Journal of Intellectual & Developmental Disability, December 2010; 35(4): 279289

Staff members understandings about communication with individuals

who have multiple learning disabilities: A case of Finnish OIVA
communication training

KATJA KOSKI1, KAISA MARTIKAINEN2, KATJA BURAKOFF2 & KAISA LAUNONEN3

1

Childrens Therapy Centre Terapeija, Finland, 2Finnish Association on Intellectual and Developmental Disabilities, Helsinki,
Finland, and 3Institute of Behavioural Sciences, University of Helsinki, Finland

Abstract
Background Often communication training has been directed at the communication practices of staff members working
with people with multiple learning disabilities. To date, the thinking habits of staff members, which also influence
interactions, have not been addressed. We identified the issues staff members perceived as important for their development
as communication partners after participating in a communication training program.
Method Six key staff members participated in semistructured interviews that explored the insights they had gained during
participation in the Finnish communication training program OIVA.
Results Participating staff members identified issues relating to the communication practices and thinking habits they had
acquired during the training. Both communication practices and thinking habits were important for the staff members
development as communication partners.
Conclusions The findings of this study suggest that it is important to give staff members the opportunity to learn new
practices and to explore the thinking that underpins the actions they perform during communication training.

Keywords: multiple learning disabilities, communication, staff, training

Introduction
The desire for love and belonging is a recognised
basic human need (Maslow, 1943). Thus, the right
to belong and to participate in a community is a basic
human right (United Nations, 1948). This right also
applies to individuals with multiple learning disabilities (MLD). Belonging to a community requires that
other members of that community are prepared to
include every member in its daily functioning
(Ferguson, 1994). For many individuals with
MLD, direct support staff members hold the key to
this inclusion; they are usually the primary communication partners for this group, and acquiring
effective membership in a community requires
communication between all those in the community.
Nevertheless, interaction with individuals with
MLD is not simple. People with MLD may rely on
developmentally early means of communication
(e.g., nonverbal communication modes, such as
gestures and vocalisations), have a slow interaction
pace (McLean, McLean, Brady, & Etter, 1991), and
have difficulties understanding spoken language
(Ware, 2004). Therefore, many authors (e.g., Nind

& Hewett, 2005; Purcell, McConkey, & Morris,

2000) have noted that staff members own interaction skills often determine the outcome of communicative interactions. In particular, staff members
need to know how to use sensitive interaction based
on, for example, attachment theory (Bowlby, 1969),
sensitive mothering (Ainsworth, Bell, & Stayton,
1974), and Intensive Interaction (Nind & Hewett,
2005). Sensitive interaction requires patience from
the staff members involved and also a desire to try to
understand the communicative attempts of the
individuals with MLD. This might mean that staff
members have to make interpretations from what are
sometimes very subtle communication attempts by
these individuals (von Tetzchner & Jensen, 1999). In
addition, staff may be unsure at first about the
accuracy of these interpretations (Ainsworth et al.,
1974; Bowlby, 1969). Furthermore, the sensitive
interaction style requires that staff have the ability to
take note of the level of language comprehension of
the individuals with MLD and, when necessary, to
adjust their own level of verbal and nonverbal
expressions. This may include using appropriate

Correspondence: Katja Koski, Childrens Therapy Centre Terapeija, Kuusiniementie 2, Espoo 02710, Finland. E-mail: katja.koski@terapeija.fi
ISSN 1366-8250 print/ISSN 1469-9532 online 2010 Australasian Society for Intellectual Disability, Inc.
DOI: 10.3109/13668250.2010.517189

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K. Koski et al.

augmentative and alternative communication (AAC)

