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An approach to implementing a total communication environment with a man who has severe learning disabilities, a profound hearing loss and challenging behaviour is described. This involved teaching the staff team visual modes of communication and supporting staff to use these methods. The intervention was evaluated by conducting observations of the communication acts taking place prior to and one year after the intervention.

Improvements were found in the amount of communication acts which were accompanied by signs and the range of communication functions employed. Changes were also reported in the communication skills set of the person with learning disabilities. Staff's perception altered from seeing him as someone who was challenging, to someone who was challenged by his hearing loss and communication difficulties.