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HOW I / COVER STORY

HOW I (2): ADULTS WITH LEARNING DISABILITIES

liveACTIVE

THE LOGISTICS OF OFFERING A THERAPY-LED ACTIVITY CLUB IN A SPORTS CENTRE TO ADULTS WITH LEARNING DISABILITIES MIGHT SEEM DAUNTING BUT JUDY GOODFELLOW FINDS WITH TEAMWORK, ENTHUSIASM AND ONGOING AUDIT AND ADAPTATION, THE PRACTICAL BENEFITS CAN BE HUGE. Our general aims were to: 1. Offer a range of appropriate therapeutic activities to adults with a learning disability who want to access community based facilities. 2. Allow carers to gain experience and confidence in using different therapeutic activities with their service user. 3. Provide a service to those who are socially isolated and / or struggle to access mainstream activities. 4. Promote individual choice making in a user-friendly way. 5. Provide a symbolised environment to promote as much independence within the building as possible. 6. Provide an opportunity for service users to gain socially from mixing with other service users. 7. Centralise therapists so clients can access us more effectively (less travel time, with group work opportunities).

ecent legislation (Scottish Executive, 2000) emphasises our clients accessing local facilities and having as much choice as possible over what happens in their lives. In late 2003 our Allied Health Professions team discussed the possibility of a therapy-led activity club in our local sports centre. The drive was led by my physiotherapy colleague who had been involved in something similar in Yorkshire. This, however, was to be much more multidisciplinary. Bells Sports Centre in Perth had a quiet day most Mondays and agreed to give us the space, although there would be a charge to each client (1.60 for the morning or afternoon; 3.20 all day). We initially agreed a five week trial, to continue if successful. READ THIS IF YOU WANT TO WORK MORE CLOSELY AS A MULTIDISCIPLINARY TEAM WIDEN THE USE OF SYMBOLS PROMOTE HEALTH, INCLUDING COMMUNICATION

8. Collect data for analysis for clinical effectiveness purposes. (We involved Tayside Audit Resource for Primary Care.) The team carried out PR Roadshows in Day Centres, Residential Homes and other community settings to publicise the day, and we also raised awareness within the area care management and community nursing teams. The clients had to get a liveACTIVE leisure card (available through Perth & Kinross Leisure at no cost), and had to register with us in case they were not already known to our service. The original timings (figure 1) have remained as they fit in with other day care provision. Examples of available activities are in figure 2.

Choice
As each service user came through the main door, there were symbolised activity sheets to assist them to sign-up to their choice of sessions. When we first started, there was an A4 sheet per activity. So if there were 4 activities per session, there could be 16 sheets of paper for people to negotiate. We expected carers to assist service users in their choice making for sessions and sign their names beside those activities chosen. This part of the day was a time-consuming and frustrating bottle-neck and staff were very keen to get past here and into the first session, which usually started late. Following the five week trial, the

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SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2006

Photo by Paul Reid - a liveACTIVE Makaton group

HOW I / COVER STORY

team met to evaluate how the liveACTIVE day was progressing. There were the inevitable teething problems but generally numbers were good. On average over the first five weeks, we had 65.4 places taken up by service users each Monday, with 16-30 people attending. We can now accommodate 30-40 people per session allowing for 120150 places to be taken up during the day. The sign-in procedure needed looked at; some names were signed in and clients did not turn up. Others were concerned that places for afternoon sessions had been filled up first thing in the morning, unfair if you only arrived at lunch time. As we progressed into the more permanent block, we produced a newsletter for all liveACTIVE therapy club members and their carers, available to pick up on Mondays at the sports centre. We thanked everyone for their support but also highlighted some of the issues. We now produce two newsletters a year, and this has become one of the speech and language therapists roles.

