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Communication Supports in Residential Services for People with an Intellectual Disability

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Title: Communication Supports in Residential Services for People with an Intellectual Disability
Language: English
Authors: Dalton, Caroline, Sweeney, John
Source: British Journal of Learning Disabilities. Mar 2013 41(1):22-30.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
Peer Reviewed: Y
Page Count: 9
Publication Date: 2013
Document Type: Journal Articles
Reports - Research
Descriptors: Residential Programs, Caregivers, Knowledge Level, Attitude Measures, Caregiver Attitudes, Interpersonal Communication, Questionnaires, Mental Retardation, Communication Strategies, Competence, Quality of Life, Speech Language Pathology, Caregiver Role, Foreign Countries, Goal Orientation, Evaluation Methods, Augmentative and Alternative Communication, Behavior Problems
Geographic Terms: Ireland
DOI: 10.1111/j.1468-3156.2011.00717.x
ISSN: 1354-4187
Abstract: This study explores front-line staff knowledge and perceptions of how people with intellectual disability residing in residential services are supported to communicate effectively. Participants ("n" = 138) completed a self-report questionnaire adapted from an instrument developed by DeSimone & Cascella (2005) "Journal of Developmental and Physical Disabilities," 17(1): 1. Support staff recognise that facilitating people with an intellectual disability to communicate is an important part of their role. Support staff indicate that when the importance of supporting communication is recognised and prioritised, it has a marked impact on the quality of life of people availing of residential services. However, front-line staff indicate that they do not always have the knowledge or resources to provide such supports. Lack of specialist support services such as speech and language therapists is identi?ed as a constraint. It is suggested that an organization-wide commitment is required across front-line services to ensure that the right of people with an intellectual disability to communicate is upheld. (Contains 6 tables.)
Abstractor: As Provided
Number of References: 27
Entry Date: 2014
Accession Number: EJ1010677
Database: ERIC
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  Value: <anid>AN0085480013;f0401mar.13;2018Jul09.15:00;v2.2.500</anid> <title id="AN0085480013-1">Communication supports in residential services for people with an intellectual disability. </title> <p>Accessible summary: • Support staff were asked what were the important things they did to support people with an intellectual disability and communication difficulties.• Support staff said that they understood that facilitating people to communicate effectively could improve the quality of life of these people.• However, support staff said they did not always have the training or resources to provide this support.• Support staff need to learn more about how to support people with an intellectual disability and ensure their right to communicate is upheld. Summary: This study explores front‐line staff knowledge and perceptions of how people with intellectual disability residing in residential services are supported to communicate effectively. Participants (n = 138) completed a self‐report questionnaire adapted from an instrument developed by DeSimone & Cascella (2005) Journal of Developmental and Physical Disabilities, 17(<reflink idref="bib1" id="ref1">1</reflink>): 1. Support staff recognise that facilitating people with an intellectual disability to communicate is an important part of their role. Support staff indicate that when the importance of supporting communication is recognised and prioritised, it has a marked impact on the quality of life of people availing of residential services. However, front‐line staff indicate that they do not always have the knowledge or resources to provide such supports. Lack of specialist support services such as speech and language therapists is identified as a constraint. It is suggested that an organization‐wide commitment is required across front‐line services to ensure that the right of people with an intellectual disability to communicate is upheld.</p> <p>intellectual disability; residential services; support staff; Communication</p> <p>For individuals with an intellectual disability who reside in residential services, the development of a rights‐based ethos and ‘person‐centred planning’ approach to service delivery has emphasised the rights of such individuals to be consulted on factors that affect their lives and to make meaningful choices (Department for Education Skills (DfES) 2004; Department of Health 2001).</p> <p>That people with an intellectual disability encounter difficulties when communicating is well documented, leading to a lack of autonomy, which has a marked impact on quality of life (Schalock et al. 2005). Without an effective means of communication, individuals may become isolated, exercise little control over their lives and experience restrictions in making meaningful choices (Harris et al. 2001) unless alternatives to speech are employed (Ware 2004).</p> <p>Another impact factor attributed to enhancing the quality of life of people with an intellectual disability is ‘interpersonal relationships’. Schalock et al. (2002) suggest interpersonal relationships are one of the core elements that impact on quality of life and front‐line staff are an integral part of the social network of people in residential services (Kelly et al. 2007). Staff who work directly with service users are essential to facilitating communication as interpersonal communication is key to the expression of need, preference and wishes. Such staff include support and care staff, nurses and therapists who all have a fundamental role to play in ensuring effective communication supports are in place. The theoretical and empirical evidence underpinning the role of support staff in communication and the barriers and facilitating factors is summarised elsewhere (Dalton & Sweeney 2010).