Makaton for Transitions and Change in Learning Disability Services

Makaton can support transitions and change in learning disability services when people need clearer information about what is happening next. Change can be difficult when staff rely on spoken explanations that are too quick, too abstract or used differently across shifts. Signs and symbols can make transitions more predictable and help people understand when something is starting, stopping, changing or staying the same.

Strong providers use Makaton as part of wider communication and accessibility in learning disability support and connect transition support with learning disability service pathways and support models. This matters because transitions happen constantly: getting up, leaving home, moving between activities, meeting new staff, attending appointments, returning from family contact or preparing for a service move.

Concept explained clearly

Makaton uses signs, symbols and speech together to support communication. In transition support, it can help explain now, next, finished, wait, go, stop, home, different, same and help. These signs can be used alongside visual timetables, objects, photos, calendars and staff reassurance.

The purpose is not to remove all anxiety from change. The purpose is to make change clearer, reduce avoidable confusion and give the person ways to ask for help or pause before distress escalates.

Why it matters in real services

Many communication-related incidents happen during transitions. Staff may think the person is refusing, delaying or avoiding support, when the person has not understood what is changing or why a routine has stopped.

Providers should be able to evidence that Makaton supports preparation, predictability and staff consistency. This helps reduce distress and creates stronger evidence around proactive support.

What good looks like

Good Makaton transition support uses agreed signs at predictable points. Staff do not introduce too many signs at once. They use the same signs, same spoken words and same supporting visuals wherever possible.

Strong services demonstrate a clear line of sight from transition communication to calmer routines, reduced escalation and improved participation.

Operational Example 1: Supporting transitions between home and community activities

Context: A person in supported living often became distressed when leaving home for activities. Staff used verbal prompts such as “come on, we’re going now”, but the person frequently moved away from the door and became upset.

Support approach: The provider introduced Makaton signs for now, next, go, home, wait and finished, linked to real photos of the activity and the return-home routine.

Five practical steps:

1. Staff identified the point in the leaving routine where anxiety usually began.
2. The team agreed a small set of transition signs used by all staff.
3. Workers practised the signs during calm preparation, not only when leaving.
4. The person was shown the activity photo and the home-return symbol together.
5. Managers reviewed distress records, cancellations and successful departures.

Day-to-day delivery detail: Staff signed “go” when showing the café photo, then signed “home” and showed the return image. When the person signed or gestured “wait”, staff paused instead of repeating instructions. The transition became slower but calmer.

How effectiveness was evidenced: The person left home more consistently and returned with less distress. Records showed fewer rushed departures, clearer use of the wait sign and improved staff consistency.

Deepening transition support through total communication

Makaton should sit within total communication beyond spoken language. A person may understand signs better when they are paired with real objects, familiar photos, routines, body language and environmental cues.

This means staff should not rely on the sign alone. They should notice whether the person looks at the symbol, moves towards the door, holds an object, repeats a gesture or shows anxiety through posture or silence.

Operational Example 2: Supporting staff changes and unfamiliar workers

Context: A residential service used occasional bank staff. One person became unsettled when unfamiliar staff supported evening routines, even when the routine itself remained unchanged.

Support approach: The provider introduced Makaton-supported staff-change communication using signs for staff, same, different, help, finished and tomorrow, supported by staff photos.

Five practical steps:

1. The manager reviewed when distress occurred during staff changes.
2. Staff prepared a photo board showing familiar and unfamiliar workers.
3. The team agreed signs to explain “different staff today” and “same routine”.
4. Bank staff were briefed before the shift on the person’s transition signs.
5. Evening records were reviewed for anxiety, reassurance-seeking and settled routines.

Day-to-day delivery detail: Staff signed “different” while showing the bank worker’s photo, then signed “same” while showing the person’s usual evening routine. The familiar senior worker introduced the bank worker before stepping back gradually.

How effectiveness was evidenced: The person tolerated staff changes more calmly when the communication sequence was used. Handover records showed reduced repeated reassurance and clearer staff understanding of the person’s transition needs.

Systems, workforce and consistency

Transition signs should be built into communication profiles, staff induction, handovers and support plans. Staff should know which signs are used for daily transitions, which are used for bigger changes and how the person shows they need more time.

Supervision should check whether staff prepare people before transitions or only respond once distress has started. Teams should review whether signs are being used consistently across supported living, residential care, respite, day services and health settings.

Operational Example 3: Preparing for a planned hospital appointment

Context: A person with complex communication needs became distressed during hospital appointments because the environment, waiting time and professional contact were unfamiliar.

Support approach: The provider developed a Makaton-supported appointment transition plan aligned with accessible information standards in learning disability services, using signs, photos and a simple now-next-finished sequence.

Five practical steps:

1. The team identified the appointment stages most likely to create anxiety.
2. Staff selected transition signs for car, wait, doctor, stop, finished and home.
3. The person practised the sequence using photos before appointment day.
4. The support worker modelled the signs during travel, waiting and consultation.
5. After the appointment, the team reviewed distress, participation and recovery.

Day-to-day delivery detail: During waiting, staff signed “wait” and showed the next clinic-room photo. After the consultation, staff signed “finished” and “home”, which helped the person understand that the appointment sequence had ended.

How effectiveness was evidenced: The person remained in the waiting area for longer than previous appointments and completed the consultation. The health action plan recorded the signs, photos and reasonable adjustments that supported the transition.

Governance and evidence

The audit trail may include communication profiles, Makaton sign lists, transition plans, visual schedules, handover notes, staff briefings, appointment records, incident analysis and outcome reviews.

Data may show fewer transition-related incidents, reduced cancellations, improved appointment attendance, calmer staff changes or shorter recovery times after disruption. Qualitative evidence should explain which signs supported predictability and what staff did in response.

Commissioner and CQC expectations

Commissioners expect providers to evidence personalised communication, proactive support and reduced avoidable distress. Makaton transition support helps demonstrate that services plan around communication needs rather than reacting after escalation.

CQC expects person-centred care, effective communication, safe support, staff competence and good governance. Inspectors may look at whether people are prepared for change and whether staff use known communication methods consistently.

Common pitfalls

• Using Makaton only during distress rather than during preparation.
• Introducing too many transition signs at once.
• Failing to pair signs with meaningful photos, objects or routines.
• Using different signs or phrases across staff teams.
• Not respecting a person’s sign or gesture for wait, stop or help.
• Recording transition refusal without checking whether the change was understood.

Conclusion

Makaton can make transitions clearer, calmer and more predictable when staff use signs and symbols consistently. Strong providers demonstrate that transition support is planned, practised and evidenced across real routines. When Makaton is linked to staff response and outcome evidence, people are better supported through change without losing control or dignity.

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