Happy new year. We are beginning our year with a blog by Hannah Bradbury a first year Speech and Language therapy student from the University of Manchester. Hannah was on her first placement with us for four weeks in her first term. Hannah was invited to create her own communication passport and to create one with one of the pupils we are supporting.
Communication Passports
Communication is power. Without it, none of the living systems on earth could exist, as life itself relies on interactions between various organisms. It’s everyone’s fundamental human right to express ideas and feelings, and for many individuals, this comes as second nature. However, at any point in a person’s life, issues can emerge, complicating this process; some people face challenges in verbal communication due to various reasons, such as neurodevelopmental disorders, cognitive impairments, or medical conditions. In such cases, a communication passport can be a valuable tool to facilitate effective communication and enhance understanding.
Over the past few weeks, I have been researching communication passports in order to create one for a student who cannot use language as a form of expressive communication. By this, I mean that she has shown ability to understand simple English, but cannot respond or share her thoughts using language. This is due to her global developmental disorder, which delays the developmental milestones that most other people her age are meeting. I wasn’t sure where to start on this project: It was my first time coming across the term ‘communication passport’, and all the examples I had seen of them had been totally different - I had seen take form as paper books, fabric books, boxes of items, powerpoint presentations and more; the main purpose being that it is tailored to the individual it is being made for (Coakes et al., 2023). There were no black and white rules about what one had to be or look like, which although allows for creativity to flourish, can make for a challenging starting point.
Searching for inspiration, I decided to gather as much information on the student as I could. During my first session, observing the student’s classroom, one thing that particularly stood out to me was how passionate her teachers were to truly portray this student’s true colours, as a unique and wonderful human being. They explained that students who struggle to communicate using language can often be overlooked and misunderstood, and whilst listening to them speak so ardently about how important it is for them to be in an environment where they are appreciated and their needs are recognized and met, the penny dropped. This is where ‘the individual has an impairment, the disability is in society’ plays a role, as I realised that my job over the next few weeks, and the purpose of a communication passport would be to adapt the student’s environment to make communication between themselves and familiar or unfamiliar faces accessible to them. My plan was to create a communication passport to essentially acts as a translator, or a bridge between two parties that communicate in different ways.
After collating information from multiple sources, such as health documents, student profiles, observations, 1-to-1 interactions with the student and speaking with her teachers and parents, I had gathered a wealth of information. So much information in fact, that I had no idea how to organise and compact it to make it digestible and practical to read. What really helped me through this process was making a communication passport for myself.
It made me think: “Say I was going out for a coffee to meet a new friend for the first time. What would I want them to know about me?”. This is so important to consider when designing a communication passport, as they are intended to encourage the individual with impairment to communicate, acting as a vessel for conversation starters or meaningful interaction on a level that individual understands, rather than listing information about the owner for others to simply read. It is also important to consider the information a person connotes, as well as tells you straight up, for example, if the barista made them the wrong drink on this coffee meet-up and they respond frustratedly, this would typically suggest the individual is short tempered or rude, versus if they respond understandingly and empathetically, you would assume they are patient and kind. It is a good idea to write some of this information in the communication passport and help it determine your tone, in order to wholly sum-up their character. I found writing the communication passport in a first person perspective most useful, as it was as if you were talking to the student when reading it.
Being confident on the ultimate goal, I then faced the challenge of deciding what to include in the passport. How could I create something to aid communication between two individuals who are at two very different levels of symbolic development (see image below), whilst also supplying a substantial level of detail? The student is on the border between coloured photograph and real object level of understanding, and those who will use the passport with her, are most likely to be at a written word level. This is why I decided to make the passport physical interaction and sensory based.
Most Abstract
There were multiple things that lead up to this decision. First of all, after meeting the pupil ‘A’, it was clear to me how important touch and joint attention was for interaction and getting to know one another. I was unsure how to incorporate this concept in order to make a transportable and practical form, until I heard about sensory stories. Sensory stories do not just focus on images and writing (visual stimuli), but incorporate all the other senses too- smell, touch, taste, sound and movement- to make it a truly immersive experience (Yogendran, 2023). This is why I made as many pages in my communication passport complete with one or more objects that incorporated the different senses and that were linked to the written content.