</p> <p>By recognising methods utilised by people with intellectual disability to communicate, services can facilitate and support such individuals irrespective of their level of ability. According to Ferris – Taylor (2003, p.257), communication involves ‘the transmission of meaning from one person to another, irrespective of the method’. This definition acknowledges the diverse, innovative mechanisms used when communicating, be it through language, natural gesture, facial expression, eye contact, augmentative methods of communication, such as sign language, or picture exchange communication systems. For those with limited verbal capacity, unmet needs may be expressed using what staff may recognise as challenging behaviour as a form of communication (Sigafoos 2000). It behoves direct care staff to acknowledge all methods/attempts to communicate. This readiness to acknowledge diverse means of self‐expression is referred to as a total communication approach requiring an eagerness from those involved to utilise all available mechanisms to support communication (Bradshaw 2000; Bray & Beasley 2003).</p> <p>Communication is ‘a shared responsibility amongst all of those who live and work with people with learning disabilities’ (Thurman et al. 2003, p.8). Support for communication in residential services is essential for those who rely on others to interpret their communication, particularly nonverbal service users (Ware 2004). Front‐line staff should react and adapt to the distinct communication needs of people with intellectual disabilities.</p> <p>Communication supports exist in environments where staff have appropriate skills, allowing them to communicate effectively with service users (Bradshaw 2001; Healy & Noonan Walsh 2007; Lund & Light 2007; McConkey et al. 1999; Ogletree et al. 2000). However, while staff acknowledge the importance of communication supports, they do not consistently have the knowledge, competency, perceived management approval or the resources to provide these essential supports (Dalton & Sweeney 2010; Healy & Noonan Walsh 2007).</p> <p>Front‐line staff generally perceive communication to be important. The majority recognise that all individuals communicate in some way and that multidisciplinary co‐operation is essential. However, while effective communication requires an awareness of what needs to be done, ‘this does not ensure these actions will be implemented’ (Barr 2007, p.124). Given the impact staff attitudes and responses have on the opportunities for those with an intellectual disability to communicate, it is imperative that further research on how front‐line staff facilitate communication is undertaken ‘as they are the persons responsible for actual communication program implementation’ (DeSimone & Cascella 2005, p.11).</p> <hd id="AN0085480013-2">Aim</hd> <p>A quantitative descriptive survey was undertaken to elicit information from front‐line staff regarding their knowledge and perceptions of the availability and use of communication supports as they naturally occur in residential settings for people with intellectual disability. The study explored whether staff had the knowledge and skills to communicate effectively with service users and means by which front‐line staff ensured the rights of service users to communicate were upheld.</p> <hd id="AN0085480013-3">Participants</hd> <p>Purposive sampling was used to recruit individuals who had experience of supporting people with intellectual disability on a day‐to‐day basis, drawn from a voluntary organisation in Southern Ireland. Those staff involved in the day‐to‐day provision of services within residential settings for a period of six months or more were included.</p> <p>It was important that participants had experience of the day‐to‐day provision of residential services and knowledge of the communication supports available within such services. This was also the basis for the decision to exclude front‐line staff with less than six months’ experience of working in residential settings from the sample as it was judged that staff would not have the same level of knowledge of the day‐to‐day provision of communication supports.</p> <p>This time scale of 6 months was used as a sampling criterion in other studies (DeSimone & Cascella 2005). Following receipt of ethical approval by the ethics committee of the organisation, access was granted to thirteen residential services comprising of large residential settings, group homes, community hostels and semi‐independent living services. As such they represented a broad spectrum of services for people with diverse needs across the lifespan.</p> <hd id="AN0085480013-4">Measures</hd> <p>A quantitative self‐report questionnaire developed by DeSimone & Cascella (2005) based on the theoretical constructs of the Communication Supports Checklist for Programs Serving Individuals with Severe Disabilities (CSC) (McCarthy et al. 1998) and adapted by the principal investigator was used with permission for data collection.</p> <p>A number of alterations were made to the questionnaire. Additional demographic items included questions detailing job title, area of work, gender, age, length of service in residential setting and training in nonverbal communication. Level of intellectual disability, gender, service users’ age and the number of verbal/ nonverbal service users was also identified.</p> <p>Section 2 of the instrument comprised of 23 forced‐choice questions using a four‐point Likert scale consisting of ‘true’, ‘sometimes true’, ‘rarely true’ or ‘never true’. The questions were related to three identified categories from McCarthy et al. (1998) as adopted by DeSimone & Cascella (2005).</p> <p>1 Overall Organisational Supports For Communication to include: philosophy (<reflink idref="bib4" id="ref2">4</reflink>), protection of communication rights [<reflink idref="bib5" id="ref3">5</reflink>] and environmental support for communication [<reflink idref="bib4" id="ref4">4</reflink>]).</p> <ulist> <item>2 Assessment Practices [<reflink idref="bib4" id="ref5">4</reflink>], Goal‐setting Practice [<reflink idref="bib2" id="ref6">2</reflink>] and Programme Implementation [<reflink idref="bib1" id="ref7">1</reflink>].</item> <item>3 Team Competencies (team knowledge [<reflink idref="bib1" id="ref8">1</reflink>], and team skills and experience [<reflink idref="bib2" id="ref9">2</reflink>]).</item> </ulist> <hd id="AN0085480013-5">Data analysis</hd> <p>Data were analysed statistically and inferentially using the Statistical Package for Social Sciences (spss) Version 12 for Windows and by coding the forced‐choice questions as ‘consistently true’ [<reflink idref="bib1" id="ref10">1</reflink>], ‘sometimes true’ [<reflink idref="bib2" id="ref11">2</reflink>], ‘rarely true’ [<reflink idref="bib3" id="ref12">3</reflink>] and ‘never true’ [<reflink idref="bib4" id="ref13">4</reflink>]. Overall results for each category as identified above were presented.