Communication Training Makes a Difference

Outcomes for two men with intellectual disability following communication support training for their workers

Authors: Meg Irwin & Tara Sheridan

Abstract

For many people with intellectual disability, successful participation is restricted by inadequate or inappropriate communication support. In Central Victoria, the local Communication Access Network service convenes and trains a network of disability support workers in advanced communication support skills. This paper outlines the positive communication and participation outcomes for two men with intellectual disability and complex communication needs after their support workers joined the Network.

Introduction

Studies in the UK indicate that up to 90% of adults with intellectual disabilities have some form of communication difficulties, with half having severe difficulties. 80% of people with severe learning disabilities never acquire an effective communication system (Baker, 2010, p.11). In Australia in 2003, 3% of the population had intellectual disabilities and almost 60% of those had severe communication limitations. (AIHW, 2008). We look at the communication and participation outcomes for two men with intellectual disabilities and complex communication needs when two of their disability support workers trained as Communication Facilitators with the Southern Loddon Mallee Regional Communication Service (SLMRCS).

The Southern Loddon Mallee Regional Communication Service, auspiced by Bendigo Health and funded by the Victorian Department of Health and Human Services (DHHS), is part of the state wide Communication Access Network (Johnson, Solarsh, Bloomberg & West, 2016).  Communication Facilitators are disability support workers trained by the SLMRCS speech pathologist to provide and promote skilled person-centred communication support. They may collaborate between their services to support each person with a communication disability across his or her various environments. Since 2006, the SLMRCS has convened, trained and supported the Communication Coordinator and Facilitator Network. Disability services involved in the Network include approximately 18 DHHS group homes, and 8 large disability funded organisations across approximately 20 sites in the region. (Communication Access Network, 2018).

Communication Facilitators start with six days of training. After that, the SLMRCS convenes quarterly collaboration meetings, and provides site visits, whole service or other trainings or consultations, phone and email support, and a shared email list.

Prior to initial training, participants identify learning goals and needs. During the training, they evaluate their learning, do a weekly knowledge quiz, practice applying skills in their own services, and undertake and submit projects. Three months after completing the training, participants complete a questionnaire about the outcomes of their training for people they support.

Following the first course in 2018, Tara was enthusiastic about outcomes for two men she supported in their residential service. The SLMRCS invited Tara to collaborate on this paper about “Sam” and “Steve” (not their real names). Tara was a practice leader at Golden City Support Services (GCSS). GCSS provides services to people with disabilities, people recovering from mental illness, frail aged people, and people with dementia, through supported accommodation, respite, and home and community-based supports.  GCSS has been a member of the Communication Coordinator and Facilitator Network since its inception, and actively supports their Communication Facilitators through an additional network within GCSS.

GCSS’s fundamental practice framework is its Five Bases of Support, built on elements of Person-Centred Active Support (Ashman, Beadle-Brown and Mansell, 2010) and Positive Behaviour Support (La Vigna, Willis and Donellan, 1989). The Five Bases are Communication, Engagement, Choice and Control, Predictability and Consistency, and Positive and Respectful Language. This framework informs all organisational policies, practice, staffing structure and employment strategies. Tara was already skilled in this approach, but she found that communication-specific training still improved outcomes.

Sam

Sam was a 45-year-old man with an intellectual disability, acquired brain injury, and obsessive-compulsive behaviours.  They included requests to purchase new clothes, but reluctance to wear new or clean clothes; continuous checking, moving, or folding of clothes throughout the day, not washing his clothes, and refusing to bathe on average, every second day. At most, Sam would choose to wear clean clothes every second day. Staff could spend entire shifts folding clothes for him, or writing lists of new clothing requests.  If Sam was not well supported to manage these behaviours, he might throw objects and cause property damage.

The accommodation service had introduced a skill development sheet so staff had consistent prompts to support Sam to bathe. This gave him more control by making his activities more predictable for him. When all fifteen staff followed the skill development sheet, Sam usually completed his routine. A year after the sheet was introduced, Sam would often show staff he had already independently bathed when they arrived. However, if he had high blood sugar levels or increased anxiety, this would not happen. Additionally, if staff did not know Sam well, they, themselves, could become anxious and, therefore, not deliver consistent prompts.

Two of Sam’s workers, one from his day support, and Tara from his accommodation service, did the six day training in early 2018. After the training, two new communication support interventions were introduced for Sam; a social story and consistent collaboration between the accommodation and day support Communication Facilitators.

The social story was developed to give Sam more control in his routine at home. It was about choosing clean clothes and washing clothes. It used positive and respectful language to confirm his right to make choices, and his ability to manage his clothing. It also affirmed that others saw Sam as handsome when he followed his routine.

