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Contents
INTRODUCTION
The purpose of the Participant Workbook
Responsibilities
Learning outcomes
Learning icons
SECTION 1: WELCOME TO DISABILITY SUPPORT WORK: EMPOWERING CLIENTS WITH DISABILITY o Facts o Attributes and personality o Roles and responsibilities o Requirements o Useful links
SECTION 2: INDIVIDUAL ABILITIES AND DISABILITIES o Defining a disability
•
Developmental disability
•
Acquired disability o Various types of disability:
•
Chronic medical conditions
•
Intellectual disabilities
•
Learning disabilities
•
Mental health issues
•
Neurological conditions
•
Physical disabilities
•
Hearing impairment
•
Vision impairment o Resources for further research
SECTION 3: EFFECTIVE COMMUNICATION o The basic communication process o Barriers to effective communication o Strategies for effective communication o Communication with clients with specific disabilities o Augmentative and alternative communication o Effective language
•
Words to watch
•
Acceptable alternatives o Conflict and issue resolution
•
Identity conflict
•
Levels of conflict
•
Cross cultural conflict resolution o Negotiation – The art of reaching a mutually satisfying argument o Confidentiality and privacy
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SECTION 4: CHOICE AND CLIENT DIRECTED CARE o New disability care environment o The meaning of choice o Client-directed care o Funding arrangements o Communication with clients and service providers o Comprehensive and holistic assessments o Collaboration with other stakeholders o Client decision-making o The support worker as advocate o Challenges to client-directed care o Dignity of risk o Defining boundaries o Duty of care o Advocacy o Indicators of abuse or risk of harm o Workplace health and safety
SECTION 5: COMMUNITY ACCESS AND SOCIAL INCLUSION o Access and equity o Transportation o Technology o Network and support groups o Employment o Disability and personal relations o Research strategies
SECTION 6: YOU AND THE DISABILITY CARE ENVIRONMENT o Self-awareness and emotional intelligence o Dealing with emotions o Building rapport o Self-awareness in conflict situations o Debriefing o Time management and effective work habits o Code of conduct o Professional development o Glossary
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The Purpose of the Participant Workbook
This workbook is issued to you in order to guide you through the course work required to complete this specialised training. It contains the learning content, reference to any textbook material you may need to access, and activities that you will need to complete either in class or in your own time.
Instructions are provided throughout the workbook to guide you as to when and how to use the information provided.
Your trainer may give you additional information and they may adjust learning activities to assist in the learning process. If you are having any difficulties with the learning resources provided please discuss this with your trainer.
Once you have completed the learning materials required to complete an assessment task, your trainer or assessor will direct you to your Candidate Assessment Guide. This guide contains all the assessment tools you are required to complete to achieve competency in this skill set. Further instruction on the assessments and what you are required to do in each task will be given by your trainer and/or assessor at this time.
What do you need to do?
 Attend face to face training when required
 Read and complete the activities in this workbook and any other resources required
 Seek assistance when required
 Participate in the learning process
What your trainer will do:
 Support your learning
 Provide you with any additional documents to assist your learning
 Ensure you are included in the learning process
 Provide you with feedback on your progress
Learning outcomes for this course
This skill set is divided into topics that incorporate nationally recognised outcomes found within training package units of competency. A full copy of the units of competency can be found at http://training.gov.au
or your trainer can provide you with a copy.
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Learning Icons
Throughout this workbook you will notice a number of learning icons. These icons are used to help direct you in how to use the information that is provided. Listed below are the icons you will see and what they mean:
Activity
An activity that you complete either in class or in your own time
Reading
Reading either in class or your own time
Research
Look further it may be of interest
Important!
An important point to remember
Case Study
A specific example of how the theory you are learning has been implemented in a workplace
Group Discussion
As a group we will discuss this topic
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Welcome to the Disability Care Skill Set Learning Package and Participant Workbook! This is an exciting part of a journey that will introduce you to some of the opportunities and challenges of working in this growing sector. Our aim is to help improve your knowledge, skills and understanding to enable you to support client choice and empowerment in the area of disability care.
This training package has been created in conjunction with clients with disability. Those with disability who will be most impacted upon by this new environment guided us with their views, experiences and opinions. Throughout this training package you will see comments from people with disability to give a greater sense of connection and understanding of their situations. This connectedness with those who are have disabilities as well as the people who support and enable them in their homes and communities is vital for real choice and empowerment to occur.
Let’s look at some startling facts to get us started:
Facts:
Ӿ One in five Australians has a disability.
Ӿ Every week, five more Australians sustain a spinal cord injury and 10 to 15 sustain a severe traumatic brain injury.
Ӿ Every two hours, an Australian child will be diagnosed with an intellectual disability.
Today, over three million Australians are living with some form of disability. People with disabilities come from all sectors of the community. They have the same hopes and dreams as everyone, and the same rights to live their daily life in a welcoming community.
People with disabilities are rarely portrayed as living an average daily life. Yet they remain people first, and just want to be treated as equals in a welcoming and inclusive community. Actions and words have the ability to enhance or corrupt the way in which members of the community treat or view people with a disability
Do you have the attributes and personality we are looking for in a good disability support worker?
Do you want to:
 contribute to someone’s life and enable choice and empowerment?
 put your life experience to good use?
 feel valued and good about yourself?
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 make a difference to someone’s day?
 support a person achieve to their goals?
 want flexible working hours?
Do you have:
 good communication skills?
 a genuine interest in people?
 a positive outlook on life?
 respect for differences?
 pleasant personality?
 a sense of humour?
 a good sense of reliability?

A sense of honesty?
 a sense of responsibility?
If you answered ‘yes’ to all of these questions then you could be a great disability support worker!
What will you do as a disability support worker?
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The main role of a disability support worker is to enable a person with a disability to live as independently as possible with as much choice and control over their current and future decisions. A large part of this role is to assist the person with disability in some aspect of their daily life, including home, work and/or their social life.
Some people with disabilities need assistance with everyday daily living tasks. Others need assistance with accessing recreation and leisure and others with finding and maintaining employment. The great diversity of jobs within the disability sector allows you to utilise your skills in a variety of settings with a variety of people.
Working in the disability sector is an enjoyable and satisfying career. Just like all of us, each person with a disability is different, with their own personalities, dreams, aspirations and abilities. People with a disability may require assistance in one or more areas of their life to enable them to maximise their full potential.
Working to assist people in their daily lives also means that your working hours can be flexible and may cover a 24 hour period. Depending on your chosen area of employment, you are able to work around your own life, including family and study.
Part of being a disability support worker is being able to relate to different people in different stages of their lives and disabilities. People with disabilities come from different cultures, faith traditions and lifestyle preferences. We need to respect their choices with regards to these areas. Our attitudes towards these differences and our own personal values will impact upon how the client feels empowered and valued.
When you hold a particular attitude towards a person this is often reflected in the way you behave in toward that person. As human beings, we all have our own values, beliefs and attitudes that we have developed throughout the course of our lives. The attitudes that we feel very strongly about are usually called values. Sometimes our own attitudes can make us blind to other people’s values, opinions and needs. Values can influence many of the judgments we make as well as have an impact on the support we give clients. It is important that we do not influence client’s decisions based on our values. We should always work from the basis of supporting the client’s values.
Our family, friends, community and the experiences we have all contribute to our sense of who we are and how we view the world. As support workers, we are often working with people who are vulnerable and/or who may live a lifestyle that mainstream society views as being different. If, as support workers, we are to provide a service that meets the needs of our target groups and help
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them to feel empowered, we need to be aware of our own personal values, beliefs and attitudes and be prepared to adopt the professional values of our industry. We will discuss this a little later in the training package.
Requirements and checks for becoming a disability support worker
We want to make sure the environment is as safe as possible for both support workers and clients with disabilities. Part of this is ensuring our potential SW’s have the necessary checks that the legislative environment requires. These may include the following:
 a satisfactory national criminal history check
 an Australian motor vehicle driver’s licence
 a current First Aid certificate or the willingness to attain one
Benefits of working as a disability support worker
Besides having that sense of purpose or feeling that you are making a difference to many in our community, other benefits occur in the following areas:
Working hours
Disability work offers flexibility. Hours of work may include weekdays, evenings, overnights and weekends, or a combination of these. The duration of work time can vary from a few hours up to 24 hours. Work can also be Monday to Friday during office hours. The options of work include full time, part time and casual work.
Salary and wages
Salary and wage rates and levels vary across agencies and depending on the nature/level of work you are engaged in. Attractive salary sacrificing options are possible with most agencies.
Other Conditions and Benefits
On the job induction and training
High level of job satisfaction
Training in Certificate III and IV in Disability Work can be offered.
Qualifications
The qualification required depends on what type of work you are doing. Past experience and relevant qualifications will be considered relating to the job you want. The entry level qualification for a
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disability services support worker is generally the Certificate III in Disability Work or similar qualification or working towards a qualification.
What are my career prospects?
You will develop a strong foundation from which to develop a career in disability services. Some of the career pathways for disability support workers after gaining experience and/or qualifications include senior disability support worker roles, Team Leader roles, Coordination and or Workplace
Trainer.
Helpful links which may provide you with background information helpful for a career in Disability
Support work.
1. Disability Service Standards- The nine standards have a primary focus of ensuring results for consumers of Disability Services that are consistent with the principles and objectives of the State legislation. The emphasis is on using the standards to encourage continuous improvement of services. Click on this link to find out more about the standards. Disability Service Standards Booklet
2. Duty of Care- A duty of care is a duty to take reasonable care of a person. A disability support worker has a duty of care to anyone who is reasonably likely to be affected by their work activities.
These are likely to include the person with a disability that they are the support worker for, the families and carers of clients other support workers and the general community when working within a community environment. Click on this link for further information. http://www.qla.org.au/PDFforms/Procedures/Duty%20of%20Care%20Procedure%20Mar07.pdf
3. Understanding Disability- It is helpful to understand disability and how it affects people. There are many different types of disabilities such as intellectual disability, cerebral palsy and autism. Click on this link for further information. http://www.adcet.edu.au/Cats/Understanding_Disability.chpx
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A disability may be visible or hidden, permanent or temporary, and may have a minimal or substantial impact upon a person’s abilities. Focusing on the ability of the individual person, who may be constrained at times by their physical, social, and psychological disability, is an important way forward to help enable them to be meaningful participants in the wider society. As support workers we are there to enable them and support the client in areas in which their disability exists, but need to be aware that many of clients with disabilities possess strong abilities in other areas which are less visible. This is part of enabling choice and control and giving our clients the capabilities and support needed to fulfil their potential.
1 in 5 Australians has one or more disabilities and this proportion is increasing with the ageing of the population. This means that sometime in our life we are all likely to have a disability and/or have a friend, family member, class mate and/or work mate with a disability.
The term disability also refers to people who have a mental illness or medical condition, such as diabetes, epilepsy or HIV/AIDS. Furthermore, 88% of disabilities are invisible. There is a tremendous variety of specific causes, as well as combinations and severity of disabilities.
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IN THIS SECTION WE WILL LOOK AT:

Defining a disability o Developmental disability o Acquired disability

Looking at the various types of disability o Chronic medical conditions o Intellectual disabilities o Learning disabilities o Mental health issues o Neurological conditions o Physical disabilities o Hearing impairment o Vision impairment

Resources for further research
There are a number of key issues that people with disabilities are faced with on a daily basis. These include legal, social, philosophical and legislative issues that guide and affect the provision of services to the disabled.
People with disabilities require a range of supports and the ability to access mainstream community services and facilities in order to have a full life in the community. This should be underpinned by individual planning and support, with the ability for the person to be as self-directed as possible and have the availability of facilitation and co-ordination where required.
Human rights for people with disabilities have been incorporated into Australian law in several ways.
The Commonwealth Disability Services Act 1986 gave the Commonwealth the power to disburse money for services for people with disabilities and to provide grants to the states and territories for the provision of services. It also enables the Commonwealth to make regulations that specify the aims and principles when providing these services. All states and territories receiving money under this act are required to pass complementary legislation confirming the aims and principles of the
Commonwealth law. The objective of this was to unify the intent of all the disability services in
Australia so as to keep its international treaty obligations.
To say that ‘people with disabilities are individuals’ may seem obvious but for a very long time they have been regarded as part of a group and not as an individual. This has led to stereotyping and large numbers of people being categorized and cared for in the same way with no focus on individual needs and expectations. People with disabilities are entitled to be treated with dignity and respect.
They have their own likes and dislikes, feelings, attitudes, interests and talents. Like every human being a person with a disability means being a unique individual who has more in common with a non-disabled people than he or she has different.
Disabled people have legal rights and human rights and there should be no differentiation between their rights and the rights enjoyed by the rest of the population of Australia. Disabled people have the right to:
 the fullest possible development
 be treated just like able bodied members of society
 a reasonable quality of life
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 participate in decisions affecting the person
 pursue grievances
People with disabilities are mothers, fathers, friends, neighbours, employees, bosses, customers, and community leaders. They are just like you and expect to be treated just as you would like to be treated. One of the ways that you can contribute to helping the disabled achieve this is through effective communication. Some of the ways that this can be achieved are:
 ensuring people with a disability have equal access to information about services, activities, events, and issues affecting their lives
 interacting with people with a disability in such a way that shows that we value their contribution and respect their rights
 using appropriate language when speaking and writing about people with a disability
Research undertaken in Australia has identified the following issues of people with a disability:

Accessibility to their community and surroundings. This relates to facilities and services, information, infrastructure, transport and opportunities for raising awareness with local businesses and organisations.

Accommodation and housing : people with disabilities have the right to the same range of housing choices as the rest of the community. There are barriers however that limit the extent to which this right can be achieved. Availability of accessible, affordable housing and transition and supported accommodation are areas that are developed and planned for by local councils in consultation with all members in the community.

A sense of belonging in the community which goes beyond having a home in a street with other people . It is about rights and opportunities, employment opportunities, participation in volunteer activities, programs which address social isolation, accessibility for participation in local cultural and festival events. These all assist the disabled person to feel as though they are part of the community.

Provision of services such as a service provider network, providing such services as respite care, vacation care programs (for children with a disability) and adequate and accessible health care providers.

Culturally specific and linguistic issues.

Financial vulnerability.

Carer/family burnout.
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
Financial support for carers e.g. income support from Centrelink, carer’s allowances.

Freedom from discrimination: discrimination occurs when people with a disability are treated less fairly than people without a disability.

Peer support for carers.

Mutual support and self-help groups.
There are a number of misconceptions in our society in respect to people with disabilities. These ultimately impact on the disabled person and how they feel about themselves and their place in society. When the community in which you live brands you as a ‘menace to society’ or sees you as an
‘object of dread and pity’ the effect that this can have on an individual can be extremely detrimental.
Some of the most common failings that are felt by people with disabilities are:
 being seen as having little or no worth in society
 being the object of pity and charity
 fear of rejection on all levels- personal , social and employment
 being seen as a burden on society
 being isolated and segregated form society
 having their life wasted
 social relationship discontinuity
 loss of control over one’s life
 being seen as belonging to a group and not as an individual
 being unable to support oneself financially
Many people with disabilities spend their whole lives being told that they are not like other people or in the extreme that they are worthless. The result of this constant berating is that a great percentage of disabled people have low self-esteem and feel that they are a source of anguish to those around them. Society’s values and attitudes towards disabled people are changing and through the implementation of government regulations/acts and education to the rest of the community on disabled people there will be even more changes and improvements.
What is disability?
A disability is an impairment that may be physical, cognitive, mental, sensory, emotional, developmental, or some combination of these. A disability may be present from birth, or occur during a person's lifetime.
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World Health Organisation define disabilities as an umbrella term, covering impairments, activity limitations, and participation restrictions.

An impairment is a problem in body function or structure.

An activity limitation is a difficulty encountered by an individual in executing a task or action.

A participation restriction is a problem experienced by an individual in involvement in life situations.
A disability may be physical, cognitive, mental, sensory, emotional, and developmental or some combination of these. A disability may be present from birth, or occur during a person's lifetime, while the degree of disability may range from mild to moderate, severe, or profound. A person may also have multiple disabilities.
DISABILITY CAN BE DEVELOPMENTAL OR ACQUIRED.
Developmental disability:
Developmental disability is a term that refers to a permanent impairment usually occurring early in life. Mostly result from damage caused;
• before birth (prenatal stage) by factors including genetics, developmental malformation and diseases
• around birth (peri natal stage) by factors including low weight, prematurity and obstetric complications
• after birth (neonatal and postnatal stages) by factors including infections, diseases, malnutrition and environmental factors
Acquired disability:
Acquired disability or acquired brain injury - or ‘ABI’- refers to any damage to the brain that occurs after birth. That damage can be caused by an accident or trauma, by a stroke, a brain infection, by alcohol or other drugs or by diseases of the brain like Parkinson's disease.
Under the Disability Discrimination Act (1992) examples of conditions that may be considered disability include:
 chronic medical conditions - (asthma, diabetes, cancer, crohn’s disease, arthritis)
 intellectual disabilities - (down syndrome, fragile X syndrome, foetal alcohol syndrome)
 learning disabilities - (dyslexia, dysgraphia, scotopic sensitivity)
 mental health conditions - (depression, anxiety disorders, schizophrenia, bipolar disorder)
 neurological conditions - (multiple sclerosis, epilepsy, asperger’s)
 physical disabilities - (spinal cord injury, cerebral palsy)
 sensory disabilities - (hearing, vision)
What are chronic medical conditions and some associated facts.

Chronic medical conditions are health condition that have been or likely to have been present for at least 6 months.

Leading causes of death and disability in Australia.

Require high use of health services, contributing to health funding pressures.

Increasing prevalence in Australia, often linked to lifestyle.

Complex and varied in terms of their nature and impact.

Increasing ageing of population played a key role in rise in prevalence.

2010 leading cause of death in Australia o Asthma o Cancer
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o Diabetes mellitus o Cardiovascular disease o Arthritis
What is an intellectual disability and some associated facts.


An intellectual disability is a disability affecting cognition.
People with intellectual disability may have difficulties with learning, communication, daily

 living skills, information processing, social functioning and problem solving.
Around 3% of Australians have an intellectual disability.
Approximately 1.8% of Australians have an intellectual disability which leads to severe or profound activity limitations.
 Intellectual disabilities are life-long, and must be identified before the age of 18.
 Examples of intellectual disabilities include Down syndrome, Fragile X Syndrome, Prader-Willi
Syndrome, and Angelman Syndrome.
What is learning disability and some associated facts.
 A learning disability refers to a varied group of conditions which impact on the development and use of listening, spelling, reading, writing, reasoning or mathematical skills.
 Has a significant effect on learning but is NOT an indicator of intelligence.
Learning disabilities include: o o
Dyslexia – difficulty with language processing
Dyspraxia – difficulty with fine motor skills or coordination o Dysgraphia – difficulty with writing, spelling or composition o o
Visual processing disorder, e.g. Scotopic sensitivity
Auditory processing disorder
What is mental illness and some associated facts.
 Mental illnesses are a varied group of conditions that significantly affect how a person feels, thinks, behaves, and interacts with other people.
 Close to 1 in 5 Australians will have a mental illness in any year.
 Mental illnesses are diagnosed according to standardised criteria.
 They are different from temporary mental health problems that may be experienced
 following stressful life events.
Some major types of mental illness include: o anxiety disorders – most common at 9.7% of Australian adults in any year
 post traumatic stress disorder (3.3%)
 generalised anxiety disorder (3.1%)
 social phobia (2.7%)
 obsessive compulsive disorder (0.4%) o substance use disorders – 7.7% of Australian adults in any year
 dependence on alcohol or a drug, leading to problems at work or home, and/or causing damage to health o depression – 5.8% of Australian adults in any year
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o psychotic disorders, including schizophrenia and bipolar disorder (much less common at 0.4-0.7%)
What is a neurological condition and some associated facts.

Neurological conditions are disorders of the brain, spine and the nerves that connect them.

The associated structural, biochemical or electrical abnormalities can result in a range of symptoms.

Interventions may include preventative, lifestyle changes, physiotherapies or other therapies, rehabilitation, pain management, medications or surgery.

Causes vary but may be genetic, congenital abnormalities, infections, lifestyle, and environmental health issues.

There are more than 600 diseases of the nervous system.

Some common neurological disorders include: o brain tumours o Parkinson’s disease o epilepsy o stroke o multiple Sclerosis o Alzheimer’s disease
What is a physical disability and some associated facts.
 Physical disabilities affect a person's physical functioning, mobility, dexterity or stamina.
 A person may be born with a physical disability, or acquire it later in life.
 Examples include: o o cerebral palsy spinal cord injury o o amputation spina bifida o musculoskeletal injuries (e.g. back injury)
What is a hearing impairment and some associated facts.


Hearing impairments range from mild hearing loss to profound deafness.
Can be caused by a genetic condition, illness, trauma, or natural aging.
 People with hearing impairment may use hearing aids, lip-reading, Auslan (Australian sign language) or a combination to assist with communication.
What is a vision impairment and some associated facts.


Vision impairment refers to some degree of sight loss.
A person is considered legally blind if: o they cannot see at six metres what someone with normal vision can see at 60 metres, or
 o their field of vision is less than 20 degrees in diameter (normal vision 180 degrees)
A person may be born with a vision impairment, or acquire it through an accident, disease or the aging process.
Examples include: o o cataracts – clouding of the clear lens in the eye glaucoma – damage to the optic nerve associated with pressure in the eye o macular degeneration – deterioration of central vision
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o retinitis pigmentosa – genetic condition causing retina to progressively degenerate
CHRONIC MEDICAL CONDITIONS
Asthma

Asthma is a chronic lung disease that inflames and narrows airways.

Causes recurring periods of wheezing, chest tightness, shortness of breath and coughing.

