how i

How I get signing into practice (1):

Its Signsational!
After completing training courses in signing, parents, carers and staff may lack the confidence and skills to actually use the signs they have learnt. The speech and language therapy team for people with learning disabilities at Yourhealthcare describe the Signsational way they found to address this.

READ THIS IF YOU WANT TO PROMOTE TOTAL COMMUNICATION DESIGN INTENSIVE TRAINING FOR CLIENTS AND CARERS MAKE MORE USE OF MUSIC IN THERAPY

Deborah

Denise

Laura

Nicky

Radhika

Roz

Wendy

s a team of speech and language therapists working with adults with learning disabilities we constantly promote the use of signs in the everyday environment to support communication. Despite a rolling programme of training encouraging people to use sign in the home environment, we were aware that many parents and staff were coming away from signing courses having learnt the signs but not the skills and confidence to put them into use. We wanted to provide an effective way of overcoming the barriers and giving staff, carers and family members the confidence to use signing as part of their everyday communication with our service users. Two of us had experience of working on intensive Kith and Kids 2:1 holiday projects with children and adults with learning disabilities, and were impressed by the positive outcomes and success. This led to the idea of designing an intensive signing course that included both service users and their carers. We chose a fun title that we hoped would capture the spirit of the course. Signsational was a light-hearted and catchy name that we thought would appeal to all participants. We chose a pleasant community facility in the high street near to local amenities and shops as the venue. We aimed to create an intensive signing / total communication focused environment that would illustrate to parents and carers how positively people respond to a signing environment, how successful and effective it can be, and how easily it can be implemented in homes and day centres. It was important for us to demonstrate that signing is not just about giving instructions, but about everyday

chatting and interaction. We wanted to develop peoples enthusiasm, skills and confidence to use signs in a natural way, and move people with basic signing skills on to being more confident and fluid. We adopted a Total Communication approach, using photographs, and signing throughout. We circulated information to promote Signsational, and invited referrals. We considered anyone who used signing to communicate, regardless of age or cognitive ability. Nine service users attended, each with a member of their family or care staff. The participants ranged from a man in his mid 50s to the youngest, a teenager. The most important element for acceptance was commitment from staff / carers / family; we asked them to sign a contract to attend for the whole week. The course was planned sufficiently in advance so that at least four of the six speech and language therapists and both our assistants could attend and facilitate. We also invited students from City and UCL to join us as part of their placements, so it was a big, bubbly group! Other health professionals were also welcome to observe. Planning the activities was the most time intensive aspect of the project. We used a wide range of activities previously developed in other groups to facilitate skills such as turn taking, anticipation, listening and participation. The speech and language therapy assistants gathered together and made resources including costumes and props for the story activities, materials for the craft sessions, refreshments, music and sound effects compilation cds. We prepared documentation such as an accessible information booklet for service users, a contract for both carers and service

users, booklets of signs and an accessible story book. A speech and language therapist or assistant or students also made visits to the homes before and after the group to conduct pre- and post-group measures. The four days of the Signsational course involved practical and fun activities with an intensive approach to the use of signs (figure 1). We used music to mark activities and provide structure. Every day the same piece of music was played at the beginning of an activity, for example Everything stops for tea for the tea break and Aquarium from Carnival of the animals for the relaxation activity. We used music throughout to provide mood and atmosphere and to engage the participants emotionally. We found music provided an opportunity for people to express themselves and interact in a poignant way. There were many special moments where groups members spontaneously expressed themselves through a performance of dance and movement. This has given us food for thought about the link between communication, music and movement. People began bringing in their favourite music to play in break and lunch times. It created more opportunities and established some common ground on which to form bonds and friendships. In terms of outcomes, the speech and language therapy team observed throughout the Signsational week an increase in both quantity and quality of signs (accuracy and appropriateness) from the service users and carers. There was also an increase in the level of interaction and communication between the service users, for example, initiating communication, anticipation, turn taking and participation in the activities. This is backed

