{"id":436,"date":"2024-07-09T11:14:41","date_gmt":"2024-07-09T10:14:41","guid":{"rendered":"https:\/\/blogs.qub.ac.uk\/sssj\/?page_id=436"},"modified":"2024-07-09T11:14:41","modified_gmt":"2024-07-09T10:14:41","slug":"is-person-centred-planning-the-best-social-work-approach-for-people-with-a-learning-disability-a-critical-analysis","status":"publish","type":"page","link":"https:\/\/blogs.qub.ac.uk\/sssj\/is-person-centred-planning-the-best-social-work-approach-for-people-with-a-learning-disability-a-critical-analysis\/","title":{"rendered":"Is person-centred planning the best social work approach for people with a learning disability? A critical analysis."},"content":{"rendered":"\n

By Andrew Rawding<\/a><\/h1>\n\n\n\n

Year 3 –\u00a0Social Work Undergraduate Student<\/p>\n\n\n\n

<\/a>Introduction<\/a><\/h2>\n\n\n\n

According to the 2021 Census in Northern Ireland, 16,923 of \u2018all usual residents\u2019, resident for three months or more from 21 March 2021, has an intellectual or learning disability (LD) (Northern Ireland Statistics and Research Agency (NISRA), 2022). This is less than 1% (0.89%) of the population, with the largest number in the 15-39 age band (NISRA, 2022). However, the number of people with LD is increasing: MENCAP (2023) states there are 31,000 adults with LD in Northern Ireland, with 25,000 of working age; more than double the figure of 10,540 for 15\u201365-year-olds in 2021 Census (NISRA, 2017). This paper[1]<\/sup><\/a> will provide a critical appraisal of person-centred planning (PCP) with people with a learning disability (PWLD). It will start with an overview of PWLD, then outline issues encountered by PWLD in relation to discrimination, inequality, and oppression. It will then provide an overview of PCP with PWLD, and critically appraise PCP in terms of its potential to promote empowerment and facilitate anti-oppressive practice.<\/p>\n\n\n\n

<\/a>Overview of <\/a>PWLD<\/h2>\n\n\n\n

It is important for social workers to recognise that the term \u2018learning disability\u2019 is disputed (Nunkoosing, 2019), and socially constructed (Gergen, 1985), like other terms used interchangeably for LD: intellectual disability (ID), developmental disability, intellectual impairment, or special educational needs (Baum & Lyngard, 2006). The National Institute of Health and Care Excellence (NICE) (2015:5) states: ‘a learning disability is generally defined by 3 core criteria: lower intellectual ability (usually an IQ of less than 70), significant impairment of social or adaptive functioning, and onset in childhood’. The Department of Health (DOH) (2023a) website and Northern Ireland government services (NIdirect, 2023) definitions emphasise a \u2018whole life\u2019 nature to the disability, \u2018problems\u2019 with understanding and learning, and the ability or not to live independently. DOH includes the potentially stigmatising term of \u2018a reduced intellectual ability\u2019 (DOH, 2023a).<\/p>\n\n\n\n

For the social worker focusing on improving people\u2019s lives through strength-based rather than deficit-based practice (Montgomery et al., 2023), these definitions raise questions about who decides and benefits from them: the person labelled and diagnosed with LD, or medical professionals, charities and other stakeholders and gatekeepers? What whole life support is or should be in place to reduce so-called disability and enhance ability? A clinical diagnosis of LD may provide access to support services but may be stigmatising and disempowering for the person themselves (Elinor et al., 2014), impinging on their rights, silencing their voice, and keeping them oppressed (Courtenay, 2020). The inclusion of \u2018independence\u2019 in definitions may serve vested interests of those wanting to keep PWLD dependent on their services, or on family through overprotection (Callus et al., 2019). This is a subtle form of \u2018disablism\u2019 (Thompson, 2016:133).<\/p>\n\n\n\n

\u2018Disability is constructed by the meaning people place on it\u2019 (Smith, 2000:910). The World Health Organisation (WHO) (2019), which still uses the definitional term \u2018mental retardation\u2019 in the International Classification of Diseases 10th Revision (ICD-10), categorises severities of learning disability as mild (approximate IQ range of 50 to 69; mental age from 9 to under 12 years), moderate (approximate IQ range of 35 to 49; mental age from 6 to under 9 years), severe (approximate IQ range of 20 to 34; mental age from 3 to under 6 years), and profound (IQ under 20; mental age below 3 years). These severities can be based on how much help and support a person needs. However, they can also \u2018infantilise\u2019 PWLD, keeping them and treating them like children with IQ criteria ignoring gifts, skills, other forms of intelligence and excluding them politically (Safta-Zecheria, 2018). A mild diagnosis may recognise an ability to communicate effectively and conduct self-care but focuses on slow learning of new skills or doing tasks like completing paperwork. A severe diagnosis may include an inability to communicate \u2018normally,\u2019 with more support needed with personal care and mobility. A profound and multiple LD (PMLD) diagnosis may require support with feeding, personal hygiene, personal safety, and toileting. Down\u2019s syndrome is also a type of learning disability, as are some forms of autism, cerebral palsy, and epilepsy (NIdirect, 2023).<\/p>\n\n\n\n

Relevant disability legislation in Northern Ireland for LD includes the Disability Discrimination Act 1995 (DDA), Special Education Needs (SEN) and Disability Act 2001, the SEN and Disability (Northern Ireland) Order 2005, the Autism (Northern Ireland) Act 2011, and Section 75 of the Northern Ireland Act (1998). Also of significance are the Human Rights Act 1998, the United Nations Convention on Rights of the Child (UNCRC) (1989), and the United Nations Convention on Rights of Persons with Disabilities (UNCRPD) (2006). The importance of the latter is the emphasis on the right of PWLD, whether child or adult, to have their voice heard (Article 12, UNCRC, 1989), with a right to freedom of expression and opinion (Article 21, UNCRPD, 2006), and the right to \u2018highest attainable standard of health without discrimination on the basis of disability\u2019 (Article 25, UNCRPD, 2006).<\/p>\n\n\n\n

Relevant strategies include the DOH Autism Strategy (2013-2020) and Action Plan (2013 \u2013 2016). However, progress reports on the Action Plan have still not been published (DOH, 2023b). A lack of evaluations since the Bamford \u2018Equal Lives: Review of Mental Health & Learning Disability\u2019 highlights just some of the inequalities experienced by PWLD (All Party Group on Learning Disability (APGLD), 2018), including the stigmatising fact that policy documents link LD with mental health, and often with uncritical acceptance (Kelly et al., 2016).<\/p>\n\n\n\n

<\/a>Issues encountered by PWLD in relation to discrimination, inequality, and oppression.<\/a><\/h2>\n\n\n\n

PWLD are discriminated against if they are treated less favourably than others, and it cannot be shown that the treatment is a proportionate means of achieving a legitimate aim (Section 15, 1 (a)(b), Equality Act 2010). PWLD are oppressed when they are treated as inferior and subordinate (Dominelli, 2002). Using the framework of Thompson\u2019s (2016:35) \u2018personal \u2013 cultural \u2013 structural\u2019 (PCS) levels of discrimination, PWLD have been discriminated against and oppressed at personal, cultural, and structural levels by language, stigma, and stereotyping. This has stigmatised them, linking them with \u2018mental illness\u2019 (Ditchman et al., 2013), and often isolated them educationally as \u2018special needs\u2019 (Thompson, 2016:23). In a survey of 1,000 adult PWLD, over 1 in 3 stated that they were most afraid of being bullied and name calling when they go out (Mencap, 2019). Historically PWLD have been subjected to labels like \u2018morons,\u2019 \u2018idiots,\u2019 \u2018deviant\u2019 and \u2018retarded,\u2019 and been locked away in \u2018madhouses\u2019 and \u2018lunatic asylums\u2019 (McClimens & Richardson, 2010:23).<\/p>\n\n\n\n

