Total Communication in my work placement ZOE RAINBOW

Transcription

1 Total Communication in my work placement ZOE RAINBOW

2 Contents Introduction... 2 Literature review... 3 Total communication in practice at my work placement... 8 Pictures and symbols Electronic communication aids Objects of reference Conclusion References Appendices Appendix A Appendix A Appendix A Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H Appendix I Appendix J

3 Introduction Total communication started in Gloucestershire in 2002 (See Appendix A for Work placement document 1, 2015) and originally was developed from the values displayed in the Communication Bill of Rights 1992 (American Speech-Language- Hearing, 2016) which was created by National Joint Committee for the Communication Needs of Persons with Severe Disabilities. The philosophy behind the policy was to encourage a more uniform way for special needs students to communicate so that communication would be possible in a variety of different establishments (Total Communication, 2016). I have been completing a work placement at a special needs school in Gloucestershire for 0-7 year olds. The school provides a specialised setting for many additional requirements including, communication/social interaction difficulties, learning difficulties, speech and language delay, disorder developmental delay, physical/medical difficulties, emotional and behaviour difficulties and sensory impairment (Work placement website, What we do, 2016). The children s wide range of needs is obviously a big challenge in this school and to support them to achieve their potential requires many different types of interventions. However from day one I could see that through this diversity of needs total communication is used to aid all the children and it has a stable, consistent theme throughout the school. All the different types of practitioners from the classroom teachers to the music therapist have key elements of total communication embedded into their procedures. From my initial observations it seems that my work placement strongly adhere to the principles of total communication. I want to find out if my observations are just surface deep or embedded into the schools pedagogy. This essay will introduce the concept of total communication and give some detail of the foundations behind the idea. It will show the principles behind it and how it is implemented at my work placement. Next a critical analysis of the procedures used at my work placement and any aspects that I feel could be improved on will be highlighted, as well as the areas which are particularly well implemented. I will also try to find ways in which total communication could be potentially improved at my work place. In the conclusion I will summarise my findings and look at what is next for total communication. 2

4 Literature review The values displayed in the Communication Bill of Rights 1992 provide a supporting framework to total communication in Gloucestershire (See Appendix A for work placement document 1, 2015; American Speech-Language-Hearing, 2016). It shows how every person no matter the disability, has certain rights which I have summarised into the three main principles below: Their own choices and preferences being met Which could be in the form of requesting or refusing objects, actions and events. Expression of personal choice and feelings which may involve requesting time with a particular person. They need to be offered choices and be able to reject an offer as well as be able to ask for and receive information about changes in routine and environment. Improving and maintaining communication skills This links to their own choices and preferences being met by progression on their communication skills. They need to receive intervention to improve communication skills which will allow a carer to respond to the requests they can make. Interventions 3

5 could be in the form of ACC (augmentative and alternative communication) and other AT (assistive technology) devices which they would need access to at all times. These devices would need to be properly functioning at all times. Inclusive communication For the individual it means being in an environment which promotes any form of communication and works with other environments and people to install preferred communication pathways. The individual has the right to be spoken to with respect and courtesy and not spoken about as a third party whist present. Communications should be set at an appropriate level and be culturally respectful (American Speech- Language-Hearing, 2016). From the Communication Bill of Rights 1992 the Gloucestershire total communication team have developed their list of priorities for children with communication issues. They believe these children should have the opportunity to express needs, make choices, be included and make friends. To make friends they need to have an understanding of others and be able to express their feelings which leads to them being less frustrated. They also have the right to learn and work towards being independent (Total Communication, About Us, 2016). These priorities support the 1992 Communication Bill of Rights. 4

