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Staff Members' Understandings about Communication with Individuals Who Have Multiple Learning Disabilities: A Case of Finnish OIVA Communication Training

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Title: Staff Members' Understandings about Communication with Individuals Who Have Multiple Learning Disabilities: A Case of Finnish OIVA Communication Training
Language: English
Authors: Koski, Katja, Martikainen, Kaisa, Burakoff, Katja, Launonen, Kaisa
Source: Journal of Intellectual & Developmental Disability. Dec 2010 35(4):279-289.
Availability: Informa Healthcare. Telephone House, 69-77 Paul Street, London, EC2A 4LQ, UK. Tel: 800-354-1420; e-mail: healthcare.enquiries@informa.com; Web site: http://informahealthcare.com/action/showJournals
Peer Reviewed: Y
Page Count: 11
Publication Date: 2010
Document Type: Journal Articles
Reports - Research
Education Level: Adult Education
Descriptors: Learning Disabilities, Severe Disabilities, Semi Structured Interviews, Participant Satisfaction, Performance Factors, Foreign Countries, Habit Formation, Thinking Skills, Staff Development, Communication Research, Communication Skills, Communication Strategies, Multiple Disabilities, Caregiver Attitudes, Interpersonal Communication
Geographic Terms: Finland
DOI: 10.3109/13668250.2010.517189
ISSN: 1366-8250
Abstract: Background: Often communication training has been directed at the communication practices of staff members working with people with multiple learning disabilities. To date, the thinking habits of staff members, which also influence interactions, have not been addressed. We identified the issues staff members perceived as important for their development as communication partners after participating in a communication training program. Method: Six key staff members participated in semistructured interviews that explored the insights they had gained during participation in the Finnish communication training program OIVA. Results: Participating staff members identified issues relating to the communication practices and thinking habits they had acquired during the training. Both communication practices and thinking habits were important for the staff members' development as communication partners. Conclusions: The findings of this study suggest that it is important to give staff members the opportunity to learn new practices and to explore the thinking that underpins the actions they perform during communication training. (Contains 1 figure and 2 tables.)
Abstractor: As Provided
Number of References: 56
Entry Date: 2012
Accession Number: EJ961786
Database: ERIC
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  Value: <anid>AN0055507810;ddi01dec.10;2019Mar28.13:29;v2.2.500</anid> <title id="AN0055507810-1">Staff members' understandings about communication with individuals who have multiple learning disabilities: A case of Finnish OIVA communication training. </title> <p>Background Often communication training has been directed at the communication practices of staff members working with people with multiple learning disabilities. To date, the thinking habits of staff members, which also influence interactions, have not been addressed. We identified the issues staff members perceived as important for their development as communication partners after participating in a communication training program. Method Six key staff members participated in semistructured interviews that explored the insights they had gained during participation in the Finnish communication training program OIVA. Results Participating staff members identified issues relating to the communication practices and thinking habits they had acquired during the training. Both communication practices and thinking habits were important for the staff members' development as communication partners. Conclusions The findings of this study suggest that it is important to give staff members the opportunity to learn new practices and to explore the thinking that underpins the actions they perform during communication training.</p> <p>Keywords: communication; staff; training; multiple learning disabilities</p> <hd id="AN0055507810-2">Introduction</hd> <p>The desire for love and belonging is a recognised basic human need (Maslow, [<reflink idref="bib34" id="ref1">34</reflink>]). Thus, the right to belong and to participate in a community is a basic human right (United Nations, [<reflink idref="bib51" id="ref2">51</reflink>]). This right also applies to individuals with multiple learning disabilities (MLD). Belonging to a community requires that other members of that community are prepared to include every member in its daily functioning (Ferguson, [<reflink idref="bib11" id="ref3">11</reflink>]). For many individuals with MLD, direct support staff members hold the key to this inclusion; they are usually the primary communication partners for this group, and acquiring effective membership in a community requires <emph>communication</emph> between all those in the community.</p> <p>Nevertheless, interaction with individuals with MLD is not simple. People with MLD may rely on developmentally early means of communication (e.g., nonverbal communication modes, such as gestures and vocalisations), have a slow interaction pace (McLean, McLean, Brady, & Etter, [<reflink idref="bib36" id="ref4">36</reflink>]), and have difficulties understanding spoken language (Ware, [<reflink idref="bib54" id="ref5">54</reflink>]). Therefore, many authors (e.g., Nind & Hewett, [<reflink idref="bib42" id="ref6">42</reflink>]; Purcell, McConkey, & Morris, [<reflink idref="bib45" id="ref7">45</reflink>]) have noted that staff members' own interaction skills often determine the outcome of communicative interactions. In particular, staff members need to know how to use <emph>sensitive interaction</emph> based on, for example, <emph>attachment theory</emph> (Bowlby, [<reflink idref="bib6" id="ref8">6</reflink>]), <emph>sensitive mothering</emph> (Ainsworth, Bell, & Stayton, [<reflink idref="bib2" id="ref9">2</reflink>]), and <emph>Intensive Interaction</emph> (Nind & Hewett, [<reflink idref="bib42" id="ref10">42</reflink>]). Sensitive interaction requires patience from the staff members involved and also a desire to try to understand the communicative attempts of the individuals with MLD. This might mean that staff members have to make interpretations from what are sometimes very subtle communication attempts by these individuals (von Tetzchner & Jensen, [<reflink idref="bib52" id="ref11">52</reflink>]). In addition, staff may be unsure at first about the accuracy of these interpretations (Ainsworth et al., [<reflink idref="bib2" id="ref12">2</reflink>]; Bowlby, [<reflink idref="bib6" id="ref13">6</reflink>]). Furthermore, the sensitive interaction style requires that staff have the ability to take note of the level of language comprehension of the individuals with MLD and, when necessary, to adjust their own level of verbal and nonverbal expressions. This may include using appropriate augmentative and alternative communication (AAC) strategies, such as pictures, gestures, or objects, to meet the needs of each individual (e.g., Bradshaw, [<reflink idref="bib7" id="ref14">7</reflink>]).