‘A Healthier Me’ aims to make sure that adults with learning disabilities using the Borders support services are supported to get the help they need to eat well and have a healthy lifestyle. The service uses a pathway or toolkit and identifies a key lead member of staff to implement it.

Background

People with learning disabilities are more likely than the rest of the population to experience poor health and be overweight or obese. The Scottish Borders Learning Disability Service and NHS Borders Public Health set up ‘A Healthier Me’ to address this. Their aims are to ensure that people with learning disabilities in the area receive consistent information and support, and can access mainstream or specialised services that can help them. ‘A Healthier Me’ begins with the assumption that everyone involved in the lives of an individual with a learning disability has a role to play in ensuring that they get the support they need, when they want it.The ‘A Healthier Me’ programme consists of the development and implementation of a Pathway (or a toolkit) to raise awareness of issues and the resources and support available for learning disability services, individuals and families.

In 2013, the Brothers of Charity Services (Scotland) were approached to work in partnership with the local Learning Disability Service and employ a Project Officer – Fiona Munro to pilot and develop ‘A Healthier Me’, initially within the charity’s own learning disability support service followed by three other local services. Fiona’s role is to provide practical support to other services and encourage them to implement the programme. She is also working with the programme’s Project Group to try and ensure the long-term sustainability of ‘A Healthier Me’.

The Brothers of Charity are an international charity with branches throughout the UK. In the Scottish Borders, The Brothers of Charity Services (Scotland) Ltd, run a supported living service, a care home and two social enterprises for people with learning disabilities.

How the pathway works

1 Key lead

Each learning disability support service has an identified member of staff to take the role as a ‘Key Lead’ and take responsibility for implementing ‘A Healthier Me’ within their service. 26 Key Leads from all 12 services use the following Pathway with those that they support. 

• Engaging with individuals – is there a need to encourage individuals to improve their lifestyle?

Key Leads within each organisation can try the following to encourage individuals to choose to take part in A Healthier Me:

• letters and leaflets
• events or taster sessions for individuals (and their carers and support workers) to find out what’s involved in some of the Healthier Me activities
• reviews and meetings

2 Knowledge and learning

Is workforce development, family and individual support required? Service staff (and family carers) in the area are offered the following training:

• The Royal Environmental Health Institute of Scotland (REHIS) Elementary Food and Health course for Carers of Adults with a learning disability.
  Run over two days, it provides basic nutrition knowledge relevant to those supporting people with learning disabilities.
• A Healthier Me Nutrition awareness course.
  This short, four-hour course provides basic nutrition information and training on how to implement the Healthier Me Pathway. Key Leads have been trained to deliver this course within their own organisations

Other training courses that may make it easier for services to understand the user-led approach that is encouraged; include free NHS Health Scotland e-learning modules, particularly the Health Behaviour Change module. This module can help staff to recognise and understand when individuals might be ready to make changes to improve their lifestyle and when they are not. This can give staff confidence and understanding about when and how they can encourage individuals. Other relevant training could include food hygiene or first aid courses.

3 Programme of support

The support programme for individuals uses the Scottish Consortium for Learning Disability (SCLD) ‘Healthy eating, healthy living’ training pack, other activities and resources

Key Leads are encouraged to use the SCLD pack to develop one-to-one or group learning sessions. The pack is suitable for people with a range of learning disabilities and includes 22 sessions which cover topics such as fat, salt, sugar and fibre, using practical activities such as cooking. The pack can be used flexibly rather than working through all 22 sessions.

Services are also encouraged to consider running larger scale peer support events or set up groups to provide sociable, fun and more informal activities such as walking groups, cooking, or tasting sessions. Events can also be used to raise awareness of the SCLD training or to celebrate individual achievements.

4 Physical health checks and lifestyle advice

Do individuals require health checks or advice?

A Lifestyle Advisor Support Service (LASS) is available throughout all medical health centres in the Borders. This mainstream service provides individualised support on a range of health issues including optional physical health checks. Advisers are aware of the Healthier Me Pathway and have access to SCLD training pack to help them tailor their messages to individuals with learning disabilities.

