Using Objects of Reference in Learning Disability Services
Objects of reference can be highly effective in learning disability services because they make communication concrete. For people who do not understand symbols, written words or verbal explanations easily, a real object can help signal what is happening, support choice and reduce anxiety.
Strong providers use objects as part of wider communication and accessibility practice, not as isolated resources. They also link them with learning disability service models and pathways, because objects are often most useful during transitions, personal care, health appointments, community access and changes in routine.
Concept explained clearly
An object of reference is an item used to represent an activity, place, person or routine. A towel may represent bathing. A cup may represent a drink. A key may represent going out. A bus pass may represent travel. The object must have meaning for the person, not just for staff.
Objects of reference matter because they can support understanding before an event happens. They allow staff to communicate through something the person can see, touch, smell or hold. For some people, this is more meaningful than speech or pictures. For others, objects work alongside signs, photographs, gestures and short phrases.
Why it matters in real services
When people do not understand what is about to happen, distress can be misread. A person may push support away because they have not understood that staff are preparing a bath, a meal, a visit or a journey. They may appear to refuse when the real issue is uncertainty.
Objects of reference can reduce this risk by making routines more predictable. They also support choice. A person may not be able to answer a verbal question about activities, but they may reach for a swimming item, gardening glove or music object when given time and space to respond.
What good looks like
Good use of objects of reference is personalised, consistent and reviewed. Staff do not simply pick objects that seem logical to them. They observe what the person associates with routines, involve family or familiar supporters where appropriate and test whether the object helps understanding.
Strong services demonstrate that objects are used consistently across shifts and settings. Providers should be able to evidence how objects support understanding, participation, reduced distress, safer transitions and clearer choice-making.
Operational Example 1: Supporting personal care
Context: A person in residential care became distressed when staff approached for bathing support. The person used limited speech and did not consistently respond to picture symbols. Staff often explained the bath verbally, but this increased anxiety.
Support approach: The team introduced a small towel as an object of reference for bathing. The towel was shown before support began, paired with a short phrase and used only for that routine. Staff agreed not to approach with personal care items without first presenting the object and allowing processing time.
Day-to-day delivery detail: Staff showed the towel while standing at a respectful distance. They waited for the person to look, touch or move towards the bathroom before continuing. If the person turned away, staff paused and tried again later unless there was an immediate hygiene or health risk.
How effectiveness was evidenced: Daily records showed fewer episodes of distress before bathing. Staff noted increased movement towards the bathroom after the towel was introduced. Supervision records confirmed staff understood the approach, and the communication plan was updated with clear guidance.
Deepening practice through total communication
Objects of reference work best when they sit within a total communication model. They should not replace every other communication method. Instead, they provide one route into understanding, particularly where speech, pictures or written information are not enough. The approach described in total communication beyond spoken language helps providers keep the focus on what the person actually understands.
This also supports pathway planning. When a person moves between home, respite, day opportunities or health settings, familiar objects can provide continuity. The object becomes part of the person’s communication environment, helping new staff understand how to prepare, explain and support change.
Operational Example 2: Preparing for community activity
Context: A supported living tenant often became anxious before community outings. Staff used a weekly activity board, but the person did not appear to understand symbols or written words reliably.
Support approach: The provider introduced a small set of objects linked to known activities: a gardening glove for the allotment, a swimming band for the pool and a café loyalty card for coffee visits. The person was supported to choose between two objects at a time.
Day-to-day delivery detail: Staff presented the objects on a plain tray, named each option once and allowed the person time to reach, push away or hold an object. The chosen object was then carried during preparation and travel. Staff avoided changing plans after an object had been selected unless necessary.
How effectiveness was evidenced: Activity records showed increased participation in preferred outings. Staff recorded clearer expressions of choice and fewer refusals at the front door. The person repeatedly selected the gardening glove over four weeks, leading to a revised activity plan with more outdoor time.
Systems, workforce and consistency
Objects of reference need clear team systems. Staff must know which object means what, when it should be used, how it should be presented and how the person may respond. Without consistency, the object loses meaning or becomes confusing.
Supervision should test whether staff understand the person’s object system. Handovers should include whether an object was used, how the person responded and whether any change was noticed. New staff should observe the approach before using it independently. Where the person accesses several settings, the object system should be shared appropriately so communication remains consistent.
Operational Example 3: Supporting hospital access
Context: A person with profound learning disabilities needed regular hospital appointments. They became distressed when leaving home unexpectedly and did not understand appointment letters or picture schedules.
Support approach: The provider introduced a hospital object pack containing a small appointment card holder, a sensory item used only during clinic visits and a photo of the hospital entrance. The pack was introduced gradually before appointments and used with short, consistent phrases.
Day-to-day delivery detail: Staff showed the pack the evening before and again on the morning of the appointment. During travel, the person held the sensory item. Staff also used guidance from accessible information standards in learning disability support to ensure appointment preparation was understandable in practice, not simply available in a formal format.
How effectiveness was evidenced: Appointment records showed fewer failed attendances. Staff noted reduced distress during travel and waiting. The hospital learning disability liaison nurse added the object pack to reasonable adjustment information, improving continuity for future visits.
Governance and evidence
Governance should show that objects of reference are assessed, implemented, reviewed and linked to outcomes. The audit trail may include communication assessments, support plan guidance, staff training records, observation notes, incident analysis and review minutes.
Data may show reduced distress, increased participation, clearer choice-making, improved appointment attendance or fewer failed transitions. Qualitative evidence should record how the person responded, what staff changed and whether the object still holds meaning. This creates a clear line of sight from communication need to support action to outcome.
Commissioner and CQC expectations
Commissioners expect providers to show that people with learning disabilities can access support, activities, health appointments and transitions in ways that reflect their communication needs. Objects of reference can evidence practical accessibility when they are embedded into support rather than kept as unused resources.
CQC expects staff to communicate in ways people understand, make reasonable adjustments and support person-centred care. Inspectors may look at whether staff know the person’s communication methods, whether these methods are used consistently and whether communication tools reduce distress, restriction or exclusion.
Common pitfalls
- Choosing objects because staff understand them, rather than because the person does.
- Using too many objects too quickly and creating confusion.
- Changing the object without reviewing whether the person still understands it.
- Using objects inconsistently across shifts or settings.
- Failing to record the person’s response and outcome.
- Treating objects as childlike resources rather than adult communication tools.
Conclusion
Objects of reference can make communication more concrete, respectful and effective. Strong services demonstrate that objects are personalised, consistently used, reviewed and linked to outcomes. When applied well, they support understanding, reduce anxiety, strengthen choice and help people participate more confidently in daily life.