Social Work with People with Learning Difficulties

Paul Williams, Michelle Evans, SAGE Publications Ltd

• Publisher: Learning Matters
• Year: 2013
• Print ISBN: 9781446267578, 9781446267561
• eBook ISBN: 9781446293607
• Edition: 3
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

This book is part of the highly successful Transforming Social Work Practice series and is written specifically to support students on the social work degree. Full of practical activities, case studies and opportunities for students to critically reflect and explore theory and practice.

Current practice in the field was driven by the government White Paper ?Valuing People? (2001) which declared some radical aims for services with people with learning difficulties. Now somewhat compromised by the local authority austerity measures, the goals set by ?Valuing People? are nevertheless still important. This third edition seeks to confirm and strenghten social work values and priciples so that the progress and successes achieved by ?Valuing People? can continue. Case studies and activities draw out the key points and reinforce learning. Summaries of contemporary research are included, as are suggestions for further reading and coverage of current government guidance and policy documents.

By examining the varied roles that a social worker might undertake in this field, the authors portray a positive picture of working with people with learning difficulties: the achievements and satisfaction, and the learning and understanding that can be gained. They also highlight the need for recognition of vulnerability, the risk of isolation, oppression and abuse, and the continuing political struggle to establish and protect the rights of the individual.

Paul Williams has over 40 years? experience of working with people with learning difficulties. He was a founder member of the organisation ?Values into Action? which campaigned for rights, inclusion and community-based services for people with learning difficulties. He is co-author of books on self-advocacy and anti-oppressive practice. A former lecturer in social work at the University of Reading, he is now retired.

Michelle Evans has 14 years of practice in all areas of sensory need, including Deaf/deafness, visual impairment and Deafblindness. She has a first class honours degree in social work and has worked as a care manager in adult services and a social worker in children?s services. She has a particular interest in methods of social research which contribute to raising sensory awareness in social work/ care management. She lectures social work students at London South Bank University and develops and delivers sensory awareness training to practitioners and managers.

Chapter 1 Who are ‘People with Learning Difficulties’?

Achieving a Social Work Degree

This chapter will help you to develop the following capabilities, to the appropriate level, from the Professional Capabilities Framework:

• Values and Ethics, Apply social work ethical principles to guide professional practice
• Diversity, Recognise diversity and apply anti-discriminatory and anti-oppressive practice
• Knowledge, Apply knowledge of social sciences, law and social work practice theory.

It will also introduce you to the following standards as set out in the 2008 social work subject benchmark statement.

• 5.1.2 The service delivery context
• 5.1.3 Values and ethics
• 5.1.5 The nature of social work practice
• 5.6 Communication skills
• 5.7 Skills in working with others

Introduction

This chapter aims to clarify what is meant in practice by the term ‘people with learning difficulties’. It covers debates about terminology, definitions and numbers. An approach is outlined to identifying strengths and achievements of people with learning difficulties, and ‘putting oneself in their shoes’. Some of the vulnerabilities of the people and their families are described. The perceptions or ‘models’ that underlie the practice of different professions and organisations providing services are covered.

Terminology

In the quotation from Horner (2003) in the Introduction, he uses the term ‘people with learning disabilities’, whereas at the beginning of this chapter, and in the title of the book, we have used the term ‘people with learning difficulties’.

There is a movement led by people with learning difficulties themselves which gives them a collective voice (see Chapter 9). This takes the form of ‘self-advocacy’ groups which are often called ‘People First’. One of the issues taken up by many of these groups is that of terminology. There is strong dislike of the term previously in common use: ‘mental handicap’. The alternative that some people said they preferred was ‘learning difficulty’. In the early 1990s, the government recognised the dislike of the term ‘mental handicap’, but instead of adopting ‘learning difficulty’ they coined the term ‘learning disability’; the reason stated was to avoid confusion with use of the term ‘learning difficulty’ (or usually ‘specific learning difficulty’) in the education field to refer to people with conditions like dyslexia, affecting the ability to read or write or do maths well, but without affecting intelligence. However, ‘learning difficulty’ continues to be the term preferred by many within the self-advocacy movement of the people themselves. Sutcliffe and Simons (1993) found that group members had a clear rationale for this: ‘disability’ means you can't do things, ‘difficulty’ means you want to learn and be taught how to do things. In this book we will use the term ‘people with learning difficulties’, except when quoting from other sources where the original terminology will be retained.

The term ‘mental handicap’ was itself a replacement for the term coined in the 1959 Mental Health Act: ‘subnormality’. This term, perilously close to ‘subhuman’, was in use during the 1960s and early 1970s. Previous terms had been ‘mental deficiency’ and ‘mental defect’. In the first half of the twentieth century, attempts were made to classify degrees of severity of ‘mental deficiency’ with the terms ‘idiot’ (very severe), ‘imbecile’ (severe) and ‘feebleminded’ (less severe). Other terms in use were ‘backward’, ‘moron’, ‘moral defective’ and (especially in the USA) ‘retarded’. Some of these terms lingered on past their sell-by date: a major textbook about people with learning difficulties published in 1974 was still called Mental Deficiency (Clarke and Clarke, 1974). The major voluntary organisation concerned with people with learning difficulties in England and Wales is still called ‘Mencap’, deriving from the term ‘mental handicap’, and the term ‘mentally retarded’ is still in common use in America.

Activity 1.1

What do you think some of the objections are to the terms mentioned above? Is it possible that the term ‘learning difficulties’ will eventually need to be replaced?