Discourse theory acknowledges how language can be used to construct dominant narratives by those who have power (Parton, 2009). Researching \u2018prevalence\u2019 in Northern Ireland, descriptive terms for LD changed from \u2018mental sub normality\u2019 (MacKay and Scally, 1964), to \u2018severe mental handicap\u2019 (MacKay et al., 1991) to \u2018learning disability\u2019 (MacKay and McDonald, 1996). In the United Kingdom (UK), the government also replaced the dehumanising label \u2018sub-normality\u2019 with \u2018mental handicap\u2019 and then adopted \u2018learning disability\u2019 (Bewley, 2008). In Northern Ireland, this language change was reflected in a \u2018Review of Policy for People with a Learning Disability\u2019 in 1995 (DHSS, 1995). However, the term \u2018learning disability\u2019 has been rejected by the self-advocacy movement \u2018People First\u2019 who use the social model of disability (Oliver, 1990) and self-identify as \u2018people with learning difficulties\u2019 (Reeve, 2019:41), rather than with disabilities.<\/p>\n\n\n\n

Within the social model of disability, \u2018learning disability\u2019 is considered a socially constructed term used by those with the power to diagnose, categorise, legislate, and write policy in medicine, psychology, education, and other professions, suggesting that some people are \u2018disabled by their learning, rather than by society\u2019 (Williams & Evans, 2013:3). It conforms to the \u2018medicalization of disability,\u2019 reinforcing the idea that there is \u2018something wrong with them\u2019 (Oliver, 2009:44), rather than acknowledging \u2018disabling environments, barriers, and cultures\u2019 (Oliver, 2009:45). However, even within the social model of disability some of those who self-identify as \u2018people with learning difficulties\u2019 (People First, 2023) have themselves a problem with the term \u2018disabled person\u2019, which they consider stigmatising as they are \u2018a person first\u2019 and do not consider themselves to be the same as  \u2018wheelchair users\u2019 (Reeve, 2019:41) who have mobility-related disabilities and are themselves discriminated against due to physical inaccessibility (Baudin & Petterson, 2023)<\/p>\n\n\n\n

The medical model continues to pathologise and discriminate against those labelled with LD with \u2018eugenics by stealth\u2019 (McClimens & Richardson, 2010:27), supported by \u2018personal tragedy theory\u2019 (Oliver, 2009:45). For example, in England the government\u2019s \u2018Office for Health Improvement & Disparities\u2019 offers the choice for pregnant mothers to screen their baby for Down\u2019s syndrome, Edward\u2019s syndrome and Patau\u2019s syndrome and then also choose to abort the baby (NHS England, 2022). In Northern Ireland, government and health trusts offer privately-funded screening for Down\u2019s syndrome using the discriminatory language of testing for \u2018abnormalities\u2019 or chromosomal conditions (NIDirect, 2024; NHSCT, 2024),   If a child is born and then labelled with LD, they will face significant health inequalities throughout their life including less access to cancer screening, higher likelihood of serious mental health problems, obesity, diabetes, constipation, gastro-intestinal disorders (Emerson et al., 2016; Mencap, 2019; NICE, 2023), and unrecognised post-traumatic stress (Daveney et al., 2019). PLWD have a shorter life expectancy: males die 14 years earlier, and females 17 years earlier, than the general population (NHS Digital, 2019). In Ireland, people with intellectual disability \u2018die younger and have a higher rate of death\u2019 than non-disabled peers (Doyle et al., 2020:1064).<\/p>\n\n\n\n

There is also the significant issue of over medication of PWLD, who are \u2018prescribed off-licence antipsychotics in the absence of a psychiatric illness\u2019 (Deb et al., 2020:10), often to restrict behaviour labelled as \u2018challenging\u2019 (Royal College of Psychiatrists (RCP), 2021; NICE, 2015). Carers and services may find the behaviour challenging but it could be a PWLD\u2019s only way to be heard, in response to how they are being treated as a person and the stress of their environment (NICE, 2015). \u2018Stopping over Medication of People with a learning disability, autism, or both with psychotropic medicines\u2019 (STOMP) was introduced in 2016 by NHS England, The Royal College of Nursing, The Royal College of Psychiatrists, The Royal College of GPs, The Royal Pharmaceutical Society and The British Psychological Society (NHS England, 2023). Significantly there is no such campaign in Northern Ireland. The term \u2018over-medication\u2019 does not feature in Mencap NI\u2019s \u2018Treat me well\u2019 briefing (2019b). During a social work practise learning opportunity in a residential setting for children with severe learning disability, an oppressive \u201cget the meds in them\u201d culture seemed to prevail (Personal Professional Development Workbook, 2022), which appeared to be centred on the needs of professionals rather than being \u2018person-centred\u2019 on the needs of the child.<\/p>\n\n\n\n

<\/a>Overview of person-centred planning (PCP) for PWLD and context for use<\/a><\/h2>\n\n\n\n

PCP (Sanderson et al., 1997) is an approach developed in the UK since \u2018Valuing People\u2019 (Department of Health, 2001) became public policy in England. Whilst humanistic in nature it is distinct from a therapeutic \u2018person-centred approach\u2019 in social work associated with Carl Rogers (Trevithick, 2012). It involves working in partnership with individuals to support planning and decision-making so they can identify needs and goals and \u2018set out to achieve their goals\u2019 (Cambridge & Carnaby, 2005:38). It is supposed to be a person-centred way of including a PWLD in the creation and management of their care plan in a residential setting or in community, which recognises their abilities (not disabilities) and provides support for their aspirations, rather than a deficit approach which expects PWLD to fit in with existing services decided for them by others.  Key features of PCP are: person-centred; partnership with family and friends; the person\u2019s priorities and support needs are central; action-orientated; exploring possibilities; with continuous reviews (Sanderson, 2000:3-7).<\/p>\n\n\n\n

Assessment frameworks formulated for PCP include \u2018Making Actions Plans\u2019 (MAPS) (Forest & Lusthaus, 1989) and \u2018Planning Alternative Tomorrows with Hope\u2019 (PATH) (Pearpoint et al., 1992). These are not formal assessments but start with blank sheets of paper to gather information, using drawings and meaningful graphics to represent concepts like \u2018dreams\u2019, visions\u2019 and \u2018gifts. They reflect the \u2018exchange model\u2019 (Smale et al., 1993) with PWLD and their family and friends acknowledged as the experts. Another tool is \u2018Essential lifestyle planning\u2019 (Smull et al., 2001) which explores what is important for PWLD, how they can stay safe and healthy, support needed, what constitutes good support and bad support for the PWLD, and what needs to be done (Thompson et al., 2008). Social work principles of collaboration, co-production and partnership can be at the heart of these processes where a social worker would be in a facilitatory role as a \u2018key problem solver and critical ally\u2019 (Medora & Ledger, 2005:168). Crucially, with PCP the emphasis is \u2018placed on shifting power from professionals to users and their chosen \u2018significant others\u2019\u2019 (Davies, 2012:50).<\/p>\n\n\n\n

There have been mixed responses to the effectiveness of PCP. Mansell & Beadle-Brown (2005) highlight problems with communication with some PWLD, particularly those labelled with severe diagnosis, where self-injurious and challenging behaviours are an issue. This contributes to difficulties with developing and maintaining empathic relationships and agreeing goals. There were also problems with building a support network due to social isolation of some PWLD. Robertson et al.\u2019s (2007) found that PWLD with mental health problems, autism, behavioural problems, and other health conditions were less likely to receive a PCP plan. Those with mental health and behavioural problems were less likely to benefit from a PCP plan (Robertson, 2007). These represent significant inequalities. For social work involvement, a key finding was \u2018participants were more than 12 times more likely to receive a plan if facilitators expressed higher levels of commitment to PCP\u2019 (Jones et al., 2007:241).<\/p>\n\n\n\n

