Staff Handbook for Running A Workshop for Adults with Learning Disabilities 1
Introduction This handbook accompanies the workbook and workshop activities for adults with learning disabilities. The intention is to simply introduce the concept of personal risk and safety to learning disabled adults who whish to understand the issues and discuss how to cope with these issues in their lives. Such work should be undertaken in conjunction with assessment of lifestyle, personal needs, and support networks. This is only an introduction, and further support and work should be made available to participants. It is helpful, if possible, to involve key family members and workers in the discussions. The exercises can be shared with an individual or groups of varying sizes. The handbook is divided into 4 sessions so that the worker can decide on how much to complete each time, and indicates the corresponding page number in the individual s workbook (shown as WP6 etc.) and slide number on the presentation (shown as SN4 etc) Any important notes for the leader are in red. Each session has an accompanying table that informs the staff member of what they will need to complete the exercises. If the sessions are done on separate days there is no need to review the previous session as an introduction. This is because the workbook contents will be referred back to as part of each session in a contextual manner. This causes less confusion and builds on the learning. 2
Getting started It is important to be clear that the exercises will suit the individuals participating in the work. Staff presenting this work to participants should ensure that they are well prepared before each session, by checking the exercises and any equipment that they will use. Be sure to have enough material available for the number of participants, and organise yourself in your timings as it is easy to run out of time due to the depth of discussion that can occur. Participants should be individuals who are able to understand and participate in communication. The venue used should enable confidential discussion, provide access to those with physical difficulties, and encourage comfort and participation. Ensure all participants have a copy of the workbook; it is best to use a ring-binder format and only give out the page being worked on as time moves. This ensures that people are able to concentrate on the task at hand. Participants should have a source of support following the session, in order for them to spend time reviewing the work they have covered and to be able to ask further questions. This role might be taken by their main carer or key worker. 3
Session 1 4
Session 1: Session 1 looks at meeting people and the people in our lives. Group session Individual session Workbook pages 1-5 and binders Slide numbers 1-10 Workbook pages 1-5 and binders Slide numbers 1-10 Flip chart and pens Flip chart and pens Shape stickers Shape stickers Workbook page 19 Workbook page 19 SN2 Whether this is done with a group or an individual, it is important to agree how each of you will behave. This sets the scene regarding interpersonal respect, an important component in understanding relationships. Ensure that individuals understand the importance of their behaviour. You will need to inform people that you have a duty to report any concerns about their safety to your manager, but that such reports will be after discussion with the involved individual (this follows your duty of care responsibilities). SN3 and WP2 & 3 Let people know why they are involved in this work. Explain that each of the topics will involve sharing some talking and work. They may want to discuss personal experiences in each of the sessions. It is important to allow this, but to be alert to the extent of breach of personal information within a group setting. The staff member needs to be sure of when to stop group disclosure, and must not permit any discussion to turn into the victimisation of any individual. 5
SN 4 Exercise 1: this exercise is to enable people to start sharing information and put getting to know people into a context. If this is a group situation get people to make contact with someone they do not know very well. The idea here is to give the participants the opportunity to experience ways of making themselves known to others. In a group session the leader should observe how people greeted and introduced themselves, making notes on the flip chart. These observations should then be discussed with the group. In a session with an individual, the staff member should compare their behaviour with that of the participant e.g. physical contact, amount of information shared, body posture etc. SN 5 & 6 and WP 4 Participants will now explore how they meet people. This is also an opportunity to acknowledge that there are many different types of people in the world and our surrounding community. The staff member should assist participants to review the different types of people in their communities by race, culture, gender, age, interest, roles etc. This issue needs to be related to the various communities occupied by the participants so that they start to recognise that some of the communities we operate in are dictated by others e.g. the community in a day centre opposed to the community in our home neighbourhood. Participants need to recognise that they only know a few of these people and that our knowledge of people varies according to why we know them e.g. we know the postman at a different level to how well we know our grandparents etc. Refer to the groupings of people listed on SN6. SN 7 Exercise 2: in this exercise participants will relate the learning from the previous slides and workbook page by looking at the range of people in their lives. This is where group participants will need to have some individual support from either their main carer or key worker. If participants need to have some type of symbol for them to recognise the names of those that go onto their sheet, they should be supported to think of a symbol to remind them e.g. 6
