What does good communication look like for adults with learning disabilities living in social care?

Support for communication is essential for adults with learning disabilities in long-term care settings, however, there is limited evidence about the best ways to implement good support for communication in daily practice.

The first work packages of the Improving Communication with Adults with Learning Disabilities (ICALD) research programme explored what helps communication support to work well and what paid and family carers and organisations needed to do to make it happen. We were particularly interested in:

• What helps communication interventions work well and what are the barriers;
• How interventions to support communication should be designed and put into practice;
• What support and resources staff and organisations need to support communication.

What we did

In the first work package, we conducted a realist review of research studies about communication in long-term care settings. We explored the evidence using Context-Mechanism-Outcome (CMO) Configurations, an approach that helps to explain the inner mechanisms by which interventions generate outcomes within specific contexts.

The findings were checked and refined in consultations with people with learning disabilities, paid and family carers and health and social care professionals to develop a programme theory that explains key factors needed to support good communication in practice. Their input helped us ensure the programme theory reflected real-world experience and to understand what works in practice and what matters most.

Following the realist review, in our second and third work packages, we conducted stakeholder workshops, focus groups, semi-structured interviews and supported conversations to refine and build upon the previous findings. We used Theory of Change to map out what needs to be in place and how the long-term goal of improving communication between staff and adults with learning disabilities can be achieved.

What we found

In the realist review we found that communication is likely to work best when staff:

• Have positive regard for people with learning disabilities and their abilities to communicate;
• Understand and know how to assess people’s different communication needs and tailor their communication to the needs and preferences of each individual;
• Gather information about a person’s communication from various sources, including family and other people who know them well;
• See communication as more than meeting wants and needs; understanding that communication should also support enjoyment, shared experiences, and having fun;
• Can respond to individuals’ situations and preferences with a range of practical tools that support choice-making, participation, relationships, and wellbeing.

In work packages two and three, forty-eight people shared their views regarding what needs to change and what should remain in place to achieve good communication support for adults with learning disabilities in social care settings. We found that good communication is more likely to occur when:

• Staff get to know each adult with learning disabilities personally, investing time to understand personal preferences outside of task-oriented interactions;
• Multiple stakeholders including family carers, speech and language therapists and staff are invested in providing good communication support;
• Documentation captures individual communication preferences, is regularly reviewed and is used to guide daily practice;
• Knowledge about how to best support communication is shared;
• Staff are trained in communication and have feedback and observations to check that learnings are applied;
• Adults with mild to moderate learning disabilities are involved in staff communication training;
• Staff recognise and respond to communication instances, including non-verbal attempts;
• Practice leaders are skilled and motivated to provide good communication support and share their knowledge and skills with others;
• Organisations recognise that communication is a human right.

What’s next

Work from the initial work packages provided a framework to guide the implementation of communication support in social care settings.

Building on these findings, alongside further input from stakeholders, we have developed a workforce development programme for social care staff.

The next step is to see how the programme works in real-world settings and explore whether it is both practical to deliver and well received by those taking part.

Animations

As part of the realist review, we developed narrative examples of each of the different elements of our programme theory which we have made into animations. Each animation focuses on one element that makes a difference to support for communication. These can also be used to support conversations about what is needed for good support for communication.  View the animations.

Read the papers:

 Good communication with adults with learning disabilities in long-term care settings: A realist review' Bauer et al, Disability and Health Journal

'Developing a theory of change to improve the implementation of communication support for adults with severe learning disabilities in social care settings' Tuudah et al, BMC Health Services Research