The day support Communication Facilitator read the social story with Sam during the day. Reading the story away from home allowed him to process what he needed to do away from the place he needed to do it.

Two months after the social story was introduced, Sam was choosing to bathe, and was washing his clothes and wearing clean clothes daily. On a good day, he was requesting to purchase four to five new clothing items twice a day, and checking his clothing only once a day.

The two trained Communication Facilitators from Sam’s day support and accommodation service communicated daily; sharing information about what was happening for him, identifying what was working and what wasn’t, thus establishing consistent support across Sam’s main environments.  

Tara believes a key impact of this collaboration was creating predictability for Sam:

“He trusts we are communicating with each other about what he needs. This can be informing him of a staffing change for the afternoon at home, or advising his day supports if he’s going to be away. This way he is reassured that everyone has the information they need to effectively support him.”

Holidays, when usual routines changed, had been a particularly stressful time of for Sam. With daily communication between the communication facilitators and use of the social story during normal non-holiday weeks, Sam had been more able to participate successfully in more activities he enjoyed. Tara explains the difference this made to holiday periods:

“The more engaged he is in his life, the more meaningful things he has in it, the less time he has to ask for stuff. When he comes to holidays, he is then happy to relax.”

There was also an increase in Sam’s verbal communication, which had previously been very limited.  Tara describes the change:

“It was ‘yes’ or ‘no’ or ‘yup’. ‘Yup’ meant either ‘yes’ or ‘I don’t understand’. He will now ask ‘Hello, how are you today?’ and you say ‘Great thanks. How are you?’ He responds ‘Yup, good, I did this today’. He is actually having a full conversation. He’s using more words and his message is clearer. Staff don’t have to interpret as much. Now he is communicating more and feeling understood, we are seeing more of his personality. He jokes and sings and wants to share things with others.”

Furthermore, as Sam initiated more interaction and produced more verbal language, staff learnt more about how he processed information and how to support him effectively to do that. Mutual trust and successful interaction kept increasing.

Steve

Steve was a 42 year old man with autism and an intellectual disability. He did not speak. He understood some speech and could recognise photographs of places and people important to him. Steve was mostly happy to sit on the couch and not interact, perhaps occasionally going to the kitchen to ask for something.

Photo boards were already in place at Steve’s home.  After the training, Tara prioritised time to ensure the boards continued to develop and that staff supported Steve to use them.

Steve’s photo board was a pin board with photos of him doing things in the community, such as buying lunch from the bakery, going to the supermarket, going to the pool, visiting his mum or his brother, or gardening at home.

After the training and the active implementation of the photo board, Tara describes the improvements:

“To start off, staff had to go into his bedroom and ask him to join them and say “What did you do?” and talk to him about it. You could tell by his body language, vocalisations and facial expressions that he was excited that we were standing there talking to him about something that he enjoyed. Now it’s got to a point that staff arrive and he takes them to the board rather than the other way around.”

“A lot of his communication needs to be interpreted by the other person. So now we have a really good tool to know what he actually likes doing, which opens opportunity for him to make choices in the future and for him to make decisions and have more control in his life.”

  • A regional network convened, trained and supported by the local Communication Access Network speech pathologist since 2006, builds the capacity of disability support workers to provide effective communication support to people with complex communication needs.
  • These “communication facilitators” are provided with knowledge, skills, tools, resources, mentoring and collegial relationships to provide and promote good person-centred communication support, including appropriate communication aids and strategies.
  • Positive outcomes for people with intellectual disabilities and communication disabilities following initial training include; increased initiation, improved choice and control, increased  participation in self-care and community activities, improved communication, and reduced  challenging behaviour
  • Even support workers within an organisation committed to communication were able to achieve improved outcomes after training focusing specifically on communication. 

References

Ashman , B., Beadle-Brown , J.,  Mansell, J. (2010).  Top of Form

 Person-centred Active Support: a Handbook. Hove, United Kingdom. Pavilion Publishing (Brighton) Ltd.

