148 . British Journal of Learning Disabilities Vol.
25 (1997)
The Importance of
Communication Partnerships:
A Study to Investigate the
Communicative Exchanges
Between Staff and Adults with
Learning Disabilities
Claire Bartlett, Speech and Language Therapist, Riverside Mental Health Trust and Karen Bunning, Department of
Clinical Communication Studies, City University.
A small-scale study was conducted to investigate the
extent to which the verbal communication skills used
by adults with learning disabilities were complemented
by those used by their keyworkers during communi-
cative exchanges. The setting was a community-based
day centre. The number of information carrying words
(ICWs) used by keyworkers with their clients was
measured in two contexts: (A) looking at selected pic-
tures; (B) free conversational exchange. These were
compared with the verbal comprehension level of each
client, also measured in ICWs, as assessed by the
administration of the Derbyshire Language Scheme:
Rapid Screening Test of Comprehension (Knowles &
Masidlover, 1982). The results revealed that major dif-
ferences existed between the communication skills used
by keyworkers, and the comprehension levels of the
participants with learning disabilities under both con-
ditions. The greater mismatch was evident in the second
condition of ‘free conversational exchange’. Some limi-
tations of the current study are discussed together with
the implications for future investigations and interven-
tion.
Introduction
A communication partnership involves two or more
people who exchange ideas and interpret meanings. Each
person engages in linguistic encoding and decoding and
makes inferences about the other’s intentions in the
context of available skills, expectations and knowledge
(Sperber & Wilson, 1986).Conversation Analysis (CA) is
an approach that is used increasingly in the assessment
and remediation of communicationproblems with various
populations including, people with acquired difficulties
as a result of stroke, for example, aphasia (Lesser &
Milroy, 1993; Perkins, 1995), children with phonological
disorders (Gardner, 1997) and people with learning dis-
abilities (Couchman, 1997). Importantly, it views com-
munication as collaborative interaction and assigns
equal value to the roles of both the participants in a
communicative exchange, stressing that a successful
interaction is not just the sum of the two halves, i.e. the
communication partners, but rather the co-construction
of discourse to which both people contribute (Perkins,
1995).
Interest in the communication partnerships between
adults with learning disabilities and their support staff
has been influenced by a number of issues. Firstly, adults
with learning disabilities are frequently limited in their
ability to assume responsibility for their own learning
and the maintenance of their skills due to the very
nature of their collective impairments. Furthermore, the
automatic transference of new skills acquired in one
situation, into another, cannot be assumed (Calculator &
Bedrosian, 1988). Adults with learning disabilities are
very often dependent on their support workers for this.
Secondly, work on the development of communication
stresses the importance of carer responsiveness (Ware,
1996) and indicates that the way staff use their com-
munication skills to support and frame those of adults
with learning disabilities, is crucial to the maintenance and
progression of their communicative abilities (Vygotsky,
1962; Goldbart, 1996).
Thirdly, the controversy that surrounds the use of
’Facilitated Communication’ highlights the importance
of accurate assessment of the individuals’communication
skills and appropriate communicative support supplied
 British Journal of Learning Disabilities Vol. 25 (1997) . 149
by significant others. ‘Facilitated Communication’ is a
technique developed by Crossley (Crossley & McDonald,
1980;Crossley, 1996) that involves the physical assistance
by a facilitator to a non-verbal person so that psycho-
emotional and/or neurophysiological problems are mini-
mised and access to communication form is facilitated
(Batt, 1990).Letter boards or similar technical devices are
commonly used and the individuals’ messages are spelt
out. However, research has shown evidence of facilitator
influence over the resulting communications (Prior &
Cummins, 1992; Datlow Smith et nl., 1994). This has
led to questions regarding where the communications
originate from: the communicator or the facilitator?
Finally, the shift in services for adults with learning dis-
abilities over the last two decades has been characterised
by the closure of residential institutions based on a
’medical’ model and the establishment of community-
based services. The latter have involved an increase in
the number of people who work with this population
who have had limited specialist training (van der Gaag
& Dormandy, 1993).
Prevalence of Communication Difficulties
It is widely acknowledged that adults with learning
disabihties experience communication problems, although
the exact size of the problem is difficult to establish. A
survey of clients in day centres and long stay hospitals
completed by Blackwell et a2. (1989), concluded a total of
62% of the population experienced identifiable communi-
cation problems, made up of 29% of the population who
were non-verbal, 25% with marked problems, and a
further 8% with some other level of verbal difficulty.
