in my experience

Great ideabut how do we do it?

Great government ideas can be quite a challenge to put into practice - particularly when accompanied by a short timescale. Undaunted, a special interest group worked on a consensus framework for developing communication strategies to benefit people with learning disabilities. Della Money and colleagues take us through the process and share the end result.

First stop was the vast evidence base that underpins our practice. Oh well... However, there was light at the end of the tunnel. Agencies in Somerset pioneered work on a collaborative communication strategy that identified the key elements for success (Somerset Total Communication: Jones, 2000). We invited Jane Jones to our Trent Region special interest group for speech and language therapists working with people with learning disabilities. She gave a short presentation then facilitated discussion around key questions such as What is a strategy?, What is total or inclusive communication? and What are the key elements for a successful strategy? After these seemingly straightforward questions were posed and debated, we left several hours later realising we still had a long way to go.

Reached by consensus
Through the next two special interest group meetings we continued to allocate time for Communication Strategies. We worked our way through the key elements of management, training and resources. For each element we identified the principles that would have to be in place to achieve success, then identified possible suggestions or processes that might be used to achieve the principles. The principles and processes were all reached by consensus - in itself an achievement. We formed a small working party, which met twice, to pull all the special interest group work together. We decided we needed a framework developed by and for speech and language therapists working with adults with learning disabilities in Trent. The framework could then be used in partnership with other agencies and stakeholders to develop local communication strategies that meet local organisational needs. One major task was to define what a communication strategy actually is. We agreed the following definition - which at 73 words clearly wont be found in a dictionary - but we feel it sums up all the elements and adequately describes communication. As the framework is designed to be a working tool, this definition could provide a starting point for further discussion and negotiation: A communication strategy is a multiagency plan to develop a consistent and coherent approach to meeting the communication needs of people with learning disabilities, within both their daily environments and wider contexts. This includes facilitating the use and understanding of a range of different means, reasons and opportunities for communication. A successful strategy has to involve the key elements of management support, training, and networks, and be underpinned by agreed and adequate resources. This collaborative approach has been a great success. It has demonstrated that we can work

I
if you feel special interest groups are underdeveloped know we need to up our evidence base are working on Valuing People

Read this

n March 2001 the Government launched the first white paper for over 30 years for people with learning disabilities. Valuing People: a new strategy for learning disability for the 21st Century made some bold proposals, within even bolder timescales, and outlined four main principles of choice, independence, civil rights and inclusion. It stated that, there was not enough effort to communicate with people with learning disabilities in accessible ways, and that, the challenge was improving information and communication with people with learning disabilities. It referred to both communication training and communication plans as well as individuals who may require communication techniques and the effective use of new technology. It quickly became obvious to us that communication was central to these principles and underpinned the whole document. The paper even stated: The Government expects organisations working with learning disabled people to develop communication policies... This of course was great news for speech and language therapists across England and Wales, although there remained one small niggling question - how do we do this?

the principles and processes were all reached by consensus - in itself an achievement.

SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2002

in my experience

across Trusts, with limited evidence bases, using the wealth of expertise that undoubtedly exists within our profession - and reach a consensus. In addition, it shows how a special interest group can be proactive in developing practical tools and resources for therapists, enabling us to address the government agenda within their relatively tight timescale. Initial feedback has been very positive, and several teams within Trent Region are using the framework. There has also been much interest from outside the region, and from other professions and non-NHS organisations. So, just in case you are feeling you never want to see another strategy, take a look at this one - and let us know what you think. Della Money and Sue Thurman (Nottinghamshire), Jane Parr (Leicestershire), Hilary Berry (Sheffield), Kath Stewart (Lincolnshire), Liz James (S. Derbyshire) and Judy Stephens (N. Derbyshire) are members of the Trent Region special interest group for speech and language therapists working with people with learning disabilities. They formed the working group to pull together the framework for developing communication strategies. Address for correspondence: Della Money, CLDT, Byron House, Newark Hospital, Boundary Road, Newark, Nottinghamshire NG24 4UW, tel.: 01636 685927, e-mail: della.money@hq.cnhctr.trent.nhs.uk.