</p> <p>For these reasons, researchers conducting observational studies and staff members themselves have identified communication skills as a professional competence that demands special training (McConkey, Morris, & Purcell, [<reflink idref="bib35" id="ref15">35</reflink>]; McVilly, [<reflink idref="bib37" id="ref16">37</reflink>]). Therefore, communication training programs have been developed and implemented (e.g., Firth, Elford, Leeming, & Crabbe, [<reflink idref="bib12" id="ref17">12</reflink>]; Golden & Reese, [<reflink idref="bib16" id="ref18">16</reflink>]; Purcell et al., [<reflink idref="bib45" id="ref19">45</reflink>]) predicated on teaching staff members <emph>communication practices</emph> that promote the sensitive interaction style described above, including, for example, the use of AAC strategies when communicating. However, the maintenance of the newly learnt practices and the generalisation of these to other situations, other clients, or nontrained staff are still problematic (Maes, Lambrechts, Hostyn, & Petry, [<reflink idref="bib29" id="ref20">29</reflink>]).</p> <p>The question then arises whether the sole emphasis of such programs on training the communication practices of the staff is enough to ensure effective communication. Ager and O'May ([<reflink idref="bib1" id="ref21">1</reflink>]) noted that accomplishing more permanent change in staff behaviour requires training programs that also address the staff members' <emph>thinking habits</emph>. Therefore, it is important that staff members are not only taught to use certain communicative practices, but are also given opportunities to focus on their own assumptions and expectations about the abilities of individuals with MLD to communicate. Furthermore, Dennis ([<reflink idref="bib10" id="ref22">10</reflink>]) found that staff members who appear to have a highly functional communication relationship with individuals with MLD stressed that communication practices are not enough: thinking habits strongly influence staff members' practices. Staff members who think individuals with MLD possess communication skills interact differently compared with those who do not think that such individuals are able to communicate (Bigby, Clement, Mansell, & Beadle-Brown, [<reflink idref="bib4" id="ref23">4</reflink>]). Consequently, it could be argued that training that focuses on staff members' thinking habits might hold the key for a more permanent change in staff members' communication skills.</p> <p>Commonly, training programs have been analysed by their effectiveness on the behaviours of the participating staff members (e.g., Golden & Reese, [<reflink idref="bib16" id="ref24">16</reflink>]; Purcell et al., [<reflink idref="bib45" id="ref25">45</reflink>]). Researchers have also explored staff members' own views about the benefits of the training (e.g., Firth et al., [<reflink idref="bib12" id="ref26">12</reflink>]). The aim of the present study was to identify what staff members perceived as important for their personal improvement as communication partners with individuals with MLD after participating in a communication training program. Did they place greater emphasis on a change in their communication practices, or a change in their thinking habits, or were changes to both important?</p> <p>An additional purpose of this article is to present the Finnish communication training program OIVA. Since this training is a work in progress, the results are aimed at gaining knowledge about the experiences of the participating staff members in order to further develop the communication training. Nonetheless, the current findings can be useful when planning and implementing other communication training programs for staff members who work in disability services.</p> <hd id="AN0055507810-3">OIVA training</hd> <p>The Communication and Technology Centre of the Finnish Association on Intellectual and Developmental Disabilities has been developing a communication training model, the <emph>OIVA-vuorovaikutusmalli</emph>® [OIVA interaction model] (OIVA is a Finnish acronym from the words <emph>participating through interaction</emph>). OIVA is aimed at training direct support staff who work with people with severe and complex communication needs. The model was piloted in 2002–2003 (Martikainen & Roisko, [<reflink idref="bib33" id="ref27">33</reflink>]). It was further developed in 2005–2008 (Martikainen & Burakoff, [<reflink idref="bib31" id="ref28">31</reflink>]; Martikainen, Burakoff, Vuoti, & Launonen, [<reflink idref="bib32" id="ref29">32</reflink>]; Vuoti, Burakoff, & Martikainen, [<reflink idref="bib53" id="ref30">53</reflink>]) when three organisations from different parts of Finland offering services for individuals with MLD took part in the <emph>OIVA training project</emph>. Thus, the OIVA training involved the development and testing phases of the OIVA interaction model. The present study focuses on the results gained from OIVA training.</p> <hd id="AN0055507810-4">The principles and participants of OIVA training</hd> <p>The OIVA training program was influenced by several other communication training approaches; for example, VIG-Video Interaction Guidance (Kennedy & Sked, [<reflink idref="bib23" id="ref31">23</reflink>]), Granlund and Olsson ([<reflink idref="bib17" id="ref32">17</reflink>]), Nafstad and Rødbroe ([<reflink idref="bib41" id="ref33">41</reflink>]), Hanen (Ruiter, [<reflink idref="bib46" id="ref34">46</reflink>]), VIKOM (Sollied & Harmon, [<reflink idref="bib48" id="ref35">48</reflink>]), PICTURE IT (Bloomberg, West, & Iacono, [<reflink idref="bib5" id="ref36">5</reflink>]), and Intensive Interaction (Nind & Hewett, [<reflink idref="bib42" id="ref37">42</reflink>]). The main principles of this training were <emph>community-based rehabilitation (CBR)</emph> and a <emph>client-oriented approach</emph>, and the training was <emph>solution focused</emph>. The working method of OIVA training was <emph>video-based guidance</emph> (see Vuoti et al., [<reflink idref="bib53" id="ref38">53</reflink>]).</p> <p>With CBR the entire community attempts to determine how each member (staff members and individuals with MLD) can participate fully and successfully in the life of the community (International Labour Organization, United Nations Educational, Scientific and Cultural Organization, and the World Health Organization, [<reflink idref="bib20" id="ref39">20</reflink>]; see also World Health Organization, [<reflink idref="bib56" id="ref40">56</reflink>]). CBR initially originated as a method of increasing disability and rehabilitation services in developing nations and aimed to ensure that the support given was closely linked to local communities (Lagerkvist, [<reflink idref="bib25" id="ref41">25</reflink>]). Nevertheless, CBR has important implications for urban practice (Kendall, Buys, & Larner, [<reflink idref="bib22" id="ref42">22</reflink>]). In Finland, the term has been used to describe services that target influencing social networks (parents, friends, caregivers, staff members) of individuals rather than the individuals per se (Hilden, Merikoski, & Launonen, [<reflink idref="bib18" id="ref43">18</reflink>]). Thus, the aim of CBR is to create a community that is able to support individuals with MLD in their everyday lives and enable them to participate equally in the life of the community. Each participating organisation identified two or more of its departments from which staff members would participate in the training. According to the principles of CBR, each department was regarded as its own "community." It was essential that all staff in the selected departments would participate in the training. Altogether, 47 staff members started the training and 31 completed it; the difference was due to staff turnover.