strategies, such as pictures, gestures, or objects, to
meet the needs of each individual (e.g., Bradshaw,
2001).
For these reasons, researchers conducting observational studies and staff members themselves have
identified communication skills as a professional
competence that demands special training (McConkey, Morris, & Purcell, 1999; McVilly, 1997).
Therefore, communication training programs have
been developed and implemented (e.g., Firth,
Elford, Leeming, & Crabbe, 2008; Golden & Reese,
1996; Purcell et al., 2000) predicated on teaching
staff members communication practices that promote
the sensitive interaction style described above,
including, for example, the use of AAC strategies
when communicating. However, the maintenance of
the newly learnt practices and the generalisation of
these to other situations, other clients, or nontrained
staff are still problematic (Maes, Lambrechts, Hostyn, & Petry, 2007).
The question then arises whether the sole emphasis of such programs on training the communication
practices of the staff is enough to ensure effective
communication. Ager and OMay (2001) noted that
accomplishing more permanent change in staff
behaviour requires training programs that also
address the staff members thinking habits. Therefore,
it is important that staff members are not only taught
to use certain communicative practices, but are also
given opportunities to focus on their own assumptions and expectations about the abilities of individuals with MLD to communicate. Furthermore,
Dennis (2002) found that staff members who appear
to have a highly functional communication relationship with individuals with MLD stressed that
communication practices are not enough: thinking
habits strongly influence staff members practices.
Staff members who think individuals with MLD
possess communication skills interact differently
compared with those who do not think that such
individuals are able to communicate (Bigby, Clement, Mansell, & Beadle-Brown, 2009). Consequently, it could be argued that training that
focuses on staff members thinking habits might
hold the key for a more permanent change in staff
members communication skills.
Commonly, training programs have been analysed
by their effectiveness on the behaviours of the
participating staff members (e.g., Golden & Reese,
1996; Purcell et al., 2000). Researchers have also
explored staff members own views about the
benefits of the training (e.g., Firth et al., 2008).
The aim of the present study was to identify what
staff members perceived as important for their

personal improvement as communication partners

with individuals with MLD after participating in a
communication training program. Did they place
greater emphasis on a change in their communication practices, or a change in their thinking habits, or
were changes to both important?
An additional purpose of this article is to present
the Finnish communication training program OIVA.
Since this training is a work in progress, the results
are aimed at gaining knowledge about the experiences of the participating staff members in order to
further develop the communication training. Nonetheless, the current findings can be useful when
planning and implementing other communication
training programs for staff members who work in
disability services.
OIVA training
The Communication and Technology Centre of the
Finnish Association on Intellectual and Developmental Disabilities has been developing a communication
training
model,
the
OIVAvuorovaikutusmalli1 [OIVA interaction model]
(OIVA is a Finnish acronym from the words
participating through interaction). OIVA is aimed at
training direct support staff who work with people
with severe and complex communication needs. The
model was piloted in 20022003 (Martikainen &
Roisko, 2004). It was further developed in 2005
2008 (Martikainen & Burakoff, 2006; Martikainen,
Burakoff, Vuoti, & Launonen, 2008; Vuoti, Burakoff, & Martikainen, 2009) when three organisations
from different parts of Finland offering services for
individuals with MLD took part in the OIVA training
project. Thus, the OIVA training involved the
development and testing phases of the OIVA
interaction model. The present study focuses on
the results gained from OIVA training.
The principles and participants of OIVA training
The OIVA training program was influenced by
several other communication training approaches;
for example, VIG-Video Interaction Guidance (Kennedy & Sked, 2008), Granlund and Olsson (1998),
Nafstad and Rdbroe (1999), Hanen (Ruiter, 2000),
VIKOM (Sollied & Harmon, 2002), PICTURE IT
(Bloomberg, West, & Iacono, 2003), and Intensive
Interaction (Nind & Hewett, 2005). The main
principles of this training were community-based
rehabilitation (CBR) and a client-oriented approach,
and the training was solution focused. The working
method of OIVA training was video-based guidance
(see Vuoti et al., 2009).