Exciting
From a speech and language therapy perspective, the liveACTIVE therapy club is a very exciting project as it addresses so many choice making and community access issues. We are active in producing symbolised material, for example a sheet to explain the benefits of the walking group, and to ensure clients come prepared with appropriate clothing. As far as the therapy-led activities go, we started with a Hot Gossip in Perth group focusing on symbols to assist communication. We were the only profession to invite people to our group as we felt very strongly that we could not run a group each week supporting their communication if we did not
Figure 1 Timings Session 1 Session 2 Lunch Session 3 Session 4 10.30 am 11.15 am 12 noon 1.00 pm 1.00 pm 1.45 2.30 pm (45 minutes) (45 minutes) (45 minutes) (45 minutes)

know who was coming. Numbers reduced as the service users wanted to try other activities, so Hot Gossip stopped during 2004. We started up a Chat Room for less structured discussion to provide a forum for those who lacked the confidence to be heard in a more vocal group. Those who came enjoyed it, but it was poorly attended, and there were other perhaps more appealing sessions available. I was happy that our therapeutic group activity reduced to Makaton as I was struggling to justify my involvement with some of the service users coming into the Chat Room. Many were perfectly able to voice their opinions and just seemed to enjoy the time and attention they received whilst speaking and listening within a supportive setting. The Makaton group is still drop-in and is not a static group of individuals (see figure 3), but is attended by some who are currently on our caseload and others who wish to learn Makaton to communicate better with their friends. For those on our caseload, the Makaton Group cannot alone ever fully address their therapeutic need. It is, however, an excellent focus; and social contact at appropriate language and symbol / signing levels is often what is missed out of our service users busy, timetabled lives. Another speech and language therapy focus is promoting independence within the sports centre as soon as a service user walks through the front doors. In early 2005 we introduced symbol timetables but many staff said their clients did not require these, although we felt a significant number - perhaps 75 per cent - would benefit. Ultimately we were proved to be right. Our A4 sized symbol signage with yellow arrows has been in evidence from the start (figure 4). Symbols are put up on each liveACTIVE morning, strategically placed
Figure 3 Makaton group attendance Period Average service users per week January March 2005 6.25 April June 2005 7.11 August December 2005 10.38

around the centre to lead to each group location, toilets, changing area and to the reception desk where the service users show their cards and pay. Many people still simply follow on and need to be reminded to look at their timetables and find the right group, but a great deal more navigate themselves very effectively around their day as a result of their timetables. This process began late in 2005. My speech and language therapy colleague Leona Tulloch and I decided to take the bull by the horns and risk the sub-zero temperatures of the unheated foyer, manning the signingin tables to ensure choices were made (figure 5) and timetables issued where necessary. As we suspected, staff members bringing groups in from centres had, for ease, written a list of who was doing what and when. We got brave and questioned this while also regularly asking the service users what they were going to do today and showing them the symbol choice. The responses were often different from the staff lists so we were able to make up timetables for each individual as he or she came through the door. Figure 4 Symbol signage

Figure 5 Session choices

Figure 2 Activities Racquet sports Yoga Football extremely popular Makaton Hockey Athletics adapted to suit the group Boccia a soft ball bowling game for two teams Curling - with the sport so huge in Perth, our physiotherapy colleagues have a curling set that can be used on hard floors. Its much warmer this way!

Races adapted to suit the group

Tai Chi

Rebound Therapy trampolining for those with disabilities Body Awareness an occupational therapyled group of music and movement

Parachute physiotherapy activity for movement and exercise with lots of fun (eg. trying to keep a balloon on top of a parachute)

Jabadao music and movement focusing on the many aspects of non-verbal communication through dance

Walking group makes use of the grounds around the sports centre

SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2006

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HOW I / COVER STORY

Figure 6 Feedback Having been involved with this group since they started, I have definitely noticed development in adults coming along. One area that stands out is the payment at Reception which has become so much easier because the adults have learnt to become confident and independentwe can enjoy a wee bit of banter with them as this is no longer a stressful occasion for them. Matt Brand is a manager at Bells Sports Centre, Perth The Makaton session at liveACTIVE gives the perfect opportunity for service users to be listened to. There is the news time when the service users tell the group of happy times / sad times / holidays etc. You see everyone bursting to tell you how their week has been, but yet they wait until it is their turn. They just love to be listened to and having this time means a lot. Tracey Hudson is a speech and language therapy support worker. Unfortunately we are unable to offer more activities due to limited multidisciplinary staff involvement. It started off with more of a multidisciplinary feel than it has now. This is, however, a very worthwhile initiative which allows adults with learning disabilities to benefit both physically and socially in a community setting with others in their peer group. A team member