</p> <p>Communities have their own unique needs with regard to the issues they want to explore and develop in daily life (Vuoti et al., [<reflink idref="bib53" id="ref44">53</reflink>]). Thus, OIVA training was <emph>client-oriented</emph> and the participating staff members played an active role. The goal was for them was to begin to resolve problems with communication in their respective working communities independently. OIVA training was also <emph>solution focused</emph>; therefore, its aim was to recognise and strengthen those interaction patterns of staff members that were identified as functioning well in practice (cf. Katajainen, Lipponen, & Litovaara, [<reflink idref="bib21" id="ref45">21</reflink>]; Vuoti et al., [<reflink idref="bib53" id="ref46">53</reflink>]).</p> <hd id="AN0055507810-5">The length of OIVA training and training components</hd> <p>During the OIVA training, staff members participated in <emph>video-based guidance meetings</emph> (see Fukkink, [<reflink idref="bib14" id="ref47">14</reflink>], for discussion on the benefits of video-based methods). In the meetings, staff and a speech–language pathologist (SLP) analysed interaction situations between dyads consisting of a staff member and an individual with MLD. Each organisation had its own separate meetings; thus, staff members participated in meetings with staff colleagues from the same organisation. The meetings were held every 6 weeks for 18 months, 12 times in each organisation (see Figure 1). After this period the participating organisations also had the opportunity to request additional meetings.</p> <p>Graph: Figure 1. The process of OIVA training.</p> <p>According to the <emph>client-oriented principle</emph>, staff members played an active role in the meetings. Firstly, staff members cooperatively chose the individuals with MLD and the staff members who were to be included on the video. Secondly, in preparing for each video-based guidance meeting, staff members videotaped two interactions from their daily work that involved attempts to communicate with individuals with MLD. Finally, from each video, staff members identified an issue they wanted to focus on during the video-observation meeting; for example, whether the staff member accurately interpreted the communication acts of the individual with whom she or he was interacting.</p> <p>In keeping with the during the meetings the SLP and the staff members focused on examples of positive interaction shown in the videos. Since the theoretical background of OIVA training is derived from research on promoting the sensitive interaction style described earlier, the SLP helped the staff members recognise from the videos five variables of interaction that had been hypothesised as promoting a sensitive interaction style during the development of the OIVA training (Burakoff & Launonen, [<reflink idref="bib27" id="ref48">27</reflink>]; Launonen, [<reflink idref="bib27" id="ref49">27</reflink>]; Martikainen & Burakoff, [<reflink idref="bib31" id="ref50">31</reflink>]; Martikainen et al., [<reflink idref="bib32" id="ref51">32</reflink>]; Vuoti et al., [<reflink idref="bib53" id="ref52">53</reflink>]): (a) being reciprocally present in the situation, (b) waiting and giving time for the individual to initiate an interaction, (c) responding to the individual's communication, (d) adjusting their own expressions to meet the individual's communication abilities, and (e) verifying mutual understanding.</p> <p>Moreover, in following the solution-focused principle, the SLP and staff members sought solutions to the issues that staff members had identified as being of most concern prior to the meeting (Martikainen & Burakoff, [<reflink idref="bib31" id="ref53">31</reflink>]; Martikainen et al., [<reflink idref="bib32" id="ref54">32</reflink>]; Vuoti et al., [<reflink idref="bib53" id="ref55">53</reflink>]). During the meeting, staff members decided on an issue that would improve their interaction with the person with MLD seen in the video. At the next meeting that aim was given more focus and developed further.</p> <p>In addition to the video-based guidance meetings, staff members also participated in six training sessions (see Figure 1). The aim of the first two training sessions was to ensure that all participating staff members had similar background knowledge about interaction and communication with the individuals with MLD. These sessions covered how to use sensitive interaction style and AAC strategies. The next two training sessions gave staff members tools for creating individual communication passports for the individuals with MLD (Millar & Aitken, [<reflink idref="bib39" id="ref56">39</reflink>]). Since the participating organisations were located in different parts of Finland, the aim of the last two training sessions was to provide all participating staff with an opportunity to meet and discuss their experiences and views of the training.</p> <p>Furthermore, the developers of the OIVA training program (viz., the second and third author of this article, both certified SLPs) worked closely with the participating organisations. The organisational manager from each organisation attended regular meetings with the developers in order to monitor the progress of the OIVA training.</p> <hd id="AN0055507810-6">Method</hd> <p></p> <hd id="AN0055507810-7">Research design</hd> <p>Qualitative methods were chosen because of the exploratory nature of the study (Miles & Huberman, [<reflink idref="bib38" id="ref57">38</reflink>]). Qualitative methods are "particularly useful when the topic under investigation is complex, dilemmatic, novel or under-researched and where there is a concern with understanding process rather than measuring outcomes" (p. 604) (Smith & Dunworth, [<reflink idref="bib47" id="ref58">47</reflink>]). We used a semistructured interview method (Kvale, [<reflink idref="bib24" id="ref59">24</reflink>]) to give staff members (hereafter referred to as <emph>informants</emph>) the opportunity to describe their own personal stories of development as successful communication partners with their clients with MLD. We used these stories to identify the particular issues they perceived were important as effective communicators.</p> <hd id="AN0055507810-8">Informants</hd> <p></p> <hd id="AN0055507810-9">Selection of informants.</hd> <p>A combination of qualitative sampling methods—criterion and opportunistic sampling—was used (Patton, [<reflink idref="bib44" id="ref60">44</reflink>]). Consequently, we acknowledge that we did not have a representative sample (Marshall, [<reflink idref="bib30" id="ref61">30</reflink>]). The criterion sampling of the present study consisted of selecting informants who (a) had participated in OIVA training from the beginning, and (b) were still employed in the same department as they were employed in during that training. It was important that the informant was able to describe the whole OIVA training and also how communication situations in the department were conducted after the video-based guidance meetings had finished. In one of the three organisations involved in the training, only two informants met these criteria. Therefore, it was decided to choose two staff members from each organisation to be interviewed.</p> <p>Opportunistic sampling was employed to select the rest of the informants. As Spradley ([<reflink idref="bib49" id="ref62">49</reflink>]) noted, informants should be able to speak as members of the communities they represent. Therefore, the staff members selected needed to be able to describe how their community—participating colleagues, nonparticipating colleagues, and supervisors—encouraged and assisted them during the training. Accordingly, the selection of the rest of the informants was influenced by the participant observer method (O'Reilly, [<reflink idref="bib43" id="ref63">43</reflink>]): two staff members from each organisation who, firstly, met the criteria mentioned above and, secondly, were competent to speak on behalf on themselves as well as their respective communities. The professionals responsible for the training identified these staff members.