Thirty-three percent had some verbal communication
difficulty. It was not made clear what percentage of non-
verbal people were also severely physically disabled, thus
perhaps accounting for a lack of verbal communication.
Nevertheless, it is possible to see the extent of difficulties
in the communication skills of the study population.
Another survey by Law & Lester (1991) in a social
education centre found slightly higher levels of need:
81% were considered to require support for their com-
munication skills with 9.5% being non-verbal and 5.9%
demonstrating low comprehension and/or low expres-
sion. The variations between these two studies may be
explained by differences in the focal populations, the
criterion used for their identification and data collection
methods.
Skill Mix of Staff
Various surveys have reported on the skill mix of staff
employed within services for adults with learning dis-
abilities since the shift from institutional care to com-
munity reprovision has taken place. The UK Social
Services Inspectorate Report (1989) stated that only 13%
of care staff surveyed had a qualification that related
directly to their work with learning disabled people; 17%
had trade qualifications and 18%had a generic teaching
qualification. There was no reported evidence of any
systematic staff training in the community-based services
of the survey.
Jackson (1988) found that the majority of front line
staff working with a similar client group were young,
inexperienced and untrained. He further states that the
present pattern of ’modular’ training courses can only
ever offer a superficial learning experience. This echoed
the sentiments of Daniels & Sandow (1987) who criti-
cised the lack of evidence for the effectiveness of this
type of training course, both in the short-term and the
long-term.
Generalisation of newly acquired skills to the work set-
ting appears to be a particular issue. This was reiterated
by McLeod et al. (1995), in their study of the effects of
communication training on experienced and naive carers.
One particular issue for staff was their expressed lack of
confidence to try out newly acquired skills. This may
have affected the transfer of learning in the classroom to
the environment of need. Importantly, they found little
difference between the skills of both ’experienced’ and
’naive’ staff, suggesting that experience alone did not
’teach’ people good practice.
Van der Gaag & Dormandy (1993) commented that a
lack of training in communication skills facilitation may
lead staff to make inappropriate judgements about their
client’s communicative ability, such that competencies
may be either over-estimated or under-estimated.
Johnston & Shook (1993) in their investigation of
training offered to day care officers, reported that the
main emphasis was on the legal, regulatory and ethical
standards with a lack of in-service training. Jackson (1988)
felt the need to eliminate all aspects of institutional
practice from current provision in the community has
influenced the type of training on offer. The develop-
ment of community care policies has continued to con-
tribute to staff training provision.
Service Philosophy
Staff training often includes an exploration of the prin-
ciples of Social Role Valorisation (SRV) (Wolfensberger,
1983). Originally termed the philosophy of ‘Normalisa-
tion‘ (Wolfensberger, 1972),it was redefined and renamed
in order that value could be given to the many different
social roles performed by an individual (Wolfensberger,
1983).A relatively recent definition of SRV was put for-
ward by Wolfensberger (1992):’the enablement, establish-
ment, enhancement, maintenance, and/or defence of
valued social roles for people - particularly for those at
value risk - by using, as much as possible, culturally
valued means.’ (p. 32). Thus staff are taught to develop
a style of service delivery that assigns value to the many
roles exercised by adults with learning disabilities in
daily life.
Tensions
An analysis of professional-client relationships in rela-
tion to ’normalisation’ suggests that there are two com-
mon misconceptions regarding ’normalisation’ (Brechin
& Swain, 1988). The first is that ’normalisation’ means
making people normal (Sinha, 1986) although it was
never intended to deny need in the pursuit of normality.
The second misconception identified by Brechin & Swain
(1988) is an overemphasis on image, such as providing
ordinary housing, or using ordinary transport, because
these will render the individual as more acceptable to
society.
A third misinterpretation might be the normalking of
communication acts to adults with learning disabilities,
150 . British Journal of Learning Disabilities Vol. 25 (1997)

even though it may involve an overestimation of their Method of Investigation

skills, i.e. a mismatch between the skills of the person The role of carers and other communication partners
with a learning disability and those of the carer. The is of major importance to the collaborative construction
tension for staff may be the desire to communicate in an of discourse with people with learning disabilities who
age-appropriate manner with the individual whilst also also have impaired communication. The aims of the study
providing meaningful support for the communicative were:
attempts by the person with a learning disability. Just
as O'Brien's original Vicious Circle (1981) illustrated the (i) To investigate the extent to which the verbal compre-
risks of responding negatively to the person with a hension of adults with learning disabilities is comple-
developmental delay (Figure l), a belief in the normal or mented by the verbal expressive skills used by their
ordinary adult life may lead to high expectations of the keyworkers during discourse.
