Health and wellness in day services for adults with an intellectual disability

by Mary Reynolds, Niamh Gallagher and Jerome Moran, Adult Day Services, Daughters of Charity Dublin-based services

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Health and wellness are an integral part of enjoying a good quality of life. The World Health Organization defines health as ‘not only the absence of infirmity and disease, but also a state of physical, mental and social well being’. For people with an intellectual disability this is an important consideration, as many may have additional health care needs which must be appropriately managed. However, a balance must be struck between providing for health care needs while also ensuring that each person has access to a good quality of life.

Since 2007 the Daughters of Charity Services for individuals with an intellectual disability have utilised the services of a community liaison nurse, Jane O’Connell, for individuals attending adult day services. Jane carries out a health.needs assessments and develops a health action plan with each person based on their identified health risk and needs. The health assessment tool used is ‘Integrate’ (Hutchinson et al. 2006). Where possible, the person will answer questions themselves or with the assistance of their family or key worker. Based on areas of need or concern, an individual health action plan is developed with the person and his/her family. The emphasis is on empowering the person or their family to access health screening or services within their local community, in keeping with the philosophy of inclusion and accessing generic services. The health action plan is also incorporated into each individual’s Person-centred plan. The health screening ensures that any problems can be identified at an early stage and appropriate interventions made.

Since 2009 the Daughters of Charity have also been actively supporting Special Olympics Ireland in developing an evidence-based health promotion toolkit. The toolkit contains fifteen workshops and resources ranging from healthy diet and recipes, to advice on maintaining good bone health. The resource packs also include a food, dental and exercise diary, easy.read health leaflets and games. These workshops are run on a regular basis for individuals, their families and support staff.

Another component of ensuring health and wellness is health promotion. Changes in the delivery of day services with a move away from a campus-based programme have contributed to a more healthy lifestyle, with individuals participating in more active leisure and recreational activities. To date, the organisation has developed six small community-based day services which provide Person-centred day programmes to individuals in Finglas, Mulhuddart, Mountview and Cabra. The meeting points are located in mainstream community facilities and service users who access them live within that local area. Each individual has a Person-centred plan developed around their own needs and preferences, which includes the promotion of a healthy lifestyle. Individuals access a range of activities within their local community such as swimming, walking groups, tag rugby, a soccer club, Tai Chi classes, dancing and community gardening. These groups help promote a sense of well being, increase physical activity and give opportunities to develop and learn new skills. Many of these classes have been supported by local community grants.

One participant, Jerome Moran, who collaborated on the writing of this article, interviewed some of his peers and their families to hear what their experience of the programmes were and how it had helped their health and well being.

The responses were overwhelmingly positive, with an acknowledgement that the quality of life of individuals had increased along with a sense of health and wellness.

Some of the comments from individuals:

‘We learn what is good for you, fruit is good – coke is bad. Water helps you; you have to drink water every day, eight cups I learnt.’

‘We go shopping and make our lunches every day. My lunch is Weight Watchers based.’

‘We do a lot of different activities here. Every day we do something based around health and fitness.’

Some of the comments from families:

‘My daughter is a lot fitter now and has a lot more stamina for walking long distances.’

‘My son has lost 8lbs and is much more conscious of what he eats.’

‘I attended the Healthy Food Made Easy workshops and got lots of ideas and tips.’

‘He takes more interest in his personal hygiene – showering, for example, after the gym.’

The Daughters of Charity promote the concept of individualised supports within a community setting, as espoused in the New Directions report (2012). There are a number of benefits to this model of service delivery, one of which is an increased awareness of the importance of health and wellness—as already outlined above. The health screening programme, the use of the Special Olympics health promotion toolkit, and participation in community-based day programmes are directly resulting in a greater awareness of health promotion activities and increased health gains for people with an intellectual disability.

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