect the patient’s needs at the point of assessment if the care package is working.
SO…Choose a superclass that best fits the patient’s needs over their time in the service.Consider the long term presentation of the patient and complexity rather than changes in severity.Consider the patient’s needs at their worst.Record appropriate cluster according to this and place a comment in the free text box confirming “this is a retrospective cluster”.
You allocate to a Cluster by using your Decision Tree
Choices &the MHLDCT scores
identify the most appropriate
‘Cluster Profile’
Care clusters identify needs of clients at a particular ‘moment in time’
Clusters allow for a certain amount of fluctuation in condition But a significant change in condition will often lead to a change in
cluster allocation. So a client’s journey may involve them moving through a range of
clusters as their condition changes over time
How do we re-allocate clusters?
We use Cluster Reviews to help understand this.
These happen on a significant change (e.g. admission to inpatient services) or at planned
reviews (typically six monthly).
Examples of when not to cluster
• No allocation to cluster on discharge but you will do a new set of scores on discharge
• No MHLDCT if only a one-off assessment or the client does not require services and it is identified that no interventions/treatment is required
Begin using the Clustering Process now
for
• all new assessments (by second contact) that lead to further assessment or treatment
• all Reviews Planned/Unplanned • Any other significant change of circumstance.
Give it a go
(Using real cases or vignettes as a practice)
Cluster Profiles for Information
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Care Cluster 9A Maintenance, engagement & minor support needs, complicated by LD
Description: This group will be experiencing minor difficulties with one or more of the following: emotional distress, behavioural dysfunction, vulnerability to others and history of aggressive behaviour. They will be likely to have relatively mild levels of: cognitive impairment; impairment in adaptive behaviours and self-regulation (emotional and/or behavioural). They are unlikely to be experiencing significant social communication & interaction difficulties
Likely primary diagnosis: F70 Mild Learning Disabilities. Minimal or no challenging behaviour.
Unlikely primary diagnosis: F71-73 Moderate – Profound Learning Disabilities. Significant challenging behaviour. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30-39 Mood (affective) disorders, F40-48 Neurotic, stress-related and somatoform disorders, F50 Eating disorders, F60-69 Personality disorders
Impairment: Some problems with ADL and role functioning
Risk: Current low levels of risk but potential for: placement breakdown, social isolation, limited social activity and occupation associated with increased vulnerability.
Course: Episodic. Unlikely to improve without intervention. Life-long vulnerability.
Likely NICE Guidance: Drawing on existing NICE guidance as appropriate including service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Depression with Chronic Health Problems CG91, Common mental health disorders CG123, OCD CG31.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury
3 Problem drinking or drug taking
4 Cognitive Problems
5 Physical Illness or disability problems 6 Hallucinations and Delusions
7 Depressed mood *
8 Other mental and behavioural problems * 9 Relationships
10 Activities of daily living
11 Living conditions 12 Occupation & Activities
13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood
B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement
E Vulnerability
F Social communication difficulties G Communication problems
H Seizures
Must score Unlikely to score
Expected to score No data available
May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Care Cluster 9B Risk to self, complicated by LD
Description: This group will be displaying self-injurious behaviour. They will not be experiencing significant social communication & interaction difficulties. They are likely to have mild to severe: cognitive impairment, impairment in adaptive behaviours, general communication difficulties, self-regulation (emotional and/or behavioural).
Likely primary diagnosis: F71-73 Moderate – Profound Learning Disabilities. Significant challenging behaviour. Unlikely primary diagnosis: F70 Mild Learning Disabilities. Minimal or no challenging behaviour. F84 Pervasive Development al Disorders. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30-39 Mood (affective) disorders, F40-48 Neurotic, stress-related and somatoform disorders, F50 Eating disorders, F60-69 Personality disorders
Impairment: ADLs and/or role functioning are likely to be significantly affected. Risk: Current high levels of injury to self.
Course: Episodic. Unlikely to improve without intervention. Life-long vulnerability.
