Using Objects of Reference in Learning Disability Services
Objects of reference can be powerful in learning disability services when people understand real objects more easily than words, pictures or symbols. An object can help a person know what is about to happen, make a choice, prepare for change or show what they want. For some people, a cup, towel, bus pass, toothbrush, swimming goggles or medication box may communicate more clearly than spoken explanation.
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 objects can make routines, transitions and choices more understandable where abstract communication does not work reliably.
Concept explained clearly
Objects of reference are physical objects used to represent an activity, place, person, routine or event. They may be actual objects, part-objects or consistent items associated with a specific experience. Their strength comes from direct connection. The person is not being asked to interpret an abstract symbol; they are being offered something concrete and familiar.
Objects of reference should be personalised. The object must mean something to the person. A generic object chosen by staff may not work if the person does not connect it with the intended activity.
Why it matters in real services
People may become anxious or distressed when routines are unclear. Staff may say “we are going out soon” or “it is time for a bath”, but the person may not understand the words, timing or expectation. Objects can reduce uncertainty because they show what is coming in a more concrete way.
Providers should be able to evidence that objects are used consistently, understood by the person and linked to real outcomes such as calmer transitions, clearer choices or better participation.
What good looks like
Good practice starts with careful selection. Staff identify objects that already have meaning for the person, introduce them consistently and observe the person’s response. The object should be used before the activity, during preparation and sometimes afterwards to confirm that the event has finished.
Strong services demonstrate a clear line of sight from object use to understanding, staff action and outcome.
Operational Example 1: Supporting a bathing routine
Context: A person became distressed when staff verbally prompted them for personal care. The person often moved away from the bathroom and became unsettled when staff repeated instructions.
Support approach: The provider introduced a soft flannel as an object of reference for bathing, linked to a predictable routine and reduced verbal prompting.
Five practical steps:
- Staff identified the point in the routine where confusion appeared to start.
- The team selected a flannel already associated with the person’s bathing routine.
- Workers introduced the object calmly before moving towards the bathroom.
- Staff used the same object, same timing and minimal speech across shifts.
- Managers reviewed distress records and personal care completion evidence.
Day-to-day delivery detail: Staff offered the flannel before the routine and waited for the person to hold it or look towards the bathroom. If the person pushed it away, staff paused rather than repeating instructions immediately.
How effectiveness was evidenced: Personal care became calmer, and staff recorded fewer repeated prompts. The provider evidenced that the object helped the person understand the routine before support began.
Deepening practice through total communication
Objects of reference work best within total communication beyond spoken language. A person may use objects alongside gesture, facial expression, movement, touch, photos, sounds, signs or routine cues.
This means staff should observe the full communication response. The person may reach for the object, push it away, hold it tightly, bring it to staff or ignore it. Each response may communicate something important.
Operational Example 2: Preparing for community transport
Context: A person became anxious when leaving home for community activities. Staff used photos and verbal prompts, but the person appeared more responsive to items they could hold.
Support approach: The provider introduced the person’s bus pass wallet as an object of reference for community travel.
Five practical steps:
- Staff reviewed which preparation cues the person already recognised.
- The bus pass wallet was introduced before travel preparation began.
- Workers paired the object with a simple photo of the destination.
- The person was given time to accept, reject or hold the object.
- Travel records were reviewed for anxiety, cancellations and successful outings.
Day-to-day delivery detail: Staff showed the bus pass wallet before coat and shoes. When the person held the wallet and moved towards the hallway, staff supported the transition without adding long verbal explanations.
How effectiveness was evidenced: Community outings became more predictable. The person accepted travel preparation more often, and records showed reduced anxiety before leaving home.
Systems, workforce and consistency
Objects of reference must be recorded clearly in communication profiles. Staff should know what each object means, when it is used, how the person responds and what action should follow.
Supervision should check whether staff use objects consistently or only when familiar workers are present. Handovers should record changes in response, rejected objects or new objects that may be emerging as meaningful. This prevents object use becoming informal knowledge held by only a few staff.
Operational Example 3: Supporting health appointment preparation
Context: A person frequently refused health appointments after being told verbally that a nurse visit was planned. Staff wanted a clearer preparation method that reduced anxiety and supported reasonable adjustments.
Support approach: The provider introduced a blood pressure cuff pouch as an object of reference for health checks, supported by accessible appointment information aligned with accessible information standards in learning disability services.
Five practical steps:
- The team identified which part of the health appointment caused uncertainty.
- Staff selected an object directly linked to the health check experience.
- The object was introduced during calm practice sessions before appointment day.
- Workers used the same object before the nurse arrived and during preparation.
- The appointment outcome and distress level were reviewed afterwards.
Day-to-day delivery detail: Staff showed the cuff pouch and used simple language such as “health check”. The person touched the pouch, then sat in the usual chair used for observations. Staff avoided introducing the object only at the moment of the appointment.
How effectiveness was evidenced: The person tolerated the health check with less distress. Health records and support notes showed that object-based preparation supported understanding and reasonable adjustment.
Governance and evidence
The audit trail may include communication profiles, object lists, staff guidance, observation records, support plans, health preparation notes, activity records, supervision notes and outcome reviews.
Data may show reduced distress, improved personal care routines, fewer cancelled activities, better appointment attendance or clearer choice-making. Qualitative evidence should explain what the object means to the person, how it is used and how the person responds.
Commissioner and CQC expectations
Commissioners expect providers to evidence personalised communication, inclusion and outcome-focused support. Objects of reference help show that services adapt communication around the person’s actual understanding.
CQC expects effective communication, person-centred care, dignity, safe support and good governance. Inspectors may look at whether staff know how people communicate and whether communication methods are used consistently in daily practice.
Common pitfalls
- Choosing objects that make sense to staff but not to the person.
- Using objects inconsistently across shifts.
- Introducing objects only when the person is already distressed.
- Failing to record what the object means and how the person responds.
- Using too many objects before the person understands the first ones.
- Not reviewing whether an object still works as routines change.
Conclusion
Objects of reference can make communication more concrete, predictable and meaningful. Strong providers demonstrate that objects are selected carefully, used consistently and reviewed against outcomes. When object-based communication is embedded into support, people are more likely to understand routines, influence choices and move through daily life with greater confidence.