Affects people of all ages, mostly starts in childhood.

Pollen, cigarette smoke, colds and flu can cause an asthma attack. One in ten Australians has asthma.

Asthma cannot be cured, requires good management which enables people to lead normal lives.

Treatment includes relievers (act quickly and relax muscles around airways) – taken when having an attack.

Preventers make airways less sensitive to triggers and reduce inflammation.

Symptom controllers slowly relax muscles around airways, taken with a preventer.

Combinations of the above in one inhaler.

An asthma attack can be life threatening. If you are not sure what to do, call an ambulance
Diabetes

Diabetes is a chronic condition where the levels of glucose (sugar) in the blood are too high.

Blood glucose levels are normally regulated by insulin (a hormone) made by the pancreas.

In people with diabetes the pancreas does not make enough insulin.
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
Two main types of diabetes Type 1 & Type 2.

About 7.4.% of Australians aged 25 years or older have diabetes.

Risk increases with age.

There is no cure for diabetes.

Aboriginal people have one of the highest rates of type 2 diabetes in the world.
Type 1 Diabetes

Auto immune destruction of insulin making cells in the pancreas, insulin is no longer made.

One of most common chronic childhood illness.

Most common in under 30 years of age.

Was called insulin dependent diabetes. This term is no longer used.
Type 2 Diabetes

Inadequate levels of insulin or failure of body cells to respond properly to insulin.

Most common over 40 years of age.

Known to have been diagnosed in overweight children and teenagers.

May be brought on by unhealthy diet or lack of exercise.

More common where close relatives and certain ethnic groups have diabetes.

Was called non-insulin dependent diabetes. This term is no longer used
Treatment
Type 1
 insulin injections
 balanced healthy diet
 monitoring blood glucose
 physical activity
 regular check ups
Type 2
 healthy eating
 physical activity
 medications and (perhaps) insulin
 weight management
 monitoring blood glucose
 cease smoking
 regular check ups
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Untreated diabetes
 kidney damage
 eye damage
 nerve damage to feet and other parts of body
 heart disease, stroke and circulation problems
 sexual problems
 foot ulcers or infections, due to circulation and nerve problems
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Cardiovascular Disease - Leading cause of death in Australia
 heart, stroke and blood vessel disease
 kills one Australian every 12 minutes
 affects one in six Australians

31.7% of deaths (45,500) in 2010 – deaths that can largely be prevented
 high prevalence and hospitalisation in lower socio economic groups, Aboriginal and Torres
Strait Islanders people and those living in remote areas
Coronary heart disease or heart disease


15.1.% ( 21,700) of deaths in 2010
 affects 1.4 million Australians kills 59 Australians each day
Heart Attack
 estimate over 380,000 Australians have had a heart attack at some stage
 about 55,000 Australians each year suffer a heart attack
 average 27 Australians die each day
 high blood pressure
 high cholesterol
 overweight and obesity
 physical inactivity
 poor diet
 alcohol
 smoking
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Risk Factors

 nine out of ten Australians have at least one risk factor
 one in four (25%) have three or more risk factors
Warning signs

Vary from person to person – may not always be sudden or severe.

Chest pain/discomfort most common sign – not all people have pain.

Symptoms may be – pain, pressure, tightness in the upper body including chest, neck, jaw, arms, and shoulders or back in combination with nausea, shortness of breath, dizziness or a
 cold sweat.
Quick response and calling triple 000 can reduce damage to the heart and increase survival.
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Arthritis

General term describing pain, stiffness and inflammation (heat and swelling) in the joints.

Group of conditions affecting joints.

Over 100 types of arthritis and there is no cure.

Most common osteoarthritis, rheumatoid arthritis, gout and ankylosing spondylitis.

Arthritis affects people of all ages, lifestyles and backgrounds.

No cure for arthritis.

Medication, physiotherapy and exercise are used in treatment.
Symptoms include;
 pain, swelling in joints
 redness and warmth in joints
 stiffness or reduced movement of a joint
 general symptoms such as fatigue and feeling unwell
Osteoarthritis

Osteoarthritis is a disease of the joints.

The two bones of a joint are normally protected by smooth, cushioning material called cartilage.



In osteoarthritis, cartilage breaks down, causing pain and stiffness in the joint.
Osteoarthritis is one of the most common forms of arthritis.
A joint is the meeting point of two bones to allow movement.
Symptoms: person to the next. More common symptoms include:
 stiffness
 joint pain
 muscle weakness
Common sites
The most common joints that develop osteoarthritis include:
 hands – usually the end finger joints
 spine – in the neck or lower back
 hips – older people are most at risk
 knees – might be caused by an old injury
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The symptoms vary from one

Risk factors
The cause of is unclear – risk factors for its development have been identified. These include:
 family history of osteoarthritis
 previous injury or overuse of the joint
 being overweight
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Managing osteoarthritis

Education – Arthritis Australia can provide you with information and self-management courses that support you with your management.

Weight management – controlling weight is important for those who are overweight and have osteoarthritis affecting the weight-bearing joints.

Medication – pain-relieving and anti-inflammatory medications.

Relaxation techniques – for example muscle relaxation, meditation or visualisation.

Support – A support or self-help group may be another option – contact Arthritis Victoria for details of support groups.

Surgery – to replace hip and knee joints, in cases of advanced osteoarthritis.

Equipment that promotes independence – there are many specially designed aids and types of equipment available to assist people with painful joints.
Rheumatoid Arthritis

Autoimmune disease causes pain & inflammation of joints.

Other body parts may be affected.

Stiffness in the joints is common, especially in the morning.

The inflammation caused by rheumatoid arthritis can result in damage to the joints.

Usually starts in middle life, with onset generally occurring between the ages of 35 to 64, and affects 1 per cent of Australia’s population.

Estimated 57 per cent of people with rheumatoid arthritis are women.
Symptoms
The most common symptoms include;
 swelling, pain and heat in the




 joints stiffness in the joints, especially in the morning persistent fatigue sleeping difficulties because of the pain weak muscles the same joints on both sides of the body are usually affected
Cause

The cause or causes of rheumatoid arthritis are not yet fully understood.

Rheumatoid arthritis is an autoimmune disease, when a person has an autoimmune disease, the immune system starts attacking the body’s healthy tissues.

The immune system targets the lining of the joints, causing inflammation and joint damage.
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
Some people may be more at risk of developing rheumatoid arthritis due to heredity factors.

There is no cure for rheumatoid arthritis.
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Management

Medication – Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to reduce pain and inflammation. The disease-modifying anti-rheumatic drugs (DMARDs) are a special group of medications used to treat inflammatory arthritis. Biological DMARDs are the newest class of arthritis medication and work to stop the disease progressing and causing structural damage to joints.

Aids and equipment – supports such as walking aids and specialised cooking utensils reduce joint strain.

Relaxation techniques – muscle relaxation, distraction, guided imagery and other techniques can help manage pain and anxiety.

Exercise – some physical activity helps maintain muscle strength and joint flexibility and assist in managing pain. Exercising in warm water, strength training and Tai chi may help.

Rest – rest can help manage fatigue and is important when joints are swollen.

Nutrition – healthy, balanced diet to maintain general health and prevent other medical problems.

Support – Contact Arthritis Victoria for more information.

Complementary therapies – such as massage or acupuncture may be helpful.

Joint surgery – may be necessary in some cases.
ACTIVITY
WHAT IS IT?
This can be found in the hands, hips and knees
ANSWER
This arthritis is an autoimmune disease
55,000 Australians suffer with this each year
Kidney damage, Eye damage, Heart disease, stroke and circulation problems, Sexual problems
Foot ulcers or infections are signs of what untreated disease
This is the leading cause of death in Australia
This condition cannot be cured and requires good management which enables people to lead normal lives
Aboriginal people have one of the highest rates of this disease in the world
Swelling, pain and heat in the joints are symptoms of what disease
There are over 100 types of this condition and there is no cure
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INTELLECTUAL DISABILITY
A person with an intellectual disability may have difficulty learning and managing daily living skills.
This is because their cognitive (thought-related) processing is impaired. Children and young people have different abilities and develop at different rates.
A person is said to have an intellectual disability if they have both the following before they are 18 years of age:
 an IQ below 70 (average IQ is 100)
 significant difficulty with daily living skills including looking after themselves, communicating and taking part in activities with others
Approximately two to three per cent of the population have an intellectual disability.
Common characteristics
Generally speaking, a person with an intellectual disability:
 learns and processes information more slowly than people without an intellectual disability
 has difficulty with abstract concepts, such as money and time
 has difficulty understanding the subtleties of interpersonal interaction.
Needs depend on individual factors
Categories of mild, moderate, severe and profound levels of intellectual disability are defined on the basis of IQ scores. These levels give some guide to the level of support someone might need, but the way the person functions in their life also depends on other factors including:
 personality and coping skills
 other disabilities – for example, physical, social or sensory
 the amount of support offered by family, friends and the community
 what is demanded of them in different situations – for example, home or work
People with a mild intellectual disability
A mild intellectual disability is defined as an IQ between 50 and 70. A person with a mild intellectual disability;
 can participate in and contribute to their families and their communities
 will have important relationships in their lives
 may find the subtleties of interpersonal relationships and social rules difficult to fully understand. They may sometimes behave awkwardly or inappropriately in social situations
 may marry and raise children with the support of family, friends and support services
 may have a job, in either open or supported employment
 may live and travel independently but may need support and help to handle money and to plan and organise their daily life
 may learn to read and write with appropriate teaching
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People with a moderate intellectual disability
A moderate intellectual disability is defined as an IQ between 35 and 50. A person with a moderate intellectual disability:
 will have important relationships in their life and will probably form valued and lasting

 friendships will enjoy a range of activities with their families, friends and acquaintances may be able to learn to travel on regular public transport routes with specific training, but will have difficulty planning trips and handling money. They may have great difficulty problem solving when unexpected events occur
 may learn to recognise some words in context, such as common signs including ‘Ladies’,
‘Gents’ and ‘Exit’
 will be able to make choices and understand daily schedules or future events if provided with visual prompts such as daily timetables and pictures of planned events
 will need lifelong support in the planning and organisation of their lives and activities
 may develop independence in personal care, such as toilet hygiene, dressing and bathing - independence in these tasks will depend on opportunities to learn and practise these tasks, and whether or not the person has other disabilities, such as cerebral palsy
People with a severe or profound intellectual disability
A severe intellectual disability is defined as an IQ between 20 and 35. A profound intellectual disability is defined as an IQ below 20. A person with a severe or profound intellectual disability:
 will usually recognise familiar people and may have strong relationships with key people in their lives
 is likely to have little or no speech and will rely on gestures, facial expression and body language to communicate needs or feelings. Communication systems for people with this level of disability generally rely on photographs or objects to support understanding. For example, a cup or a photograph of a cup may be used with the spoken question: ‘Would you like a drink?’
 will require lifelong help with personal care tasks, communication and accessing and participating in community facilities, services and activities
ACTIVITY
What is the average IQ for the following levels of an intellectual disability?
Mild
Moderate
Severe
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DOWN SYNDROME

Down syndrome (also known as trisomy 21) is a genetic condition in which the person has an extra copy of chromosome 21.

This results in a number of physical and developmental characteristics and some level of intellectual disability.
Down syndrome and the extra chromosome

Chromosomes are the blueprint for the body’s development.

They determine our physical and mental characteristics.

The usual number of chromosomes is 46 (arranged in 23 matched pairs).

People with Down syndrome have an extra chromosome 21.

Down syndrome is the most common chromosome disorder and occurs in all races and cultures at around the same rate.

Some level of intellectual disability is the only feature common to all, although a range of other features are also associated with the condition. These include characteristic physical features and a number of health and developmental indications.
Common physical characteristics
There are a number of physical characteristics associated with Down syndrome. The most common physical characteristics include:

Eyes – nearly all people with Down syndrome have a slight upward slant of the eyes. There can also be a small fold of skin on the inside of the eye (epicanthic fold) and small white patches on the edge of the iris of the eye (Brushfield spots).

Face – this is often rounded and tends to have a flat profile.

Stature – babies with Down syndrome are usually smaller and weigh less at birth than others. Children tend to grow more slowly and are commonly smaller than other children their age. Adults with Down syndrome are commonly smaller than in the general population.
Delayed development

Babies reach the same developmental milestones (such as smiling, sitting up, crawling,

 walking, talking and toileting) as all babies, but with some degree of delay.
Speech and language development is often the area of greatest delay.
Everyone with Down syndrome will experience some delay in their development and some
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level of learning disability, but the extent and specific areas of delay vary from one individual to another.

Generally need more support than most other people in order to achieve their potential – some will need very little support, while others may require a high level of support.
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Capabilities and potential

Down syndrome affects, but does not determine, development and achievement in a person.

People demonstrate a wide range of capabilities.

What happens after birth will be far more important in shaping the outlook for a person than the occurrence of the extra chromosome at conception.

These days, children with Down syndrome attend childcare settings, pre-schools and primary and high schools alongside other children of their age.

Adults with Down syndrome attend post-school training, participate in the workforce and lead full lives as productive and valued members of their communities.

An increasing number are achieving independent living, with some level of support, within the community.

People with Down syndrome often have their abilities and potential underestimated.

A person with this condition will achieve in many areas when offered the opportunity and encouraged to do so.
Diagnosis of Down Syndrome
Down syndrome is usually recognisable at birth and confirmed by a blood test. Prenatal tests that can help to detect Down syndrome in a foetus include:
 ultrasound scans
 maternal serum screening
 amniocentesis
 chorionic villi sampling
FRAGILE X SYNDROME

Fragile X syndrome is an inherited condition causing various degrees of intellectual disability.

It affects males more than females and is the most common known cause of inherited intellectual disability.

Fragile X syndrome is a genetic disorder caused by an alteration in the X chromosome (that
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is, a change in the DNA structure.)

It results in a wide range of developmental, physical and behavioural problems.

Prevalence estimates for Fragile X syndrome vary – the best estimate is that about one in
4,000 males have this syndrome.
Fragile X syndrome presentation
The most significant effects of Fragile X syndrome are:
 developmental delay
 intellectual disability - can vary from mild learning difficulties through to severe intellectual impairment
 behavioural problems – present in some Fragile X individuals
 mimicking
 tend to be more severe in males than in females
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Characteristics of Fragile X syndrome
Some children with Fragile X syndrome will display behaviours similar to those of children with autism, including: hand flapping
 repeating of words and sentences.
Fragile X males may have certain physical features, including:
 large, prominent ears
 enlarged testes
 flexible joints
 not all of these characteristics are seen in every person with fragile X syndrome
Chromosomes

Chromosomes are located in the cells of the human body and contain all our genetic information.

In every cell, there are 23 pairs of chromosomes, one pair of which determines the sex of a

 person.
A male has an X and a Y, a female has two X chromosomes.
A child will receive one of their sex chromosomes from the father’s sperm (X or Y) and one from the mother’s egg (X).
Fragile X syndrome is inherited

The Fragile X syndrome is inherited in a way known as ‘X-linked’.

The altered gene is on the X chromosome.

On the X chromosome, there is a gene called FMR1, which produces a protein that helps the brain to function normally.

If this gene is altered, it cannot produce its normal protein.

Our genes often contain regions that are repeated.

In the ‘normal’ form of the gene, there will be between five and 55 repeated copies of a small section of the gene.

In a person with Fragile X syndrome, this copy number is increased to more than 200 repeats
(called a ‘full mutation’).

When there are more than 200 repeats, the gene is switched off, leading to the symptoms seen in Fragile X syndrome.

A repeat number of between 55 and 200 is classed as a ‘pre-mutation’.

The number of repeats may increase when the mother passes on her X chromosome to her child.

Therefore, an apparently unaffected woman – with fewer than 200 repeats – may have an affected son or daughter with greater than 200 repeats.
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PRADER-WILLI SYNDROME
Prader-Willi syndrome is a rare genetic disorder that affects development and growth.
Estimates of its incidence vary; around one in 10,000 to 20,000 children are born with the syndrome, with females slightly more prone than males.
There is no cure for the condition; health care from a range of specialists can improve the child’s quality of life.
Symptoms of Prader-Willi syndrome

The affected child is unusually floppy at birth and has feeding difficulties and a weak cry.

Males frequently have undescended testes and may have underdeveloped genitalia

Around half of all children will have fair skin, blonde hair and blue eyes.

The child is delayed in all aspects of development, reaching developmental milestones – such as sitting, crawling and walking – later than other children.

The average IQ is around 70, but the degree of intellectual disability will differ for each child

By five years of age, a feature is the child’s excessive appetite, which often leads to obesity if not managed carefully with dietary and behavioural control.
Causes
Humans have 23 pairs of chromosomes, with one set inherited from each parent. Research indicates that missing genes on chromosome 15, contributed by the father, cause Prader-Willi syndrome.
The loss can happen in four ways, including:

The father’s chromosome 15 is altered – usually, genes are deleted. This is the most common cause, accounting for between 60 and 70 per cent of cases.

The baby inherits two of the chromosomes from the mother, and none from the father. This happens in about 25 to 30 per cent of cases.

A translocation occurs, which means some of the genes on chromosome 15 get shuffled around or swapped with genes from other chromosomes.

The father’s chromosome 15 is intact, but the genes in the Prader-Willi region do not work properly.
Obesity and Prader-Willi syndrome

At birth, the child has poor sucking ability and may not grow at the expected rate.

This changes remarkably by the time the child is one to four years of age.

Prader-Willi syndrome is associated with an excessive appetite, which means that the child is
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prone to obesity.

Challenge for the child with Prader-Willi syndrome and their family, but it can be managed by dietary and behavioural measures.
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Problems associated with Prader-Willi syndrome
A child with Prader-Willi syndrome is prone to a range of associated health and behavioural problems as they get older. Some of these problems may include:
 obsessive and compulsive behaviours, such as picking at the skin
 eye problems, such as near sightedness short stature, often due to growth hormone deficiency
 delayed onset of puberty
 scoliosis (sideways curves in the spine)
 kyphosis (exaggerated hump in the spine)
 delayed or absent menstrual periods in girls
 abnormally small penis in boys
 diabetes, triggered by obesity
 osteoporosis (weakened bones that are prone to fracturing)
 teeth problems, including soft enamel and tooth grinding
 sleep apnoea (periods of breathing cessation during sleep)
 problems with short term memory
 temper tantrums
Diagnosis of Prader-Willi syndrome
Prader-Willi syndrome is diagnosed by physical examination and blood tests to check for problems with chromosome 15.
Treatment for Prader-Willi syndrome
There is no cure for Prader-Willi syndrome and no means of prevention. Treatment aims to ease some of the associated problems.
Some of the treatment options may include:

Strict supervision of diet. Currently, there are no medical means of curbing appetite.

Plenty of physical activity to help maintain the child’s body weight within the normal range.

Growth hormone treatment to overcome the hormone deficiency that contributes to the child’s short stature.

Hormone therapy to increase muscle mass.

Hormone therapy to boost inadequate sex hormone levels.

Medications to help control any obsessive and compulsive behaviours.

Orthopaedic treatment for scoliosis or kyphosis.

Appropriate prescription eye glasses.

Specialist care from a range of health care professionals.
Specialist care
Health professionals often include:
 general practitioner
 paediatrician
 dietician
 physiotherapist speech therapist
 dentist
 optician
 behavioural psychologist
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ANGELMAN SYNDROME
Angelman syndrome is a genetic condition that is present at birth (congenital). It causes intellectual disability, distinctive facial features, mental retardation, speech problems and hyperactive behaviour.
In most cases, the cause is a missing section (deletion) on the mother’s copy of chromosome 15. The syndrome was known as ‘happy puppet syndrome’ because of the child’s sunny outlook and jerky movements. Most diagnoses are made between the ages of three and seven years of age and are thought to affect one child in every 10,000 to 25,000.
Symptoms of Angelman syndrome
Characteristic symptoms usually present include:
 delayed motor development, such as delay in sitting, crawling and walking

 jerky, puppet-type movements
 stiff-legged walking style
 hand flapping speech problems
Hyperactive behaviour
 loving, happy and social demeanour
 a child easily moved to laughter
 intellectual disability – a child will have delayed development in all areas and disability is severe in most cases
Characteristic symptoms include:
 small head
 characteristic EEG (brainwave) abnormalities
 epilepsy (occurs in 80 per cent of cases)
Physical characteristics
The characteristic physical features are not always obvious at birth, but evolve during childhood.
Characteristic physical features include:
 flattened back of the head
 deep-set eyes
 wide, ever-smiling mouth
 prominent jaw and widely spaced teeth
 lightly pigmented hair, skin and eyes
Behaviour problems
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Some common problems include:
 feeding difficulties
 disturbed sleep
 delayed toilet training (about 80 per cent of adults are dry during the day)
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Chromosome disorder
Angelman syndrome occurs in the following scenarios:

A section of genetic material is missing from the copy of chromosome 15 inherited from the mother. This is the most common scenario. Note that the mother’s chromosome 15 is normal, and the genetic material is lost during the development of the egg.

The child inherits two copies of chromosome 15 from its father and none from its mother.
This happens occasionally.

The child may inherit one chromosome 15 from each parent, but the chromosome from the mother works in the same way as the chromosome from the father.

In 20–30 per cent of cases, there is no cause found. Some of these patients have a fault
(mutation) in a gene called UBE3A on chromosome 15.
Diagnosis

Diagnosis methods include checking for the clinical features and performing DNA tests.

May be mistaken for autism because of similar symptoms including hyperactive behaviour,

 speech problems and hand flapping.
A child with Angelman syndrome is highly sociable, unlike a child with autism.
It is important that the child is carefully diagnosed. Sometimes Angelman syndrome and autism are both present.

