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Factsheet Hints on Teaching Skills for Work

Introduction

Only 4% of people who are classified as ‘blind’ have no sight at all.  The rest have some useful vision that they can use in their daily lives.  People with learning disabilities are more likely to have sight problems than other people, yet they are seldom taught to use their sight successfully.  Their ability to learn new skills is therefore further reduced.

Sighted children with learning disabilities have a wealth of visual experience although they may have problems in understanding or reacting to it.

Blind and partially sighted children with learning disabilities need to learn in a more structured way than sighted children and they usually take longer to learn.  They are more dependent on being taught about their world and are less able to learn informally (such as from observing or copying others).  They need special help to make sense of things and to understand what is being asked of them.

Visually impaired children, on becoming adults, may still have an unclear view of the world.  The information they receive through the visual pathways has been substantially reduced, and may not be fully understood or interpreted.  People may have assumed that they have understood many things, which have not been adequately explained to them.

Some people with visual and learning disabilities are ‘late developers’.  They may have found it hard to acquire skills in childhood but easier to learn things as an adult, especially when supporters understand what motivates them.  People have developed skills that have amazed and delighted their family and staff. 

    

Many people with visual and learning disabilities want to become more independent, learning new skills and making more choices for themselves.  Others may have a different concept of ‘independence’, seeing help from others as crucial in getting what they want.

  

It is important that goals are realistic.  Some people may be able to learn only part of a task - ideally the part which gives them the greatest reward.  For example, it may take a long time for them to learn how to walk from their bedroom to the dining-room, but the person may swiftly learn how to independently move the last few paces and find their place at the table.  

 

Learning concepts and acquiring skills  

People born with a visual impairment or who lost their sight in early childhood may have difficulty understanding certain words describing objects, actions and situations:  

• Objects   

Imagine trying to describe an elephant to someone who has never seen one! Would the person hearing you really grasp what was being said and get a true picture in their mind?  Things which are not easily interpreted with hearing, touch, smell or taste may be difficult for blind people to fully understand.

  

• Actions  

How do you describe seeing to someone who has always been totally blind? How would you describe a whole range of activities sighted people are able to do in their ordinary lives like crossing a large open space or finding the way around a shopping precinct?  

 

• Situations  

Imagine walking into a room where two people are talking but the television is on and an announcer is interviewing a person.  Without sight, or with imperfect vision, it would not be so easy to make sense of what is going on.  

Some people with visual impairment and learning disabilities find it difficult to learn abstract concepts, for example the words "up" and "down", or "left" and "right", may mean little to them.  

Where to start  

Many people working with service users with more than one disability find it hard to know where to start when it comes to demonstrating a new skill or set of skills.   

They may feel discouraged by people who do not want to learn, or who present behaviour ‘which challenges’ to avoid involvement in an activity.  Many people with visual and learning disabilities have had few successes in their lives and it may seem sensible to them to opt out, rather than try to do something, and fail.  

The key to success is often helping people to make the best possible use of their vision and other senses, usually hearing and touch.  People need to be exposed to different sounds, smells and textures.  They may need explanations about the information they are receiving from their different senses.  This could be as part of a specific aromatherapy or sensory session, or alternatively could be introduced informally as part of another activity, such as cooking. 

  

For example, preparing food provides opportunities for people to use their existing vision and touch and smell - as well as listening to the sounds created by the utensils.  They may need to be encouraged to feel the shape and texture of a whole carrot, smelling the skin.  After the carrot has been peeled and chopped, the person can then compare how the carrot feels and smells.  This activity may be rewarding - if the person likes carrots!

  

By working in a systematic way that maximises sight, hearing and other senses, measurable success can be achieved.  A way for doing this is now described.  

Steps to take

1. Establish the task
2. Assessment of vision
3. Get the environment right
4. Think about how and what you communicate
5. Break down the skills into appropriate components
6. Decide how you are going to demonstrate/teach the skill. 

1.     What task will you teach - how can you decide?  

Think about what to teach.  What excites or interests this person?  Many visually impaired people with learning disabilities may seem poorly motivated.  They may sit and wait for people to come to them - life has always been that way.  They may not know that things can be different and better!  