individual's communication skills and unrealistic oppor- (ii) To compare the verbal output of the staff participants
tunities being provided for the person. This may result under two separate conditions (looking at selected
in failure and thus establish negative or diminished pictures us free conversation exchange).
experiences which, in turn, will lead to more restricted (iii)To compare the mean number of 'Information Carry-
communication skills use. The overall effect of this ing Words' (ICWs) used by participants across the two
pattern of devaluation is likely to be poor self-esteem conditions.
and isolation of adults with learning disabilities and (iv)To review the range of ICWs used by participants
their exclusion from communication partnershps. This across the two conditions.
is illustrated in Figure 2.
Participants were selected in chronological order of their
Figure 1 The Vicious Circle (or 'Deviancy Career') referral to the Speech and Language Therapy service. The
first six people referred who had some verbal means of
communicating, ranging from single words to simple
Initial achievement phrases, were accepted for the study. Each one was in a
delay pair with an appropriate keyworker. The age range of
L the clients was 26 to 48 years. Keyworkers had been in
Prejudiced contact with their clients for a continuous period of no
less than six months.
7 The study focused on the use of verbal communication
skdls. The chosen unit for communication analysis was
More severe expectations 'Information Carrying Words' (ICWs). Each participant
performance delay was assessed using an adapted version (i.e. adult objects
replaced toys) of the Derbyshire Language Scheme Rapid
Screening Test of Comprehension (Knowles & Masidlover,
Opportunity 1982) to establish the level of information carrying words
(ICWs) understood. An 'Information Carrying Word' is
defined as a word which carries a key meaning within a
message. They are the minimal words required for under-
standing an utterance.
Source: O'Brien. 1981 Each keyworker was asked to initiate a conversational
exchange with the appropriate participant under two
Figure 2 The Vicious Circle (or 'Over-estimation separate conditions. In condition A, the keyworker was
Career') asked to discuss a selection of picture cards with the
appropriate participant and in condition B, the keyworker
Learning disability and impaired was asked to develop a free conversational exchange with
communication skills the appropriate participant. Some topic guidelines were
given, e.g. clothes, day centre activities, television, etc.
A tape recorder was used to record communicative
Philosophy of exchanges. There were no time restrictions for either
'normalisation' and belief condition as it was recognised that this may have added
of the 'ordinary life' pressure to the conversational exchanges. For consistency
across participants, a ten-minute sample of each recorded
exchange was isolated for analysis.
High expectations
More restricted
communication Data Analysis
skills use The data were transcribed in traditional orthography
within three hours of each session. A number of utter-
Unrealistic ances were omitted from the data sample. These con-
opportunities tained linguistic redundancies such as courtesy markers
Negative or diminished and rhetoricals. The words that were essential for under-
experiences standing meaning and for responding appropriately
(ICWs) were counted. This was carried out separately
for each condition.
 British Journal of Learning Disabilities Vol. 25 (1997) . 151

Table 1 Comprehension level of participants with pants under the two conditions. Examination of the
learning disabilities in relation to mean number of raw frequencies show that the keyworkers used more
ICWs produced under the two conditions utterances in the second condition (free conversational
exchange) apart from one case (participant 4) although
Compre- the difference was non-significant when tested with a
hension Mean Wilcoxon Matched Pairs Test [ Z = -1.3628, p < 0.1730
Condition Level (Rapid No. (2 tailed)].The adult with learning disabilities in this part-
A = Picture Screening of lCWs Amount nership (participant 4) had the most severely restricted
B = Con- Test): Per of communication skills of the sample and it is, therefore,
Participant versation No. of lCWs Utterance Difference
possible that the keyworker found the first condition
A 1.65 +0.65 (looking at pictures) more accessible due to its concrete
1 B 1 3.26 +2.26 content.
Table 2 also shows that the staff used more ICWs in the
A 2.93 +0.93 free conversational time (Condition B), without a specific
2 B 2 4.57 +2.57 context, than when looking at pictures (Condition A),
A 2.94 +0.94 with a specific context with the exception, once again, of
3 B 2 3.56 +1.56 participant 4. Again, statistical analysis based on a rank
A 1.99 +0.99 comparison was non-significant [Z = -1.7724, p < 0.1159
4 B 1 2.51 +1.51 (2 tailed)]. However, a comparison of the mean ICWs
under the two conditions was significant [ Z = -2.2014, p
A 2.40 +0.40 < 0.03 (2 tailed)].