Here are some examples of my planning:
After gathering information, and really breaking down what I wanted the communication passport to look like and incorporate, I was able to combine a few ideas from the examples I had seen and read about, as well as utilising what I knew about A:
-Black backgrounds help her focus on images and objects, so I made all the pages black, as well as the backgrounds of all the images and writing.
-Yellow is a colour she particularly engages with, so I have bordered all the images and writing with yellow
-She is strong and has a tendency to throw items when she is excited, so the book had to be soft and durable. Therefore, I made it out of sturdy fabric with cardboard inserts (to keep its shape).
-She needs minimal distractions to help her engage, and sitting in a dark room with a torch shining on one item at a time helps, so I inserted a torch
-She does not engage with anything in her lower field of vision, so I made all items and images removable so they can be held close to her face, at eye level
-She is moving onto further education, so details of her may change as well as her character, so I ensured that no items or written content are permanently fixed in. I did this by creating transparent pockets on all the pages for the images and writing to be inserted into, and also made fabric pockets and elastic strips to hold the items.
-She likes being messy, so the fabric I used for the pockets (which covers a lot of the pages) is a plastic material, as well as laminating any paper, so they can easily be wiped clean. I also put wet pipes in the pocket on the back page.
-She will be taking this on the go, so to help with transportation, I made sure that the book could be ‘sealed’ on the edge to keep it closed
-she uses aromatherapy to help establish routine, so I made the book scented. This scent is an essential oil that is different from others she uses in the class, so can be used by her to relate the smell to the communication passport
-Shining a light on items of interest really help her to focus on them, so I laminated the images with matt lamination, so that they don’t reflect and blur the photos when light it on them.
-Her and her family have busy lives, so I ensured to include any items that may need replacing or restocking in the book in the last page (I.e- batteries, glow sticks, wet wipes etc).
-She is also in an interaction based class, so I was sure to use some of the interactions I had found A to take a particular liking to, like hand massages and holding bright objects in front of her face. This can help her relax and engage, and maybe relate the communication passport to fun and for her to enjoy. I also thought the activities for A to carry out with whoever is reading the passport would be a good way of getting in know each other, as they can have fun together and let their guards down.- essentially breaking the ice in a way that is enjoyable for both parties.
-She responds well to bright, sparkly objects, so I made sure to include fairly lights, sparkly fabric, fluorescent fabric, torches (UV and normal), neon facepaint and a mirror etc.
Other things I had to take into account were:
-The order of the pages. I thought that knowing the information about how to communicate with her was most useful, so put this in first. This ensured that whoever is going through the passport with her knows how to go through the rest of the pages with her to help engage her.
-I managed to collect a wealth of information from A’s health records, speaking to her mother and teachers, and meeting her myself. I had to compact, organise and simplify this information so ensure it would all fit and would be digestible in the passport. I understood that it may be a challenge to multitask (reading the information whilst interacting with A), so I made the key details in bold, in case they need to skim over the written information and look at in more detail afterwards.
-how to get her parents involved. I was understanding that her parents must be very busy, however also knew the importance of making them feel included and valued. I ensured to plan my conversation with her mother beforehand, so that I was able to ask her questions efficiently and note down her answers in an organised way.
All in all, I am so grateful to have had this experience and opportunity. As a first year SaLT student, on my first ever work placement with university, I was not expecting to fall in love with a job so much. The opportunity to combine my academic skills with my passion for creativity has really been an experience I will never forget. I hope that this blog has helped begin to explain the endless possibilities of a communication passport and can be used as a tool for people interested in making one, or even just inspire others to create an accessible environment for those who need it. I can’t emphasise enough how much of an enjoyable experience it was being able to get to know such wonderful people, as well as have the chance to leave something behind, after my short few weeks working with Total Communication. I feel more motivated than ever to get my qualifications and get out in the field of speech and language therapy.
For further reading I would highly suggest having a look at the links in the referencing list. I found them very useful.
References:
Coakes , L. A., Little, T., & Drysdale, L. (2023). It’s My Book: Ownership of a Communication Passport. Communication Matters, 18(1), 21–23. https://www.communicationmatters.org.uk/wp-content/uploads/2019/02/cmj_vol_18_no_1.pdf
Yogendran, K. (2023, April 20). What is Sensory Storytelling? SAAAC. https://saaac.org/what-is-sensory-storytelling/#:~:text=Sensory%20stories%20incorporate%20all%20the
Millar, S., & Aitken, S. (2004). Personal communication passports : guidelines for good practice. Call Centre.