a drawing of a newspaper for the man in the paper shop where they go every morning etc. If you are running a group and such support is not available on the day, provide each participant with a flip chart sheet and the exercise instructions the week prior to the session, and ask a key person to support them in completing the exercise so that they can bring it to this session. SN 8 & 9 WP 5 & 17 Participants need to explore the issue of trust and what it means. The staff member should encourage discussion about trust. Assist the discussion by providing a personal example that everyone can relate to e.g. parents trust teachers to look after their children in school and keep them safe. Get participants to complete their personal page for the workbook after this discussion (WP 19) SN10 Exercise 3: participants will now need to reflect on the names of people that appear on their flipchart sheet, developed in Exercise 2. Here the staff member will encourage participants to make an initial decision about the feelings that they hold for the people named on their sheet. There are 3 symbols indicating the depth of feeling and each symbol should be used in turn starting with the triangle, then the circle, then the heart. Participants might change their view of names and wish to allocate a different symbol. This is o.k. Finish this session by asking participants to choose one name off their sheet and describe the person, explaining why they have allocated them the chosen symbol. The leader should also do the same and conclude the session reminding participants of SN5. 7
Session 2 8
Session 2: Session 2 looks at communicating feelings. Group session Individual session Workbook pages 6-9 and binders Slide numbers 11-20 Workbook pages 6-9 and binders Slide numbers 11-20 Flip chart and pens Flip chart and pens Shape stickers Shape stickers Workbook pages 20-22 Workbook pages 20-22 Personal flipchart sheet from Session 1 Personal flipchart sheet from Session 1 Greeting scenario cards Greeting scenario cards Touch scenario cards Touch scenario cards This session explores feelings and how they are expressed/communicated. The leader my find that some participants become distressed in this session as they remember some negative experiences. Comfort and reassurance should be offered but any serious disclosure in a group setting should be distracted and dealt with at the end of the session in line with appropriate procedures. SN2 Whether this is done with a group or an individual, it is important to agree how each of you will behave. This sets the scene regarding interpersonal respect, an important component in understanding relationships. Ensure that individuals understand the importance of their behaviour. You will need to inform people that you have a duty to report any concerns about their safety to your manager, but that such reports will be after discussion with the involved individual (this follows your duty of care responsibilities). 9
SN11 and WP6 Start the session by re-introducing participants to the personal flipchart sheets that they produced during Session 1. If Session 1 has not been completed prior to this then the leader will need to do Exercises 2&3 from that session, before going ahead. Remind participants about the symbols that they allocated to the names on their sheet and give them an opportunity to change the allocated symbols if they wish. The leader must now enable participants to explore the roles played by the people allocated to each symbol by explaining SN11. Participants need to discuss the roles of the people on their sheets within their own lives. The leader can facilitate this exploration by having a sheet of their own. This can then be used to show the various roles as indicated on SN11. Participants are now being introduced to the concepts of LIKE, LOVE and SPECIAL LOVE. Support participants to complete WP6 by noting the roles of the people they have allocated symbols to. This exercise is to re-enforce the issue of roles for participants. Historically adults with learning disabilities have had problems with relationships because role and personal importance became blurred. Social behaviour is improved if people learn to recognise the true basis for a relationship and can allocate a socially acceptable behaviour to it. This way people start to understand what behaviour to expect from others, and the behaviour they should display in return. WP 18-20 Participants now have the opportunity to transfer the names of the people from their sheet to the separate workbook pages. SN12 & 13 10
It is important for participants to understand that our feelings can change. This can be re-enforced by asking participants if any of them had swapped the symbols allocated to names on their lists. The leader can also use a common example like their first boy/girl friend and how that relationship has changed. The issue of the extra meaning that comes from special love should be explored here by discussing things like hurt, trust, caring, missing etc. This workshop does not explore the issue of sexual relationships as this is a very individualised topic. If participants raise the issue then it should be acknowledged, but not focused upon. Any participant, who has a need to have a fuller discussion regarding sexual relationships, should be supported and directed to appropriate advice from a knowledgeable agent. SN 14 and WP 7 In order for participants to be able to make use of the previous discussion, they need to be able to explore social behaviour. The leader needs to encourage debate on how people show their feelings. Using the categories of behaviour described on SN14 and WP7 assist participants to debate examples of each behaviour. The cartoons shown can be examples. SN15 and 16 and WP8 Remind people of what they did in Exercise 1. If the leader has notes about various ways in which participants introduced themselves this can help the discussion of this section. The way in which we introduce ourselves and greet on another says much about our feelings and the relationship we have. It may be that our greetings are influenced by our culture e.g. continental cheek kissing, or Japanese bowing. Try to explore a couple of cultural examples so that participants can see that sometimes people might greet us in an unexpected way. Moving onto SN 16 get the group to discuss when the different types of greeting might be used. Encourage them to explore when each of these greetings might not be acceptable e.g. shouting to a friend you spot in the theatre etc. 11