5 B 2 3.63 +1.63 It is important to note that with this very small num-
A 2.22 +0.22 ber of participants, one pair that goes against the trend
6 B 2 3.14 +1.14 (e.g. participant 4) is bound to have a disproportionate
effect on the analysis. Examination of the raw data shows
that there is a consistent trend for the number of utter-
ances and ICWs to be greater in conversation than picture
Table 2 Staff initiated utterances under the two description.
conditions: Number of utterances;number of ICWs; Finally, the range of ICWs per utterance shows the
mean number of ICWs; and range of ICWs per variability in the staff’s communications in each context.
utterance
Conclusion
Range
Mean of The number of participants involved in the research
Condition No. ICWS was limited and, therefore, the results should be viewed
A = Picture No. No. of lCWs per as preliminary findings. The study restricted its focus to
B=Con- of of per Utter- the use of verbal communication skills, specifically the
Participant versation Utterances lCWs Utterance ance use of ICWs and has ignored other aspects of verbal com-
munication, e.g. pragmatics. Furthermore, no attention
A 17 28 1.65 1-3 has been paid to the use of non-verbal communication
1 B 72 235 3.26 1-7 skills. It is recognised that future research on the com-
A 15 44 2.93 1-7 municative exchanges between adults with learning
2 B 66 201 4.57 1-7 disabilities and their keyworkers needs to examine the
use of multi-modal communication skills, e.g. gesture,
A 18 53 2.94 1-6 sign, facial expression, objects of reference, etc., in the co-
3 B 25 89 3.56 1-8
construction of discourse.
A 72 143 1.99 1-6 However, some preliminary findings may be reported.
4 B 41 103 2.51 1-4 The degree of communication skills mismatch between
A 30 72 2.40 1-5 participant and keyworker is greater in the unstructured
5 B 54 196 3.63 1-9 situation (i.e.open conversation).The concreteness offered
by looking at pictures appears to focus the staff members’
A 18 40 2.22 1-4 communications more appropriately to meet their parti-
6 B 21 66 3.14 1-7
cipant’s communication needs. The context appears to
have affected the staff’s linguistic input to the participant
in terms of the amount of information expressed and this
may be important for the participant’s eventual under-
Results standing.
Table 1shows the difference between each participant’s
comprehension level and the number of ICWs used by the The Communication Partnership
keyworkers. The resulting communications of each staff A number of initial issues for discussion are raised
member are shown to consistently over-estimate the com- which relate to the formation of communication part-
prehension level of the individual participant. nerships between adults with learning disabilities and
Table 2 summarises the number of utterances initiated members of staff. Firstly, if context is important to both
by staff members when addressing individual partici- staff and adults with learning disabilities, alternative
 152 . British Journal of Learning Disabilities Vol. 25 (1997)
ways of rendering a context ’more concrete’ should be
explored. This could be done by introducing informal
gestures and/or signs, e.g. Makaton (Walker, 1976), to
augment the meaning of the spoken word. Hart ef al.
(1984) found that the use of Makaton signs and/or
symbols, such as Rebus, to emphasise key words helped
staff to modify their level of language to that of the
recipient. Objects of reference have been recommended
for use in demarcating the meanings within a communi-
cation environment for those with very limited com-
munication skills (McLarty, 1995; Parks, 1997). This
involves introducing objects that are familiar to the
individual in support of verbal communication to
enhance meaning, for example ’cup’ is introduced to
denote ’teatime’.
The optimal communication environment for the
impaired communicator will match the underlying com-
petencies of the individual, such that the communicative
output of significant others is understood and an appro-
priate response follows. This study identified communi-
cative competencies in only one area, i.e. the number
of ICWs. It is recommended that future investigations
employ the use of conversational analysis methods as
described by Lesser & Milroy (1993) which would pro-
vide useful insights into the full range of competencies
of the participants as well as qualitative information on
communication breakdown.
Communicative exchanges between staff and adults
with learning disabilities should be viewed as part-
nerships. The communicative domination of the person
with more sophisticated communication skills (for
example, the staff member) is, perhaps, predictable and
this was evidenced in the degree of mismatch between
the ICWs used by staff and the receptive skills of the
participants with learning disabilities. This may be due
to an over-estimation of the participant’s true skills and/
or the lack of ability by staff to modify their communi-
cations to match the input needs of their communication
partners.