Other conditions that share some common characteristics with Angelman syndrome include
Rett syndrome, Lennox-Gastaut syndrome and non-specific cerebral palsy.
Treatment
There is no cure, but the child can benefit from a range of treatments for some symptoms including:
 speech therapy
 behaviour modification
 communication therapy
 occupational therapy
 physical therapy
 special education
 social skills training
 anti-epileptic medication lifespan.
Angelman syndrome is not a degenerative disease. Children can expect a normal
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LEARNING DISABILITY
DYSLEXIA
Dyslexia is a type of specific learning difficulty (SLD) in which the person has difficulties with language and words. The term dyslexia, although still used by some, is generally felt to be too narrow and SLD is often used to describe these learning difficulties.

Most children with SLD also have difficulty with spelling.

The most common characteristic is that people have difficulty reading and spelling for no apparent reason. The person may be intelligent, able to achieve well in other areas and exposed to the same education as others, but is unable to read at the expected level.

Common problem areas include spelling, comprehension, reading and identification of words.

Up to five per cent of the population are thought to have dyslexia.

Cause remains unknown.

Most people affected eventually learn to read, they may have severe spelling problems unless they get support and specialised education.

Dyslexia isn’t a symptom of low intelligence.
Symptoms in pre-schoolers
Some of the symptoms of dyslexia or SLD in a pre-schooler could include:
 delayed speech
 problems with pronunciation
 problems with rhyming words and learning rhymes
 difficulty with learning shapes, colours and how to write their own name
 difficulty with retelling a story in the right order of events
Symptoms in primary school children
Some of the symptoms in a primary school age child could include:
 problems with reading a single word
 regularly confuses certain letters when writing, such as ‘d’ and ‘b’ or ‘m’ and ‘w’
 regularly writes words backwards, such as writing ‘pit’ when the word ‘tip’ was intended
 problems with grammar, such as learning prefixes or suffixes
 tries to avoid reading aloud in class
 doesn’t like reading books
 reads below their expected level
Symptoms in high school children
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Some of the symptoms in a high school student could include:
 poor reading
 bad spelling, including different misspellings of the same word in one writing assignment
 difficulties with writing summaries
 problems with learning a foreign language
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Symptoms in adults
Some of the symptoms in an adult could include:
• reading and spelling problems
• doesn’t like reading books
• avoids tasks that involve writing, or else gets someone else to do the writing for them.
• better than average memory
• Often, a greater than average spatial ability - the person may be talented in art, design, and mathematics or engineering.
Theories
The exact causes of dyslexia remain unknown, but theories include:
• problems with phonological awareness (distinguishing the meaning of contrasting speech sounds)
• a person with poor phonological awareness has trouble with their short-term memory for spoken words, which means they tend to forget instructions or word lists
• problems with the visual, auditory, linguistic or neurological processes that are involved with recognising the written word
• reading difficulties tend to run in families which suggests a genetic link
Diagnosis methods
Dyslexia or SLD can be hard to diagnose unless the problem is severe. Evaluation may include testing a range of factors including:
• cognitive (thinking) skills and memory
• vocabulary
• literacy skills
• intellectual ability
• information processing
• psycholinguistic processing
Contributing factors
Not everyone who has trouble with reading and writing is dyslexic.
Some of the reading and writing difficulties of someone with dyslexia may be caused or worsened by other factors. Some contributing factors to be considered include:
• Health - the person may have health issues that have interfered with their language development and writing ability, such as deafness or visual problems.
• Language - a child from a non-English speaking background usually takes longer to master speech, reading and writing in both languages.
• Education - the person may have missed out on educational opportunities; for example, a chronic illness may have kept them out of school for long periods of time.
• Behavioural or developmental disorders - the person may have attention deficit hyperactivity disorder (ADHD), which can cause learning problems.
Treatment options
There is no cure for dyslexia, support provided could include:
• one-to-one tutoring from a specialist educator
• a phonics-based reading program that teaches the link between spoken and written sounds
• a multi-sensory approach to learning, using as many different senses as possible such as seeing, listening, doing and speaking
• arrangements with the child’s school - for example, for them to take oral instead of written tests
• learning via audiotape or videotape
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DYSPRAXIA
• Dyspraxia is a neurologically developmental disability which is present from birth
• Dyspraxia is a motor planning disorder, not a muscular deficit. A child knows what they want their body to do but can't get their body to do it.
• There are three (3) types of Developmental Dyspraxia - Oral, Verbal and Motor.
• A child with Dyspraxia can have one or a combination of all three types of Dyspraxia and in varying degrees of severity.
• Dyspraxia is a hidden handicap. Children with this disability appear the same as any other child. It is only when a skill is performed that the disability is noticeable.
• Dyspraxia is believed to be an immaturity of parts of the motor cortex (area of the brain) that prevents messages from being properly transmitted to the body.
• Dyspraxia affects up to 10% of the population with approximately 70% of those affected being boys.
• Dyspraxia does not impact on intelligence, children with Dyspraxia have average or above average intelligence.
• Dyspraxia can impact on behaviour and social skills.
• Dyspraxia is a specific learning disability.
Oral Dyspraxia

Oral dyspraxia is a difficulty with planning and executing non-speech sounds, such as blowing, sucking or individual tongue/lip movements.

May indirectly affect speech and/or swallowing skills.

A child with Oral Dyspraxia may dribble profusely, have difficulty licking an ice-cream and may have a preference for either soft or hard textured foods.
Verbal Dyspraxia
Verbal Dyspraxia is a speech disorder that affects the programming, sequencing and initiating of movements required to make speech sounds.
Children with Verbal Dyspraxia may:
 display highly unintelligible speech
 simplify words e.g. ‘bur’ for ‘burger
 have inconsistent speech patterns
 move sounds in a word e.g. ‘to be’ for ‘boat’
 exhibit ‘lost’ or searching movements of the tongue and lips as they endeavour to find the position to make a sound
 have delayed expressive language
 adopt a complex gesture system to aid communication skills
 have difficulty with sequencing words, and sounds in words
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Motor Dyspraxia
Motor Dyspraxia is a difficulty in planning, sequencing and then executing the correct movement to perform age appropriate skills in a smooth and coordinated manner at will or on command.
Children with Motor Dyspraxia may have difficulty with:
• learning a new skill
• coordinated movement
• handwriting
• consistent performance
• age appropriate skills
• generalising learnt skills
• timing and rhythm
• learning rules
• responding quickly
• spatial organisation
• problem solving
• using appropriate cues
• analysing what is needed for task performance
• preparing for the next stage in task performance
(Ref Australia Dyspraxia Association)
DYSGRAPHIA

Dysgraphia is a specific learning disability that affects written expression.

Can appear as difficulties with spelling, poor handwriting and trouble putting thoughts on paper.

Can be a language based, and/or non-language based disorder.

A neurological disorder that generally appears when children are first learning to write.

Experts are not sure what the causes are, early treatment can help prevent or reduce problems.

Writing requires a complex set of motor and information processing skills. Not only does it require the ability to organize and express ideas in the mind. It also requires the ability to get the muscles in the hands and fingers to form those ideas, letter by letter, on paper.

Dysgraphia that is caused by a language disorder may be characterised by the person having difficulty converting the sounds of language into written form (phonemes into graphemes), or knowing which alternate spelling to use for each sound.

A person with dysgraphia may write their letters in reverse, have trouble recalling how letters are formed, or when to use lower or upper case letters.

A person with dysgraphia may struggle to form written sentences with correct grammar and punctuation, with common problems including omitting words, words ordered incorrectly, incorrect verb and pronoun usage and word ending errors.

People may speak more easily and fluently than they write.

Non-language based dysgraphia’s are those caused by difficulties performing the controlled fine motor skills required to write. The generic term apraxia refers to a wide variety of motor skill deficits in which the voluntary execution of a skilled motor movement is impaired.

Apraxia can involve a single controlled movement, or a sequence of movements, such as writing a single letter or entire words.
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Signs of Dysgraphia
 generally illegible writing
 inconsistencies in writing, e.g. mixtures of printing and cursive writing, upper and lower case, or irregular sizes, shapes, or slant of letters
 unfinished words or letters, omitted words
 inconsistent position of letters on the page with respect to lines and margins
 inconsistent spaces between words and letters
 cramped or unusual grip of the writing instrument, especially o holding the writing instrument very close to the paper, or o holding thumb over two fingers and writing from the wrist
 strange wrist, body, or paper position
 talking to self-whilst writing, or carefully watching the hand that is writing
 slow or laboured copying or writing
 large gap between written ideas and understanding demonstrated through speech.
 difficulty organising thoughts on paper
Supporting people with dysgraphia
There are many ways to help a person with dysgraphia achieve success. Generally strategies fall into three categories:
• accommodations: providing alternatives to written expression, such as adjusting assessments
(oral)
• modifications: changing expectations or tasks to minimize or avoid the area of weakness
• remediation: providing instruction for improving handwriting and writing skills
ACTIVITY
Match the condition in the left column with the correct signs in the right column.
Dysgraphia This is a hidden disability, there are three types of this condition
Dyslexia Illegible Writing, unfinished words, difficulty organising thoughts on paper
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Dyspraxia Doesn’t like reading books.
Avoids tasks that involve writing, or else gets someone else to do the writing for them.
Better than average memory.
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VISUAL PROCESSING DISORDER
A Visual Processing Disorder is the inability for an individual to make proper sense of information taken in through the eyes. This disorder has nothing to do with one's vision or the sharpness of it, but it is the difficulties experienced with how visual information is processed by the sufferer's brain. The individual may have 20/20 vision but may have problems in figuring out background from foreground, size, forms and positions in space.
There are five main regions affected by Visual Processing Disorder. They are object recognition, spatial relations, visual closure, visual discrimination and whole/part relationships.
Object Recognition - Here the individual finds it difficult to recognize familiar objects. One reason is because they are unable to put the whole image into place. They see it in parts and not as a whole object. For some others it could be a visual memory problem, where, even if the object is recognized as a familiar object, they may not be able to recollect from memory an object which is similar or are unable to make a connection between the object before them and the remembered object.
Difficulties in object recollection and recognition can often be frustrating when it comes to learning numbers, letter, words, pictures and symbols. What could be even more frustrating is the fact that something learned today may not be able to be recalled the next day.
Spatial Relations - This has reference to objects in space and their position and also the ability to perceive objects in space in relation to other objects. Mathematics and reading are two subjects that deal with numbers, letter, symbols and where the understanding of spatial relationships and accurate perception are rather important. A person with this condition, therefore, generally finds it difficult to figure out the difference between p and q and b and d.
Visual Closure - The individual finds it difficult to figure out an object only if part of it is visible. For example he/she will find it difficult to figure out a word if a letter is missing from that word, or perhaps will be unable to recognize a car if the wheels are missing or difficulty in recognizing a face if the nose or mouth or eye does not complete the picture.
Visual discrimination - Here the individual, by sense of sight is unable to tell the difference between two similar objects, or two similar shapes or even two similar letters. He/she is also unable to tell or notice the differences and similarities between a particular colour, patterns and shapes.
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Whole/part relationships - Here the individual finds it difficult to recognize an object. For example, either he/she sees the whole object or he/she sees only parts of the object. A typical example would be an individual may see the tree but not the forest or may see the forest and not the tree.
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AUDITORY PROCESSING DISORDER (APD)
Also known as central auditory processing disorder (CAPD) is an umbrella term for a variety of disorders that affect the way the brain processes auditory information. Individuals with APD usually have normal structure and function of the outer, middle and inner ear (peripheral hearing). However, they cannot process the information they hear in the same way as others do, which leads to difficulties in recognizing and interpreting sounds, especially the sounds composing speech. It is thought that these difficulties arise from dysfunction in the central nervous system (i.e., brain). APD has been referred to as dyslexia for the ears.
APD can affect both children and adults, although the actual prevalence is currently unknown. It has been suggested that males are twice as likely to be affected by the disorder as females
Characteristics
 have trouble paying attention to and remembering information presented orally, and may
 cope better with visually acquired information have problems carrying out multi-step directions given orally; need to hear only one
 direction at a time
 have poor listening skills
 need more time to process information
 have low academic performance
 have behaviour problems have language difficulties (e.g., they confuse syllable sequences and have problems
 developing vocabulary and understanding language) have difficulty with reading, comprehension, spelling, and vocabulary
APD can manifest as problems determining the direction of sounds, difficulty perceiving differences between speech sounds and the sequencing of these sounds into meaningful words, confusing similar sounds such as ‘hat’ with ‘bat’, ‘there’ with ‘where.
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MENTAL HEALTH
POST TRAUMATIC STRESS DISORDER (PTSD)

A set of mental health reactions that can develop in people who have experienced or witnessed an event that threatens their life or safety (or others around them) and leads to feelings of intense fear, helplessness or horror.

This could be a car or other serious accident, physical or sexual assault, war-related events or torture, or a natural disaster such as bushfire or flood.

Other life-changing situations such as being retrenched, getting divorced or the expected death of an ill family member are very distressing, and may cause mental health problems, but are not considered events that can cause PTSD.
Anyone can develop PTSD following a traumatic event but people are at greater risk if:
 the event involved physical or sexual assault
 they have had repeated traumatic experiences such as sexual abuse or living in a war zone
 they have suffered from PTSD in the past
Signs and symptoms
People with PTSD often experience feelings of panic or extreme fear, which may resemble what, was felt during the traumatic event. A person with PTSD has three main types of difficulties:

Reliving the traumatic event – through unwanted and recurring memories and vivid nightmares. There may be intense emotional or physical reactions when reminded of the event. These can include sweating, heart palpitations or panic.

Being overly alert or ‘wound up’ – sleeping difficulties, irritability, lack of concentration, becoming easily startled and constantly being on the lookout for signs of danger.

Avoiding reminders of the event and feeling emotionally numb – deliberately avoiding activities, places, people, thoughts or feelings associated with the event. People may lose interest in day-to-day activities, feel cut off and detached from friends and family, or feel flat and numb.
People with PTSD can also have what are termed ‘dissociative experiences’, which are frequently described as follows:

‘It was as though I wasn’t even there.’

‘Time was standing still.’

‘I felt like I was watching things happen from above.’

‘I can’t remember most of what happened.’
A health practitioner may diagnose PTSD if a person has a number of symptoms in each of the three areas for a month or more, which:
 lead to significant distress, or
 impact on their ability to work and study, their relationships and day-to-day life
It is not unusual for people with PTSD to experience other mental health problems at the same time.
Up to 80 per cent of people who have long-standing PTSD develop additional problems; most commonly depression, anxiety and alcohol or other substance misuse. These may have developed directly in response to the traumatic event or have developed sometime later after the onset of
PTSD.
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Impact of PTSD

PTSD can affect a person’s ability to work, perform day-to-day activities or relate to their family and friends. A person with PTSD can often seem disinterested or distant as they try not to think or feel in order to block out painful memories.

They may stop participating in family life, ignore offers of help or become irritable. This can lead to loved ones feeling shut out.

People with PTSD need the support of family and friends but may not know that they need help.
Alcohol and drug use

People commonly use alcohol or other drugs to blunt the emotional pain that they are experiencing.

Alcohol and drugs may help block out painful memories in the short term, but they can get in the way of a successful recovery.
When to get help
A person who has experienced a traumatic event should seek professional help if they:
 don’t feel any better after two weeks
 feel highly anxious or distressed
 have reactions to the traumatic event that are interfering with home, work and relationships
 are thinking of harming themselves or someone else
Some of the signs that a problem may be developing are:
 being constantly on edge or irritable
 having difficulty performing tasks at home or at work
 being unable to respond emotionally to others
 being unusually busy to avoid issues
 using alcohol, drugs or gambling to cope
 having severe sleeping difficulties
Support is important for recovery
Many people experience some of the symptoms of PTSD in the first couple of weeks after a traumatic event, but most recover on their own or with the help of family and friends. For this reason, formal treatment for PTSD does not usually start for at least two weeks following a traumatic experience.
A range of treatments

If problems persist after two weeks, a doctor or a mental health professional may discuss starting treatment. Effective treatments are available. Most involve psychological treatment but medication can also be prescribed.

Generally, it’s best to start with psychological treatment rather than use medication as the first and only solution to the problem.

The cornerstone of treatment for PTSD involves confronting the traumatic memory and working through thoughts and beliefs associated with the experience.
Trauma-focussed treatments can:
 reduce PTSD symptoms
 lessen anxiety and depression
 improve a person’s quality of life
 be effective for people who have experienced prolonged or repeated traumatic events
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ANXIETY DISORDERS

Anxiety disorders are a group of mental health problems.

They include generalised anxiety disorders, social phobias, specific phobias (for example, agoraphobia and claustrophobia), panic disorders, obsessive compulsive disorder (OCD) and post-traumatic stress disorder. Untreated, anxiety disorders can lead to depression.

Anxiety disorders are common mental health problems that affect many people.

Approximately 25 per cent of the population have an anxiety disorder that warrants treatment at some time in their life and up to another 25 per cent have less severe anxieties such as fears of spider and snakes.
Not all anxiety is a disorder

Everyone experiences anxiety and fear at times; they are normal and helpful human emotions that help us deal with danger.

However, some people experience excessive and irrational anxiety, and worries that become ongoing and distressing and that interfere with their daily lives. This may indicate an anxiety disorder.

Often there appears to be no obvious or logical reason for the way the person feels.

This may make an anxiety disorder even more worrying to the sufferer.
Symptoms of anxiety disorders
The main features of an anxiety disorder are fears or thoughts that are chronic (constant) and distressing and that interfere with daily living. Other symptoms of an anxiety disorder may include:
 panic or anxiety attacks or a fear of these attacks
 physical anxiety reactions – for example trembling, sweating, faintness, rapid heartbeat, difficulties breathing or nausea
 avoidance behaviour – a person may go to extreme lengths to avoid a situation that they think could bring on anxiety or panic
Panic attacks are a common symptom

A panic attack is a sudden feeling of intense terror that may occur in certain situations or for no apparent reason.

A panic attack does not mean a person is necessarily suffering an anxiety disorder.

A panic attack is a common feature of each type of anxiety disorder.
Symptoms of a panic attack may include:
 shortness of breath
 dizziness
 rapid heartbeat
 choking
 nausea
The cause of panic attacks is unknown but they may be related to a chemical response in the brain, caused by actual threatening or stressful events or by thinking about stressful events. The brain response leads to physiological changes in the body, such as shallow breathing and rapid heartbeat.
Panic attacks can be frightening. Some people say they feel like they are going to die or go crazy.
People affected by panic attacks may avoid situations in which they think attacks might occur. In some cases, this may lead to the development of other anxiety disorders including agoraphobia.
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Types of anxiety disorders
Anxiety becomes a disorder when it is irrational, excessive, too persistent and attached to situations that do not warrant it and when it interferes with the person’s daily life.
Anxiety disorders include:
 generalised anxiety disorder
 social phobias – fear of social situations
 specific phobias – for example a fear of open spaces (agoraphobia) or enclosed spaces
(claustrophobia)
 panic disorders – frequent and debilitating panic attacks
 obsessive compulsive disorder
 post-traumatic stress disorder
Generalised anxiety disorder
Generalised anxiety is excessive anxiety and worry about common issues. The focus of the anxiety might be family or friends, health, work, money or forgetting important appointments.
A person may be diagnosed with a generalised anxiety disorder if:
 the anxiety and worry has been present most days over a six-month period
 the person finds it difficult to control their anxiety
SOCIAL PHOBIAS

People with social phobia are afraid of being negatively judged or evaluated by others.

This leads to fear of doing something that may humiliate them in public – for example public speaking, using public toilets, eating and drinking in public, writing in public, or any social encounters such as parties or workplaces.

Some social phobia sufferers may only fear one type of situation.

Others may be concerned about several types of situations. This can lead them to avoid the feared situations, which can lead to severe isolation.
SPECIFIC PHOBIAS

A person with a specific phobia has a persistent and irrational fear of a particular object or situation.

They may fear animals, places or people. Fear of the object or situation is so severe that a person may experience physical symptoms and panic attacks.

Fears may include dogs, blood, storms, spiders or other objects or situations but, in all cases, the anxiety is both excessive and interfering.

The adult phobia sufferer usually knows that their fear is excessive or unreasonable
However, their need to avoid the object, place or person can significantly restrict their life.
PANIC DISORDERS

Panic or anxiety attacks are common.

Panic disorders are less common; they affect about two per cent of the population.

For a person to be diagnosed with a panic disorder, they would usually have had at least four panic attacks each month over an extended period of time.

Often panic attacks may not be related to a situation but come on spontaneously.

Panic disorder may be diagnosed if panic attacks are frequent and if there is a strong and persistent fear of another attack occurring.
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OBSESSIVE COMPULSIVE DISORDER

People with obsessive compulsive disorder (OCD) have intrusive, unwanted and involuntary thoughts or impulses (obsessions.)

They also feel compelled to perform behavioural and mental rituals (compulsions) such as excessive hand washing, showering or checking.

They are usually aware of the irrational and excessive nature of their behaviour
Anxiety disorders can have serious effects

An anxiety disorder may lead to social isolation and clinical depression, and can impair a person’s ability to work, study and do routine activities.

It may also hurt relationships with friends, family and colleagues.

Depression can be a serious illness with a high risk of self-harm and suicide.
Recovery is possible with treatment
Recovery from an anxiety disorder is possible with the right treatment and support. Effective treatments for anxiety disorders may include:

Cognitive behavioural therapy – aims to change patterns of thinking, beliefs and behaviours that may trigger anxiety. Part of the therapy may involve gradually exposing a person to situations that trigger anxiety: this is called desensitisation.

Anxiety management and relaxation techniques – for example hypnotherapy, meditation, breathing exercises and counselling.

Medication – this may include antidepressants and tranquillisers.
Drug & Alcohol Dependency

There are a number of services available to help a person with drug dependency.

The best treatment depends on the needs of each person.

