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Promote Communication in Health, Social Care or Children’s

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1.1 Identify the different reasons people communicate.

People communicate for various reasons:

to build and maintain relationships
to get and/or share information or knowledge
to gain reassurance and/or acknowledgement
to voice needs, wants, preferences, ideas, thoughts and feelings to socialise
to understand and be understood for attention for making choices and taking decisions

1.2 Explain how communication affects relationships in the work setting. The ability to communicate does not entail simply spoken language (verbal communication) but also non-verbal communication, through body language. Squire (2007) states that when one is spoken to, more information is received from body language than from the actual words spoken, therefore only 10% of what is communicated is in the form of the words used whereas the rest comes from non-verbal communication (gestures, eye contact, facial expressions, physical contact etc…). For communication to be effective and successful one must listen and understand in order to be listened to and understood. Therefore, when information is shared it should be done in an appropriate and accurate manner so as to avoid a ‘Chinese whispers’ scenario.

This is important in all workplaces but it is vital in any children’s or young people’s setting/s. Effective communication leads to successful work with children, young people including their families, carers or legal guardians. It is essential to establish strong and positive relationships with the various people involved in the children’s care in order to successfully plan and meet their needs. Therefore, those professionals having good communication skills are the ones most likely to build strong relationships with the children entrusted in their care as well as their parents or carers. The reason being, that there are many factors which contribute to effective and positive communication such as body language and facial expressions. To form relationships with children one has to begin by recognising that each individual is unique and he/she is valued as a special human being.

Squire G, Boak A, Bulman K, Butcher J, Daly M, Griffin S, Hill K, Horne S, Hucker K, Snaith M, Tassoni P (2007) Children’s Care Learning & Development. China: Heinemann – Pearson Education 2nd Edition Tassoni P, Beith K, Bulman K, Griffin S (2010) Children & Young People’s Workforce. Spain: Heinemann – Pearson Education

2. Be able to meet the communication and language needs, wishes and preferences of individuals.

2.1 Demonstrate how to establish the communication and language needs, wishes and preferences of the individuals. Communication is a two-way process. Therefore, effective communication requires those involved to understand and be understood, a process which thrives on the basic principle of honest listening and appropriate feedback. The job requires any professionals involved to ensure that each individual’s language communication and other needs are suitably met. This is done by using various methods, techniques or options available accordingly. One must make sure that the environment (where particular communication is taking place), time, approach, topic and interests as well as body language (including gestures and emotions etc…) are suitable for the individual. It is also important to be open to other people’s ideas and opinions.

In Bright Futures in Practice: Mental Health – Volume II Howard BJ (2002) suggests that when communicating with children it is important to keep the following points in mind: sit at the child’s level and maintain eye contact with him/her listen carefully (with feelings and eyes not just the ears) be aware to the child’s attempts to communicate and be ready to respond appropriately look out for a child’s indirect expression of feelings such as slouching when ashamed or jumping up and down when excited enquire about any emotions the child might be feeling at the time and discuss it requesting feedback rephrase what the child is saying without adding your own ideas to confirm what is being said be aware of posture and tone of voice as this can affect communication when listening or speaking to a child try to keep your emotions from showing to a point where they might influence his/her emotions, ideas or expression of feelings use plenty of non-verbal praise (such as stickers, pats, hi-5’s winks and smiles) for not misbehaving and for small but specific actions praise the child with other adults so the impact is reinforced when he/she hears it again correct the child in private whenever possible respond frequently to the child to let him/her know that you are attentive to what is being said keep instructions specific and short

2.2 Describe the factors to consider when promoting effective communication. Many factors should be considered when communicating with others. One should begin by deciding which communication method would be most appropriate for the particular interaction. Face-to-face interaction is most commonly used however it is not always the case. Everyone has slight different styles of communication and this is one of the things which make us unique individuals. Location is also an important factor to take into consideration. One must find a location which best suite the ‘occasion’ or reason for interaction. Tassoni states that “for parents and young people, we may sometimes require a quiet place whereas with toddlers and young children, we may need to create cosy and homely places.” (Tassoni P et al 2010) Time is of the essence. Both children and adults need time to think about a reply and also what they wish to bring to light or express.

