Training Programmes

The goal of training is to provide better delivery of preventive, curative and rehabilitative medical care to persons with disability. After the training,by better understanding of various types of barriers in providing the services, the manpower involved will be able to help in improving delivery of medical care to persons with disability having sensory, motor, cognitive or communication disabilities. They can help the persons with disability in overcoming these barriers by good communication, developing rapport with the persons and assisting them in use of various services available. The training can be conducted in form of workshops in which active participation of the employees is useful. A feedback workshop for persons with disability visiting the healthcare facility will also be very useful.

During training, the staff needs to be told that thepersons with disability of different types may require different ways and methods of communication. The expectations of medical staff and expectations of patients who are with disability, from each other, may be different as compared to other patients. Even behavioral expectations may differ. It is required to understand problems of persons with various types of disabilities and the ways they can be addressed. The staff is taught about various communication means that can be used. They need to understand how the directions are to be given to the patients. They should know the alternative means of communication that can be used while interacting with these persons. Learning about appropriate behavior for dealing with persons of different types of disabilities is important. It should be emphasized that the communication should be with the person with disability directly and not through the attendant, as far as possible.They should provide the person with disability who comes to the healthcare facility to get medical care all the information and education material, if required in auditory format, in Braille or in large print.No assumptions regarding their problems and abilities should be made.When the person has understanding problems, the person accompanying also need to be explained so that treatment is taken as advised. Any support required should be provided without harming dignity, privacy and autonomy of the person. Any expression showing pity or disrespect should be avoided. If anything is impairing accessibility, the issue should be addressed at the earliest. The staff should discuss with administration the problems they face in communicating with persons with disabilities so that the best solution of the problem can be found.

They should be told during the training programme about how thefeatures added tovarious equipments make them accessible.The ways and means of communication including ICT means such as messaging, apps and calls, and care and precautions to be taken while interacting and communicating with persons with different types of disability are given below:

Interacting and communicating with persons with disability

Communication with persons with disabilities should be as effective as with others. It is more important in a health care facility, as a small mistake while communicating may lead to undesired or harmful change in management of his or her medical problem. While interacting with a person with disability, he or she also requires to be treated with respect, dignity, consideration and humbleness. They have right to equal opportunities and rights like a person without disability. While interacting with a person with disability

• Address a person with disability by his name, preferably 1st name.
• Do not pat the person on head or shoulder to show that you are caring.
• Do not insist if the person declines your offer of assistance.
• Communicate with the patient directly rather than speaking through attendant.
• Don’t feel troubled if you are not clear what to provide to the person, let him/her seek the assistance.
• Keep in mind that the person may take longer to respond because of his/her disability so be considerate.
• Don’t use common expressions that can’t be related to the person in view of his disability.
• While using ICT for providing information or interacting with a person with disability relevant instructions should be followed.

Language to be used for persons with disability

• While interacting with a person with disability the healthcare facility staff should know that
• Language of interaction should be “the person first language” which means that use person before disability so use “person with disability” and not “disabled person”.
• Use “person” first while addressing him using the condition he is suffering from. For example,use “person with cerebral palsy” and not “cerebral palsy person”.
• Use “a person who uses wheelchair” in place of wheelchair bound or confined person aswheelchair is an assistive technology to improve persons mobility.
• Ask “How long have you been using wheelchair” in place of “How long have you been in wheelchair”.

Interacting and communicating with persons with locomotor disabilities

While interacting with a person with locomotor disability the healthcare facility staff should know that

• Assumptions should not be made about capabilities of a person.
• Any type of assistance to the person to help in mobility should be provided only if the person asks for it.
• If an assistive aid of a person is to be moved from the place where it is kept, ask him before doing it.
• Talking to aperson seated in a wheelchair, one should make himself comfortable sitting at the level of the patientif talks are to be for more than a few minutes long.
• While giving directions to a person with disability consideration should be given to distance, accessibility and weather conditions.
• Do not avoid shaking hand with a person with upper extremity prosthesis.

Interacting and communicating with persons with low vision or blindness

Infrastructure with adequate indoor as well as outdoor lighting, use of internationally accepted standards of displaying information for persons with low vision, unobstructed views of displayed information and provision to provide information by audible means are some of the ways to provide access to healthcare facility and services. While interacting with a person with low vision or blindness, the healthcare facility staff should know that

• When approaching a person with low vision or blindness the healthcare provider should identify himself or herself. If there is another person present, introduce him or her also.
• In contrast to person with locomotor disability a touch on shoulder or arm is appropriate when speaking to the person.
• Talk to the person face to face.
• Don’t speak in a loud voice as the person can hear easily.
• Inform him when you are leaving.
• Be specific while offering directions and informing about obstacles.
• When offered to help, the person should be allowed to touch your arm, that will help in better guidance.
• Inform the person about the posted information or alert signals.
• Don’t touch or play with an accompanying dog without owner’s permission.