Staff Training
The results of this small-scale study identified a local
need for staff training in practical strategies and tech-
niques to facilitate communicative exchanges between
adults with learning disabilities and their staff. More
detailed information regarding the communication skills
of participants with a learning disability was needed
so that staff could observe communicative attempts and
support them appropriately. The aim was to provide
relevant data so that staff could recognise breakdowns
as they occured within communicative exchanges and
select appropriate facilitation strategies to repair the
exchange. This is in accordance with an approach to staff
training (Cullen, 1988) that builds on the existing slulls
of staff so they are helped to identify the communication
skills of the individuals concerned, and to devise use-
ful and realistic ways of meeting their communication
needs.
Correspondence
All correspondence to Karen Bunning, Dept of Clinical
Communication Studies, City University, Northampton
Square, London EClV OHB.
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 British Journal of
Learning Disabilities

Index
Volume 25
1997

Editor
John Harris

Book Review Editor

Beryl Smith
 AUTHORS
Adams, R. See: Moore, E., Adams, R., Elsworth, J. and
Lewis, J.
Allt, J., Fenner, S. and Marvell, C. The Introduction oj
Role-play to a Group of Women with Learning
Disabilifes: Graded Stages in Developing Role-play
Skills and Some Practical Hints for Facilitating
Role-play. Vol. 25.4: 144-148.
Bartlett, C. and Bunning, K. The Importance of
Communication Partnerships: A Study to Investigate
the Communicative Exchanges Between Staff and
Adults with Learning Disabilities. Vo125.4: 148-153.
Bunning, K. See: Bartlett, C. and Bunning, K.
Cambridge, P. and Knapp, M. A t What Cost? Using
Cost lnformation for Purchasing and Providing
Community Carefor People with Learning Disabilities.
VOI. 25.1: 7-12.
Cheseldine, S. See: Walker, T. and Cheseldine, S.
Clarke, D.J. Towards Rational Psychotropic Prescribing
for People with a Learning Disability. Vol. 25.2: 46-52.
Cullen. P. See: Lavis, D., Cullen, P. and Roy, A.
Elsworth, J. See: Moore, E., Adams, R., Elsworth, J.
and Lewis, J.
Elsworth, J.D. See: Rikberg Smyly, S. and Elsworth,
J.D.
Fenner, S. See: Allt, J., Fenner, S. and Marvell, C.
Freeman, S. Treating a Dog Phobia in a Person with
Down’s Syndrome by Use of Systematic
Desensitisation and Modelling. Vol. 25.4: 154-157.
Goodman, W. See: Leggett, J., Hurn, C. and
Goodman, W.
Hegarty, J. See: Matthews, D. and Hegarty, J.
Holland, A. a n d Meddis, R. People Living in
Community Homes: Their Views. Vol. 25.2 68-72.
Hum, C. See: Leggett, J., Hurn, C. and Goodman, W.
Hussain, F. and Raczka, R. Life Story Workfor People
with Learning Disabilities. Vol. 25.2: 73-76. -
Justice, S. See: March, J., Steingold, B. and Justice, S.
with Mitchell, P.
Kelman, L.V., Lindsay, W.R., McPherson, F.M. and
Mathewson, Z. Smoking Education for People with
Learning Disabilities. Vol. 25.3 95-99.
Knapp, M. See: Cambridge, P. and Knapp, M.
Lavis, D., Cullen, P. and Roy, A. Identification of
Hearing Impairment in People with a Learning
Disability: From Questioning to Testing. Vol. 25.3:
100-105.
Leggett, J., Hurn, C. and Goodman, W. Teaching
Pyschological Strategies for Managing Auditory
Hallucinations. Vol. 25.4: 158-162.
Lewis, J. See: Moore, E., Adams, R., Elsworth, J. and
Lewis, J.
Lindsay, W.R. See: Kelman, L.V., Lindsay, W.R,
McPherson, F.M. and Mathewson, Z.
Link, H.M. Auditoy Integration Training ( A n ) : Sound
Therapy? Case Studies of Three Boys with Autism who
Received AlT. Vol. 25.3: 106-110.
Male, D.B. and May, D.S. Burnout and Workload in
Teachers of Children with Severe Learning Difficulties.
Vol. 25.3: 117-122.
March, J. Steingold, B. and Justice,S. with Mitchell, P.
Follow the Yellow Brick Road! People with Learning
Dificulties as Co-researchers.Vol. 25.2: 77-80.
Marvell, C. See: Allt, J., Fenner, S. and Marvell, C.
Mathewson, Z. See: Kelman, L.V., Lindsay, W.R,
McPherson, F.M. and Mathewson, Z.