Sight is a strong motivating force, and if things (activities, snacks, etc.) that people enjoy, arrive without action or communication, people can learn to become very passive.  It effectively will remove their incentive to engage.  

It is important to consider tasks carefully and check out that everyone has the same understanding of the task and goal.  An example might be making a cup of tea.  A blind person who has always lived in residential care may believe that tea arrives in a cup with milk and sugar already added.  If tea has always been given to them that way they may have no idea what effort has gone into making it.  

Do the tasks chosen help in the development of other skills?  Are they fun to learn? Is it something they will be able and allowed to do in their home, residential or day care setting?  Is a risk assessment required first?  Does this person have the necessary foundation of other skills to succeed in doing this task?  For example, it would not be sensible to begin teaching tea-making to a person who does not have any pouring skills.  It would be much more sensible (and motivating) to start with a simpler skill - pouring a cold fluid (say, juice) into a cup, and then moving on to pouring hot fluid, before moving on to a task with many component parts, such as tea making (see "Breaking the down the skills" section later in this factsheet).  

People with poor sight may need to learn to identify the objects used in the task they want to learn.  They may need to be helped to develop their sense of smell or touch.

2.     How much can the person see?  

Has this person had a recent sight test?  Should they be wearing glasses?  What are the glasses for - near or distance, or both?  What sort of problems does this person present as having - problems focussing, problems seeing detail, problems spotting things that are to one side?  Can they see colour, light and dark?  Is more light helpful? 

 

These are all things that need to be established prior to teaching new skills.  Were they born with sight?  Did they go blind recently?  Can they still remember how things were or has everything been changed around? Where is the best place to stand for them to see the task, to hear instruction? 

How much can they hear?  What is their comprehension of language?  Do they understand what is involved in the task they are to learn?  

3.     Getting the setting right  

Life can be made much easier for many people with visual impairments by helping them use what sight they have, and their other senses, usually hearing and touch.   

Lighting 

There is no one way of lighting a room that is perfect for everyone, so it is important to consider both the needs of the individual and the task to be learned.    

Background lighting - good even background lighting is important.  For most people with sight problems, more light is better.  People benefit from ceiling lights with lampshades (like big paper balls) or strip lights with diffusers that evenly scatter the light around the room.  Wall-mounted lights may help too.  Dimmer switches are useful in increasing or reducing light levels.   

Glare problems are very common in people with some eye conditions.  (People with these conditions may experience glare when others do not consider it particularly bright.)  People may be able to move about in poorly lit areas, but not cope with glare that makes them totally blind.

 

Many people find great variations in lighting difficult, and adapting to changes in the level of lighting is a real problem for people with some eye conditions.   

Lighting for close work - needs careful thought to prevent additional problems.  

• position of the lamp - to avoid casting shadows
• brightness - but avoiding glare
• type of lamp (ideally one that does not give out an uncomfortable amount of heat)
• manoeuvrability of the light to get it to the best position
• ease of use - can the person switch it on and off themselves?  

Contrast  

Contrast is how much something stands out from the background.  Colour contrast helps people use their sight.  It enables people with limited sight to see and find things e.g., a brown door against a white wall.  It is also useful at meal-times:  bright cutlery and crockery on different colour contrasting plain tablecloths.  

 

People with some eye conditions respond better to different colours, so it is worth experimenting with different types of colour contrast.  It is important not to assume that all visually impaired people see colour in the same way.  People are individuals; two people with the same eye condition may see colour in different ways.  

Noise  

Background noise from television, radio or music may mask other sounds, like the footsteps of an approaching person.  Keeping noise levels down helps people understand their environment.  It allows them to use their hearing to focus on what is going on, and identify individual sounds.  Loud noise may make people insecure and jumpy.  It is far easier, and usually less tiring, to concentrate and learn in a quiet environment.  

Equipment  

It is helpful to give careful thought to what equipment is to be used in any task, and to get it assembled in advance, unless locating and fetching the equipment is part of the task being taught.  If this is the case, it is essential that equipment is always kept in the same place in the same cupboard or location.   