Likely NICE Guidance: Challenging behaviour and Learning Disabilities (due 2015). Drawing on existing NICE guidance as appropriate Service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Common mental health disorders CG123.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury 3 Problem drinking or drug taking 4 Cognitive Problems 5 Physical Illness or disability problems 6 Hallucinations and Delusions
7 Depressed mood * 8 Other mental and behavioural problems * 9 Relationships
10 Activities of daily living 11 Living conditions 12 Occupation & Activities 13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood
B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement E Vulnerability F Social communication difficulties G Communication problems
H Seizures
Must score Unlikely to score Expected to score No data available May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
Care Cluster 9C Risk to others, complicated by LD
Description: This group will be displaying physical and/or verbal aggression towards others. They will not be experiencing significant social communication & interaction difficulties. They are likely to have mild to moderate: cognitive impairment, adaptive functioning impairment, general communication difficulties, self-regulation - emotional and/or behavioural.
Likely primary diagnosis: F70-73 Mild – Profound Learning Disabilities. Significant challenging behaviour. Unlikely primary diagnosis: Minimal or no challenging behaviour. F84 Pervasive Development al Disorders. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30-39 Mood (affective) disorders, F40-48 Neurotic, stress-related and somatoform disorders, F50 Eating disorders, F60-69 Personality disorders
Impairment: ADLs and/or role functioning are likely to be significantly affected. Risk: Risk of injury to others.
Course: Episodic. Unlikely to improve without intervention. Life-long vulnerability.
Likely NICE Guidance: Challenging behaviour and Learning Disabilities (due 2015). Drawing on existing NICE guidance as appropriate Service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Common mental health disorders CG123.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury 3 Problem drinking or drug taking 4 Cognitive Problems 5 Physical Illness or disability problems 6 Hallucinations and Delusions
7 Depressed mood * 8 Other mental and behavioural problems * 9 Relationships
10 Activities of daily living 11 Living conditions 12 Occupation & Activities 13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood
B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement E Vulnerability F Social communication difficulties G Communication problems
H Seizures
Must score Unlikely to score Expected to score No data available May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Care Cluster 9d Risk to others, complicated by mild LD & ASD
Description: This group will be displaying physical and/or verbal aggression towards others but not self-injurious behaviour. They will be experiencing social and communication difficulties and have relatively mild: cognitive impairment; problems with adaptive functioning; social communication and interaction difficulties; self-regulation (emotional and/or behavioural).
Likely primary diagnosis: Significant challenging behaviour. F70 Mild Learning Disabilities. F84 Pervasive Development al Disorders.
Unlikely primary diagnosis: Minimal or no challenging behaviour. F71-73 Moderate – Profound Learning Disabilities. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30-39 Mood (affective) disorders, F40-48 Neurotic, stress-related and somatoform disorders, F50 Eating disorders, F60-69 Personality disorders
Impairment: ADLs and/or role functioning are likely to be significantly affected. Risk: Risk of injury to others.
Course: Episodic. Unlikely to improve without intervention. Life-long vulnerability.
