Individuals with intellectual disabilities experience comorbid physical and mental illnesses and have poorer health outcomes, resulting in early mortality of 15-20 years when compared to the general public. This inequality is distressing, particularly as it is preventable and avoidable with good quality health provisions. The NHS Long Term Plan (2019) highlights commitment to tackle preventable deaths in those with intellectual disabilities by improving health checks, increasing staff awareness, and understanding of intellectual disabilities.
Currently, healthcare professionals commonly report lacking awareness of comorbidities in individuals with intellectual disabilities, as well as feeling unprepared to provide support, appropriate treatment, and make reasonable adjustments. Thus, it is unsurprising that individuals with intellectual disabilities have negative experiences with healthcare professionals and in healthcare environments. There is currently a lack of education and training to support individuals with intellectual disabilities; whilst some education and training does exist, there is limited research supporting the effectiveness, particularly regarding the impact on clinical practice and the improvement of patient care.
Maudsley Learning has recently published an academic paper highlighting the positive impact of simulation training on clinical practice and care specifically for individuals with intellectual disabilities. To our knowledge, it is the first paper investigating the longitudinal impact of simulation training and the positive effects on clinical practice.
About the project
Participants attending a one–day simulation course called ‘Meeting the Health Needs of People with Learning Disabilities’. This one-day interprofessional course focused on how learning disabilities affect people, the challenges of physical and mental health inequalities, barriers to accessing healthcare, and ways to overcome these issues through reasonable adjustments. The training involved simulated scenarios with actors with a intellectual or learning disability from the Baked Bean Company, and reflective debriefs to consolidate learning led by our skilled facilitators. This course was coproduced with experts by experience as well as subject matter experts. In particular, the Estia Centre – which is widely acknowledged as one of the market leaders in training and research in mental health and intellectual disabilities – aided in the coproduction of this course. We have an animation to explain our mental health training using simulation available here.
We conducted interviews with delegates 12- 18 months post-training in order to gain an understanding of what they remembered about the course, what they felt they learnt, what changes had occurred, and how this impacted their practice. Notably, the most significant findings emerging from the data fell into the categories of communication skills and tools, patient-centred care, reflective practice, multi-disciplinary working, and improvements in making reasonable adjustments. The results have significant clinical implications, with the potential to improve clinical practice of healthcare professional, as well as the experience and potentially health outcomes for individuals with intellectual disabilities. Evaluating the outcomes of training can be difficult. Research suggest that much of the knowledge and skills gained during training is lost as soon as 1–month post training (Cecilio-Fernandes et al, 2018), and virtually nothing is retained after 12 months (Sak, & Belcourt, 2006). The current research is noteworthy, demonstrating knowledge and skills retained 12 to 18 months post training with significant changes to clinical practice. However, as this paper is the first of its kind, more research is needed.
Future Developments
Maudsley Learning and Maudsley Simulation are continuing to develop the research described above further, although more funding is needed to advance this research. Initially constructed for multi–professional groups across the community and general inpatient settings, the course has now been adapted to train individuals from uni–professional groups with more limited exposure to individuals with a learning or intellectual disability, and to more specialised forensic services. Specifically, we have adapted the course to the University of Greenwich Nursing Associate Programme and to the Forensic Unit at Bethlem.
Conclusion
The preliminary findings described above suggest, Maudsley Simulation’s –‘Meeting the Health Needs of People with Learning Disabilities’ training course, has a sustainable impact to clinical practice which has the potential to improve the care and treatment of those with intellectual disabilities. Whilst more research is needed, this innovative coproduced course, whilst more expensive, could be a more effective training modality compared to tradition methods which could yield a higher return in investment.
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The research described below was funded by Health education England (HEE), the full report, executive summary and easy read version can be seen here. This research has been published in the Advances in Mental Health and Intellectual Disabilities journal, to access the full academic paper please click here
References
Iannelli, H., Tooley, C., Billon, G., Cross, S., Pathan, J., & Attoe, C. (2020). Improving clinical practice through simulation training on intellectual disabilities: a longitudinal study. Advances in Mental Health and Intellectual Disabilities.
Cecilio-Fernandes, D., Cnossen, F., Jaarsma, D.A. and Tio, R.A., 2018. Avoiding surgical skill decay: a systematic review on the spacing of training sessions. Journal of Surgical Education, 75(2), pp.471-480.
Saks, A.M. and Belcourt, M., 2006. An investigation of training activities and transfer of training in organizations. Human Resource Management: Published in Cooperation with the School of Business Administration, The University of Michigan and in alliance with the Society of Human Resources Management, 45(4), pp.629-648.
Article written by Hannah Iannelli of Maudsley Learning