Staff members understandings about communication

With CBR the entire community attempts to
determine how each member (staff members and
individuals with MLD) can participate fully and
successfully in the life of the community (International Labour Organization, United Nations Educational, Scientific and Cultural Organization, and the
World Health Organization, 2004; see also World
Health Organization, 2001). CBR initially originated
as a method of increasing disability and rehabilitation
services in developing nations and aimed to ensure
that the support given was closely linked to local
communities (Lagerkvist, 1992). Nevertheless, CBR
has important implications for urban practice (Kendall, Buys, & Larner, 2000). In Finland, the term has
been used to describe services that target influencing
social networks (parents, friends, caregivers, staff
members) of individuals rather than the individuals
per se (Hilden, Merikoski, & Launonen, 2001).
Thus, the aim of CBR is to create a community that
is able to support individuals with MLD in their
everyday lives and enable them to participate equally
in the life of the community. Each participating
organisation identified two or more of its departments from which staff members would participate in
the training. According to the principles of CBR, each
department was regarded as its own community. It
was essential that all staff in the selected departments
would participate in the training. Altogether, 47 staff
members started the training and 31 completed it; the
difference was due to staff turnover.
Communities have their own unique needs with
regard to the issues they want to explore and develop
in daily life (Vuoti et al., 2009). Thus, OIVA training
was client-oriented and the participating staff members
played an active role. The goal for them was to begin
to resolve problems with communication in their
respective working communities independently.
OIVA training was also solution focused; therefore,
its aim was to recognise and strengthen those
interaction patterns of staff members that were
identified as functioning well in practice (cf. Katajainen, Lipponen, & Litovaara, 2008; Vuoti et al.,
2009).

Figure 1.

The process of OIVA training.

281

The length of OIVA training and training components

During the OIVA training, staff members participated in video-based guidance meetings (see Fukkink,
2008, for discussion on the benefits of video-based
methods). In the meetings, staff and a speech
language pathologist (SLP) analysed interaction
situations between dyads consisting of a staff
member and an individual with MLD. Each organisation had its own separate meetings; thus, staff
members participated in meetings with staff colleagues from the same organisation. The meetings were
held every 6 weeks for 18 months, 12 times in each
organisation (see Figure 1). After this period the
participating organisations also had the opportunity
to request additional meetings.
According to the client-oriented principle, staff
members played an active role in the meetings.
Firstly, staff members cooperatively chose the
individuals with MLD and the staff members who
were to be included on the video. Secondly, in
preparing for each video-based guidance meeting,
staff members videotaped two interactions from their
daily work that involved attempts to communicate
with individuals with MLD. Finally, from each
video, staff members identified an issue they wanted
to focus on during the video-observation meeting; for
example, whether the staff member accurately interpreted the communication acts of the individual with
whom she or he was interacting.
In keeping with the solution-focused principle, during
the meetings the SLP and the staff members focused
on examples of positive interaction shown in the
videos. Since the theoretical background of OIVA
training is derived from research on promoting the
sensitive interaction style described earlier, the SLP
helped the staff members recognise from the videos
five variables of interaction that had been hypothesised as promoting a sensitive interaction style during
the development of the OIVA training (Burakoff &
Launonen, 2002; Launonen, 2002; Martikainen &
Burakoff, 2006; Martikainen et al., 2008; Vuoti et al.,
2009): (a) being reciprocally present in the situation,

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K. Koski et al.

(b) waiting and giving time for the individual

to initiate an interaction, (c) responding to the
individuals communication, (d) adjusting their
own expressions to meet the individuals communication abilities, and (e) verifying mutual
understanding.
Moreover, in following the solution-focused principle, the SLP and staff members sought solutions to
the issues that staff members had identified as being
of most concern prior to the meeting (Martikainen &
Burakoff, 2006; Martikainen et al., 2008; Vuoti et al.,
2009). During the meeting, staff members decided
on an issue that would improve their interaction with
the person with MLD seen in the video. At the next
meeting that aim was given more focus and developed further.
In addition to the video-based guidance meetings, staff members also participated in six training
sessions (see Figure 1). The aim of the first two
training sessions was to ensure that all participating
staff members had similar background knowledge
about interaction and communication with the
individuals with MLD. These sessions covered
how to use sensitive interaction style and AAC
strategies. The next two training sessions gave staff
members tools for creating individual communication passports for the individuals with MLD
(Millar & Aitken, 2003). Since the participating
organisations were located in different parts of
Finland, the aim of the last two training sessions
was to provide all participating staff with an
opportunity to meet and discuss their experiences
and views of the training.
Furthermore, the developers of the OIVA training
program (viz., the second and third author of this
article, both certified SLPs) worked closely with the
participating organisations. The organisational manager from each organisation attended regular meetings with the developers in order to monitor the
progress of the OIVA training.

