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CHAPTER THREE: OVERARCHING ISSUES
3.1. Communication support needs is a relatively new term which is intended to act as an overarching expression for all the different communication disabilities listed. Attempts to unify these different disabilities at all are relatively new. The first attempt that we could identify in the UK was the report for the Communication Forum in England entitled Living with Communication Impairment (Parr, Byng, Woolf et al. 1997). Drawing on the experiences of people with dyslexia, aphasia, autism, head injury, learning disability and laryngectomy the authors describe the consequences of communication impairment and conclude that:
" While some people became overcome by such barriers, others indicate issues which need to be tackled and how this could be done. They feel that the emphasis should shift from fixing the impairment to removing the barriers in society through education, information, awareness raising, legislation and applying the principles of equal opportunities and human rights to the issue of communication impairment."
(Parr, Byng, Woolf et al. 1997 p.3)
3.2. A recent initiative in Scotland has proposed the conceptualisation of people with communication support needs as a single group. In The Case for Action: A Strategy for People with Communication Impairment Turnbull and colleagues have highlighted the disadvantages of separating out the needs of the different groups that come under the umbrella of communication support needs and attempts to characterise the impact of communication impairment (Turnbull, Macintosh, Edmonstone et al. 2004). They ask readers to imagine living for a day as a person with a communication support need:
- Unable to fully understand what is being said to you
- Unable to understand the "funny side" when everyone else laughs
- Wondering as you speak how or indeed if the words are going to come out to express your thoughts
- Unable to make sense of written words
- Wondering if the next person you try to speak to will wait and listen, or turn away or even accuse you of being drunk.
Turnbull, Macintosh, Edmonstone et al. 2004 p.5.
3.3. The concept of an inclusive communication strategy as a way of providing for these needs has started to be rolled out in some areas in Scotland (eg. the Lothian Inclusive Communication Strategy 2006) but such strategies tend to be local or relate to specific services and are by no means generally applied.
3.4. The sense that there are moves in the direction of combining the needs of people with CSN is reflected in a recent paper produced for The King's Fund in England as part of The Communication Access Toolkit project (Parr et al 2006, forthcoming) has attempted to develop this further by looking in more detail at the provision for the needs of the following groups with communication disabilities:
- People with learning disabilities
- People with dementia
- People with mental health issues
- Older people
- People who use technologies and devices in communication
- Deaf people and those with hearing impairment
- People with aphasia
3.5. The review looked at different initiatives around access for people with communication difficulties rather than support needs.
Given the disparate nature of access initiatives for people with different communication impairments, this study imposed a coherent conceptual framework, and considered each initiative along the following parameters:
- Model of disability
- The relationship between the person with communication disability and the service provider
- Access to different services
- Levels of access
- Focus of efforts to enhance access
- Relevance to other groups and to the wider community
The conclusion drawn from this review was that many initiatives work along similar or related lines, and that people with different communication impairments would broadly benefit from the same attempt to lessen or remove disabling barriers, although obviously specific skills and techniques for supporting interaction might vary from impairment to impairment. However, the links between the issues faced by people with different impairments have not often been made explicit within the literature.
3.6. The survey of the needs of adults with "speech disabilities" in Newcastle ( UK) carried out by the Joint Advisory Group (sensory and physical disability) and Disability North (Knight, Sked and Garrill 2003) has highlighted the level of public ignorance about this group, an ignorance that runs across society from the health and social service sector through to the retail and utilities sectors.
3.7. In the main the focus of this review is the experience of individuals with communication support needs, the barriers that they face and the mechanisms which facilitate their access to services. But another dimension which is important is the economic implications of communication support needs. It has been argued that the nature of employment has changed considerably over the last century, with white collar jobs replacing blue collar jobs in western economies (Ruben 2000). This has considerable implications for the person with communication support needs. One of the features of the increasing proportion of white collar jobs is the rise in the demand for adequate communication skills. Indeed it is not uncommon for business leaders to complain about the poor levels of communication and literacy skills in those leaving schools. The argument is used to imply that the school system is failing children but, of course, this shortfall may well also be a function of the increasing expectations of the workforce. Economic analysis is not a feature of this review but it is important to draw attention to a recent review from the children's charity ICAN entitled the Cost to the Nation of Children's Poor Communication (Hartshorne 2006). In it, the case is made for the significance of communication as a matter of social policy. This is a significant issue because the rationale for action on communication support needs must rest on both humanitarian and economic issues.
3.8. Finally, it is important to recognise that there are many documents related to disability of one sort or another which have a direct bearing on the needs of people with communication support needs, but which do not explicitly refer to them. For example, the Disability Rights Commission regularly produces documents which are highly relevant. The DRC published their guidance on web access for people with disabilities in 2004 ( DRC 2004). No mention is made of communication support needs specifically, but every aspect of the document is relevant. Similarly, three relatively recent reports on the state of health and disability in Scotland and in England (Scottish Council Foundation 2005, Disability in Scotland 2005-2020: A state of the nation report; Scottish Executive (2004) Social Focus on Disability; Disability Rights Commission (2006 a and b) Parts 1 and 2 Equal treatment: Closing the gap) scarcely mention people with communication support needs at all.
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