Improving Communication with Adults with Learning Disabilities (ICALD)

This project addresses two questions: What are the challenges to consistent delivery of communication-focused support for people with learning disability (LD) and severe communication impairment?

Can a co-produced staff training package designed to address these challenges deliver consistent, high-quality communication-based support?

The right to communicate, and to have your mode of communication respected, is enshrined in the Universal Declaration of Human Rights.

However, individuals with LD who are non- or minimally verbal in residential social care can experience social isolation, misunderstanding, neglect or abuse which they cannot report.

Those with severe levels of LD, higher levels of need and communication impairment and behaviours that challenge others often receive lower-quality support.

People working in residential settings should provide person-centred support that is inclusive and empowering, but they often lack appropriate qualifications, and there are barriers to delivering high-quality personalised care. Staff training has not resulted in substantial improvements to quality of support.

Potential challenges include inadequate time to implement good practice and limited staff empathy or consideration of individuals communication needs.

We aim to identify challenges in the consistent delivery of communication-focused support in residential care settings for adults with LD; and co-produce and evaluate a staff training package and reduce barriers to delivering high-quality communication-focused support practices. Our mixed-methods design has two phases.

Discovery and development (WP1-WP4): 1) realist review incorporating research and policy data and stakeholder consultation to understand current care context; 2) focus groups and interviews to identify current and ideal approaches, and barriers experienced; 3) identifying outcomes that matter most to stakeholders and selecting/designing key outcome measures; 4) a subset of participants from WP1-WP3 will co-produce a training package and research assessment tools.

Theory of Change (ToC) models will be used throughout.

Implementation and evaluation (WP5): to pilot (3 sites) and subsequently implement the training package (10 sites) using a stepped-wedge RCT to evaluate feasibility, acceptability, costs and impact in various contexts.

Measurement will be at five time-points for 2 adults with LD each with up to 2 relatives, and up to 8 staff in each site (pilot and RCT participants to total 182 participants; 784 assessments). Measures include questionnaires and brief interviews.

A subset of 4 individuals with LD in different homes, 2 relatives and up to 4 staff working with them will participate in ethnographic interviews (10 observation days and 7 interviews per home). Over 60 months, we anticipate 6 months for start-up.

WPs 1-4 are allocated 12 months each with overlapping periods, WP5 does not overlap (24 months), with a final 6 months for analysis, reporting and close down.

Publications are planned after each phase including: the realist review; stakeholder-informed priorities; the ToC mapping prerequisites needed to achieve improved implementation of communication strategies; and report of the implementation phase. Our co-produced intervention for staff and measures reflecting stakeholder priorities will be freely available.

We will liaise with organisations such as VODG and run workshops, present at academic and practitioner events, and use social media. Easy-read versions and infographics of key outputs will be produced.