Clicker Success Stories

Berkshire Healthcare NHS Foundation Trust
and Bracknell Forest Borough Council

Warren Oldreive and Mary Waight – Accessible information – A new perspective  

How do you make complex information accessible to people who cannot read and are likely to forget or become confused? These challenges confront services like ours every day.

Existing methods of support have their limitations which can affect their effective use for all individuals. They often rely on literacy skills to some degree. Other approaches that do not rely on literacy skills do not use explicit language, which can increase the risk of confusion and increase the need for people to remember what they have been told exactly.

A format was needed which was language based, reduced the need for literacy skills and was accessible independently. Ideally this format should also be accessible to individuals who, as a result of either physical or sensory needs, are unable to access written materials.

In response to these needs, we devised a new format that uses a dynamic screen aid and voice output software. This approach has been labelled Computer AideD Information (CADI). Each program has two aims – to support access to information (i.e. reading) and to enable use of information (reasoning and linking information together).

These CADI programs enable individual navigation – this can occur via mouse, touch screen or switch access. The software can be accessed via the desktop screen. Navigation icons are consistent within programs to enable generalisation of skills. Different grids are included which have specific functions within the overall program. Many grids can be accessed from different places within a program to enable cross referencing of information. Two main elements are consistently present: a menu option and a timeline to support sequential understanding. Groups of programs can be stored together in an ‘Index’. If each program was considered to be a book, the index would be the accessible library. The language and images used can be personalised to each individual.

‘Clicker’ software has been used to build up the programs. It is useful because of its underlying flexibility. This means that lots of different grid designs can be incorporated, pop-up grids and arrows are helpful in certain situations. The difference between sending and non-sending grids has also been of benefit and both are currently used in different clinical situations. Sending grids allow responses to be stored and printed if required.

To date, a number of different CADI formats have been developed. These are all based on the Clicker software package:

  • Information access programs on a variety of topics
  • Support in activities of daily living – decision making and problem solving
  • Programs to support Capacity assessments
  • Interactive questionnaires – enabling access and retaining responses
  • Person centred planning formats – enables access to information and documenting of decisions
  • Other non-CADI formats include specific assessment batteries – money screening tool

The CADI format has been shown to be effective at supporting access to information. It is a framework that uses software to meet its objectives but involves a broader philosophy including the need to assess, individually plan and evaluate. This framework can be used in conjunction with other formats to meet the needs of individuals.

Successes

The CADI approach has already proven to be very effective. Resources have been created on topics ranging from money management to adoption and pregnancy advice.

There have been a lot of successes. One gentleman that has benefited from the program is almost blind, but the auditory prompts in Clicker enabled him to use the program to sign the tenancy agreement for his own home independently. Another lady was supported to understand a book of information given to her by the police following an alleged assault, but couldn't read it. The Clicker CADI program helped her to understand the vital information that the police had provided. Several mothers have been supported to understand the adoption process and complex reports made accessible. Information has been made available on complex health matters (dementia) and social care topics (elections and voting). A current project involves the use of CADI within a secure environment, where it is used to help individuals understand the mental health act sections. Another example involved a man being supported to make real life decisions by splitting tasks into steps and making explicit information available (i.e. contact telephone numbers appropriate to specific scenarios).