Introduction
Here at Total Communication Services CIC, we have been having a lovely summer! We received some funding from the Bury Council Lets Live Well project to run Multisensory Story sessions for children and adults around Bury. We were also commissioned by Bolton Library to run some sessions in the beautiful venue Smithills Hall. As well as running sessions, we have been training staff and supporting centres with their own home-made story planning sessions. It’s safe to say, we have thoroughly enjoyed running this project, just as much as the participants attending our sessions. For more information about our project, please see our other blogs linked below.
I first heard about Multisensory Storytelling when I was at university in 2014. I was trained as a storyteller by Bag Books and I enjoyed the approach so much I went to complete my undergraduate and postgraduate dissertations all about Multisensory Storytelling. I’m now back at university once more, training to become a (BAPT registered) Play Therapist. Through this training, I have been learning about attachment, relationships and emotional development. With these new ideas in mind, it has been interesting to experience Multisensory Storytelling from a different perspective during this project.
What is Multisensory Storytelling?
Multisensory Storytelling (MSST) is an interactive approach combining sensory experience and storytelling. The approach is typically used with children or adults who have additional support needs and is most often facilitated in a small group. The approach uses different objects (stimuli) which stimulate the five senses, touch, smell, hearing, taste, and vision. Each stimulus is linked to one sentence of a short story. The stories are designed to be interactive, playful, and fun. Repetition is an important part of multisensory storytelling and sessions are often run over a number of weeks.
Why is Multisensory Storytelling beneficial?
MSST is beneficial for people for many reasons. Firstly, opportunities for sensory exploration and experience are offered. Sensory experience and stimulation are important for brain development, and during MSST participants might experience new or interesting textures, sounds, smells, or visuals. Repetition of experience builds new neural pathways, important as brain development is use-dependant (Hong and Mason, 2016). Participants are able to explore the stimuli at their own pace and often gain the confidence to try something new.
Furthermore, opportunities for developing early communication skills also occur through MSST. Research has found that MSST supports engagement and responsiveness in people with complex support needs, and they can help people to develop skills in social communication, such as turn taking, eye contact, and choice making (Halfens, 2012). A key feature of MSST is the repetition of the story and the anticipation which occurs when in a group setting. We have found that some people really enjoy being last in the group. This is because going last builds excitement, participants are able to watch other group members take their turn and thus, anticipate their own.
This also allows children who are nervous about being in a new environment the chance to see what happens before it is their turn.
This picture shows one participant watching his cousin explore the object. He particularly enjoyed watching the other members of the group go before him and was able to anticipate his turn in the group.
Shared Interaction
As well as the communicative benefits, MSST offers opportunities for building positive relationships, through the pleasurable, shared interaction with a communication partner. As MSST is designed to be playful, there are many opportunities for joy, pleasure, interest, delight, humour, laughter, and fun. It is a shared experience between the storyteller and participant, and also, between the participant and their caregiver. At Total Communication Services CIC
we feel it is beneficial to involve caregivers who have come to support participants within the session. This is because opportunities for pleasurable, shared interaction are then extended. Research into attachment shows us that a common feature of securely attached relationships is mutual pleasure in each other’s company (Beebe et al., 2012); we often find that participants and their caregivers experience mutual delight in the other person’s participation during MSST. An example of this might be a child finding it humorous or enjoyable to see a caregiver wear a silly hat or pretending to run away from a pirate. Parents have reported enjoying the sessions, as they might see the child engage in ways that are unusual. For example, speaking out loud or touching something they usually would refuse to. The interaction elicited through MSST supports positive relationship building; participants share mutual pleasure in each other’s company through joyful, playful, meaningful experiences.
Further opportunities to support positive experiences in relationships occur in the relationship between the storyteller and participant. As a storyteller, it is important to build rapport with participants and notice subtle changes in their presentation and communication when delivering MSST sessions. This might look like a short smile when engaging with a certain stimulus or it could be that someone is looking worried before having their turn. It is also important for the storyteller to respect boundaries, know when a participant has finished or had enough, or is overwhelmed by a stimulus. As the trust in the relationship builds week upon week, the storyteller becomes more able to assess the participants needs and can make judgements about when to gently encourage exploration and when to take a step back. The storytelling session becomes a dynamic process, adapting to the needs of each participant. This might look like giving a participant longer to explore something if they seem to be enjoying it. It could also look like skipping a certain stimulus or modelling how it used on yourself first if someone seems unsure. Noticing how another person feels and acting accordingly is called attunement. Attunement is an important part of building relationships and helps another person feel heard, valued and understood.