McCausland et al. (2020) found that PCP can be effective in improving life for adult PWLD in community settings providing there is consistency and familiarity with staff and family. In a systematic review on the effectiveness of PCP, Ratti et al. (2016:63) concluded: \u2018The evidence supporting the effectiveness of PCP is limited and does not demonstrate that PCP can achieve radical transformations in the lives of people with ID.\u2019<\/p>\n\n\n\n

Clearly whilst the introduction of PCP was welcome, and meaningful outcomes have been produced for some PWLD, it has not been beneficial across the wider population of PWLD (Ratti et al., 2016). There needs to be consideration of differing social contexts, levels of relationship and dependency (Hassan, 2017). Inadequate funding, staff turnover levels, lack of training, inflexibility and power struggles have also limited the effectiveness of PCP (Dowling et al., 2007). Linked to this are the findings of a systematic review of health and social care professionals\u2019 knowledge and attitudes to PWLD, which concluded: \u2018health and social care professionals appear to hold negative views of people with learning disabilities, which adversely influences their willingness to work with them\u2019 (Ee et al., 2022:468).  A lack of confidence and skills from insufficient specific training, high staff turnover, and limited resources leaves PCP looking good on paper, in textbooks, articles and in policy rhetoric, but still leaves some PWLD disempowered, oppressed by medication, and isolated.<\/p>\n\n\n\n

Increased funding, better resources and improved training for staff could all help turn person-centred plans into reality. There has been a move with direct payments and now \u2018personal health budgets\u2019 (NHS England, 2023b) to empower PWLD themselves and give them more control, promoting living in the community, rather than in institutions. In England, the \u2018Building the Right Support Action Plan\u2019 placed an emphasis on commissioning for people\u2019s lives rather than just for a service. The commitment is to support PWLD \u2018to lead healthier, happier, longer lives\u2019 (NHS England, 2023c). In Northern Ireland, self-directed support (SDS) was introduced in 2015, giving people and carers more \u2018more control of their agenda and day-to-day lives\u2019 (Patient and Client Council, 2029:17). However, service users and carers felt hampered by administration and bureaucracy and inadequate information about SDS from social workers (Patient and Client Council, 2019), reinforcing the need for professional knowledge to underpin effective social practice and empower rather than oppress (BASW, 2019).<\/p>\n\n\n\n

<\/a>Potential of PCP to promote empowerment and facilitate anti-oppressive practice (AOP)<\/a><\/h2>\n\n\n\n

It might seem obvious that PCP and any \u2018person-centred\u2019 practice which places PWLD at the centre and gives a voice to their goals, \u2018dreams\u2019 and hopes has the potential to be anti-oppressive and empowering. As Burke and Harrison (2009:218) make clear: \u2018the strength of anti-oppressive practice is that it combines the concepts of participation, partnership and empowerment, offering the potential for the service user\u2019s voice to be heard and acted upon.\u2019  PCP appears to fit well with \u2018the empowerment and liberation of people, human rights, respect for diversities\u2019 promoted by the International Federation of Social Work (2014), and \u2018strengths-based\u2019 and \u2018rights-based\u2019 practice (BASW, 2019).<\/p>\n\n\n\n

However, decades after PCP were introduced as policy in the UK, research has demonstrated that PWLD continue to be oppressed and discriminated against at personal, cultural, and structural levels (Thompson, 2016). The fault is not with the PWLD, nor their family and friends, nor even with social workers, as \u2018the struggle to recognise and respect the autonomy, citizenship and rights of people with a learning disability is a political struggle\u2019 (Stainton, 2009:353). PWLD continue to be faced with a dominant \u2018medico-psychological model\u2019 (Stainton, 2009:346) and limited resources in terms of funding (Disability Rights UK, 2023). PWLD have also been subjected to physical and psychological abuse by staff in residential care settings, for example at Winterborne View (Care Quality Commission, 2011) and Whorlton Abbey (Social Care Institute for Excellence (SCIE), 2022) in England, and at Muckamore Abbey in Northern Ireland (Mongan and Sutherland, 2022; The Guardian, 2022). <\/p>\n\n\n\n

The complexities and the diversity of PWLD with varying levels of impairment, social contexts, and relationships, means that whilst PCP may have potential it is not in itself the answer. Reviews into abuse in residential settings found that PWLD and their families were not listened to, there was a lack of advocacy and inconsistent support from designated professionals (SCIE, 2022), and PWLD were not validated as \u2018experts by experience\u2019 (Mongan and Sutherland, 2022). Innovative approaches may be promoted in health and social care policy like \u2018personal health budgets\u2019, but these could be restricted by funding constraints or withdrawn (Disability Rights UK, 2023). Another global pandemic could further exacerbate inequalities for PWLD (Scherer et al., 2022).<\/p>\n\n\n\n

These sources of oppression highlight the need for the individual social worker to provide the potential for positive change, emancipation, and empowerment of PWLD. The social worker\u2019s rights-based and relationship-based practice can promote social justice, advocating for PWLD wherever they may be working, in residential care, in the community; or writing policy to challenge oppressive power structures. Social workers need to be \u2018critical practitioners\u2019 (Adams, 2009:233), using professional curiosity to courageously question and challenge in their teams and with other healthcare professionals. Informed by research, up to date knowledge of legislation and the voice of PWLD and their families, they can have the confidence to educate other professionals and hold them to account, ensuring that care of PWLD is person-centred.<\/p>\n\n\n\n

This requires a willingness to actively listen and be educated by PWLD and their family and friends. It requires self-critical reflection on practise, and effective supervision, to enable reflexivity, creativity and positive risk-taking when others are not empathising with PWLD but focusing on deficits, disabilities and \u2018challenging behaviour.\u2019  It requires \u2018constructive social work\u2019 (Parton, 2009:227) which creates and promotes a different discourse and social justice for PWLD, where power is expressed in emotionally intelligent relationships, dialogue, and a commitment to listening to PWLD, particularly when they are non-verbal. It requires social workers to challenge and liberate themselves from paternalistic questioning, procedural, care management<\/em> approaches that stifle the relational heart of social workers so valued by PWLD (Thompson et al., 2008).<\/p>\n\n\n\n

 <\/h2>\n\n\n\n

<\/a>Conclusion<\/a><\/h2>\n\n\n\n

This paper has provided an overview of the disputed and complex world of PWLD, subjected to discourses that label, stigmatise, discriminate, and oppress. PWLD continue to suffer significant inequalities in many areas of their lives, particularly in relation to health and well-being. Whilst PCP is potentially a liberating and empowering approach for PWLD, there are limitations to its effectiveness. At structural, cultural, and personal levels, critically practicing and reflective social workers can engage in socially constructive relationship-based social work that is person-centred and empowering for PWLD. It is the approach of the social worker that counts not the social work approach.<\/p>\n\n\n\n

<\/a>References<\/a><\/h2>\n\n\n\n

Adams, R. (2009) \u2018Being a critical practitioner\u2019 in Adams, R., Dominelli, L., Payne, M. (Eds.) Critical Practice in Social Work <\/em>(Second Edition), <\/em>Basingstoke: Palgrave Macmillan.<\/p>\n\n\n\n

All Party Group on Learning Disability (2018) Priority issues for people with a learning disability in Northern Ireland, <\/em>Available at:  https:\/\/arcuk.org.uk\/northernireland\/files\/2018\/06\/2018-050-APGLD-report_Final-May-2018.pdf Accessed: 20 March 2023.<\/p>\n\n\n\n

Baudin, K., & Pettersson, C. (2023). I Know My Rights! A Longitudinal Study of Discrimination due to Physical Inaccessibility from the Perspective of Wheelchair Users. Studies in health technology and informatics<\/em>, 306<\/em>, 403\u2013408. Available at: https:\/\/doi.org\/10.3233\/SHTI230651 Accessed: 2 April 2024.<\/p>\n\n\n\n

Baum, S. & Lyngaard, H. (2006) Intellectual disabilities: a systemic approach.<\/em> London: Karnac.<\/p>\n\n\n\n

