Objects of Reference for Choice and Control in Learning Disability Services

Objects of reference can strengthen choice and control in learning disability services when people understand real items more clearly than spoken words, pictures or symbols. Choice is not meaningful if the person does not understand what is being offered. For some people, holding a swimming towel, café loyalty card, music speaker, toothbrush or medication cup can communicate far more clearly than a verbal question.

Strong providers include objects of reference within wider communication and accessibility in learning disability support and connect them with learning disability service pathways and support models. This matters because real choice depends on understanding, time, recognition of refusal and staff acting on the person’s response.

Concept explained clearly

Objects of reference are physical objects used to represent an activity, routine, place, person or event. In choice-making, they can help people compare options, show preference, reject an activity, request more time or indicate that they are ready to proceed.

The object must have meaning for the person. A generic item chosen by staff may not support choice if the person does not associate it with the option being offered.

Why it matters in real services

People may appear passive, resistant or inconsistent when choices are not communicated accessibly. A person may be asked whether they want to go out, but not understand where, when or what will happen. They may accept support because staff present one option strongly, or reject everything because the choice feels unclear.

Providers should be able to evidence that objects support real preference and refusal, not just compliance with planned routines.

What good looks like

Good object-based choice support presents clear, realistic options using items the person already recognises. Staff give time, observe the person’s response and act on acceptance, rejection, hesitation or repeated selection.

Strong services demonstrate a clear line of sight from object use to the person’s choice, staff action and outcome.

Operational Example 1: Choosing between community activities

Context: A person was usually taken to a local park because staff believed they preferred quiet outdoor activities. However, they often reached towards a cupboard where craft materials were stored before leaving.

Support approach: The provider introduced objects of reference for two real options: a leaf-shaped keyring for the park and a paintbrush for the craft group.

Five practical steps:

1. Staff reviewed whether previous activity choices had been offered accessibly.
2. The team selected objects already linked to each activity.
3. Workers presented two objects at a time, with enough processing time.
4. Staff recorded reaching, holding, pushing away and repeated selections.
5. The weekly activity plan was updated using consistent choice evidence.

Day-to-day delivery detail: Staff placed the leaf keyring and paintbrush on the table before preparing to leave. The person repeatedly picked up the paintbrush and moved towards the craft cupboard. Staff supported the craft group instead of assuming the park remained the preferred option.

How effectiveness was evidenced: Activity records showed increased participation and less resistance before outings. The provider evidenced that object-based choice changed the planned support in response to the person’s communication.

Deepening choice through total communication

Objects of reference should sit within total communication beyond spoken language. A person may choose through touch, gaze, movement, vocalisation, facial expression, pushing away, holding an object or bringing it to staff.

This means staff should not look only for a neat yes or no. The whole response matters, especially when the person shows preference through repeated behaviour over time.

Operational Example 2: Supporting refusal during personal care

Context: A person became distressed when offered evening personal care. Staff recorded frequent refusal, but there was limited evidence that the person had a clear way to request delay, pacing or a different order.

Support approach: The provider introduced two objects of reference: a flannel for washing and a night-time lotion bottle for the later settling routine. Staff used these objects to support pacing and choice.

Five practical steps:

1. Staff identified which personal care stages caused the most distress.
2. The team selected familiar objects linked to each stage.
3. Workers offered the objects before beginning support and waited for response.
4. Staff treated pushing away or turning away as communication requiring pause.
5. Managers reviewed dignity, distress and completion records after the change.

Day-to-day delivery detail: When the person pushed away the flannel but held the lotion bottle, staff supported the calming routine first and returned to washing later. They stopped treating refusal as a single fixed response.

How effectiveness was evidenced: Evening distress reduced, and personal care became more flexible. Records showed clearer evidence of pacing, refusal and staff response to object-based communication.

Systems, workforce and consistency

Object-based choice support must be recorded clearly. Staff should know what each object means, how choices are offered, how long to wait and what different responses may indicate.

Supervision should check whether staff respect refusal and uncertainty. Handovers should record emerging preferences, rejected objects and whether the person appears to understand the object consistently across staff and settings.

Operational Example 3: Choosing health appointment support

Context: A person needed a routine GP appointment but became anxious when staff discussed it verbally. The person had previously responded well to objects but no object-based approach was used for health choices.

Support approach: The provider introduced a stethoscope toy as an object for GP contact and a familiar comfort item as a support choice, alongside accessible information aligned with accessible information standards in learning disability services.

Five practical steps:

1. The team identified what the person needed to understand about the appointment.
2. Staff introduced the health object during calm preparation sessions.
3. The person was offered a choice of support item for the appointment.
4. Workers recorded acceptance, rejection, anxiety cues and recovery after preparation.
5. The health action plan was updated with the object-based preparation method.

Day-to-day delivery detail: Staff showed the health object with the GP photo and offered the comfort item before travel. The person held the comfort item during the waiting period and pushed the health object away once the appointment was finished.

How effectiveness was evidenced: The appointment was completed with lower distress. Records showed that objects supported both preparation and control during health access.

Governance and evidence

The audit trail may include communication profiles, object lists, choice records, support plans, supervision notes, activity logs, health preparation records and outcome reviews.

Data may show clearer choices, fewer distressed refusals, improved participation, calmer personal care or better appointment attendance. Qualitative evidence should explain how the object was selected, what it means to the person and how staff acted on the response.

Commissioner and CQC expectations

Commissioners expect providers to evidence person-centred support, meaningful involvement and improved outcomes. Objects of reference help show that people are supported to influence daily life through communication methods that work for them.

CQC expects effective communication, dignity, consent-aware support, person-centred care and good governance. Inspectors may look at whether staff understand how people express choice and whether refusal is recognised and respected.

Common pitfalls

• Using objects to tell the person what will happen rather than offer choice.
• Choosing objects that are not meaningful to the person.
• Ignoring rejection, hesitation or pushing away.
• Offering too many objects at once.
• Recording choice without describing the communication evidence.
• Failing to update object choices when routines or preferences change.

Conclusion

Objects of reference can make choice and control more concrete for people who do not understand verbal or symbolic options reliably. Strong providers demonstrate that objects are meaningful, used consistently and acted on. When object-based communication is linked to records and outcomes, people have stronger influence over daily life and support becomes easier to evidence.

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