Taking a Total Community Approach
Communication plays a vital role in how we learn, work, maintain relationships and participate within society. Around 90% of individuals with learning disability also experience communication difficulties. Some individuals have profound and multiple learning disabilities that may pose an extreme limitation to communication, spanning from language, facial expressions to eye contact and dexterity. Due to such variation in learning disabilities and other disabilities, communication is personal to the individual and therefore takes a person-centred approach. A Total Communication approach refers to adapting communication in the most accessible and effective way for the service user. Total Communication often requires a marriage of communication strategies including non-verbal, written, verbal and manual.
Signalong is one such strategy used by service users and their support staff. It is a keyword signing system and, unlike BSL, is not a language as it has no independent grammar or syntax. Instead, Signalong uses simplified keyword signs adapted from BSL to support people with communication difficulties. It has been found to be a useful alternative communication channel and a valuable addition to a communication toolkit, empowering service users to make choices about daily routines and communicate non-verbally, particularly during times of stress and frustration.
Within the social model of disability, it is thought that prejudice and exclusionary norms in society are the arbiters of who is disabled. Spoken language and understanding social cues is considered the standard form of communication within public services. Oftentimes, adults with learning disabilities benefit from a family member or a support worker assisting them in public spaces such as during hospital visits and on public transport. This is not because service users are not able to communicate, but because the world is not equipped to communicate in the style appropriate to the service user.
Support staff have a responsibility to respect people’s chosen forms of communication and use them themselves. In this sense, staff and carers have an important role for adults with learning disabilities, particularly in advocacy in public space. Despite this, constant support can place adults with learning disabilities vulnerable to forms of abuse and/or neglect. It is important that individuals are afforded ample opportunity to communicate and execute autonomy. To allow for appropriate communication, adults with learning disabilities require skilled communication partners. Individuals with intellectual and psychological differences are disabled by a world that was not built with them in mind. This is not just the way of life; this is not inevitable. Public service workers would benefit from communication training like Signalong, to increase accessibility to basic needs. Total Communication Services CIC is dedicated to social action. The non-profit organisation works with service users, carers and the wider community to enable people to understand and express decisions and opinions, access services, maintain health and wellbeing, and develop personalised services.
Collaborating with local day centres along with self-advocates from Bury and Rochdale People First, we have coproduced four films based on vocabulary relevant to service users. These topics included ‘daily living,’ ‘activities,’ ‘advocacy,’ and ‘fire prevention.’ The latter of the four was created in collaboration with Greater Manchester Fire and Rescue Service. During the placement, we participated in and facilitated staff workshops demonstrating signs related to these four topics. The reception from staff members was overwhelmingly positive. But this is only the beginning.
Fire Prevention and Education (2020)
In 2020, Total Communication Services CIC partnered with Greater Manchester Fire and Rescue Service (GMFRS) to develop a video simulating a rescue from a car accident. In the simulation a service user was ‘rescued’ by the fire service. During the rescue the firefighters communicated with the service user what they were doing to give a forewarning. The fire service used visual aids, (see below), and speech to communicate this.
The firefighters were enthusiastic and proactive during the simulation, providing scrap cars to provide a realistic experience and utilised the training exercise.
Unfortunately, due to external pressures on the service, we have not been able to continue our work with the Greater Manchester Fire and Rescue Service, as of yet.
In the meantime, we have been editing the simulation video and preparing our own Signalong resource for fire prevention vocabulary. We hope to continue working with GMFRS as we believe fire prevention and communication for adults with learning disabilities to be vital.
