Demonstrate an ability to support a person with a ...€¦ · 6 Demonstrate an ability to support a person with a communication impairment Careerforce – Issue 1.1 – February 2011

Demonstrate an ability to support a person with a communication impairment16874 V2

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4 Getting started

10 Definition of communication

11 Effective communication

17 The function of communication

20 Strategies

48 Acknowledgement

54 Commitment to communication support

63 Implementing communication support—the process

64 Assessing communication

72 Communication goals

74 Developing a communication plan

75 Implementing a plan

80 Case studies

Demonstrate an ability to support a person with a communication impairment16874 V2

Getting started

Look before you leap!Take the time to go through this workbook before starting on the activities. Read the sections and make notes as you go.

Welcome to Demonstrate an ability to support a person with a communication impairment: one in a series of workbooks especially developed for support workers in the CPQ (Career Pathway Qualifications).

How do I use this workbook?• Use highlighters to identify

the important ideas.

• Take your own notes.

• Complete activities as you go through the workbook and write answers in the spaces provided.

What will I learn about?When you have finished this workbook you will have learned more about:

• Communication—the definition of communication, effective communication, and the function of communication.

• Communication strategies.

• Assessing communication.

• Communication goals.

• Communication plans.

Acknowledgements This workbook has been designed to support your learning and prepare you for the unit standard assessments.

The contents of this workbook include scenarios, learning activities and activities for general health and disability settings. They are not specific to any setting and should be used as a general guide for learning.

Careerforce would like to thank the people who have contributed their time and effort into each workbook in:

• Research and content validation.

• Advice and expertise.

• Testing of activities and assessments and their personal experiences.

And the people who have contributed a human dimension to the workbooks.

4 Demonstrate an ability to support a person with a communication impairment Careerforce – Issue 1.1 – February 2011

Getting started

Stop activitiesYou will also come across the pencil in places where you are asked to STOP (see the graphic on the left) and record your current knowledge or impressions, as a reference point to return to later.

Pause and Rewind activitiesPauses are for summarising, questioning, and reflecting as a reference point to return to later. Rewinds take you back to a PAUSE, STOP or TEST YOUR KNOWLEDGE and give you an opportunity to add to, change or validate some of your initial thoughts and ideas.

Learning activities These help you understand the content, and will help you with workplace verification tasks. The instructions and answer panels for learning activities have a light yellow/orange background like this.

Trainee assessment portfolio

The trainee assessment portfolio contains assessed activities and workplace verification, which must be completed to meet the requirements of the unit standard. These questions or tasks must be completed by you and signed by your workplace assessor in order for you to be credited with the unit standard.

Demonstrate an ability to support a person with a communication impairment 5Careerforce – Issue 1.1 – February 2011

Mark is a young man who loves McDonalds. He is very independent, non-verbal, and relies on staff support when he wants to order a meal. A communication board with pictures of items like burgers, fries, and Fanta drink was made to fit on the tray of his wheelchair.

Mark is now able to indicate what he wants by pointing at the picture of the particular food. On the board there are also instructions for McDonalds staff like, “I would like to buy a…” and

“thank you”. Having this board on his wheelchair means that Mark is able to make his meal choices on his own in McDonalds without relying on staff.

Mark…

Today I want…

Chicken tendersFanta

Crispy chicken snack wrap

Crispy chicken deluxe burger


Yvonne is a lady in her 50s who has an intellectual disability. Staff who support her living in her own flat have assisted her to put together a book about her life as her speech is very difficult to understand. This includes things like a picture of her parents on their wedding day, photographs of herself as a baby, photographs of her and her siblings growing up, and photographs from her present job.

The purpose of this book is to enable her to share some of her history with her visitors and friends, and to remind her of the lovely family times she has had. It also has space for her to put in new photographs and important things. Her support worker has written captions that identify who the people are and the places in the pictures. This means that Yvonne can share her life with visitors who cannot understand her speech.

Yvonne…


Before you go any further in this workbook, think of what you know about communication impairment…

TEST your kNowlEDgEHere are some questions to get you thinking:

What is communication? (Write your description here.)

What is the purpose of communication?

How do you communicate with others?

Do you use your face and body to communicate? (Give a reason why/why not.)


Is communication only about speaking? (Circle one.)

Yes / No

Give a reason why/why not.

What sort of “messages” do we send and how?

What is meant by communication impairment?

What do you think this means for the person with the impairment?

How do you communicate with others? For example, body language, talking.


Communication is so much more than speaking.

Definition of communicationWhat is communication?Many people think that communicating is only about speaking to another person but communication includes much more than this. Communication is a two-way process of interacting with another person. It involves sending and receiving messages. Communication can occur in many different ways, for example—when we communicate we speak, listen and look at the faces and body movements of the people we are communicating with.

Communication is a two-way process of giving and receiving information using any number of ways to get a message across.

What is the purpose of communication?The purpose of communicating is to share with another person or a group of people our:

• Ideas.

• Thoughts.

• Beliefs.

• Values.

• Feelings.

• Wishes.

• Information.

• Needs.

Sender Receiver

Verbal Non-verbal

Verbal Non-verbal


Effective communicationCommunication is a complex process. Effective communication requires:

• A Function—something to communicate about (a purpose or reason for communicating).

• A Strategy—a way to communicate.

• Acknowledgement—somebody to communicate with.

When any of these factors is missing, limited, or ineffective, a person will have difficulty communicating.

For example:• Difficulty with the Function of

Communication—Imagine that you are at a party. You suddenly become involved in an in-depth conversation with a group of marine biologists. They are debating the causes of disease infestations in the xintu fish species. Although you probably have a way of communicating (verbal communication as well as other methods), and somebody to communicate with, you are likely to struggle to find something to communicate about—you probably don’t have the knowledge or vocabulary to participate. This can make communication difficult.

• Difficulty with the Communication Strategy—Imagine that you have gone on holiday to the jungle regions of northern Peru. You have booked in for a home-stay with a local family. The family speak a local language that you have never even heard of. You probably have something you want to communicate about, because

you are interested in their lifestyle and country. You have somebody to talk to—the whole home-stay family is there! But, you might struggle to communicate because you don’t have an effective way to communicate with your hosts. This can make communication difficult.

• Difficulty with Acknowledging Communication—Imagine that you are planning a party. You phone your best friend to ask for advice about where to hire a duke box. However, your friend is distracted—she is talking to you and also watching her favourite TV programme. She isn’t listening properly and you have to keep on repeating yourself. You have something to communicate about (hiring a duke box), and you have a way of communicating (speaking on the phone), but your friend (somebody) isn’t effectively responding to your communication. This can make communication difficult.


Communication impairments vary a lot. Some people have significant difficulties with communication, while others have mild difficulties. Communication impairments can include difficulties with:

• Speech (clarity of speech sounds)—difficulties with speech can include having unclear speech, slurred or unco-ordinated speech, not being able to produce particular sounds, or speech muscles becoming easily tired and less easy to use.

• Language (complexity of grammar, and vocabulary)—difficulties with language can include having a limited vocabulary, or limited grammar, using vocabulary or grammar in odd ways, or having trouble remembering specific words.

Communication Impairment

For some people, communication is hard. They may benefit from additional support to aid their communication. When a person has ongoing difficulty with any part of the communication process this is known as “communication impairment”.

• Social use of language (knowing what to say, when, and to whom)—difficulties with social use of language can include having trouble with initiating or maintaining interactions, not knowing what is appropriate conversation for particular situations, or limited understanding of social rules/expectations.

• Fluency (the flow of speech and language)—difficulties with fluency can include stuttering/stammering and stilted speech (stuttering).

