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Total Communication Charlotte Smith and Andrea Arnold look back on how the Total Communication Now project has evolved from an original vision to a county-wide initiative that continues to help adults with learning disability and all those around them discover new ways to communicate more effectively.
READ THIS IF YOU WANT TO BE INCLUSIVE CREATIVE SOLUTION FOCUSED

e are writing this on behalf of a wider group of therapists who work with adults with learning disability. At a time when there is sadness and loss to face within public sector services and our profession, as well as issues to take a stand on, it is even more important to reflect on our successes. We wanted to share an innovative project that has enabled us to develop partnership working and meet communication needs more effectively at a community level. It has been an uplifting experience for all involved, and we hope it will inspire you to be bold in your ambitions. Total Communication Now creates opportunities in local places in Devon for people with learning disability, support workers, other professionals and family carers to get ideas and help in making meaningful visual aids to support whatever they need to communicate about. In addition, organisations can get help and advice in making their face-to-face communication, signage and information easier to understand, thereby becoming more inclusive. There has been a Total Communication Strategy in Devon for many years, thanks originally to the generous support and inspiration of Jane Jones and her colleagues in the Somerset adult learning disability speech and language therapy service. Total communication training has been provided by speech and language therapists and cotrainers as part of this. Implementation of the county-wide strategy has fluctuated depending on resource levels, and at times it has felt like a paper-based aspiration. However, two years ago, we were successful in getting Total Communication written into the Devon Learning Disability Health and Social Care Partnership Business Plan under the Freedom from discrimination and harassment outcome: Tackling inequalities remains a fundamental part of everyones role working with people learning disabilities, not least of which are the inequalities inherent in our own practice and systems. As noted in Valuing People Now (2009), if services develop communication and accessibility for people with more complex needs, they are probably getting it right for most people.

As a result, we were able to put the Total Communication Now project proposal forward and secure funding from the Learning Disability Development Fund. This was a significant breakthrough.

Funded time

In the first year the funding paid for 14 mobile kits. These include a touchscreen laptop with relevant software, a printer, laminator, camera and small hand-held video-cameras which can be loaned out. There is input from speech and language therapists employed by three different Trusts, and vitally important time was funded for trained support workers to provide local learning opportunities for one day every two weeks. The kits are based within a day service building for use there and in other venues across ten towns and their surrounding areas. We ran thirty five workshops and roadshow events to promote the project and demonstrate how Total Communication can improve the quality of everyday interactions. Solution focused ideas are central to

the principles and processes of the Total Communication Now initiative, focusing on what works rather than becoming bogged down in problem-based thinking (Burns, 2005; George et al., 2006; Smith, 2006). The outcomes for individuals are determined by: what communication change the person and / or their supporter wishes for or needs building shared language through visual as well as verbal forms based on what works working together in short bursts, at the persons pace being based in the now and / or what next? in do-able amounts and observable ways enabling maximum involvement of individuals whilst motivating all concerned through noticing what works well. In addition, we have used solution focused approaches to agenda planning within the sixmonthly Devon-wide Total Communication Now staff network meetings. This has enabled us to focus on what we are pleased to notice has worked and to appreciate the different creative solutions and outcomes

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Now!

opportunities promoted by the Total Communication Now initiative. Here are a few examples of types of outcomes individuals have gained: 1. More people have materials for using with Talking Mats. One person was enabled to make their own decision about a cataract operation; one person chose where to live; one woman was able to communicate she wished to end a relationship, relieving her worry and anxiety. 2. A mother got ideas and symbol pictures to use with her autistic son in letters to each other while he is an in-patient in a mental health unit.

Solution focused ideas are central to the principles and processes...focusing on what works rather than becoming bogged down in problem-based thinking

that have evolved within each area of Devon despite and due to different levels of service capacity and strengths. It has helped us pool and exchange resources, expertise and resourcefulness whilst being employed by different organisations. As a result, there is a buzz at these network meetings and we come away feeling supported, inspired and resilient. Participatory Appraisal, involving service users in planning and evaluation from their point of view, has also been integral to the project, as well as customer feedback forms. For example, 55 people turned up at one of our events and we produced a celebratory slide-show as a participatory activity within the day from the photos taken of the examples people had brought along to show and share.

Good practice

At the end of year one we carried out an evaluation across Devon. We gathered examples of individual and joint good practice which evidenced improved communication

3. A young woman with learning disability for whom English is a second language made a photo-story to aid her transition to a new day service. 4. An autistic man with epilepsy and his keyworker have made a short DVD to show other staff how to communicate with him to enable him to get ready to go out. 5. A woman made a photo-book about her dad after he died, which is helping to support her through her bereavement. In Mid Devon, Total Communication Now has supported people with learning disability in making an awareness raising film about everyday communication breakdown. This film had a special showing at a cinema attended by local councillors. Community services have also gained. For example, in North Devon, the project is helping police to improve communication with victims about hate crime. In South Devon, partnership working is flourishing in the local leisure centre in Newton Abbot. This initiative was inspired by the excellent practice and evidence shared