Bewley, T (2008) Madness to Mental Illness: A History of the Royal College of Psychiatrists<\/em>. Royal College of Psychiatrists Publications. Trowbridge: Cornwell Press.<\/p>\n\n\n\n

British Association of Social Workers (2019) Capabilities Statement for Social Workers Working with Adults with Learning Disability<\/em> [Online] Available at: https:\/\/www.basw.co.uk\/system\/files\/resources\/181064%20Learning%20Disability%20Capability%20Statement%2019.06.19.pdf Accessed: 24 March 2023.<\/p>\n\n\n\n

Burke, B. & Harrison, P. (2009) \u2018Anti-oppressive approaches\u2019 in in Adams, R., Dominelli, L., Payne, M. (eds.) Critical Practice in Social Work <\/em>(Second Edition), <\/em>Basingstoke: Palgrave Macmillan.<\/p>\n\n\n\n

Callus, A.M., Bonello, I., Mifsud, C. & Fenech, R. (2019) \u2018Overprotection in the lives of people with intellectual disability in Malta: knowing what is control and what is enabling support\u2019, Disability & Society<\/em>, 34:3, 345-367, Available at: DOI: 10.1080\/09687599.2018.1547186 Accessed: 20th<\/sup> December 2023.<\/p>\n\n\n\n

Cambridge, P. & Carnaby, S. (2005) (Eds.) Person centred planning and care management with people with learning disabilities. <\/em>London: Jessica Kingsley.<\/p>\n\n\n\n

Care Quality Commission (CQC) (2011) Review of Compliance: Castlebeck Care (Teesdale) Ltd<\/em> [Online] Available from: https:\/\/www.cqc.org.uk\/sites\/default\/files\/documents\/1-116865865_castlebeck_care_teesdale_ltd_1-138702193_winterbourne_view_roc_20110517_201107183026.pdf Accessed: 18th<\/sup> November 2023.<\/p>\n\n\n\n

Courtenay, K. (2020) \u2018The case for removing intellectual disability and autism from the Mental Health Act\u2019, The British Journal of Psychiatry <\/a>, Volume 218 <\/a>, Issue 1 <\/a>, January 2021 , pp. 64 \u2013 65. Available at:                                                                             DOI: https:\/\/doi.org\/10.1192\/bjp.2020.183 <\/a> Accessed: 23 March 2023.<\/p>\n\n\n\n

Daveney, J., Hassiotis, A., Katona, C., Matcham, F., & Sen, P. (2019). \u2018Ascertainment and Prevalence of Post-Traumatic Stress Disorder (PTSD) in People with Intellectual Disabilities.\u2019 Journal of Mental Health Research in Intellectual Disabilities<\/em>, 12(3\/4), 211\u2013233. Available at: https:\/\/doi.org\/10.1080\/19315864.2019.1637979 Accessed: 23 March 2023.<\/p>\n\n\n\n

Davies, M. (2012) (Ed.) Social work with adults. <\/em>Basingstoke: Palgrave Macmillan.<\/p>\n\n\n\n

Department of Health (DOH) (2001) Valuing People: A new strategy for learning disability for the 21st<\/sup> century. <\/em>London: The Stationery Office.<\/p>\n\n\n\n

Department of Health (DOH) (2023a) Mental Health and learning disabilities<\/em> [Online] Available at: https:\/\/www.health-ni.gov.uk\/topics\/mental-health-and-learning-disabilities Accessed: 20 March 2023.<\/p>\n\n\n\n

Department of Health (DOH) (2023b) Autism Strategy (2013 \u2013 2020) Action Plan (2013 \u2013 2016) Progress Reports<\/em> [Online] Available at: https:\/\/www.health-ni.gov.uk\/austismstrategy-progressreports Accessed: 20 March 2023.<\/p>\n\n\n\n

DHSS (1995) Review of Policy for People with a Learning Disability,<\/em> Belfast: DHSS.<\/p>\n\n\n\n

Disability Rights UK (2023) News and policy <\/em>[Online] Available at: https:\/\/www.disabilityrightsuk.org\/news-policy Accessed: 24 March 2023.<\/p>\n\n\n\n

Ditchman, N., Werner, S., Kosyluk, K., Jones, N., Elg, B. and Corrigan, P.W. (2013) \u2018Stigma and intellectual disability: potential application of mental illness research\u2019. Rehabilitation Psychology<\/em>, 58<\/em>(2), p.206.<\/p>\n\n\n\n

Dominelli, L. (2002) Anti-oppressive social work theory and practice<\/em>. Basingstoke:  Palgrave Macmillan. Dowling, S., Manthorpe, J., & Cowley, S. (2007). \u2018Working on person-centred planning: From amber to green light?\u2019 Journal of Intellectual Disabilities<\/em>, 11<\/em>(1), 65\u201382. Available at: https:\/\/doi.org\/10.1177\/1744629507073999 Accessed: 22 March 2023.<\/p>\n\n\n\n

Doyle, A., O\u2019Sullivan, M., Craig, S., McConkey, R. (2020) People with Intellectual Disability in Ireland and still Dying Younger, Journal of Applied Research in Intellectual Disabilities, 34, pp. 1057-1065.<\/em><\/p>\n\n\n\n

Ee, J., Stenfert Kroese, B., & Rose, J. (2022). \u2018A Systematic Review of the Knowledge, Attitudes and Perceptions of Health and Social Care Professionals towards People with Learning Disabilities and Mental Health Problems.\u2019 British Journal of Learning Disabilities<\/em>, 50(4), 467\u2013483. Available at: https:\/\/onlinelibrary.wiley.com\/doi\/epdf\/10.1111\/bld.12401<\/a>  Accessed: 23 March 2023.<\/p>\n\n\n\n

Elinor, K., Beail, N., Jackson, T. (2014) \u201cLearning Disability: Experience of Diagnosis.\u201d British journal of learning disabilities<\/em> 42.4 (2014): 257\u2013263. Available at: DOI: 10.1111\/bld.12054. Accessed: 23 March 2023.Emerson, E., Hatton, C., Baines, S. et al.<\/em> (2016) \u2018The physical health of British adults with intellectual disability: cross sectional study\u2019. Int J Equity Health<\/em> 15<\/strong>, 11. Available at: https:\/\/doi.org\/10.1186\/s12939-016-0296-x<\/a> Accessed: 21 March 2023.<\/p>\n\n\n\n

Equality Act (2010), Part 2, Chapter 2, Discrimination, Section 15<\/em>, Belfast: The Stationary Office. Available at: https:\/\/www.legislation.gov.uk\/ukpga\/2010\/15\/section\/15 Accessed: 2 April 2024.Forest, M. & Lusthaus, E. (1989) Promoting educational equality for all students: Circles and Maps. in Stainback, S., Stainback, W. & Forest, M. (eds.) Educating all students in the mainstream of regular education. <\/em>Baltimore, MD: Paul H Brookes.<\/p>\n\n\n\n

Freire, P. (1972) Pedagogy of the oppressed,<\/em> New York: Penguin.<\/p>\n\n\n\n

Gergen, K.J. (1985) \u2018The constructionist movement in modern psychology\u2019. American Psychologist, <\/em>40 (3), pp. 266-275. Available at: https:\/\/psycnet.apa.org\/doi\/10.1037\/0003-066X.40.3.266 Accessed: 20 March 2023.<\/p>\n\n\n\n

Grant, G., Ramcharan, P., Flynn, M. & Richardson, M. (2010) (eds.) Learning disability: a life cycle approach <\/em>(Second Edition), Maidenhead: Open University Press\/McGraw Hill Education.<\/p>\n\n\n\n

Hassan, N. (2017) \u201cPutting music on\u201d: everyday leisure activities, choice-making and person-centred planning in a supported living scheme.\u2019 British Journal of Learning Disabilities<\/em>, 45<\/em>(1), 73\u201380. Available at: https:\/\/doi.org\/10.1111\/bld.12178 Accessed: 23 March 2023.<\/p>\n\n\n\n