• Voice (the actual sound produced by the vocal chords)—difficulties with “voice” include having a husky voice, unusual pitch and tone of voice (such as having a very monotonous tone of voice), not being able to make any sound (losing your voice), and having difficulty physically speaking loudly enough to be heard.

Effective communication


• Physical difficulties—conditions that affect the way the speech muscles move can result in unclear speech.

• Hearing impairment—some people who have hearing impairments also have difficulty with developing speech and language—it is hard to learn to speak if you cannot adequately hear what speech and language should sound like.

• Intellectual disability or learning difficulties—many people with intellectual disability have trouble learning and remembering new things, and this can affect their ability to learn speech, language and social communication.

• Developmental delays—some children and young people experience delayed development. This often means that they are slower at developing speech and language than other children of the same age.

Some people may have a single type of communication difficulty, while others may have difficulty with many aspects of communication. Some forms of communication impairment are permanent (though it is recognised that people’s communication can improve and/or change over time). Other forms are temporary.


• Acquired neurological conditions (conditions that affect the brain)—often having had a stroke or brain injury, or acquiring a condition such as Motor Neurone Disease, will affect a person’s ability to communicate. The particular type of difficulty will depend on which area(s) of the brain have been damaged.

• Other specific conditions—some specific conditions result in difficulties with communication. For example, all people with Autism Spectrum Disorder have some level of difficulty with the social aspects of communication.

Communication impairments occur for a variety of reasons, including:

A hearing aid can be used to help a person with a hearing impairment.


“Imagine shopping without being able to ask for what you want, or check how much you have to pay, or say ‘I’m just looking thanks’. Shopping can be a challenging task. It can be even more difficult when your speech is difficult to understand or you do not use speech to communicate. People with complex communication needs… can face problems with many community activities.” From Horizon Magazine, Scopevic, Communication Resource Centre, Melbourne, December 2007.

“You go into a shop… all smiles. You open your mouth and it all goes. They get embarrassed, frustrated, push you onto someone else.” Jack, 42, “Living with Communication Impairment”, a study commissioned by Communications Forum, UK, www.communicationsforum.org.uk.

The impact of having a communication impairment

“Does she like fish? Is she an old age pensioner? Why do they ask my daughter-in-law and not me?” Madge, 62, “Living with Communication Impairment”, a study commissioned by Communications Forum, UK, www.communicationsforum.org.uk.


Knots

There are knots in my voice Big ones I can’t undo

Tied around my tongue Trapped between sounds

Waiting to be free.

Messages from my brain That don’t get through

Swim around Play games of hide n seek

With the dead cells.

There are words in my head That don’t come out

The way I think, Feel,

Would like to say.

Messages to my speech The ones that get there Come sneaking out;

Slow me down Make me think

Give me another chance.

To express myself through the words I’ve untied.

By Melinda Smith, 1990

Published in Beneath the Surface ISAAC 2000

Read the poem by Melinda Smith below, an Australian woman who has cerebral palsy and uses an electronic communication support system. The poem is called Knots, and describes her experiences of having a communication impairment.



Learning activityThink about a person you support who has a communication impairment. Record on the diagram how each area of that person’s life is affected by communication difficulties. Some areas may not be affected at all, while others may be significantly affected.

Impact of communication

impairment

LearningEmployment

Other

Recreation

Daily living Spirituality

Health and wellbeing

Fun and enjoyment

Friendship and relationships


The function of communicationWhat is the purpose of communicating?There are many reasons for communicating, including:

• Sharing ideas, thoughts, beliefs, values.

• Sharing feelings.

• Making needs and wants known.

• Sharing or gathering information.

• Building or maintaining relationships.

• Protesting or refusing.

• Having fun.

• Connecting with other people.

• Understanding our environments and other people.

• Clarifying or checking what we understand.

You may hear the term “function of communication”. It means the purpose or reason for communicating.

We can express our needs, wants and choices. “No I don’t want to go to lunch just yet! I want to go to the toilet.”

We can transfer information, such as when we talk to our friends. “Let me tell you about the meal I went for last night.”

We can help in supporting social closeness and personal relationships, by telling jokes or by expressing sympathy at times when someone has lost a loved one.


Learning activitySome of our reasons for communicating relate to physical, social and emotional needs. In this activity you will see a list of common needs. Decide whether each need is physical, social or emotional, and put a tick in the correct column.

Remember that each person you support may have these needs at different times. Having these needs understood and responded to is an important part of quality of life.

Reason for communicating Physical needs Emotional needs Social needs

Wanting to be included and accepted in the group.

Going to the toilet.

Wanting to be loved.

Wanting a friend.

Feeling hot or cold.

Needing to be liked.

Wanting a hamburger.

Feeling safe.

Wanting a hug.

Being part of a group.

Feeling sick.

Being able to share your worries with others.

Feeling thirsty.

Being able to tell someone you are afraid.

Having a headache.


Definitions:• Expressive Communication—refers to

the way in which a person sends the message to another person. This may be by gesturing, speaking, writing, pointing or signing. Meaning is often added to the way we communicate with others through gesturing and specific body language.

• Receptive Communication—refers to the way in which a listener receives and understands a message from a communication partner.

Most people want to communicate for a variety of reasons. It’s important to consider:

• What the people you support currently communicate about successfully.

• What they try to communicate about but are less successful with.

• What they currently do not (or cannot) communicate about that they might want to communicate about.

Function and communication ImpairmentSome people who have communication impairments can struggle with the function of communication. This might be because:

• They don’t have the vocabulary (right words) for a particular topic—for example, not knowing the words to describe their emotions.

• They may not be able to use sophisticated language (grammar, ability to put sentences together). This can make it difficult for them to make their messages understood. Though they might want to communicate and try to communicate, the other person can’t make sense of it.

• They might use a less acceptable way to communicate particular messages (such as using challenging behaviour as their way of refusing something or protesting). This isn’t always interpreted or understood by others.

The function of communication

Some of these reasons for communicating are about giving a message (expressive communication), and some are about receiving a message (receptive communication or comprehension). All of them are important. Each one contributes to our quality of life.


StrategiesIn the previous section we discussed the importance of having a reason or purpose to communicate (the communication function). All people also need to have a “strategy” or a way of communicating. Without this there is no way to get a message across or to understand what others are communicating.

Definition of a communication strategy A communication strategy is a way of communicating.

There are many ways to communicate. Most people use both verbal and non-verbal ways of communicating, including:

• Spoken words.

• Vocalisations.

• Body language.

• Gestures.

• Facial expressions.

• Pictures and symbols.

• Written words.


Term Definition Example

Verbal communication

Use of spoken words, or attempts at using real spoken words Saying “no ank oo” – though the speech is unclear the person meant “no thank you”.

Speech and language

Speech is the sounds we use to produce verbal communication.

Language is the way we put words together—our grammar and vocabulary.

The person who said “no ank oo” has difficulty with speech.

The person who said “no ank oo” was trying to say “no thank you”. In this case the language/grammar was OK.

Non-verbal communication

Any way of communicating that does not use spoken words, or attempts at spoken words.

Writing a letter by email is a non-verbal way of communicating.

Clapping to show you enjoyed a performance is a non-verbal way of communicating.

Vocalisation The use of uttered sounds that are not spoken words made by the voice for communication.

Vocalisation is a non-verbal way of communicating.

• “Uh-huh,” “uh-uh”.• Sneezing, hiccupping and snoring are vocalisations.• Yawning, laughing and moaning are also examples

of vocalisations.

Body language and gestures

A non-verbal way of communicating where the body is used.

A gesture is also a form of non-verbal communication made with a part of the body, used instead of or with, spoken words. The language of gesture means that an individual can express a variety of feelings and thoughts, from fear and sadness to agreement and affection.

