The development of a care package for clients with a learning disability
accessing contraception and reproductive health services
E. Maudsley (1), S. Kinvig (1), A. Gunstone (1), M. Atkins (2)
Abacus Clinics for Contraception and Reproductive Health Liverpool, UK
(1); Learning Disabilities Directorate, Liverpool, UK (2)
Introduction: Clinical staff had reported concerns when dealing with
clients with a learning disability (LD). The identified issues related to the
client’s capacity to consent to contraception, breast and cervical screening
and the ability to obtain an accurate history from the client/carer. When a
history and/or consent were not obtained, the consultation could go no further
and clinical staff believed the health care needs of these clients were not
being met.
Aims & Method: The goal was to develop a care package appropriate
to the diverse needs of these clients, ensuring that they were provided with the
same rights of access as all other service users. From February 2003,
multi-disciplinary meetings were held to identify options for the new care
package. Several issues were raised including, barriers to access, communication,
provision of an adequate support network and promotion of the new development to
all clinicians throughout the city. Five areas were developed.
Results: 1. Referral/assessment forms were designed to ensure an
appropriate medical, social and sexual history could be obtained with particular
emphasis on assessing client communication methods. 2. An aid to assessment of
the client’s competency to consent and in particular, identify whether
preparatory work/education would be beneficial. If the latter was requested, the
option of providing this service at home would be feasible via referral to the
Domiciliary team. If consent and preparatory work were both declined an option
would be given for follow up at a later date. 3. A guide for good practice in
assessing the client’s capacity to consent was developed and was included in
the package for reference purposes. 4. Several information booklets were
obtained for inclusion in the LD package: these booklets were specifically
developed for women with LD’s by People First (Liverpool), who themselves have
LD’s. 5. Instructions for the new proposal were drafted to aid clinicians in
the use of the new package. 6. The final LD package was agreed in November 2003
and is now being piloted for a 12-month trail period, from January 2004.
Conclusion: Multidisciplinary working has led to a package which
enables staff to feel more confident in carrying out consultations with clients
with LD’s and these client’s are more confident to access health services.