AIHW (Australian Institute of Health and Welfare). 2008. Disability in Australia: intellectual disability. Bulletin no. 67. Cat. No. AUS 110. Canberra:AIHW

Baker, V., Oldnall, L., Birkett, E., McCluskey, G. & Morris, J. (2010). Adults with learning disabilities (ALD). Royal College of Speech and Language Therapists position paper. London.  Royal College of Speech and Language Therapy, 11

Communication Access Network. (2018). Southern Loddon Mallee Regional Communication Service Communication Coordinators Network, Communication Access Network. Retrieved from: https://www.communicationaccessnetwork.com/2018/06/21/southern-loddon-mallee-regional-communication-service/

Johnson, H., Solarsh, B., Bloomberg, K., West, D. (2016). Supporting people with complex communication needs through community capacity building: the Communication Access Network. Tizard Learning Disability Review. 21(3). pp.130-139

La Vigna, G.W., Willis, T.J., Donellan, A.M. (1989). The role of positive programming in Behavioural treatment. In Cipanni, E. (Ed.) The treatment of severe behaviour disorders Behaviour Analysis approaches. Monographs of the American Association on Mental Retardation (12). San Francisco: American Association on Mental Retardation

Social Connections for Aging Well

Golden City Support Services is a My Aged Cared provider supporting older people and people with dementia and their families. The specialist service supports people to continue to live actively in their home, and community.

This year Golden City Support Services are celebrating 40 years of support in their community. 

This local Bendigo support organization has grown dramatically.  Initially there were 19 people involved through a network of families providing community- based and personalised accommodation support. Now the organisation delivers tailored services to over 350 people and their families, this includes older people and people with dementia.

Golden City Support Services understand that social relationships are important for people’s quality of life.   John is a support person who has been running a social group for men in the early stages of dementia for 12 years.

“We come up with solutions to over come barriers that people with dementia may experience getting out into the community and enjoying the company of friends,” says John.  “We provide support and access – like assistance with communication and social connection so that people can participate at a level that suits them.”

Recently they took a day trip to the silo art trail to admire the new art work on the Rochester silos.

Terry is a regular who says that meeting up every Thursday is good for his health and is good relaxation.  “It keeps me sane because I get out of the house – it just seems to work for me.”

“Our studies into learning from older people who are socially connected informs the programs we design and the support we provide for older people and their families,” says Ian McLean CEO of Golden City Support Services.

“We know that meaningful participation and social involvement contribute to aging well.  Our services include support with day-to-day activities and opportunities for people with early dementia and their carers to enjoy activities and stay connected to their community of choice.”

Catching up for lunch every Friday

Elaine looks forward to Friday lunch.  Not only does she enjoy skipping cooking, she catches up with her friends.

The Friday social lunch group have been meeting together every Friday lunch for two years, and over this time have developed new friendships.  Support worker Katie says, “It’s important to meet up each week.  When people regularly come together they feel comfortable.”

Lunch at the bakery and then a spot of op-shopping is one of the Friday lunch events that Jenny enjoys.  “We might sit down in a restaurant or sometimes have a BBQ,” she says.  “We travel together and eat out together.”

Volunteering

David is one of over 100 volunteers at Uniting AgeWell.  He started volunteering with the support of Creative Links, a Golden City Support Services program, which helps people to connect people to their interests in the community.

He first began volunteering on a Thursday in the laundry, but soon decided that this task wasn’t the best fit for his skills. As a well-known and loved artist with CreateAbility’s Performance Ensemble, David was naturally drawn to the weekly singing group.

Volunteer Manager Kerry says that when David first started he seemed very shy, but since he has been helping out with the singing group he has made lots of friends and accompanies the singing with his guitar.

 

Find out something new

Wayne’s advice to anyone who is invited to try something new is; “Give it a go.” 

He never knew that he could paint.  It is a new passion that gets him up every day.  “Before I tried painting at the Access Creative Studios I was just sitting at home; now I am motivated,” he said. 

Tammy, Wayne’s Golden City Support Services Support Coordinator, suggested that he might like to visit and see what happens at the Access Creative Studios. At first, Wayne admits he wasn’t sure about this idea but found he felt comfortable at the studios. 

“I discovered something new about myself, I never knew – I can paint!  I feel good when I paint.” 

“I have made new friends here – it is like a little family,” he said. 

“I make sure everyone has a cuppa, and I even drop into the studio for a visit – to say Hello and share a cuppa.” 

“I like painting animals.” Wayne’s recent body of artwork features gorillas, cats, giraffe and also a Christmas wombat series.  “Animals bring a lot of joy into your life,” he explains.  “They make you feel comfortable and calm.  Animals are soothing.” 

Wayne wants his viewers to enjoy his artwork and realise that painting is something that is worth doing. 

“You should give it a go to try something new,” says Wayne. “You might think you can’t do it, but there is always the opportunity to discover.”

Doing Business

Melissa Gordon-Cooke’s small business “Mels Munchies” has been operating for several years now.  

One of Mel’s favourite parts of any workday is counting the earnings and banking her proceeds.  

Over quite a few months, Mel slowly developed a rapport with bank staff at the Strath Village Branch of the Commonwealth Bank. Mel’s confidence to bank independently continued to increase, and Mel especially enjoyed using the automatic coin deposit machine.  