Method
Research design
Qualitative methods were chosen because of the
exploratory nature of the study (Miles & Huberman, 1994). Qualitative methods are particularly
useful when the topic under investigation is
complex, dilemmatic, novel or under-researched
and where there is a concern with understanding
process rather than measuring outcomes (p. 604)
(Smith & Dunworth, 2003). We used a semistructured interview method (Kvale, 1996) to give staff
members (hereafter referred to as informants) the

opportunity to describe their own personal

stories of development as successful communication partners with their clients with MLD. We
used these stories to identify the particular issues
they perceived were important as effective
communicators.
Informants
Selection of informants. A combination of qualitative
sampling methodscriterion and opportunistic
samplingwas used (Patton, 2002). Consequently,
we acknowledge that we did not have a representative sample (Marshall, 1996). The criterion
sampling of the present study consisted of selecting
informants who (a) had participated in OIVA
training from the beginning, and (b) were still
employed in the same department as they were
employed in during that training. It was important
that the informant was able to describe the whole
OIVA training and also how communication
situations in the department were conducted after
the video-based guidance meetings had finished. In
one of the three organisations involved in the
training, only two informants met these criteria.
Therefore, it was decided to choose two staff
members from each organisation to be interviewed.
Opportunistic sampling was employed to select the
rest of the informants. As Spradley (1979) noted,
informants should be able to speak as members of
the communities they represent. Therefore, the staff
members selected needed to be able to describe how
their communityparticipating colleagues, nonparticipating colleagues, and supervisorsencouraged
and assisted them during the training. Accordingly,
the selection of the rest of the informants was
influenced by the participant observer method
(OReilly, 2005): two staff members from each
organisation who, firstly, met the criteria mentioned
above and, secondly, were competent to speak on
behalf on themselves as well as their respective
communities. The professionals responsible for the
training identified these staff members.
Selected informants. All six informants were women,
and their ages ranged from 29 to 58 years. Four of
the staff members worked in residential settings and
two in day services for individuals with MLD. The
work experience of the staff members ranged from 4
to 38 years. Two of the informants had bachelors
degrees in social services and one of the informants
was a trained nurse. Three of the informants had a
degree in practical nursing. All informants had
specialised in working with individuals with MLD
in their studies.

Staff members understandings about communication

Interview
Each informant was interviewed 2 months after the
last training session of the OIVA training. The
interviews took place at the premises of each
informants organisation, and were located in different parts of Finland. Thus, to save time and expense,
each organisation had a different interviewer. The
first author of this paper was one of the interviewers.
The other two interviewers were research assistants
who were final year SLP students completing their
masters theses on OIVA training. The interviewers
did not take part in the preceding OIVA training and
did not have a previous professional relationship with
the informants. Before the interviews, the first author
of this paper introduced the research assistants to the
OIVA training to ensure they had enough background knowledge to be able to ask informed
questions.
The interviewers jointly designed an interview
protocol based on a pilot interview of one staff
member who had participated in OIVA training (see
Table 1). The questions were open-ended; this
allowed staff members to talk about their personal
experiences and also to volunteer any additional
information they thought was relevant (Kvale, 1996).
There was, however, flexibility in the sequence of the
topics covered, and the exact wording of the
questions asked in each interview varied. In order
to facilitate the accuracy of data collection, interviews
were videotaped with the informants consent.
Data analysis
The duration of the videotaped interviews ranged
from 20 to 30 minutes. Interviews were transcribed
verbatim and analysed using a combination of
Miles and Hubermans (1994) inductive approach,
Thomas (2006) general inductive approach, and
Auerbach and Silversteins (2003) approach for
analysing qualitative data (based on grounded theory). Initially, the first author of this paper read and
reread all the transcripts and, once familiar with the
data, began the process of data reductionselecting
the relevant passages from the transcripts. The aim
was to focus on passages where informants described
issues about communication with individuals with
MLD that they or their community had come to
understand as a result of the training; thus, these
extracts were identified prior to the analysis. A
passage was identified as a description of such an
understanding if the informant used words related to
acquiring new information or practices such as I
learned, I started to, we became more aware of, or
described the new understandings directly using