Tassoni (2010) says that giving one enough time is crucial especially when working with young children or with adults who are being given complex or unexpected information. Proximity refers to the distance between the people who are communicating. This is important because someone might prefer close contact whereas another person might find this to be intimidating. This all depends on the type of interaction taking place, the person’s personality as well as his/her cultural background. In the case of children Tassoni (2010) explains that it might not be the same for those who are shy or unfamiliar with you. The reason is that being too close to someone whom you are not familiar with is normally found to be intimidating. Orientation refers to the body’s position. Tassoni (2010) explains that when one is directly facing the other it sends out different signals to when someone is at the side. For example when working with children it is best to stoop to their level rather than stand tall looking down at them.

With adults it also makes things less direct when standing at a slight angle as it allows one to break off eye contact at any time. Posture is also a very important point to keep in mind. One should ask what kind of signals he/she is giving – are they ‘bored’ or ‘interested’ signals? Tassoni (2010) shows that slouching down or leaning back in a chair might give the impression of boredom whereas sitting straight and leaning forward shows interest. Listening skills come in very handy when communicating. Tassoni (2010) explains that ‘Active listening’ refers to the way one listens to what is being said, thinks about it and also observe the speaker’s body language, gestures and other signals. This requires a person’s full attention and focuses not only on what is being said but how it is being said.

Positive and trusting relationships between parents and carers are the foundation stones of child care practices which take into consideration a child’s background (including culture and language) to better his/her wellbeing. Given the diversity from which today’s society is made of, it is of the utmost importance that professionals are well equipped with the suitable skills and capabilities to work together with the parents/carers/guardians with different family backgrounds, values, beliefs and languages. Professionals should be familiar with the parents’ ideas and aspirations for their children as well as their approaches to parenting. This means that it is important that carers incorporate aspects of the child’s culture and background, celebrating where possible religious festivities and other celebrations (or at least acknowledging them when this is not possible). 2.3 Demonstrate a range of communication methods and styles to meet individual needs. Verbal communication: vocabulary

tone and pitch
Non-verbal communication: eye contact
body language
facial expressions interpreting/signing PECS
visual aids
labelling of items social stories

3. Be able to overcome barriers to communication.

3.1 Explain how people from different backgrounds may use and/or interpret communication methods in different ways.
Communication comes in various forms when using it with people who have different backgrounds, therefore it may be interpreted in different ways by different people. For this reason it is vital to know how people with various backgrounds may interpret these differently. “Where people have the same shared experiences, they interpret things in similar although not identical ways and this makes communication much easier.” (Tassoni et al, 2010 page 10) When considering effective communication, it is useful to keep in mind that other people’s experiences will vary greatly from yours, bearing in mind their upbringing and family background, culture and language. As Tassoni (2010) says one cannot take for granted that a person’s point of view and communication approach will be the same and as effective as somebody else’s. Language is a primary communication method.

If two people trying to communicate do not share a common language, this becomes a barrier. Therefore, language must first and foremost be taken into consideration when one is considering both verbal and written communication. Culture and religious belief strongly affect the way one may opt to use a method of communication. What is acceptable in one culture might be taken as an offence or considered a taboo in others. For example in some cultures it is unacceptable for a woman to shake a man’s hand or to speak unless expected or asked to speak. Tassoni (2010) gives an example about eye contact, whereby saying that it may be interpreted differently in some cultures as it might not be as commonly used. Family Background also makes a difference when it comes to interpreting communication methods. As Tassoni (2010) explains each family has its own unique way of communicating with each other and this affects how a child will communicate with others and in turn communicate as an adult. Examples of different family environments would be one where swearing is somewhat of a norm or one with a lively atmosphere when compared to one with a quiet lifestyle.