Comment

One of the objections that people have made to the adjective ‘mental’ is that it creates confusion with mental illness. The term ‘handicap’ has been felt to have connotations of ‘cap in hand’, with the image of begging and dependence on charity. The terms ‘idiot’ and ‘imbecile’ and ‘moron’ became widely used terms of abuse in ordinary language. ‘Defective’, ‘deficient’, ‘retarded’, ‘backward’, ‘subnormal’ and ‘feebleminded’ all put a highly negative emphasis on ‘something being missing’, and again are in use as terms of abuse.

The disability rights movement has developed a ‘social model’ of disability (in contrast to the ‘medical model’) (Priestley, 2003; Barnes and Mercer, 2010). This will be explained further later in this chapter. In the social model, the term ‘disability’ refers to the imposition of restrictions or oppressive experiences on people because of poor attitudes, low skills or unhelpful physical and social structures in society. The term ‘learning disability’ implies that people are disabled by their learning rather than by society, so it would be rejected in the social model. The term ‘learning difficulty’ has been chosen by at least some people with learning difficulties themselves, rather than being invented and imposed by others. However, it too may become a term of abuse, or the people themselves may choose another term that they wish to be used.

Other more modern terms you may come across, particularly in a scientific context, are ‘intellectual disability’ or ‘developmental disability’.

Definition

Whatever our terminology, an interesting fact is that ‘learning difficulty’ can't be defined. Much of the historical terminology implies that the people we are concerned with are primarily people who have low cognitive intelligence. The IQ test, the method that was developed in the early twentieth century to measure cognitive intelligence, was originally devised to identify people of low intelligence for the purposes of providing support, special education or social control.

There is a problem, however. It is not possible to define a level of IQ below which people have learning difficulties and above which they don't. Statistically, about 3 per cent of the population have an IQ below 70 (the average IQ in the population as a whole is 100). This gives a figure of about 1,800,000 people in Britain with this level of IQ. The majority of these people never come to the notice of services designed to support people with learning difficulties. Most people with IQs below 70 are functioning in ordinary society without requiring special services; they are in work, are married with children and live ‘ordinary’ lives. On the other hand, surveys of people actually receiving services for ‘people with learning difficulties’ have found that some have IQs above 70. Even in the old institutions it was known that a proportion of patients had IQs above this level (Kushlick and Blunden, 1974).

Without a definition, the numbers of people with learning difficulties cannot be determined. However, numbers are required for the planning of services. For this purpose the concept has been developed of ‘administrative prevalence’. This refers to the number of people known to, or actually being served by, specialist services catering for people under the label ‘learning difficulty’ or equivalent. It would include pre-school children receiving support because of a diagnosis of ‘learning difficulty’ or ‘developmental delay’, children receiving special schooling or who have a statement of educational needs under a heading of severe, profound, multiple or moderate learning difficulty (but not ‘specific learning difficulty’), and all those adults receiving services labelled ‘learning difficulty services’ or an equivalent.

Surveys of administrative prevalence have found that around half of one per cent of the population are receiving services for ‘people with learning difficulties’; about half of those are defined as having a severe degree of difficulty and about half are said to have milder difficulties (Race, 1995; Emerson et al., 2001). In Britain, with a population of around 60 million people, only around 300,000 people are actually receiving services as a result of being classified as ‘people with learning difficulties’.

Numbers

The idea persists, however, that there is a hidden cohort of people who should be described as ‘people with learning difficulties’ who are not known to specialist services under that name. For example, a survey of people with learning difficulties carried out by the Department of Health (NHS, 2005) states:

that 2.2% of the adult population of England have a learning disability … It has been recognised for many years, however, that most adults with learning disabilities are not known to statutory services for people with learning disabilities … Administrative definitions only include 22% of English adults who we estimate to have learning disabilities (i.e. approximately four out of five adults with learning disabilities are not defined as such by statutory services for people with learning disabilities).

(Supplementary Appendix: 16–17)

It is unclear what advantages there might be to according a higher number of people the label ‘person with learning difficulties’. It may be that many more people than at present would benefit from support from services designed for people with learning difficulties, but that has yet to be demonstrated. There seems little point in labelling people as having ‘learning difficulties’ if there is no evidence it will bring tangible benefits. Being labelled may be accompanied by social stigma and control elements of social policy that can act to the great disadvantage of people (an extreme example was seen in Nazi Germany where people were at risk of extermination – see Chapter 2).

Activity 1.2

Can you think of advantages or disadvantages that there may be to defining a larger proportion of people than are served at present as having learning difficulties?

Comment

Some of the arguments you might consider include the following.

• There may in fact be many people who are missing out on needed services, and identification of those people so that their needs can be assessed and provided for is desirable.
• Relatively small service input for people with a mild degree of learning difficulty may help more people to achieve independent living or to gain a job.
• However, services may have a vested interest in claiming that there is a ‘hidden cohort’ of potential clients, so that they can argue for a greater role and more finance, and there may be a risk of people unnecessarily being labelled as ‘having learning difficulties’.
• Serving more people who have milder ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• Introduction
• Chapter 1 Who are ‘People with Learning Difficulties’?
• Chapter 2 The Importance of Values: A Historical Account
• Chapter 3 Policy and Legislation
• Chapter 4 The Role of the Social Worker
• Chapter 5 Working with Children and Families
• Chapter 6 Working with Adults
• Chapter 7 Assessment, Planning and Evaluation
• Chapter 8 Communication and Sensory Needs
• Chapter 9 Advocacy and Empowerment
• Conclusion
• Internet Resources
• Appendix 1: Professional Capabilities Framework
• Appendix 2: Subject Benchmark for Social Work
• References
• Index