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Moving toward change, embracing reasonable adjustment
Moving toward change, embracing reasonable adjustment
Hello, and welcome back. We are now entering our final week of the programme, and I hope you are enjoying the interactions and learning new things. We’ve explored the differences in the health status of people with an intellectual disability, and the difficulties some may have when expressing their needs. We’ve examined the challenges with communication that can exist, and laid down principles to follow in order to make reasonable adjustments to promote excellence in communication with people with an intellectual disability. This week, we’re going to explore the concept of reasonable adjustment farther and see how it fits into daily practice. How can we make the health assessment a better experience for people with intellectual disability?
We know that people with an intellectual disability have challenges when it comes to their health, and communicating those needs to health care professionals. However, people must attend their doctor, their physio, or other health care professional when the need arises. Therefore, being prepared is the responsibility of the health care professional and is prudent.
At times, the terms equality and equity are used interchangeably without much thought to their actual meaning. Not realising the implications of each of these terms can lead practitioners to believe they are doing the right thing when in fact, the opposite is the case. Equality is treating everyone equally, which can be interpreted as treating everyone the same. When in fact people’s health, and other needs, are not the same, but can be very different. It is essential the practitioner considers not only equality of service, but also equity of service. So for example, if the person requires an outpatient appointment and they received their letter similar to everyone else who is attending the outpatient department, this is equality.
However, if that person has a mild intellectual disability, lives alone, and cannot read, they will not understand what they have to do. Therefore, may not attend their appointment even if a follow up reminder letter is sent, resulting in failure to meet their health care needs. This scenario inadvertently creates barriers to health care access. This is where the health care professional must consider equity of service. Equity is defined as the quality of being fair and impartial by introducing reasonable adjustment. That is, making that appointment letter easy to read, with a follow up phone call, ensures the person has equity in accessing their appointment.
It is important to remember that failure to consider the implications of equality of health care access can, in fact, create an inequitable service. Remember, many of the disparities are modifiable and can be addressed. Once attention is given to all aspects of the barriers to health care that can occur, modifications can be made, and equity and equality restored. There are several aspects to your practice that can be included to promote good health care practice for people with an intellectual disability. We have discussed communication at length and its key to success.
Other positive actions health care professionals can do include developing the proactive health check, initiating an annual health check for the person with intellectual disability to proactively identify health needs and to meet them as they arise. Develop the health check passport for the person. This is an easy read passport that will keep their key information at hand so that if they have to attend clinics or hospital, their needs are easily identified, and key information conveyed. Identify the experts. Are there specialists trained in the area of intellectual disability, like intellectual disability liaison nurse, who can be a contact and support for both the person and you? If not, consider, are there external organisations you can talk to for support or advice?
Promote education among your professional colleagues. Through education, change can occur. Adopt the values of reasonable adjustments to your practise and, in doing so, raise awareness of its need. We will be asking you to create your own templates for this later on in the week. Raise awareness of the difference in health care need, and the barriers that exist, for people with intellectual disability. This can include positive promotion. Although many of these options are in vogue, and some are not available, they are not always successful and needs can continue to go unmet. However, that is no reason not to try. It is our professional obligation to employ strategies of change to promote the best health practise for people with intellectual disability.
By understanding the implications to practice, and why change is necessary, this will promote a fundamental impetus to change.
Welcome back for Week 3 of the course. In the video above, Eilish spoke about the importance of embracing reasonable adjustment, and mentioned the following practical resources in the video. Take some time to look through these resources which may help you to implement reasonable adjustment in your workplace.
Perform an annual health check
Initiate an annual health check for people with an intellectual disability. This will help you to be proactive in identifying health needs as they appear.- Royal College of General Practitioners: Health checks for people with learning disabilities toolkit
- Surrey Health Action: Easy Read Health Checklists
- University of Hertfordshire: Annual Health Checks for People with Intellectual Disabilities in General Practice
Develop a health check passport
An easy read passport will help keep key information at hand. Clinic or hospital appointments are captured, as well as individual needs and key information is conveyed to all health care workers.- Surrey Health Action: My Care Passport
- University of Hertfordshire: Passport to health
- National Health Service: Health Care Passport
Identify the experts
Are there specialists trained in intellectual disability, such as an ‘Intellectual Disability Liaison Nurse’, who may be available to consult with? This can be a useful contact and support for all.Promote education among your professional colleagues
As the phrase goes “Through Education, Change Can Occur”. Here are some relevant research articles you may wish to share with your colleagues about improving care for people with an intellectual disability.- Friese and Ailey (2015) Specific standards of care for adults with intellectual disabilities. Nursing Management. 22 (1) 32-37
- Robertson et al. (2010) Health checks for people with learning disabilities: a systematic review of evidence. In Improving Health and Lives: Learning Disabilities Observatory.
Adopt the values of reasonable adjustment in your practice
In doing so, you can raise awareness with your colleagues and acknowledge the different healthcare needs and barriers that exist for people with intellectual disability:Reflecting on these resources
- Have you used any of these resources or applications before in your practice?
- Do you think they would be useful? Why / why not?
- Are there barriers that would you face in implementing a health check passport, for example?
This article is from the online course:
Improving Health Assessments for People with an Intellectual Disability
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Improving Health Assessments for People with an Intellectual Disability
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