King's College London

In Work Packages 2 and 3 of the ICALD programme we asked relevant stakeholders about their experiences of communication support in social care. We asked them what works and what doesn't work, what is helpful and what may act as a barrier when delivering communication support to adults with communication difficulties. We also wanted to find out what changes people would like to see in the future in relation to communication with adults with learning disabilities.

Aims

We wanted to find out what people would find helpful to improve and support the use of communication strategies for people with very little or no speech who live in social care settings. We wanted to learn from people with learning disabilities, their families and from staff working in social care settings. This information will help us to improve staff training and provide the right support after the training.

Methods

We conducted online and in person workshops, interviews, focus groups and supported conversations with adults with learning disabilities, family members, social care staff and other health and care professionals. We aimed to understand the barriers and facilitators of communication support for people with little or no speech and how we would measure any improvements in communication support. 

In total, forty-eight people shared their views and experiences to help researchers understand what needs to be in place and what needs to change to achieve good communication support for adults with learning disabilities in social care settings.

Researchers worked with participants to develop a Theory of change. This is an approach for developing complex interventions that illustrates why a programme works and how activities lead to outcomes. A Theory of Change acts as a roadmap connecting short-term actions to long-term impact.

Summary of results

Participants shared that getting good support for communication is harder when:

• Support staff do not have much communication training
• People do not have access to speech and language therapists
• Staff do not have good ways to share information about people with learning disabilities
• Support staff do not know about good communication

Participants shared that getting good support for communication is easier when:

• Support staff understand each person they support's unique ways of communicating and adapt when their needs change.
• Family members of individuals with learning disabilities help staff to understand their relative's communication and how to respond appropriately
• Speech and language therapists, staff, and family carers work together
• Support staff support one another and share knowledge and information
• Support staff notice and respond to communication attempts

Overall, participants believed that effective communication support could be achieved and sustained through collaborative communication training and resources, improved processes for information sharing and recording, ongoing skills development, peer mentoring and supervision.

These findings have informed the development of a new programme to help social care staff provide effective communication support for adults with learning disabilities. 

 A pre-print of our publication, "Developing a theory of change to improve the implementation of communication support for adults with severe learning disabilities in social care settings" can be found at: Open Science Framework 

An easier to read summary of the results can be found at: Work Packages 2 & 3 Easy Read

See below for our simplified theory of change map.

The map outlines a theory of change made up of four stages: pre‑implementation, resources, intermediate outcomes, and long‑term outcomes and impact. It shows how better communication for adults with learning disabilities can be achieved over time. The pre‑implementation stage requires buy‑in and implementation support from social care organisations, enabling time and resources to be allocated for communication. Speech and language therapists then support social care staff through training, assessment, and ongoing learning. Adults with learning disabilities and family carers are supported to engage in co‑design and training activities to ensure approaches reflect lived experience. These activities lead to shared, accessible communication strategies across services. As a result, adults with learning disabilities are better able to express their needs, experience improved communication with staff, and achieve better outcomes, with organisations remaining accountable for sustaining good practice.