The intellectual and developmental disabilities clinical stream comprises two services: one for adults with an intellectual disability (also known as learning disability) and one for adults with neurodevelopmental conditions.
People with intellectual disability (also known as learning disability) make up about 2% of the population, meaning that in Nottingham and Nottinghamshire, there are about 21,000. It is expected that there will be a gradual increase the number of adults with intellectual disabilities known to services, leading to an overall increase of 11% by 2021. Just under a quarter of this group will have severe or profound intellectual disabilities requiring the expertise of specialist health services. Contributing factors to this increase are the increased survival rate among young children with severe and complex disabilities and also the reduced mortality among older adults with intellectual disabilities. In addition, a survey of special schools in Nottingham City showed a predicted rise of 44% by 2022. These numbers have significant implications for both specialist health and adult social care services.
We provide specialist health services for people with intellectual disabilities, focusing on those whose needs cannot be met by mainstream provision. We work to improve both mental and physical wellbeing of our service users, providing a tiered service offering consultation to mainstream services on the less complex needs, specialist time-limited care to those with more complex difficulties, and intensive intervention and care coordination to those with the most severe and complex needs.
To be eligible for our direct assessment and treatment services people must:
A: Be aged over 18 (age 16-18 only in exceptional circumstances and in direct liaison with children’s services)
B: Have an intellectual disability, i.e. all three of the following
- significant cognitive impairment
- significant impairment in adaptive functioning
- with onset before the age of 18
C: Have complex specialist health needs that can only be met by specialist services. Complex needs may include additional physical health problems, additional mental health problems, or serious risk issues.
Within the Intellectual Disability Service, we take a professional approach to providing services to people with intellectual disabilities. We aim to meet individual needs and ensure that people receive the support they require to live a fulfilling life within their local community. Our services are community focused in all aspects of service delivery, ensuring that all in-patient services have closely coordinated links with community-based services. The service is delivered by uni- and multi-professional teams. Some services focus on mental health, some on physical health, and some straddle both.
Assessment and Treatment is delivered within a stepped model: Routine assessment and treatment is delivered within, or in partnership with, nine multi-disciplinary and multi-agency Community Learning Disability Teams across Nottinghamshire. More intensive assessment and treatment, where there has been an increase in risk or deterioration in mental health, is delivered by two multi-disciplinary Intensive Community Assessment and Treatment Teams. The aim of these teams is to provide rapid-response, short-term advice and intervention, and to prevent placement breakdown where possible. The most intensive assessment and treatment is delivered in the Orion Unit, our new 16 bed inpatient Assessment and Treatment Unit. This provides a service for those people with an Intellectual Disability and associated challenging behaviour and mental health issues, who cannot be managed in the community at the time of their admission.
County and City Learning Disability Teams
In the community, our staff work in partnership with adult social care staff, many being located within Community Learning Disability Teams. All community nurses, physiotherapists and occupational therapists are co-located; other professions are co-located in some teams.
Joint health and social care team co-located within the CIDT (not integrated). Multi-disciplinary and multi-agency teams. Supports a range of professionals: Consultant Psychiatrists, Occupational Therapists, physiotherapists, Social Workers, Welfare Rights Officers, Speech and Language Therapists and Clinical Psychologists. Gatekeeper to needs led services. Transition service for clients aged 16 - 18 available.
Within the Country of Nottinghamshire, the service has teams working from Ashfield, Mansfield, Gedling, Broxtowe, Rushcliffe, Bassetlaw and Newark and within the City of Nottingham from Bulwell Riverside and Clifton Corner Stone.
Assessment and treatment locations
Orion Unit at Highbury Hospital Short term admission to ascertain and develop an MDT Treatment Plan, which would enable a swift return to either a permanent long term residence or an agreed alternative environment to meet an individual’s changing needs.
Locked Rehabilitation Unit Alexandra House - Step down from low secure provision, Rehabilitation of offending behaviours, including individuals who have been presented to court. Index offences include: Arson, sex offending, physical aggression / assault. Focus on rehabilitation and reintegration into community settings.
Day Services at Holly Lodge in Newark, Bungalow 1 in Mansfield and Horizon at Highbury Hospital Day services for people with a range of challenging behaviour and complex needs, people with a learning disability and / or associated mental health needs and provides individualised and longer-term treatment packages for people with significant levels of need. Provision also available for those with additional physical disabilities. Day Assessment and Treatment packages. Peripatetic service to meet individual needs.
Other teams that work within the service include Epilepsy Specialists’ Nurses, Acute ID liaison Nurses. ID primary Care Nurses.
Adult Neurodevelopmental Service Provides diagnostic assessments for Asperger syndrome and offers multidisciplinary support to clients who have been diagnosed with Asperger syndrome. This service is hosted within the ID clinical stream, but the clients it serves do not have an intellectual disability. In additional Assessment, diagnosis and treatment service for people with ID and autism. Also clinical psychology and psychiatry provide diagnostic assessments and management of attention deficit hyperactivity disorder (ADHD). The Adult ADHD clinic provides diagnostic assessments for previously undiagnosed adults suspected of having attention deficit hyperactivity disorder (ADHD), medication initiation and titration, neuropsychological assessment, psychological interventions.