Different treatments aim for different outcomes, whether it’s total abstinence or reduction of drug use to a safer and less harmful level.

Options include individual counselling, group therapy and medications to ease the symptoms of withdrawal. Not everyone completes a treatment program the first or even second time, but this does not mean a person cannot seek help again.

Some people find they need to explore a number of different treatment options before they find what works for them.
Assessment

A person with a drug dependency is normally assessed at a treatment centre or health agency to find out which forms of treatment might work best for them.

Face-to-face interviews and questionnaires help to pinpoint key areas of the person’s drug use in relation to their history, lifestyle and personality.
The issues discussed may include:
 the type of drug used
 how much is used
 the regularity of the drug use
 the level of drug dependency or severity of addiction
 any previous dependency problems with other drugs
 the person’s motivation for change regarding their drug use
 lifestyle issues such as housing, employment and relationships
Following assessment, a treatment plan can be developed. Treatment plans are a common part of many drug and alcohol interventions.
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Brief intervention for drug dependency

Brief intervention means attempting to treat a person in the earlier stages of their drug use before they develop serious drug-related problems.

It is based on the theory that a person can manage their own drug use and associated issues if they are provided with the appropriate information or other intervention at the right time.

These intervention sessions may include an assessment of the person’s drug use and provide a self-help manual or other information.

Brief intervention has been used successfully with cigarette smokers and heavy alcohol drinkers.
Counselling options for drug dependency
A person can receive individual or group counselling as an outpatient or as part of their inpatient treatment. The different models of counselling may include:

The Egan model – the person decides which issues are important and the best ways to address them, with the counsellor as a ‘sounding board’.

Motivational interviewing – the person is encouraged to reduce their level of drug use by exploring the consequences of their addiction and the benefits of behavioural change. Taking responsibility for their behaviour and decision-making helps the person to see their ability to make changes in their life.

Cognitive behavioural therapy (CBT) – the person is helped to overcome irrational thoughts.
The theory aims to change the way people think about their own behaviour.

The systems theory – a form of counselling that places a person in the context of family, social, cultural and other environments in which they live. The theory proposes that change in one area creates change in other areas.
Detoxification is withdrawal from the drug

Detoxification (‘detox’), or withdrawal, is a program to rid the person’s body of toxic drug levels.

A person who is dependent on a drug may suffer from withdrawal symptoms when they stop using the drug.

Withdrawal from certain drugs – such as alcohol and minor tranquillisers (benzodiazepines) – can be life-threatening in extreme circumstances. Therefore, a medical assessment should be considered before a person withdraws from a drug.

Medical withdrawal means using other medications to ease the symptoms of withdrawal.
This can be carried out either in hospital or through a drug withdrawal service.
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Typical withdrawal symptoms can include:
 insomnia
 nausea
 shaking
 sweating
 coma or death, in very rare cases
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Harm reduction when breaking drug dependency

Harm reduction recognises that most people regularly use drugs of some type, such as alcohol.

The concept of harm reduction centres on reducing drug use or changing drug use behaviour so it is less harmful to the drug user.

An example is the needle exchange program, which is designed to reduce the incidence of
HIV and other blood borne diseases that are spread through sharing needles.

For many people, reducing drug use is a more realistic goal than quitting altogether
Pharmacotherapy and medication to treat drug dependency
Sometimes a prescribed medication is used to replace the drug a person is trying to stop using. This is call substitution pharmacotherapy e.g. Methadone, instead of heroin.
Methadone is a synthetic drug that is taken in place of heroin. While it doesn’t provide the same
‘high’ as heroin, it eases the withdrawal symptoms.
Methadone works for longer than heroin, so it only needs to be taken once daily instead of every few hours.
Substitution pharmacotherapy has a number of benefits. Depending on the drug a person is using, some of these benefits can include:

An easing of withdrawal symptoms, which allows the person to function in day-to-day life.

The person is no longer taking a drug that is manufactured in a ‘backyard lab’ with no quality control or knowledge of its purity.

The person is no longer using a drug in harmful amounts or using a potentially dangerous method, such as injecting.

Providing a person with the chance to address their life issues without having to worry about finding enough money each day, getting the drug, using it and so on.
Examples of pharmacotherapies for different drugs include:
 alcohol – acamprosate (campral), disulfiram (antabuse), naltrexone (revia)
 opioids (such as heroin) – buprenorphine (subutex®, suboxone), methadone, naltrexone
(revia)
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 tobacco – nicotine replacement therapies (NRT) such as patches, gum and inhalers, bupropion (zyban), clonidine, nortriptyline.
Relapse prevention during drug dependency treatment

A person undergoing treatment for drug dependency needs considerable support to make a
 successful transition to a drug-free lifestyle.
There are various support programs available – for example, to help the person find employment or housing.
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Other drug dependency treatments

A person with a drug problem can gain insights into their drug use by talking to others who have been in a similar situation. Many of these groups can also offer support services.

Also, there are ‘therapeutic communities’, the aim of which is personal growth, aided by the understanding and care of others in the community. A person may join a therapeutic community for months or years.

Because women are less likely to seek help for drug use than men, several treatment options have been established specifically for women – for example, group counselling sessions that are for women only, with childcare available if required.
DEPRESSION

Different types of depression exist, with symptoms ranging from relatively minor (but disabling) to very severe.

Risk factors for depression include stressful life events, personal factors such as family history and personality, serious medical illness, and drug and alcohol use.

Early detection of depression is important, as untreated depression can lead to suicide.
Treatment is widely available and effective.

Different types of depression often have slightly different symptoms and may require different treatments. Several mental health disorders have depression as a key feature, including major depressive disorder, bipolar disorder, dysthymic disorder, cyclothymic disorders and seasonal affective disorder.

While the exact cause of depression isn’t known, multiple factors can be associated with its development, including life events, personal factors such as family history and personality, serious medical illness, and drug and alcohol use.

Generally, depression does not result from a single event, but from a mix of recent events and other longer-term or personal factors.
Depression is not just feeling sad

While we all feel sad, moody or ‘low’ from time to time, some people experience these
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feelings intensely for long periods of time (weeks, months or even years) and sometimes without any apparent reason.

Depression is more than just a low mood – it’s a serious illness that has an impact on both physical and mental health.

On average, one in six people – one in five women and one in eight men – will experience depression at some stage of their lives.
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Symptoms of depression
A person may be depressed if, for more than two weeks, feelings of sadness, down or miserable most of the time, lost interest or pleasure in usual activities, and experienced several of the signs and symptoms across at least three of the groupings below.
It’s important to note that everyone experiences some of these symptoms from time to time – it may not necessarily depression. Not every person who is experiencing depression will have all of these symptoms.
Behaviour
A person with depression may:
 have stopped going out

 not be getting things done at work or school
 be withdrawing from close family and friends
 be relying on alcohol and sedatives have stopped their usual enjoyable activities
 be unable to concentrate
Thoughts
A person with depression may have thoughts such as:

‘I’m a failure’

‘It’s my fault’

‘Nothing good ever happens to me’

‘I’m worthless’

‘Life’s not worth living’

Feelings without me.’
A person with depression may feel:
• overwhelmed
• guilty
• irritable
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‘People would be better off

• frustrated
• unconfident
• unhappy
• indecisive
• disappointed
• miserable
• sad
Physical symptoms
A person with depression may experience:
• fatigue
• feeling sick and ‘run down’
• headaches and muscle pains
• churning gut
• sleep problems
• loss or change of appetite
• significant weight loss or gain
Risk factors for depression

While the exact cause of depression isn’t known, many things can be associated with its development, including life events, family history, personality, illness, drug or alcohol misuse, or brain changes.

Everyone is different and often a combination of factors can contribute to developing depression. It’s important to note that the cause of depression cannot always be identified.
The most important thing is to recognise the signs and symptoms and seek help.
Life events

Research suggests that continuing difficulties – such as long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, or prolonged exposure to stress at work – are more likely to cause depression than recent life stresses.

However, recent events (such as losing a job) or a combination of events can trigger depression in people who are already at risk because of past bad experiences or personal factors.
Family history

Depression can run in families, so some people are at increased genetic risk.

This doesn’t mean that a person will automatically experience depression if a parent or close relative has had the illness.

Life circumstances and other personal factors are still likely to have an important influence.
Personality

Some people may be more at risk of depression because of their personality, particularly if they have a tendency to worry a lot, have low self-esteem, are perfectionists, are sensitive to personal criticism, or are self-critical and negative.
Serious medical illness

Having a medical illness can trigger depression in two ways. Serious illnesses can bring about depression directly or can contribute to depression through the associated stress and worry, especially if it involves long-term management of the illness or chronic pain.
Drug and alcohol use
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
Drug and alcohol use can both lead to and result from depression.

Many people with depression also have drug and alcohol problems.
Changes in the brain

What happens in the brain to cause depression is not fully understood.

Depression may be related to changes in the levels or activity of certain chemicals that carry messages within the brain – particularly serotonin, norepinephrine and dopamine, the three

 main chemicals related to mood and motivation.
Changes to stress hormone levels have also been found in people with depression.
Research suggests that behaviour can affect brain chemistry – for example, long-term stress may cause changes in the brain that can lead to depression.

Changes in brain chemistry have been more commonly associated with severe depression rather than mild or moderate depression.
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Different types of depression
Different types of depression often have slightly different symptoms and may require different treatments. The five main types of depression are:
• major depressive disorder
• bipolar disorder (which used to be called manic depressive illness)
• cyclothymic disorder
• dysthymia
• seasonal affective disorder (SAD)
Major depression

Sometimes this is called major depressive disorder, clinical depression, unipolar depression or simply depression.

It involves low moods, and loss of interest and pleasure in usual activities, as well as other more common symptoms.

The symptoms of major depression are experienced most days, nearly every day and last for at least two weeks.

The symptoms interfere with all areas of a person’s life, including work and social relationships.

Depression can be described as mild, moderate or severe, melancholic or psychotic.
Melancholia

Melancholia is a term used to describe a severe form of depression in which many of the physical symptoms of depression are present e.g. one of the major changes is that the person moves more slowly.

The person is also more likely to have depressed mood characterised by complete loss of pleasure in everything or almost everything.
Psychotic depression

Sometimes people with a depressive disorder can lose touch with reality.

Experiencing psychosis can involve hallucinations (seeing or hearing things that are not there) or delusions (false beliefs that are not shared by others.)

People with this type of severe depression may believe they are bad or evil, being watched or followed, or feel as though everyone is against them (paranoia), or that they are the cause of illness or bad events occurring around them.
Antenatal and postnatal depression

Women are at increased risk of depression during pregnancy (known as the antenatal or prenatal period) and in the year following childbirth (known as the postnatal period).

The causes of depression at this time can be complex.

Many women experience the ‘baby blues’ – a common condition related to hormonal changes affecting up to 80 per cent of women.

The ‘baby blues’, or general stress adjusting to pregnancy or a new baby, are common experiences, but are different from depression.

Depression is longer-lasting and can affect not only the mother, but her relationship with her baby, the child’s development, the mother’s relationship with her partner and other members of the family.

Almost 10 per cent of women will experience depression during pregnancy and 16 per cent in the first three months after having a baby.
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PSYCHOTIC DISORDERS

Are a group of serious illnesses that affect the mind.

These illnesses alter a person's ability to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.

When symptoms are severe, people with psychotic disorders have difficulty staying in touch
 with reality and often are unable to meet the ordinary demands of daily life.
Even the most severe psychotic disorders usually are treatable.
ACTIVITY
List the five types of depression.
Define the following words.
WORD
Melancholia
Depression
Methadone
Detoxification
Obsessive Compulsive
Disorder
Brief Intervention
DEFINITION
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SCHIZOPHRENIA
Schizoaffective Disorder: People with this illness have symptoms of both schizophrenia and a mood disorder e.g.: depression or bipolar disorder.
Schizophreniform disorder: People with this illness have symptoms of schizophrenia, but the symptoms last between one and six months.
Brief Psychotic Disorder: People with this illness have sudden, short periods of psychotic behaviour, often in response to a very stressful event, such as a death in the family. Recovery is often quick - usually less than a month.
Delusional disorder: People with this illness have delusions involving real-life situations that could be true, such as being followed, being conspired against, or having a disease. These delusions persist for at least one month.
Shared psychotic disorder: Occurs when a person develops delusions in the context of a relationship with another person who already has his or her own delusion(s).
Substance-induced psychotic disorder: Caused by the use of or withdrawal from substances, such as alcohol and crack cocaine, may cause hallucinations, delusions, or confused speech.
Psychotic disorder due to a medical condition: Hallucinations, delusions, or other symptoms may be the result of another illness that affects brain function e.g. head injury or brain tumour.
Paraphrenia: This is a type of schizophrenia that starts late in life and occurs in the elderly population.
What Are the Symptoms of a Psychotic Disorder?

Symptoms of a psychotic disorder vary from person to person and may change over time.

The major symptoms are hallucinations and delusions.

Hallucinations are unusual sensory experiences or perceptions of things that aren't actually present, such as seeing things that aren't there, hearing voices, smelling odours, having a
‘funny’ taste in your mouth, and feeling sensations on your skin even though nothing is touching your body.

Delusions are false beliefs that are persistent and organized, and that do not go away after receiving logical or accurate information. For example, a person who is certain his or her food is poisoned, even if it has been proven that the food is fine, is suffering from a delusion.
Other possible symptoms of psychotic illnesses include:
 disorganized or incoherent speech
 confused thinking
 strange, possibly dangerous behaviour
 slowed or unusual movements
 loss of interest in personal hygiene
 loss of interest in activities
 problems at school or work and with relationships
 cold, detached manner with the inability to express emotion
 mood swings or other mood symptoms, such as depression or mania
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Causes

The exact cause is not known, but researchers believe that many factors may play a role.

Some psychotic disorders tend to run in families, suggesting that the tendency, or likelihood, to develop the disorder may be inherited.

Environmental factors may also play a role in their development, including major life changes, stress, and drug abuse.

In addition, people with certain psychotic disorders may have an imbalance of certain chemicals in the brain. They may be either very sensitive to or produce too much of a chemical called dopamine. Dopamine is a neurotransmitter, a substance that helps nerve cells in the brain send messages to each other.

An imbalance of dopamine affects the way the brain reacts to certain stimuli, such as sounds, smells, and sights, and can lead to hallucinations and delusions.
Schizophrenia

Schizophrenia is a complex brain disorder, which affects about one in a 100 Australians.

The illness is characterised by disruptions to thinking and emotions, and a distorted perception of reality.

It usually begins in late adolescence or early adulthood and does not spare any race, culture, class or sex. 
 About 20 to 30 per cent of people with schizophrenia experience only a few brief episodes. For others, it is a chronic condition.

Ten per cent of people with schizophrenia commit suicide.
Symptoms of schizophrenia
Symptoms include:
 hallucinations
 delusions
 thought disorder
 social withdrawal
 lack of motivation

‘blunted’ emotions
 inappropriate responses
 impaired thinking and memory
 lack of insight
Not all people affected by schizophrenia have all these symptoms. Some symptoms appear only for short periods or ‘episodes’.
Hallucinations, delusions and thought disorder

Hallucinations and delusions are psychotic symptoms.

Hallucinations can involve hearing, seeing, tasting, feeling or smelling something that does not exist, but which the sufferer believes is real.

Delusions are unfounded beliefs, for example, of persecution, guilt or grandeur that seem utterly real to the person experiencing them.

Thought disorder manifests as disconnected, illogical speech.
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Social isolation – a major problem
While these psychotic symptoms are more alarming, other symptoms reinforce the alienation of people with schizophrenia. They are often unable to participate in normal social events or conversations, and lack sufficient motivation for simple activities like bathing or cooking.
Sufferers lack the insight to recognise how their inappropriate behaviour appears to others.
Schizophrenia is not a split personality
There are many myths. Sufferers do not have ‘split personalities’ and are not intellectually disabled.
Aggression may occur among a minority of patients during an untreated acute episode, it is uncommon and not like that portrayed in the media of serial killers or ‘psychopaths’.
Current treatments

Medication, hospital care and rehabilitation are the best forms of treatment.

Admission to hospital is only necessary during crises; normal living can resume once symptoms subside. Effective antipsychotic medications enable many people with schizophrenia to lead full and productive lives.

Antipsychotic drugs help stabilise some symptoms, but do not cure the disease and are frequently associated with side effects.

Most people need to stay on medication to prevent relapse.
Current research
Schizophrenia is highly complex. The exact cause of the illness is not yet known, although research to date has yielded several valuable ‘leads’. Several lines of research are currently being pursued at the Mental Health Research Institute. Some of these include:
• Molecular research aims to develop new antipsychotic medications.
• A protein that appears altered in people with schizophrenia has been identified – this may be relevant to the development of future drug treatments.
• Structural changes have been found in the hippocampus (a brain region involved in memory and thinking) after the onset of psychotic symptoms. This suggests that brain changes are actively occurring during the period of transition to illness.
• Research looking at the protective effect of oestrogen in schizophrenia may help with delaying the onset of illness and treating negative symptoms.
• Information about the behavioural, thought, hearing and structural brain abnormalities related to auditory hallucinations, or ‘hearing voices’, has provided new insights into the nature of auditory hallucinations.
• Clinical research has led to the development of resources for professionals to support families where children are living with mentally ill parents.
• Clinical researchers are collecting data as part of an international study of families in which there is a clearly inherited pattern of the illness. This may help them to learn more about genetic links in the illness.
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BIPOLAR DISORDER

Bipolar disorder, or bipolar mood disorder, used to be called ‘manic depression’.

It is a psychiatric illness characterised by extreme mood swings.

A person may feel euphoric and extremely energetic, only to drop into a period of paralysing depression.

The exact cause is unknown and a number of factors may be involved, a genetic predisposition has been clearly established.

Around one in 50 Australians develops this illness, which affects men and women equally.

Most of those affected are aged in their 20s when first diagnosed.

Bipolar disorder typically involves extreme moods of mania and depression – each lasting days, weeks or even months.

The severity of the mood swings and the symptoms vary from person to person.

The person may be affected so much that they experience the symptoms of psychosis and are unable to distinguish reality from fantasy.
Bipolar disorder and mania
Common symptoms include:
 feeling extremely euphoric (‘high’) or energetic
 going without sleep
 thinking and speaking quickly
 delusions of importance
 reckless behaviour, such as overspending
 unsafe sexual activity
 aggression
 irritability
 grandiose, unrealistic plans
Bipolar disorder and depression
Common symptoms include:
 withdrawal from people and activities
 overpowering feelings of sadness and hopelessness
 lack of appetite and weight loss
 feeling anxious or guilty without reason
 difficulty concentrating
 suicidal thoughts and behaviour
Contributing factors

The underlying mechanisms of bipolar disorder are not fully understood.

A strong genetic predisposition has been established.

One theory is that the illness might be linked to particular brain chemicals
(neurotransmitters) called serotonin and norepinephrine that help regulate mood.

In a person with bipolar disorder, it is thought that these chemicals are easily thrown out of balance.

Other contributing factors may include stressors in life that can trigger episodes of illness.
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Treatment for acute episodes of bipolar disorder
When people experience an acute episode of mania or depression, they often require immediate care and treatment. These episodes can often be prevented by regular medication.
Help for bipolar disorder
Treatment depends on the severity of the condition, but may include:
 mood-stabilising medications such as lithium
 antidepressants for depression
 a range of medications for mania, such as sedatives or tranquillisers
 counselling and education to help the person understand and manage their condition
 community support programs, which provide rehabilitation, accommodation and employment support
 self-help groups for emotional support and understanding
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NEUROLOGICAL CONDITIONS
EPILEPSY

Involves recurring seizures – partial or generalized.

Brain controls the body’s actions, sensations through nerve cells (neurones) that carry messages from the brain to the body. Messages are transmitted through electrical impulses.
Seizures occur when sudden burst of electrical activity in the brain disrupts the pattern.

Up to 10% of people may have an isolated seizure and a third of that group will go on to have a recurrence and may be diagnosed with epilepsy.

Approximately 2 % of people have epilepsy.

Seizures can involve loss of consciousness, unusual movements, odd feelings or sensations or changed behaviours.
Types of seizures
Generalised

Tonic clonic – muscles stiffen, person may fall, jerking may follow, person may bite their tongue, become incontinent. May be confused afterwards.

Absence seizure – occur mostly in children. Person may go blank – where they stare/eyelids flicker. May not be noticed by others.

Tonic – body stiffens, person may fall. Recovery usually quick.

Atonic – sudden loss of muscle tone causes person to fall, recovery usually rapid.

Myoclonoc – brief, shock like jerks of muscle or muscle group, usually in upper body.
Partial Seizures
Simple partial
 person remains conscious, may have unusual sensations, pins & needles, unpleasant smell/taste, feel nauseous or have a déjà vu experience
Complex Partial
 may be preceded by a partial seizure
 persons conscious state is altered, may appear confused and dazed and may do strange and repetitive actions e.g. fiddling with clothes, unusual sounds
 maybe trance like or robot like, usually last one to two minutes, but person maybe confused and drowsy for some time and have no memory of the seizure
Causes
Causes of seizures are not always known, some causes include:
 brain injury
 stroke
 brain infection
 structural abnormalities of the brain
 genetic factors
Treatment
Medication is the main treatment, where people are considered at risk of having further seizures.
Surgery may be an option where medication has not been effective in controlling seizures.
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MULTIPLE SCLEROSIS (MS)

Most common chronic disease of the central nervous system among young Australians.
Victoria has more people with MS than any other state.

MS is not contagious, but progress is progressive and unpredictable.

Cause is unknown and there is no cure, treatment can ease symptoms and slow the progress of the disease.

MS occurs when the protective sheath (myelin) around the nerve fibres in the brain and spinal cord is damaged, causing random patches called plaques or lesions. These patches interrupt and distort the messages sent along the nerves.

