Wednesday, May 8, 2019


There's one question we receive more often than others at CQL | The Council on Quality and Leadership, and it's a common issue that human service organizations face across the globe - how do you gather information about quality of life outcomes from people who do not use words to communicate? More specifically at CQL, we are asked how do you apply the Personal Outcome Measures® discovery process to people who communicate through non-verbal methods? 


By Gretchen Block CQL Manager of Partner Engagement
  1. Interviewers should always talk to more than one person who knows the individual well. Sometimes people suggest things that they think would or should be important to the individual vs. what the individual truly wants or needs.
  2. You shouldn't assume because something was important at one time in a person’s life, that it is important today. Our opinions and interests change over the years. Our past is part of our story, but it might not be the most important thing presently.
  3. Like Vickie referenced above, interviewers can be a detective of sorts, by observing body language, gestures, facial expressions, etc. You can ask to see the person’s personal space such as an apartment, bedroom, etc. It might be helpful for people to share their photo albums, class yearbook, scrapbooks, etc.
  4. In identifying the location for the interview, the interviewee might want to choose their favorite place to hang out. Can the POM interview happen there? It’s a great way to ensure you are in an environment that is comfortable for the person!
  5. A great activity for DSPs and people they support is to make a collage poster/book of all of the things that are important to the person before the POM interview and ask them to bring it to their interview. CQL has developed a free Person-Centered Plan Template that could be used for this purpose.
  6. One POM 'Golden Rule' is to always ask the question. You should never let a lack of words affect your ability to get the right answer.
  7. People receiving supports should be supported and encouraged to try new and different things. For example, vanilla ice cream might be someone's favorite but only because no one ever offered them mint chip. Everyone needs experiences, education, and exposure to the world around them in order to make informed decisions about what’s important, how to spend their time, who to spend their time with, etc. For people who do not use words to communicate, make sure to take note of their reactions to each of these new experiences.


By Vickie Overpeck | CQL Quality Enhancement Specialist
Observation is the first step. It’s important to observe people's body language including excitement, anxiety, frowning, smiling, withdrawing, shutting down, lighting up, and then reflect that "feeling" back to them:
  • Are you sad?
  • Are you excited?
  • Are you thinking about something fun?
Visual cues and tools can be used when talking about topics, such as sharing pictures of food while discussing dinner or having photos of places when deciding somewhere that people might like to go. Pictures should be simple and clear. Using professional advertising icons that are created by expert designers can be useful, as they are recognizable and help us associate imagery with places, things, or concepts. For example, most kids learn to recognize the McDonald's arches long before they can say "McDonalds" - same goes for other well-known icons that can be used in conversations about places to go or things to do.
Photos of others the person lives, works, or spends time with can be helpful in interactions and discussions by asking questions like "Who is this?" or "Do you know this person? Point to her/him and ask "Who is a friend of yours?" or "Who would you like to go to the movies with?"
Gestures and natural signs can accompany verbal communication, as they help people visualize what you are saying. Encourage them to use these signs too, like making a cup with your hand to talk about drinking something or putting both hands to one side of your head, tilting your head, and closing your eyes to talk about going to sleep.
Video recordings can by used by filming activities and then talking about it - if the person isn’t too shy or self-conscious for this approach. For others who are a bit of a "ham," even using a microphone might encourage them to speak more.
People looking at photo albumPicture albums will assist you in discussing interests, activities, and more, as they will encourage people to talk about the fun times they experienced. You can also use cookbooks with a lot of pictures to prompt people to talk about their favorite food, which is something that most everybody likes to talk about!
Preference testing can encourage communication. In this method you present two items in the same 'category'  - like two colors, two pictures, two shirts, two kinds of cereal - and ask, "Which one do you like better?" Then pay attention for a reaction such as a look, a head nod, a pointed finger, and acknowledge that choice, with responses such as "Did you pick the blue one?" or "I see you like Rice Krispies better than Corn Flakes - is that right?" After a while you can try three objects in the same category.
Expect the unexpected and get ready to be surprised when people communicate in new ways. Have high expectations for people and be prepared to be quiet, patient, and to listen with all your senses.
Have fun! Some people communicate best during engaging activities. I watched a group of adults who did not have effective communication skills play an exciting game of Yatzee - and, boy were they communicating during that game and everyone had a good time!
Woman completes The CQL POST AppObjects can be used to learn about topics. For example, when exploring grooming and personal care, you could fill a box with a hairbrush, toothbrush, small mirror, deodorant, wash cloth, bar of soap, comb - and so on. Then ask someone to take one item out of the box and show or "tell" how you would use the item. Encourage all efforts to communicate about the use of the item. One organization used this technique to teach people more about their rights.
Augmentative Alternate Communication (AAC) may be helpful. You can try different forms of AAC such as simple pictures, flash cards, or electronic devices with buttons that says things like "Yes" and "No" when pushed. iPads and other tablets have all sorts of apps available to help people express themselves. CQL has developed The CQL POST App, a user-friendly app that provides a snapshot view of a person’s quality of life, which can be completed either independently by the person receiving services or with support by others.

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