However, a small hitch became obvious. The bank had located a small fixed table adjacent to the machine. This table was a convenient place for ambulant customers to place items but made it impossible for Mel to position her wheelchair close enough to the device to reach it without some form of hand on hand support from staff.  

As a result, Mel started asking to move to another bank. With support and encouragement, Mel explained to the bank staff what the problem was and even had a face-to-face chat with the Branch Manager.  

Several weeks later, Mel entered the bank expecting to have the “same old problem” only to discover that the table was relocated – solving her problems of access to do her business banking.

 

Choice to change

It happens to all of us – sometimes the same routine stops giving us challenges and meaning, and we are ready to try something new. 

Ross, a man with a disability, has been attending the same day program for over a decade. He was ready for a change, to try new activities and meet new people. 

With his new NDIS Plan, that provides for one on one support, he is actively making a change in his life and choosing to try new activities indoors and outdoors. 

Maddie, Ross’s support person, found out about Sailability on Facebook and suggested it to Ross as one activity he might like to try. 

Ross is developing quite a knack for creative crafts and is enjoying expressing himself through this. Getting into making and creating has given Ross an opportunity to exercise his hands and arms more frequently with a noticeable increase in his motor skills.  

As a result, Ross has become more independently mobile and confident in the use of his wheelchair.  This is a bonus for Ross.  With increased mobility and confidence he is going out with his partner more often.

Cooking To Share

Tam’s housemate Paula inspired her to start cooking.

“When I came around for a sleepover she was baking,” says Tam, a young woman with a disability, who recently celebrated her 21st birthday.

With her support person, Tam developed her cooking skills. “I love spaghetti, and that was the first thing I wanted to learn how to make,” she said. “I can cook meals on my own, and the best part is sharing my cooking with others.”

“I feel happy when I give to other people,” says Tam. Making a cup of tea for her flatmate is just another one of the nice things she likes to do for other people in the kitchen.

Confident to Try Something New

Justin is growing in his confidence.

Justin is a young man with a disability who is supported at his regular job delivering newspapers and to do his household shop.

Over time, with support, Justin has begun to feel more independent.

He is thinking about having less support in his regular activities like shopping to that he can have support to try a new experience. He thought he would like to go to Melbourne.

Justin planned the support he needed to make the visit to Melbourne. Because of his confidence to shop independently, he decided to do his shopping without to support and save up his support hours for a trip to Melbourne.

“My favourite thing about Melbourne was patting the horse and talking to people on the train, I enjoyed the fish market and spent a lot of money on sushi,” Justin said.

Shopping and Auslan

Can you imagine going shopping without being able to ask anyone a question, or hear his or her answer?

Communication is important for everyone to express what is important to others and in return actively listen to other people to understand what is important to them.

“I like to go to places where people can do some signing.” Colin is deaf and Auslan is his language. Together with Jimmy, his hearing dog, Colin does his regular grocery shop at ALDI.

A hearing dog is just like an eye-seeing dog. When he goes to the supermarket with Colin, Jimmy wears a jacket – that is his uniform and that alerts everyone he is working and they can’t pat him.

Golden City Support Services support worker Janelle supports Colin in his day-to-day communications at work and out in the community.

“We always get lots of attention when Jimmy is with me and my support person Janelle,” says Colin. “Between the three of us, there is a lot of signing happening without any sound!”

“That is how we met Brad while shopping. He asked us to show us some signs – so I showed him ‘Hello’ and ‘How are you?’.”

“Then, the next week Brad remembered the signs for ‘Hello’ and ‘How are you?’ I showed him ‘How much?’ Then the next week shopping I showed him some more signs!

“One day when we went into the shop three different people signed to me ‘Hello’ and ‘How are you?’ – Brad taught people in his team how to talk to me!

Above: Colin and Brad demonstrate how to say ‘Hello’ using Auslan.

“It was exciting to teach other people my language. To help everyone learn and remember, Janelle and I created a poster for their tearoom of Auslan signs.

Next time Colin went shopping the team at ALDI presented him with a gift. “They were so happy with the Auslan sign we created they gave me a present – to say thank you for teaching them sign language. I love that they gave me a gift!”

Above: Colin and Brad demonstrate how to say ‘Thank you’ using Auslan.

Recently the Manager of Colin’s local ALDI enrolled for an Auslan course. He says that “I like talking to people and having the skills to talk to anybody is really important.”

Above: Colin and Brad demonstrate how to say ‘How are you?’ using Auslan.

“To give the best possible support we need to know what is important to a person,” says Ian McLean CEO of Golden City Support Services. “Communication is key to knowing someone well and is the foundation of our team’s support practice.”

Here is a great resource that supports learning and conversation between Auslan and English for your ipad.