Communicate and Connect

Taking a Total Community Approach

Chloe

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.