Public Transport Workshop (1998)
This approach to working with the community is not new, it has always been a fundamental part of a total communication approach. In 1998, Therapists from Total Communication Services CIC partnered with Greater Manchester Passenger Transport Executive (GMPTE) in preparation for Oldham’s new bus station. GMPTE requested advice for using symbols to signpost the bus station. Co-producing with local service users we developed a workshop to generate some feedback. Each participant and support worker were provided with an envelope containing three exercises: get 135 bus for one stop and return; find the toilets; look for stand for bus to Oldham. From completing these exercises, the participants provided some positive feedback and some constructive criticism:
Room for improvement:
o More symbols and clearer signs for directions
o Signs and information posters would be better on the ground – to help wheelchair users
o Crossing could be safer
o There were no seatbelts for wheelchair users
Positives:
o Automatic doors
o All on one level without steps
o Painted floor demonstrates the safest walkway
o Everything in the bus station is nearby
This workshop served great use for service users in Oldham and was well received by GMPTE. Consulting adults with learning disabilities is a vital step in improving accessibility of public services. This was a great step towards greater inclusion in public transport services. Accessible information is only one part of the puzzle.
During my time here at Total Communication Services CIC I have had the privilege to converse with advocates from Bury and Rochdale People First groups. One of the times I attended a self-advocate session, an advocate discussed feeling that bus drivers could perhaps benefit from learning some keyword signs in Signalong, to aid productive communication. The advocate reported feeling distressed on the bus and that he would have benefited from using Signalong with the bus driver. There are oftentimes we may need to alert bus drivers to something suspicious on the buses or ask for further accommodations. Not being able to express this would be extremely frustrating and even dangerous. This is a potential avenue for future training programmes, which would improve autonomy and decision-making.
The Royal Oldham Hospital (1999)
A further example of work with the community as part of a total communication approach can be seen with the innovative work with the Royal Oldham hospital. A multidisciplinary Symbols Group in Oldham worked with adults with learning disabilities, speech and language therapist, and hospital staff to improve access to public services through symbol-based communication. After identifying barriers caused by text-only signage at the Royal Oldham Hospital, the group designed and tested simple symbols to help navigate complex environments. Trials showed that symbols were effective through straightforward picture-matching, even for people unfamiliar with them. Following a successful pilot, the hospital committed to introducing symbol-based signage and involving departments in the design process. The project demonstrates how adapting public environments, rather than expecting individuals to adapt, is a practical and powerful step towards inclusive public services.
A similar approach could be taken for disseminating health information. Healthcare professionals must explain treatment plans and diagnoses to patients. It is important to be able to express oneself to receive appropriate care. Without skilled communication partners, adults with learning disabilities may not understand what is being asked of them. This is not to be confused with the mental capacity to make decisions about their own care but instead the information is not being communicated in an accessible manner. It is vital to not misconstrue communication difficulties for a lack of mental capacity to make decisions. To improve comprehension, a variety of methods should be used by healthcare professionals, tailored to the patient’s communication needs.
Final Notes
Accessible communication should not be viewed as an optional adjustment, but as a fundamental requirement of inclusive practice. Adults with learning disabilities are too often expected to adapt to systems that were never designed with them in mind. A Total Communication approach challenges this imbalance by placing responsibility on services, professionals, and communities to communicate better.
Training in strategies such as Signalong equips public service workers with practical tools to increase accessibility, reduce distress, and promote autonomy. Small changes in how we communicate can have profound effects on safety, dignity, and participation within society. Meaningful inclusion requires awareness but more importantly it requires action.
Total Communication Services CIC will continue to work alongside service users, carers, and professionals to develop accessible resources and promote communication equity. We encourage organisations, public services, and community groups to reflect on whose input is currently being excluded. Communication is a shared responsibility, and inclusion begins when we choose to listen differently.
Hello, my name is Archer Morgan and I am a speech and language therapy student from the University of Manchester on placement with Total Communication Services CIC working with adults with learning disabilities. I had Alison Matthews and Helen Newman as my placement leads, both of which are Speech and Language Therapists (SLTs).
SLTs have a vital role to play in supporting advocacy, providing guidance and support on the most appropriate method or style of communication and sharing theory about communication development.