6 Total communication often uses signing but this is used in a different way to British sign language (BSL). BSL is used to help deaf individuals to communicate and has its own grammar and vocabulary making it a complete language (Ndsc, 2016). This language is quite complex and often not suitable for other learning difficulties such as autism and Down s syndrome. Total communication uses signs adapted from BSL when trying to aid communication for special needs students. These signs are simplified signs which are presented at the same time verbal communication occurs (Total Communication, 2016). In Gloucestershire special educational needs schools Makaton sign language is used to provide a simple signing system (Class teacher B, 2016). Total communication was implemented originally in special schools in the county. It now is implemented by many county services including speech therapy, portage and early help advisors as well as in the wider community at early years setting, scouts, sports clubs, police and many more. Total communication uses a variety of communication types including hand gestures, touch, talking, photos and drawings including symbols, objects, the written words and letter, body language and facial expressions. Vocalisation, verbalisation and the tone of your voice can also be used in combination with other communication types or on its own (Total Communication, 2016; See Appendix A for Work placement document 1, 2015). Many individuals with severe communication problems will benefit from the aid of visual communication tools or actions. Not only does the brain process visual 5

7 information at a greater speed than auditory information but the combination of more than one type of sensory stimuli can also promote communication. There are many theories on language acquisition including behaviourist, nativist, cognitive, interactionist and social-culturalism. They all have interesting interpretations of how language develops however when dealing with communication issues looking from an interactionist perspective seems help development communication in children with learning disabilities. Interactionists believe that a child responds to facial expression, body language and gestures as well as the tone of your voice (Brock and Rankin, 2008). Language programmes are created around an individual s needs and could use interactionist theory to yield results (Kersner and Wright, 1996). Behaviourist theory can also be used to support the development of language programmes. Behaviourist believe that language is learnt by being exposed to a stimuli and the child then imitates the adult s language in connection to the object (Brock and Rankin, 2008). Again individual language programmes could be built around this strength in a student (Kersner and Wright, 1996). Each child is an individual and will need differing support with their communication depending on their disability. Total communication has been developed to highlight the use of any type of communication model. With severe communication issues what s important is that the child is provided with a way of communicating but how they communicate is not an issue. However the communication types as stated in bold above, as well as electronic communication devices have been seen to yield results (Icommunicate therapy (2016). However there have been concerns in the past that because Total Communication believes in the importance of communication in any form that the wide range of communication techniques is so vast that many Special Education 6

8 practitioners are unable to provide the consistency needed in the techniques. (Stewart,1992). The Childrens and Family Act of 2014 (Tutt and Williams 2015) has brought forward new SEN Regulations. These regulations clearly link to the principles of in the Communication Bill of Rights 1992 which total communication uses as its framework. It can be seen in the 2015 SEND Code of Practice that an emphasis on the importance of health, education and social services working together was promoted. Children with SEN and their families were also highlighted in the code of practice as needing to be central to the planning of interventions as they often felt their voice was unheard. Total communication supports this with children s own choices and preferences being meet and involving the children and families and treating them with respect (American Speech-Language-Hearing, 2016). The SEND regulations have been implemented to aid children with SEN and their families to be given a holistic approach to their needs and to reduce the frustration caused by the lack of communication between services which also aids safeguarding. The updated SEND Code of Practice, 2015 still covers the importance of communication and integration, sensory and physical requirements, learning and cognition from the 2001 Code of practice. These are also key factors in total communication with sensory and physical therapy often used in early interventions as a stepping stone to verbal communication being developed (See Appendix D for work placement document 4, 2011). 7

9 Many special needs schools have chosen to use Makaton as their preferred sign language which is not the same as BSL but has some similar signs and is a more simple type of signing. Often in Makaton the sign clearly represents the object of discussion (Makaton, 2016) while according to Cooper (2016) presenting at a Makaton training day, some BSL signs are quite abstract. Special needs schools in Gloucestershire use Makaton signs which are presented at the same time as the verbal communication in line with the principles of total communication (Class teacher B, 2016). There is a substantial amount of research into the positive effect total communication can have on special needs students. For example, comparative research into the effects of total communication on autistic children has shown a significant improvement in verbal communication when trained with total communication techniques appropriate to the child, compared with just verbal communication training (Carbone et al, 2006). However there is a lack of research into the negatives of total communication which may have a big impact on the whole class and the professionals involved due to the large range of techniques that might need to be used. Total communication in practice at my work placement The aim of total communication in Gloucestershire is to ensure a common language is adopted for all people to help make a consistent and positive difference to everybody's lives (Total Communication, 2015, welcome page). 8