5 Learning disability services

Do individuals require more specialised support?

Some individuals may be less able to access mainstream support. The Borders Learning Disability Service provides specialised support for individuals with specific needs. Local Area Co-ordinators, who are part of this service work with individuals to promote healthy lifestyles and assist them to get involved in local community activities.

6 Other resources

What other resources can services and individuals make use of?

The Pathway also raises awareness of other relevant local or national resources that services can use; individuals can benefit from or be inspired by. These include food-related courses for people with learning disabilities at Borders College, a learning disability health champion programme and the Borders Sports and Leisure Trust which has a disability sports development officer.

The toolkit has information about mainstream health promotion resources and information about relevant national campaigns. It also provides details on how to access easy-read health information and recipes to support individuals or groups.

Services are provided with information about where to apply for funding, to help them develop activities. They are also encouraged to consider approaching local supermarkets for help with input into events or resources.

How the pathway was developed

This ambitious project aimed to encourage all separate and independent organisations within the Borders area to provide people using their services access to the same range of quality information and activities. This was to be achieved with one part time project officer, without extra funding for services.

The NHS Health Improvement Team were able to provide staff or carer training for a limited period and funding was found to provide materials or packs, such as the SCLD healthy eating, healthy living training packs. The Brothers of Charity also received funding from Community Food and Health (Scotland) to buy kitchen equipment that services can borrow.

During the Pathway development phase, Fiona formed a Best Practice Group, to find out:

• how accessible local mainstream services were for people with learning disabilities
• what knowledge and skills services and people with learning disabilities have
• what support and information about food, health and physical activity is available to them and
• what resources (leaflets, recipes etc.) are available for this client group and sector

They identified that people with learning disabilities and some support staff had a gap in skills and knowledge around nutrition awareness, food label knowledge and cooking skills. They also found some mainstream services were less accessible to people with learning disabilities than they could be. And, although some specialised services, such as physical activities for people with learning disabilities are available in the Borders, some people in this rural area may have trouble getting to these.

After exploring what resources were available, Fiona piloted these within the Brothers of Charity support services and three other services. Meanwhile she worked with representatives from the three services and the Project Group to develop the Pathway. After two years, Fiona worked to include other services and this cumulated with a conference attended by representatives from all 12 services and additional leads from statutory services. This conference shared the work of the project, launched the Pathway provided practical information, discussed the Pathway toolkit and how to implement A Healthier Me. The services also received the SCLD pack free of charge.

Challenges and what worked well

Fiona experienced a range of challenges whilst developing the programme and had to consider how to address these. Other activities had more immediate success.

• Evaluating the impact that the programme has on individuals. Although individuals are asked for feedback after a training session, it has been difficult to gather consistent base-line information, (e.g. individuals’ levels of skills or knowledge before they take part in the programme) as each service may record information about individuals, or manage support plans differently.
• Encouraging people with individuals with learning disabilities to take part. It was not particularly difficult to encourage individuals to take part in A Healthier Me. Its success may be because of the non-judgmental approach taken by staff, and emphasis on it being user-led and empowering. Some individuals liked being given homework tasks as part of the SCLD training, others did not. Some particularly enjoyed having their own course-work folder of materials and used this for reference with support staff in-between training sessions.
• People with learning disabilities might be trying to manage on a low-income. Services and staff will need to work together with individuals to consider what foods, equipment or activities they can buy or take part in if their income is restricted
• Engaging with families. Getting family carers involved can ensure consistent messages and support at home. Fiona found that more informal, or peer type events were more likely to attract family members than more formalised training.
• Facilities and capacity within services to run practical cooking activities. Support services did not always have the time or resources to run these. Fiona ran cooking sessions for some of the services; however, they will eventually have to run these for themselves. A pack of kitchen equipment is available for services to borrow and Fiona will help staff learn how to run these themselves.
• Some services report that the REHIS Elementary Food and Health course for Carers of Adults with a learning disability is too long for their staff to attend. This course takes a minimum of nine hours to complete. Although those attending it provided positive feedback, many services are unable to free up staff time to attend it. In response, NHS Borders Public Health developed a shorter course. Key Leads can deliver this short course within their services after completing the full REHIS course and learning about A Healthier Me.
• Support for people to take part in specialised physical activities is not accessible across the Borders. Some services are considering how to set up walking groups and support individuals to become walk leaders.
• Encouraging services to implement A Healthier Me
  Fiona and the Project Group succeeded in encouraging all the learning disability services to implement A Healthier Me because it undertook extensive consultation with services, as well as individuals and families involved in the pilot sessions. It has tried to identify and address any barriers (eg. staff training, equipment etc.) The Pathway has been developed as a flexible toolkit of resources which have shown to be adaptable to different types of services and individuals with a wide range of abilities.
• Helping individuals with learning disabilities who received minimal support from services
  Receiving consistent and regular support and encouragement has helped to make a difference for those that have taken part in A Healthier Me. However, some individuals with learning disabilities may not be entitled to daily support or may just receive it for a short duration (eg. 15 minute slots). Taking part in group activities and courses can help as these provide peer support; however, further help might be needed from family members.
• Finding easy-read resources for people with learning disabilities. Whilst there is a small range of leaflets, recipes etc. aimed at people with learning disabilities these are limited.
• Mainstream services such as LASS required support to make sure they were accessible to people with learning disabilities. The project will continue to provide training to staff within LASS to increase their confidence and understanding when supporting people with learning disabilities on lifestyle advice