283

Table 1. Interview protocol

Questions exploring the views before the OIVA training:
1. What did you think about the OIVA training when it
started?
2. Why did you participate in the training?
3. What kind of goals did your community/colleagues set to be
achieved?
4. What kind of goals did you set for the individuals to be
achieved?
Questions exploring the views during the OIVA training:
5. What did you think about the length of the OIVA training
period?
6. If you could go back, what would you have done differently
during the training?
7. How did the community/colleagues support you during the
training?
8. What did your colleagues think about the training?
9. What did you think about watching the videos in meetings
with your colleagues?
Questions exploring the views after the OIVA training:
10. How did the OIVA training impact the lives of the
individuals in your community?
11. What do you think now about the training?
12. Do you think that you have changed as an interaction
partner as a result of the training?
13. If you believe you have, what contributed to such progress?
14. What do your colleagues think now about the training?
15. Has your communitys interaction environment changed as
a result of the training?
16. If it has, what contributed to the change?
17. Have you seen changes in the behaviour of the individuals
with whom you interact?
18. If you have, how do you account for these changes?

sentences such as x has changed, I do x differently,

or if the informant used temporal adverbs such as
before we x, but now we x, previously I. The
informants used a mean value of 2,512 words in the
interviews (ranging from 1,541 to 3,484 words), and
1,229 (49%) (ranging from 600 to 2,184 words) of
those words were used to describe the improvements
in informants communication.
After this process of identifying the relevant
passages, the first author of this study developed
initial categories based on patterns and relationships
in the data. Since this was a qualitative study, the
subjectivity of the first authors interpretations and
the research context no doubt affected the creation of
these categories to some extent. Therefore, the
trustworthiness or the justifiability of the categories
and the analysis was examined through the categories transparency and communicability (Auerbach
& Silverstein, 2003). Transparency was established
in two ways. Firstly, both the first author and one of
the research assistants independently coded one of
the interviews using the initial categories developed
by the first author. Afterwards, the first author and
the research assistant compared their codes and

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discussed the relevance of each category and

how the interpretations of the passages were
made. This was done to affirm the clarity of the
categories and to establish a final coding scheme
(Thomas, 2006).
Secondly, specific examples from the data were
included throughout the results to demonstrate and
corroborate assertions. In the examples given, the
informants have been assigned a random number to
ensure their anonymity. The original interviews were
in Finnish and have been translated into English,
with every attempt not to impair the content. An
authorised translator confirmed the translations.
The communicability of the categories was also
ascertained using two separate means. Firstly, the
first author explained the categories to the research
assistant and together they discussed and established
the final titles for each category. Secondly, the
categories were explained to one of the informants,
and she confirmed that they accurately reflected her
experience. To avoid repetition, the results are
discussed below after presenting each category.
Results and discussion
During the interviews the informants explored
several issues that, as a result of the OIVA training,
they saw as important for their development as
communication partners. These realisations were
related to communication practices and thinking
habits about communication (see Table 2).
Communication practices
Being patient. All informants (n 6) emphasised that
the OIVA training had taught them to be more
patient during interaction situations and to give more
time and opportunities for the individual with MLD
to take the lead during communication situations. As
one informant explained
One now thinks more of approaching the communication situation in the sense that there be [sic] more room
for the partner to be able to express himself. (Staff
member 4)

Dennis (2002) has also noted that skilled interaction

partners value the capacity to make room for silence
when communicating with people with MLD.
Furthermore, individuals with MLD need more
time to initiate communicative acts (McLean et al.,
1991). Thus, the ability of staff members to be
patient provides the individual with MLD with more
opportunities for interaction (Light, Dattilo, English,
Gutierrez, & Hartz, 1992).

Learning to interpret communication attempts by the

people with MLD. The informants (n 6) repeatedly
voiced that their new priority was to try to understand their clients communication attempts. Thus,
they had started to focus on the individuals gestures
and facial expressions to help them to better understand what was being communicated:
We ponder what the individual means and wants to say
with that particular facial expression, and if we had not
started to concentrate on these expressions and ask [the
individuals] if they mean this or that, no change would
have happened. (Staff member 5)

Furthermore, informants (n 5) had begun discussing with their colleagues how different individuals used different nonverbal modes to
communicate. They felt that this new practice had
improved their ability to interpret the intended
meaning of individuals, as explained here:
We talk a lot more about the individuals initiatives, like
this individual did this and whether he has ever done
that before and whether you think that it was related
to . . . and in our daily official meetings [with other staff
members and supervisors] we also try to concentrate on
this. (Staff member 3)