International Federation of Social Workers (IFSW) Global definition of Social Work<\/em>, Available from: https:\/\/www.ifsw.org\/what-is-social-work\/global-definition-of-social-work\/ Accessed: 24 March 2023.<\/p>\n\n\n\n

Jones, V. & Haydon-Laurelut, M. (2019) (Eds.) Working with people with learning disabilities: systemic approaches<\/em>, London: Red Globe Press.<\/p>\n\n\n\n

Kelly, B., McShane, T., Davidson, G., Pinkerton, J., Gilligan, E. & Webb, P. (2016) Transitions and outcomes for care leavers with mental health and\/or intellectual disabilities: Short Report<\/em>. Belfast: QUB.<\/p>\n\n\n\n

MacKay, D.N. & Scally, B.G. (1964) Mental Sub normality and its prevalence in Northern Ireland. Acta Psychiatrica Scandinavica, <\/em>40, pp. 203-11.<\/p>\n\n\n\n

MacKay, D.N., Mallon, J.R., McDonald, G. & Wilson, R. (1991) The prevalence of severe mental handicap in Northern Ireland, Journal of Mental Deficiency Research<\/em>, 35, pp. 66-72.<\/p>\n\n\n\n

MacKay, D.N. & McDonald, G. (1996) The prevalence of learning disability in a Health and Social Services Board in Northern Ireland, Journal of Intellectual Disability Research, <\/em>40, 6, pp. 550-566.<\/p>\n\n\n\n

McCausland, D., Murphy, E., McCarron, M. & McCallion, P. (2022) \u2018The potential for person-centred planning to support the community participation of adults with an intellectual disability.\u2019 Journal of Intellectual Disabilities<\/em>, 26<\/em>(3), 603\u2013623. Available at: https:\/\/doi.org\/10.1177\/17446295211022125 Accessed: 23 March 2023.<\/p>\n\n\n\n

McClimens, A. & Richardson, M. (2010) \u2018Social Constructions and social models: disability explained?\u2019 in Grant, G., Ramchardan, P. & Flynn, M. (eds.) Learning Disability: A life cycle approach<\/em> (Second Edition) Maidenhead: Open University Press\/McGraw Hill Education.<\/p>\n\n\n\n

Medora, H. & Ledger, S. (2005) \u2018Implementing and Reviewing Person Centred Planning\u2019 in Cambridge, P. & Carnaby, S. (2005) (eds.) Person centred planning and care management with people with learning disabilities. <\/em>London: Jessica Kingsley.<\/p>\n\n\n\n

Mencap (2019a) New research from Mencap shows bullying of people with a learning disability leading to social isolation<\/em> [Online] Available at: https:\/\/www.mencap.org.uk\/press-release\/new-research-mencap-shows-bullying-people-learning-disability-leading-social Accessed: 23 March 2023.<\/p>\n\n\n\n

Mencap (2019b) Mencap NI Briefing Paper No.3, Treat me well: Equal access to healthcare for people with a learning disability.<\/em> Available at: https:\/\/northernireland.mencap.org.uk\/sites\/default\/files\/2019-10\/Mencap%20%E2%80%98Treat%20Me%20Well%E2%80%99%20report%20on%20health%20inequalities%20Oct%2019.pdf Accessed: 21 March 2023.<\/p>\n\n\n\n

Mencap (2023) How common is learning disability? <\/em>[Online] Available at: https:\/\/www.mencap.org.uk\/learning-disability-explained\/research-and-statistics\/how-common-learning-disability#:~:text=956%2C000%20adults%20with%20a%20learning,learning%20disability%20in%20Northern%20Ireland. Accessed: 20 March 2023.<\/p>\n\n\n\n

Mongan, B. & Sutherland, I. (2022) Independent Review of The Learning Disability Resettlement Programme in Northern Ireland<\/em> [Online] Queen\u2019s University Belfast. Available from: https:\/\/niopa.qub.ac.uk\/bitstream\/NIOPA\/15418\/1\/doh-ind-review-ld-resttlement-july-2022.PDF Accessed: 29th<\/sup> December 2023.<\/p>\n\n\n\n

Montgomery, L., MacDonald, M., Walakira, E.J. (2023) \u2018Engaging Families in Assessment and Managing Risk\u2019 in Taylor, B., Fluke, J.D., Graham, J.C., Keddell, E., Killick, C., Shlonsky, A. & Whittaker, A. (Eds.) The Sage Handbook of Decision Making, Assessment and Risk in Social Work<\/em>. London: Sage.<\/p>\n\n\n\n

National Institute for Health and Care Excellence (NICE) (2015) \u2018Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges\u2019. NICE guideline<\/em> (NG11). London: NICE. Available at: <\/a>https:\/\/www.nice.org.uk\/guidance\/ng11\/resources\/challenging-behaviour-and-learning-disabilities-prevention-and-interventions-for-people-with-learning-disabilities-whose-behaviour-challenges-pdf-1837266392005 Accessed: 21 March 2023.<\/p>\n\n\n\n

NHSCT (2024) Antenatal Blood Tests and Screening <\/em>[Online] Available at: https:\/\/www.northerntrust.hscni.net\/services\/maternity-services\/booking-your-maternity-appointment\/blood-tests\/ Accessed: 2 April 2024.<\/p>\n\n\n\n

NHS Digital (2019) Health and Care of People with Learning Disabilities, Experimental Statistics: 2018 to 2019<\/em> [Online] Available at: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/health-and-care-of-people-with-learning-disabilities\/experimental-statistics-2018-to-2019\/condition-prevalence#:~:text=Based%20on%202018%2D19%20data,life%20expectancy%20of%2067%20years. Accessed: 21 March 2023.<\/p>\n\n\n\n

NHS England (2022) Guidance: Down\u2019s syndrome, Edwards\u2019 syndrome and Patau\u2019s syndrome<\/em> Available at: https:\/\/www.gov.uk\/government\/publications\/screening-tests-for-you-and-your-baby\/downs-syndrome-edwards-syndrome-and-pataus-syndrome-combined-or-quadruple-test-taken-on-or-after-1-june-2021#:~:text=a%20blood%20test%2C%20called%20the,Edwards’%20syndrome%20and%20Patau’s%20syndrome Accessed: 20 March 2023.<\/p>\n\n\n\n

NHS England (2023a) Stopping over medication of people with a learning disability, autism, or both (STOMP)<\/em> [Online] Available at: https:\/\/www.england.nhs.uk\/learning-disabilities\/improving-health\/stomp\/ Accessed: 20th<\/sup> March 2023.<\/p>\n\n\n\n

NHS England (2023b) What is a personal health budget? <\/em>[Online] Available at: https:\/\/www.nhs.uk\/nhs-services\/help-with-health-costs\/what-is-a-personal-health-budget\/ Accessed: 20 December 2023.<\/p>\n\n\n\n

NHS England (2023c) Supporting people with a learning disability and autistic people to live happier, healthier, longer lives: Bitesize guide for local systems<\/em> [Online] Available at: https:\/\/www.england.nhs.uk\/long-read\/supporting-people-with-a-learning-disability-and-autistic-people-to-live-happier-healthier-longer-lives-bitesize-guide-for-local-systems\/ Accessed: 21 December 2023.<\/p>\n\n\n\n

NIDirect (2023) Learning disabilities<\/em> [Online] Available at: https:\/\/www.nidirect.gov.uk\/conditions\/learningdisabilities#:~:text=A%20learning%20disability%20can%20be,have%20other%20disabilities%20as%20well. Accessed: 22 March 2023<\/a><\/p>\n\n\n\n

NIDirect (2024) Tests to find abnormalities or chromosomal conditions<\/em> [Online] Available at: https:\/\/www.nidirect.gov.uk\/articles\/tests-find-abnormalities-or-chromosomal-conditions#toc-1 Accessed: 2 April 2024<\/p>\n\n\n\n