Likely NICE Guidance: Adults with Autism CG142, Challenging behaviour and Learning Disabilities due 2015. Drawing on existing NICE guidance as appropriate Service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Common mental health disorders CG123.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury 3 Problem drinking or drug taking 4 Cognitive Problems 5 Physical Illness or disability problems 6 Hallucinations and Delusions 7 Depressed mood * 8 Other mental and behavioural problems * 9 Relationships
10 Activities of daily living 11 Living conditions 12 Occupation & Activities 13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement E Vulnerability F Social communication difficulties G Communication problems H Seizures
Must score Unlikely to score Expected to score No data available May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Care Cluster 9E Risk to others, complicated by moderate - profound LD & ASD
Description: This group will be displaying physical and/or verbal aggression towards others but not self-injurious behaviour. They will have moderate to severe: cognitive impairment; problems with adaptive functioning, social communication & interaction difficulties, self-regulation (emotional and/or behavioural). Likely primary diagnosis: Significant challenging behaviour. F71-73 Moderate – Profound Learning Disabilities. . F84 Pervasive Development al Disorders. Unlikely primary diagnosis: Minimal or no challenging behaviour. F70 Mild Learning Disabilities. F84 Pervasive Development al Disorders. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30-39 Mood (affective) disorders, F40-48 Neurotic, stress-related and somatoform disorders, F50 Eating disorders, F60-69 Personality disorders
Impairment: ADLs and/or role functioning are likely to be significantly affected. Risk: Risk of injury to others. Course: Episodic. Unlikely to improve without intervention. Life-long vulnerability. Likely NICE Guidance: Adults with Autism CG142, Challenging Behaviour and Learning Disabilities due 2015. Drawing on existing NICE guidance as appropriate Service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Common mental health disorders CG123.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury 3 Problem drinking or drug taking 4 Cognitive Problems 5 Physical Illness or disability problems 6 Hallucinations and Delusions 7 Depressed mood * 8 Other mental and behavioural problems * 9 Relationships
10 Activities of daily living 11 Living conditions 12 Occupation & Activities 13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement E Vulnerability F Social communication difficulties G Communication problems H Seizures
Must score Unlikely to score Expected to score No data available May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Care Cluster 9F Risk to others & self, complicated by moderate - profound LD & ASD
Description: This group will be displaying physical and/or verbal aggression towards others and self-injurious behaviour. They will have moderate to severe: cognitive impairment; problems with adaptive functioning; social communication & interaction difficulties; self-regulation (emotional and/or behavioural). Likely primary diagnosis: Significant challenging behaviour. F71-73 Moderate – Profound Learning Disabilities. . F84 Pervasive Development al Disorders. Unlikely primary diagnosis: Minimal or no challenging behaviour. F70 Mild Learning Disabilities. F84 Pervasive Development al Disorders. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30-39 Mood (affective) disorders, F40-48 Neurotic, stress-related and somatoform disorders, F50 Eating disorders, F60-69 Personality disorders
Impairment: ADLs and/or role functioning are likely to be significantly affected. Risk: Risk of injury to others and self. Course: Episodic. Unlikely to improve without intervention. Life-long vulnerability.
Likely NICE Guidance: Adults with Autism CG142, Challenging behaviour and Learning Disabilities due 2015. Drawing on existing NICE guidance as appropriate including Service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Common mental health disorders CG123.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury
3 Problem drinking or drug taking
4 Cognitive Problems
5 Physical Illness or disability problems 6 Hallucinations and Delusions
7 Depressed mood *
8 Other mental and behavioural problems * 9 Relationships
10 Activities of daily living
11 Living conditions 12 Occupation & Activities
13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood
B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement
E Vulnerability
F Social communication difficulties G Communication problems
H Seizures
Must score Unlikely to score
Expected to score No data available
May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Care Cluster 22 Physical health, complicated by mild LD
Description: This group will be experiencing significant physical health problems complicated by difficulties associated with mild learning disabilities which make unsupported access to mainstream services problematic. They will have mild: cognitive impairment; problems with adaptive functioning, impairments in self-care and communication difficulties.
Likely primary diagnosis: F70 Mild Learning Disabilities. G40-41Epilepsy. R25-29 Nervous & Musculoskeletal Systems Unlikely primary diagnosis: F71-73 Moderate – Profound Learning Disabilities F33 Recurrent depressive disorder , F40-48 Neurotic, stress-related and somatoform disorders, F50 Eating disorders, F60 Specific personality disorders, F50 Eating Disorder. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30 Manic Episode, F31 Bipolar Disorder
Impairment: Some problems with ADL and role functioning
Risk: Risk of self-neglect and physical harm through their problems in maintaining their own personal wellbeing. Course: Episodic. Life-long vulnerability Likely NICE Guidance: Drawing on existing NICE guidance as appropriate including Epilepsy CG20, Service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Common mental health disorders CG123.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury
3 Problem drinking or drug taking
4 Cognitive Problems 5 Physical Illness or disability problems
6 Hallucinations and Delusions
7 Depressed mood * 8 Other mental and behavioural problems *
9 Relationships 10 Activities of daily living
11 Living conditions
12 Occupation & Activities 13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood
B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement E Vulnerability
F Social communication difficulties
G Communication problems H Seizures
Must score Unlikely to score
Expected to score No data available May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
Care Cluster 23 Physical health, complicated by moderate - profound LD
Description: This group will be experiencing significant physical health problems complicated by difficulties associated with moderate to profound learning disabilities (e.g. specific neurological impairments; sensory impairments). They will have moderate to profound: cognitive impairment; problems with adaptive functioning, impairments in self-care and communication difficulties.