Sclerosis means scar and the disease is called multiple, because damage occurs in a number of areas.

The health effects of this disease are varied and no people will share the same symptoms.
Symptoms
 blurred or double vision
 numbness, pins & needles
 weakness in arms and legs
 loss of balance
 tendency to drag one foot
 fatigue
 loss of coordination
 continence problems
 hand tremors
 loss of mobility
 problems or changes in memory function
 speech difficulties or slurring
Types of MS
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Relapsing – remitting MS – 85 % of people with MS start with this disease course. Acute episodes occur, which may last for days, weeks, months before completely or partially resolving. Intervals between attacks vary, but on average occur every one to two years.
Primary progressive MS – affects about 10 % of people with MS. Experience no relapses, but have gradual onset of disability, which does not recover or reverse.
Secondary relapsing- remitting MS – occurs in people who started with relapsing – remitting, but relapses diminish or cease altogether, though disability continues to increase. About 60% of people who start with relapsing – remitting MS develop secondary progressive MS after 15 years.
Relapsing progressive MS – occurs about 5%of people from the outset, with relapses occurring and disability accumulating between relapses.
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BRAIN & SPINAL TUMOURS

Brain cancer affects adults of all ages and is one of the few cancers that occur in children.

Most brain tumours are gliomas, which develop from glial cells.

Symptoms and treatment depend on which part of the brain is affected.

The brain and spinal cord make up the central nervous system.

Brain and spinal cord tumours can be either malignant (cancerous) or benign (not cancerous).

The brain controls thoughts, intelligence, memory and emotions.

It coordinates body functions (such as movement, blood circulation and production of hormones.)

Interprets information from our senses (sight, hearing, smell, touch and taste.)

It weighs about one and a half kilograms and is made up of nerve cells (neurones.)

Nerve fibres run out of the brain and join together to make the spinal cord.

The brain and spinal cord form the central nervous system, which helps all the different parts of the body to communicate with each other
There are over 100 different types of brain tumours. Tumours that begin in the brain are known as primary brain tumours.
Some types of brain tumours are malignant (cancerous) and others are benign (non-cancerous).
Differences include:

Benign brain tumours – are often slow growing and are unlikely to spread, but they can press on and damage the surrounding brain tissue. Usually, this type of tumour can be successfully removed with surgery.

Malignant brain tumours – vary in how they grow and respond to treatment. Some are contained inside a capsule and are easy to remove, while others have thin filaments spreading through the brain making them very difficult to take out.
The causes of primary brain tumours are not fully understood.
Symptoms
Depends on which part of the brain is affected.
Generally, a growing tumour and swelling brain tissue presses on the brain causing symptoms including:
• headaches – this is the most common symptom and may be severe and persistent, or come and go
• seizures (fits)
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• nausea and vomiting
• difficulty speaking or thinking of words
• disturbed vision, hearing, smell or taste
• weakness or paralysis in parts of the body
• loss of balance
• irritability, drowsiness or personality changes
• loss of consciousness
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Treatment
Aims to remove the tumour or at least slow its growth and relieve the symptoms.
Treatment may include:
• Surgery – some tumours can be completely removed. If it has spread throughout the brain, it may be more difficult to remove.
• Radiotherapy – using x-rays to kill cancer cells. In children, low doses are used because the xrays can slow a child’s development and growth.
• Chemotherapy – using anti-cancer drugs to stop the cancer cells from multiplying.
Chemotherapy is rarely used for adults, but often used for children because of the possible side effects of radiotherapy.
• Steroid therapy – drugs to reduce the swelling around the tumour. These do not treat the tumour itself but they do help to relieve the swelling and pressure.
• Complementary and alternative therapies – when used alongside conventional cancer treatment, some of these therapies can improve quality of life. Others may not be so helpful and in some cases may be harmful.
Secondary Brain Tumours
• Many malignant brain tumours are ‘secondary cancers’. This means they developed from a cancer that began elsewhere in the body.
• Cancers of the lung, breast, kidney, stomach, bowel (colon), and skin (melanoma) can all spread to the brain.
• The symptoms of secondary brain tumours are similar to those of a primary tumour, but they are treated differently.

Affects one in 100 people over the age of 60.

Symptoms range from tremor, rigidity and slow movements to lethargy, masked face and sleep disturbance. Cause is unknown, treatments include medication, surgery and multidisciplinary therapy.

Progressive, degenerative neurological condition that affects the control of body movements

Symptoms result from the progressive degeneration of nerve cells in the middle area of the brain. Causing a deficiency in the availability of dopamine, a chemical messenger necessary for smooth, controlled movements.

Symptoms appear when about 70 per cent of the dopamine producing cells cease to function normally.

It is estimated that approximately four people per 1,000 have Parkinson’s in Australia, incidence increasing to one in 100 over the age of 60.

In Australia there are approximately 80,000 people living with Parkinson’s.
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Physical symptoms
The type, number, severity and progression of symptoms varies greatly between individuals. Some of the main symptoms are:
 tremor (shaking)
 rigidity (muscle stiffness)
 bradykinesia (slowness of movement)
 freezing
 stooped posture
 shuffling gait
 micrographia (small handwriting)
 lethargy
At present there is no known cause. Research worldwide is investigating possible causes including:
 pesticides, toxins, chemicals
 genetic factors
 head trauma
Management of Parkinson’s
Parkinson’s is managed by:
 medication
 neurosurgery
 multidisciplinary therapy (physiotherapists, dieticians, counsellors )
STROKE

Stroke is often referred to as a cerebrovascular accident.
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
The underlying conditions of a stroke (or cerebrovascular disease) are usually present for years before a stroke occurs, although the symptoms of a stroke may occur suddenly.

Transient ischaemic attacks (TIAs) are an important warning sign that a stroke may occur in the future.

There are sometimes quite specific warning signs of an impending stroke.
Symptoms of a stroke can include:
 a numb or weak feeling in the face, arm or leg
 trouble speaking or understanding
 unexplained dizziness
 blurred or poor vision in one or both eyes
 loss of balance or an unexplained fall
 difficulty swallowing
 headache (usually severe or of abrupt onset) or unexplained change in the pattern of headaches
 confusion
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TRANS ISCHAEMIC ATTACKS (TIA)

Are caused by a temporary cut in blood supply to the brain, due to the partial blockage of an artery by a blood clot or debris.

TIAs have the same symptoms as a stroke, but they are temporary and do not usually cause long-term brain damage.

A TIA can appear hours, days, weeks or months before a full stroke but is more common within days or a few weeks.



Just like full strokes, TIAs need emergency treatment and should not be ignored.
A TIA, or mini-stroke, is a warning of an impending stroke.
A person who has had a TIA is at greater risk of having a stroke or heart attack. Early identification of symptoms and early management greatly reduces the chances of a major stroke.
A TIA is:

Transient – symptoms last for less than 24 hours

Ischaemic – failure of blood flow to part of the brain or eye

Attack – sudden onset of symptoms, depending on which part of the brain or eye is starved of blood
ALZHEIMERS DISEASE

Alzheimer’s disease is a progressive and eventually fatal disease of the brain.

It impairs higher brain functions such as memory, thinking and personality.

Alzheimer’s disease is the most common form of dementia.

It affects one in 25 Australians aged 60 years and over.

There is no cure and no way yet proven to prevent the disease from developing.
Early stage symptoms of Alzheimer's
Since Alzheimer’s disease is a progressive disease, the initial symptoms may be too subtle to notice.
The symptoms differ from one person to the next, depending on the affected brain areas, common early stage symptoms can include:
 memory lapses
 problems with thinking of the right word for common objects
 difficulties with making decisions
 confusion
 personality changes, such as irritability
Late stage symptoms of Alzheimer's
The symptoms become more severe as time goes by and can include:
 long term memory loss, including forgetting the names of family members
 inability to manage responsibilities, such as work or running the house
 inability to look after oneself; for example, help may be needed to go to the toilet
 severe personality changes
 loss of social skills, such as the ability to hold a conversation
 speech loss
In the later stages, the person is usually bed-ridden and needs full-time care.
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Two types of Alzheimer's
Sporadic Alzheimer’s disease -
 accounts for more than 90 per cent of cases
 most cases occur in people over the age of 65 years

It can take up to 20 years for the disease to develop
Familial Alzheimer’s disease - this rare type is caused by a genetic mutation.
The age of onset is earlier than for sporadic Alzheimer’s disease, with symptoms appearing at 40s or
50yrs
Protein build-up

Brain cells (neurones) ‘talk’ to each other by means of connections called synapses.

In Alzheimer’s disease, these connections are broken and ultimately disappear entirely in the parts of the brain where thinking occurs.

Post mortems of the brains of people who have died from Alzheimer’s disease reveal remnants of damaged cells called ‘tangles’ as well as ‘amyloid plaques’ in the spaces
 between the cells.

These plaques are mostly made up of aggregates of a protein called ‘A-beta’.

It is the build-up of this otherwise normal protein that is thought to cause the damage.
Research has shown that, sometimes, the A-beta can convert oxygen into hydrogen peroxide
- a form of bleach - which then corrodes the grey matter, particularly the parts of the brain concerned with memory and reasoning.
Risk factors for Alzheimer's
• Advancing age - the incidence of Alzheimer’s disease increases with age. Some estimates suggest that about one quarter of people aged 85 years and over have Alzheimer’s disease.
• Down syndrome - a person with down syndrome has an increased risk because they have an extra chromosome. This means they have an additional copy of the gene for the amyloid precursor protein, the ‘mother’ molecule from which A-beta is made. This makes it more
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likely that this protein will accumulate in their brains.
• Family history - each child of a parent who carries the familial Alzheimer’s gene has a 50 per cent chance of inheriting the disease.
• Environmental factors - researchers are investigating possible environmental causes, such as head injuries and other stresses.
• Unknown - for most people who develop Alzheimer’s disease, no known risk factors can be found.
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Diagnosis of Alzheimer's

There is no definite test for the disease. Only a post mortem can establish beyond doubt whether Alzheimer’s disease was present.

Diagnosis is about 90 per cent accurate. It is important to rule out the presence of other conditions that can mimic the symptoms of Alzheimer’s disease, such as brain tumours, depression or some types of malnutrition.
Diagnostic tests used may include:
 medical history
 physical examination
 blood and urine tests (called a ‘dementia screen’)
 urine tests
 x-rays
 imaging techniques, such as a CT scan
 neurological examination
 neuropsychological tests
 intellectual function tests
 psychiatric assessment
Treatment for Alzheimer's
There is no cure.

Treatment may include the use of drugs that boost the efficiency of damaged neurones.

Drugs can also ease some of the secondary symptoms, such as depression.

Second generation drugs, which are aimed at inhibiting the production or toxic effects of the
A-beta protein, are in development.

Professional associations, support groups and counselling can help the affected person and their family come to terms with the diagnosis, and plan ahead.
There is currently no cure for Alzheimer’s Disease
Alzheimer’s only affects one man in 25 Australians aged 60 years and over.
TIA stands for Trans Ischaemic Attack
A numb or weak feeling in the face, arm or leg is a sign of stroke
Many malignant brain tumours are ‘secondary cancers’. This means they developed from a cancer that began elsewhere in the body.
TIA is another name for a stroke
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CEREBRAL PALSY

Describes a range of disabilities associated with movement and posture.

Cerebral refers to the brain and palsy means weakness or lack of muscle control.

Cerebral palsy affects people in different ways – some may have minor motor skill problems, others may be totally physically dependent.

Cerebral palsy distorts messages from the brain, can cause increased muscle tension or reduced muscle tension. The tension can fluctuate becoming more or less obvious. Messages from the brain can be mistimed, sent to the wrong area or not sent at all.

This causes the erratic movement of the muscles, the message path between brain and muscles is affected.
Types of cerebral palsy

Spastic cerebral palsy – most common type. Spasticity means stiffness or tightening of muscles, most obvious when the person tries to move.

Athetoid cerebral palsy – uncontrolled movements, which often lead to erratic movements.

Ataxic cerebral palsy – least common type. Ataxia means lack of balance and coordination.
Presents as unsteady, shaky movements called tremors.

Mixed type cerebral palsy – may involve a combination of types.
Other disabilities sometimes occur with cerebral palsy – hearing, sight and speech, epilepsy or an intellectual disability
Causes

CP Is a condition, it is not contagious and not hereditary.

Usually result of changes or injury to the developing brain before or during birth or early childhood.

Usually the result of reduced blood supply and lack of oxygen to areas of the brain.

Maybe caused by illnesses e.g.: rubella during pregnancy, meningitis in young children or accidental injury to the brain.

Extremely premature babies may also be at risk.
Implications

If speech is affected, the person may understand what is said to them but may have difficulty responding.

Many people with CP may not be able to walk or require assistance.

CP can also lead to reduced control of facial muscles.

Many people with CP can and do live independently in the community.
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SPINAL CORD INJURY
Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility and/or feeling.
In order for the loss of function to occur, the spinal cord does not have to be completely severed. In most individuals with SCI, the spinal cord is intact, but it's the damage to it that results in the loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves.
Also, a person can ‘break their back or neck’ yet not sustain a spinal cord injury if only the bones around the spinal cord (the vertebrae) are damaged, not the actual spinal cord. In these cases, the bones usually heal and the person does not experience paralysis.
The majority of people who have a spinal cord injury are young males (they have a greater tendency to indulge in risky behaviour). However, there are people from both sexes and of all ages with spinal cord damage.
Frequent causes of spinal cord injury
The most common causes of damage to the spinal cord are traumas such as car accidents, motor bike accidents, falls, diving mishaps (particularly diving into shallow water), sports injuries and work accidents.
There are currently around 10,000 people living with a spinal cord injury in Australia, with a further
300 – 400 new cases reported every year.
Around half of all new cases are people aged between 15 and 34 years old.
What are the effects of SCI
The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury - complete and incomplete. A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected. An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, may have more functioning on one side of the body than the other or may even be able to walk. With the advances in acute treatment of SCI, incomplete injuries are becoming more common.
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The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses.
 Cervical (neck) injuries usually result in quadriplegia.
 C1 to C4 injuries may require a ventilator for the person to breathe.
 C5 injuries often result in shoulder and bicep control, but no control at the wrists or hands.
 C6 injuries generally yield wrist control, but no hand function.
 C7 and T1 injuries can straighten their arms but still may have dexterity problems with the hand and fingers.


Thoracic level injuries and below result in paraplegia, with the hands not affected.
T2 to T8 injuries have control of their hands, but poor trunk control as the result of lack of abdominal muscle control.
 T9 to T12 injuries allow good trunk control and good abdominal muscle control. Sitting
 balance is very good.
Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.
Besides a loss of sensation or motor functioning, individuals with SCI also experience other changes.
For example;

 incontinence of the bowel and bladder erectile dysfunction
 fertility may be affected in SCI men
 wide and rapid fluctuations in body temperature
 inability to sweat below the level of injury
 low blood pressure
 chronic pain.
Very high injuries (C1, C2, C3) can result in a loss of many involuntary functions. For example;
 the ability to breathe (may require breathing aids such as mechanical ventilators or
 diaphragmatic pacemakers) inability to regulate blood pressure effectively
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Some common health problems
Other problems which can arise for people with spinal cord injuries are:
 frequent urinary tract infections
 kidney stones
 muscle spasm
 pressure sores from sitting in one position for too long without a correct pressure cushion;
 Higher level injuries may develop a condition called autonomic hyper reflexia, also known as autonomic dysreflexia. This condition can be triggered by a variety of factors, including distended bladder, distended bowel and skin or pressure sores. The symptoms of this condition include raised body temperatures, profuse sweating, high blood pressure, slow pulse rate and blackouts. http://www.aqavic.org.au/sci_facts/whats_sci.html
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MUSCULOSKELETAL INJURIES (EG BACK INJURY)

More than 6.1 million Australians are reported to have arthritis or a musculoskeletal condition.

Most commonly reported conditions are back pain and various forms of arthritis.

Almost 1.2 million of these are reported to have disability associated with their condition.
Musculoskeletal disorder is an umbrella term for related injuries and disorders including:
 sprains and strains of muscles, ligaments and tendons
 back injuries, including damage to the muscles, tendons, ligaments, spinal discs, nerves, joints and bones
 joint injuries or degeneration, including injuries to the shoulder, elbow, wrist, hip, knee, ankle, hands and feet
 bone and nerve injuries
 soft tissue hernias
 muscular and vascular disorders as a result of hand-arm vibration
SPINA BIFIDA
Spina bifida is a condition in which the bones of the spinal column do not close completely around the developing nerves of the spinal cord. As a result, part of the spinal cord may stick out through an opening in the spine, leading to permanent nerve damage. Spina bifida results when a structure called the neural tube fails to close completely during the first few weeks of embryonic development.
The neural tube is a layer of cells that ultimately develops into the brain and spinal cord. Because spina bifida is caused by abnormalities of the neural tube, it is classified as a neural tube defect
(NTD).
Children born with spina bifida often have a fluid-filled sac on their back covered by skin. If the sac contains part of the spinal cord and its protective covering, the abnormality is known as a myelomeningocele. If it does not, the abnormality is known as a meningocele.
The signs and symptoms of these abnormalities range from mild to severe, depending on where the opening in the spinal column is located and how much of the spinal cord is affected. Related problems can include a loss of feeling below the level of the opening, weakness or paralysis of the feet or legs, and problems with bladder and bowel control. Some affected individuals have additional complications, including a build up of excess fluid around the brain (hydrocephalus) and learning
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problems. With surgery and other forms of treatment, many people with spina bifida live into adulthood.
There is also a milder form of the condition called spina bifida occulta, in which the spinal column is abnormal but the nerves of the spinal cord do not stick out through an opening in the spine. Spina bifida occulta usually causes no health problems, although rarely it can cause back pain or changes in bladder function.
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How common is spina bifida?
Spina bifida is one of the most common types of neural tube defect, affecting an estimated 1 in 2,500 newborns worldwide. The prevalence of spina bifida varies among different geographic regions and ethnic groups.
How do people inherit spina bifida?
Most cases of spina bifida are sporadic, which means they occur in people with no history of the disorder in their family. A small percentage of cases have been reported to run in families; however, the condition does not have a clear pattern of inheritance. First-degree relatives (such as siblings and children) of people with spina bifida have an increased risk of the condition compared with people in the general population.
AMPUTATION
Amputation is a surgery to remove a limb or part of a limb. Amputation can also happen as an accident, which is called a traumatic amputation.
Who is a candidate for the procedure?
Amputation is most often used for one of four conditions:
 gangrene, which is a severe limb infection with death of tissue
 lack of enough blood flow through the arteries that supply blood and oxygen to the affected limb
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
 cancer or a tumour involving a limb severe trauma or injury of a limb
Amputation has serious emotional and physical effects. For this reason, limb removal is usually advised only when other options are not possible or have little chance of success.
What happens later at home?
In many cases, a person will need a prosthesis, or artificial body part, after surgery. The prosthesis can help a person continue to walk after limb removal. The new body part often requires a custom
‘fit.’ Physiotherapy to learn how to use the new limb is usually given. The area of the incision should be watched closely for signs of infection. These signs include increasing pain, warmth, or redness.
Any new or worsening symptoms should be reported to the doctor.
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What are the potential complications of amputation?
The most common complications of amputation are:
 phantom limb pain, a condition in which the person feels pain in the body part that is missing
 stump pain, due to abnormal nerve growth at the site of surgery
Medication, more surgery, or another type of therapy may be needed for these types of pain.
Many of the people who need an amputation have poor circulation, diabetes, or both. These conditions interfere with healing. If healing does not occur, more surgery or other therapy may be needed in the future.
Musculoskeletal disorders can occur suddenly as a result of a single forceful action or develop over long periods as symptoms associated with minor tissue injuries are ignored, eventually resulting in a more serious injury. Many workers performing repetitive tasks or work of a similar nature fall into the longer-term category.
ACTIVITY
Question
What is amputation?
What is phantom limb pain?
Describe spina bifida.
List five musculoskeletal injuries and or disorders.
List the four sections of the spine
The spine consists of how many vertebrae
What age are half of all new spinal injury cases?
How common is spina bifida worldwide?
What is the main reason for amputation?
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Answer

FURTHER INFORMATION CAN BE FOUND AT:
For more information about Chronic Medical Conditions:

Healthinsite

Department of Health

Aged Care Australia

Better Health
For more information about intellectual disability:
 NSW Council for Intellectual Disability
 Bruyere, S.M., & Golden, T.P. (2000). Working effectively with persons who have cognitive disabilities. Employment and Disability Institute: Cornell University.
For more information about learning disabilities:
 Specific Learning Disabilities Association of NSW (SPELD)
For more information about mental health disabilities:
 SANE Australia
 Beyond Blue
 Mancuso, L.L., & Bruyere, S.M. (2000). Employing and accommodating workers with psychiatric disabilities. Employment and Disability Institute: Cornell University.
 Centre for Psychiatric Rehabilitation
For more information about Neurological Conditions
 ehow.com

World Health Organisation

National institute of Neurological Disorders

Alzheimer’s Association

Epilepsy Foundation

Epilepsy Action Australia

Guillain Barrѐ Syndrome Support Group

Australian Huntington's Disease Association

MS Australia
For more information about Physical Disabilities
 The Cerebral Palsy Alliance
 Paraplegic and Quadriplegic Association of NSW
 Multiple Sclerosis Society of Australia
 The Northcott Spina Bifida Group
For more information about hearing impairments:
 Better Hearing Australia
 National Relay Service
For more information about vision impairments:
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 Vision Australia
 Dickson, M.B., Moore, E., & Bruyere, S.M. (2000). Working effectively with people who are blind or visually impaired. Employment and Disability Institute: Cornell University.
Communication basically means ‘meeting of the minds’! I understand you and you understand me.
For communication to be successful you need a ‘meeting of the minds’. This doesn’t mean we need to agree: it does mean that we need to be sure that we understand the message that the other is delivering and that we clearly communicate our own message. We communicate and share information, thoughts and feelings through speaking, writing or body language. While this sounds simple and we think we are communicating clearly and understand a message conveyed to us, our life experiences, habits, emotions and daily pressures can sometimes block or cloud the real message. This can result in miscommunication.
In this section, we will look at communication, especially in the setting of a support worker and client with disability. Poor communication can result in serious consequences for the support worker and clients and hamper our efforts to support our client’s journey for choice and independence.
IN THIS SECTION WE WILL LOOK AT:

The basic communication process

Barriers to effective communication

Strategies for communication

Communication with clients with specific disabilities

Augmentive and Alternative Communication

Effective Language o Words to watch o Acceptable Alternative

Conflict and Issue Resolution o Identify conflict o Levels of conflict o Self-awareness in conflict situations o Cross cultural conflict resolution

Negotiation – The art of reaching a mutually satisfying agreement
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
Confidentiality and privacy
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BASIC COMMUNICATION PROCESSES
The Communication Equation
What you hear : 40% of the message
• Tone of voice
• Vocal clarity
• Verbal expressiveness
What you see or feel :
 Facial expression 50% of the message
 Dress and grooming
 Posture
 Eye contact
 Touch
 Gesture
 WORDS: 10% of the message!
Channels of communication include:
 Verbal channels include face-to-face meetings, telephone and videoconferencing.
 Non-verbal channels include sign languages, body language, gestures, and facial expressions.
 Written channels include letters, emails, memos and reports, signs and symbols.
Different communication channels have different strengths and weaknesses; the most important thing is that the receiver can access the message through that channel. For example, if the intended receiver has a hearing disability and you do not share a common non-verbal language; your message would be better understood in written form.
In discussions, it is good to be mindful of non-verbal gestures that provide information about how we are feeling and how the other person is coping. Pay attention to things like eye contact, gestures, posture, body movements, and tone of voice. All of these signals can convey important information
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that isn't put into words. By paying closer attention to other people's nonverbal behaviours, you will improve your own ability to communicate nonverbally.
Your tone of voice can convey a wealth of information, ranging from enthusiasm to disinterest to anger. Start noticing how your tone of voice affects how others respond to you and try using tone of voice to emphasise ideas that you want to communicate.
If you are confused about another person's nonverbal signals, don't be afraid to ask questions. A good idea is to repeat back your interpretation of what has been said and ask for clarification. An example of this might be, ‘So what you are saying is that...’
Communication problems occur when the sender and receiver do not share the same understanding of the language used. For example, when young people use the word 'whatever' in response to a question it is often unclear to parents whether this signals agreement, disagreement or general apathy.
At any time in the communication process, a lack of response or an inappropriate response would alert the sender to a problem with the communication. The sender would then need to interpret the
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message differently or use a different channel to ensure that the communication is received and understood.
Barriers to effective communication
A communication barrier is anything that prevents you from receiving and understanding the messages others use to convey their information, ideas and thoughts. These barriers may be related to the message, internal barriers related to thoughts and feelings, or external barriers.
Barriers related to the message include:

 lengthy or disorganised messages complex or ambiguous language
 inconsistent body language
 disregard for specific need
Internal barriers include:
 fatigue
 disinterest
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 poor listening skills
 past experiences with the client
 home or work problems
 poor listening skills
External barriers include:

 unpleasant environment
 problems with technology or equipment noise and other distractions
These barriers keep the message from getting through. When you are communicating, monitor the actions of the receiver by observing their body language, response to the message, etc. To check that the message has been received as it was intended, ask questions and listen to their response.
STRATEGIES FOR EFFECTIVE COMMUNICATION
As disability can affect people in different ways, communication is not always just a matter of speaking and hearing. It can involve a range of methods by which people choose to communicate
(such as via sign language or communication aids), depending upon the level of disability and the way it affects each individual.
Interaction with people with disabilities is an unfamiliar and sometimes threatening experience for many people. Avoidance behaviour can occur. Interacting with people with disabilities requires common sense and simple sensitivity. A few key points need to be stressed:
 Good service behaviours such as active listening, a service orientation and a results focus work equally well with people with disabilities as with all other people.
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







Think of the person first and the disability second. Sensitive use of language can help reinforce the ‘person first’ attitude.
Reference to ‘people with disabilities’ rather than to ‘disabled people’ helps maintain this stance.
Accept people with disabilities as individuals. People with disabilities may have in common a disability, but the consequences of their disabilities will vary considerably from person to person. Factors such as the degree of impairment, duration, individual coping strategies and styles, support structures available and a host of personality traits will all combine to influence the nature of the individual’s needs. Don't generalise about all people with disabilities from your knowledge of a few.
Listen to what people say. Don't assume you know what they want or what is best for them.
People with disabilities are no less capable of thinking for themselves than anyone else.
There may be challenges in communicating their needs, but assumptions that they cannot decide what they need are also offensive.
Be yourself, be natural, don't force enthusiasm. Do not patronise or speak down to people with a disability.
A disability is not necessarily an illness. Do not treat people with disabilities as though they are sick. Treat them as healthy individuals. Research indicates that people with disabilities take fewer sick days than other employees. Their impairments cause inconvenience and disability in particular areas of activity, but they are rarely dysfunctional.
Treat people in a manner that is appropriate to their age. It is not appropriate to talk to people with disabilities as if they were children, or to refer to them as children. Terms such as ‘girlie’ or ‘sonny’ are not appropriate for adults with disabilities.
Speak directly to the person, not to their carer or other third party. People with disabilities often have carers. However, the carers are there to assist in specific ways. Do not assume that they are the mouthpiece or the advocate for the person with a disability. It is insulting to talk in the third person about a person who is present.
If the person with a disability has a communication problem they will usually let you know and indicate a preferred method.
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 A disability is an inconvenience in certain situations, but it is not necessarily a tragedy which dominates a person's life and makes fulfilment impossible. Individuals find their own ways of adapting.
SPECIFIC DISABILITIES
People with vision impairment
Effective ways of providing information to people who are blind or have vision impairment include:
Large Print
Text can be produced in a variety of sizes to meet individual needs. Printed material should ideally be in a sans serif font and 16 point, with a minimum size of 11 point. Use a text colour that contrasts with the background (avoid red type as it has poor contrast and makes it difficult for people to read).
Black type on white or off-white background is optimal. Use style devices such as underlining, italics and hyphenation sparingly.
Try your local library they generally have a wide selection of large print books.
Information and Communication Technology
Providing information electronically, either on a website, through email or an electronic file or document, can be a good option if the information is prepared in an appropriate format. Unlike sighted people, most computer users who are blind or vision impaired do not use a mouse. Many use a screen reader or, in some cases, a Braille keyboard. A screen reader is software that works with a speech synthesiser to read aloud everything on a computer screen, including icons, menus, text, punctuation and control buttons. It reads across the screen from left to right, one line at a time. This software will attempt to ‘read any formatting — for example, instead of reading columns from top to bottom it will read the first line of text in the first column and then jump across to read the first line of the next column. For this reason, it is best to keep formatting (including tabs, tables and columns) to an absolute minimum in your document.
Information provided as a PDF file should also be available electronically as an RTF file. This will ensure it can be read by a screen reader and will also be able to be enlarged by users to suit their needs.
Advice and guidelines for creating accessible websites are available from the World
Wide Web Consortium website ( www.w3.org/WAI ).
Audiotape/CD-ROM
Newsletters, books and reports can be produced on audiotape or CD-ROM. It is best to use an organisation that specialises in the production of audio material for people with a print disability, such as the Queensland Narrating Service. Costs are minimal.
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Radio
4RPH 1296AM is the Queensland radio station for the print handicapped. The station airs a wide range of printed material, including newspapers, magazines, books and journals to people who for reasons of age, disability or literacy problems cannot handle or read information in a printed format.
Braille
Braille is used by a small proportion of people who are blind. Documents on computer file can be converted into Braille using Braille conversion software and printed out by a Braille embosser.
People with a hearing impairment
Effective ways of providing information to people who are deaf or have a hearing impairment include:
Written/printed information
Printed information should be written in plain
English and include cartoons, diagrams, photographs and pictures to help communicate your message clearly.
Captioning
Captioning films, videos, television programs and advertisements assists viewers who are deaf or hearing impaired to understand what they are not able to hear.
Telephone typewriter (TTY) and/or National Relay Service (NRS)
Organisations can communicate with people who are profoundly deaf through the use of a TTY or the NRS.
Sign language
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Skilled sign-language interpreters are available for seminars, meetings, conferences and other community events. Qualified interpreters can be booked through Auslan Services Australia wide or check the web for individual states Deaf Interpreting Services. http://auslanservices.com
Audio Loop
An audio loop in public meeting places such as halls, churches, seminar rooms, lecture theatres and schools will allow people who use hearing aids to participate.
People with an intellectual disability
People with an intellectual disability may require information to be presented in a brief and clear but not patronising or childlike manner. Written information may need to be supported by symbols, pictures or photographs.
People with a physical disability
People with a mobility disability, including those with a temporary disability, may find their access to mainstream information limited. They may be unable to travel to libraries or meetings or may encounter difficulties with inaccessible buildings. They too may prefer to receive information via the internet, email, radio, DVD or disk. People with a manipulatory disability have difficulty holding and/or moving objects as a result of nerve injuries, arthritis or amputation. They may find it difficult to hold books or papers and turn pages. When providing information for this audience, the formats to consider include the internet, disk, DVD and radio.
Many people with a disability have complex communication needs (CCN) which cover a range of issues in the areas of speech, language, auditory and visual processing. CCN considers receptive language skills (difficulties understanding spoken language), expressive language skills (difficulties producing speech), or both. Some general characteristics of CCN are:
 the inability to follow instructions
 incomprehensible speech
 difficulty in identifying visual cues
 overly slow speech
 trouble with articulation, voice, and fluency
 stuttering
 difficulty in forming sentences (often saying words out of order)
People who have complex communication needs (CCN) are unable to communicate effectively using speech alone. They and their communication partners may benefit from using augmentative and alternative communication (AAC) methods, either temporarily or permanently.
Augmentive and alternative Communication
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Augment means to add to or to enhance. For example, we can augment speech by using gestures, eye pointing and body language. Alternative means a choice or a substitute. We can use alternative communication to speech by pointing to symbols, signing or by spelling.
Communication means to send and receive messages with at least one other person. Therefore AAC is the term used for all communication that is not speech, but is used to enhance or to replace speech. o pointing and gestures mime
AAC covers a large number of ways of communicating. It can include one or more of the following:
 Natural communication methods, such as: o o o facial expressions body language
 Methods that can be taught, such as:
Signing - this involves the use of a formal set of signs, or signs which are particular to an individual. Signing is useful to help children to understand language. The sign can be seen and held for slightly longer if needed, whereas speech disappears as soon as it is spoken. Signing can also be used as a means of expression with other people who know signs.
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Object symbols - these are objects such as small versions or parts of objects which represent an activity, object or person (for example, a set of keys represents that it’s time to go in the car)
Photos, drawings, symbols - these are used like object symbols to represent words in a visual way.
Communication boards and displays - these are sets of photos, drawings, symbols or words that are used by an individual for communication.
Speech generating devices - communication boards or displays on a machine which speak a message when a particular button is pressed.
Spelling - using an alphabet board or typing device to spell out words and messages
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People with a disability should be portrayed as individuals first. Like everyone else they have emotions, interests, problems, talents, frustrations and faults and have a number of roles such as parent, friend, work colleague and club member. As each person with a disability is an individual, the disability will affect his or her life in different ways. You cannot assume that all people with a disability share the same viewpoint, interests or outlook on life.
Using appropriate language emphasises this individuality, rather than the disability that a person happens to have. This does not mean that the disability should be hidden, ignored or deemed irrelevant but it should not be the focus of a story except when the subject is disability.
Effective Language
In the general community, as well as in the disability community, there is considerable debate about how people with a disability should be described. Words and terms that are considered appropriate and acceptable change over time. For example, once the word ‘cripple’ was in common and respectable use. Today its use to describe a person with a disability is considered offensive and unacceptable. The same applies to words and expressions such as ‘insane’, ‘spastic’ and
‘handicapped’. Also unacceptable are words which imply a lack of something or some kind of inferiority, such as ‘invalid’, ‘infirm’ or ‘incapacitated’.
The following list of inappropriate terms and appropriate alternatives is a guide only. When considering which terms are most appropriate to use in any situation it is best to ask the person how he or she would like to be referred to.
WORDS TO WATCH ACCEPTABLE ALTERNATIVE
Abnormal, s ubnormal (negative terms that imply failure to reach perfection)
Afflict e d with (most people with d is abilities don't s ee them s elves as afflicted)
Specify the disability
Say ‘the per s on ha s ...(th e dis ability)’
Say ‘the person with a disability s ince birth’,
‘per s on with c ong e nital disability’
Birth defect, al s o congenital defect, deformity
Blind (th e ), vi s ually impair e d (th e )
C o nfin e d t o a wh ee l c hair, wh ee l c h a ir-b o und (a w he e l c hair pro vid e s mob i lit y not re s tr ic tion)
Cripple, crippled (these terms convey a negative image of a twisted, ugly body.)
Deaf and dumb (the inability to hear and speak does not imply intellectual disability.)
Defective, deformed (degrading t e rm s .
)
Deaf (the)
Say ‘p e rs impairm e o n who i nt s blind’, ‘p
Say ‘hearing impaired’; lack of speech usually results from impaired hearing
Specify the di s ability e r s on with
Say ‘has a physical or mobility disability v
Say ‘has a physical or mobility disability’ ision
Only appropriate when referring to the Deaf community; say ‘person who is deaf’
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WORDS TO WATCH
Di s abled (th e )
Epil e ptic
Fit, attack, s pell
Handicapped (the)
ACCEPTABLE ALTERNATIVE
Say ‘peopl e with a di s ability’; ‘th e di s ability co mmunity’
Say ‘p e rs o n with e pil e p s y’
Say ‘ s eizure’
Say ‘per s on with a di s ability’ unl e s s r e ferring to an e nvironmental o r attitudinal barrier, in s uch c a s e s ‘per s on who i s handi c app e d by a disability’ is appropriate.
Say ‘person with a mental health disability’ or a specific condition.
Insane (also lunatic, maniac, mental patient, mentally diseased, neurotic psycho, psychotic, schizophrenic, unsound mind and others are derogatory terms.)
Invalid (the literal sense of the word is ‘not valid’.)
Mentally retarded (also defective, feeble minded, imbecile, moron and retarded are offensive and inaccurate terms.)
Mongol (out da t ed and derogatory )
Say ‘person with a disability’
Say ‘person with an intellectual disability’
Pati e nt (only us e in cont ex t of doctor/patient relation s hip or in hospital )
Physi c ally/intellectually/vertically chall e nged, diff e rently abl e d, ( ridiculous euphemi s m s for disability)
Say ‘has Down Syndrom e ’.
Say ‘p e rs
Say ‘per s o n with a disability’.
on with a di s ability’
Spastic (u s ually refer s to a p e rson with c e r e bral pal s y or who ha s uncontrollable s pa s m s .
Derogatory, often term of abu s e.
S uff e r s fr o m, s uff e r e r , s tri c k e n w ith ( N o t all
Say ‘per s on with a di s ability’.
Say ‘per s on with a di s ability’.
p eo pl e with di sa biliti es act u a lly s uff e r. Say
‘person with a mental health illness or disability’ or a specific condition.
From ‘A Way with Words’ (1995), Community Disability Alliance, Department of Families, Youth and Community Care and Department of the Premier and Cabinet, Brisbane.
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ACTIVITY

QUESTION
What is an Alphabet Board used for?
What does speech generating devices used for?
List three natural communication methods.
What is the appropriate language for Disabled?
What is the appropriate language for Mongol?
What is the appropriate language for Deaf?
What is the appropriate language for
Handicapped?
Define communication.
List six barriers to communication, these can be internal or external.
Who would use Braille as a form of communication?
What is signing?
What is CCN?
What is the appropriate language for Insane?
List three forms of communication for people with a hearing impairment.
List three form of communication for people with vision impairment.
What is AAC?
ANSWER
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CONFLICT AND ISSUE RESOLUTION
It is normal in life, especially a world in which different cultures, traditions and belief systems operate, to encounter differences of opinions. We are human! Sometimes, however, these differences can lead to conflict which can block our ability to communicate effectively and provide support and a service to people in our community. The potential for misunderstanding and tensions within the worker-client relationship may be related to the following issues:

Support workers and the service support people not understanding the complex challenges the clients and their families face every day due to the disability.

Client and family frustrations with the care and support they receive from support workers and organisations. Also, general frustration with the overall ‘system’ and compliance issues which impact upon the support workers to deliver the type of support that the client and family would like.

General breakdown in communication between all parties involved in the client care.

Clients experiencing major crises in their lives – leading to a heightened emotional state and frustrations.
You need to demonstrate patience, understanding, and respect for others' cultural, religious or other preferences. In this way, you can minimise any barriers arising from the clients' and co-workers' actions or beliefs, and ensure that they do not contribute to breakdowns in communication, resulting in mistrust or conflict.
The need for a support worker to demonstrate patience and understanding and a commitment to avoiding unnecessary conflicts and tensions due to miscommunication is essential .
Identify conflict
Conflict may be unavoidable, due to the nature and purpose of some communications; however, by identifying early signs of conflict it is possible to avoid communications becoming emotionally charged or destructive.
Signs of conflict can be verbal, non-verbal, or indicated through body language.
Verbal disagreement Non-verbal indicators Body language
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This may include:
 a raised voice
 a sharp tone
 snide remarks
 asides (comments intended for one person to hear, but directed
 toward others) direct explanation
This may include:
 non-participation
 distraction
 withdrawal
 continual lateness
 non-attendance
This may include:
 closed posture (crossed arms, etc.)
 colour of face (pallor)
 angry expression
 positioning (e.g., moving away)
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Levels of conflict
The Levels of conflict diagram, describes the escalation of conflict from early signs of discomfort through to incidents, misunderstandings, tension and crisis.
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When a conflict is developing between yourself and a client or colleague, anger is usually present. It is important to examine where that anger is coming from and what needs are not being met – both within yourself and within the client's situation. This will be discussed later in the final section in more length.
You need to be very honest in acknowledging personal limitations and prejudices, and avoid imposing your own personal values and beliefs on others. These could include:
 feeling threatened by the other person
 commitment to personal values or beliefs
 being unsure of your information
 being unassertive, aggressive, talkative, or having low self-esteem.
 being judgmental or having expectations
 using inferences rather than facts or observations
Feelings can bubble up unexpectedly and you may not be prepared for their intensity. This can exacerbate the potential for conflict developing with clients or co-workers. It is important for you to be able to examine your responses to others and to be constantly aware of what your feelings and perceptions tell you, about your needs and those of your client, and whether these are being met.
People in conflict can approach the situation competitively or they can attempt to cooperate, while still acknowledging the existence of a conflict. When people compete in a conflict, they usually perceive that there will be an outcome in which one side wins and the other loses. If people attempt to approach a conflict cooperatively, they try to find a solution both parties can be satisfied with.
People's behaviour in conflict falls into five styles described below:
 avoiding – withdrawing from the conflict
 smoothing – finding common interests or areas of agreement
 compromising – bargaining so that each side gets a part of what they want
 forcing – one side causes the other side to change
 problem-solving – attempting to find a solution that meets both needs
Any conflict and also conflict in the workplace can be incredibly destructive to good teamwork.
Managed in the wrong way, real and legitimate differences between people can quickly spiral out of control, resulting in situations where co-operation breaks down and the team's mission is threatened.
This is particularly the case where the wrong approaches to conflict resolution are used. To calm these situations down, it helps to take a positive approach to conflict resolution, where discussion is
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courteous and non-confrontational, and the focus is on issues rather than on individuals. If this is done, then, as long as people listen carefully and explore facts, issues and possible solutions properly, conflict can often be resolved effectively.
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Conflict resolution
Successful conflict resolution comprises three aspects:
1.
Desire and necessity for the conflict to be resolved.
2.
Understanding of possible barriers to the resolution of the conflict.
3.
The choice of method of conflict resolution.
1. Desire and necessity for the conflict to be resolved
To resolve cross-cultural conflicts or misunderstandings, community service and disability service workers need to be committed to resolving potential conflicts and take responsibility for bridging the cultural gaps. They must:
 have self-awareness of their own cultural practice, including prejudice, stereotyping and bias
 understand various cultural factors contributing to cultural differences
 be sensitive and appreciate a migrant’s migration experience
 have a good knowledge of, and skills in, communication
 be able to work with interpreters
 be willing to accept and appreciate other cultures (modified from Lachowicz 1997)
2. Understanding of possible resistances
During the conflict resolution process, you might experience internal resistance to recognition of problems or problem-solving.
This resistance may take the form of:
 resistance to examining your own values
 resistance to acknowledging your own cultural stereotyping or bias
 denial of the existence of conflict
 tendency to blame others for causing problems
 looking for the right time to deal with conflicts
You must take prime responsibility for exploring the barriers and minimising this resistance to conflict resolution.
3. Methods of conflict resolution
Different people might accept different conflict resolution methods, so it is important to use methods or approaches that are suitable to all parties and enlist the help of acceptable people in resolving cross-cultural conflicts.
To resolve conflicts arising from cultural differences, you need to:
 identify the similarity and differences between your cultural practice and those of the person
 in conflict with you acknowledge the differences and attempt to balance the interests of both parties
Build on common ground
Instead of focusing on the differences, you could look for common ground between you and the other party, and build on it.
Break down power structure
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The imbalance of power between community service and disability service workers and clients or between co-workers can be an obstacle for conflict resolution.
 Clients may feel powerless: Such feelings may act as a force of resistance in the conflict resolution process. One way to break the power structure is to respect clients as experts in their own conditions.
 Power differences also exist between workers, due to seniority: The focus should be directed to the cause of conflict instead of seniority of the position.
Use of mediation
Mediation means to have a middle person acting in the role as a go-between or facilitator. The role of mediator is to provide both parties with opportunities to put forward their views and assist in analysing the problem and looking for solutions.
Mediation with clients or their family
If you have conflict with a client or a client’s family members, you could approach your team leader to act as a mediator or you may seek external mediators from multicultural organisations (with the client’s or their family member’s consent).
Mediation with co-workers
When you have conflict with co-workers, you could use the conflict resolution process or the grievance procedure used in your workplace.
Both of these processes would involve a mediator. The mediator could be:
 a senior from your discipline area, if you and the co-worker are from the same discipline
 a team leader or other senior staff member
 an independent person from human resources management
ACTIVITY: This activity will be discussed in a group situation.
Consider a situation in which a person was verbally or physically aggressive towards you in a work context. If you cannot describe an incident that happened to you in a work context, you can choose to describe an incident you witnessed happening to a co-worker, or from your personal life.
Do not use names or any other identifying details.
1.
Describe the situation briefly.
2.
How did you feel at the time?
3.
Describe your response to the aggression - how you may have looked, the way you stood, your tone of voice, etc.
4.
Which of the behaviours below describes your response? (Place a tick under the response)
Avoiding Smoothing Compromising Forcing Problem-solving
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Negotiation – the art of reaching a mutually satisfying agreement!
As we discussed earlier, the impact of life experiences, personalities and life in general, will lead to differing opinions. We are all unique individuals and while this adds richly to our culture and world, this uniqueness can also lead to outright disagreements! The Disability Care environment which advocates greater choice and control for our clients with disability is a great way forward. However, we are more likely to see support workers engaging in conversations requiring effective negotiation skills as we try to balance the areas of choice, control and risk.
We often find in 99% of cases, we do not need to say ‘no’, but rather present an opinion in a more positive way.
A strategy for successful negotiations
 Listen carefully to the requests or arguments of the other person and assess the logic of their
 reasoning.
Clarify issues you are not clear about by asking how, why, where, when and what questions.