Creating understanding between individuals and

staff members requires that staff interpret the verbal
and nonverbal expressions of their clients (von
Tetzchner & Jensen, 1999). However, making the
right interpretation can be difficult. These interpretations are easier if (a) the staff member knows the
individual very well, or (b) if there are several staff
members involved in making the interpretations
(Ware, 2004). Thus, sharing knowledge about an
individuals different ways of communication gives
the staff a better chance of understanding that
individual accurately.
Communicating clearly. All six informants discussed
the ways they expressed themselves when communicating with individuals with MLD. Firstly, they
(n 3) realised that when they use clear sentences
and nonverbal communication, and talked about one
topic at a time, they are more likely to be understood.
Being conscious of the need to simplify their
attempts at communication with their clients is a
challenge for staff members (Bradshaw, 2001).
Secondly, three informants started to consider
their own use of AAC strategies. They reported that
they had learned the importance of ascertaining
whether individuals had understood the AAC strategies that had been used, and noted that it is the

Staff members understandings about communication

285

Table 2. The final coding scheme

Main category
Communication
practices

Subcategory
Being patient
Learning to interpret
communication attempts by the
communicants

Communicating clearly

Thinking habits

Realising the individuals

communication skills
Giving priority to communication

Viewing the essence of work

Examples
Giving more opportunity for communicants to communicate
Waiting for communicants to initiate communication
Knowing what communicants mean with their nonverbal and verbal
expressions
Verifying that there is a mutual understanding
Exploring and discussing with other staff members what communicants
might mean
Using clear sentences and speaking about one thing at a time
Using augmentative and alternative communication (AAC) strategies that
suit communicants
Using communication acts similar to those used by the communicants
(such as vocalisations) to establish contact
Communicants have opinions
Communicants try to express their opinions
Communicants can make decisions about their daily life
It is important to stop and listen to communicants
It is important to concentrate on the communicants while taking care of
them
It is essential to spend time together rather than to perform tasks
Productiveness also includes situations when nothing special happens
Work can be fun

staff members responsibility to try to find strategies

that benefit the individual with MLD.

clients] conversation and you should try it and you can

have much better contact with him. (Staff member 2)

For years we just showed him a [picture of a] clock and

said that it meant to take a break but to him it meant that
it is a clock. (Staff member 2)

Dennis (2002) and Nind and Hewett (2005)

reported that mirroring the communicative behaviours of individuals with MLD is an important
means of establishing or encouraging interaction.
However, staff members often have reservations
about using this kind of approach (Firth et al.,
2008). The reason for these reservations stems from
the philosophy of normalisation in social care
(Wolfensberger, 1972): that activities provided to the
individuals should be age-appropriate. Because
using vocalisations are considered childish, the
conclusion has been that this is not suitable for
adults. The informant quoted above provided further
insight into such reservations: she had been embarrassed to use the mirroring approach. As Dennis
(2002) noted, taking risks and making mistakes are
some of the traits possessed by the successful
interaction partners of individuals with MLD.
Thus, flexibility and overcoming uncomfortable
personal inhibitions are key factors if staff members
are to improve their communicative interactions with
these clients.

An appropriate AAC strategy for an individual

cannot be predetermined based on the persons
developmental age or measures such as the level of
the individuals learning disability (Mirenda &
Mathy-Laikko, 1989). Thus, it is important that the
staff members acknowledge the limitations of what
can be communicated and understood by the
individual (Ware, 2004), and to try to find strategies
that are suitable for each individual.
Finally, the informants (n 6) realised that using
communicative acts that are similar to those used by
their clients (such as vocalisations and gestures)
helps create contact. Indeed, one of the informants
stated that, although previously embarrassed to do
this, OIVA training had given her confidence to
express herself this way:
In my previous job I had clients who did not speak at all
but they did vocalise a lot, and whenever I was alone I
secretly [vocalised with them] . . . but, in a way, its
embarrassing . . . I dont care at all anymore. If a new
[staff member] comes along and I am vocalising with my
clients . . . I clarify [to her] that this is like his [the

Thinking habits
Realising the individuals communication skills. It
seemed that OIVA training increased the informants

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(n 6) confidence in the ability of their clients to

express opinions. Essentially, they understood that
individuals with MLD do have opinions about their
daily life, as the following passage explains:

do have and can make choices, organisations

themselves learn the need to be more flexible and
consider new solutions for meeting the needs of
individuals with MLD (Cullen, 1988).