Likely primary diagnosis: F71-73 Moderate - Profound Learning Disabilities. G40-41Epilepsy. R25-29 Nervous & Musculoskeletal Systems Unlikely primary diagnosis: F70 Mild Learning Disabilities. D13 Dysphagia. F33 Recurrent depressive disorder , F40-48 Neurotic, stress-related and somatoform disorders, F50 Eating disorders, F60 Specific personality disorders, F50 Eating Disorder. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30 Manic Episode, F31 Bipolar Disorder
Impairment: ADLs and role functioning will be severely affected Risk: Risk of self-neglect and physical harm through their inability to maintain their own personal wellbeing. Course: Episodic. Life-long vulnerability Likely NICE Guidance: Drawing on existing NICE guidance as appropriate including Epilepsy CG20, Service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Common mental health disorders CG123.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury 3 Problem drinking or drug taking 4 Cognitive Problems 5 Physical Illness or disability problems 6 Hallucinations and Delusions 7 Depressed mood * 8 Other mental and behavioural problems * 9 Relationships
10 Activities of daily living 11 Living conditions 12 Occupation & Activities 13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement E Vulnerability F Social communication difficulties G Communication problems H Seizures
Must score Unlikely to score Expected to score No data available May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
1 2 3 4 5 6 7 8 9A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Care Cluster 24 Physical health with dysphagia, complicated by moderate - profound LD
Description: This group will be experiencing significant physical health problems complicated by difficulties associated with moderate to profound learning disabilities (e.g. specific neurological impairments; sensory impairments). They will have definite physical difficulties eating and drinking safely. They will have severe to profound: cognitive impairment; problems with adaptive functioning; impairments in self-care.
Likely primary diagnosis: F71-73 Moderate-Profound Learning Disabilities. D13 Dysphagia. Unlikely primary diagnosis: F70 Mild Learning Disabilities. F32 Depressive Episode, F40 Phobic Anxiety Disorders, F41 Other Anxiety Disorders, F42 Obsessive-Compulsive Disorder, F43 Stress Reaction / Adjustment Disorder, F50 Eating Disorder. F00-03 Dementias, F20-29 Schizophrenia, schizotypal and delusional disorders , F30 Manic Episode, F31 Bipolar Disorder
Impairment: ADLs and role functioning will be severely affected Risk: Risk of self-neglect and physical harm through their inability to maintain their own personal wellbeing. Specific risks associated with, health nutrition &, hydration.
Course: Episodic. Life-long vulnerability Likely NICE Guidance: Drawing on existing NICE guidance as appropriate including Epilepsy CG20, Service user experience in adult mental health CG136, Anxiety CG113, Depression in adults CG90, Common mental health disorders CG123.
NO ITEM DESCRIPTION RATING
0 1 2 3 4
1 Overactive, aggressive, disruptive or agitated behaviour
2 Non-accidental self-injury
3 Problem drinking or drug taking
4 Cognitive Problems
5 Physical Illness or disability problems 6 Hallucinations and Delusions
7 Depressed mood *
8 Other mental and behavioural problems * 9 Relationships
10 Activities of daily living
11 Living conditions 12 Occupation & Activities
13 Strong Unreasonable Beliefs
14 Non-accidental self-injury (associated with cognitive impairment)
15 Physical Problems with eating and drinking
A Agitated behaviour/expansive mood
B Repeat Self-Harm
C Safeguarding other children & vulnerable dependant adults
D Engagement
E Vulnerability
F Social communication difficulties G Communication problems
H Seizures
Must score Unlikely to score
Expected to score No data available
May score
*Use the highest rating from Scales 7 & 8 when deciding if the rating fits the range indicated.
1 2 3 4 5 6 7 89A
9B
9C
9D
9E
9F
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24