</p> <p>Mann–Whitney U tests were performed on the ordinal results to identify difference between the responses of registered nurses and care staff, representing the largest proportion of front‐line staff within the sample population.</p> <hd id="AN0085480013-6">Procedure</hd> <p>Research packs were delivered to designated contact persons who liaised with the principal investigator in each residential setting containing a cover letter for each participant, an information leaflet detailing the nature of the study, a copy of the questionnaire and a return‐addressed envelope. Consent to participate in the study was implicit from the decision of the participants to complete and return the questionnaire.</p> <p>Two different approaches were employed to maximise the return of questionnaires. For respondents in small community urban and rural settings, individually stamp‐addressed envelopes were provided for ease of return. In large residential settings, respondents were provided with addressed envelopes, for return to a sealed cardboard postbox provided by the researcher in a central location.</p> <hd id="AN0085480013-7">Results</hd> <hd id="AN0085480013-8">Demographic details</hd> <p>A response rate of 42.5% (n = 138) was achieved, of which 7.5% were men (n = 10) and 92.5% (<reflink idref="bib123" id="ref14">123</reflink>) were women, with the majority of participants (58%n = 79) working in residential settings for 24 months or more (see Table 1).</p> <p>1 Length of service</p> <p> <ephtml> <table><tr><th>Length of service</th><th>Frequency</th><th>Valid (%)</th><th>Cumulative (%)</th></tr><tr><td>Valid</td></tr><tr><td> 6–12 months</td><td>33</td><td>24.3</td><td>24.3</td></tr><tr><td> 12–18 months</td><td>11</td><td>8.1</td><td>32.4</td></tr><tr><td> 18–24 months</td><td>13</td><td>9.6</td><td>41.9</td></tr><tr><td> 24 or more</td><td>79</td><td>58.1</td><td>100.0</td></tr><tr><td>Total</td><td>136</td><td>100.0</td><td> </td></tr><tr><td>Missing</td></tr><tr><td> System</td><td>2</td><td> </td><td> </td></tr><tr><td>Total</td><td>138</td><td> </td><td> </td></tr></table> </ephtml> </p> <p>The majority of participants, 45.7% (n = 63), were staff nurses followed by care staff, 43.5% (n = 60). Clinical nurse managers comprised 8% (n = 11) of the workforce, and 2.9% (n = 4) were identified as ‘other’. Of these, 55.5% (n = 76) worked in large residential settings, followed by 27% (n = 37) of staff who worked in group home settings and 13.1% (n = 18) of staff who worked in 7‐day community hostels. The least number of staff 4.4% (n = 6) worked in semi‐independent living settings.</p> <p>With respect to staff training in nonverbal communication, 62.4% (n = 83) indicated that they had not received any specific professional education despite the fact that 58% of service users were classified as nonverbal communicators.</p> <hd id="AN0085480013-9">Communication supports</hd> <hd id="AN0085480013-10">Service philosophy</hd> <p>The majority, 88.2% of participants (n = 120) acknowledged that all people communicate in some way, with 73% (n = 100) believing multidisciplinary co‐operation was essential for effective services. While the majority of front‐line staff (87.7%, n = 121) believed that setting appropriate communication goals could improve the quality of life of service users, a significant minority (43.6%, n = 58) were rarely involved in communication assessments of service users. The compiled median results from the above questions indicated 62.3% (n = 86) of staff believe that the current organisational service philosophy supported communication; 34.8% (n = 48) stated this was sometimes true and 2.9% (n = 4) stated this was rarely true (see Table 2).</p> <p>2 Service philosophy</p> <p> <ephtml> <table><tr><th valign="bottom">Service philosophy</th><th>Consistently true</th><th>Sometimes true</th><th>Rarely true</th><th>Never true</th></tr><tr><th>N (%)</th><th>N (%)</th><th>N (%)</th><th>N (%)</th></tr><tr><td>All individuals communicate</td><td>120 (88.2)</td><td>16 (11.8)</td><td>0 (0)</td><td>0 (0)</td></tr><tr><td>Multidisciplinary co‐operation</td><td>100 (73)</td><td>30 (21.9)</td><td>6 (4.4)</td><td>1 (0.7)</td></tr><tr><td>Quality of life</td><td>121 (87.7)</td><td>16 (11.6)</td><td>0 (0)</td><td>1 (0.7)</td></tr><tr><td>Communication assessments</td><td>26 (19.5)</td><td>36 (27.1)</td><td>58 (43.6)</td><td>13 (9.8)</td></tr><tr><td>Service philosophy supports communication</td><td>86 (62.3)</td><td>48 (34.8)</td><td>4 (2.9)</td><td>0 (0)</td></tr></table> </ephtml> </p> <hd id="AN0085480013-11">Protection of communication rights</hd> <p>A significant proportion of staff (47.1%, n = 64) acknowledged service users’ attempts to communicate with a total of 49.2% (n = 65), indicating that front‐line staff could recognise and acknowledge requests for objects, events etc. Staff were mainly positive regarding the availability of communication interventions for those who needed them with 63.5% (n = 87), stating that interventions were consistently available.</p> <p>However, when asked if augmentative and alternative communication systems (AAC) were consistently available, responses were less positive with 33.6% (n = 41) of respondents, stating this was sometimes true. Less than half of participants (47.3%, n = 62) perceived alternative choices of activities were consistently available for service users.</p> <p>The compiled median results from the above questions indicated that 43.5% (n = 60) believed that communication rights were protected, almost as many (42%, n = 58) suggested that this was sometimes true; 10.9% (n = 15) stated this was rarely true and 3.6% (n = 5) stated this was never true (see Table 3).