10 My work placement was one of a group of special needs schools who first implemented total communication in Gloucestershire in 2002 (See Appendix A for work placement document 1, 2015). The school continuously revisit the principles and any new developments with regular training sessions given to the staff. Within the school is a dedicated team which not only delivers the in-house training on total communication but also provides training for other establishments which wish to improve their total communication skills (Total Communication team member, 2016; See Appendix B for work placement document 2, 2011). From this approach of supporting total communication in the whole community as well as the school it can be seen that my placement is committed to the aims of total communication. Looking back at the methods of communication presented in bold above, the range is vast and with the limitations of this essay it is not possible to cover them all. However every method mentioned in bold above is used at my work placement which shows the variety of needs at the school and the commitment to these needs that the professionals at the school have. The main communication methods used in my work placement classroom situation are signing, pictures/symbols, electronic communication aids, facial expressions/body language, objects of reference and with all of these the use of verbal communication occurs at the same time. On occasions the children will be taken out of the class and work with different professionals including, speech, music, occupational, and sensory therapists who may utilize other tools to promote communication and then this would be fed back to the classroom staff if seen as a substantial benefit to the child. Signing occurs throughout the school and the classroom. Makaton is used and all staff have at least a basic knowledge of the signs. As a student on placement I had a 9

11 list of 80 signs (see Appendix G, for work placement document 7, no date) given to me in an introduction pack for me to become familiar with before I started my work placement. This allowed me to support the children s own choices and requests from day one. The school has a lot of volunteers and students and potentially this could dilute the signing skills pool in a classroom leaving children frustrated as only some of the staff understand their requests. By learning some signs before starting at the school it reduces the chances of frustration. The school also presents a sign for the day which concurs with the theme on that term. For example, when the theme was the farm a sign of the day was cow. Signing is also used when singing songs. The school has at least two together time sessions when the whole school sits in the hall together singing and signing songs. These songs are the same for a term to allow the children to learn some of the words and signs. These songs are available in the classroom and I have seen how the signing has enabled some students to request a song at play time. Pictures and symbols Pictures and symbols are used throughout the classroom. Pictures showing activities that the children do, with a written description, are displayed on the walls for reference at any time. The children s photos are displayed with their names and a profile of their needs (see Appendix H ) which gives the other children a visual reference of their peers. It also gives anyone new to the class some background information which allows them to support the child s communication needs. Symbols are used on individual time tables (see Appendix A1 for image) and the class time table which allows them to receive information about the plan for the day and any changes to the normal day that might be occurring which is a key principle in total 10

12 communication. Symbols are used on PEC boards (Appendix A2) for some children to allow choice at snack and drink time. There is also a board with pictures and symbols of various toys which the children can request at play time only. If a request for a toy or snack cannot be fulfilled signing is used to say no so the child knows they have been understood rather than feeling frustrated by a lack of response. This follows the principles of total communication. Electronic communication aids Electronic communication aids in the classroom are not suitable for all the children. At circle time a voice button (Appendix J for image) allowing non-verbal children to say hello is used but only for 2 children. The others have very limited verbal communication but are encouraged to use what voice they can and to sign. More sophisticated devices with many options like the Go talk (Appendix I) are only suitable for a small range of disabilities. Only one child out of 10 was seen to benefit from this tool in my work placement class. This shows the diversity of total communication tools and their complexity. Using the Go talk is of great benefit to the one child but others are unable to comprehend its use despite being interested in using it. This means at time the device can be taken by other children or used inappropriately. Many of these devices are very expensive and can be damaged easily, this is an issue in a special needs school with a wide range of abilities and needs (Class Teacher B, 2016). Facial expressions/body language are used regularly in the classroom. For children with learning difficulties exaggerating facial expressions to show different emotions aids the children to understand these concepts (Class teacher A, 2016; Palermo et 11

