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Introducing reasonable adjustment

This article explains the concept of reasonable adjustment.
A collage of images. A button to open a door, a boy with an intellectual disability using augmentative communication, a clipboard, and a doctor explaining medication to an older woman.
© Trinity College Dublin

One of the main concepts that underpins policies relating to intellectual disability is ‘reasonable adjustment’.

Reasonable adjustment describes the measures that can be taken to reduce the disadvantage experienced by someone because of their disability.
Reasonable adjustment includes:
  • Making changes to the built environment (e.g. providing ramps)
  • Communication using plain language
  • Communication using Easy Read material
  • Being welcoming and inclusive in your attitude toward all people

Why make reasonable adjustment?

To function well in society, we have to be able to access goods and services and we also need to communicate with the people we meet every day. All of this can be challenging for people with an intellectual disability; even tasks like reading the bus sign, or doing the shopping, can be challenging.
This can be further complicated if someone has never received an education, does not know how to read or write, or perhaps lacks the ability to interpret social cues. This immediately places someone at a disadvantage when connecting with their environment and those they meet.
Along with these challenges, someone with intellectual disability is more likely to have poor hearing and eyesight.
It has been reported that people with an intellectual disability are between 8 and 200 times more likely to have a vision impairment than their non-disabled peers (Woodhouse, 2010).
Frequently many people with severe to profound intellectual disability have difficulty with verbal language and may have no verbal skills at all.

Challenges within health services

As we will see later, people with intellectual disabilities face many challenges in using health services.
  • For example, if a person is in a large personalised wheelchair, unusually wider than most conventional wheelchairs, it may not fit through the door space of the clinical room.
  • Or, it could be the lack of courtesy at the reception desk that causes distress for the person.
When considering adjustments, there is a wide sphere to choose from.

Making reasonable adjustment through partnership

It is clear that not everything can be changed: an old hospital may have rooms that are inaccessible to someone in a wheelchair; a reception desk may be staffed by a temporary office worker who has little training in customer service.
Reasonable adjustment is about making a reasonable effort to change something so that someone with a disability can use it in the same way as someone without a disability.

If you are determining what reasonable adjustments you ought to make to promote equality, you should do so through partnership. If you include the person with the disability, you can then take their perspective and requirements into account. Ultimately, this means that you will be more likely to provide a service, environment or facility to accommodate most people.

Frequently people with disability are marginalised and not consulted. Partnership ensures robustness of the end product, and also assists in determining what supports are appropriate and needed. It also ensures the voice of the person with the disability is included in decision making and that choices are responding to identified needs.

Target what you want to do

The best way to make a reasonable adjustment is to assess what the requirements are, in partnership with the people who use (or should use) the service. Together, identify the best adjustments that are possible, starting with what is most urgent.

Don’t forget, when you want to achieve a specific adjustment, be SMARTER when setting your goals.

The word smarter on a set of wooden blocks

S = Specific – be exact about what adjustment you are going to target.

M = Measurable – as the old adage goes, what you can measure gets done.

A = Achievable – be realistic about your goal and know what you can achieve to get the best results within the time allowed.

R = Relevant – to what you want to achieve will bring the best results to the person.

T = Time bound – set a schedule to achieve the goal.

E = Evaluate – It is always good practice to evaluate what works and what doesn’t and if there are any further adjustments to make.

R = Review – or auditing the effect of the adjustment provides you with the necessary feedback and motivation to identify and make further adjustments to your practice.

© Trinity College Dublin
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Improving Health Assessments for People with an Intellectual Disability

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