This was seen throughout my placement with Total Communication Services CIC, when supporting Alison with this year’s project ‘Communication and Connect’. This was through a multitude of scenarios.
One of these scenarios was when I was supporting Alison with providing training to support staff, where she shared information on the stages of communication development and the stages of symbolic development. Despite the staff having some awareness of these concepts, they had not been exposed to the underpinning theory, they just adjusted their ways of communication, intuitively just knowing it works. Furthermore, the understanding of symbolic development helped staff to understand the best ways to show choices to their service users, such as showing them the actual object instead of a picture as they don’t understand them to be the same thing, promoting improved communication between staff and service users. It also gave them the tools to write in their case notes now best to support their service users, ensuring other professions take it into consideration when caring for them, advocating on behalf of their service users to make sure they are heard. Additionally, giving the staff training allows them to support training the service users and other members of staff at their places of work, making this information more available and normalised.
SLTs would embrace a broad range of communication approaches. However, this doesn’t mean purely teaching positive language. Recently, in teaching practice there has been discussion about idea of using the word naughty and therefore the sign for bad/naughty. People do not want to use negative language when describing someone (e.g, a child is naughty) despite this being very unfair to take a vital word away from people, as the word ‘bad’ has many other meanings than just describing someone, it could describe a behaviour or a food as ‘bad’ both of which it would be used to keep individuals safe as well as giving an understanding about right vs wrong.
I do understand the ideology of not wanting to associate someone with purely negative connotations, however you wouldn’t tell a child they can’t learn the word bad, so why stop someone signing it?
There is also a level of connection that S<s can have with service users, since we are there to help them to connect with others, which first potentially requires them to connect with us. We may also be a relief to them, being a way for them to finally be heard and understood without impatience and judgement as well as giving them the tools to interact with others.
This can be seen through the self-advocate group with Rochdale People First, where we were teaching them important signs you may not first think of. These are signs such as advocacy signs and fire safety signs, as well as day-to-day signs such as activities, daily living and food signs, all of which are on the Total Communication YouTube channel (https://m.youtube.com/@TotalCommunicationServicesCIC). This advocacy group was also an important part of the creation process, choosing the sign topics and giving us feedback on the signs we had chosen to make sure they were as clear as they could be. We then also had Gareth who has a learning disability, ADHD and autism and is the non-executive director of Total Communication, to help record some of the signs.
It is important for advocacy to not just have co-production but also co-delivery, since it promotes important topics such as accessibility and inclusion. Inclusion being especially important since it shows that the people they are talking about can and will speak up for themselves, breaking down stereotypes which can prevent them from doing activities that we take for granted such as being able to work. Since people with learning disabilities are less likely to find work, only 53.1% of disabled people were employed compared to 81.6% of non-disabled people in 2024 (GOV.UK, 2025), a significant gap that doesn’t need to be there but is due to discrimination and fear, since only 1 in 5 people with disability, health condition or impairment inform their employers about it (Quinn Roache, 2025).
SLTs will have a role in supporting people in having a voice when starting conversations at work and ensuring they fully understand how the conversation may go, how to best ask for reasonable adjustments and more. This could lead to a role for S< in supporting pupil voice enabling them to self-advocate for instance an EHCP plan.
This is not the only place that SLTs can help people find a voice, such as people with dementia, since as they progress they lose their ability to communicate as effectively as they once did. SLTs will find other ways that are easier for them to communicate, such as talking mats to understand what is important to them. SLTs can also help them choose if they like their accommodation or not and which ones may be better for them.
One final way that SLTs can help someone find their voice is through supporting self-advocacy groups, this can be seen again with Rochdale People first and my placement. The group had asked to learn some Signalong vocabulary, and they felt Signalong is very important for them but also for many other people with learning disabilities. It gives them a way to communicate using a simplified sign support system alongside speech. This is helpful for individuals where they may experience difficulties understanding and where they may struggle to use speech. Furthermore, it is the official signing support system of their area in that there is a policy to use Signalong in Rochdale, Bury and Oldham amongst other areas. Consistency of sign support systems is vital across services. The decision to opt for Signalong as the preferred method was made initially by self-advocates in Oldham back in the 1990s and ever since then some regions have respected their voice and used a consistent approach in school and in the local community services.