A person’s character also affects the way in which he/she communicates with peers or other acquaintances. Tassoni (2010) explains that as children get older one can easily tell those who are outgoing even when their language is not yet developed. It is very important to take into consideration somebody’s personality as this will also establish whether he/she prefers talking in a group or with just one person. It will also make a difference when it comes to communicating with people whom he/she is not accustomed to and the approach that will be taken. Communication also depends on how self-confident a person is. “… a child who was mocked because of something that they wrote incorrectly may become the adult who avoids writing; whereas a child who was listened to carefully may become the adult who is confident to voice an opinion.” (Tassoni P et al, 2010 page 10-11)

Literacy is also a key point to consider when it comes to interpreting communication methods. The extent to which one can read and/or write affects his/her confidence when it comes to the written approach. Some might have a very competent level whereas others might struggle very much. This might be due to learning difficulties or disability, his/her family’s financial status, his/her own will to learn as a child as well as the family’s approach to learning. Other factors may include environment stimulation, encouragement etc… Competence to technological approaches of communication such as e-mails, online conversations, accessing websites, newsrooms, journals, articles etc…, also require literacy skills as well as ICT (Information & Communication Technologies) skills. Depending on a person’s level of competency, he/she may either feel confident using this approach or feel rather uncomfortable. 3.2 Identify barriers to effective communication.

language problem: if an individual does not speak or understand the main language used in a setting there will be a language barrier learning difficulty and/or low literacy level/s: a child with these difficulties will not manage to keep up and/or express him/herself due to low IQ and literacy/vocabulary skills visual, auditory and/or speech impairment: someone with any of these impairments will find difficulties in understanding what is being said to them and in turn what is expected of them unless they have an alternate method of communication such as sign language low self-esteem or self-confidence and/or emotional problems: high levels of anxiety may result in emotions being given priority as opposed to conversations taking place around them inappropriate use of technical ‘jargon’: not everybody is trained with certain specific vocabulary which will result in them not understanding technicalities and as a result may direct their thoughts elsewhere topic or information is either unsuitable or uninteresting: consequences for this will also result in those involved withdrawing their interest and/or attention person’s background limitations such as cultural or religious: every culture has its own values and priorities, what might be a norm for Maltese culture might be considered inappropriate in others (for example in some cultures women do not receive intensive education) incorrect assumptions: assumptions are never expressed and so may turn out to be incorrect.

For example we assume others see, feel, think about a matter or situation as we do. This may be incorrect, therefore it is always best to verify whenever possible. inappropriate timing: this is especially important with emotional or delicate conversations. It is important to consider the other person’s state of mind, emotions etc… by asking I would like to talk to you about something, is this a good time? unsuitable environment: not all conversations should take place in public or areas where someone might overhear what is being said, just like not all conversations are best addressed formally as it might trigger tension lack of feedback: communication is a two-way process therefore lack of feedback will leave question marks as to what has been understood or not negative body language: this might give the impression that the person is uninterested and might give rise to negative feelings which will prevent the conversation from going any further inappropriate tone and pitch of voice: inappropriate tonalities will give the wrong impression for example a stern, loud voice might give the idea of anger or dislike unsuitable method of communication: letters and/or e-mails might not be delivered, phone lines may be faulty which might cause misunderstandings and/or delays

3.5 Explain how to access extra support or services to enable individuals to communicate effectively. When barriers to effective communication are encountered, one can access extra support or services to meet these needs (available both for adults and children). These may include:

Interpreters who are specifically trained to facilitate language communication between users of different languages (definition adapted from Wikipedia – please find link in Reference section) Translators whose profession is to translate documents from one language to another (definition adapted from Wikipedia – please find link in Reference section) Signers who sign out any information for those who have a hearing impairment Advocators whose job is to make sure that children and young people are consulted about matters concerning them. “A child or young person might be assigned an advocate whose task is specifically to reflect their best interest and to relay back to others the feelings and needs of the child or young person. The use of advocates is essential for young children or young people who are in local authority care or for children or young people with communication difficulties. (Tassoni P et al 2010 page 15)

