Good Care Series - Communicating with people with profound and multiple learning disabilities

The Good Care Series

In our latest collection of articles, named ‘The Good Care Series’ we will be celebrating good practice and championing high quality care and support. We will be talking with customers and colleagues to explore what good care looks like for people with different needs and in different settings across our organisation.

The first of our articles focuses on the support we provide people with profound and multiple learning disabilities (PMLD) at home. People with PMLD have more than one disability. They have a profound learning disability and may have, sensory or physical disabilities and complex health needs.

People with PMLD experience difficulty communicating and need those who know them well to interpret their responses and intent. People with PMLD require skilled and understanding support staff who can listen well and communicate responsively. From July 2021 we embarked on a project, which centred on enhancing our interactions with the people with PMLD that we support.

This project came about in direct response to feedback we received from a family carer. The family member noted in a survey response that whilst she knew her relative was safe and well cared for by the support team, she wanted her relative to be more actively supported and supported to be
more active.

This prompted us to think about how we could support the team to enhance their skills. We called upon the specialist expertise of a Community Interest Company called NAC, which is dedicated to the emotional support and wellbeing of people with complex needs and PMLD.

Building our team member’s skills

A 2-part training course facilitated by NAC, was offered to staff. The sessions allowed support staff space to explore ways to connect with people who use other means than words to communicate, and how to read the subtleties expressed in non-verbal communication.
During the training, staff were introduced to HOP or the Hanging Out Programme. HOP is described as both an approach and an attitude. The approach is simple: spend 10 minutes interacting with a person, giving them 100% attention. The attitude is also simple: all people need interaction with other people. It is intentionally easy to learn and simple to implement – so that all our support teams could adopt this approach, where there would be benefit to the individual.
HOP starts as a task to begin with, to provide some structure, but also because 10 minutes can easily be incorporated into a person’s day. Over time, as the staff member learns how to naturally tune into the person, it no longer becomes contained to the
10- minute activity.

When a person has limited communication abilities there can be a tendency to overcompensate for the person’s difficulties by taking the role of initiator. With this approach the person with learning disabilities always takes the lead.

Connecting with people

The interactions between the individual and staff member are recorded, to enable the support team to reflect upon and learn what is working and what is not working for the person. Staff members were also encouraged to learn from each other. Using team meetings to share knowledge and support. The team was asked to think about the skills and techniques their colleagues were using, one team member explained “it is about noticing the good things and putting into words what you are seeing”

Jon a support worker who attend the training, talked about the immediate benefits

“I loved (the course). I was already spending a lot of time engaging with our customers but much of this was task- orientated, using music and books etc. The course showed me a whole other level of communicating, taking the lead from the person and providing a whole new level of interaction. An agency staff member saw me using this approach, and started using it with a customer. Seeing (the customer) laughing for a straight 30minutes made me feel really made up.”

Support Plans have also been amended to build in communication needs and daily record notes provide an opportunity to record meaningful contacts.

Some of the key concepts within the training have now been embedded in our in-house Communication Training, including the application of HOP, in the hope that we can introduce more of our services to this way of working.