• Smiling.• Nodding.• Shaking head.• Frowning.• Turning away from the person.• Shrugging shoulders. • Head shaking for “yes” or “no.”• Bringing the hand to the mouth, indicating eating.• Bringing hands to the side of the head, indicating sleeping.• Nose wrinkling indicating “I’m disgusted.”• Making a ‘V’ sign. • Forming a circle with fingers to indicate “OK.”


Gestures/body language Intended message

Learning activityIn the space provided, please list some gestures and body language you use to get your message across to another person. Include what each message’s intended meaning is.


Types of communication.

Your definition of each type of communication.

An example of each type. What is the intended message of your example?

Verbal

Vocalisation

Body language

Gesture

Learning activityIn the table below provide a definition and an example for each of the four main types of communication. Then explain the intended message of your examples.


Learning activityThough it feels like we mostly use verbal communication, we actually communicate with each other in many ways. For example, the following symbols and pictures are easy for most of us to understand. Visual communication is a big part of our daily lives. Identify what each of these pictures represents.


Learning activityNow identify and record six symbols, signs or pictures that you see every day that give a message.


Patrick is a man in his 40s who lived in an institutional environment until a year ago. Patrick uses Residential Services, and lives with three others, with full-time support. Patrick has a severe intellectual disability and spastic quadriplegia cerebral palsy.

Patrick has a limited understanding of his world and does not appear to understand or respond to spoken language, though he clearly recognises particular voices. He recognises familiar people and situations and appears to anticipate some steps in familiar activities (for example, smiling when he hears the spa bath tap turned on). Patrick does not intentionally communicate with others, but his staff are able to interpret some of his body language and facial expressions so that they can tell when he is happy/enjoying something, or anxious/upset.

Everyone communicates in some way, and it is important that this is recognised. Even people who have the most severe communication impairments still communicate, though it may not always be a conscious act.

Some people who have communication impairments are only able to use typical communication strategies in limited ways. They may be more successful using some alternative communication support strategies. In many cases people with communication impairments will also need you to change the way that you communicate with them.

Strategies

We will discuss the support worker’s role in supporting communication in the Acknowledgement section of this workbook.


What is a communication support strategy?A communication support strategy is something that adds to, enhances, supports or replaces a person's usual way of communicating.

Communication support strategies can provide valuable assistance to people who have communication impairments.

StrategiesThere are some other terms that mean the same thing as “communication support strategy”, including:

• Augmentative Communication.

• Augmentative and Alternative Communication (AAC).

• Assisted Communication.

• Communication aid/device.


True False

Everyone with a communication impairment should have a ‘book about me’ (a communication passport).

Conversation books serve the purpose of providing a way for accessing social contact.

Communication support strategies need to be devised to meet the individual communication needs of a person.

Communication support strategies must take into account more than just the communication needs of a person.

Voice Output Communication Aids (VOCAs) speak for a person by the person operating the aid, either by scanning or selection of words/phrases.

Everyone can have access to speech through a VOCA.

Communication books and boards work in exactly the same way.

Communication books and boards are portable and easy to access.

To communicate effectively, a person must always have access to his/her communication strategy.

Read the statements below and decide if each statement is true or false, and tick either “true” or “false” in the boxes provided:

Before you go any further in this workbook…

TEST your kNowlEDgE


This section of the workbook introduces some of the different types of communication support strategies, including:

• Voice Output Communication Aids.

• Communication books or boards.

• Conversation books.

• Signing.

• Picture Exchange Communication System (PECS).

• Visual Strategies.

• Personal Communication Dictionary.

• A book about me (communication passport).

Strategies

There are many types of communication support strategies to suit different people, depending on their skills, difficulties, preferences and needs.

No single communication support strategy will be appropriate for all people, and it is important that the strategy is chosen and/or adapted specifically for each person. When selecting a communication support strategy it is important that the strategy meets the function that it is required for (the purpose or reason for communicating).

The strategy also needs to meet the person’s needs in the following areas:

• Vision.

• Hearing.

• Physical ability—fine motor skills, movement.

• Cognitive ability.

• Memory.

• Understanding.

• Communication skills and needs.

• Preferences.

If a strategy doesn’t meet the person’s needs it will probably not be used successfully.


Strategy: Voice Output Communication Aids (VOCAs)

Function/purposeVoice output devices can be used to “speak” a message that the person isn’t able to speak on his/her own. They are an expressive communication tool.

Description Voice output devices “speak” pre-programmed messages. They range from simple devices that communicate only one single message, through to extremely complex devices that can be used to put together complex and unique messages.

The messages are usually played (spoken) by activating buttons on the device. The buttons may have symbols/pictures, written words or letters on them.

The way that the buttons are activated depends on the person’s needs, abilities and preferences. Methods include:

• Direct Selection—the person touches the buttons using a finger or an alternative technique, such as a pointer attached to the head.

• Scanning—the person, or a communication partner, scans through the buttons, one at a time. When the desired button is highlighted the person indicates his/her choice—either by pointing, nodding or pushing a switch. Scanning is often used if the person has difficulty moving with enough control to use a direct selection technique.



Support tipsAs a support person you should:

• Know how to operate all aspects of the device, so that you can help if required.

• Know how to charge the device or change its batteries.

• Encourage use of the device and make sure that it is available at all times.

• Be able to explain to other people what the device is for and how it works—so that they are more likely to interact with the person you support.

• Respond to all uses of the device.

Skills required To use a voice output device the person needs to be able to:

• Understand the message that the device is going to speak.

• Have a way of activating the message (either by pointing, nodding, pushing a button, or looking with his/her eyes at the desired buttons).

• Be able to see or feel what is on each button, in order to choose the desired messages.

• Remember what messages the device can be used for. This is especially important for sophisticated devices that might have several “pages” or “layers” that the person has to navigate and choose from.

Using a voice output device. This device scans through choices, which are then selected by leg movements.


The BIGmack is a single message voice recorder—it can record a message of up to 75 seconds long, but can only record and play back one message at a time. It has some limitations because it requires someone who is able to communicate verbally to record the message(s) and anticipate what needs to be on it. However it is easy to change the message, so this can be done quickly and often. A BIGmack has many uses. For example, it could be used to order fish and chips, tell someone that you need to use the bathroom, request a drink, or sing the chorus of a song.

This is a high tech computerised voice output communication aid. It would probably be mounted to a person’s wheel-chair and activated by touching the screen. The person puts a message together by selecting the relevant symbols from different

“pages” on the computer, then the computer speaks the message.

Here are some examples of Voice Output Communication Aids: some that are very simple and some that are more complex.



This aid enables Ben to communicate with others.

The computer scans through images. Ben pushes/knocks the button with his knee to choose from the selection of words, images and symbols.

The computer changes the words, images and symbols into speech. A successful communication has occurred.



Strategy: Communication books or boards

Function/purposeCommunication books or boards are used by a person with a communication impairment to get a messages across. They are an expressive communication tool. The type and complexity of the message(s) can be altered to suit each individual person.

DescriptionCommunication books and boards vary for each individual. Some will be used to convey one or two messages only. Others contain many thousands of items. The person using the book or board will select items from the book or board to convey a message. The person might do this by pointing with a finger, using a head pointer or another alternative to pointing, looking at the item, or having a support person scan through the items and then indicating to the person when he/she has touched the correct item. Communication books and boards are usually small enough to be portable, so they can be taken with a person wherever that person goes.

Communication books and boards can be presented in many different ways, including:

• A portable whiteboard—items can be drawn, written or stuck on to the board as necessary.