</p> <hd id="AN0055507810-10">Selected informants.</hd> <p>All six informants were women, and their ages ranged from 29 to 58 years. Four of the staff members worked in residential settings and two in day services for individuals with MLD. The work experience of the staff members ranged from 4 to 38 years. Two of the informants had bachelor's degrees in social services and one of the informants was a trained nurse. Three of the informants had a degree in practical nursing. All informants had specialised in working with individuals with MLD in their studies.</p> <hd id="AN0055507810-11">Interview</hd> <p>Each informant was interviewed 2 months after the last training session of the OIVA training. The interviews took place at the premises of each informant's organisation, and were located in different parts of Finland. Thus, to save time and expense, each organisation had a different interviewer. The first author of this paper was one of the interviewers. The other two interviewers were research assistants who were final year SLP students completing their master's theses on OIVA training. The interviewers did not take part in the preceding OIVA training and did not have a previous professional relationship with the informants. Before the interviews, the first author of this paper introduced the research assistants to the OIVA training to ensure they had enough background knowledge to be able to ask informed questions.</p> <p>The interviewers jointly designed an interview protocol based on a pilot interview of one staff member who had participated in OIVA training (see Table 1). The questions were open-ended; this allowed staff members to talk about their personal experiences and also to volunteer any additional information they thought was relevant (Kvale, [<reflink idref="bib24" id="ref64">24</reflink>]). There was, however, flexibility in the sequence of the topics covered, and the exact wording of the questions asked in each interview varied. In order to facilitate the accuracy of data collection, interviews were videotaped with the informants' consent.</p> <p>Table 1. Interview protocol</p> <p> <ephtml> <table><tbody valign="top"><tr><td>Questions exploring the views before the OIVA training:</td></tr><tr><td> 1. What did you think about the OIVA training when it started?</td></tr><tr><td> 2. Why did you participate in the training?</td></tr><tr><td> 3. What kind of goals did your community/colleagues set to be achieved?</td></tr><tr><td> 4. What kind of goals did you set for the individuals to be achieved?</td></tr><tr><td>Questions exploring the views during the OIVA training:</td></tr><tr><td> 5. What did you think about the length of the OIVA training period?</td></tr><tr><td> 6. If you could go back, what would you have done differently during the training?</td></tr><tr><td> 7. How did the community/colleagues support you during the training?</td></tr><tr><td> 8. What did your colleagues think about the training?</td></tr><tr><td> 9. What did you think about watching the videos in meetings with your colleagues?</td></tr><tr><td>Questions exploring the views after the OIVA training:</td></tr><tr><td> 10. How did the OIVA training impact the lives of the individuals in your community?</td></tr><tr><td> 11. What do you think now about the training?</td></tr><tr><td> 12. Do you think that you have changed as an interaction partner as a result of the training?</td></tr><tr><td> 13. If you believe you have, what contributed to such progress?</td></tr><tr><td> 14. What do your colleagues think now about the training?</td></tr><tr><td> 15. Has your community's interaction environment changed as a result of the training?</td></tr><tr><td> 16. If it has, what contributed to the change?</td></tr><tr><td> 17. Have you seen changes in the behaviour of the individuals with whom you interact?</td></tr><tr><td> 18. If you have, how do you account for these changes?</td></tr></tbody></table> </ephtml> </p> <hd id="AN0055507810-12">Data analysis</hd> <p>The duration of the videotaped interviews ranged from 20 to 30 minutes. Interviews were transcribed verbatim and analysed using a combination of Miles and Huberman's ([<reflink idref="bib38" id="ref65">38</reflink>]) inductive approach, Thomas' ([<reflink idref="bib50" id="ref66">50</reflink>]) general inductive approach, and Auerbach and Silverstein's ([<reflink idref="bib3" id="ref67">3</reflink>]) approach for analysing qualitative data (based on grounded theory). Initially, the first author of this paper read and reread all the transcripts and, once familiar with the data, began the process of data reduction—selecting the relevant passages from the transcripts. The aim was to focus on passages where informants described issues about communication with individuals with MLD that they or their community had come to understand as a result of the training; thus, these extracts were identified prior to the analysis. A passage was identified as a description of such an understanding if the informant used words related to acquiring new information or practices such as <emph>"I learned," "I started to," "we became more aware of,"</emph> or described the new understandings directly using sentences such as <emph>"x has changed," "I do x differently,"</emph> or if the informant used temporal adverbs such as <emph>"before we x, but now we x," "previously I."</emph> The informants used a mean value of 2,512 words in the interviews (ranging from 1,541 to 3,484 words), and 1,229 (49%) (ranging from 600 to 2,184 words) of those words were used to describe the improvements in informants' communication.</p> <p>After this process of identifying the relevant passages, the first author of this study developed initial categories based on patterns and relationships in the data. Since this was a qualitative study, the subjectivity of the first author's interpretations and the research context no doubt affected the creation of these categories to some extent. Therefore, the trustworthiness or the justifiability of the categories and the analysis was examined through the categories' transparency and communicability (Auerbach & Silverstein, [<reflink idref="bib3" id="ref68">3</reflink>]). Transparency was established in two ways. Firstly, both the first author and one of the research assistants independently coded one of the interviews using the initial categories developed by the first author. Afterwards, the first author and the research assistant compared their codes and discussed the relevance of each category and how the interpretations of the passages were made. This was done to affirm the clarity of the categories and to establish a final coding scheme (Thomas, [<reflink idref="bib50" id="ref69">50</reflink>]).</p> <p>Secondly, specific examples from the data were included throughout the results to demonstrate and corroborate assertions. In the examples given, the informants have been assigned a random number to ensure their anonymity. The original interviews were in Finnish and have been translated into English, with every attempt not to impair the content. An authorised translator confirmed the translations.