</p> <p>3 Protection of communication rights</p> <p> <ephtml> <table><tr><th valign="bottom">Protection of communication rights</th><th>Consistently true</th><th>Sometimes true</th><th>Rarely true</th><th>Never true</th></tr><tr><th>N (%)</th><th>N (%)</th><th>N (%)</th><th>N (%)</th></tr><tr><td>Q.4 Acknowledge attempts to communicate</td><td>64 (47.1)</td><td>35 (25.7)</td><td>27 (19.9)</td><td>10 (7.4)</td></tr><tr><td>Q.14 Communication interventions available</td><td>87 (63.5)</td><td>29 (21.2)</td><td>12 (8.8)</td><td>9 (6.6)</td></tr><tr><td>Q.17 Recognise and acknowledge requests</td><td>65 (49.2)</td><td>59 (44.7)</td><td>7 (5.3)</td><td>1 (.8)</td></tr><tr><td>Q.18 Access to AAC is available</td><td>38 (31.1)</td><td>41 (33.6)</td><td>20 (16.4)</td><td>23 (18.9)</td></tr><tr><td>Q.21 Multiple choice available</td><td>62 (47.3)</td><td>52 (39.7)</td><td>12 (9.2)</td><td>5 (3.8)</td></tr><tr><td>Protection of communication rights</td><td>60 (43.5)</td><td>58 (42)</td><td>15 (10.9)</td><td>5 (3.6)</td></tr></table> </ephtml> </p> <hd id="AN0085480013-12">Environmental supports for communication</hd> <p>The majority of respondents (36.4%, n = 48) expected service users to communicate by waiting for responses and maintaining visual contact with 44.8% (n = 60) of respondents, indicating that age‐appropriate materials are available within residential settings to support communication. A total of 40.6% (n = 54) of front‐line staff indicated they could use AAC devices to some extent with 45.4% (n = 59), indicating that staff sometimes change their means of communicating with clients to enhance communication.</p> <p>Mann–Whitney U tests revealed staff nurses (mean rank =64.12) scored statistically more highly (U = 1291.00, P =0.032) when compared to care assistants (mean rank = 51.55) in identifying that staff can enhance communication by changing their own means of communication.</p> <p>The compiled median results from the above four questions indicated 15.2% (n = 21) of respondents believed it was consistently true that environmental supports for communication were available in residential services with 52.2% (n = 72), stating this was sometimes true, 24.6% (n = 34) stating this was rarely true and 8% (n = 11) stating this was never true. (see Table 4).</p> <p>4 Environmental supports</p> <p> <ephtml> <table><tr><th valign="bottom">Environmental supports for communication</th><th>Consistently true</th><th>Sometimes true</th><th>Rarely true</th><th>Never true</th></tr><tr><th>N (%)</th><th>N (%)</th><th>N (%)</th><th>N (%)</th></tr><tr><td>Q7 Staff seldom expect communication from clients</td><td>36 (27.3)</td><td>48 (36.4)</td><td>34 (25.8)</td><td>14 (10.6)</td></tr><tr><td>Q.12 Age‐appropriate materials are available</td><td>60 (44.8)</td><td>49 (36.6)</td><td>18 (13.4)</td><td>7 (5.2)</td></tr><tr><td>Q.16 Staff know how to use AAC devices</td><td>27 (20.3)</td><td>54 (40.6)</td><td>37 (27.8)</td><td>15 (11.3)</td></tr><tr><td>Q.23 Staff change their way of communicating</td><td>38 (29.2)</td><td>59 (45.4)</td><td>21 (16.2)</td><td>12 (9.2)</td></tr><tr><td>Environmental supports for communication</td><td>21 (15.2)</td><td>72 (52.2)</td><td>34 (24.6)</td><td>11 (8)</td></tr></table> </ephtml> </p> <hd id="AN0085480013-13">Assessment, goal‐setting practices and programme implementation</hd> <hd id="AN0085480013-14">Assessment practices</hd> <p>According to 38.7% (n = 48) of staff, hearing and vision tests were rarely routinely conducted. The majority of staff (60.4%, n = 81) indicated the importance of measuring how staff respond to communication acts, and 58% (n = 80) of staff felt they could consistently identify individuals means of social communication. A total of 40.9% (n = 54) indicated they could describe service users current form of communication.</p> <hd id="AN0085480013-15">Goal‐setting practices</hd> <p>The majority of staff 34.8% (n = 46) indicated that communication goals had an impact on service users quality of life, and 35.4% (n = 45) stated it was sometimes true that transitional goals were selected for individuals.</p> <hd id="AN0085480013-16">Programme implementation</hd> <p>The majority of respondents 50.4% (n = 66) stated that communication goals were consistently established within residential services.</p> <p>The compiled median results of the above questions indicated that 32.6% (n = 45) of respondents stated it was consistently true that communication assessments and goals were implemented, 52.9% (n = 73) stated this was sometimes true, 13.8% (n = 19) stated this was rarely true and.7% (n = 1) stated this was never true (see Table 5).</p> <p>5 Assessment, goal‐setting practices and programme implementation</p> <p> <ephtml> <table><tr><th valign="bottom">Assessment, goal‐setting practices and programme implementation</th><th>Consistently true</th><th>Sometimes true</th><th>Rarely true</th><th>Never true</th></tr><tr><th>N (%)</th><th>N (%)</th><th>N (%)</th><th>N (%)</th></tr><tr><td>Q.2 Hearing and vision tests</td><td>20 (16.1)</td><td>36 (29)</td><td>48 (38.7)</td><td>20 (16.1)</td></tr><tr><td>Q.5 Measure how staff respond to communication acts</td><td>81 (60.4)</td><td>40 (29.9)</td><td>8 (6.0)</td><td>5 (3.7)</td></tr><tr><td>Q.15 Staff can describe clients social communication</td><td>80 (58)</td><td>41 (29.7)</td><td>15 (10.9)</td><td>2 (1.4)</td></tr><tr><td>Q.22 Staff can describe clients current form of communication</td><td>54 (40.9)</td><td>53 (40.2)</td><td>18 (13.6)</td><td>7 (5.1)</td></tr><tr><td>Q.13 Communication goals impact on clients quality of life</td><td>46 (34.8)</td><td>34 (25.8)</td><td>39 (29.5)</td><td>13 (9.8)</td></tr><tr><td>Q.20 Transitional goals</td><td>35 (27.6)</td><td>45 (35.4)</td><td>33 (26)</td><td>14 (11)</td></tr><tr><td>Q.6 Communication goals are established within the residential environment</td><td>66 (50.4)</td><td>48 (36.6)</td><td>12 (9.2)</td><td>5 (3.8)</td></tr><tr><td>assessment, goal‐setting practices and programme implementation</td><td>45 (32.6)</td><td>73 (52.9)</td><td>19 (13.8)</td><td>1 (0.7)</td></tr></table> </ephtml> </p> <hd id="AN0085480013-17">Team competencies</hd> <p>The majority of front‐line staff 58.8% (n = 80) recognised challenging behaviour as a form of communication. A total of 56.2% (n = 77) indicated they had access to at least one person who could plan, implement, monitor and modify communication intervention programmes with 56.6% (n = 77) of staff having access to one person who could assess functional communication.</p> <p>The compiled median results for the above questions indicated 54.3% (n = 75) of front‐line staff stated it was consistently true that there was a competent team available to support communication in residential services, 34.8% (n = 48) stated this was sometimes true, 6.5% (n = 9) stated this was rarely true and 4.3% (n = 6) stated this was never true (see Table 6).