• An eye-gaze board—a Perspex or see-through board that sits upright on a stand, with words/symbols/pictures stuck on to it, that can be seen from both sides. The person with the communication impairment sits on one side, and a communication partner sits

on the other side. The person with the communication impairment uses his/her eyes to communicate, by holding a gaze over the words/symbols/pictures that are stuck on to the board.

• A book with as many pages as is appropriate for an individual. Often the pages are colour coded into different categories to make it easier to find each item. Pages can be thick or thin, plastic coated or plain paper, depending on the person’s unique needs.

• A board of any size. This could include a large wooden board, screwed on to a wall, with real objects glued on to it (such as real objects to indicate choices—a cup to mean “drink please”, a towel to mean

“swimming please”, or a book to mean “story time please”).

The support worker points to the activities that Sally can choose from. Sally chooses to watch her favourite TV programme.


Strategy: Communication books or boards


• Be familiar with the layout of the communication book or board so that you can assist with turning pages or finding symbols as required.

• Encourage use of the book and make sure that it is available at all times.

• Be able to explain to other people what the book/board is for and how it works—so that they are more likely to interact with the person you support.

• Respond to all uses of the book or board.

Skills requiredTo use a communication book or board a person needs to be able to:

• Understand the messages that the person is choosing to communicate about.

• Have a way of selecting the message (either by pointing, nodding, pushing a button, looking at the desired buttons, or indicating when someone else has chosen the correct item on the person’s behalf).

• Be able to see or feel each item on the book or board, in order to choose the desired messages.

• Remember what messages the book or board can be used for. This is especially important for sophisticated books that might have many pages.

This person is using a communication book made up of several pages. Each page is colour coded according to its content. The person points to the picture symbols to make his/her message known.

This is an example of an eye gaze communication board. The person holds his/her gaze over “yes” or “no” to indicate personal choice. A communication partner would sit on the other side of the board and be able to see where the person is looking.


Strategy: Conversation books

Function/purposeA conversation book is an expressive communication tool. It is used as a

“conversation starter”—a way to begin or maintain a conversation about topics that are of interest to the person with the communication impairment.

It is common for people with communication impairments to be ignored by other people, who are often unsure of how to communicate with them. A conversation book (or remnant book) can help communication partners know what to talk about with the person, and give them an easy way to start.

DescriptionThere is no limit as to what can be put into a conversation book. However, the content should be relevant and of interest to the person who uses it. It is always best if the person is involved in selecting content and items to put in the book.

Conversation books usually contain a message at the front telling the communication partners how to use the book. For example, “this is my conversation book. I find it hard to talk but it would be great if you could talk to me. This book has got lots of info in it about the things I like doing, and topics of interest to me. You can use them to start a conversation with me. Feel free to ask me questions, make comments about what you see, and tell me what you like doing as well. We might have some things in common!”

Most books have separate pages for each topic or area of interest. There may be some pages that stay in the book all the time, and other pages that stay for short periods of time to explain current events. Some books

are made up of written information and photographs or pictures. Other books contain

“remnants” from activities such as a napkin from McDonalds, church bulletin, ticket from a show, swatch of hair from a haircut, tag from a new pair of shoes or clothing, leaves from the park, or wrapping paper from a birthday party. Books containing remnants are sometimes called a “remnant book” instead of a conversation book, but they are essentially the same thing.

It is useful if someone is able to write in comments or questions that can help the communication partner to start conversations, such as “I went to McDonalds on Saturday. Do you go to McDonalds? What do you order?”

Conversation books need to be updated regularly or they easily become out of date. Nobody likes to have the same conversations every day!


Strategy: Conversation books Support tipsAs a support person you should:

• Be familiar with the content of the conversation book.

• Regularly support the person to update the book and add new information.

• Encourage use of the book and introduce it to people who are interacting with the person you support.

• Make sure that the book is available at all times.

Skills requiredTo use a conversation or remnant book the person needs to be able to:

• Be familiar with the topics included in their book.

• Want to be involved in conversation or interaction with others.

• Recognise what is included in their book.

• Have some capacity for interacting, whether it is verbal or non-verbal communication.


Strategy: Signing Function/purposeSigning is traditionally an expressive communication tool. New Zealand Sign Language (NZSL) and Signed English are both used expressively. However, key word signing is often used as a receptive communication tool to help people with intellectual disabilities to understand what is being said to them. The use depends on the individual person. See the following information for more detail.

DescriptionThere are many different sign languages used across the world. The most commonly used in New Zealand are:

• New Zealand Sign Language (NZSL)—an official language in New Zealand, used by more than 27, 000 people. NZSL is the natural language of the deaf community in New Zealand. NZSL is its own language. It conveys ideas by signs, facial expressions, body language and lip patterns, and has its own grammar, rules and sentence structures, which are different from English or Māori.

• Signed English—a form of signing that has the same grammatical structure as spoken English—there is a sign for every word.

• Key word signing (including Makaton). Key word signing is mainly used by and with people who have intellectual disabilities, rather than people with hearing impairments. Only the main words/concepts of a message are signed, as opposed to using a sign for every word (which could be too difficult for

someone with a disability). The message is usually spoken at the same time as it is signed (where possible), especially if it is being used by support people to help aid a person’s understanding. There are some specific key word systems, including Makaton. Other people use signs from NZSL or Signed English.

For example—Many adults with intellectual disabilities learnt to sign when they lived in institutions. Unless they have had support people who can also sign they are likely to have stopped using signing. You may be surprised at the difference you could make to someone’s life just by starting to use sign again.


Strategy: Signing Support tipsAs a support person you should:

• Be familiar with all signs used by the person you support.

• Know at least as many signs as the person you support.

• Use sign regularly when interacting with the person you support.

• Practise your signing often to keep up to date.

• Encourage the person you support to sign when necessary.

• Act as “interpreter” when necessary.

Skills requiredTo use signing effectively a person needs to be able to:

• Know what the signs mean, or able to learn new signs, in order to use them appropriately.

• Have some ability to move own hands—however, signs can be adapted for people who have physical disabilities, and there are some sign systems that can be done with one hand (rather than two hands), or with other body parts.

• Recognise the signs if they are signed by other people.

For more information and a helpful pamphlet on finger spelling visit the New Zealand Sign Language Teachers’ Association at:

www.nzslta.org.nz

Message


Strategy: Picture Exchange Communication System (PECS)

Function/purposeThe Picture Exchange Communication System (PECS) is a system for teaching expressive communication through the use of pictures.

PECS can provide a very effective functional communication system to individuals with no verbal communication, but it can also teach important skills to those who talk. The PECS protocol emphasises teaching a person to approach others to initiate a communication interaction. This is often especially helpful for some people with Autism Spectrum Disorder who struggle with the social aspects of communication. Other people may talk, but will only do so if asked a question or if encouraged to use words. These individuals may be able to learn about spontaneous, self-initiated communication through PECS.

PECS can be an alternative communication system for those who don’t speak, or a supportive system for those who do.

DescriptionPECS involves a person selecting a picture symbol and giving it to another person (an

“exchange”) to communicate. There is a strict protocol for teaching PECS, which involves six phases of teaching, as well as other strategies. People are reinforced for their use of the technique, to encourage them to continue with it. The system starts with making requests for highly motivating items, and moves on to teach the person to understand a variety of symbols and how to put them together in simple sentences. In the most advanced phases, individuals are taught to comment and answer direct questions.

Skills requiredTo use PECS effectively the person needs to be able to:

• Communicate intentionally—but may be able to learn this while using PECS.

• Recognise that the pictures/symbols being used relate to something, and understand what each one means.

• Choose between a number of symbols that are presented at one time (though this can be modified to suit the person’s ability—for example, just two symbols might be presented at a time).