</p> <p>The communicability of the categories was also ascertained using two separate means. Firstly, the first author explained the categories to the research assistant and together they discussed and established the final titles for each category. Secondly, the categories were explained to one of the informants, and she confirmed that they accurately reflected her experience. To avoid repetition, the results are discussed below after presenting each category.</p> <hd id="AN0055507810-13">Results and discussion</hd> <p>During the interviews the informants explored several issues that, as a result of the OIVA training, they saw as important for their development as communication partners. These realisations were related to communication practices and thinking habits about communication (see Table 2).</p> <p>Table 2. The final coding scheme</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Main category</td><td>Subcategory</td><td>Examples</td></tr></thead><tbody valign="top"><tr><td valign="top">Communication practices</td><td valign="top">Being patient</td><td>Giving more opportunity for communicants to communicate</td></tr><tr><td>Waiting for communicants to initiate communication</td></tr><tr><td valign="top">Learning to interpret communication attempts by the communicants</td><td>Knowing what communicants mean with their nonverbal and verbal expressions</td></tr><tr><td>Verifying that there is a mutual understanding</td></tr><tr><td>Exploring and discussing with other staff members what communicants might mean</td></tr><tr><td valign="top">Communicating clearly</td><td>Using clear sentences and speaking about one thing at a time</td></tr><tr><td>Using augmentative and alternative communication (AAC) strategies that suit communicants</td></tr><tr><td>Using communication acts similar to those used by the communicants (such as vocalisations) to establish contact</td></tr><tr><td valign="top">Thinking habits</td><td valign="top">Realising the individuals' communication skills</td><td>Communicants have opinions</td></tr><tr><td>Communicants try to express their opinions</td></tr><tr><td>Communicants can make decisions about their daily life</td></tr><tr><td valign="top">Giving priority to communication</td><td>It is important to stop and listen to communicants</td></tr><tr><td>It is important to concentrate on the communicants while taking care of them</td></tr><tr><td valign="top">Viewing the essence of work</td><td>It is essential to spend time together rather than to perform tasks</td></tr><tr><td>Productiveness also includes situations when nothing special happens</td></tr><tr><td>Work can be fun</td></tr></tbody></table> </ephtml> </p> <hd id="AN0055507810-14">Communication practices</hd> <p></p> <hd id="AN0055507810-15">Being patient.</hd> <p>All informants (<emph>n</emph> = 6) emphasised that the OIVA training had taught them to be more patient during interaction situations and to give more time and opportunities for the individual with MLD to take the lead during communication situations. As one informant explained</p> <p>One now thinks more of approaching the communication situation in the sense that there be [<emph>sic</emph>] more room for the partner to be able to express himself. (Staff member 4)</p> <p>Dennis ([<reflink idref="bib10" id="ref70">10</reflink>]) has also noted that skilled interaction partners value the capacity to make room for silence when communicating with people with MLD. Furthermore, individuals with MLD need more time to initiate communicative acts (McLean et al., [<reflink idref="bib36" id="ref71">36</reflink>]). Thus, the ability of staff members to be patient provides the individual with MLD with more opportunities for interaction (Light, Dattilo, English, Gutierrez, & Hartz, [<reflink idref="bib28" id="ref72">28</reflink>]).</p> <hd id="AN0055507810-16">Learning to interpret communication attempts by the people with MLD.</hd> <p>The informants (<emph>n</emph> = 6) repeatedly voiced that their new priority was to try to understand their clients' communication attempts. Thus, they had started to focus on the individuals' gestures and facial expressions to help them to better understand what was being communicated:</p> <p>We ponder what the individual means and wants to say with that particular facial expression, and if we had not started to concentrate on these expressions and ask [the individuals] if they mean this or that, no change would have happened. (Staff member 5)</p> <p>Furthermore, informants (<emph>n</emph> = 5) had begun discussing with their colleagues how different individuals used different nonverbal modes to communicate. They felt that this new practice had improved their ability to interpret the intended meaning of individuals, as explained here:</p> <p>We talk a lot more about the individuals' initiatives, like "this individual did this and whether he has ever done that before and whether you think that it was related to ..." and in our daily official meetings [with other staff members and supervisors] we also try to concentrate on this. (Staff member 3)</p> <p>Creating understanding between individuals and staff members requires that staff interpret the verbal and nonverbal expressions of their clients (von Tetzchner & Jensen, [<reflink idref="bib52" id="ref73">52</reflink>]). However, making the right interpretation can be difficult. These interpretations are easier if (a) the staff member knows the individual very well, or (b) if there are several staff members involved in making the interpretations (Ware, [<reflink idref="bib54" id="ref74">54</reflink>]). Thus, sharing knowledge about an individual's different ways of communication gives the staff a better chance of understanding that individual accurately.</p> <hd id="AN0055507810-17">Communicating clearly.</hd> <p>All six informants discussed the ways they expressed themselves when communicating with individuals with MLD. Firstly, they (<emph>n</emph> = 3) realised that when they use clear sentences and nonverbal communication, and talked about one topic at a time, they are more likely to be understood. Being conscious of the need to simplify their attempts at communication with their clients is a challenge for staff members (Bradshaw, [<reflink idref="bib7" id="ref75">7</reflink>]).</p> <p>Secondly, three informants started to consider their own use of AAC strategies. They reported that they had learned the importance of ascertaining whether individuals had understood the AAC strategies that had been used, and noted that it is the staff member's responsibility to try to find strategies that benefit the individual with MLD.</p> <p>For years we just showed him a [picture of a] clock and said that it meant to take a break but to him it meant that it is a clock. (Staff member 2)</p> <p>An appropriate AAC strategy for an individual cannot be predetermined based on the person's developmental age or measures such as the level of the individual's learning disability (Mirenda & Mathy-Laikko, [<reflink idref="bib40" id="ref76">40</reflink>]). Thus, it is important that the staff members acknowledge the limitations of what can be communicated and understood by the individual (Ware, [<reflink idref="bib54" id="ref77">54</reflink>]), and to try to find strategies that are suitable for each individual.