Matthews, D. and Hegarty, J. The OK Health Check: A
Health Assessment Checklistfor People with Learning
Disabilities. Vol. 25.4: 138-143.
May, D.S. See: Male, D.B. and May, D.S.
McPherson, F.M. See: Kelman, L.V., Lindsay, W.R,
McPherson, F.M. and Mathewson, Z.
McVilly, K.R. Residential Staff: How They View Their
Training and Professional Support. Vol. 25.1: 18-25.
Meddis, R. See: Holland, A. and Meddis, R.
Mitchell. P. See: March, J., Steingold, B. and Justice, S.
with Mitchell, P.
Moore, E., Adams, R., Elsworth, J. and Lewis, J. An
Anger Management Groupfor People with a Learning
Disability. Vol. 25.2 53-57.
Pendaries, C. Pilot Study on the Development of the
Learning Disability Healthcare Resource Groups. Vol.
25.3: 122-126.
Pennell, D. See: Sigafoos, J., Pittendreigh, N. and
Pennell, D.
Phillips, G. See: Redworth, M. and Phillips, G.
Pittendreigh, N. See: Sigafoos,J., Pittendreigh, N. and
Pennell, D.
Raczka, R. See: Hussain, F. and Raczka, R.
Redworth, M. and Phillips, G. Involving People with
Learning Disabilities in Community Care Planning.
Vol. 25.1: 31-35.
Rikberg Smyly, S. See: Gardner, A. and Rikberg
Smyly, S.
Rikberg Smyly, S. and Elsworth, J.D. Interviewing
Clients: A Project to Explore Client Views About a
Change in Service Provision. Vol. 25.2 64-67.
Roy, A. See: Lavis, D., Cullen, P. and Roy, A.
kmker, J. Gender, Race and Sexual Behaviour: lssues in
Service Responses to HIV/AIDS. Vol. 25.2: 58-63.
Sigafoos, J., Pittendreigh, N. and Pennell, D. Parent
and Teacher Ratings of Challenging Behaviour in
Young Children with Developmental Disability. Vol.
25.1: 13-17.
Simons, K. Residential Care, or Housing and Support?
Vol. 25.1: 2-6.
Steingold, B. See: March, J., Steingold, B. and Justice,
S. with Mitchell, P.
I’hurman, S. Challenging Behaviour Through Communi-
cation. Vol. 25.3: 111-116.
rowell, D. Promoting a Better Life for People with
Learning Disabilities and Their Families: A Practical
Agenda for the New Governmnt. Vol. 25.3: 90-94.
Nalker, T. and Cheseldine, S. Towards Outcome
Measurements: Monitoring Effectiveness of Anger
Management and Assertiveness Training in a Group
Setting. Vol. 25.4 134-137.
SUBJECTINDEX
Aberrant Behaviour Checklist 13-17 New Government 90-94
Adult 64-67,95-99, 138-143
AIT 106-110 Outcome Measurement 134-137
Alternative Therapies 106-110
Anger Management 53-57,134-137 Participant Evaluation 53-57
Assessment 13-17,138-143 Participation 64-67, 77-80
Auditory 106-110 Partnership 148-153
Autism 106-110 Pharmacology 46-52
Philosophy 148-153
Burnout 117-122 Planning 7-12,31-35
Policy Proposals 90-94
Casemix Costs 122-126 Prevalence 100-105
Challenging Behaviour 13-17,111-116,117-122 Pre-school Children 13-17
Cognitive-Ekhavioural Techniques 158-162 Priorities 90-94
Commissioning 122-126 Professionals 18-25
Communication 111-116,148-153 Providing 7-12
Community Care 31-35 Psychosis 158-162
Community Services 68-72 Psychotropic 46-52
Contract 122-126 Purchasing 7-12
Costings 7-12
Qualitative Research Outcomes 68-72
Disability 64-67
Dog Phobia 154-157 Race 58-63
Down’s Syndrome 154-157 Registration and Inspection 2-6
Regulation 2-6
Evaluation 18-25,64-67 Relationships 26-30
Relaxation 154-157
Families 77-80 Research 77-80
Residential Care 2-6,18-25
Gender 58-63 Role-Play 144-148
Generalisation 154-157
Group Work 134-137,158-162 Satisfaction 18-25
Self-Advocacy 77-80
Hallucinations 158-162 Services 64-67
Health Education 95-99 Severe Learning Disability 111-116,117-122
Healthcare 122-126,138-143 Sexuality 58-63
Hearing Impairment 100-105 Skill Mix 148-153
HIV/AIDS 58-63 Smoking 9599
Housing and Support 2-6 Speech and Language 111-116
HRGs 122-126 Staff 138-143
Staff Client Interaction 26-30
Integration Training 106-110 Strategies 31-35
Interview 64-67 Stress 117-122
Involvement 31-35 Supported Living 2-6
Systematic Desensitisation 154-157
Keyworker Involvement 53-57
Teachers 117-122
Learning Difficulties Therapy 111-116
Learning Disabilities 58-63,73-76,77-80, Training 18-25
95-99,100-105,138-143,144-148 Transitions 73-76
Life Story Work 73-76
Loss and Bereavement 73-76 Valuing 26-30
Views 68-72
Market 7-12
Medication 46-52 Womens’ Group 144-148
Methodology 100-105 Workload 117-122
Mild Learning Disability 158-162 Workshop 26-30
Multidisciplinary 111-116
BOOK REVIEWS
Ail About Attention Deficit: Symptoms, Diagnosis
and Treatment/Children and Adults. Vol. 25. 3:
128-129.