Other options would be contacting a Speech Therapist to help with alternative communication methods such as: Speech Therapy
Sign Language/Key Word Signing
PECS (Picture Exchange Communication System)
Breille (for the visually impaired)
Communication Books and/or Boards (image found in Appendix 1) Talking Mat (image found in Appendix 1)
Social Stories
In extreme cases where body movement is not possible options which require Eye-Pointing methods of communication could be taken into consideration. These include: Communication Passport is a small booklet containing important as well as interesting information about its owner. (image found in Appendix 1) E-Tran Frame which is a vertically held or mounted board made of plexiglass or rigid paper with a window cut in the middle. This will enable those with severe speech problems to communicate by focusing their gaze on selected items displayed on the board. (image and how it works found in Appendix 1) Partner-Assisted Scanning which is a technique which allows one to communicate by using choices presented aloud. This however, requires the user to have an established ‘yes’ signal (be it a wink, light nod, grunt etc)

Additionally one may also seek support for dealing with these barriers to communication. Government bodies also provide Language Support Services such as: Local Hospitals and/or Health Clinics
KNPD (Kummissjoni Nazzjonali Persuni b’Dizabilita`) – National Commission for Persons with Disability Speech Language Department
ACTU – Access to Communication Technology Unit
CDAU – Child Development Assessment Unit
Deaf People’s Association
Malta Blind Association

4. Be able to apply principles and practices relating to confidentiality. 4.1 Explain the meaning of the term confidentiality.
The definition of confidentiality would be a set of rules or an agreement which would limit access to unauthorised persons to certain information. Therefore, confidentiality is about trust. It has to do with the protection of people’s data from public view. Such data might include personal details such as address, contact numbers, date of birth, medical records as well as financial and employment records. Tassoni states “Confidentiality is about respecting other people’s rights to privacy and keeping safe the information that they have provided.” (2010 page 15)

Confidentiality is such an important matter when it comes to working with children and young people that there is even legislation (Data Protection Act 1998) which covers all kinds of information gathered. In a child-care setting this would exclude circumstances where a child’s well-being is at stake such as neglect and/or abuse etc… An example would be a case where a child is to taken home from his/her setting by someone different than the usual, the setting or school should be informed and given some information such as ID card number, mobile number of this person. Confidential records in a school could include: enrolment forms

health records including immunisation records
emergency contact persons and their information
contact information for people authorised to pick up child
consent forms including those for special care
names of medical providers for child
any medicinal or nutritional allergies
assessment reports
documentation of any evaluations, referrals, follow-ups or anything related to the child’s participation at the setting

4.2 Demonstrate ways to maintain confidentiality in day to day communication. When working with children and young people information is continuously being gathered, both verbally and written. Generally child care centres, nurseries and schools have a confidentiality policy which has to be followed. It is good to keep in mind that: get accustomed to the confidentiality policy of the work place all information is confidential ‘need to know’ rule this means that only people who need to know certain information will have access to it parents’ consent should be obtained before passing on any information ensure that information is kept in confidentiality excluding circumstances where a child’s well-being is at stake do not discuss parents with other parents, children/parents with colleagues or colleagues with other colleagues or outsiders make sure nobody is overhearing what is being said

Information on paper should always be stored in appropriate files or folders (ideally in alphabetical order) in a cabinet or office under lock and key with access only to authorised personnel, and not left lying about for anyone else to see. Unnecessary carrying around of such documents should be avoided for fear of theft, loss or unauthorised people seeing them. Information stored on any electronic device such as a PC, USB stick/pen drive, tablets, laptops or notebooks etc should be kept in documents and folders locked with a password. This password should be known only to people who require access to this information. It is also important to have this information backed up just in case something should go wrong. An important point to keep in mind would be that any of the above mentioned devices might be visible to others, so these documents should be closed when you move away.