• Have a way of exchanging the symbols (or indicating which ones the person would like to select).


Strategy: Picture Exchange Communication System (PECS)


• Have attended a registered PECS training course, or be supervised by someone with expert skill who has PECS as a technical strategy.

• Be familiar with the level of complexity that the person you support can manage.

• Know how to motivate the person you support.

• Encourage the use of PECS.

• Ensure that the person you support has PECS tools available at all times.

• Be able to explain to others what the PECS system is for and how they can assist in its use.

• Respond to all uses of the strategy.

• Know how to set up the PECS tools for the person you support.

An example of PECS—Draw a lime to the animals that match.

cat

cat

cow

cow

duck

duck


Strategy: Visual Strategies

Function/purposeA visual strategy is something that presents information visually to help a person’s understanding—it is a receptive communication tool.

Visual strategies are usually used for people who find it easier to understand what they see than what is said to them. They can be particularly useful with people who have intellectual disabilities, and those who have Autism Spectrum Disorders.

DescriptionVisual strategies are often used to make things more predictable by showing items such as:

• The routine for the day or week.

• Changes to a routine.

• What’s happening next.

• Steps in a task.

• Rules or expectations of behaviour.

• Staff rosters.

• Tasks that need to be completed.

Real objects, parts of objects, photos, symbols, line drawings, and written words are all “visual”—a visual strategy uses whatever visual form is understood by the person.

Skills requiredTo use a visual strategy effectively a person needs to:

• Be able to interpret, or make sense of, the visual images that are presented— if the person doesn’t know what they are then the person will not be able to respond to them. Not everyone is able to make sense of visual images easily, particularly people with significant intellectual disabilities.

• See the visual images—they need to be the right size, colour for the person’s visual ability.

• Understand that there is a sequence involved (if applicable).


Strategy: Visual Strategies

Support tipsTo support a person to use a visual strategy you should:

• Make sure the person understands what is expected and what the symbols/pictures mean—you may need to teach these first.

• Know what you need to do to make the strategy as successful as possible.

• Use the strategy consistently—it will probably only be helpful in helping a person understand a “change” if it has been used on an everyday basis.

• Know how to prompt the person you support—use the same prompts each time the strategy is used.

• Encourage use of the strategy.

• Make sure that the strategy is available for use at all appropriate times.

• Update the strategy as necessary.

There are some excellent books and websites about visual strategies, including:

• “Visual Strategies for Improving Communication” by Linda Hodgdon is a book focused specifically on children with ASD. It can be adapted for use with adults.

• www.todolearn.com is a specialist website, that has free pictures to download and use for creating visual strategies.

• www.nas.org.uk is the National Autistic Society’s (UK) website and has some great information too.

It is important to develop individualised visual strategies. It is usually best to get support from a professional to do this. It is easy to develop visual strategies that don’t work, or don’t suit the individual. A professional can help you to get it right. Seek advice or guidance from someone with skills in the area of communication, such as:

• Speech-Language Therapists or their assistants.

• Psychologists.

• Occupational Therapists.

• Behaviour Support Specialists.


Strategy: Personal Communication Dictionary

Function/purposeA Personal Communication Dictionary (PCD) is intended to help communication partners understand/interpret a person’s unique ways of communicating. They are most often used when supporting people who use limited verbal communication, or people who communicate unintentionally.

DescriptionThe PCD is a low-technology tool. It is usually produced on paper, in the form of a table with three columns. It shows:

• What the person does.

• What the action means.

• How to respond.

Sometimes photographs of the person are included in the first column, but usually the information is written as a description.

Skills requiredNot applicable—this is a strategy primarily for the use of communication partners.

Support tipsTo make the most use of a Personal Communication Dictionary a support worker should:

• Be familiar with the information in the dictionary.

• Respond to communication attempts as suggested in the dictionary.

• Help keep the dictionary up to date by reporting new items, or reporting necessary changes to the person responsible for its upkeep.

• Encourage new communication partners to read the dictionary.

• Make sure that the dictionary is available to communication partners at all times.

• A PCD is an excellent tool that can help support workers to better understand the person they support. Developing a PCD can make a significant difference to the quality of support and interactions that a person receives.


Strategy: Personal Communication Dictionary

The following PCD relates to Patrick, a man in his 40s who has a significant intellectual disability and spastic quadriplegia cerebral palsy. Patrick needs full support with all aspects of daily living and communicates unintentionally through his body language. It can be very difficult to know what Patrick needs or wants. The PCD helps with this. The following is a sample of the items in Patrick’s PCD.

Patrick’s Personal Communication Dictionary

What Patrick does What it means How to respond

Patrick’s body tenses all over and he makes a high pitched squeal.

Patrick is uncomfortable in some way.

Let Patrick know that you are going to move him, by touching his arm gently.

Support Patrick to become more comfortable by trying the following things first:

• Check Patrick’s continence products—they may need to be changed.

• Alter the position that he is sitting or lying in.

• Re-arrange his back and/or head supports, as they move over time.

Patrick shakes his head rapidly and makes a deep snorting noise.

Patrick is having a really good time, and enjoying the activity that is going on.

Give Patrick a pat on the shoulder to show that you have understood his enjoyment, tell him you can see that he is having fun, and continue the activity.

Patrick cries. This usually indicates that something is wrong with Patrick’s health, often an ear infection or stomach upset.

Sit with Patrick and tell him that you will stay. Play his favourite country music CD quietly, and give him a hand rub every now and again.

Monitor his health status, using the health form in his file, taking his temperature regularly. Seek medical assistance as required.


Rewind back to page 28 and check your answers. Make any changes to your answers if you feel the need.

Strategy: A book about me

Skills requiredNot applicable—this is a strategy primarily for the use of communication partners.

Support tipsTo make the most use of a “book about me” a support person should:

• Be familiar with the information in the book.

• Help keep the book up to date.

• Encourage new communication partners to read the book.

• Make sure that the book is available to communication partners at all times.

Function/purposeA “book about me” (sometimes called a communication passport) is a tool that is used to explain information about a person to others. It is usually used when a person isn’t able to provide the information him/herself, particularly if the person’s communication is largely unintentional. It can be a good way to show the person in a positive light, and highlight strengths that might otherwise go un-noticed. It also helps communication partners get to know the person and know how to communicate with the person in the most effective way.

A “book about me” differs from a communication book, in that the person with the communication impairment isn’t expected to respond or interact with others who are using the book. It is intended for the purpose of information-sharing, rather than expressive communication.

DescriptionEvery “book about me” can be presented in a different way. However, a book could include the following:

• Important information.

• Communication and comprehension.

• Personal communication dictionary.

• About me.

• About my family.

• About school or work or where I live.

• Things I like to do at school or work.

• Things I like to do outside of school or work.

• Friendships and relationships.

• Likes and dislikes.

• Other relevant things.


Think about a person you support who has a communication impairment.

What is the impairment?

What is/are the strategy/strategies you use to communicate?

What works well with the chosen strategy/strategies?

What could you do to be a more effective communicator when using this/these strategy/strategies?

What additional supports do you or the person you are supporting use to ensure this is an efficient way to communicate?

PAuSEIIDemonstrate an ability to support a person with a communication impairment 47Careerforce – Issue 1.1 – February 2011

AcknowledgementSuccessful communication also relies on communication partners doing a good job. For people who have complex communication needs it is vital that their communication partners know how to support the person’s communication and can adapt their own communication to meet the person’s need. This is known as “acknowledgement”.

Communication partnerA communication partner is anyone a person communicates with. This may include the person’s family, support workers, librarians, friends, next door neighbours, health care professionals such as the General Practitioner (GP), bus driver or taxi driver.

