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Referral
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Community Learning Disabilities Team - Plymouth
Plymouth's Community Learning Disabilities Team (CLDT) provides specialist assessments and interventions to people whose lives and needs are complex as a result of their learning disabilities.
We provide support to families, carers and provider organisations to improve the quality of their service delivery and ability to meet the needs of those they support
Before making a referral to the CLDT, referrers must ask themselves the following:
If I did not think that this person had learning disabilities, where would I direct the referral? Where appropriate people with learning disabilities should be directed to the relevant mainstream service in accordance with their presenting need.
The CLDT can support and facilitate mainstream services to make reasonable adjustments so that people with learning disabilities can have fair and equal access to services.
Out of scope
People whose functioning is impaired as a result of a:
- Condition that arose after the age of 18 (e.g. neurological insult).
- Mental or physical health issues (rather than learning disabilities)
People with an autism spectrum disorder, whose intellectual functioning is in the normal range. If diagnosis of autism is required for someone without learning disabilities please refer to Community Mental Health Teams for Psychiatric opinion.
People with learning disabilities whose primary presenting issue is mild to moderate depression or anxiety that meets criteria for Plymouth Options. Plymouth Options can consult with us as required to enable them to work with people with mild learning disabilities.
People who do not identify as having learning disabilities often prefer not to engage with a Community Learning Disabilities Team. We recommend that referrers discuss this with people prior to contacting us.
People with primary social care needs (e.g. housing, help with employment or benefits, support with daily living skills)
People whose predominant need is related to their physical health, including all referrals for physiotherapy, adaptations and equipment. If a person has an identified need for these services, unrelated to their learning disabilities, he or she should be referred to the relevant generic physiotherapy or occupational therapy team. Community Therapies Team (Health) or Adult Social Care.
People with GPs outside of the Plymouth locality.
National guidance from the British Psychological Society recommends that women in late pregnancy, or who have just given birth should not be offered an assessment of their intellectual disabilities. Please do not refer women for assessment of their learning disabilities if they are in their last trimester of pregnancy or in the first three months of having their baby.
If the referrer wishes to access the CLDT, they should consider the following:
1) Does this person have significant and global learning disabilities? This is defined as:
- Significantly reduced cognitive/intellectual functioning, usually defined by a standardised intelligence test score 2 standard deviations below the mean (i.e. full scale IQ of 69 or below).
- Concurrent deficits in adaptive and social functioning. This is defined as the person's effectiveness in meeting the standard expected for their age in at least two of the following: communication; self-care; home living; social – interpersonal skills; use of community resources; self-direction; functional academic skills; work; leisure; health and safety.
- Onset before age 18 years.
All three must be present if the person is to be identified as having learning disabilities. Referrers can use the decision aid tree to i) aid their decision about whether to refer to CLDT, ii) gather information to include on the referral:
2) Does this person require specialist learning disabilities health services?
- Does their behaviour significantly challenge other people such that there is (or there is risk of) physical/emotional harm to the person or others; damage to property; placement breakdown.
- Does the person experience levels of emotional distress or mental health issues that are influenced by their learning disabilities and have a significant impact on their health and well-being (e.g. are they self-harming; isolating themselves; finding themselves in risky situations)
- Does the person require specialist support in order for their health needs to be met or for reasonable adjustments to be made to mainstream services (e.g. desensitisation work for a needle phobia prior to essential blood test)
- Does the person require a specialist assessment regarding their functional ability and/or to promote their engagement in meaningful activities?
- Does the person require a specialist assessment of their communication skills?
- Is there a query about dementia that could not be assessed within mainstream Older People's Mental Health services (N.B. Most people with global learning disabilities, and who are eligible for CLDT will require dementia assessment to take place within CLDT).
- Where people with learning disabilities present with a sudden, acute onset of behaviour that challenges the following needs to be ruled out:
- An undiagnosed health condition
- Abuse. Safeguarding alerts to be made to Adult Social Care on 306900.
- People who present with high risk of suicide should be directed to appropriate mental health services. If they require immediate attention, please contact the Emergency Department.
- Prior to referral for assessment of mental health/dementia please consider the following blood tests;
- full blood count
- electrolytes
- calcium
- glucose
- renal and liver function
- thyroid function and vitamin B12 and folate
Primary Care health services can support people with learning disabilities to access their services by:
- Using simple language. Avoid complex medical terms. Keep sentences short and allow people time to process what you have said.
- Use visual prompts to aid communication (e.g. a picture of a procedure).
- Speak to the person with learning disabilities first, and only check with the carer/family if something is not clear. Be sensitive to the person's feelings and encourage them to talk to you (be mindful that they may be used to people speaking for them).
- Book appointment times at the beginning or end of the day to minimise waiting times.
- Allow extra time for the appointment.
- Check back understanding: ("I want to check that we have understood each other. Please can you tell me in your own words what we need to do next?").
- Be mindful that closed "yes or no" questions can lead to people acquiescing. Try asking open questions, or changing the question round to see if you still get the same response.
- Time concepts can be tricky for people with learning disabilities. Use events that the person might understand (e.g. "take this with breakfast and supper").
Referral Criteria
Please follow the guidance above to help you decide whether or not to refer.
Please include information gathered using the
decision aid tree as advised in the 'assessment' section above.
Livewell Southwest - Community Learning Disabilities Team referral form
Referral Instructions
For referral to Community Learning Disabilities Team
- e-Referral service selection
- Specialty: Mental Health
- Clinic type: Not otherwise specified
- Service: DRSS-Western-Mental Health-Adult- Devon ICB-15N
For Patient Self-Referral
Forms can be sent to:
Community Learning Disabilities Team
Westbourne
Scott Business Park
Beacon Park Rd
Plymouth, PL2 2PQ
Tel: 0845 155 8077
Referrals can be sent via email to our Referral Co-ordinator: vickycarr@nhs.net
Referral form
Livewell Southwest - Community Learning Disabilities Team referral form
Patient information
Livewell Southwest - Community Learning Disabilities Team
Livewell Southwest - Community Learning Disabilities Team - Occupational Therapy
British Institute of learning disabilities
NHS Choices - What is a learning disability?
Long-term Condition Self-Management Programme
GPs and patients can refer to Improving Lives Plymouth for patient support with any long-term physical or low level mental health condition. The service helps people to better manage their condition and to achieve a better quality of life.
Evidence
'Valuing People Now' (Department of Health, 2009)
'Healthcare for All' (Department of Health, 2008)
Mansell Report' (Department of Health, 2007)
Pathway Group
his guideline has been signed off by the Psychological Therapies Strategic and Implementation Group on behalf of NHS Devon.
Publication date: May 2016