It is so easy to think that when one talks, things get to be

resolved. But what happens when one [client] does not
talk? One [a staff member] has not considered that such
an individual can have opinions even though he does not
speak. (Staff member 3)

Giving priority to communication. Informants also felt

that they had started to give priority to communication situations. All six described that they had
learned to stop and listen to individuals, even at
their busiest times:

This demonstrates a problem staff members face

everyday: since the clients do not speak, it is difficult
to know what they mean. As noted previously, the
informants perceived that they had become better at
interpreting the expressions of individuals with MLD
as a result of OIVA training. All six informants
perceived that these clients do have opinions:
Some people clearly seem to have good opinions of their
own which they bring forward, and now we have noted
that they express them very clearly, but we just did not
see them before. (Staff member 3)

Bigby et al. (2009) noted that staff members do not

value the possibility that clients who use developmentally early means of communication can make
choices. Therefore, if staff members are better able
to interpret the individuals expressions, the issue of
choice making becomes relevant. This, however,
requires the belief that such individuals can and do
attempt to express their views (Dennis, 2002; von
Tetzchner & Jensen, 1999). Informants perceived
that they had become more successful at interpreting
the communicative acts of the individuals with
MLD. This gave them confidence in realising that
their clients do try to communicate and thus can
make choices, and should be given opportunities
to choose their daily activities, as suggested here:
Today our clients can influence what we do. We have in
our weekly schedule a choice in the opportunities we can
give. Obviously we cannot give limitless choice. But
earlier, everyone painted today and will do puzzles
tomorrow. However, now [following OIVA training]
individuals can have their say [in the daily routine].
(Staff member 1)

This demonstrates that OIVA training led informants to ask about individuals desires and that, as a
result, staff members are obliged to match those
desires with the opportunities the organisation can
provide. Since policies dictate the roles of an
organisations staff members (Forster & Iacono,
2008), staff members can only provide the choices
that are available to individuals. Nevertheless, as a
result of staff members judgments that their clients

Then I just learnt to think in a different way; that this

individual means something now and that I cannot just
ignore it by saying that I am busy. I need to stop and
listen to him. (Staff member 6)

Furthermore, two of the informants described how

they had started to make sure that care situations
always included communicative interaction with
individuals; this change in their thinking habit was
thus reflected in their practices:
I have started to concentrate on what I am doing with
the individual. Now every situation has interaction
within it; thus the daily care situations are not only
tricks that we do, like washing the individual quickly,
but the situation also includes communication. (Staff
member 5)

Moreover, another informant described the same

issue including some self-criticism of previous work
habits:
[Now] we try not to talk over [the individual] and if
there are two of us [staff members] taking care of the
individual, we try to talk to the individual, and the
weekend conversation [with the other staff members]
will be left to another time. (Staff member 3)

Hile and Walbran (1991) also noted this same

issue: staff members easily engage in nonworkrelated conversations with other staff members while
at their work. Hile and Walbran offered two possible
reasons for this. Firstly, with many staff members
present at the same time, it is easy to have a
conversation with colleagues. Secondly, the responsibility (Latane, 1981) between the staff members is
diffused and the need to work hard diminishes.
There is still another possibility: since interacting
with the individuals with MLD can be difficult, staff
members may choose to interact with other staff
members rather than with the individual with MLD.
Therefore, if staff members feel that communication
with the individuals with MLD is easy or easier, they
might include these individuals in their conversations
more often.

