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In 2003 specialist provider MacIntyre Care reviewed its child care practice and procedures as part of its quality assurance process at its two schools. MacIntyre is one of the largest providers of services for people with severe and complex learning difficulties in the voluntary sector in England.

NCH-The Bridge Child Care Development Service carried out the review and found that the biggest single risk to the safety of students was the high use of agency staff.

Brenda Mullen, director of lifelong learning for MacIntyre schools, says: "We consequently put a new energy into recruitment, we changed our salary structure, advertised in new places and recruited quality staff whom we could train with the knowledge they would stay for a significant length of time.

"The Bridge also encouraged us to develop more consistency in communication - in some areas our curriculum was trying to be too many things to too many people. This has led to an increasing emphasis on the importance of clear planning in terms of the communication environment and our approach to staff training. We have adopted a mentoring approach with the support of external speech and language therapists who have trained MacIntyre practitioners to become effective communication mentors."

At MacIntyre's school at Wingrave, Buckinghamshire, a communication environment is being created around the students and communication skills embedded into every aspect of life.

So, school timetables are visual with objects, photos or symbols displayed; everything in school and home environments is labelled with pictorial symbols; administrative staff are equipped with computers that write in pictorial symbols; and at home young people have choice boards from which they can choose leisure activities or meals.