Communication environmentCommunication occurs in a communication environment. A communication environment is anywhere that people communicate. For people with a communication impairment or difficulty, this may be in their home, a taxi, in their workplace, the shop where they buy groceries, the museum or the swimming pool. It is any place where a person needs to be understood and needs to understand someone else.


Acknowledgement

• Making sure that the communication environment is set up to make communication as successful as possible. For example, making sure the lighting is right (so that the person can see the communication partner or strategy), there is not too much background noise, or there are too many distractions.

• Choosing our words carefully—The words we use when communicating with another person depend on a number of different factors:

• The age of the person.• The person’s known word vocabulary.• The person’s cognitive ability.• The language the person chooses to

communicate with (for example, te reo Māori, Samoan, Japanese).

• The way the person communicates (for example, with symbols, pictures, phrases or gestures).

• Choosing words for the message we want to send—The type of words we use when we speak to others is shaped by a number of things. Men and women use different words, and different age groups use different words too. Children

and teenagers sometimes use different words to the words adults use. This affects the words we might choose when supporting the person with a communication difficulty.

• Using whatever ways are necessary to help people understand us—this may mean using more body language or gestures, showing or demonstrating what we mean, using visual strategies, signing, or repeating in many different ways until we get it right!

• Responding appropriately to all attempts at communication from the people we support.

• Not giving up when it’s difficult to understand people (clarify—ask them to tell you another way, or show you what they mean, or check with someone else who might know)—and making sure that we are respectful and let someone know when we are not able to make sense of their message.

• Giving people time to get their messages across, and waiting patiently while they do.

• Encouraging people to communicate with us and others using whatever communication strategies they are able to.

• Being consistent in the way that we provide our support, so that people know what to expect, and know that they can rely on us.

• Making sure that everyone who supports the person with the communication impairment knows how to communicate with that person.

• Working in partnership with the people we support, so that we equally contribute to the communication process and value each other’s contributions.

Being a good communication partner means:


Learning activityThink about a person you support who has a communication impairment and answer the following questions by filling in the tables.

What are the person’s communication environments?

What aspects of communication does the person have difficulty with (the nature of the communication impairment)?

1

2 What are the person’s communication support strategies?

4How does the person communicate with others? (Expressive communication.)

5

List the person’s communication partners and the roles they play in the communication process.

3Communication partner Role they play


AcknowledgementWhat strategies do you use to check that you received and interpreted the message correctly?

6

Explain these terms in your own words.

Term Definition

Communication environment

Communication impairment

Communication partner

Communication support strategy

Expressive communication

Receptive communication

7


Making sure work and home environments both

support the person to understand what is

happening in his/her world.

Factors that support effective communication.

Communication with a person who has a communication impairment can be improved by:

Making sure that others in the environments treat the person

as an individual. For example—making sure communication partners

understand the communication needs of the person.

Using a variety of strategies that support the person to express his/her

messages and choices.

Acknowledgement

Making sure that everyone in the person’s environment is using

the same signs, aids and supports, and that the aid or support chosen

is understood by all people involved in the person’s care.

Being patient and respectful.


“My friend in the institution could use over 400 signs, but when she moved to another part of the country, her notes got lost so no-one knew and no-one listened to her signing”—page 31, From To Have an Ordinary Life, National Health Committee, Sept 2003.

This quote is an example of what happens when information about communication is not shared with everyone who supports a person.

This quote from Brothers, 1991, is a good example of a person’s attempts at communication not being acknowledged. Think how awful it would be to have your preferences ignored on a daily basis.

“I know what it is like to be fed potatoes all my life. After all potatoes are a good basic food for everyday, easy to fix in so many ways. I hate potatoes! But then who knew that except me? I know what it’s like to be dressed in reds and blues when my favourite colours are mint greens, lemon yellow and pinks. I mean really, can you imagine?“


Commitment to communication support

Whatever the communication strategy chosen, all people involved need to be committed to using it.

The person

If a person no longer seems committed, an assessment needs to be made as to why this might be:

• Are the person’s attempts not being acknowledged?

• Does everyone understand the meaning of the communication support strategy and how to use it?

• Are staff and others using the strategy consistently?

Support worker

If you are no longer feeling committed to a communication strategy, you need to reflect on why this might be.

• Are the notes in the file current?

• Has an assessment been completed by a registered health care professional?

• Has the communication strategy been updated?

• Do you practise the signs used by the person?

• Do you understand the signs used?

• Do you consult with friends and family on new words that might need to be added to a communication strategy?

• Have you taught new staff how to use the communication support strategy?

By recording on the step-by-step communicator each day, one of Sally’s communication partners (her mother) is showing commitment to the communication strategy to Sally.


Rate your commitment to the communication. Circle where you are on the line.

Very committed Committed Not committed

Why did you rate yourself where you did on the scale? (Explain.)

What can you do to ensure that you maintain commitment to the person’s communication strategy? (Explain.)

PAuSEII

Think of a person you support who has a communication impairment.


ScenarioSarah who has lived at Ransfield House for three years now has always used an alphabet board to communicate her needs. Over the last three years the alphabet board has worked well for Sarah, according to staff who work there. However, Adele (Sarah’s support worker) believes there may be other ways that Sarah can communicate with staff.

In her past job Adele supported a young woman who had a learning disability. Unable to speak, the young woman used a “communication book” to add to her limited speech. This allowed her to show what she would prefer, by being able to make choices. Sarah and Adele then worked together to design a flip-top photo booklet of activities Sarah likes to do in her spare time. Staff then can offer choices from the photo booklet.

Adele knows it is important that all people who are communicating with Sarah use the same strategies in the same way, and that it is important to observe, listen and watch for signs of understanding. It is also very important that staff and

others interpret Sarah’s message and respond to it as soon as possible. The person and Sarah need to have the same understanding about what all the symbols and photos mean. Otherwise Sarah may become confused or even stop using the strategy. If Sarah feels she is being “listened to” she is more likely to use the strategy again to communicate with others.

Adele also knows that it is important to respond to and acknowledge the choices made by Sarah each time she uses the strategy. This is so that Sarah knows that what she points to/looks at/reaches for, she gets, because she has been understood.

Acknowledgements could include nodding to let her know she has been understood, being patient, leaning forward to show interest, smiling or simply stating “Sorry, I didn’t quite get that.” Sarah has not been used to being able to make many choices, so Adele wants to make sure that Sarah can show what she prefers. Adele intends to get some feedback from Sarah today so that she gets an opportunity to say how she feels

about how she communicates, and if she feels “listened to” by Adele and other staff members. Adele is using a form to collect information about how well Sarah’s communication strategy is working for her. The form records the strategy now used and the date the strategy was introduced. It also has places to record if Sarah has difficulty with listening and understanding, or with explaining her needs and wants; who the communication partners are; if the new communication passport and photo flip-top booklet are working for Sarah; and a plan for the next three months.

For example, does another assessment need to be made? Does Sarah feel included with the others in the house? Could more be done to support Sarah?


Learning activityRead the scenario on the previous page and answer the following questions.

Why is it important to make sure that everyone is using the aids or techniques in the same way?

1What can support people or communication partners do to support Sarah to use the communication strategy?

2

What are some ways support people or communication partners can give feedback and acknowledgement when Sarah uses the strategy?