Approaches to People with Challenging Behaviour:
A Distance Learning Package for Direct Care Staff.
Vol. 25.4: 167-168.
Assessor Workbook: Guidance and Practice in
Vocational Assessment. Vol. 25.1: 37-38.
Autism Focus: The Training Workbook for Carers.
Vol. 25.2: 83.
The Autistic Spectrum: A Guide for Parents and
Professionals. Vol. 25.2: 85.
BILD Seminar Papers, Number 4. People with
Learning Difficulties at Risk of Physical and
Sexual Abuse. Vol. 25.1: 36.
Blackstone’s Guide to the Disability Discrimination
Act 1995. Vol. 25.4. 167.
Brothers, Sisters and Learning Disability. Vol. 25.4:
169-170.
Community Care in Transition. Vol. 25.1: 38.
Developing Personal Safety Skills in Children with
Disabilities. Vol. 25.2: 83.
Disabilty Politics: Understanding Our Past,
Changing Our Future. Vol. 25.3: 130.
Dramatherapy for People with Learning Disabilities.
Vol. 25.1: 37.
Everyday Skills Pack: ’New Opportunitues for
People with a Learing Disability’: Road Safety
Pack. Vol. 25.3: 128.
Going to the Doctor. Vol. 25.4: 168.
’Have a Good Day’ Units 1-8:An Independent Study
for Staff Working with People with Learning
Disabilities in Day Services. Vol. 25.4: 168.
Healthy Sexuality, HIV and People with Learning
Difficulties. First National Conference Report
1992. Vol. 25.1: 36-37.
HIV & AIDS ’It isn’t an issue here! ... is it?:
Information for People Working in Residential
Settings. Vol. 25.2: 84.
Interactive Approaches to Teaching: A Framework
for INSET. Vol. 25.4: 170.
Invisible Victims: Crime & Abuse Against People
with Learning Disabilies. Vol. 25.3: 129.
Literacy: Programs for Adults with Developmental
Disabilities. Vol. 25.4: 169-170.
Music for All. Vol. 25.2: 85.
Pupils with Severe Learning Disabilities who Present
Challenging Behavious: A Whole School
Approach to Assessment and Intervention. Vol.
25.3: 127.
Refined Competencies. Vol. 25.1: 38.
Sex Education for Parents: A Resource Pack for
Professionals to Support Parents in their Role as
Sex Educators. Vol. 25.3: 130-131.
Sexuality, Learning Difficulties and Doing What’s
Right. Vol. 25.2: 84.
Sexuality and Learning Disability:The Way Forward.
Vol. 25.2: 84.
Sexuality and Young People with Learning
Difficulties. Vol. 25.2: 84.
Still an Chance to Learn? A Report on the Impact of
the Further & Higher Education Act (1992) on
Education for Adults with Learning Difficulties.
Vol. 25.4: 169.
Support for Families. Vol. 25.3: 127.
Supported Living: A New Paradigm? Vol. 25.1: 38.
Taking A Break: Liverpool’s Respite Services for
Adult Citizens with Learning Disabilities. Vol.
25.1: 38.
Talkabout. Vol. 25.3: 129-130.
Values and Visions: Changing Ideas in Services for
People with Learning Difficulties. Vol. 25.3: 131.
What Can We Do? The Legal Framework of
Community Care Services for Adults with
Learning Disabilites in England and Wales. Vol.
25.1: 38.
Working with Children in Education: The Impact of
Head Injury (Information Pack). Vol. 25.3: 130.