</p> <p>6 Overall team competencies</p> <p> <ephtml> <table><tr><th valign="bottom">Overall team competencies</th><th>Consistently true</th><th>Sometimes true</th><th>Rarely true</th><th>Never true</th></tr><tr><th>N (%)</th><th>N (%)</th><th>N (%)</th><th>N (%)</th></tr><tr><td>Q.10 Challenging behaviour</td><td>80 (58.8)</td><td>49 (36)</td><td>7 (5.1)</td><td>0 (0)</td></tr><tr><td>Q.8 Plan intervention programmes</td><td>77 (56.2)</td><td>30 (21.9)</td><td>15 (10.9)</td><td>15 (10.9)</td></tr><tr><td>Q.11 Functional communication</td><td>77 (56.6)</td><td>41 (30.1)</td><td>10 (7.4)</td><td>8 (5.9)</td></tr><tr><td>Overall team competencies</td><td>75 (54.3)</td><td>48 (34.8)</td><td>9 (6.5)</td><td>6 (4.3)</td></tr></table> </ephtml> </p> <hd id="AN0085480013-18">Discussion</hd> <p>Communication supports are essential for those who rely on others to interpret their communication, particularly nonverbal service users (Ware 2004); front‐line staff must react and adapt to the distinct communication needs of these individuals. Communication supports exist in environments where staff have appropriate skills allowing them to communicate effectively with service users (Bradshaw 2001; Healy & Noonan Walsh 2007; Lund & Light 2007; McConkey et al. 1999; Ogletree et al. 2000). While front‐line staff recognise the importance of communication supports, it is evident from the findings of this study that supports are not consistently available for those who require them suggesting a gap exists between best practice guidelines and clinical practice, a finding reflected in other studies (Carnine 1997; DeSimone & Cascella 2005; Ogletree et al. 2000). This disparity must be addressed to ensure effective communication supports are available in residential services.</p> <hd id="AN0085480013-19">Service philosophy</hd> <p>It is positive to note that staff acknowledge all individuals communicate in some way, specifically because the majority of service users were identified as nonverbal. Arguably, front‐line staff when consistently exposed to individuals who use a variety of communicative techniques can recognise diverse and innovative methods of communication. That the majority of respondents indicated appropriate communication goals could improve the quality of life of people is reflected in other studies where lack of communication interventions lead to the isolation of individuals (Sheerin 2004).</p> <p>Multidisciplinary co‐operation was deemed essential for effective services again consistent with the findings of DeSimone & Cascella (2005); however, only a minority of staff were consistently involved in communication assessments. This may indicate a breakdown between the expressed opinions of staff and actual clinical practice. The importance of multidisciplinary co‐operation may be recognised but not actually occur resulting in a lack of involvement of front‐line staff in communication assessments (Ogletree et al. 2000). Conversely, assessments may not be conducted because of a lack of qualified personnel as over 40% of staff could not consistently access speech and language therapists; this shortage of appropriately qualified individuals has been referred to nationally and internationally (Bacon 2001; Bloomberg et al. 2003; Inclusion Ireland, 2007).Overall, the majority of staff indicated the philosophy of the organisation encouraged the provision of appropriate communication supports consistent with the findings of DeSimone & Cascella (2005). However, that 80.5% of respondents were not involved in communication assessments is concerning as lack of collaboration between professionals is identified as a barrier to effective communication support (Lund & Light 2007).</p> <hd id="AN0085480013-20">Protection of communication rights</hd> <p>Over 50% of front‐line staff could not consistently acknowledge service users’ attempt to communicate; that 62% of staff were untrained in nonverbal communication could explain why attempts at communication were not consistently acknowledged. This has implications for those reliant on others to have their needs met (Ware 2004) and is of concern because all opportunities to communicate must be availed of to empower people (Healy & Noonan Walsh 2007; Thurman et al. 2003). The majority of respondent could not consistently recognise and acknowledge requests from service users closely mirroring the results detailed above. Again, staff training might account for this finding as untrained staff may struggle to provide appropriate communicative supports for those who require them (Healy & Noonan Walsh 2007; McConkey et al. 1999).</p> <p>Almost three‐quarters of staff have indicated AAC devices such as picture boards and electronic communication tools are not consistently available, which is alarming. Without such supports, the rights of people to communicate and their capacity to identify their needs and make choices will be diminished as identified in other studies (Healy & Noonan Walsh 2007). This could have serious implications, limiting the capacity of service users to identify their needs and impacting on the development of person‐centred services.</p> <p>Almost 50% of respondents believe alternative choices in activities are consistently available for people suggesting an effort is made to provide a diverse range of activities in contrast to the findings of other (Healy & Noonan Walsh 2007). However, the question must be asked, how do people choose activities they want to be involved in without appropriate communication supports such as AAC? Without such supports, will they be afforded the opportunity to make their needs known and to participate in the ‘person‐centred planning’ process, to the fullest extent possible?</p> <hd id="AN0085480013-21">Environmental supports for communication</hd> <p>Healy & Noonan Walsh (2007) indicate that residential services must become more responsive to peoples individual needs, a finding reflected in this study as only 27% of respondents consistently expected communication from service users. Front‐line staff must be aware of the importance of interacting with service users to provide opportunities for communication. The availability of age‐appropriate materials, activities and key workers within residential settings were confirmed by 44% of respondents mirroring opinions expressed regarding multiple choices of activities. However, consideration must be paid to how people choose materials they wish to avail of without appropriate communication supports. Additionally, can key workers develop effective communication with service users?