NISCC (2019), Standards of Conduct and Practice for Social Workers, <\/em>[Online] Available from:  www.niscc.info\/app\/uploads\/2020\/09\/standards-of-conduct-and-practice-for-social-workers-2019.pdf Accessed: 21 March 202321st<\/sup> November 2021].<\/a><\/a><\/p>\n\n\n\n

Northern Ireland Statistics Research Agency (NISRA) (2017) Northern Ireland Multiple Deprivation Measure 2017 (NIMDM2017), <\/em>Available at: https:\/\/www.nisra.gov.uk\/statistics\/deprivation\/northern-ireland-multiple-deprivation-measure-2017-nimdm2017 Accessed: 19 March 2023.<\/p>\n\n\n\n

Northern Ireland Statistics Research Agency (NISRA) (2022) MS-D09 Type of long term-condition: Intellectual or learning disability by broad age bands.<\/em> Available at: https:\/\/www.nisra.gov.uk\/publications\/census-2021-main-statistics-health-disability-and-unpaid-care-tables Accessed: 19 March 2023.<\/p>\n\n\n\n

Nunkoosing, K. (2019) \u2018What is social construction and what does it offer learning disability scholarship and practice?\u2019 in Jones, V. & Haydon-Laurelut, M. (2019) (eds.) Working with people with learning disabilities: systemic approaches<\/em>, London: Red Globe Press, pp. 23-25.<\/p>\n\n\n\n

Oliver, M. (1990) The politics of disablement<\/em>. London: Macmillan.<\/p>\n\n\n\n

Oliver, M. (2009) Understanding disability: from theory to practice<\/em> (Second Edition) London: Palgrave Macmillan.<\/a><\/p>\n\n\n\n

Parton, N. (2009) \u2018Postmodern and constructionist approaches to social work\u2019 in Adams, R., Dominelli, L., Payne, M. (eds.) Critical Practice in Social Work <\/em>(Second Edition), <\/em>Basingstoke: Palgrave Macmillan.<\/p>\n\n\n\n

Patient and Client Council (2019) Our Experiences of self-directed support: service users and carers share their views.<\/em> Available at: https:\/\/niopa.qub.ac.uk\/bitstream\/NIOPA\/10208\/1\/Our-Experiences-of-Self-Directed-Support.pdf Accessed: 2 April 2024.<\/p>\n\n\n\n

Pearpoint, J. O\u2019Brien, J. & Forest, M. (1992) PATH: Planning alternative tomorrows with hope. <\/em>Toronto:Inclusion Press.<\/p>\n\n\n\n

People First (2023) A voice for people with learning difficulties<\/em> [Online] Available at: https:\/\/peoplefirstltd.com\/about-us\/ Accessed: 21 March 2023.<\/p>\n\n\n\n

Personal Professional Development Workbook (PPDW) (2022) BSW Level One Practise Learning Opportunity<\/em>.<\/p>\n\n\n\n

Ratti, V., Hassiotis, A., Crabtree, J., Deb, S., Gallagher, P. & Unwin, G. (2016) \u2018The effectiveness of person-centred planning for people with intellectual disabilities: A systematic review.\u2019 Research in Developmental Disabilities<\/em>, 57<\/em>, 63\u201384. Available at: https:\/\/doi-org.queens.ezp1.qub.ac.uk\/10.1016\/j.ridd.2016.06.015 Accessed: 23 March 2023.<\/p>\n\n\n\n

Reeve, D. (2019) \u2018Understanding Disabling Barriers Faced by People with Learning Difficulties: The Social Model and Beyond\u2019 in Jones, V. & Haydon-Laurelut, M. (eds.) Working with people with learning disabilities: systemic approaches<\/em>, London: Red Globe Press, pp. 36-50.<\/p>\n\n\n\n

Robertson, J., Emerson, E., Sanderson, H., Routledge, M., Oakes, P., Joyce, T., Hatton, C., Elliott, J., Mclntosh, B., Swift, P., Krinjen-kemp, E., Towers, C., Romeo, R., & Knapp, M. (2007). \u2018Person-centred planning: factors associated with successful outcomes for people with intellectual disabilities.\u2019 JIDR. Journal of Intellectual Disability Research (Print)<\/em>, 51<\/em>, 232\u2013243. Available at: http:\/\/pascal-francis.inist.fr\/vibad\/index.php?action=search&terms=18512906 Accessed: 23 March 2023.<\/p>\n\n\n\n

Royal College of Psychiatrists (2021) Position Statement PS05\/21: Stopping the overprescribing of people with intellectual disability, autism, or both (STOMP) and supporting treatment and appropriate medication in paediatrics (STAMP).<\/em> Available at: https:\/\/www.rcpsych.ac.uk\/docs\/default-source\/improving-care\/better-mh-policy\/position-statements\/position-statement-ps0521-stomp-stamp.pdf?sfvrsn=684d09b3_6 Accessed: 23 March 2023.<\/p>\n\n\n\n

Safta-Zecheria, L. (2018). The infantilization of intellectual disability and political inclusion: a pedagogical approach. Journal of Educational Sciences<\/em>. 38. 104-112. Available at: DOI:10.35923\/JES.2018.2.08. Accessed: 23 March 2023.<\/p>\n\n\n\n

Sanderson, H., Kennedy, J. & Ritchie, P. (1997) People, Plans and Possibilities: Exploring Person Centred Planning<\/em>,<\/em><\/strong> Edinburgh: SHS.<\/p>\n\n\n\n

Sanderson, H. (2000) Person-centred planning: key features and approaches<\/em>. Joseph Rowntree Foundation. Available at: http:\/\/www.familiesleadingplanning.co.uk\/Documents\/PCP%20Key%20Features%20and%20Styles.pdf Accessed: 22 March 2023.<\/p>\n\n\n\n

Scherer, N., Wiseman, P., Watson, N., Brunner, R., Cullingworth, J., Hameed, S., PEARSON, C., & Shakespeare, T. (2022). \u2018Do they ever think about people like us?\u2019: The experiences of people with learning disabilities in England and Scotland during the COVID-19 pandemic\u2019. Critical Social Policy<\/em>, 0<\/em>(0). Available at: https:\/\/doi.org\/10.1177\/02610183221109147 Accessed: 24 March 2023.<\/p>\n\n\n\n

Smale, G., Tuson, G., Biehal, N. & March, P. (1993) Empowerment, Assessment, Care Management, and the Skilled Worker. <\/em>London: HMSO.<\/p>\n\n\n\n

Smith, R.M. (2000) \u2018Mystery or typical teens? The social construction of academic engagement and disability.\u2019 Disability and Society, <\/em>15, pp.909-922. Available at: https:\/\/doi.org\/10.1080\/713662011 Accessed: 19 March 2023.<\/p>\n\n\n\n

Smull, M., Sanderson, H., Allen, B. (2001) Essential lifestyle planning: a handbook for facilitators.<\/em> Manchester: Northwest Training and Development Team.<\/p>\n\n\n\n

Social Care Institute for Excellence (SCIE) (2022) Safeguarding Adults Review on Whorlton Hall Commissioned by Durham Safeguarding Adults Partnership Executive Summary<\/em> [Online] Available from: https:\/\/www.safeguardingdurhamadults.info\/media\/41326\/Whorlton-Hall-Safeguarding-Adults-Review-Executive-Summary-December-2022-pdf\/pdf\/WhorWltonHallSafeguardingAdultsReviewExecutiveSummaryDecember2022.pdf?m=638058557112270000 Accessed: 29th<\/sup> December 2023.<\/p>\n\n\n\n

Stainton, T. (2009) \u2018Learning disability\u2019 in Adams, R., Dominelli, L., Payne, M. (eds.) Critical Practice in Social Work <\/em>(Second Edition), <\/em>Basingstoke: Palgrave Macmillan.<\/p>\n\n\n\n

