Reasonable adjustments

Reasonable adjustments in health care include policies, processes, systems, and communication that adjust for the needs of the person with intellectual disability. Reasonable adjustments prevent direct and indirect discrimination against a person with a disability.

Reasonable adjustments are underpinned by person-centred communication, multidisciplinary teamwork and creating pathways to health care.

Legal framework for reasonable adjustment

Within Australia, Commonwealth and state and territory legislation is in place to: acknowledge the human rights of people with a disability; promote independence, economic and social inclusion; facilitate access; provide safeguards and enact the United Nations Convention on the Rights of Persons with Disabilities (CRPD).

Under the Commonwealth Disability Discrimination Act 1992 (the Act), reasonable adjustments are described as a duty of care to prevent discrimination.

State and territory governments each have disability inclusion legislation for public authorities, including health, mandating disability inclusion action plans. The inclusion of a Disability Access and Inclusion Plan (DAIP) ensures services meet the needs of people with a disability, their families, and carers.

To provide safe and inclusive health care for people with intellectual disability, the Four Steps to Inclusive Health Care assists in making reasonable adjustments.

Examples of reasonable adjustments

Pre-appointment:

• Accessible information pack about the hospital/clinic/appointment
• Pre-appointment visit to the hospital/clinic to become familiar
• Flexibility in appointment times, for example, appointment times which fit around their daily routines
• Telephone reminders for the appointment
• Accessible car parking.

Appointment

• Speaking directly to the person with intellectual disabilities throughout the healthcare encounter, for example, to explain during the procedure what is happening and what is happening next
• A longer appointment time, for example, a double appointment
• An appointment during a quiet time, for example, first or last appointment of the day
• The family being present during the appointment
• Explaining consent procedures and providing Easy Read information
• Checking for understanding of the information that has been given
• Demonstration of a physical examination using either yourself or another to show what is planned to gain the person's permission
• Procedure explanations in Easy Read or pictorial format, or if available, a video of a planned procedure
• Access to toilets before and after a visit
• Playing the person with intellectual disability’s favourite music, or music in general during the procedure to relax and distract them.

Further resources

Some resources to guide and support reasonable adjustments and different ways of communicating with individuals, and providing health-related information:

• Department of Developmental Disability Neuropsychiatry (3DN) Resources for health and mental health professionals, including guides and Easy Read resources
• The Council for Intellectual Disability (CID) has health guides in Easy Read for people with intellectual disability
• Health Resources – Down Syndrome Australia for people with disability and clinicians, access information and Easy Read resources to support consumers
• Health – Inclusion Australia: Information about intellectual disability and a collation of health related resources from around Australia
• Queensland Centre for Intellectual and Developmental Disability
• The NSW Agency for Clinical Innovation (ACI) developed The 10 guiding principles of quality health services for people with Intellectual Disability
  An Easy Read version is available – 10 things we believe about good health services for people with intellectual disability
• Queensland Acquired Brain Injury Outreach Service (ABIOS) outlines common communication changes after an acquired brain injury (ABI) and provides a range of practical resources to assist in understanding and managing communication difficulties
• Speech Pathology Australia has a range of fact sheets (with Easy Read)
• National Relay Service (NRS) – A call through the NRS allows communication with a hearing person who is using a phone even if someone can’t hear or use their voice
• Augmentative and alternative communication (AAC) methods can help people who are unable to use verbal speech to communicate, if they choose. AAC encompasses a wide range of methods, from sign language and picture boards to mobile device apps and dedicated speech-generating devices. See Speech Pathology Australia fact sheet on AAC for further information.
• Healthy Mind e tool for people with intellectual disability, Black Dog Institute
• Centre for Developmental Disability Health (CDDH) Monash Health, resources for health professionals
• The Australian Commission on Safety and Quality in Health Care has developed a National Safety and Quality Health Service Standards User guide for health services providing care for patients with cognitive impairment or at risk of delirium 2019
• Books Beyond Words are award-winning wordless picture stories covering topics including physical and mental health. Each story is co-created with and for people who find pictures easier to understand than words
• The General Medical Council in the UK includes information on Learning disabilities in the Ethical issues hub, including highlights on key reasonable adjustments.