</p> <p>Research consistently indicates a mismatch between strategies employed by staff when communicating, and the communicative needs of service users (Bradshaw 2001; DeSimone & Cascella 2005; Healy & Noonan Walsh 2007). That less than 30% of staff believed changing their method of communicating might enhance communication is of concern, attributable to lack of initial and ongoing training. It is noted that nurses recognised this more readily than care staff, the only statistically significant difference noted between these two groupings. Of those who received training, the majority indicated they had undertaken modules in communication as part of nursing degrees suggesting such modules emphasise the importance of adapting approaches to communication.</p> <p>Of all aspects of communication supports, environmental supports received the lowest ‘consistently true’ rating with only 15% of respondents indicating environmental supports for communication are consistently available. The need for appropriate environmental supports that enhance communication is well established (Thurman et al. 2003); however, it is clear from this and other studies that such supports are not consistently available (Ogletree et al. 2000;., DeSimone & Cascella 2005; Healy & Noonan Walsh 2007).</p> <hd id="AN0085480013-22">Assessment practices</hd> <p>With respect to routine assessments, hearing and vision tests are not routinely available in direct contrast to the finding of DeSimone & Cascella (2005), perhaps reflecting a lack of understanding of the impact of sensory deficits; Bradshaw (2001) suggests hearing loss is underestimated and audiology reports are required for definitive diagnosis.</p> <p>Positively, the majority of staff, 60%, recognise the importance of measuring how they communicate with service users given concerns expressed regarding communication strategies employed by staff and the communicative needs of service users (Bradshaw 2001; Healy & Noonan Walsh 2007). However, despite this, only 20% of staff were consistently involved in communication assessments with the majority indicating this was rarely true. Although staff perceive the importance of assessing how they respond as communicators, it cannot be assumed that such assessments are actually conducted.</p> <p>Almost 60% of respondents could consistently recognise individuals means of commenting, protesting and requesting. However, when asked to describe individuals current form of communication, only 40% could consistently do so suggesting communication between front‐line staff and service users occurs in situations where instructions are given or shared activities are undertaken (McConkey et al. 1999). Therefore, it could be argued that staff have a better understanding of how service users communicate requests or protest but have difficulties in describing how communication occurs outside of these specific situations, within a social context. Training must be provided to ensure communication between staff and service users is not purely directive (Healy & Noonan Walsh 2007).</p> <hd id="AN0085480013-23">Goal‐setting practices</hd> <p>Communication supports have a positive impact on the ability of people to make a smooth transition from one environment to another, and without such supports, they may struggle to adapt. Despite this, a minority of respondents indicted communication supports were provided around periods of transition, a factor seen in other studies (Ogletree et al. 2000).</p> <p>Again, the issue of the lack of availability of speech and language therapists to provide such services could be a factor here.</p> <p>While 87% of respondents recognised communication goals could improve the quality of life of people, only 34% indicated communication goals consistently positively impact on the quality of life of people. This may indicate communication goals in situ are not fit for purpose or suggest communication goals are not put in place in residential settings. Approximately half of the sample indicated that communication goals are established in residential environments, but additional information is required regarding how these goals are identified. For example, the majority of respondents stated that AAC devices are not available for those who require them; issues arise as to how communication goals are implemented for this group without access to appropriate resources, an issue referred to by DeSimone & Cascella (2005). It could be suggested that communication goals are limited to what can be provided as opposed to what each individual requires. If this is the case, service provision must change to achieve a person‐centred focus, factors such as staff training, access to speech and language therapists and environmental supports need to be addressed.</p> <p>The results of this study suggest international best practice is not implemented in the clinical setting. Only 32% of respondents indicated assessment, goal planning and communication programme implementation consistently occurs. Given that the majority of clients within such services have a severe/profound level of ability, it is essential that appropriate communication interventions are in place. As the majority of staff stated current communication goals do not positively impact on the quality of life of service users, this aspect of service provision must be addressed.</p> <hd id="AN0085480013-24">Team knowledge</hd> <p>That the majority of staff recognised challenging behaviour as a form of communication is surprising and in direct contrast to the findings of DeSimone & Cascella (2005), who indicated this question was one of those least often rated as consistently true. This may be accounted for by the effectiveness of the in‐service training in challenging behaviour provided by the service for its staffs where the communicative aspect of challenging behaviour is emphasised.</p> <p>Just over 56% of respondents had access to at least one individual who could plan, implement, monitor and modify intervention programmes, similarly 56% had access to at least one person who could assess functional communication.