List all the issues which are important to both sides and identify the key issues.
Understand any outside forces that may be affecting the problem.
Keep calm and use assertive rather than aggressive behaviour. Use tact and diplomacy to diffuse tensions.
Use both verbal and non-verbal persuasion skills. Use open, encouraging body language such as mirroring, not defensive or closed.
Know when to compromise. Offer concessions where necessary, but minor ones at first.
Distinguish between needs: important points on which you can't compromise and interests where you can concede ground.
Allow the other party to save face if necessary via small concessions.
Make sure there is an agreed deadline for resolution of the negotiations
Decide on a course of action and come to an agreement.
The final agreement needs to be summarised and written down at the conclusion of the negotiations.
Plan for alternative outcomes if you can't reach agreement.
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CONFIDENTIALITY
‘ Support workers should never discuss other clients as it creates insecurity and distrust. When
I hear what they say to me, I wonder what they are saying about me to others.
’
All clients have a right to expect that information they give will be kept confidential. This is part of your commitment to working legally and ethically.
You probably have heard some good stories from other workers about their clients. It might be something funny or something that was really silly - however you all have a good laugh! Just think about it. How would you like your service provider talking about you to their colleagues? There may be some facts that are distorted that make an innocent situation seem quite different. It is not a pleasant thought is it?
Confidentiality is the protection of personal information. Confidentiality means keeping a client’s information between you and the client, and not telling others including co-workers, friends, family, etc.
Examples of maintaining confidentiality include:
 individual files are locked and secured
 support workers do not tell other people what is in a client’s file unless they have


 permission from the client information about clients is not told to people who do not need to know clients’ medical details are not discussed without their consent adult clients have the right to keep any information about themselves confidential, which includes that information being kept from family and friends
The types of information that is considered confidential can include:
 name, date of birth, age, sex and address
 current contact details of family, guardian etc.
 bank details
 medical history or records
 personal care issues
 service records and file progress notes
 individual personal plans
 assessments or reports
 guardianship orders
 incoming or outgoing personal correspondence
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Other information relating to ethnic or racial origin, political opinions, religious or philosophical beliefs, health or sexual lifestyle should also be considered confidential. Adult clients have the right to determine what information they consider personal and confidential.
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There is, however, no such thing as absolute confidentiality in the community services industry.
Workers are required to keep notes on all interactions with clients and often to keep statistics about who is seen and what issues are addressed. As a worker, there will be times when you could be faced with some personal difficulties regarding confidentiality. You need to give your client an assurance that what is said will be in confidence (that it will stay secret between you and the client) because, unless you are able to do that, the client is unlikely to be open with you.
However, you also need to be aware of the limits to the confidentiality that you are offering. There are several instances where total confidentiality is either impossible, undesirable or illegal. These include:
 cases where the law requires disclosure of information which will be o if the health and/or welfare of a child or young person is at risk. You are required to contact Department of Community Services and notify them of your concerns o if your client tells you he/she has committed a serious crime. You are required




 to notify your supervisor or the police directly o if a worker is subpoenaed to present information in a court of law when the client needs to be protected from harming themself (e.g. if suicidal) where others may need to be protected (if the client has threatened to harm others or will do so inadvertently) the need to keep records when working in conjunction with other professionals in caring for a client the requirements of professional supervision, training, workshops or seminars
It is always good practice to tell clients at the beginning of your contact with them that whatever they tell you is confidential except in the above circumstances. When writing up case notes you need to be careful about what you include and how you write this information up. Always remember that clients have the right to see files and read anything that has been written about them.
When working with other professionals it is good practice to obtain the written consent of the client before exchanging information.
If you are going to be discussing a client and their situation in supervision, in a training session or at a workshop, you can always change the name and any information that may identify the client. Other workers in these situations are also bound by the same ethical and legal requirements relating to confidentiality that you are.
Confidentiality also extends to things like:
 names and addresses of clients
 phone numbers and addresses of staff and volunteers
 names and personal details of people who donate money or time
 details of funding agreements
 information about strategic planning
Importance of confidentiality
Confidentiality is important for several reasons. One of the most important elements of confidentiality is that it helps to build and develop trust. It potentially allows for the free flow of information between the client and worker and acknowledges that a client’s personal life and all the issues and problems that they have belong to them.
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One of the major purposes for obtaining a client’s consent before speaking to a third party (such as another agency or a family member/carer) is to protect the confidentiality and privacy of the client.
Informed consent (obtaining personal information with the formal permission of the client or a person who has the legal authority to provide permission on behalf of the client) is considered essential in maintaining the privacy of the client.
It is important to keep your clients’ business as just that; ‘ their business’. You should only discuss matters relating to your clients’ business with co-workers, and then only what needs to be discussed.
Discussions should take place in the workplace and not be audible to other members of staff or the general public. You should never discuss clients’ business with family or friends.
Respect for client confidentiality and staff personal information should be a high priority for all community services to comply with legislation that governs disclosure of information. In this regard all organisations have policies and procedures that provide guidelines for workers. Appropriate worker behaviour can also be incorporated in a code of conduct.
To ensure confidentiality, workers should only access confidential information for work that is covered by their job description and the policies and procedures of the organisation. They should only disclose information to other parties where a client (or co-worker in relation to their personal information) has consented to the release of the information or where disclosure is required or mandated by legislation due to indications of risk of harm. Further workers need to ensure that any information that is collected is securely stored and disposed of.
Confidentiality agreement
All health services and or facilities take a very serious view of failure to observe confidentiality as it constitutes a breach of the client’s privacy. This places both the service/facility and the individual concerned at risk of legal action and its consequences and may constitute grounds for dismissal.
When you begin working in an organisation regardless of whether it is residential or community based, you may be required to sign a confidentiality agreement. This statement means that it is absolutely essential to treat any personal details of medical, social or family history of a patient and any other information pertaining to the aged care facility and its operation as strictly confidential.
Legislation governing confidentiality
All workers need to be aware that there are State and Federal laws that cover confidentiality. The following Acts relate to privacy and confidentiality of clients:
Health Administration Act 1982
This Act covers any information that is provided or recorded within the health system. Basically, information cannot be disclosed, without the consent of the person to whom the information relates or for the purpose of legal proceedings, such as a court order or subpoena that allows access to health information on a client.
The Public Health Act 1999
This Act also relates to disclosure of information without consent. The most important confidentiality provision of this Act is the part that deals specifically with HIV/AIDS related information. Under this
Act, this means two things:
 the fact that a person has had or is going to have an antibody test
 the fact that the person is HIV positive.
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The Public Health Act allows for the disclosure of information relating to a person’s HIV status where the failure to provide the information could place the health of the public at risk. This disclosure provision is limited and allows notification to the Director-General of the Health Department. It does not authorise disclosure to any other person.
Health Records and Information Privacy Act 2002
This Act is designed to protect the privacy of an individual’s health information, enable individuals to gain access to their health information and provide an accessible framework for resolution of complaints regarding the handling of health information.
Privacy and Personal Information Protection Act 1998 (NSW)
This Act consists of internationally accepted privacy principles dealing separately with collection, storage, use and disclosure of personal information.
One of the key principles relates to accessibility of information, stipulating that agencies must allow access to a client’s personal information without reasonable delay and expense, when it is requested.
Personal information includes information kept on the records of the clients, personal details shared with you by the client and/or others, or medical information if the client has been referred to your service by a doctor. There are numerous sources of possible private information including written communication coming from other agencies.
Crimes Act 1900 (NSW)
There is an obligation for people who have information about serious criminal offences to notify the police. A serious criminal offence is an offence that attracts a penalty of five years imprisonment or more. Support workers should be aware that this covers offences such as drug trafficking, serious assaults, sexual assaults, murder and manslaughter. It does not include minor possession offences or any offences under public health legislation.
Exceptions to the general rule of confidentiality
There are few exceptions to the general rule of confidentiality, and they all have legal bases. These include:



 if the client tells you they have committed a serious crime if the client is a child and is being abused or is at risk of abuse if you are concerned that the client might harm themself or someone else if a child is under the age of 16 years, and especially under the age of 14, parents
 legally have the right to know what happens in counselling. making records available to the police if they have a warrant to inspect documents
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

 making information available in the case of suspected or confirmed physical or sexual abuse responding to a summons or subpoena responding to a request under freedom of information legislation
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In the case where legal obligations override a client’s right to keep information private and confidential, a community service organisation has the responsibility to inform the client and explain in a way that they can understand, the limits of confidentiality. Information may also be sought through a subpoena for court proceedings.
Breaches of confidentiality
All community service organisations have a responsibility to keep client or service-user information private and confidential. In some circumstances, clients can take legal action against a worker or an organisation under the law of negligence. We owe a duty of care to our clients to prevent any risk of harm.
If a worker breaks client confidentiality they are seen to have breached (If something is breached it has been violated or broken) the policies of the organisation and, as a result, he or she may be dismissed from their position—that is, sacked! This may also open the worker to legal action from a client.
If you, as a worker, notice that another worker seems to be breaching client confidentiality you should:
1.
See if they have the client’s permission to share the information (you can either ask the worker or check in the client’s file).
2.
Check to see what the service providers policy is regarding breaches of confidentiality and follow the procedures outlined.
3.
If there isn’t a policy, and if you feel comfortable enough, approach the worker and express your concern.
4.
Talk with your supervisor and tell them what you have observed or overheard and express your concerns.
5.
Ask that all staff receive training in confidentiality, why it is important and how to maintain it.
Confidentiality and duty of care
Confidentiality applies to all information that a client or colleague tells you verbally or gives you in writing. It also applies to things that you learn through observation. All information in a person’s health care record is confidential and may not be disclosed without permission from the client or their guardian.
Confidentiality is a critical aspect of your duty of care.
Remember that all clients have the same rights as everyone else in the community, regardless of whether they have a drug and alcohol problem, a mental illness, or a physical or intellectual disability. Their confidentiality must be respected. This includes difficult clients and clients with dementia. Unless you believe a client is at risk of serious harm, don’t share the client’s personal information with others. Respect their right to privacy. Only the client has the right to decide who to share their personal information with.
Every service organisation should have a confidentiality policy. This policy will usually include an agreement, signed by workers and volunteers to uphold client confidentiality, and an authority, signed by the client, allowing you to discuss their personal information with specified others, but only in order to provide an effective service.
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Community Services need to have a range of policies and procedure in place to ensure that workers comply with legislation and maintain a duty of care to not place clients at risk of harm. These may include:


Recruitment policies that include police checks
Induction training of new workers and ongoing training of existing workers that

 includes policies and procedures on confidentiality, privacy and record keep
Policies on secure access of stored information, record collection and disposal
Policies on how to deal with breaches
Confidentiality and privacy
What is the difference between confidentiality and privacy? Privacy is more often taken to mean
‘the right to be left alone’. The term privacy usually attaches to individuals. Confidentiality is a much broader concept. Information may be confidential that is not personal.
Legally, organisations do not have privacy rights — individuals do. In community services personal information may become subject to confidentiality procedures and policies but that will not affect the rights of the individual who is the owner of that information. Information about an individual may be given to others for legitimate purposes under ethical standards of confidentiality. Privacy is an obligation to the individual who is the owner of the information and applies regardless of who is providing the information.
Privacy principles
The NSW Privacy Committee Data Protection Principles outline the privacy principles that all NSW community services organisations must follow. These guidelines are to protect client rights and ensure that only essential information about the client is collected.
1.
Collect information directly from the client, except if: a.
the client agrees otherwise b.
the other information source also follows these principles.
2.
Make sure the client knows whether it is compulsory or optional to give the information.
3.
Make sure the client knows the purpose for collecting the information.
4.
Make sure the client knows who you usually pass information on to (and who they usually pass it on to).
5.
Make sure the client can look at and correct their information (unless the law stops this), and the client knows this right.
6.
Make sure the information is actually needed for your purpose.
7.
Limit your use of the information to: a.
the purpose you collected it for b.
other purposes with the client’s consent c.
preventing harm to the client or someone else
8.
Make sure the information is accurate, up-to-date and complete.
9.
Make sure the information is protected from unauthorised access.
10.
Make sure the information is kept for no longer than necessary for the purpose it was collected for.
11.
Make sure that the information is only used or disclosed with the freely given, clear written consent of the client if the information concerns their: a.
ethnic or racial origin b.
political opinions
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c.
religious or philosophical beliefs d.
trade union membership e.
health and sexual life
Confidentiality and security
There is no such thing as absolute confidentiality in our industry—especially when it comes to recording information about client contact or observations about clients. We are required to keep notes of our interactions with clients and often to keep statistics about who we see and what issues are addressed.
There may be people authorised in your organisation, or working in other services that are authorised to see information about clients. As well, it is every client’s right to see the information recorded about them if they wish to do so. It is not, however, any client’s right to see information recorded about another person.
Confidentiality also extends to things like names and addresses of clients, consumers or residents, telephone numbers and addresses of staff and volunteers, names and personal details of people who donate money or time, details of funding agreements, and information about the organisation’s strategic planning. Therefore, workers must not disclose any information about other workers or people involved in the agency to anyone.
It follows that it is essential that all information and documents that are confidential are kept secure.
Upholding confidentiality and security involves keeping information and documents in a place that can’t be easily accessed by non-authorised people.
Storage of records
All community service organisations need to ensure that all records are correctly stored in line with legal requirements. Record storage must be secured in a place where there is no possibility that they could be damaged. The storage system must be easily accessed by authorised workers.
Secure spaces are:
 rooms that are locked
 filing cabinets that are locked
 drawers that are locked
 passwords on computers
Store case notes, case management plans and files in filing cabinets and remember to lock filing cabinets when leaving the office. Ways of maintaining confidentiality are to:
 talk about clients in a private and soundproof place
 not use client’s names
 only talk about clients to relevant people
 keep communication books in a drawer or on a desk away from visitors to the agency
 keep staff files in a locked cabinet in the manager’s or coordinator’s office
 use case numbers when recording information about clients on a database
 remove identifying information when discussing cases for teaching purposes
Destruction of records
Most records are kept for as long as they are in use by the organisation or for the length of time that the client receives a service. In some cases legislation requires the archiving of client files for 7 years
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and each organisation needs to be familiar with the legislation as it applies to their service and client group. Any confidential information must be shredded before it is sent for recycling.
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ACTIVITY – True or False
Statement
Confidentiality means not leaving your observation notes lying around
If the police ask you, you must show them any records you have?
You can store records in the drawer of your desk if the room is locked at night.
Without privacy life could be hell
Family members have an automatic right to see the client’s records.
Privacy is different to confidentiality
In some cases legislation requires the archiving of client files for 7 years
Confidentiality is a critical aspect of your duty of care.
Respect for client confidentiality and staff personal information should be a low priority
I discussed one of my clients condition with my husband last night, I didn’t mention their name so that is not a breach of confidentiality?
Privacy can simply be defined as the right to be left alone.
The wrongful intrusion by individuals or the government into private affairs with which the public has no concern could be classed as a breach of privacy.
Under the privacy Acts, it is illegal for any of the information on record to be disclosed even through an overheard conversation.
You are concerned that one of the newer members of your workgroup who is a personal friend is openly discussing the mental health records of the clients in a residential facility. This is a breach of confidentiality.
Privacy laws ensure that: personal information about clients is collected and used responsibly with their consent (or by their guardian, if required).
As a disability worker, you need to be aware that you have confidential information about people in terms of their disability, health, injury or agerelated condition, and that this is privileged information and you can discuss this with other workers only.
Commonwealth and state laws on freedom of information enable people to gain access to documents, including their own personal and health records.
TRUE
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FALSE

Duty of Care and Ethical Conduct
We have a duty of care to our clients, and this duty is bound in legislation.
Ethical conduct is closely associated with ‘duty of care’ and we want to do the right thing by our clients and minimise any harms associated with ‘doing’ or ‘not doing’ an act. The study of ethics was developed many years ago and attempts were made to determine what is morally ‘right’ and ‘wrong’ and this was translated into some rules to guide citizens behaviours in their communities. From the perspective of a disability support worker, working ethically is based on a clarification of what is good and bad practice. The aim is not to restrict you in what you want to do, but to protect both you and
the client from harms that may result from your actions or inactions. Your organisation will have a
‘code of ethics’ that recognises and makes explicit the moral responsibility and accountability of support workers.
In terms of duty of care, it is based on both the following:
 the principle of doing good for clients by improving the quality of their lives and helping in their self-determination
 avoiding bad practice, which may lead to harm and injury to a client and may further lead to a tort of negligence
The principle of duty of care will sometimes lead to an organisation adopting a code of ethics as a guide to the professional behaviour it requires of its employees. The code of ethics, comprising the standards of personal and professional behaviour, is reflected by the mission statement, which sets out the aspirations of the organisation in terms of meeting the needs of clients.
Organisations involved in devising a code of ethics include:
 professional bodies
 residential accommodation facilities-e.g. group home and independent living accommodation venues
 educational and training organisations - e.g. TAFE and community education centres
 foundations, charitable and religious organisations involved in disability services e.g.
Anglicare, Salvation Army
An examination of codes of ethical practice in all these organisations is useful in deciding what would be included as ethical practice for your role as a disability worker. The following aspects of working ethically should be included in forming ethical principles and practices:
 protecting the rights of the client
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 using effective problem-solving techniques with competing value systems
 delivering service to clients regardless of personal values, beliefs and attitudes
 recognising and responding to potential ethical issues and dilemmas
 working within boundaries applicable to your work role
 demonstrating effective application of guidelines and legal application of disclosure and confidentiality
 demonstrating awareness of your own personal values and attitudes
 recognising, avoiding and/or addressing any conflict of interest
 recognising and responding to the rights and interests of clients
 recognising witnessed signs of financial, physical, emotional or sexual abuse and neglect of the client
 recognising and responding to cultural/linguistic and religious diversity .
Source: The Disability Support worker. G Arnott.
The law, ethics and morals are most important in your role. Ethics is concerned with human character and conduct. It provides a system for morals and rules of behaviour. Ethics identifies areas of desired behaviour—that is, the actions we wish people to take, not the actions that are governed by law.
An ethical dilemma is a choice that must be made to reach a solution to a difficult problem where there is no clear ‘right’ or ‘best’ answer. Ethical dilemmas that could arise in your workplace could include issues such as mental competency, confidentiality, the right to refuse healthcare, risk and death.
One of the most basic rules of healthcare ethics is that life is precious. It is not always easy to keep this in mind, especially when a client is dying and or in pain. Adherence to the ethical code ensures privacy, confidentiality and a respect for personal and religious beliefs.
Review the latest nursing code of ethics at www.anmc.org.au
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ACTIVITY – Place a tick in the correct box, either yes or no.
Is this action ethical?
You call in sick to your supervisor because it’s a beautiful day and you decide to go to the beach, or shopping, or…
You work in a restaurant in which wait staff tips are shared equally and you withhold a portion of your tips from the common pot before the tips are divided.
You take office supplies from work to use at home because you justify, you often engage in company work at home, or you worked extra hours this week, and so on
Being honest with yourself and others about what you can do.
YES
Show up on time or early, don't exceed break times, help others when you can, don't take credit for other people's work, give credit to others when you can.
You claim credit for the work of another employee, or you fail to give public credit to a co-worker’s contribution, when you share results, make a presentation, turn in a report or in any other way appear to be the sole owner of a work product or results.
Always have the best interests of the client in mind.
You overhear a piece of juicy gossip about another employee and then repeat it to other co-workers. Whether the gossip is true or false is not the issue.
Be loyal to your company, your boss and your coworkers, be cheerful, don't cheat or steal, don't lie; leave your personal life at home.
Some staff members treat women staff as sex objects and making inappropriate remarks to them or touching them in a sexual manner.
Always be professional and dress accordingly
As a support worker, you are expected to work to a certain standard. You need to be able to do your job properly, behave properly, and do the right thing at all times.
Many times people refuse to work well with others who are of a different ethnic background or different sex.
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NO


FURTHER INFORMATION CAN BE FOUND AT:
Vision Australia http://www.visionaustralia.org/
The Royal Society for the Blind South Australia http://rsb.org.au/
Queensland Blind Association Inc. http://www.qba.asn.au/
Royal Blind Society of NSW http://www.rsb.org.au/
DeafBlind Association NSW. http://www.dbansw.org.au/
Canberra Blind Society Inc. http://users.tpg.com.au/canblind/
Australian DeafBlind Council http://deafblind.org.au/
Association of Blind Citizens of NSW Inc. http://www.asnblind-nsw.org.au/
Blind Welfare Association of South Australia. http://blindwelfare.org.au/
Blind Citizens Australia http://www.bca.org.au/
Royal Institute for Deaf and Blind Children http://www.ridbc.org.au/
Association for the Blind WA. http://www.health.wa.gov.au/services
Royal Victorian Institute for the Blind http://www.vic.australis.com.au/pottaroo/blind.htm
NSW legislation is available at: http://www.legislation.nsw.gov.au/
Commonwealth legislation is available at: http://www.comlaw.gov.au/
Lawlink NSW: http://www.lawlink.nsw.gov.au/lawlink/privacynsw
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Disability Care will give people with disability a right to realise their potential, and to make choices and be in control of the decisions that affect their lives. It will enable them to:

Have more choice and control over the type of support they receive

Have the right information and support to make decisions and take control

Have opportunities to be more independent and get the right type of supports that allow them to reach their full potential

Be helped to stay connected to their communities of support, their families, carers and friendship groups
Key words and concepts in this disability care environment are choice, control and independence.
This means also dealing with risk and client choice and understanding the concept ‘Dignity of Risk’.
IN THIS SECTION WE WILL LOOK AT:

Why have a new disability care environment?