Interacting and communicating with persons with hearing problems like hard of hearing and deaf

Communication is very important in medical care. Wrong understanding can lead to wrong interpretation of history so wrong diagnosis. If the person is not able to understand the directions given by doctor, it may lead to improper or wrong treatment.

Persons with auditory disability usually communicate by speaking or by using auditory aids, oral interpreter, cued speech interpreter or Computer Assisted Real Time Transcription (CART) etc.

Providing written information is a useful way for exchange of small information. If longer interaction is required or the information exchanged is complicated or crucial, a qualified interpreter or a sign language interpreter should be provided. An interpreter is also required when a minor patient is accompanied by a person with hearing disability.

Interpretation if required, should be done by a qualified interpreter. Help of any other person like family members may be taken in an emergency situation. There are many situations whiledelivering healthcare where interpreter may be required for effective communication seeing the importance of the information. The interpreter should be able to effectively understand and convey the information to both the parties. The interpretation should be effective and impartial and should maintain privacy of the communication.

Sign language interpreters are effective only for people who use sign language. Other methods of communication such as the use of a transcriber may be necessary for those who lose hearing later in life and do not use sign language.

Hospital staff should be well versed with the hospital protocol of getting an interpreter at the earliest. Information boards or display screens should be placed near the place where the information is sought usually.

Teletypewriter (TTY, TTD or TDD) is used by some persons with hearing disability. The device helps in telephonic communication by converting spoken message into text which is displayed on a screen and vice-versa.

Visual alarms must be provided where audible alarms are provided.

Some of public phones must be compatible with TTY and hearing aid. They should have volume control.

All the communications aids should be made available without any charge.

Following points need to be emphasized during training of the healthcare facility staff for communicating and dealing with persons with hearing disability

• Ask the person how to communicate with him or her.
• Give enough time to the sign language interpreter particularly when some technical words are used.
• To get the person’s attention when you want to speak to him a light waving of hand or touch on arm is useful.
• Speak clearly in an expressive manner and with a normal tone.
• Allow the person to read your lips while you speak to the person. Face the person when speaking to him.
• While writing, don’t speak to the person as the person can’t read your lips when looking at the written information.
• Minimizing disturbing background noise is very useful when talking to him or her.
• Try to get feedback to assess clear understanding.
• Don’t hesitate to ask the person to repeat or write down, if what he spoke is not understood.

Interacting and communicating with persons with speech and language problems/difficulties

While interacting with a person with disability the healthcare facility staff should know the following.

• Be polite and friendly and start talking to the person as is done with anyone else.
• Give him time to speak and convey what he wants to, without speaking for him.
• Don’t lose attention and ask the person to repeat.
• For better communication repeat what you have understood
• Don’t hesitate to ask the person to repeat or write down, if what he spoke is not understood.
• Use any available communication device that the person prefers to make the communication better.
• Speak in normal tone if the person has no hearing problem.
• Ask short and clear questions without insulting him or her by over-simplification of the communication.
• Communication manners with the person should not be discouraging.

Interacting and communicating with persons with intellectual disability

Before providing accessible services, the healthcare providing staff should know the following points

• Be alert and if required change your method of communication to gestures, writing on a paper, diagrams, demonstrations etc. for better communication.
• Use simple language with words relating to the things that are seen around.
• Provide the information clearly and precisely and check if the person has understood.
• Repeat the information if the person has not understood.
• Don’t hesitate in giving the information again but in a different way.
• Persons with intellectual disability,to please the staff,may showthat he or she thinks that the informing staff is good. So, confirm the response by asking in a different way.
• Don’t pretend to have understood the information given by the person.
• Instruction given should be clear and specific. Too many instructions may confuse the person.
• Be patient and don’t get irritated by patient’s response. Your perception may be wrong.
• If the person is expected to have memory deficit, they may not remember and ask for the information again.
• Adjust your method of communication and if required change to communicate better if the person has auditory or visual perception problem.
• Keep the background noise to minimum.
• There may be difference in the type of response you are able to elicit with the same type of question if asked to two different persons.
• Be clear about the literacy status of the person.

Interacting and communicating with persons with psychiatric disabilities

• Make eye contact with the person and speak directly to him.
• Keep the communication simple and clear.
• Be patient and listen to the person carefully. Never pretend to have understood.
• Behave with the person as you would do with any other person.
• Be careful in your mannerism, the person’s interpretation may be different
• Your body language should not indicate that you are uncomfortable with the person.
• Provide the information clearly and precisely and check if the person has understood.
• Repeat the information if the person has not understood.
• Don’t hesitate in giving the information again but in a different way.
• Don’t make assumptions about the person’s preferences or response. Treat the person as an adult. Do not make decisions for him or her.
• Do not give an advice or assistance which is not solicited.
• If the person appears to be experiencing a mental health crisis, do not panic and run for help. Try to find how you can help.
• Do not be influenced by the information you received from movies and social media regarding dealing with persons with psychiatric disabilities.

Source : Ministry of Health & Family Welfare