The liveACTIVE walking group We are in regular contact with Perth & Kinross Leisure management with a view to involving more sports centre staff and fewer therapists. Leona and I held a well-received training day on communication for sports centre front line staff reception, catering and management. There are likely to be a few projects on the tail of this, as staff from Bells Sports Centre proposed more permanent signage, while other centres felt the work done in Bells should be replicated in the others. They would like symbol resource books for keeping at the reception desks for the use of customers with communication difficulties. This would be for showing the options available as well as the costs. Sports coaches will be attending training in the next few months and hopefully will be keen to become more involved in the therapy sessions and in time may take over some of the running of sessions to make them more available mainstream. The first step is for the sports centre to support the current sessions with the therapists, sharing ideas and expertise in both directions. Ultimately many of the sessions could and should be available without as much therapeutic intervention, for the general public - which of course includes our service users. Judy Goodfellow is a specialist speech and language therapist working in the Perth and Kinross area for NHS Tayside, Birch Avenue Centre, 55 Birch Avenue, Scone PH2 6LE, tel. 01738 555419, e-mail jgoodfellow@nhs.net.

Focus on process
This process took forever, with often a frustrated staff member champing at the bit to get into the first session with their service users. This was when it became so obvious to us how staff focus exclusively on the activity rather than the process. While physiotherapy or occupational therapy-led activity is a very important part of the day, the team had to keep emphasising that this process was just as important. Having stood our ground, in early 2006 we had one staff member from a centre asking for copies of all the symbols so they could assist the service users to make up their own timetables before they came out to liveACTIVE. We felt we had made a major breakthrough. From our humble beginnings of, Do you think Jane might use a symbol timetable?, we now have only around five people who dont want them. Two of the resource centres have taken on the choice-making discussions with their clients so that they arrive with timetables already made up. On occasions these need to be altered at the sign-in stage if activities have been changed or cancelled due to staff absence or other reasons. We have found that clients are very adaptable as we can provide symbols to support this type of explanation. They are encouraged to choose a different activity and given a replacement symbol. We have many allied health profession staff groups (usually physiotherapy-led as ours has been) visiting our liveACTIVE therapy day in action to get ideas for setting up their own local version. Our audit cycle continues with symbolised questionnaires for our service users. We ask about the general day but also about individual sessions. A carer questionnaire goes out too and, as we aim to involve carers in the therapeutic activities, we need to get feedback both from their point of view and as to how they feel their service user(s) is benefiting. General feedback also suggests we are going in the right direction (figure 6).

Acknowledgements
Thank you to all the liveACTIVE Therapy Team (past and present members) without whom this exciting initiative would never have been born: Angela McManus, Karin Young (now Taylor), Alison MacIntyre, Leona Tulloch, Tracey Hudson, Julie Millar, Susan Wallace, Ruth Adamson and Sheila Frenz. Thanks also to Gill McShea, Physical Activity Officer for Perth & Kinross Leisure, frontline staff in Bells Sport Centre, Dave Angus, volunteer walk leader and the service users themselves who have all embraced this project. Last but not least, thanks to Carole Sutherland and Bernie Brophy-Arnott of the speech and language therapy department for their support.

References
Scottish Executive (2000) The same as you? A review of services for people with learning disabilities. Available at: http://www.scotland.gov.uk/ldsr/docs/tsay-00.asp (Accessed: SLTP 27 June 2006).

REFLECTIONS DO I TAKE ACCOUNT OF LEGISLATION AND POLITICAL PRIORITIES WHEN CONSIDERING SERVICE PROVISION? DO I TAKE ADVICE TO ENSURE ONGOING AUDIT IS USEFUL? DO I UNDERSTAND THAT CHANGE EVOLVES AND SOMETIMES I JUST NEED TO GIVE PEOPLE MORE TIME TO SEE THE NEED FOR IT?

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SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2006