Brightly coloured equipment is more readily seen than items which merge into the background.  For example, it is easier to see and use a solid wooden coat hanger on a contrasting background than a bendy wire one, or to learn to pour coloured fruit juice into a different coloured container.  It would, for example, be difficult for a person with sight problems to learn to pour water into a transparent glass.

 

4.     How and what to communicate  

For visually impaired people to understand a task they are likely to need more than just a verbal explanation.  Speak slowly and use only a few key words or signs, or pictorial prompts.  Keep it simple, and make sure they have sufficient understanding of whatever system of communication you are using.  Be consistent in your use of language - make sure everyone is describing things in the same way.  For example “lunch-time”, “tea-time”, “food” and “let’s go to the dining-room” might all be used by staff - and the person might be confused by all the different words.  

Can they cope with more than one key word or concept at a time?  Are you using language that is unclear or too abstract ("it's over there" might mean little to a person with sight problems)?  Allow people time to feel and become familiar with the equipment that is to be used.  For a long or complicated task, teach specific objectives first, and then add these in to longer sequences to encourage and motivate.   

For example, your long-term aim may be for Tom to learn some independent activities of daily living, your short-term aim may be for him to make a cup of a tea, and the specific objective may initially be to get him to fill the kettle.  Once this has been accomplished, the specific aim might change, say, to plugging in the kettle.   

Think about the end product - learning to make beans on toast may not be exciting if you prefer Marmite sandwiches.   

Demonstration may need to be done hand on hand, with staff gently helping people to explore objects and environments, for part of the task (see "Decide how to teach the skill" section of this factsheet).  

 

5.     Breaking down the skills into stages  

In teaching tasks it is important to break them down into simple stages (sometimes called task analysis).  It is worth pointing out that some visually impaired people will not understand why a particular stage comes before another.  Many blind and partially sighted people (and sighted people too!) have difficulty in remembering a long sequence.  It is important not to overload people with too much information.  

With little or no sight, people may need to be told if they have successfully completed a task, or a stage of the task.  They may not understand and enjoy their own success.  They may need to be told how well they have performed tasks - and some people will want to know if others are doing things better than them.  

Visually impaired people may take more time to learn some skills than sighted people may.  It is important that other people realise this and do not hurry them, or take over.   

For example, if the desired task is making a cup of tea, using boiling water from a kettle on to a tea bag, it may be broken down into a number of component parts:  

1.      Locating the kettle
2.      Unplug the kettle lead
3.      Take kettle to sink
4.      Take lid off
5.      Fill kettle
6.      Put lid back on
7.      Take back to power supply
8.      Plug in lead
9.      Switch on
10.    Locating china cupboard
11.    Finding a mug
12.    Taking to work surface near kettle
13.    Finding the tea bags
14.    Finding a teaspoon
15.    Putting a tea bag into the mug
16.    Pouring the water in
17.    Stirring and retrieving the tea bag
18.    Disposing of the tea bag
19.    Locating the milk
20.    Fetching the milk
21.    Pouring the milk
22.    Locating the sugar
23.    Locating a teaspoon
24.    Spooning the sugar in
25.    Stirring
26.    Putting milk back in fridge
27.    Putting sugar back in cupboard
28.    Drink tea  

Some of these stages are not important to the end product, and might be left out altogether.  For example, you may assemble all of the objects together before you begin teaching the skills.  Alternatively you may include finding them as part of the task for the person you are teaching, but not include putting them back.  Therefore, your task analysis must include all vital stages, but not necessarily all the stages.  However, the task analysis must be explicit and written down.  This is because all stages that are to be taught must be followed consistently, whoever is supporting the person doing the activity.  

There are other ways to approach the teaching and recording of a task.  Here is an example of a different layout of a Task Analysis.  Some people have found that the ‘sequential task analysis’ is better when the task is carried out exactly the same on every occasion with the same ingredients and same order.  However, this format may work better if the ingredients may vary or if the person may vary the order in which they carry out the task.  This format also makes it nice and easy for staff to see what the person should be doing for themselves - if the staff allow them to!       

Name: Fred                            Start date:    April 2006

Long term goal: 

To participate in making a sandwich or toasted sandwich  

Review date:    October 2006

Stages required to achieve goal:

• Encourage Fred to focus on the task and concentrate on one thing at a time.
• Fred can find his way around in the kitchen.
• Fred to choose what he would like to eat and drink.  