4.3 Describe the potential tension between maintaining an individual’s confidentiality and disclosing concerns.
Confidentiality is a delicate matter and should be kept at all times and under all circumstances. However one might find him/herself in an awkward and apprehensive situation where information has to be disclosed for the greater good such as physical/drug/sexual abuse and neglect. “While parents and children have the right to confidentiality, there are occasions when the need to maintain confidentiality might be breached.” (Tassoni P et al 2010 page 17) Such situations include: raised concerns about a child’s welfare and well-being for example neglect or abuse (physical, sexual, drug etc…) suspicions of a child carrying out abuse on others

in cases of committed crime
Breaching confidentiality may have serious consequences and repercussions on all those involved, especially children and young people. In situations where a child or young person is either hinting at or openly disclosing any of the above or similar scenarios, one should never promise to let it go unnoticed. Having said all this, one must always explain that information will be brought to light to professionals who have his/her (the child’s) best interests at heart and can provide help and support. Should strict confidentiality be promised at all costs, the person opening up might lose trust in whoever he is talking to should he/she find out that the confidentiality so strongly promised by the person he/she trusted has been breached. Another possible reaction might be the child or family feeling humiliated. This is why it is crucial that in cases where information must be breached, the protocol laid out in the particular setting is strictly followed. Tassoni (2010) goes on to say that in such cases information should be given directly to the person/s concerned.

This will in turn ensure that partial confidentiality is retained and unconcerned people will not know anything. Another important point is to make sure to avoid cross-examining the child as this might put words into his/her mouth (even if it is to help the child put his thoughts into words) which will result in him/her using your words not their own. The only things that should be recorded (and if possible have a witness listen in) are what the child says and nothing else. The greatest conflict of all, however, is the fact that as a professional being involved in such issues could be stressful, leaving a need to vent out and talk about it to someone for support. This should only be done to somebody who is legally authorised to know. In the case of ‘crime’ it all depends on the type of crime, as it may cover a wide range of issues such as drugs, prostitution, piracy, benefit fraud, theft, burglary, murder etc…

If a child is being hurt, harmed or in any way endangered then it is obvious that confidentiality should be breached, however should the ‘crime’ be minimal such as piracy then a blind-eye should be turned so as to keep the positive relationship with the parents/guardians going. This would mean we could keep an eye on things and the child involved, allowing us to make sure that he/she is kept safe from harm. The worst case scenario with disclosing confidential information would be a ‘Chinese whispers’ effect, where the original information is taken out of context and twisted out of proportion changing into anything but the original concern. As professionals it is our duty to protect and monitor those entrusted in our care. Every child by law has the right to be kept safe from harm.

Communication Book (colour coded for nouns etc..)
Communication Board

Talking Mat Communication Passport

E-Tran Frame
How to Use an E-Tran Frame
The communication partner faces the user and holds the chart up between them. The user gazes at the letter, symbol, or word they want to say. Initially one symbol or word will be placed at each corner. As the user and communication partner become more skilled, symbols can be added in the middle of each side. The method can be developed using colour or number coding systems so that more items can be accessed. Some very skilled users use a transparent letter board and spell out messages by eye gazing letter by letter. The communication partner requires skill to identify and remember which letter is being looked at. (Information on How to use an E-Tran Frame obtained and copied from www.communicationmatters.org.uk – full link may be found in References section.)

Squire G, Boak A, Bulman K, Butcher J, Daly M, Griffin S, Hill K, Horne S, Hucker K, Snaith M, Tassoni P (2007) Children’s Care Learning & Development. China: Heinemann – Pearson Education 2nd Edition Tassoni P, Beith K, Bulman K, Griffin S (2010) Children & Young People’s Workforce. Spain: Heinemann – Pearson Education Websites

http://www.brightfutures.org/mentalhealth/pdf/families/ec/communicating.pdf seen on the 3rd June 2013 http://www.communicationmatters.org.uk/page/e-tran-frames seen on 8th June 2013 http://en.wikipedia.org/wiki/Language_interpretation seen on 7th June 2013 http://en.wikipedia.org/wiki/Translator_%28disambiguation%29 seen on 7th June 2013 All images used were obtained from www.google.com

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