Achievements

Within the first 18 months of A Healthier Me, and working with four services, the programme had achieved the following:

• 50 people with learning disabilities had taken part in healthy eating, healthy living training (just three dropped out before the end of training)
• 34 staff and carers completed the REHIS Elementary Food and Health course for Carers of Adults with a learning disability
• 8 staff attended ‘A Healthier Me Nutrition awareness course’
• There is some anecdotal evidence of improved health behaviour change in both service users and staff, and service users have provided positive feedback about the informal, flexible and enjoyable approach of the activities.

By the end of 2014, all learning disability services and statutory services in the Borders had identified a member of staff to take the role as a Key Lead. These 26 individuals are taking responsibility for implementing the programme throughout their service.

Future plans

A concern for A Healthier Me is continuation after the funding for the project officer post ends in 2016. Representatives from each service currently attend the project meetings. Fiona’s role over the next year will consider how to ensure the network is continued and improved over the coming years.

More formal evaluation is planned in October 2015 supported by the Joint Improvement Team.

Funding

A Healthier Me was initially funded by the Scottish Government Health inequalities fund. It is a partnership project led by the Scottish Borders Learning Disability Service, NHS Borders Public Health and Brothers of Charity Services.

Policy links

The Keys to Life is the learning disability strategy in Scotland. It follows on from and builds on the principles and successes of ‘The same as you?’ a review of services for people with a learning disability. The emphasis of the Keys to Life is on health, and reducing health equalities experienced by people with learning disabilities. Upholding human rights are integral to its approach and ensuring that mainstream health services are accessible to people with learning disabilities.

‘A Healthier Me’ in practice

Supporting an older couple with learning disabilities using the SCLD Healthy eating, Healthy Living pack

A learning disability nurse had concerns about an older couple that they supported. The man seemed to be communicating less often with those around him and his partner was providing him with excess food because he responded positively to her when she did. Both the woman and the man seemed to be eating too much and they were putting on excess weight.

The nurse encouraged the couple to run some SCLD healthy eating, healthy living sessions with them in their own home. In total they worked through seven sessions over a period of five months. These focused on understanding food labelling, learning about fat, salt and sugar, fruit and vegetables and bone health. The nurse found that the couple required little support and thought that using praise and mini-ceremonies and setting small achievable goals together with them, such as taking short walks each day, helped to motivate them.

The couple’s support service assisted them by helping them prepare and freeze home cooked meals to try and avoid the temptation of buying a take away.

As a result, both lost between ½ and one stone in weight each. The man improved his mobility, is more involved in cooking tasks and eats more fruit and vegetables. The woman walks more often and reports feeling healthier. The couple can now make an informed choice about when and how often they can treat themselves to ‘chippy nights’ and other treats.