28

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2011

how i
Figure 1 Structure of the week DAY 1 An afternoon signing workshop for the people accompanying the service users. We taught them a core vocabulary of signs in a functional and conversational way and covered the signs for the story telling activity. DAYS 2 - 5 10.00 Good morning activity. This provided an opportunity for sharing news and promoting conversational skills. 10.10-11.00 Morning signing activities: structured turn taking games and activities focusing on specific topics for signs. Tea Break opportunities to make choices, take responsibility for offering drinks and to sign in an informal, conversational way. 11.3012.30 Community / practical activity. We recognised that for some of the carers using sign out and about was difficult, so this involved everyone going out into the community to shop for items to use in the following practical session. The practical sessions always linked in to the afternoons story telling. An example was to buy decorations for party invitations, make the invitation to invite another person from the group and then post the letter for the Friday afternoon party. Lunch break more opportunities to sign in an informal, conversational way and use signing in the community. People were encouraged to go out and use the local cafs and shops. 13.3014.50 Afternoon story telling activity: A story was told over the four days Alice in Wonderland. This activity was based on Nicola Groves work where a story is told using a series of games and activities using a multi-sensory approach. 14.50-15.00 Relaxing time using a parachute, specific relaxing music and glowing balloons. Key for figures 2-4: pre-Signsational post-Signsational

Figure 2 Number of signs observed 20 15 10 5 0 A B C D Service user E

No. of signs Level of confidence

Figure 3 Confidence using signs at home

up by the change in pre- and post- measures for clients use of sign (some are illustrated in figure 2) and carers reported confidence signing at home and out and about following their participation in Signsational (some shown in figure 3). Feedback from staff also implies that service users and staff are signing more and can be more easily encouraged to use signs when required: I didnt know much about signing before the course but I learned a lot and feel very confident about signing now. Its good shes learnt signs otherwise she wouldnt be able to communicate. Seeing other proficient signers makes me realise how useful signing is and makes me want to learn it more...consistent signers around her will help her learn. [pre-Signsational] Although Id done the 2 day course I still lacked confidence. [postSignsational] Fabulous system to learn signs. Im more confident in working out signs on bigger words. Our service users are able to communicate better and are able to let us know what their needs are by signing. We have since run two further Signsational courses for service users and their carers in November 2009 and May 2010 and held Christmas parties in both 2009 and 2010 to get together again and maintain the friendships that formed. Both courses have been as successful as the first, and had 100 per cent attendance. Where there is a need we will continue to support service users and their carers for as long as possible to maintain a total communication, signing environment. If you are considering this kind of approach, it is worth noting that we have learned not to underestimate the amount of preparation time required each time to put on the week. This is especially from the speech and language therapy assistants, who are fantastic at sourcing and making all the resources for the story groups. We clear their caseload SLTP ahead of time so they can do it all!

This article was written by the speech and language therapy team for people with learning disabilities at Yourhealthcare. For further information on the morning activities or copies of the Signsational accessible contract and information booklet and the general information pack for carers, contact Deborah Green (email deborah.green@ yourhealthcare.org), Wendy Reed (email wendy. reed@yourhealthcare.org) or Roz Angier (email rosalind.angier@yourhealthcare.org). Acknowledgement The PLD SLT team at Your healthcare would particularly like to thank Nicky Chibah speech and language therapy assistant extraordinaire for her outstanding contribution to the Signsational project. Recommended reading Chadwick, D. and Joliffe, J. (2008) A pilot investigation into the efficacy of a signing training strategy for staff working with adults with intellectual disabilities, British Journal of Learning Disabilities 37(1), pp.34-42. Graves, J. (2000) Vocabulary needs in augmentative and alternative communication: a sample of conversational topics between staff providing services to adults with learning difficulties and their service users, British Journal of Learning Disabilities 28(3), pp.113-119. Grove, N. & Park, K. (1996) Odyssey Now. London. Jessica Kingsley Publishers. OCallaghan, P. (2008) Rise and sign, Speech & Language Therapy in Practice Summer, pp.11-13. Powell, G. (1999) Current research findings to support the use of signs with adults and children who have intellectual and communication difficulties. Available at: http:// www.makaton.org/research/powell99.htm (Accessed: 11 January 2011). Volpato, D., Orton, D. & Blackburn, D. (1986) Making Progress with Makaton, Nursing Times 30 April, pp.33-35. Available at: http:// www.makaton.org/research/research.htm (Accessed: 11 January 2011). Resource www.kithandkids.org.uk

10 8 6 4 2 0 F G H Carers I

Figure 4 Confidence using signs out and about Level of confidence 10 8 6 4 2 0 F G H Carers I

REFLECTIONS ON GROUPS DO I PUT THOUGHT INTO CHOOSING AN APPROPRIATE NAME? DO I MONITOR THE IMPACT USING SIMPLE PRE AND POST MEASURES? DO I FACTOR IN ENOUGH TIME FOR PREPARATION?
What difference has this article made to you? Please see the information about Speech & Language Therapy in Practices Critical Friends at www. speechmag.com/About/Friends, and let us know.

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2011

29