by colleagues in Victoria, Australia (www. scopevic.org.au). Historic links already existed between adult learning disability services and the leisure centre, as staff used to provide gym sessions at the local day centre. The staff were however keen to move away from this style of working, and were open to ideas for increasing inclusion opportunities within the leisure centre itself. After consultations with the staff team, local groups, and people with learning disabilities who use the leisure centre, we developed a set of visual communication aids. We made a communication board (an A3 colour photographic and symbolic chart) and sited it on the reception desk. It aims to support people to communicate effectively, encouraging positive social interaction and independence throughout the leisure centre. A set of flashcards (of individual photos/symbols) is also available at the reception desk, gym and swimming pool areas. As well as being used to ask specific questions about those activities, they are useful for people who find the large board too complicated. We provided training to a core group of leisure centre staff around using total communication with people with learning disabilities, and particularly about giving people the time and space to use the resources successfully. Information about the new communication board was sent out to carer groups, residential and supported living organisations as well as being promoted in learning disability service publications. The communication board was piloted for a year. An evaluation process involving service users resulted in minor adaptations to the visual display. Feedback was positive, not only from leisure centre staff themselves, but also from a range of individuals and organisations using the centre. Interestingly the leisure centre has found that the communication board has also been useful for others with communication difficulties, including people for whom English is a second language. What has been particularly pleasing is the real interest from other local leisure centres and service providers in making their own resources. As a result, a communication board is now used in three other leisure centres and is beginning to be introduced within library and other District Council services. Overall, Total Communication Now has had a positive impact on the adult learning disability speech and language therapy service delivery, supporting every level of the tiered model described in the RCSLT ALD

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Figure 1 How Total Communication Now supports the tiered model of service delivery (RCSLT, 2010) Speech and language therapist uses time with the individual and supporters for assessment, eg. checking visual aids are meaningful The individual referred and / or supporter can book in to: get help in making visual aids to support identified strategies modify existing visual aids to make them more effective learn skills to enable them to update visual aids to keep them relevant in the future come along to show and share good practice workshops

Tier 4 Specialist interventions Specialist interventions to address communication and eating and drinking needs in all environments

Tier 3 Capability in specialist learning disabilities services Interventions which contribute to the creation and maintenance of capable specialist learning disability services

Support staff can get help via Total Communication Now sessions with implementing actions into practice following training, eg. Talking Mat materials, photo menus; producing easier read documents Sharing top copy examples via website Support and training with producing easier to read or multimedia information Support with making materials to support choice-making, decisions and consent Support and training with producing easier to read info, eg. leaflets, standard letters Communication board

Tier 2 Capability in mainstream Interventions to enable the development of capable mainstream services to address communication and eating and drinking needs of people with learning disabilities

Tier 1 Capability in the community Interventions to promote health, well being and inclusion of people with learning disabilities at a general population level

Position Paper (2010, figure 1). Speech and language therapy teams from three different Trusts provide the adult learning disability service across Devon, and all have benefited from this collaborative project. Parts of Devon are already experiencing a reduction in lengthy waiting lists and times as, following assessment, people and their support worker or carers can be signposted to book into a Total Communication Now slot to support the therapeutic intervention process. This initiative is also beginning to offer a preventative element to service delivery by building on the capability in the community and universal services to communicate more effectively and inclusively. We are exploring possibilities for providing this service within library premises and / or services. It is potentially a way to develop further integration with adult speech and language therapy services, with adults with learning disability leading the way in helping to bridge the gap experienced by many people with SLTP communication disability. Charlotte Smith (email charlotte.smith@ devon.gov.uk) is the Professional Lead in speech and language therapy for adults with learning disability in South Devon Locality and Torbay, and the Devon Health and Social Care Learning Disability Partnership Lead for Total Communication. Andrea Arnold (email andrea.

arnold@devon.gov.uk) is a speech and language therapist with adults with learning disability. Both are employed by South Devon Healthcare Foundation Trust.

Smith, I. (2006) Ideas for Solution Based Working with People who Have Intellectual Disabilities, Solution News 2(2), pp.21-25.

Acknowledgements

Resources

Thanks to everyone else involved in inspiring and making the Total Communication Now project work so well, in particular: South Devon Ian Weller, Dr. Cath Valentine, Gail Rochelle, Lisa Green, Sue Cooke, Helen Buswell (Occupational Therapist) North Devon Anne Kershaw, Lucy Holding, Laura Wignall, Hazel McDonald, Hailey Graham, Colin Cornell, Laura Snead Exeter, East & Mid Devon Sue Brain, Adela Lewis, Lynne Walker, Charmaine Simpson, Lesley Baker, Vicky Hooper.

Participatory Appraisal, see www.3Ps.org.uk Talking Mats, see www.talkingmats.com

References

Burns, K. (2005) Focus on Solutions: A Health Professionals Guide. London: Whurr. Department of Health (2009) Valuing People Now: a new three year strategy for people with a learning disability. London: Crown copyright. George, E., Iveson, C., & Ratner, H. (2006) Problem to Solution. Brief Therapy with individuals and Families. London: BT Press. RCSLT (2010) Position Paper ALD. London: Royal College of Speech & Language Therapists.

REFLECTIONS DO I KEEP TRYING TO INFLUENCE AT A STRATEGIC LEVEL, EVEN WHEN MY PLANS FEEL LIKE A PAPERBASED ASPIRATION? DO I IMPROVE MY SERVICE THROUGH BUILDING RELATIONSHIPS ACROSS ORGANISATIONAL BOUNDARIES? DO I NOTICE WHAT WORKS WELL AND DO MORE OF IT?
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SPEECH & LANGUAGE THERAPY IN PRACTICE summer 2011