SN 17 Exercise 4: this exercise provides an opportunity for participants to practice different greetings in different scenarios. Use the greeting scenario cards and ask pairs to act out how they would greet each other. Get the rest of the group to comment. The leader might need to select the scenarios to suit the participants rather than allowing random self selection. If this session is being done with an individual, the staff member should be prepared to act out the scenario with the person as it will re-enforce the learning. SN 18 20 and WP 9 Verbal communication plays a large part in social relationships. Often adults with learning disabilities are not supported to develop their social communication appropriately. This can lead to upset, breakdown in friendships, and continuation of the childlike stigma. Participants need space to explore how verbal communication assists in expressing how we feel about people, and to see that sometimes people can be damaged by what others say. The leader can facilitate this discussion by getting participants to offer examples that have been spoken to them. This section should be ended by asking participants to say something nice to the person on their right. The leader should start this off e.g. thank you for being helpful before, or I like your sweater. 12
Session 3 13
Session 3: Session 3 looks at touch and it s role within relationships. Group session Workbook pages 10-14 and binders Slide numbers 21-28 Flip chart and pens Touch picture scenario cards Individual session Workbook pages 10-14 and binders Slide numbers 21-28 Flip chart and pens Touch picture scenario cards In this session participants will start to explore the role of touch as a form of communication and how it has a role within relationships. Although there is some opportunity to discuss intimate touch, the fuller context of sexual and intimate relationships is not covered as this requires personalised assessment and staff with higher levels of skills and knowledge as deliverers. SN2 Whether this is done with a group or an individual, it is important to agree how each of you will behave. This sets the scene regarding interpersonal respect, an important component in understanding relationships. Ensure that individuals understand the importance of their behaviour. You will need to inform people that you have a duty to report any concerns about their safety to your manager, but that such reports will be after discussion with the involved individual (this follows your duty of care responsibilities). SN 21 and WP10 14
The form of communication to explored at this point is touch. This is a very common form of communication used by adults with learning disabilities. However it is not always used appropriately, and not being able to recognise when and what kind of touch is appropriate can lead to people being very vulnerable. Participants need to understand that touch is not always nice or right. The leader should encourage discussion of simple examples of when touch is used e.g. shaking hands, helping someone to put on their coat, hugging in celebration are all acceptable examples. Pinching someone, holding someone who wants to be alone, and kissing a stranger are all unacceptable examples SN 22 Exercise 5: this exercise assists in re-enforcing the learning from the start of this session where they explored the roles people have in their lives. Using the picture scenario cards, the leader should select a relationship from SN22, and get the group to discuss how touch is being used and decide if they feel it is ok according to the selected relationship. Ask the group to think if their opinion would be different if the relationship was another one from the list. SN 23 Participants should now be able to discuss the issues raised on this slide. They now have the opportunity to explore why they made the decision in exercise 5, by considering what is important in communication by touch, and when they are able to say no to touch. SN 24 and WP 11 For some participants this section is one which they will only feel comfortable with amongst their own gender. If this is the case, then the leader should divide the group by gender, ensuring gender specific support to do the required work with the participants. Each participant will have a body map sheet (WP11) that is gender appropriate for them. They should select a coloured pencil and be supported to decide which areas of their body they would not like other people to touch. Remember that this is personal but participants should be supported to understand that they are identifying the parts of their body that are out of bounds to most 15
people. The leader should re-enforce that the coloured areas of the body maps are private areas. It is ok for participants to include extensive areas of their body if they feel that this is important to them. Remember that some participants may have blocks about this work, or may have been strictly educated about body privacy, and so the leader should not force the issue. If a participant seems to accept that key areas of their body are not private, this may identify further individual work that needs to be done at a later stage. SN 25 and WP 12 It is important to support participants in exploring how they might feel when unwanted touch happens. This is not only about sexual touch, but also about touch in general e.g. being hugged when you want to be alone, someone placing their hand on your leg while talking to you, or someone holding your hand when you are walking outside. SN 26 and WP 13 The information and learning about touch can now be explored further by supporting participants to understand that they do not need to agree to everything. This point is a discussion opportunity. The leader needs to support participants to discuss the various ways in which they understand that people might be saying no (showing that they are not happy). Again try to think of examples in ordinary situations e.g. when saying no to sugar in a drink, or when someone in a shop offers you unwanted assistance etc. Ask participants to think about how people who cannot speak may do this. SN27 Exercise 6: in this exercise participants will explore various ways of indicating no. Participants might be embarrassed initially so start with something simple like let s say no quietly and politely building up to let s shout no as loudly as we can. With participants who do not have verbal communication, get them to use their own method and see if they can develop degrees of strength. 16