13 al, 2006). This is coupled with a verbal account of the feeling. Reading an adult helpers body language can help the children understand when they have done well at a task or done something naughty. This helps to control behaviour in the classroom as they discover right from wrong. The children can also use their own body language to help in communicating their feelings. One child at placement will cross his arms in front of his body and say me cross if he is feeling that way. Without the body language he might be taken less seriously and carers wouldn t be sure of the level of anger which could then escalate into aggressive/upset behaviour disrupting the whole class. Objects of reference Objects of reference allow a child with limited communication skills to understand what activity is about to happen. At my work placement the sensory therapist runs a handy hands session which helps to strengthen the children s hands and develop fine motor skills. Before this activity starts a yellow rubber glove is passed around the children. It is full of rice and sealed at the wrist. This is used to show the children what activity is about to commence and to warm up the children s hands. They all take it in turn to squeeze and pull the fingers on the glove. Once this is done the group sing and sign the handy hands song which reinforces the activity which is beginning. Objects of reference can also be used in a more simple way. For example, just showing the child a nappy before they have it changed. This is done at my work placement at the same time as verbal communication. A main principle of total communication is to promote any type of communication for individuals with learning difficulties. However it is important that these alternative 12

14 modes of communication are presented at the same time as verbal communication. They are not intended to replace verbal communication and often help to promote it. At my work placement the use of all communication types are presented at the same time as verbal communication. The verbal communication is kept as simple as possible to avoid overloading the children and prioritising the most important words to allow clear communication. The staff follow the KISS process to ensure communication is kept simple (see Appendix A3 for detail). The aim of total communication in Gloucestershire is to ensure a common language is adopted for all people to help make a consistent and positive difference to everybody's lives (Total communication, welcome page, 2016).Total communication uses a variety of communication types including hand gestures, touch, talking, photos and drawings including symbols, objects, written words and letter, body language and facial expressions (Total Communication, 2016). All of which are used at my work placement in conjunction with verbal communication (see Appendix A for work place document 1). I have highlighted signing, pictures and symbols, electronic communication aids and objects of reference as the main modes of communication used in my work place which are recommended by Gloucestershire total communication (Total Communication, 2016), promoted by my work placement (see Appendix A for work placement document 1, 2015; see Appendix B for work placement document 2, 2011; see Appendix C for work placement document 3, no date) and follow the values displayed in the Communication Bill of Rights 1992 (American Speech-Language-Hearing 2016). 13

15 There are many staff with a diverse range of skills at my work placement. This range includes teaching staff, support staff, music, sensory, occupational and speech/language therapist. Working alongside the full-time staff are volunteers and students as well as staff from outside agencies. This creates some logistical problems when dealing with continuity of signing in the school. However the school works hard to prevent this being an issue by providing regular updated training sessions on total communication and provides a sign for the day to refresh everyone s knowledge (Class teacher A, 2015; Forest school teacher/total communication team member, 2016; see Appendix A for work placement document 1, 2015; see Appendix B for work placement document 2, 2011). There is a large gap between advanced Makaton users and new staff/volunteers abilities to sign. This is addressed by the more experienced staff taking the lead in activities whilst signing at the same time. Other staff then can use what they know and build in extra by copying other signs. However, the less experienced staff can still use the basics to allow continuous support in communication with the children which adheres to the values displayed in the Communication Bill of Rights There is no stigma attached to forgetting a sign at my work placement. I have seen several occasions where teaching assistants have corrected or reminded higher ranking staff members to ensure continuity. This shows the importance of total communications aims in the school by providing a consistent form of communication for children. Pictures and symbols are consistent throughout the school. Different classrooms have the same timetables/schedules, PECs boards, and communication profiles. These items are mostly used the same way however on occasions I have seen individuals using PECs board symbols without the board and members of staff 14