</p> <p>Finally, the informants (<emph>n</emph> = 6) realised that using communicative acts that are similar to those used by their clients (such as vocalisations and gestures) helps create contact. Indeed, one of the informants stated that, although previously embarrassed to do this, OIVA training had given her confidence to express herself this way:</p> <p>In my previous job I had clients who did not speak at all but they did vocalise a lot, and whenever I was alone I secretly [vocalised with them] ... but, in a way, it's embarrassing ... I don't care at all anymore. If a new [staff member] comes along and I am vocalising with my clients ... I clarify [to her] that this is like his [the client's] conversation and you should try it and you can have much better contact with him. (Staff member 2)</p> <p>Dennis ([<reflink idref="bib10" id="ref78">10</reflink>]) and Nind and Hewett ([<reflink idref="bib42" id="ref79">42</reflink>]) reported that mirroring the communicative behaviours of individuals with MLD is an important means of establishing or encouraging interaction. However, staff members often have reservations about using this kind of approach (Firth et al., [<reflink idref="bib12" id="ref80">12</reflink>]). The reason for these reservations stems from the philosophy of "normalisation" in social care (Wolfensberger, [<reflink idref="bib55" id="ref81">55</reflink>]): that activities provided to the individuals should be age-appropriate. Because using vocalisations are considered "childish," the conclusion has been that this is not suitable for adults. The informant quoted above provided further insight into such reservations: she had been embarrassed to use the mirroring approach. As Dennis ([<reflink idref="bib10" id="ref82">10</reflink>]) noted, taking risks and making mistakes are some of the traits possessed by the successful interaction partners of individuals with MLD. Thus, flexibility and overcoming uncomfortable personal inhibitions are key factors if staff members are to improve their communicative interactions with these clients.</p> <hd id="AN0055507810-18">Thinking habits</hd> <p></p> <hd id="AN0055507810-19">Realising the individuals' communication skills.</hd> <p>It seemed that OIVA training increased the informants' (<emph>n</emph> = 6) confidence in the ability of their clients to express opinions. Essentially, they understood that individuals with MLD do have opinions about their daily life, as the following passage explains:</p> <p>It is so easy to think that when one talks, things get to be resolved. But what happens when one [client] does not talk? One [a staff member] has not considered that such an individual can have opinions even though he does not speak. (Staff member 3)</p> <p>This demonstrates a problem staff members face everyday: since the clients do not speak, it is difficult to know what they mean. As noted previously, the informants perceived that they had become better at interpreting the expressions of individuals with MLD as a result of OIVA training. All six informants perceived that these clients do have opinions:</p> <p>Some people clearly seem to have good opinions of their own which they bring forward, and now we have noted that they express them very clearly, but we just did not see them before. (Staff member 3)</p> <p>Bigby et al. ([<reflink idref="bib4" id="ref83">4</reflink>]) noted that staff members do not value the possibility that clients who use developmentally early means of communication can make choices. Therefore, if staff members are better able to interpret the individuals' expressions, the issue of choice making becomes relevant. This, however, requires the belief that such individuals can and do attempt to express their views (Dennis, [<reflink idref="bib10" id="ref84">10</reflink>]; von Tetzchner & Jensen, [<reflink idref="bib52" id="ref85">52</reflink>]). Informants perceived that they had become more successful at interpreting the communicative acts of the individuals with MLD. This gave them confidence in realising that their clients do try to communicate and thus can make choices, and should be given opportunities to choose their daily activities, as suggested here:</p> <p>Today our clients can influence what we do. We have in our weekly schedule a choice in the opportunities we can give. Obviously we cannot give limitless choice. But earlier, everyone painted today and will do puzzles tomorrow. However, now [following OIVA training] individuals can have their say [in the daily routine]. (Staff member 1)</p> <p>This demonstrates that OIVA training led informants to ask about individuals' desires and that, as a result, staff members are obliged to match those desires with the opportunities the organisation can provide. Since policies dictate the roles of an organisation's staff members (Forster & Iacono, [<reflink idref="bib13" id="ref86">13</reflink>]), staff members can only provide the choices that are available to individuals. Nevertheless, as a result of staff members' judgments that their clients do have and can make choices, organisations themselves learn the need to be more flexible and consider new solutions for meeting the needs of individuals with MLD (Cullen, [<reflink idref="bib9" id="ref87">9</reflink>]).</p> <hd id="AN0055507810-20">Giving priority to communication.</hd> <p>Informants also felt that they had started to give priority to communication situations. All six described that they had learned to stop and listen to individuals, even at their busiest times:</p> <p>Then I just learnt to think in a different way; that this individual means something now and that I cannot just ignore it by saying that I am busy. I need to stop and listen to him. (Staff member 6)</p> <p>Furthermore, two of the informants described how they had started to make sure that care situations always included communicative interaction with individuals; this change in their thinking habit was thus reflected in their practices:</p> <p>I have started to concentrate on what I am doing with the individual. Now every situation has interaction within it; thus the daily care situations are not only "tricks" that we do, like washing the individual quickly, but the situation also includes communication. (Staff member 5)</p> <p>Moreover, another informant described the same issue including some self-criticism of previous work habits:</p> <p>[Now] we try not to talk over [the individual] and if there are two of us [staff members] taking care of the individual, we try to talk to the individual, and the weekend conversation [with the other staff members] will be left to another time. (Staff member 3)</p> <p>Hile and Walbran ([<reflink idref="bib19" id="ref88">19</reflink>]) also noted this same issue: staff members easily engage in nonwork-related conversations with other staff members while at their work. Hile and Walbran offered two possible reasons for this. Firstly, with many staff members present at the same time, it is easy to have a conversation with colleagues. Secondly, the responsibility (Latané, [<reflink idref="bib26" id="ref89">26</reflink>]) between the staff members is diffused and the need to work hard diminishes. There is still another possibility: since interacting with the individuals with MLD can be difficult, staff members may choose to interact with other staff members rather than with the individual with MLD. Therefore, if staff members feel that communication with the individuals with MLD is easy or easier, they might include these individuals in their conversations more often.</p> <hd id="AN0055507810-21">Viewing the essence of work.