The Guardian (London, England) (2022) Inquiry opens into alleged patient abuse at Muckamore Abbey; More than 70 staff suspended and 34 arrested at psychiatric hospital in County Antrim since allegations came to light.<\/em> 6 June. Available at: https:\/\/search-ebscohost-com.queens.ezp1.qub.ac.uk\/login.aspx?direct=true&db=edsbig&AN=edsbig.A706200250&site=eds-live&scope=site Accessed: 24 March 2023.<\/a><\/p>\n\n\n\n

The National Care Line (2023) Social Care Funding: Direct Payments<\/em>. [Online] Available at: https:\/\/www.thenationalcareline.org\/AccessingHelp\/SocialCareFundingDirectPayments#:~:text=Personal%20health%20budgets%20work%20in,system%20called%20self%2Ddirected%20support. Accessed: 20 December 2023.<\/p>\n\n\n\n

Thompson, J., Kilbane, J. & Sanderson, H. (2008) Person Centred Practice for Professionals<\/em>. Maidenhead: Open University Press\/McGraw Hill.<\/p>\n\n\n\n

Thompson, N. (2016) Anti-Discriminatory Practice<\/em> (Sixth Edition), London: Palgrave.<\/a><\/p>\n\n\n\n

Trevithick, P. (2012) Social Work Skills and Knowledge: a practice handbook <\/em>(Third Edition) Maidenhead: Open University Press.<\/p>\n\n\n\n

Ulster University (2023) Learning disability data and Northern Ireland <\/em>[Online] Available at: https:\/\/www.ulster.ac.uk\/research\/topic\/psychology\/projects\/completed\/learning-disability-data-and-northern-ireland Accessed: 20 March 2023.<\/p>\n\n\n\n

United Nations Convention on the Rights of Persons with Disabilities (CRPD) (2006), Geneva. Available at: http:\/\/www.un.org\/disabilities\/convention\/conventionfull.shtml Accessed: 20March 2023.<\/p>\n\n\n\n

United Nations Convention on the Rights of the Child (UNCRC) (1989) Geneva Available at: https:\/\/www.ohchr.org\/en<\/a> Accessed: 22 March 2023.<\/p>\n\n\n\n

World Health Organisation (WHO) (2019), International Statistical Classification of Diseases and Related Health Problems 10th Revision<\/em> (ICD-10)-WHO Version for; 2019-covid-expanded. Available from: https:\/\/icd.who.int\/browse10\/2010\/en#\/F70-F79 Accessed: 22 March 2023.<\/p>\n\n\n\n

\n\n\n\n

[1]<\/a> This is a revised undergraduate \u2018Social Work in Context\u2019 assignment.<\/p>\n","protected":false},"excerpt":{"rendered":"