16 accepting a choice of symbol by the child just pointing instead of handing the symbol to the staff member. Another issue is that the PEC board should be handed to the person whose picture is being used to ask for the item. Pictures of staff members aren t always available and that staff member might be sat at another table causing the child to leave their seat which is not promoted at snack time. Deciding at the beginning of the day which staff members will be at each table would reduce the confusion and a check for any missing photos of staff would also ensure continuity of the communication mode. According to the Communication Bill of Rights 1992 communication tools need to be in working order at all times to prevent a lack of consistency for the user. Electronic communication aids are only used by a few children in my work placement classroom. The say hello button is useful at circle time to allow none verbal children to be included in saying hello to everyone. However the more advanced Go talk device is quite large which causes difficulty for the child as she is unable to hold it due to the weight and her disability. There is only one child that uses this device and often other children are so excited about it they jump up and press lots of its buttons which causes disruption in the class. The child that uses the Go talk therefore needs a member of staff to stay with her protecting the Go talk from being damaged or reset by other children and to support the heavy device. This has a knock on effect on the rest of the class as that staff member is fully occupied. The replacement of batteries is organised through the speech and language therapists and therefore is not instantaneous. These are both difficult issues to control but if an old version of the Go talk was available then perhaps the class could use it as an exploratory item taking the novelty factor away from the one that is being used as a communication 15

17 tool. Also allowing classroom staff to change batteries would reduce the wait time for the device to be up and running again. The use of objects of reference at the beginning of different activities is used throughout the school. However it is not used at the beginning of every activity. If objects of reference were used more often and the objects were consistent throughout the school this would produce a more transferable environment. Children who need to move from one class to another would have a greater concept of what activity was coming next which would reduce fear and confusion. This would allow a child to receive information about what they are doing as per the 1992 Communication Bill of Rights. If the same objects of reference could be used at home, school and any other facilities accessed by these children then they would have a consistent and coherent approach (Gloucestershire Total Communication, 2016, about us page) throughout all environments. Conclusion Total communication is an established method of supporting children with learning difficulties in Gloucestershire since being introduced in 2002 (see Appendix A for work place document 1). However the concept was first discussed in the 1960 s (Stuart, 1992). It has developed and remodelled itself to what we know today with its primary aim being to promote communication in special educational needs students using any form of communication (Gloucestershire total communication, 2016). Total 16

18 communication strategies have been implemented throughout special schools in Gloucestershire and are regularly updated to ensure continuity in procedures. It is evident that special schools in Gloucestershire are working together to promote Total Communication which is providing a uniform and consistent way for special needs students to communicate (Gloucestershire County Council, 2005). However, the evidence of total communication spreading to non-specialised facilities is few and far between. The staff at my work placement have embraced the concept and are committed to providing a consistent means of communication for each child s individual needs. I ve seen numerous examples of its use from session planning (see Appendix E for work placement document 5) to class observations (see Appendix F for work placement document 6). It is obviously deeply embedded into the schools pedagogy and with the exceptions of a few minor improvements it is incredibly well executed. However from my investigation I cannot find any current (i.e. within the last 10 years) research into the benefits of it. There has been research into total communication and its effects on communication with individuals who have had cochlear implants around the dates of (McDonald Connor, 2000; McConkey Robbins, 2002) but there is a lack of current research into the effectiveness of total communication for children with learning difficulties. This is of grave concern as the efforts of the school to follow total communication principles may not be yielding the expected results. Despite this, the professionals at the school who are highly skilled and motivated to do the best for the children strongly believe the principles of total communication are making a big difference to the children they work with (Total communication team member, 2016; Sensory therapist,2016; Class teacher B, 2016). Hopefully new research will confirm the 17

19 validity of total communication as the children at my work placement clearly benefit from finding their preferred way of communicating. Word count 4392 References American Speech-Language-Hearing (2016) National Joint Committee's Communication Bill of Rights Association. Available at: (Accessed: 9 January 2016). Brock, A. and Rankin, C. (2008) Communication, language and literacy from birth to five. London: SAGE. Carbone, V., Lewis, L., Sweeney-Kerwin, E., Dixon, J., Louden, R., and Quinn, S. (2006) A Comparison of Two Approaches for Teaching VB Functions: Total Communication vs. Vocal-Alone Journal of Speech-Language Pathology and Applied Behaviour Analysis, 1(3), pp [Class teacher A] (2015) Conversation with Zoe Rainbow, 15 December. [Class teacher B] (2016) Conversation with Zoe Rainbow, 2 February. 18