</hd> <p>The OIVA training program appeared also to influence how some of the informants viewed the essence of their work (<emph>n</emph> = 3). One of the informants in particular explored this topic extensively. She had concluded that it is more essential for individuals to be understood in their own community than it is to complete tasks. Furthermore, she realised that keeping busy was not the only way she was able to show her supervisors that she was doing her work properly. The moments when nothing special happens can also be productive, as she explained:</p> <p>It is not so important anymore that we can get the puzzle done but if he wants to talk about something else other than the puzzle, then so what? I think it is much more important to the client that, if he has some thing to tell me, I try to understand it. (Staff member 1)</p> <p>Gardner and Rikberg Smyly ([<reflink idref="bib15" id="ref90">15</reflink>]) noted that serving the needs of individuals with MLD means not only providing activities but also creating opportunities for them to express emotions and to establish close relationships. It seemed that during OIVA training, informants had started to ponder the contribution of their companionship to the lives of the people with whom they worked.</p> <hd id="AN0055507810-22">Limitations and directions for future research</hd> <p>When interpreting the findings of the present study, several limitations should be acknowledged. Firstly, since only six informants were interviewed, we therefore cannot claim that all of the participating staff members had started to think similarly. Secondly, the sampling of informants was conducted by those who were directly involved with the training and the sampling was opportunistic. However, since only 31 staff members completed the OIVA training, the sample size was already small. Therefore, it was considered important to find those informants who were viewed as able to describe their own and their communities' stories of improvement to gain as much information as possible about the staff members' experiences during OIVA training. Finally, the qualitative method used for analysing the interviews does not claim to be objective, although the researchers aimed to overcome any personal bias by discussing their interpretation of the data as described above.</p> <p>There is a need for future research that focuses on the relationship between thinking habits and communication practices in the communication training programs. Based on the premises of the findings reported here, there is need for qualitative studies that measure the efficacy and outcomes of training. For example, it would be of interest to investigate at what point staff members come to new understandings about work practices and thinking. OIVA training was of an extended duration, which consumed considerable time resources from the staff. Furthermore, informants perceived that their organisations influenced their ability to implement the new practices they had learned as OIVA participants. Consequently, more research is needed into which organisational factors help staff members successfully participate in interaction training. This could provide a more in-depth understanding of how to plan and implement training programs that influence staff members' communication practices and thinking habits successfully, particularly those that are adopted on a long-term basis. Finally, it is essential to study how OIVA training impacts the quality of daily life for people with MLD.</p> <hd id="AN0055507810-23">Conclusions</hd> <p>The aim of this paper was to identify what the informants realised was important for their professional development as communication partners after OIVA training. The results showed that, in addition to discovering new communication practices, the informants had also pondered several ethical questions relating to individuals with MLDs' sense of belonging in the community, and their right to be understood and to understand the communication of others. This resulted in informants reporting that they started to ask clients for their opinions about daily life and to act according to their clients' wishes. These results are similar to the findings of Ager and O'May (2001): change in thinking habits is an essential factor for well-implemented staff training.</p> <p>Since the informants described both communication practices and thinking habits, it can be argued that they perceived that both were important for their development as successful communication partners. Moreover, the change in the communication practices seemed to be closely related to such newly discovered thinking habits, since the changes in thinking were clearly reflected in the informants' reports of their subsequent practices. Thus, interaction training should give opportunities for participants to learn new practices and at the same time explore the assumptions that underlie the services they perform. Furthermore, informants in this study perceived that their organisation influenced their ability to implement what they had learned as OIVA participants. Thus, for any change to be effective, the whole organisation should be committed to the improvements sought by staff training, as it relates to both communication practices and the typical assumptions involved in those practices.</p> <p>It is not possible to pinpoint exactly how OIVA training's main principles—<emph>community-based rehabilitation, client-oriented</emph> and <emph>solution-focused approach</emph>, or the <emph>video-based guidance working method</emph>—helped the informants to understand the issues discussed above. However, the principle of community-based rehabilitation seemed to have influenced them since the informants noted that sharing knowledge about people with MLDs' ways of communication with other staff members was important. Furthermore, the video-based guidance meetings gave staff a structured form for sharing that information. To conclude, in the future the training will concentrate both on promoting staff members' communication skills and on giving them the possibility to reflect on their thinking habits.</p> <hd id="AN0055507810-24">Author note</hd> <p>This research was funded by the Finnish Association on Intellectual and Developmental Disabilities and the Finnish Concordia Fund. The funding bodies have not imposed any restrictions on free access to or publication of the research data. The authors will not receive any direct financial benefit from the findings presented in this paper.</p> <hd id="AN0055507810-25">Acknowledgements</hd> <p>The assistance of Liisa Alapuranen and Piia Siivonen is gratefully acknowledged. The authors also acknowledge the comments of Tom Regelski and Anu Klippi on this paper.</p> <ref id="AN0055507810-26"> <title> References </title> <blist> <bibl id="bib1" idref="ref21" type="bt">1</bibl> <bibtext> Ager, A., O'May, F. (2001). 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Geneva, Switzerland: Author.