</p> <p>These results closely mirror the results reported by respondents with respect to the level of access they had to qualified individuals who could plan intervention programmes for clients with an intellectual disability in residential services. These findings reflect differing levels of access to communication expertise such as speech and language therapists; Bacon (2001) and Inclusion Ireland (2007) acknowledge a service shortage of speech and language therapist in Ireland. Additionally, the majority of respondents, 55%, stated they worked in large residential settings with a further 27% working in group home settings. Congregate settings might provide easier access to speech and language therapists as therapists are usually based in central locations. Thus, the 13% of front‐line staff working in community‐based settings and 4% of front‐line staff in semi‐independent living settings might have more limited access to such therapists, particularly in residential settings based in rural communities.</p> <hd id="AN0085480013-25">Overall team competencies</hd> <p>That 45% of staff in residential settings did not have the knowledge, skills and expertise to support communication could be indicative of the limited availability of speech and language therapists in Ireland (Bacon 2001), who provide expertise and support to front‐line staff in residential facilities. Lack of such therapists could impact on the ability of staff to access training in communication, an issue referred to in other studies (Bloomberg et al. 2003) and evident in this study as over 62% of respondents did not have any training in nonverbal communication.</p> <hd id="AN0085480013-26">Conclusion</hd> <p>The findings of this study concur with those of other studies, indicating that the manner in which communication supports are provided in residential services can both support and inhibit communication (DeSimone & Cascella 2005; Healy & Noonan Walsh 2007; Ogletree et al. 2000). Service philosophy attracted the highest ‘consistently true’ rating with environmental supports attracting the lowest ‘consistently true rating’, a finding that concurs with the reported results of DeSimone & Cascella (2005). While front‐line staff recognise the importance of communication supports, such supports are not consistently available for all who require them.</p> <p>The majority of staff have not undertaken specific communication training, and the literature suggests there is limited availability of speech and language therapists in Ireland to provide such training. Therefore, a co‐ordinated strategy must be developed from appropriate evidence‐based policies (van der Gagg 1998). The development of communication supports requires commitment, such a commitment must come from all sectors of society, at governmental level, at management and multidisciplinary team level in residential services and most importantly, from front‐line staff responsible for providing communication supports on a day‐to‐day basis.</p> <p>To conclude, it is evident that front‐line staff recognise the importance of communicating with service users and are aware of the positive impact that communication can have on quality of life. However, the provision of communication supports in residential settings is a complex process, and issues such as operational constraints and staff training can negatively impact on the ability of staff to facilitate communication. This is of particular importance since residential services may have for more people with invited verbal language ability. Research suggests that best practice guidelines in the provision of communication supports may not be implemented in services for people with intellectual disability (DeSimone & Cascella 2005; Ogletree et al. 2000). Without such supports, the views of this population will go unheard and their needs unmet. If the right of people with an intellectual disability to communicate is not protected, then person‐centred planning will become the latest in a long line of developments that are benignly paternalistic and ineffective in realising a vision for real choice, this must not be allowed happen. Front‐line staff must play a greater role in bringing the issue of communication supports to the forefront of the service delivery agenda and ensure that facilitating communication becomes a corner stone of service provision.</p> <hd id="AN0085480013-27">Implications</hd> <p>• The adoption of best practice guidelines in supporting communication in intellectual disability services is paramount.</p> <p>• The training needs of staff must be addressed and any training provided should encourage staff to reflect on their attitudes and beliefs regarding communicating with people with intellectual disability in conjunction with teaching functional communication skills.</p> <p>• The importance of multi‐disciplinary collaboration must be emphasized when developing communication supports.</p> <ref id="AN0085480013-28"> <title>References</title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext>Bacon P. ( 2001 ) Current and future supply and demand conditions in the labour market for certain professional therapists. Wexford, Peter Bacon & Associates, Economic Consultants. </bibtext> </blist> <blist> <bibl id="bib2" idref="ref6" type="bt">2</bibl> <bibtext>Barr O. ( 2007 ) It is not enough to know what to do. Journal of Intellectual Disabilities, 11 : 123. </bibtext> </blist> <blist> <bibl id="bib3" idref="ref12" type="bt">3</bibl> <bibtext>Bloomberg K., West D. & Iacona T. ( 2003 ) Picture it: an evaluation of a training program for carers of adults with severe and multiple disabilities. Journal of Intellectual & Developmental Disability, 28 : 260 – 82. </bibtext> </blist> <blist> <bibl id="bib4" idref="ref2" type="bt">4</bibl> <bibtext>Bradshaw J. ( 2000 ) A total communication approach towards meeting the communication needs of people with learning disabilities. Tizard Learning Disability Review, 5 : 27 – 30. </bibtext> </blist> <blist> <bibl id="bib5" idref="ref3" type="bt">5</bibl> <bibtext>Bradshaw J. ( 2001 ) Complexity of staff communication and reported level of understanding skills in adults with intellectual disabilities. J Intellect Disabil Res, 45 : 233 – 43. </bibtext> </blist> <blist> <bibl id="bib6" type="bt">6</bibl> <bibtext>Bray A. & Beasley D. ( 2003 ) Effective communication for adults with an intellectual disability. Wellington, National Advisory Committee on Health and Disability. </bibtext> </blist> <blist> <bibl id="bib7" type="bt">7</bibl> <bibtext>Carnine D. ( 1997 ) Bridging the research to practice gap. Exceptional Children, 63 : 513 – 21. </bibtext> </blist> <blist> <bibl id="bib8" type="bt">8</bibl> <bibtext>Dalton C. & Sweeney J. ( 2010 ) Communication supports in