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Communication: one test that can keep people with mild learning disabilities engaged

TROG, a test of language skills, aids healthcare staff's communication with people who have a mild learning disability, helping to reduce confusion

TROG, a test of language skills, aids healthcare staff's communication with people who have a mild learning disability, helping to reduce confusion

TROG, a test of language skills, aids communication with people who have a mild learning disability, helping to keep them engaged. Picture shows a TROG test in which a woman points at symbols on a board in response to questions.
TROG, a test of language skills, can help healthcare staff communicate with people who have mild learning disabilities

If all healthcare staff understood how language can be a barrier to care, service users might not feel discriminated against and experience minority stress.

In people with a mild learning disability, language often acts as a barrier to getting the right service. Many healthcare professionals misinterpret language, often leaning towards a negative stereotype which becomes an obstacle. There is also evidence that healthcare staff communicate in a way that confuses people with mild learning disabilities.

When a breakdown in communication happens, the individual may have a sense of not being cared for. But could a test for the reception of grammar (TROG) be the answer to removing the obstacle, and could nurses lead on using it?

TROG is a simple assessment tool used by speech therapists and TROG-2 is a shorter version used to assess language skills. The outcome of a TROG evaluation could help nurses choose what sort of sentences to use and so fine-tune practice.

Communicating effectively and engaging with someone who has mild learning disability

I was trained to use TROG while working in a mental health centre for people with learning disabilities. It helped me know straight away how I should communicate effectively and engage the client.

I was also involved in a study of people with learning disabilities who have mental health problems, and carried out TROG assessments before engaging the clients in cognitive behavioural therapy.

‘When nurses take on a new aspect or skill and run with it they can change the healthcare landscape’

This helped with many things, particularly engagement (the average use in therapy was 14 times per hour), which is encouraging as drop-out rates are usually high. TROG was a significant factor in helping to keep patients engaged.

Nurses are best placed to administer TROG as we carry out the assessment, planning, implementation and evaluation of care for the patient. If we get the language right, co-creation and co-production of services can occur, making the process a dynamic one.

Minority stress in people with learning disabilities

In the interests of transparency and co-production I believe it is necessary to look at expanding clinical applications of TROG into mainstream provision. This is especially so when some people with learning disabilities struggle with mental health problems such as depression and anxiety. This would be recorded on file, so other healthcare professionals would know how to construct a sentence for meaningful dialogue.

The use of TROG may reduce the effects of minority stress – the theory that people in stigmatised groups experience high levels of stress – in people with learning disabilities. Minority stress includes a reluctance to speak in front of those perceived to be more intelligent, and a reluctance to speak for fear of being socially rejected.

There was a time when psychotherapy was deemed inappropriate for people with learning disabilities, but evidence now suggests the opposite. This move has helped bring about more equality of opportunity and increased visibility. History has shown many times that when nurses take on a new aspect or skill and run with it they can change the healthcare landscape. TROG assessments carried out by nurses could reduce confusion, and help people with learning disabilities make better choices and feel understood.

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Matt Broadway-Horner is senior consultant at the Broadway-Horner consultancy. He is a consultant nurse in mental health and learning disability and a cognitive behaviour psychotherapist

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