By Andrew Rawding Year 3 –\u00a0Social Work Undergraduate Student Introduction According to the 2021 Census in Northern Ireland, 16,923 of \u2018all usual residents\u2019, resident for three months or more from 21 March 2021, has an intellectual or learning disability (LD) (Northern Ireland Statistics and Research Agency (NISRA), 2022). This is less than 1% (0.89%) of the population, with the largest number in the 15-39 age band (NISRA, 2022). However, the number of people with LD is increasing: MENCAP (2023) states there are 31,000 adults with LD in Northern Ireland, with 25,000 of working age; more than double the figure of 10,540 for 15\u201365-year-olds in 2021 Census (NISRA, 2017). This paper[1] will provide a critical appraisal of person-centred planning (PCP) with people with a learning disability (PWLD). It will start with an overview of PWLD, then outline issues encountered by PWLD in relation to discrimination, inequality, and oppression. It will then provide an overview of PCP with PWLD, and critically appraise PCP in terms of its potential to promote empowerment and facilitate anti-oppressive practice. Overview of PWLD It is important for social workers to recognise that the term \u2018learning disability\u2019 is disputed (Nunkoosing, 2019), and socially constructed (Gergen, 1985), like other terms used interchangeably for LD: intellectual disability (ID), developmental disability, intellectual impairment, or special educational needs (Baum & Lyngard, 2006). The National Institute of Health and Care Excellence (NICE) (2015:5) states: ‘a learning disability is generally defined by 3 core criteria: lower intellectual ability (usually an IQ of less than 70), significant impairment of social or adaptive functioning, and onset in childhood’. The Department of Health (DOH) (2023a) website and Northern Ireland government services (NIdirect, 2023) definitions emphasise a \u2018whole life\u2019 nature to the disability, \u2018problems\u2019 with understanding and learning, and the ability or not to live independently. DOH includes the potentially stigmatising term of \u2018a reduced intellectual ability\u2019 (DOH, 2023a). For the social worker focusing on improving people\u2019s lives through strength-based rather than deficit-based practice (Montgomery et al., 2023), these definitions raise questions about who decides and benefits from them: the person labelled and diagnosed with LD, or medical professionals, charities and other stakeholders and gatekeepers? What whole life support is or should be in place to reduce so-called disability and enhance ability? A clinical diagnosis of LD may provide access to support services but may be stigmatising and disempowering for the person themselves (Elinor et al., 2014), impinging on their rights, silencing their voice, and keeping them oppressed (Courtenay, 2020). The inclusion of \u2018independence\u2019 in definitions may serve vested interests of those wanting to keep PWLD dependent on their services, or on family through overprotection (Callus et al., 2019). This is a subtle form of \u2018disablism\u2019 (Thompson, 2016:133). \u2018Disability is constructed by the meaning people place on it\u2019 (Smith, 2000:910). The World Health Organisation (WHO) (2019), which still uses the definitional term \u2018mental retardation\u2019 in the International Classification of Diseases 10th Revision (ICD-10), categorises severities of learning disability as mild (approximate IQ range of 50 to 69; mental age from 9 to under 12 years), moderate (approximate IQ range of 35 to 49; mental age from 6 to under 9 years), severe (approximate IQ range of 20 to 34; mental age from 3 to under 6 years), and profound (IQ under 20; mental age below 3 years). These severities can be based on how much help and support a person needs. However, they can also \u2018infantilise\u2019 PWLD, keeping them and treating them like children with IQ criteria ignoring gifts, skills, other forms of intelligence and excluding them politically (Safta-Zecheria, 2018). A mild diagnosis may recognise an ability to communicate effectively and conduct self-care but focuses on slow learning of new skills or doing tasks like completing paperwork. A severe diagnosis may include an inability to communicate \u2018normally,\u2019 with more support needed with personal care and mobility. A profound and multiple LD (PMLD) diagnosis may require support with feeding, personal hygiene, personal safety, and toileting. Down\u2019s syndrome is also a type of learning disability, as are some forms of autism, cerebral palsy, and epilepsy (NIdirect, 2023). Relevant disability legislation in Northern Ireland for LD includes the Disability Discrimination Act 1995 (DDA), Special Education Needs (SEN) and Disability Act 2001, the SEN and Disability (Northern Ireland) Order 2005, the Autism (Northern Ireland) Act 2011, and Section 75 of the Northern Ireland Act (1998). Also of significance are the Human Rights Act 1998, the United Nations Convention on Rights of the Child (UNCRC) (1989), and the United Nations Convention on Rights of Persons with Disabilities (UNCRPD) (2006). The importance of the latter is the emphasis on the right of PWLD, whether child or adult, to have their voice heard (Article 12, UNCRC, 1989), with a right to freedom of expression and opinion (Article 21, UNCRPD, 2006), and the right to \u2018highest attainable standard of health without discrimination on the basis of disability\u2019 (Article 25, UNCRPD, 2006). Relevant strategies include the DOH Autism Strategy (2013-2020) and Action Plan (2013 \u2013 2016). However, progress reports on the Action Plan have still not been published (DOH, 2023b). A lack of evaluations since the Bamford \u2018Equal Lives: Review of Mental Health & Learning Disability\u2019 highlights just some of the inequalities experienced by PWLD (All Party Group on Learning Disability (APGLD), 2018), including the stigmatising fact that policy documents link LD with mental health, and often with uncritical acceptance (Kelly et al., 2016). Issues encountered by PWLD in relation to discrimination, inequality, and oppression. PWLD are discriminated against if they are treated less favourably than others, and it cannot be shown that the treatment is a proportionate means of achieving a legitimate aim (Section 15, 1 (a)(b), Equality Act 2010). PWLD are oppressed when they are treated as inferior and subordinate (Dominelli, 2002). Using the framework of Thompson\u2019s (2016:35) \u2018personal \u2013 cultural \u2013 structural\u2019 (PCS) levels of discrimination, PWLD have been discriminated against and oppressed at personal, cultural, and structural levels by language, stigma, and stereotyping. This has stigmatised them, linking them with \u2018mental illness\u2019 (Ditchman et al., 2013), and often isolated them educationally as \u2018special needs\u2019 (Thompson, 2016:23). In a survey of 1,000 adult PWLD, over 1 in 3 stated that they were most afraid of being bullied and name calling when they go out (Mencap, 2019). Historically PWLD have been subjected to labels like \u2018morons,\u2019 \u2018idiots,\u2019 \u2018deviant\u2019 and \u2018retarded,\u2019 and been locked away in \u2018madhouses\u2019 and \u2018lunatic asylums\u2019 (McClimens & Richardson, 2010:23). Discourse theory acknowledges how language can be used to construct dominant narratives by those who have power (Parton, 2009). Researching \u2018prevalence\u2019 in Northern Ireland, descriptive terms for LD changed from \u2018mental sub normality\u2019 (MacKay and Scally, 1964), to \u2018severe mental handicap\u2019 (MacKay et al., 1991) to \u2018learning disability\u2019 (MacKay and McDonald, 1996). In the United Kingdom (UK), the government also replaced the dehumanising label \u2018sub-normality\u2019 with \u2018mental handicap\u2019 and then adopted \u2018learning disability\u2019 (Bewley, 2008). In Northern Ireland, this language change was reflected in a \u2018Review of Policy for People with a Learning Disability\u2019 in 1995 (DHSS, 1995). However, the term \u2018learning disability\u2019 has been rejected by the self-advocacy movement \u2018People First\u2019 who use the social model of disability (Oliver, 1990) and self-identify as \u2018people with learning difficulties\u2019 (Reeve, 2019:41), rather than with disabilities. Within the social model of disability, \u2018learning disability\u2019 is considered a socially constructed term used by those with the power to diagnose, categorise, legislate, and write policy in medicine, psychology, education, and other professions, suggesting that some people are \u2018disabled by their learning, rather than by society\u2019 (Williams & Evans, 2013:3). It conforms to the \u2018medicalization of disability,\u2019 reinforcing the idea that there is \u2018something wrong with them\u2019 (Oliver, 2009:44), rather than acknowledging \u2018disabling environments, barriers, and cultures\u2019 (Oliver, 2009:45). However, even within the social model of disability some of those who self-identify as \u2018people with learning difficulties\u2019 (People First, 2023) have themselves a problem with the term \u2018disabled person\u2019, which they consider stigmatising as they are \u2018a person first\u2019 and do not consider themselves to be the same as  \u2018wheelchair users\u2019 (Reeve, 2019:41) who have mobility-related disabilities and are themselves discriminated against due to physical inaccessibility (Baudin & Petterson, 2023) The medical model continues to pathologise and discriminate against those labelled with LD with \u2018eugenics by stealth\u2019 (McClimens & Richardson, 2010:27), supported by \u2018personal tragedy theory\u2019 (Oliver, 2009:45). For example, in England the government\u2019s \u2018Office for Health Improvement & Disparities\u2019 offers the choice for pregnant mothers to screen their baby for Down\u2019s syndrome, Edward\u2019s syndrome and Patau\u2019s syndrome and then also choose to abort the baby (NHS England, 2022). In Northern Ireland, government and health trusts offer privately-funded screening for Down\u2019s syndrome using the discriminatory language of testing for \u2018abnormalities\u2019 or chromosomal conditions (NIDirect, 2024; NHSCT, 2024),   If a child is born and then labelled with LD, they will face significant health inequalities throughout their life including less access to cancer screening, higher likelihood of serious mental health problems, obesity, diabetes, constipation, gastro-intestinal disorders (Emerson et al., 2016; Mencap, 2019; NICE, 2023), and unrecognised post-traumatic stress (Daveney et al., 2019). PLWD have a shorter life expectancy: males die 14 years earlier, and females 17 years earlier, than the general population (NHS Digital, 2019). In Ireland, people with intellectual disability \u2018die younger and have a higher rate of death\u2019 than non-disabled peers (Doyle et al., 2020:1064). There is also the significant issue of over medication of PWLD, who are \u2018prescribed off-licence antipsychotics in the absence of a psychiatric illness\u2019 (Deb et al., 2020:10), often to restrict behaviour labelled as \u2018challenging\u2019 (Royal College of Psychiatrists (RCP), 2021; NICE, 2015). Carers and services may find the behaviour challenging but it could be a PWLD\u2019s only way to be heard, in response to how they are being treated as a person and the stress of their environment (NICE, 2015). \u2018Stopping over Medication of People with a learning disability, autism, or both with psychotropic medicines\u2019 (STOMP) was introduced in 2016 by NHS England, The Royal College of Nursing, The Royal College of Psychiatrists, The Royal College of GPs, The Royal Pharmaceutical Society and The British Psychological Society (NHS England, 2023). Significantly there is no such campaign in Northern Ireland. The term \u2018over-medication\u2019 does not feature in Mencap NI\u2019s \u2018Treat me well\u2019 briefing (2019b). During a social work practise learning opportunity in a residential setting for children with severe learning disability, an oppressive \u201cget the meds in them\u201d culture seemed to prevail (Personal Professional Development Workbook, 2022), which appeared to be centred on the needs of professionals rather than being \u2018person-centred\u2019 on the needs of the child. Overview of person-centred planning (PCP) for PWLD and context for use PCP (Sanderson et al., 1997) is an approach developed in the UK since \u2018Valuing People\u2019 (Department of Health, 2001) became public policy in England. Whilst humanistic in nature it is distinct from a therapeutic \u2018person-centred approach\u2019 in social work associated with Carl Rogers (Trevithick, 2012). It involves working in partnership with individuals to support planning and decision-making so they can identify needs and goals and \u2018set out to achieve their goals\u2019 (Cambridge & Carnaby, 2005:38). It is supposed to be a person-centred way of including a PWLD in the creation and management of their care plan in a residential setting or in community, which recognises their abilities (not disabilities) and provides support for their aspirations, rather than a deficit approach which expects PWLD to fit in with existing services decided for them by others.  Key features of PCP are: person-centred; partnership with family and friends; the person\u2019s priorities and support needs are central; action-orientated; exploring possibilities; with continuous reviews (Sanderson, 2000:3-7). Assessment frameworks formulated for PCP include \u2018Making Actions Plans\u2019 (MAPS) (Forest & Lusthaus, 1989) and \u2018Planning Alternative Tomorrows with Hope\u2019 (PATH) (Pearpoint et al., 1992). These are not formal assessments but start with blank sheets of paper to gather information, using drawings and meaningful graphics to represent concepts like \u2018dreams\u2019, visions\u2019 and \u2018gifts. They reflect the \u2018exchange model\u2019 (Smale et al., 1993) with PWLD and their family and friends acknowledged as the experts. Another tool is \u2018Essential lifestyle planning\u2019…<\/p>\n","protected":false},"author":1441,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-436","page","type-page","status-publish","hentry"],"jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/pages\/436","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/users\/1441"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/comments?post=436"}],"version-history":[{"count":1,"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/pages\/436\/revisions"}],"predecessor-version":[{"id":437,"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/pages\/436\/revisions\/437"}],"wp:attachment":[{"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/media?parent=436"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}