SN28 and WP14 Now that participants have discussed touch and being able to say no, it is important that they understand that not all touch is bad, or un-welcomed. Here participants will explore occasions when touch is o.k. because of a) its use, b)it s context and c)the relationship between the people. The leader should get people to identify how, when/where and with who touch is acceptable. Start with simple examples e.g. a passenger holding an elderly person s arm to help them get off the bus When examples indicate the need for privacy e.g. medical examination, support in bathing, a couple cuddling/kissing the leader should encourage discussion about why privacy is important, but also re-enforce the need for personal safety. If participants start to wish to go further with discussion about personal relationships and sexual touch, the staff member needs to either a) re-direct this topic if within a group setting, or b) within a 1:1 session ensure that this level of discussion is transferred to later discussion with an appropriate worker/service. It is important for staff not to appear embarrassed if participants veer towards sexual relationship discussion, but the staff member needs to remember that this workshop/education is not the arena for such discussion. Being able to re-direct participants in an appropriate manner is key to ensuring that they do not feel that wishing to explore the topic of sexuality, and sexual relationships is wrong. 17
Session 4 18
Session 4: Session 4 looks at consent, decision making and keeping/ending relationships. Group session Workbook pages 15-19and binders Slide numbers 29-35 Flip chart and pens Voice Assert Yourself film clip Public campaign posters Individual session Workbook pages 15-19 and binders Slide numbers 29-35 Flip chart and pens Voice Assert Yourself film clip Public campaign posters This session looks at the meaning of consent in relation to relationships and personal safety. It also provides the opportunity for participants to understand how they can make informed choices and access information. This includes understanding the longevity of relationships and where to get help if emotionally distressed. SN2 Whether this is done with a group or an individual, it is important to agree how each of you will behave. This sets the scene regarding interpersonal respect, an important component in understanding relationships. Ensure that individuals understand the importance of their behaviour. You will need to inform people that you have a duty to report any concerns about their safety to your manager, but that such reports will be after discussion with the involved individual (this follows your duty of care responsibilities). 19
SN29 & 30 and WP15 This is the opportunity for participants to explore the fact that they have rights as individuals. Leaders may wish to use the exercise provided in the Staying Safe workshop toolkit to re-enforce the learning. The main focus of the issue here is that of consent and understanding that people have the right to either give or withhold permission. The staff member should enable participants to discuss examples of when their permission/agreement is required e.g. a friend wants to borrow a CD from you; the dentist needs to examine your teeth SN31 Exercise 7: this exercise is to enable participants to explore an example of when an individual needs to give permission for something. The film clip looks at a staff member entering someone s bedroom without being invited. The participants should have the opportunity to explore what this shows and then to review the situation when the woman takes control by saying no. SN32 & 33 and WP16 It is important for participants to start developing an understanding about how decisions are made. Here they have the opportunity to explore accessing information, and understanding how decisions are made. The leader needs to enable discussion around where participants get information from and how easy it is to understand it e.g. leaflets, advice from family/staff/friends, watching TV etc. It is good to discuss a broad range of information access. The leader needs to support participants to recognise what has to be taken into consideration when making a decision and the affect it may have. Support to explore examples here is important, and will help in clarifying the affects of decision-making. Using current campaigns in the media can be useful e.g. drink-driving; dropping litter; smoking in certain places etc. Use the posters provided to engage participants in discussion that examines the points on SN33. SN34 Exercise 8: this exercise is to re-enforce the mechanisms used when making decisions. It provides the opportunity for participants to consider: personal choice, relationship levels, personal safety, 20
and difficulties in relationships. The leader may re-enforce the exercise by encouraging participants to role-play their suggestions. SN 35& 36 and WP 17 Participants will now be able to explore the issue of the ending of relationships. The break-up of friendships is often dealt with in an un-adult way amongst learning disabled adults, and services responses can often be a factor within this. Friendships are often taken as being unimportant and transient, but this is often because individuals are not supported to develop them effectively by the networks they operate in. Enabling participants to review what the ending of friendships means to them, and recognising that differences between friends do not always result in the ending of them, is a very important learning curve. The leader should have personal examples to share with participants e.g. sharing a time when they were at odds with a friend, or misunderstood a situation that then threatened their friendship. The leader needs to encourage participants to consider times when they have lost friends, why and how it happened, and what it felt like. This is an opportunity for the leader to remind participants that they can turn to people they trust if they are worried or upset by a relationship. Participants need to re-affirm the kinds of things that might make them feel this way e.g. having an argument; unwelcomed touch; imbalance of power; being asked or forced to do things they don t feel comfortable with. There is a possibility that someone my disclose something here. If this happens, the staff member should stop full disclosure and reassure the individual that they will help them to deal with this after the session. This will be done following the appropriate procedure. SN 37 & 38 and WP 19-22 The closing discussions are to re-enforce the learning that this and the previous 3 sessions have enabled. The leader should support participants to review the learning using WP 19-22 as an aid. Participants can again review who appears on their sheets and should also be given available local advice/information regarding advocacy services and organisations specialising in supporting individuals in relationship difficulties. The tool-kit provides examples of these organisations but local information is the best. 21