20 Cooper, D. (2016) Conversation with Zoe Rainbow, 24 January. [Forest school teacher/total communication team member] (2016) Conversation with Zoe Rainbow, 23 January. Gloucestershire County Council (2005) Total Communication Spreads the Word: New release. 28 June Available at: KEwjpt- SQ7pzKAhVLuRQKHSMID60QFghCMAQ&url=http%3A%2F%2Fwww.gloucestershi re.gov.uk%2fmedia%2fword%2fk%2f8%2fglos%2520total%2520communicatio n%2520project.doc&usg=afqjcnf5kcvnz_qmpci7rgpz2xxwvhlqgg&sig2=qiw 3S_YSkQqqPV_gSfwwGw&cad=rja (Accessed: 9 January 2016). Icommunicate therapy (2016) Total Communication. Available at: (Accessed: 9 January 2016). Kernser, M. and Wright, J. (ed.1996) How to manage communication problems in young children. 2nd edn. London: David Fulton. 19

21 Makaton (2016) FAQ S. Available at: (Accessed: 27 January 2016). McConkey Robbins, A. (2002) A Sign of the Times Loud and Clear!, (4)2. McDonald Connor, C., Hieber, S., Alexander Arts, H. and Zwolan, T. (2000) Speech, Vocabulary, and the Education of Children Using Cochlear Implants: Oral or Total Communication? Journal of Speech, Language, and Hearing Research. 43, pp ). Ndsc (2016) Learning Sign Language. Available at: d=coxyzchylcscfssgwwodtygahq#contentblock1 (Accessed: 26 February 2016). Palermo, M., Pasqualetti, P., Barbati, G., Intelligente, F. and Rossini, P. (2006) Recognition of schematic facial displays of emotion in parents of children with autism. Autism: The International Journal of Research & Practice (AUTISM), Jul2006; 10(4), pp [Sensory Therapist] (2016) Conversation with Zoe Rainbow, 3 February. 20

22 Spectronics (2016) GoTalk Communication Device Series. Available at: (Accessed: 16 March 2016). Stewart, D. (1992) Initiating reform in total communication programs, The Journal of Special Education, 26(1), pp Total Communication (2016) Gloucestershire Total Communication. Available at: (Accessed: 9 January 2016). Tutt, R. and Williams, P. (2015) The SEND CODE of Practice, Policy, Provision and Practice, 0-25 years. London:SAGE. [Work placement Document 1] (2015) [Gloucestershire Total Communication]. Gloucestershire: Gloucestershire Total Communication. Comment [U1]: Needs checking with Nicky Williams [Work placement Document 2] (2011) [Work placement total communication policy]. Gloucestershire: [Work placement]. [Work placement Document 3] (no date) [Work placement fundamentals of communication]. Gloucestershire: [Work placement]. [Work placement Document 4] (no date) Music Therapy in the Early Years. London: British Association for music therapy. 21

23 [Work placement Document 5] (2016) [Overview of session 13/1/16]. Gloucestershire: [Forest School Teacher]. [Work placement Document 6] (2016) [Observation of Learning and Teaching]. Gloucestershire: [Head teacher]. [Work placement Document 7] (no date) [Signs]. Gloucestershire: [Work placement]. [Work placement] (2016) What we do. [Work placement website]. 22

24 Appendices Appendix A 23

25 24

26 25

27 26

28 27

29 28

30 Appendix A2 29

31 Appendix A1 30

32 31 Appendix A3

33 32

34 Appendix B 33

35 34

36 Appendix C 35

37 Appendix D 36

38 Appendix E p1 37

39 p2 38

40 p3 39

41 Appendix F 40

42 Appendix G 41

43 42

44 43

45 44

46 Appendix H Appendix I 45

47 Go talk device Appendix J Go talk Hello button (Spectronics, 2016) 46