Current stage:    The whole task  

Time of session:    Usually in the afternoon  

Duration of session:    Approximately 30 minutes

Materials and preparation:

• Staff to ensure that Fred can easily reach plate or bowl in cupboard.
• Requires crockery, cutlery and ingredients.  

Instructions to achieve task:  

Fred’s Input

• Wash and dry hands.
• Choose fillings.
• Collect large plate or bowl.
• Collect spreading knife.  

Shared Input

• Collect chopping board.
• Collect bread.
• Collect margarine.
• Collect filling.
• Butter bread (Hand over hand).
• Add filling (Hand over hand).
• Place bread on top of filling.
• Cut sandwich.
• Pour cold drink.
• Operate sandwich toaster.  Fred can place bread into toaster when the bread is cold.  

Staff Input:

• Collect sharp knife.
• Make hot drink if required.        

6.     How will you demonstrate or teach this skill?  

As mentioned above, it is necessary to know what level of skills the person has, what they see, what their hand control is like, etc.  

Once all these have been assessed or established you can decide how best to teach the skill(s).  

There are a number of options for teaching skills to visually impaired people with learning disabilities.  These include:

• errorless discrimination
• fading
• forward chaining
• backward chaining 

Errorless discrimination is a way of removing the likelihood of failure from learning a new task.  An example might be in laying a table, where the person only has to put a plate in place, and this is repeated until the person is sure of the skill, and then a spoon only is introduced until the person knows where this goes in relation to the plate, and so on.  

Fading is a way of teaching skills where the amount of prompting and support varies, either during the task, or as the person becomes more competent at the task or at parts of the task.  The prompting can be: verbal, sign, gesture, physical (e.g., hand over hand).  There may be part of the task that the person does independently, or refuses to do at all.  As the person's understanding and skill level increases, the support or prompting fades.  For example, the person may need hand over hand support to pour fluid, be shown (with a gesture) how to add sugar or perhaps the sugar being passed into their line of vision, verbal prompt to stir, but no prompting needed to drink!  

Forward chaining is a method of teaching a task using a task analysis and teaching it in a logical sequence from start to finish (although the stages are likely to be grouped into smaller groups of stages).  For example, you might teach steps 1 - 9 only, and then complete the rest of the task yourself, with the cup of tea still appearing shortly after.  

Backward chaining is a method of teaching a task using a task analysis, but teaching it in a reverse way.  The aim of this is for the person learning the skill to understand the aim of the exercise and get the reward of completing the task, whatever level of skill they have attained.  Teaching a skill ‘backwards’ is often more meaningful and motivating to someone who does not understand the chain of events that needs to happen for a task to be completed.  For example, if you are making tea, you begin with the tea, ready made, sugared and with milk, and then add on skills at the beginning - so from ready-sugared tea, you present unsugared tea that the service user then adds sugar to.  A benefit of this system is that the new skill or part of the skill is learned first, and then the rest of the routine is familiar to the person, and they can predict they will get a cup of tea at the end. 

Try it yourself!  

If people are not acquiring skills, ask why!  It may be that staff members have underestimated the disabilities of life with a visual impairment, chosen inappropriate equipment or tasks, or not allowed enough time for people to learn.  Staff commonly overlook the role of sight in co-ordinating other senses - particularly hearing and touch.  Think about the language or other communication system you use to support the person.  

Although most blind people do have useful vision, it may still be worthwhile shutting your eyes or putting on a blindfold and going through the different stages of the task slowly.  Are the individual stages too complex?  Are they being taught in a logical way? They may need to be given an opportunity of feeling a cold teapot, milk bottle, empty cup, etc.  

They may also need help to understand that a specific cup is not exactly the same as all other cups, but has some similar features.  

One staff member may make tea in a different way from another - particularly if they are from different ethnic groups.  There are many ways of making tea.  It is important that this is recognised, to prevent people becoming confused.  

We know of people who were believed to be profoundly disabled and were thought incapable of learning new skills.  Some have made progress beyond the wildest dreams of their staff and carers.  It can be done.  

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