I was very excited when I read the subtitle of this book, particularly as I have learned a great deal about developing the communication of people with severe to profound learning difficulties from two of the authors—Nicola Grove and Karen Bunning. However, I felt that the book did not deliver what the title promised. I had expected to find a treasury of ideas about observing the ways in which people with severe to profound learning difficulties may communicate, how to enhance these and aid others to understand them. What this book, in fact, gives is a structure for involving a service user in the making of decisions which directly impact on them.
Although this is not quite what one would expect from the title, it is, nevertheless, an excellent idea. As the authors explain, it is essential that people are included in decisions which are made about their lives, and it is equally essential that we have a structure within services which encourages staff to consider the clients’ attempts to communicate and a system for recording and checking the interpretation of these.
The book contains four forms which can be photocopied and used by staff when any decision has to be made. The forms are entitled: Information gathering, Discussion checklist, Checking interpretations, and Summary. They take the staff member carefully through a procedure through which a clear picture is built up of what the decision is, how the service user may be involved in it, the service user’s communication skills, how the service user took part in the decision-making process, how to check the interpretations of the service user’s communicative behaviours, and a summary of the decision made and how it will be reviewed and monitored.
There are obvious benefits in having a well-structured process to be used by all staff and with all service users in situations where decisions or changes have to be made. However, it struck me that the process of form-filling and checking could be quite lengthy and, as a result, might not be used as frequently as desired. To institute this process into any service would require the commitment and backing of management.
The book begins with a short introduction to communication. The language used is rather dense and difficult to stay with. Communication is a dynamic, interactive process which can be most difficult to explain on paper. Perhaps the book should come with a training package for staff—preferably delivered by someone who is aware of all forms of communication (e.g. a speech and language therapist). With such training, staff would be more aware of service users’ attempts to communicate and there would be less likelihood the first question on the information-gathering form, which carries the statement that the decision is to be made ‘on behalf of the individual concerned’. Without such training it could be that this procedure would be used to defend the exclusion of people from the decision-making process, rather than in defence of their right to be included in it.
My initial disappointment that the title of this book did not match its contents was replaced by excitement at the possibility of including these guidelines within a training package on communication for staff.