</bibtext> </blist> </ref> <aug> <p>By Katja Koski; Kaisa Martikainen; Katja Burakoff and Kaisa Launonen</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib34" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib51" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib11" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib36" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib54" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib42" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib45" firstref="ref7"></nolink> <nolink nlid="nl8" bibid="bib52" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib35" firstref="ref15"></nolink> <nolink nlid="nl10" bibid="bib37" firstref="ref16"></nolink> <nolink nlid="nl11" bibid="bib12" firstref="ref17"></nolink> <nolink nlid="nl12" bibid="bib16" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib29" firstref="ref20"></nolink> <nolink nlid="nl14" bibid="bib10" firstref="ref22"></nolink> <nolink nlid="nl15" bibid="bib33" firstref="ref27"></nolink> <nolink nlid="nl16" bibid="bib31" firstref="ref28"></nolink> <nolink nlid="nl17" bibid="bib32" firstref="ref29"></nolink> <nolink nlid="nl18" bibid="bib53" firstref="ref30"></nolink> <nolink nlid="nl19" bibid="bib23" firstref="ref31"></nolink> <nolink nlid="nl20" bibid="bib17" firstref="ref32"></nolink> <nolink nlid="nl21" bibid="bib41" firstref="ref33"></nolink> <nolink nlid="nl22" bibid="bib46" firstref="ref34"></nolink> <nolink nlid="nl23" bibid="bib48" firstref="ref35"></nolink> <nolink nlid="nl24" bibid="bib20" firstref="ref39"></nolink> <nolink nlid="nl25" bibid="bib56" firstref="ref40"></nolink> <nolink nlid="nl26" bibid="bib25" firstref="ref41"></nolink> <nolink nlid="nl27" bibid="bib22" firstref="ref42"></nolink> <nolink nlid="nl28" bibid="bib18" firstref="ref43"></nolink> <nolink nlid="nl29" bibid="bib21" firstref="ref45"></nolink> <nolink nlid="nl30" bibid="bib14" firstref="ref47"></nolink> <nolink nlid="nl31" bibid="bib27" firstref="ref48"></nolink> <nolink nlid="nl32" bibid="bib39" firstref="ref56"></nolink> <nolink nlid="nl33" bibid="bib38" firstref="ref57"></nolink> <nolink nlid="nl34" bibid="bib47" firstref="ref58"></nolink> <nolink nlid="nl35" bibid="bib24" firstref="ref59"></nolink> <nolink nlid="nl36" bibid="bib44" firstref="ref60"></nolink> <nolink nlid="nl37" bibid="bib30" firstref="ref61"></nolink> <nolink nlid="nl38" bibid="bib49" firstref="ref62"></nolink> <nolink nlid="nl39" bibid="bib43" firstref="ref63"></nolink> <nolink nlid="nl40" bibid="bib50" firstref="ref66"></nolink> <nolink nlid="nl41" bibid="bib28" firstref="ref72"></nolink> <nolink nlid="nl42" bibid="bib40" firstref="ref76"></nolink> <nolink nlid="nl43" bibid="bib55" firstref="ref81"></nolink> <nolink nlid="nl44" bibid="bib13" firstref="ref86"></nolink> <nolink nlid="nl45" bibid="bib19" firstref="ref88"></nolink> <nolink nlid="nl46" bibid="bib26" firstref="ref89"></nolink> <nolink nlid="nl47" bibid="bib15" firstref="ref90"></nolink>
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  Label: Title
  Group: Ti
  Data: Staff Members' Understandings about Communication with Individuals Who Have Multiple Learning Disabilities: A Case of Finnish OIVA Communication Training
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Koski%2C+Katja%22">Koski, Katja</searchLink><br /><searchLink fieldCode="AR" term="%22Martikainen%2C+Kaisa%22">Martikainen, Kaisa</searchLink><br /><searchLink fieldCode="AR" term="%22Burakoff%2C+Katja%22">Burakoff, Katja</searchLink><br /><searchLink fieldCode="AR" term="%22Launonen%2C+Kaisa%22">Launonen, Kaisa</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+%26+Developmental+Disability%22"><i>Journal of Intellectual & Developmental Disability</i></searchLink>. Dec 2010 35(4):279-289.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Informa Healthcare. Telephone House, 69-77 Paul Street, London, EC2A 4LQ, UK. Tel: 800-354-1420; e-mail: healthcare.enquiries@informa.com; Web site: http://informahealthcare.com/action/showJournals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2010
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Adult+Education%22">Adult Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Learning+Disabilities%22">Learning Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Severe+Disabilities%22">Severe Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Semi+Structured+Interviews%22">Semi Structured Interviews</searchLink><br /><searchLink fieldCode="DE" term="%22Participant+Satisfaction%22">Participant Satisfaction</searchLink><br /><searchLink fieldCode="DE" term="%22Performance+Factors%22">Performance Factors</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Habit+Formation%22">Habit Formation</searchLink><br /><searchLink fieldCode="DE" term="%22Thinking+Skills%22">Thinking Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Staff+Development%22">Staff Development</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Research%22">Communication Research</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Skills%22">Communication Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Strategies%22">Communication Strategies</searchLink><br /><searchLink fieldCode="DE" term="%22Multiple+Disabilities%22">Multiple Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Caregiver+Attitudes%22">Caregiver Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Finland%22">Finland</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.3109/13668250.2010.517189
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1366-8250
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Often communication training has been directed at the communication practices of staff members working with people with multiple learning disabilities. To date, the thinking habits of staff members, which also influence interactions, have not been addressed. We identified the issues staff members perceived as important for their development as communication partners after participating in a communication training program. Method: Six key staff members participated in semistructured interviews that explored the insights they had gained during participation in the Finnish communication training program OIVA. Results: Participating staff members identified issues relating to the communication practices and thinking habits they had acquired during the training. Both communication practices and thinking habits were important for the staff members' development as communication partners. Conclusions: The findings of this study suggest that it is important to give staff members the opportunity to learn new practices and to explore the thinking that underpins the actions they perform during communication training. (Contains 1 figure and 2 tables.)
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 56
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2012
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ961786
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ961786
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    Identifiers:
      – Type: doi
        Value: 10.3109/13668250.2010.517189
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 279
    Subjects:
      – SubjectFull: Learning Disabilities
        Type: general
      – SubjectFull: Severe Disabilities
        Type: general
      – SubjectFull: Semi Structured Interviews
        Type: general
      – SubjectFull: Participant Satisfaction
        Type: general
      – SubjectFull: Performance Factors
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Habit Formation
        Type: general
      – SubjectFull: Thinking Skills
        Type: general
      – SubjectFull: Staff Development
        Type: general
      – SubjectFull: Communication Research
        Type: general
      – SubjectFull: Communication Skills
        Type: general
      – SubjectFull: Communication Strategies
        Type: general
      – SubjectFull: Multiple Disabilities
        Type: general
      – SubjectFull: Caregiver Attitudes
        Type: general
      – SubjectFull: Interpersonal Communication
        Type: general
      – SubjectFull: Finland
        Type: general
    Titles:
      – TitleFull: Staff Members' Understandings about Communication with Individuals Who Have Multiple Learning Disabilities: A Case of Finnish OIVA Communication Training
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            – TitleFull: Journal of Intellectual & Developmental Disability
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