3


Positive programming is a model of support developed by Lavigna and Donnellan, and is used by most providers of behaviour support services. It is relevant in the context of communication impairment, because the risk of challenging behaviour is increased for people who have impaired communication, especially for those who also have an intellectual disability. Positive programming recognises that all behaviour has a communicative function—all behaviour communicates something, whether it is on purpose (intentional) or not. Positive programming suggests that if we want to solve a problem behaviour we need to:

• Find out what message the behaviour is communicating (often it is something like, “I don’t like this”, “I’m bored”, “I don’t feel well”, “I’m confused and don’t understand what is going on”, “I have no control over what’s going on here”, “I need some attention and interaction”).

• Support the person to find another/better way to get a message across (which may mean using a communication support strategy, or teaching the person a new skill).

Positive programming. • Change or eliminate the causes of the behaviour (often this means changing what we do as support workers—for example, simplifying our language so that the person can understand us; making sure that we stick to a routine on a daily basis so that the person’s day is predictable; or making sure that the person’s programme is interesting and motivating for them).

Positive programming requires a long-term positive approach, where the focus is on teaching new skills, changing support, and maintaining a good relationship with the people we support.

Commitment to communication support


Communication elements Response

What communication strategy has been chosen?

What is the function of the communication strategy?

How do you acknowledge the person’s use of the strategy?

Learning activityThink of a person you are/have supported to use a strategy to enhance communication. Using the table below answer the following questions.


Factors which can assist communication

Describe how the factors can assist the person with his/her communication

Example

Environmental factors

Communication partners

Communication strategies

Learning activityThree factors which can assist communication are listed in the table below. Briefly describe how each of the three factors can assist the person with communication. Provide an example of each situation.


Factors which can be barriers to communication

Explain how each factor could be a barrier to the communication process

Example

Environmental factors

Communication partners

Communication strategies

Learning activityThe factors which can assist communication can also be barriers to communication. Explain how each of the factors could be a barrier to the communication process. Provide an example of each situation.


Before you go any further in this workbook, find out your organisation’s policies and procedures (practices) around…

CommuNICATIoN SuPPorTSWhat role are you expected to play in the…

Planning?

Implementation?

Reviewing, monitoring and/or evaluation process?


Implementing communication support—the processIn the previous sections of the workbook we have discussed a variety of different ways of supporting a person’s communication. It is always important to remember that not every strategy will suit every person, and that most people will benefit from a very individual approach to their communication support. For this reason it is important to follow a communication support plan. This last section of the workbook will discuss what a communication support plan is, and what a support worker can do to make it as successful as possible.

The communication support process

Assess

Set goals

Develop a plan

Implement the plan

Review, monitor, evaluate progress


Assessing communicationThe first step in supporting someone’s communication is to ensure that thorough assessment information is available. This information is important because:

• It forms the basis of the rest of the communication support process (from choosing a goal, to selecting a strategy to meet the person’s needs, to knowing who has to be trained to support the person).

• It ensures that decisions are made based on facts rather than opinions.

• It allows comparisons to be made over time to see if progress is being made.

Assessment is usually carried out by a speech language therapist or a specialist in the area of communication.

Please check the policy and procedure manual in your area on how to contact a speech language therapist or registered health professional.

Assessing the communication needs of a person will be carried out by a specialist in communication, like a speech language therapist.


Assessing communicationWhat does a communication assessment assess?During a communication assessment, information is gathered about all of the things that influence a person’s ability to communicate successfully.

This information includes, but is not limited to:• What the person is able to communicate

about now.

• How the person communicates now (including assessment of behaviour).

• How well the person can be understood by others (through use of words, gestures, signs, use of a communication aid).

• The person’s understanding—how well the person makes sense of what others are communicating to the person, and the level of understanding about what’s going on in the environment (routines, expectations, rules).

• How the person interacts with others socially.

• The person’s vision, hearing, fine motor skills—these things influence the types of support strategies that a person can effectively use. For example, a picture-based communication board may not be the best strategy for a person who has very impaired vision.

• The activities that the person is involved in—this influences the type of support strategy that may be required, given that all environments require different ways of communicating.

• How others contribute to the success of the person’s communication.

• What the person needs to communicate about to participate successfully in a variety of environments.


Accessing a speech language therapistThere are different ways to access a speech language therapist, depending on the age of the person, and the reason for the person’s communication impairment.

Assessing communicationFor example:

• Children and young people with significant or complex communication needs usually receive their communication support through the Ministry of Education, Special Education.

• Children who attend a special school may receive their communication support directly through their school—the school may employ its own speech language therapists.

• People (children, young people and adults) who have health conditions that affect their communication will usually receive their communication support through their local District Health Board.

• People whose communication impairment is the result of an accident will usually receive their communication support through a private provider funded by ACC.

• Some people with a communication impairment may choose to pay a private provider for the service.

Each of these services has strict eligibility criteria and different processes for making referrals. Some people may not be eligible for communication support services.


Learning activityCheck with your manager how to access a speech language therapist, or other communication support professional, in your workplace. Record the answer in the box opposite.


Learning activityThere are many environments that people participate in, each of which has different communication requirements. Think about a person you support and the environments that the person participates in. Add these to the list (at least three more).

Add three other “environments” to the following list.

1 Living

2 Sporting

3 Working

4

5

6


What happens during communication assessment?The assessor will gather information about everything that contributes to a person’s ability to communicate effectively. The assessor will do this by:

• Talking to the person and people the person knows well—their ideas, concerns, and knowledge are important.

• Observing the person with the communication impairment in that person’s natural environment, or doing everyday tasks that are part of his/her lifestyle.

• Investigating the environments that the person uses.

• Testing the person using formal assessment tools.

The assessor records accurate factual information, rather than basing an assessment on opinions, assumptions, feelings or judgements.

Changes to a person’s ability to communicate will mean that his/her communication needs will have to be reassessed.

Assessing communicationAssessmentsAssessments need to take place because the person’s lifestyle may change, or a communication difficulty or disability may become more severe and the communication aid being used may no longer fit the required needs. Communication equipment may need to be replaced or repaired. For some people as they mature, more opportunities open up, such as getting a job or learning a new skill; and for others the ageing process may lead to changes in their ability to use current equipment.


An assessment will look at more than just the communication needs of a person. It will consider other factors in a person’s life that will impact on the success of the communication strategy.

Assessment information

The assessment information will include:• Current communication skills, strengths

and weaknesses.

• Current communication strategies.

• The person’s condition/disability and how it impacts on communication ability.

• The type of settings that the person lives, works and plays in.

• The people who need to be communicated with.

• The people currently being communicated with.

• The goals the person is trying to work towards.

Communication assessment tools:There is a huge variety of communication assessment tools available, depending on what needs to be assessed, and at what level. There may be specific tools that are used in your workplace. Some of these tools may be tools that a support worker can assist with or contribute to.

Assessing communication


Learning activityFind out what, if any, communication assessment tools are used in the place where you work. Find out how you would be expected to contribute to the assessment. Record your answer in the box opposite.


Communication goalsCommunication goalsIdentifying goals is important because it enables the person and his/her communication partners to develop a relevant and realistic communication plan, and work towards something specific. This helps to keep everyone focused.

The communication specialist will work with the person and his/her support networks to choose goals that meet the person’s needs and will add to quality of life. The type of goals chosen will depend on many factors, including:

• The person’s own wishes for communication.

• What is realistic and achievable (the assessment information will assist with this)—long-term goals can be broken down into small achievable steps.

• What the next steps are in terms of development—this is especially relevant for children and young people who are growing and moving through developmental milestones.

• What is going to make the most difference to the person’s life—for example, spending years of “therapy” learning to pronounce “s” correctly might not make as much difference to a person’s life as learning the social aspects of communication that improve the person’s chances of building friendships and relationships.

Goals can be as varied as individual people. However, these goals should always be focused on achieving a functional improvement for the person—achieving something that is meaningful and useful.