residential services. Learning Disability Practice, 13 : 14 – 19. </bibtext> </blist> <blist> <bibl id="bib9" type="bt">9</bibl> <bibtext>Department for Education Skills (DfES) ( 2004 ) Special educational‐needs‐ code of practice. London, HMSO. </bibtext> </blist> <blist> <bibl id="bib10" type="bt">10</bibl> <bibtext>Department of Health ( 2001 ) Valuing people: a new strategy for learning disability for the 21st century. London, HMSO. </bibtext> </blist> <blist> <bibl id="bib11" type="bt">11</bibl> <bibtext>DeSimone E.A. & Cascella P.W. ( 2005 ) Communication quality indicators: a survey of Connecticut group home managers. Journal of Developmental and Physical Disabilities, 17 : 1 – 17. </bibtext> </blist> <blist> <bibl id="bib12" type="bt">12</bibl> <bibtext>Ferris – Taylor ( 2003 ) Communication. In: Gates B., editor. Learning disabilities. Towards inclusion. China, Churchill‐Livingstone : 255 – 87. </bibtext> </blist> <blist> <bibl id="bib13" type="bt">13</bibl> <bibtext>van der Gagg A. ( 1998 ) Communication skills and adults with learning disabilities : eliminating professional myopia. British Journal of Learning Disabilities, 26 : 88 – 93. </bibtext> </blist> <blist> <bibl id="bib14" type="bt">14</bibl> <bibtext>Harris J., Hewett D. & Hogg J. ( 2001 ) Positive approaches to challenging behaviour. Workbook 2. Kidderminster, British Institute of Learning Disabilities. </bibtext> </blist> <blist> <bibl id="bib15" type="bt">15</bibl> <bibtext>Healy D. & Noonan Walsh P. ( 2007 ) Communication among nurses and adults with severe and profound intellectual disabilities. Journal of Intellectual Disabilities, 11 : 127 – 41. </bibtext> </blist> <blist> <bibl id="bib16" type="bt">16</bibl> <bibtext>Inclusion Ireland ( 2007 ). Budget 2007 submission to government. Dublin, Inclusion Ireland. Available at: <ulink href="http://www.inclusionireland.ie/">http://www.inclusionireland.ie/</ulink> (last accessed on 21 April 2011). </bibtext> </blist> <blist> <bibl id="bib17" type="bt">17</bibl> <bibtext>Kelly F., Kelly C. & Craig S. ( 2007 ) Annual report of the national intellectual disability database committee. Dublin, Health Research Board. </bibtext> </blist> <blist> <bibl id="bib18" type="bt">18</bibl> <bibtext>Lund S. & Light J. ( 2007 ) Long‐term outcomes for individuals who use augmentative and alternative communication: part III contributing factors. Augmentative and Alternative Communication, 23 : 1 – 15. </bibtext> </blist> <blist> <bibl id="bib19" type="bt">19</bibl> <bibtext>McCarthy C.F., McLean L.K., Miller J.F., Paul‐Brown D., Romski M.A. et al. ( 1998 ) Communication supports checklist. Baltimore, Paul Brookes Publishing Company. </bibtext> </blist> <blist> <bibl id="bib20" type="bt">20</bibl> <bibtext>McConkey R., Morris I. & Purcell M. ( 1999 ) Communications between staff and adults with intellectual disabilities in naturally occurring settings. J Intellect Disabil Res, 43 : 194 – 205. </bibtext> </blist> <blist> <bibl id="bib21" type="bt">21</bibl> <bibtext>Ogletree B.T., Sportsman J.S., Van Giesem T. & Siegel E. ( 2000 ) Communication based services for persons with severe disabilities: a survey of speech‐language pathologists working in North Carolina residential centers. Education and Training in Mental Retardation and Developmental Disabilities, 35 : 336 – 46. </bibtext> </blist> <blist> <bibl id="bib22" type="bt">22</bibl> <bibtext>Schalock R.L., Brown I., Brown R., Cummins R.A., Felce D. et al. ( 2002 ) Conceptualization, measurement and application of quality of life for people with intellectual disabilities. Report of an international panel of experts. Ment Retard, 40 : 457 – 70. </bibtext> </blist> <blist> <bibl id="bib23" type="bt">23</bibl> <bibtext>Schalock R., Verdugo M., Jenaro C., Wang M., Wehmeyer M. et al. ( 2005 ) A cross‐cultural study of core quality of life domains and indicators: an exploratory analysis. American Journal on Mental Retardation, 110 : 298 – 311. </bibtext> </blist> <blist> <bibl id="bib24" type="bt">24</bibl> <bibtext>Sheerin F. ( 2004 ) Identifying the foci of interest to nurses in Irish intellectual disability services. Journal of Learning Disabilities, 8 : 159 – 74. </bibtext> </blist> <blist> <bibl id="bib25" type="bt">25</bibl> <bibtext>Sigafoos J. ( 2000 ) Communication development and aberrant behaviour in children with developmental disabilities. Educational Training Mental Retardation, 35 : 168 – 76. </bibtext> </blist> <blist> <bibl id="bib26" type="bt">26</bibl> <bibtext>Thurman S., van der Gaff A., Money D. & Jones J. ( 2003 ) Speech and language therapy provision for adults with learning disabilities. London, Royal College of Speech and Language Therapists. </bibtext> </blist> <blist> <bibl id="bib27" type="bt">27</bibl> <bibtext>Ware J. ( 2004 ) Ascertaining the views of people with profound and multiple learning disabilities. British Journal of Learning Disabilities, 32 : 175 – 9. </bibtext> </blist> </ref> <aug> <p>By Caroline Dalton and John Sweeney</p> </aug> <nolink nlid="nl1" bibid="bib123" firstref="ref14"></nolink>
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  Data: Communication Supports in Residential Services for People with an Intellectual Disability
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  Data: This study explores front-line staff knowledge and perceptions of how people with intellectual disability residing in residential services are supported to communicate effectively. Participants ("n" = 138) completed a self-report questionnaire adapted from an instrument developed by DeSimone & Cascella (2005) "Journal of Developmental and Physical Disabilities," 17(1): 1. Support staff recognise that facilitating people with an intellectual disability to communicate is an important part of their role. Support staff indicate that when the importance of supporting communication is recognised and prioritised, it has a marked impact on the quality of life of people availing of residential services. However, front-line staff indicate that they do not always have the knowledge or resources to provide such supports. Lack of specialist support services such as speech and language therapists is identi?ed as a constraint. It is suggested that an organization-wide commitment is required across front-line services to ensure that the right of people with an intellectual disability to communicate is upheld. (Contains 6 tables.)
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