One major task was to define what a communication strategy actually is

Framework for developing communication strategies

1. Management
Principles
1. Commissioners and Managers of key agencies (such as health, social services, further education and the voluntary and independent sectors) are involved in communication strategies. This includes partnership boards and planning groups 2. Service Users and carers are the major stakeholders in developing communication strategies 3. Communication strategies are jointly owned 4. Managers recognise the integral role that communication plays in relation to key legislation and guidance (such as Valuing People/ Disability Discrimination Act) 5. Speech and Language Therapy services are a key part of communication strategies. Their role and service designs are fully negotiated 6. There is an agreed protocol for responsibilities and accountability for communication strategies 7. Communication strategies are documented with agreed definitions of terminology

Processes may include:

Identifying other peoples agendas Identifying your local management structures (across all key agencies) Developing the role of the lead Speech and Language Therapist at a strategic level Being consistent and repetitive in the messages given to key managers and commissioners about communication, in order to create a shared vision Liasing with Partnership Boards/Planning Groups Presentations to and feedback from key people Involvement in relevant working groups or other appropriate development activities Agreement to time, personnel and financial commitments from stakeholders at a strategic level Agreement to a protocol Multi agency steering group Linking with JIP (Joint Investment Plan), HIMP (Health Improvement Plan) and other business planning processes Mechanism for meaningful service user involvement Assessing readiness for Partnership

2. Training
Principles
1. Training promotes awareness of communication, develops communication skills and/or supports implementation of new initiatives 2. Training is based on identified needs of individuals, environments or communities 3. Differing learning styles and needs of individuals, and the cultures of organisations, are taken into account when designing and delivering training 4. There is a clear statement and agreement for the purpose of all training. Training is planned with defined and agreed outcomes, negotiated with relevant people 5. Ongoing support and supervision is necessary to achieve the outcome. Outcomes are measured and evaluated as part of a performance management cycle 6. There are recognised levels of competence for trainers 7. Training is delivered within an agreed inter-agency training framework (eg. LDAFLearning Disabilities Awards Framework)

Processes may include:

Agreeing and evaluating a training strategy with all agencies, including service users Providing different models of training to meet different needs for individuals, environments and communities Identification of trainers and their training needs Analysis of training needs of participants and their environments Developing a training plan, including resources required Delivering, evaluating and feeding back to stakeholders Establishing supervisors Framework for ongoing support and supervision Agreeing levels of competence of trainers Cascading of training

Acknowledgements
We would like to thank Jane Jones for setting us off and all the therapists who belong to Trent Region SIG and have contributed to the framework.

Reference
Jones, J. (2000) The total communication approach: towards meeting the communication needs of people with learning disabilities. Tizard Learning Disability Review 5 (1) 20-26.

3. Networks & Resources

Principles
1. Formalised Networks are established across services, agencies and appropriate localities in order to support all the elements of the communication strategy 2. Each Network has a defined purpose, scope and support mechanism. This includes clear channels of communication and information exchange 3. Communication tools used to support the strategy are evidence based and agreed 4. Multi-modal resources are widely and easily accessible, using a co-ordinated process of selection, training and dissemination 5. Management, technical and financial support is essential for the development of accessible resources

Processes may include:

Identifying the stakeholders who need to be involved Identifying the named people within each of the stakeholder groups Developing ways of sharing information newsletters, meetings, publications, IT Developing selection and design criteria for signs and symbols and other communication tools Identifying business planning processes Identifying and defining networks (user groups, statutory agencies, advocacy) and purpose (communication, information, professional) Developing guidelines on accessible information Auditing current availability of IT support and resources and identifying shortfalls Identifying skill mix required to support strategy Agreeing a protocol for sharing resources and points of access Developing an evidence base

Reflections
Do I give sufficient time to thinking through my strategy before trying to put an idea into practice? Do I get involved in the work of special interest groups? Do I see the bigger picture and how I can play a part?

SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2002