LETTERS
Cardiff Universities Social Services. Vol. 25.1: 40.
f i e Derek Ricks Fellowship. Vol. 25.1: 40-41.
Health Promotion. Vol. 25.4: 171.
Learning Disability Resettlement Re-admissions.
Vol. 25.1: 40.
+en Days 1997. Vol. 25.3: 132.
jchizophrenia and Learning Disability: A Response.
Vol. 25.1: 39.
Strategies for Independent Wayfinding. Vol. 25.1: 40.
CONFERENCE REPORTS
f i e BILD 1997 International Conference ‘Services
Challenged by Complex Needs’. Vol. 25.4: 163.
OBITUARIES
3r Ann Craft. Vol. 25.2: 81-82.
ios Fraser. Vol. 25.4: 164.
3orothy Jeffree. Vol. 25.4: 164-165.
4lbert Kushlick. Vol. 25.4: 165-166.
 British Journal of Learning Disabilities Vol. 25 (1 997) . 153

McLeod, H., l-Iouston, M. and Seyfort, B. (1995)

Communicative interactive skills training for caregivers
of nonspeaking adults with severe disabilities.
bild publications
International J o i i r d of Practical Approaches to Disability Now Available in Paperback!
9 (l), 5-11.
O’Brien, J. and Tyne, A.(1981) The Principle ofNornmlisation: Challenging Behaviour and Intellectual
A Fo~rndafionfor l:ffective Semices. London: Values into
Action. Disability: A Psychological Perspective
Parks, K. (1997) Using objects o f reference: A review of the Edited by Robert S P Jones and Caroline B Eayrs
literature. E~iropeanJournal of Special Needs Education 10
(l), 40-6. This collection of papers addresses key topics
Perkins, L. (1995) Applying conversational analysis to for those concerned with the management of
aphasia: Clinical implications and analytic issues. challenging behaviours. With contributions from
Eiiropean Jonrnai of Disorders of Conimunicafion 30 (3),
372-83. leading researchers, it covers the identification
Prior, M. and Cummins, R. (1992) Questions about facilitated and analysis of challenging behaviour, service
communication and autism. Journal of Aiitisnz and responses, theoretical issues, and future
Developmental Disorders 22 (3), 331-7.
Sinha, C. (1986) Psychology, education and the ghost Kaspar
directions.
Hauser. Disability, Handicap and Society 1, 245-59.
Social Services Inspectorate (1989) Inspection of Day Servicesfor Important topics include:
People with a Mental Handicap. London: DOH. + Assessment using functional analysis
Sperber, D. and Wilson, D. (1986) Relevance, Cognition and
Commiinication. Oxford: Blackwell.
+ Self-injury
van der Gaag, A. and Dormandy, K. (1993) Commiinication and
+ The management of violence and aggression
Adults with Learning Disabilities. London: Whurr + Gentle teaching
Publishers. + Ordinary housing
Vygotsky, L. (1962) Tlioiiglit and Langiiage. Cambridge MA:
MIT Press. f14.95 + 75p p&p 1993 Paperback
Walker, M. (1972) The M a h t o n Vocabiilary Development Project. ISBN 1 873791 63 1
Camberley, Surrey.
Ware, J. (1996) Creating a Responsiue Environment ,for People
7uith Profound and Multiple Learning Difficulties. London: Available from: BlLD Publications,
David Fulton Publishers. Plymbridge Distributors, Estover Road,
Wolfensberger, W. (1972) The Principle of Nornzalisation in Plymouth, PL6 7PZ. TelOl752 202300
Human Services. Toronto: National Institute on Mental
Retardation.
Wolfensberger, W. (1983) Social role valorisation: A proposed
new term for the principle of normalisation. Mental
Retardation 21, 234-9.
Wolfensberger, W. (1992) A Brief Introduction to Social Role
Valorisation as a High-order Concept for Strirctiiriiig H u m a n
Services. USA: Syracuse University.

bild British Institute of Learning Disabilities

presents

From t h e margin
I t o t h e centre
ONE DAY CONFERENCE
This one day conference considers the services that are offered to people with learning
disabilities who are from ethnic backgrounds. A range of services and the cultural needs
of people with learning disabilities will be discussed.
Speakers:
Razia Aziz & Aqeela Alam, Limbed Spencer, Harriet Uvanney & Jackie Downer
TUESDAY 5TH MAY 1998, THE CAVENDISH HOTEL, EASTBOURNE
€79.90 inc VAT
Wolverhampton Road, Kidderminster, Worcs. DY 10 3PP Tel: 01562 850251