Another issue for support staff we encountered on the placement was that due to austerity cuts there is a lack of access to training and resources, which is similar for other forms of communication aids since most advocacy groups are non-for-profit. This has left the 3rd sector to fill the void left by the public sector. This is seen through the training Total Communication Services CIC provides to support staff, ensuring that none of the service users go through their lives unheard and staff come out more educated on Signalong but other important topics too, such as intensive interaction, communication with parents with learning disabilities and visual support for communication.
Overall, S<s play a massive role to play in supporting advocacy. Especially for people with learning disabilities, from supporting the individuals themselves to the staff that support them, leading to better communication between the two. Signing is just one approach and it may not work for everyone so it is important to have an S< to support them deciding the best communication approaches which give them the opportunities to speak for themselves.
This has purely positive implications for both, having ideas be effectively explained to their communication partner. This can prevent misconceptions between the staff and service users, which can mean they are more likely to agree to do what is asked of them because they understand as well as prevent panic, it can also prevent frustration from not being understood. We are in desperate need of third sector provisions to fill gaps that were left by the austerity cuts to allow support staff to continue to improve the ways people communicate and connect with their service users.
REFERENCES:
GOV.UK (2025) ‘The employment of disabled people’ Available at: https://www.gov.uk/government/statistics/the-employment-of-disabled-people-2024/the-employment-of-disabled-people-2024 (Accessed: 17th December 2025)
Quinn Roache (2025) ‘Bullying, harassment and discrimination of disabled people in the workplace’ Available at: https://www.tuc.org.uk/research-analysis/reports/bullying-harassment-and-discrimination-disabled-people-workplace (Accessed: 17th December 2025)
The next blog in our communicate and Connect project by the Speech & Language Therapy students from the University of Manchester is written by Sophie. This project was funded by the National Lottery Community Fund. W e endeavour to co-produce as much as possible in the project and the logo for communicate and connect was designed by DISC student Izzy. Sophie was interested in our use of games as a means of teaching signing skills.
As a student on placement observing Total Communication Signalong workshops,
I have learned a great deal about the importance of interactive games. For any group - whether service users, support staff or parents, these games have a real impact on creating a creative and uplifting space for people to learn.
When supporting service users, Total Communication ensures activities are designed to reflect the types of games played in day centres, homes and social settings. Using recognisable formats such as matching games, turn-taking activities or movement-based tasks helps people feel comfortable and confident. I have definitely noticed that when a service user recognises the structure of a game, they are far more likely to engage and enjoy the learning experience, rather than seeing it as a chore.
Total Communication sessions include a balance of fine motor skills, such as picking up cards or matching symbols, and larger motor movements, including throwing, reaching or moving around the room. This inclusive approach ensures there is a game for everyone, regardless of skill level. I also consistently see games being adapted or simplified to ensure person-centred practice at all times.
Most importantly, throughout my placement I have observed continuous co-production. Resources are never created in isolation; they are co-produced with support workers, people with learning disabilities and self-advocates to ensure they are enjoyable, relevant and accessible. This active desire for feedback helps ensure the games reflect the real experiences of the people who use them, rather than assumptions made by others.
Interactive games are just as valuable when training staff. After speaking to support workers during training sessions, many shared how positive and refreshing the experience felt. They explained that the training was not textbook-heavy like much of the training they attend, but instead practical, engaging and enjoyable. This hands-on approach is important, as it gives staff first-hand experience of the games they can then take back to their own settings. Having played the games themselves gives staff the confidence to adapt activities and introduce them to others, ensuring Signalong is shared and used beyond the training room.