Finally…
It has been interesting and valuable to consider the ways in which relationships are positively impacted by MSST from a new perspective as a trainee Play Therapist. Running the sessions as a storyteller have been rewarding and we would love to run more sessions in the future. This blog explores MSST from a relationship building perspective but our other blog explores the other part of our project, where the self-advocates from Bury People First became the ones to tell the stories.
More information
Beebe, B., Lachmann, F. M., Markese, S., Buck, K. A., Bahrick, L. E., Chen, H., & Jaffe, J. (2012). On the origins of disorganized attachment and internal working models: Paper II. An empirical microanalysis of 4-month mother–infant interaction. Psychoanalytic dialogues, 22(3), 352-374. Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental psychology, 28(5), 759
Grace, J (2015). Sensory Stories for Children and Teens with Special Educational Needs. London: Jessica Kingsley Publishers Halfens, J. L. (2012). Multisensory Storytelling: the effect on positive social responsiveness in children with profound multiple disabilities. Utrecht University.1-62. Hong, R., & Mason, C. M. (2016). Becoming a neurobiologically-informed play therapist. International Journal of Play Therapy, 25(1), 35. Perry, B. D. (2001). Attachment: The first core strength. Early Childhood Today, 16(2), 28-29.
Our wonderful volunteers from the key stage 4 dance and drama pathway in New Bridge Academy, (Lumenus) supported us to teach our one day Talking Mats training course recently. We had been invited to provide the Talking Mats Foundation training course, for a group of Speech & Language Therapists and their Occupational Therapy and Physiotherapy colleagues in Sheffield. We talked to the Communication Advocate volunteers about them attending the training and providing some co-training. This was arranged as a school trip. We explored any concerns the advocates had about the day and learned that one of the things they were really looking forward to was driving over snake pass. Which we agreed has an apt title given its winding route.
The Lumenus students (Communication Advocates) have been working on talking mats and they are becoming very experienced at explaining the process and teaching others how to do a mat. We decided that they were ready to co-train, and we also wanted to showcase a movement piece they have created called ‘hear my voice’. The piece is about good listeners and bad listeners and during the performance there were quite a few tears from the audience as it really is a powerful message.
The Communication Advocates attended two courses in March. On the day, once their movement piece was complete the students worked with the therapists and taught them how to complete a talking mat. Feedback from the course participants was great-
“I particularly enjoyed the children’s dance/drama performance.”
“Meeting the students was an unexpected bonus.”
“Loved being trained by the students too.”
“Was great to have a go on the receiving end of a Talking Mat and see how it feels as a recipient and what’s important as a listener.”
“Presentation was super – never had an experience with co-delivery/training by students – they performed such a moving drama; it was such a brilliant experience of learning by interacting with the students.”
“Thank you for a really informative and inspiring day. Working with the young people was a very special bonus.”
“Young people coming to teach us was so valuable. Their performance was really poignant and beautifully explained
– good vs bad listeners and the impact this can have.”
“It was great to see the children and to have a chance to work with them.”
Following the training the students visited a park in Sheffield and luckily they had sunshine too, before returning to Oldham via snake pass of course. https://en.wikipedia.org/wiki/Snake_Pass
I asked the Communication Advocates for their thoughts on the trip.
Their comments were as follows:
What we thought of performing
· Fabulous
· Inspiring – inspired me to be confident
· I thought it was really really, really good. I felt sad because the bad listeners wrapped people up, but then I felt happy
because the good listeners unwrapped them
· Very, very fabulous, I want work on showing even more facial expression
· It was very important for people to listen
· It was good
What we thought of training the staff
· I felt proud because I’d never done teaching before
· I think working with the people on the course was good for me
· I felt uncomfortable teaching adults
· It was good to help the staff
The trip
· It was tiring
· I fell asleep
· I felt really happy
· I think going to Sheffield on snake pass was fun
· I loved the park!
· I love snake pass
Class Teacher Sophia Pilgrim said of her key stage 4 group
‘I’m immensely proud of Lumenus, how confident they have become. They have learned how to teach talking mats in such a short space of time’
Alison Matthews
With thanks to OL1-Oldham for funding towards the project.
