Scenarios

Chapter 14: Health promotion and people with learning disabilities

Lorna is a 35-year-old British-born woman of East African descent. She has a mild learning disability. Lorna lives in flat in an inner city with her 31/2-year-old son Samuel. Lorna has no contact with Samuel's father. Lorna and Samuel's flat is quite small. It has a cramped living/dining room that is usually cluttered with Samuel's toys. There is a galley kitchen, a bedroom for Lorna and a box room for Samuel. There are damp patches in the kitchen, bathroom and lounge area since the flat above them had a leak about a year ago.

Lorna is overweight and this has worsened since Samuel was born. In the past year, Lorna has gained 1 stone (about 6.5 kg). In the past three months, Lorna has been experiencing frequent throbbing headaches, and she becomes short of breath when she takes Samuel to nursery three days a week. This scares Lorna so she tends to stay indoors more now. Lorna only has a few clothes that fit her at her current weight. She doesn't see the point of showering or putting on clean clothes when she isn't going out.

Samuel is generally a happy boy, and Lorna has always tried to make sure that he is clean and tidy. This has seemed harder lately as Lorna struggles to find the energy to get Samuel bathed and dressed. Samuel likes watching his favourite TV shows with Lorna, especially when he has his favourite tea of pizza and chips.

So far, Samuel has been meeting his developmental milestones. He receives a "Universal Plus" level of service from his health visitor in line with the Healthy Child Programme (DH, 2009a). This means that Samuel's Health Visitor is aware of Lorna's additional needs and is able to offer a rapid response if Lorna needs support (DH, 2011). Samuel is now due his pre-school booster vaccinations and a developmental check. Kulvinder, his health visitor, has sent out appointments for this, but Lorna and Samuel have not attended the clinic. They have now missed three appointments, and Kulvinder is concerned. She decides to visit Lorna and Samuel at their flat.

• 1. How could you work with Lorna to improve her and Samuel's health and well-being?

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  Correct answer:
  Lorna needs support to access health appointments. This will benefit both Lorna and Samuel. Lorna's weight has been increasing, and this is affecting her bathing and possibly her blood pressure. Her increasing isolation and lack of attention to her personal hygiene could indicate the onset of depression. Lorna needs a full, holistic health assessment to help to prioritize the interventions she needs.

• 2. What other professionals and services could you involve in supporting Lorna and Samuel?

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  Correct answer:
  Health visitor, GP, mental health services, learning disability nurse, social worker.

• 3. What are the positive things in Lorna and Samuel's life?

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  Correct answer:
  Samuel is generally happy, and he enjoys spending time with Lorna. He is going to nursery regularly, and he is meeting his milestones. They are in contact with Samuel's health visitor, though they have recently missed appointments. In general, Lorna is a good mum who is providing love, care and support for Samuel. This is an important message for Lorna to hear, to raise her self-esteem, and to let her know that in spite of her current difficulties, she is still doing well.