Staff members understandings about communication

Viewing the essence of work. The OIVA training
program appeared also to influence how some of
the informants viewed the essence of their work
(n 3). One of the informants in particular explored
this topic extensively. She had concluded that it is
more essential for individuals to be understood in
their own community than it is to complete tasks.
Furthermore, she realised that keeping busy was not
the only way she was able to show her supervisors
that she was doing her work properly. The moments
when nothing special happens can also be productive, as she explained:
It is not so important anymore that we can get the puzzle
done but if he wants to talk about something else other
than the puzzle, then so what? I think it is much more
important to the client that, if he has some thing to tell
me, I try to understand it. (Staff member 1)

Gardner and Rikberg Smyly (1997) noted that

serving the needs of individuals with MLD means
not only providing activities but also creating
opportunities for them to express emotions and to
establish close relationships. It seemed that during
OIVA training, informants had started to ponder the
contribution of their companionship to the lives of
the people with whom they worked.
Limitations and directions for future research
When interpreting the findings of the present study,
several limitations should be acknowledged. Firstly,
since only six informants were interviewed, we
therefore cannot claim that all of the participating
staff members had started to think similarly. Secondly, the sampling of informants was conducted by
those who were directly involved with the training
and the sampling was opportunistic. However, since
only 31 staff members completed the OIVA training,
the sample size was already small. Therefore, it was
considered important to find those informants who
were viewed as able to describe their own and their
communities stories of improvement to gain as
much information as possible about the staff
members experiences during OIVA training. Finally, the qualitative method used for analysing the
interviews does not claim to be objective, although
the researchers aimed to overcome any personal bias
by discussing their interpretation of the data as
described above.
There is a need for future research that focuses on
the relationship between thinking habits and communication practices in the communication training
programs. Based on the premises of the findings
reported here, there is need for qualitative studies
that measure the efficacy and outcomes of training.

287

For example, it would be of interest to investigate at

what point staff members come to new understandings about work practices and thinking. OIVA
training was of an extended duration, which consumed considerable time resources from the staff.
Furthermore, informants perceived that their organisations influenced their ability to implement the
new practices they had learned as OIVA participants.
Consequently, more research is needed into which
organisational factors help staff members successfully participate in interaction training. This could
provide a more in-depth understanding of how to
plan and implement training programs that influence
staff members communication practices and thinking habits successfully, particularly those that are
adopted on a long-term basis. Finally, it is essential
to study how OIVA training impacts the quality of
daily life for people with MLD.
Conclusions
The aim of this paper was to identify what the
informants realised was important for their professional development as communication partners after
OIVA training. The results showed that, in addition
to discovering new communication practices, the
informants had also pondered several ethical questions relating to individuals with MLDs sense of
belonging in the community, and their right to be
understood and to understand the communication
of others. This resulted in informants reporting that
they started to ask clients for their opinions about
daily life and to act according to their clients
wishes. These results are similar to the findings of
Ager and OMay (2001): change in thinking habits
is an essential factor for well-implemented staff
training.
Since the informants described both communication practices and thinking habits, it can be argued
that they perceived that both were important for their
development as successful communication partners.
Moreover, the change in the communication practices seemed to be closely related to such newly
discovered thinking habits, since the changes in
thinking were clearly reflected in the informants
reports of their subsequent practices. Thus, interaction training should give opportunities for participants to learn new practices and at the same time
explore the assumptions that underlie the services
they perform. Furthermore, informants in this study
perceived that their organisation influenced their
ability to implement what they had learned as OIVA
participants. Thus, for any change to be effective, the
whole organisation should be committed to the
improvements sought by staff training, as it relates

288

K. Koski et al.

to both communication practices and the typical

assumptions involved in those practices.
It is not possible to pinpoint exactly how OIVA
trainings main principlescommunity-based rehabilitation, client-oriented and solution-focused approach, or
the video-based guidance working methodhelped the
informants to understand the issues discussed above.
However, the principle of community-based rehabilitation seemed to have influenced them since the
informants noted that sharing knowledge about
people with MLDs ways of communication with
other staff members was important. Furthermore,
the video-based guidance meetings gave staff a
structured form for sharing that information. To
conclude, in the future the training will concentrate
both on promoting staff members communication
skills and on giving them the possibility to reflect on
their thinking habits.
Author note
This research was funded by the Finnish Association
on Intellectual and Developmental Disabilities and
the Finnish Concordia Fund. The funding bodies
have not imposed any restrictions on free access to or
publication of the research data. The authors will not
receive any direct financial benefit from the findings
presented in this paper.
Acknowledgements
The assistance of Liisa Alapuranen and Piia Siivonen
is gratefully acknowledged. The authors also acknowledge the comments of Tom Regelski and Anu
Klippi on this paper.

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