For example, goals could be as varied as:

• Members of a support team simplifying their verbal language to three – four word phrases when communicating with Richard at all times, starting January 2008.

• Mia to learn to use a communication board to request breakfast items on a daily basis at home, by March 2009.

• Thomas to follow his new pre-school morning routine by using a photographic visual schedule, by August 2009.

• Yin to use a Lightwriter voice output communication aid successfully for all necessary communicative interactions by May 2009.

• Pedro’s support team to use Pedro’s key word signing vocabulary in all interactions with Pedro by October 2009.


Communication goalsOnce you have identified the wishes and aspirations of the person you support, you can help that person to identify a realistic and achievable outcome that relates to these goals. It is important to focus on what the person wants to achieve at the end—this is the basis for the whole communication support plan. Sometimes this means that you need to break down a large goal into smaller bits and gradually work towards it.

When choosing a specific learning outcome (based on the wishes and aspirations you have identified previously), it is important to find out what is important to the person you support and what is going to make a difference to that person’s life. It can take a long time and a lot of effort to learn something new, particularly for a person with an intellectual disability, so the effort should be spent on something that will make a significant difference to the person.

It is a good idea to start with something that the person is motivated about and interested in, even if you don’t think it’s the highest priority. If you can create a fun and interesting learning environment the person you support will probably be more willing to try other things further down the track.


Developing a communication planGood plans are always:• Developed in consultation with the

person that the plan is for—this is respectful, and encourages an equal relationship.

• Recorded in writing, and in a way that the person who the plan is for can understand (where possible).

• Dated, so that it is easy to tell when the plan was written—this helps with measuring progress.

• Realistic and achievable.

Making a plan is about finding a way to reach the chosen goals—it is about matching strategies to the person’s strengths, needs and preferences (the assessment information).

A communication support plan will usually detail the following:

• The goals.

• The steps required to meet the goals (including which strategies will be used).

• The resources required (including communication strategies, training for communication partners, specific costs).

• Who is responsible for implementing each step in the plan.

• What the timeframe is for meeting the goals/outcomes.


Implementing a planBeing prepared means that you need to:• Know what is in the plan, and what your

responsibilities are.

• Follow through with your responsibilities.

• Be consistent with your own support, and with the rest of the support team.

• Record progress toward the goals in the way that is required in your workplace.

• Know the person you support—find out about what helps that person learn best.

• Make sure the environment is right for learning.

• Organise any resources that are needed.

• Prepare the person you support.

• Know how to prompt the person you support, give feedback, and provide encouragement in a way that works for that person.

There are lots of things that can help the implementation of a plan to be successful. It is important to make sure that you are prepared and can give the people you support the best chance of being successful.


Monitor/review/evaluate the plan. It may take several weeks or months for the person you support to achieve his/her outcome/goals. During that time you will probably have supported the person many times. To make sure that you are supporting the person in the best way, and that the plan is working, it is important to monitor and record what is happening. You should use whatever forms or systems that are required in your place of work.

Tips for monitoring and recording progress:• You don’t need to keep a record every

day, but keep a mental note and make a recording on paper every few sessions.

• Your whole support team needs to agree how often to keep a written record.

• Be discrete with recording—it’s off-putting to have someone standing by and writing down what you are doing—it alters how someone performs almost every time, makes people nervous and isn’t helpful. You will probably be able to remember what happened and then record later, or be very discrete about it, or have the person you support help you do the recording.

• Keeping a record will help you work out when you need to make changes. For example, if you notice that there is no progress, or there is a pattern of errors, you may need to adapt something, change the prompts you are using, or simplify the task. Your record may also help you recognise when the person has made really quick progress and needs more of a challenge!

Implementing a plan


EvaluateAt the end of the implementation you should consider what went well, what you could change next time, and what the person you support wants to do next.

• Evaluate yourself and your communication and support style—what do you think you did well, and what could you improve on in the future? It is useful to reflect on your own practice.

• Ask other people for feedback—this helps you to learn and develop your own skills.

• Evaluate the plan—what worked well for that person, for that goal; and what wasn’t so great?

• Evaluate the impact that the outcome had for the person you support—has it made a difference to the person’s life? What does the person think about it?

• Consider where to next… this is not the end but just the beginning.

There may be other forms of recording that you will be expected to do in your workplace. For example, there may be a form to complete to record progress on individual plan goals. Your organisation will have policies and procedures about recording and monitoring progress. If you are unsure of what your organisation’s policies and procedures are, you should talk to your supervisor.

Implementing a plan


True False

A gesture is not an acceptable form of communication.

Someone who cannot speak cannot communicate.

Communication is important to us all.

The communication process can be interrupted at any point, and can cause miscommunication or difficulty.

A communication partner has to be a health care professional.

A communication difficulty can only be assessed by a support worker.

The communication strategy or plan needs to be designed by a health care practitioner, and will reflect the communication needs of each individual.

The communication plan or strategy must fit the person’s needs and abilities.

PAuSEII

Think about what you have learned so far about getting the message across. Read the statements below and decide if each statement is true or false, and tick either true or false to the following:


For the next section of this book you will need to think about two people you are currently supporting who have a communication impairment.

You will need to answer the questions over the following pages.

Remember…The person’s right to privacy.

Note you do not need to name the person.


Briefly describe the impairment:

1Case studiesCase study 1

In what way does the impairment make it difficult for the person to communicate?

2

What communication support strategy was used with the person?

3

Learning activityThink of a person with a communication impairment you have supported. Write your responses to the questions in the spaces provided.


Why was that particular strategy chosen?

4

Choose at least one other possible strategy, and explain why you did not use it.

5

Was the strategy successful? How do you know?

6

What information was the person attempting to convey? (Be specific.)7

Was the strategy the best one for that person? How do you know?

8


“It is important that a person’s communication partners all use the same strategies and that they use them consistently.”

Explain what this statement means and why it is important:

1How do you react/respond to that person:

When his/her message is clear? Why do you respond like this?

When his/her message is not clear? Why do you respond like this?

2Learning activityRead the questions on this page and the next and then answer them in the spaces provided.

Think of a person you have communicated with using a communication support strategy.

Answer the following questions based on that person.

Case study 2


How do you know if the intended communication has occurred?

3What record have you kept of the strategy being used? (Circle your answer.)

A Date.

B The strategy/strategies used.

C Receptive language.

D Expressive language.

E Who else used the strategy.

F How you, other carers, friends and family, evaluated the strategy.

4How will you continue to support this person’s strategy? (Your commitment to the strategy.) List three methods/approaches.

•

•

•

5


To pages 8 and 9

Do you agree with your initial thoughts and ideas?

yes / no

yes

no

If yes, do you have anything you would like to add?

If no, what would you change?

If you have any more questions, what could you do or who could you ask to find the answers?


When you have completed the trainee assessment portfolio and have been signed off as competent by your assessor, your assessor will complete a Certificate and give it to you.

If you wish, you could frame it for display or mount it in a record book.

You have come to the end of:

Demonstrate an ability to support a person with a communication impairment

Check the following:

Please check over all the activities to make sure you have completed them.

Complete the trainee assessment portfolio and remember to sign your assessment portfolio in the place provided, verifying that you are the one who has completed all the assessments.


You have now completed

16874 V2 Demonstrate an ability to support a person with a communication impairment:part of a Careerforce learning series designed for support workers in a health or disability setting.

Disclaimer: The images contained in these workbooks are visual illustrations only and are not representative of actual events or personal circumstances.

Careerforce – Issue 1.1 – February 2011

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Demonstrate an ability to support a person with a ...€¦ · 6 Demonstrate an ability to support a person with a communication impairment Careerforce – Issue 1.1 – February 2011