Choice: What does this mean?

Client-directed care: How does this work in the disability care environment
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Funding arrangements
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Communication with clients and service providers in the CDC environment
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Comprehensive, holistic assessments in the CDC environment
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Collaboration with other stakeholders
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Client decision-making in the CDC environment
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The support worker as advocate for client choice and client-directed care
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Challenges to client-directed care
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Dignity of risk
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Defining boundaries
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Duty of care
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Advocacy
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Indicators of abuse or risk of harm
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Workplace health and safety
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Why have a new Disability Care environment?
The disability system, prior to the establishment of the Disability Care scheme was reported by the
Productivity Commission to be underfunded, unfair, fragmented and inefficient. They recommended the establishment of a National Disability Insurance Scheme (NDIS) or Disability Care as we now call it. The Disability Care environment aims to achieve the following outcomes for eligible people with disability:
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People with disability will be supported to participate in and contribute to social and economic life to the extent of their abilities.
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People with disability and their carers will have certainty that people with disability will receive the individualised care and support they need over their lifetime.
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People with disability will be able to exercise more choice and control in their lives, through a person-centred, self-directed approach to service delivery with individualised funding.
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People with disability, their families and carers, service providers, the public and governments will have greater transparency and certainty of funding for disability care and support.
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Disability care and support will be more accessible, meet nationally consistent standards, sustainably resourced and will contribute to government’s commitments to closing the gap on Indigenous disadvantage.
This will enable those with disabilities and their families to plan better for their futures and realise their potential through greater choice and empowerment.
With the right type of support, people with disability are able to lead full and independent lives – go to school, gain employment, participate fully in their communities, and live with friends, families or in their own homes. This means that people with disability will have more opportunities to live the way they want to and in the most independent way possible.
There are many terms used to describe the way that we want disability service and support systems to operate so that a person living with disability has greater control, such as 'individualised funding',
'self-managed care', 'direct payments' and 'individualised budgets'. The key theme, or concept is the same – that the person living with disability is supported to be in control of their support services and funding.
Choice: What does this mean?
We often forget how important it is to have choice in our lives. There is something powerful in the experience of choosing and taking responsibility for our own life. It gives us direction over the way in
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which we live and the way in which we interact with others. It gives us a sense of control and ensures that we have a personal sanctuary.
Choice consists of the deciding or selecting between options. This generally empowers individuals to make their own decisions. Most people regard having choices as a good thing, though a severely limited or artificially restricted choice can lead to discomfort with choosing and possibly, an unsatisfactory outcome. In contrast, a choice with excessively numerous options may lead to confusion, regret of the alternatives not taken, and indifference in an unstructured existence.
However, choice should be informed choice. In other words, the person choosing should have information about the different possible choices, so they can base their decision on facts. Also, sometimes having a variety of options can seem overwhelming and people will often go with what they know, rather than something new and different, unless they understand this new and different option.
We want to support the client making their own choice, but ensure they have adequate information on which to base their choice.
ACTIVITY
You are a support worker working with Kevin who has an acquired brain injury. Kevin has difficulty making decisions or initiating activities. You have three hours each week for an activity for Kevin. You are aware he enjoys being outdoors and science fiction. Give three examples of outdoor activities and two examples of science fiction activities.
Client-directed care: How does this work in the Disability Care environment?
Client-directed care allows people to have greater control over their own lives by allowing them, to the extent that they are capable and wish so to do, to make choices about the types of care services they access and the delivery of those services, including who will deliver the services and when.
Evaluations of existing consumer directed care programs show this approach can lead to better outcomes for care recipients in respect to their quality of life, independence and satisfaction with
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care. Client-directed care allows community care clients to actively choose the types of services they receive, and direct how, when and by whom they are delivered.
People of all ages with disabilities and their carers, including dementia families, generally benefit from participation in client-directed care. International studies of these programs across a number of different countries with varying cultural traditions and programs show that:
• Program participants of all ages and their family carers have better outcomes related to quality of life, independence, and satisfaction with care than those who rely on home care agencies.
• Quality of care is at least as good in client-directed care programs as it is in traditional programs.
• There is no systematic evidence of abuse or neglect of participants in client-directed care programs.
Client-directed client also can enhance the quality of life for participants and their family carers, who feel that they have more control over how things are done. These benefits are accompanied by increased responsibilities, which may include choosing services and managing, training, and paying workers, and assuring the quality of services received.
Case Study
The example of Mrs. Bennett, a 58-year-old widow who lives with her daughter illustrates how CDC can be helpful to dementia families. Mrs. Bennett has early onset dementia, high blood pressure, and needs help with three daily activities and walking. Mary, her daughter, is Mrs. Bennett’s representative. Previously, Mrs. Bennett received care from Mary and a home care agency. The agency’s hours were such that workers came at 8:00 am, even though Mrs. Bennett does not get out of bed until 10:00 am and workers often changed daily and sometimes did not even show up for work. With client-directed care, Mary was able to hire one worker – Sylvia—who receives higher
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hourly pay and a more convenient schedule than she had while working in an agency. Since Sylvia is reliable and her schedule convenient Mary has been able to resume her in-home accounting business. The relationship between Mrs. Bennett and Sylvia is a good one and Mrs. Bennett’s family appreciates Sylvia’s good work.
Client-directed care means the interventions, training, and skills by which clients with a chronic condition, disability, or disease can effectively take care of themselves and or learn how to do so.
Client-directed care helps people with physical disabilities to increase control over their lives by helping them develop their own care plans and directly arrange and administer their own support service needs. Funds will be provided to eligible individuals so that they may directly employ care providers for the purpose of meeting their approved service needs.
The self- manager (client) assumes full responsibility for the coordination and management of the funded services. Self-directed funding is also known by a range of terms, including 'individualised funding', 'self-managed care', 'direct payments' and 'individualised budgets'. The key theme, or concept is the same – that the person living with disability is supported to be in control of their own funding and the support it can create.
The term ‘client-directed services’ describes a broad approach to developing supports based on people having control over the planning and delivery of services. This contrasts with the traditional service delivery model which fits people into the services on offer.
Self-direction is about people being at the centre of determining what they need and how services should work for them. It re-casts service users from passive consumers or clients into active directors of their support arrangements.
Principles of Client-directed Care
• Collaborative and active partnership between client and service provider
• Shared responsibility for outcomes
• Empowerment and enhanced capacity as goals of care
• Care is lifelong
Let’s take a look at the difference between the traditional care format and self-directed support.
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Service provider is expert and the client basically has little say.
Expertise is shared between client (expert on their life) and provider (expert on needs and care).
Care is disease and/or service centered and often standardised or generic.
Care is planned around the client’s individualised circumstances, needs and preference.
A single service provider is the principle caregiver and therefore responsible for outcomes.
Responsibility for outcomes is shared between the client and often multiple service providers.
The goal is compliance with funded packages and the implementation of care along with the provision of information and advice.
The goal is to empower the client and enhance their capacity to engage in activities that will improve their health and care.
Immediate needs are addressed and care is a one-time assessed activity.
Long-term change and impacts are addressed and care is a continual and self-corrective process.
There is no one size that fits all. Services need to be shaped to respond to each person and community’s needs and aspirations.
Achieving client-directed care
As a concept, a self-managed approach places the individual at the centre of decision making and treats family members as partners. The process focuses on discovering the person’s skills and capacities, and identifying the priorities of the person in terms of their hopes, goals and lifestyle choices. The individual and their family are then able to design the supports that will meet their own needs and goals, rather than being limited to choosing only from a predetermined list of service options.
What does it mean in practice?
A client-directed approach aims to give people with disability and their family (or support network):
 control over the what, when, where and by whom of support
 assistance to plan, implement and change the nature of supports provided by another person. The person providing the support remains accountable to the person with disability
 the option to delegate financial, legal and administrative responsibilities to an intermediary service
 the ability to build their knowledge and skills to direct their own support
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Why is client choice and client-directed care important?
Research has found that people who manage their own supports are more satisfied with their outcomes. They feel more in control of their lives and able to change their supports when they want.
According to one recent study: ‘All respondents said that individual funding had improved their control, choice, independence and self-determination in their lives’.
The main benefit is that by focusing on the person with disability, a self-directed approach can deliver more flexible and appropriately targeted supports that make a difference in the lives of people with disability and their families. At the same time, it can lead to better utilisation and effectiveness of limited resources.
Funding arrangements
Who will make the decisions about a person’s funding?
The freedom to make decisions about things which affect our lives is a right that everyone should enjoy.
The person requiring the support will make the decisions about how they will use their self-managed funding to meet their support needs and goals. For some participants a guardian or carer may do this on their behalf. Some people may want or need some support to make decisions and plan their support arrangements.
A range of people will be able to help with decision making and planning, including:
• Parents and other family members
• Carers
• Friends and Circles of support
• Guardians
• Service providers
Facilitators will work with participants and their support network to develop a personal plan which details how the funding will be used.
How will the funding be administered?
Some people will want to manage their self-managed funding independently. Some people may need support to put in place their personal plan and manage their support and funding arrangements. For this reason different mechanisms for administering a person’s self-managed funding will be made available.
These include direct payments to:
• A person with a disability to enable them to arrange and purchase the services they require.
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• A recognised carer or a legally nominated or recognised guardian, administrator or attorney of a person with a disability. This person will act on behalf of a person with a disability with respect to arranging and purchasing services.
• An organisation which will support a person with a disability to manage the financial arrangements associated with self-managed funding.
• An organisation which will support the person to put in place their personal plan. This includes arranging services and managing the funds.
What can be purchased with self-managed funding?
Self-managed funding is provided to meet the disability support needs of a person with a disability.
Funds may be used to purchase services or items that address these needs and assist with a person’s goals, such as living independently, improving skills or participating in the community. The person will be encouraged to use their funding in innovative ways to meet their unique needs and goals.
The funding cannot be used for anything that is against the law or for gambling.
We have looked at details of self-managed support, now let’s take a look at the planning and decision making process.
How do we achieve this?
• communicate and engage effectively with clients and service providers
• conduct comprehensive, holistic assessments
• plan and provide care collaboratively
• support and empower clients
• deliver care using a variety of approaches
• possess care knowledge
• use decision supports, information and communication management systems effectively
• identify and respond to clinical risks
• engage in continuous quality improvement activities
Communicate and engage effectively with clients and service providers
Whether the clients with disability are doing the planning by themselves, with the help of supporters or with a facilitator, there are a number of things to think about. These begin with:
• What are the goals?
• How can the goals be achieved?
If the client is using a facilitator or disability service provider to help with planning, they will be able to help the client work out what their current goals are and tell them about the services in the area which will help them meet those goals. The Local Area Coordinator or chosen facilitator may also advise the client to talk to their family or friends and work out who will do what.
The following are a few key issues that the Local Area Coordinator or disability service provider may say to the client with disability and/or advocate in regards to comprehensive, holistic assessments.
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Conduct Comprehensive, Holistic Assessments
What supports did you need?
• Do you still need the same supports?
• Has something changed in your life that means you might need different supports?
What services do you need?
• Do you know what is available or suitable for your needs?
• Do you have some ideas, but want to talk them over with the facilitator or disability service provider?
• Are there people in your life that could provide some support without charge?
Collaborating: Clients & service providers.......... to define problems, set goals, actions, support and empower clients
Who will provide the services?
• Do you know any service providers that you want to use?
• Are there any service providers that have been recommended to you?
• Are there any service providers you don’t want to use?
What funding administration arrangement will be used?
• What funding administration arrangement best fits the level of control and responsibility you want for your supports?
• What arrangement is the most efficient way of managing the package of supports you have selected?
How will your plan work?
• Who will make contact with the suppliers or service provider(s) to start the service delivery?
• Who will make sure the support happens when and how you want it to?
• Who will follow up if something goes wrong?
• How will payment for services happen?
How will the funding be monitored and accounted for?
• Who is going to receive reports on how much funding has been spent on your behalf or how much is left?
What will happen if you want your plan of supports reviewed?
• Who do you need to ask?
• Who will ask?
Deliver Care Using a Variety of Approaches
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Registered disability service providers
Some organisations that provide disability services are registered by the department under the
Disability Act. To be registered, the service provider has to show the department that they can provide a service for persons with a disability and meet the requirements of the Disability Act.
The Disability Act says that registered service providers have to:
• give people information about their services, including the cost have a complaints process
• meet the Standards for Disability Services in the relevant state
The Disability Act also enables people to make a complaint about a registered disability service provider to the Disability Services Commissioner.
Registered providers may also be required to:
• conduct pre-employment safety screening (police checks and Working with Children checks where appropriate), comply with financial accountability requirements
• have processes in place to meet the obligations of the Workplace Health and Safety Act
2012. Have a WorkCover policy
• comply with the departmental incident reporting procedures
• have appropriate insurance
Providers of personal support – not registered
There are providers of personal support that are not registered under the Act. You can choose one of these organisations but you need to know that:
• they do not need to comply with the Disability Act, such as meeting the disability standards
• you cannot make a complaint to the Disability Services Commissioner about their services
• they are not monitored by the department
Providers of generic community services
Generic community services may be the most appropriate provider of the supports you need.
Generic community services include supports that many community members use, such as dental services, therapy and recreation. These services are not covered by the Disability Act.
You may want to visit some disability service providers and talk about what they do and how much they will charge, and then make a choice.
Further information on service providers can be found on the following web sites: http://www.adhc.nsw.gov.au
http://www.disability.vic.gov.au
http://www.disability.wa.gov.au
http://sa.gov.au
http://www.qld.gov.au
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Client decision-making in the client-directed care environment
Decision-making is the act of expressing choice and preference and being able to act upon that choice. For people with a disability this particularly relates to being able to choose the supports they need to enable them to lead a lifestyle of their choice. The types of choices people have are not limitless. A person’s individual circumstances will influence the choices open to them. This includes factors such as the following:
Lifestyle and Recreation: family and friendships, relationships and sexuality, involvement in cultural and religious events, keeping fit, shopping, using the internet, smoking/drinking, going to the pub / club / cinema, holidays and days out
Employment and Education: choosing a field of work, applying for jobs, attending tertiary education, changing jobs/courses
Living Arrangements: who to live with and where, type of accommodation, leaving home, moving home, decorating or making changes
Access to Services: choosing service providers, choosing day services and times to attend, choosing support workers
Healthcare and Medical: routine medical and dental, emergency care, speech therapy, physiotherapy, hospital visits and surgery, right to refuse care
Financial: banking, buying everyday items, paying for expensive items, getting a loan, paying bills
Legal: signing contracts, providing consent, giving power of attorney, getting married/divorced, wills and estate management
People should be provided with the opportunities required to address these factors including information and appropriate supports. Sometimes people may need additional assistance to understand and communicate their choices. This might include information in different formats, communication aids, translators or longer timeframes. The methods that people need to both understand and communicate their decisions do not affect their right to make decisions. People have the right to any information or supports they need to help them make and express their decisions.
‘Authority, control and power: Person centred thinking shifts the power from professionals to the person and their family. No organisation ‘owns’ the person’s life
– the person and their family does.’
NSW Department of Ageing, Disability and Home Care (DADHC)
HOW CAN WE ASSIST?
Service providers can:
 ensure their workers have ready access to the legislation and relevant policy documents
 discuss the legislation and policy at team meetings
 consider including this topic in work plans and performance management programs
 engage staff and service users in discussions around a human rights approach within the organisation
Support workers can:
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 remind people with a disability (and their supporters) that they have a right to make decisions remind co-workers that people with a disability have a right to make decisions help to set up situations where people have real choices
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 help people to get information as required to help them make decisions
 refer a person to experts if they require specific help or assistance
 allow time for people to explore their thoughts and feelings
 understand that it’s difficult to make decisions about some issues, and that it’s normal not to
 have an answer straight away
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 encourage people to make up their own mind about what they think
 take the time to ask people their opinions and not assume what they want
 speak up and take action if required where people are being denied the right to make decisions
 help people to lodge a complaint if they are denied the right to make decisions
 knowledge of the range of services and treatments available
 knowledge of the range of self-management support tools available to clients knowledge of the range of support networks available to clients knowledge of evidence-based guidelines for care
 understand the roles of other members of the health care team
 maintain carer professional development, implement knowledge into practice
Supporters can:
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 remind people that they have a right to make decisions, even if other people say otherwise actively encourage people to decide for themselves as often as possible help to set up situations where people with a disability can make decisions help people to get information that will help them make their decision take the time to ask people their opinion and not assume what they might want provide people with opportunities to discuss choices in an informal way
Source:Department of Human Services Victoria
The support that a person needs to make a decision will vary depending on a wide range of issues.
The need for support may decrease over time as people gain experience and/or confidence. It may increase as the type of decisions become more important.
It’s like a jigsaw puzzle…………………putting all the pieces together.
CHALLENGES TO CLIENT DIRECTED CARE
As with everything new there will be teething problems, barriers and or issues that will need to be addressed. Issues that may arise could be:
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 concern about managing direct payments from service users and support workers
 difficulties getting personal assistant staff
 lack of demand from service users and carers
 inadequate training for front line staff
 measuring and maintaining standards
 ongoing service viability
 complexity of the system
 dealing with crisis or unforeseen situations
 the management of financial risk for service users
 accountability for spending of funds
 having self-directed care does not necessarily mean better supports
 support worker to complete service administration tasks
 need to view client-directed care as means to a better life not the final goal
Some of the most difficult barriers people with disabilities face are the negative attitudes and perceptions of other people. However, the intent of this approach is to develop a viable service that will enable real choice and flexibility and to assist the realisation of peoples’ aspirations. One area which has been highlighted by clients with disabilities and organisations working in this area is getting the balance right between choice, risk and duty of care. We will now explore these areas.
Dignity of Risk
Anyone who leads a life of dignity and meaning takes risks. Each of us, in the pursuit of jobs, our personal and romantic relationships, our leisure activities, and our adventure has stepped into the unknown and risked failure, rejection, and even our physical well-being. Anything any of us have ever accomplished has come from some level of risk-taking. The benefits of succeeding in these situations, or from learning from our mistakes are a crucial element in our development as independent people.
People who work and live with individuals with disabilities, usually with the best of intentions, often try to eliminate all of the risks and prevent any opportunities for failure in these individuals' lives.
What can result is a life where an individual has never been tested, never had the opportunity to grow, and never experienced the satisfaction of achieving something that was not certain to be achieved from the beginning.
Allowing individuals to take risks and step into the unknown is part and parcel with treating them as dignified adults. This is not equivalent to encouraging recklessness; allowing risk does not mean being unsafe or setting people up to fail. Providing them with the opportunity to try new things, test their limits, and discover capabilities they never knew they had will help them to achieve goals that enrich their lives.
Social Care Institute for Excellence
RISK
A dictionary definition is: ‘Risk - the possibility of suffering harm or loss; danger.’ Or to look at it another way – harm is only one possible outcome, which means there may be beneficial outcomes too.
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Risk can be a good thing. Some people worry about taking risks because bad things can happen.
Vulnerable people who need support services are often perceived as being more likely to experience harm or be in a dangerous situation (for themselves, or for others). For example:
 risks associated with impairment or disability such as falls accidents
 risks associated with everyday activities that might be increased by a person’s impairment or disability
 risks of a carer being overwhelmed
 the use of medication
 the misuse of drugs or alcohol
 behaviours resulting in injury, neglect, abuse, and exploitation by self or others
 suicide or self-harm
 aggression and violence
People who care about a vulnerable person want them to be safe. This can sometimes cause families, friends and support staff to be over-protective and form a negative perception about the risks of independence, choice and control.
A Positive Approach to Risks
Most people make choices that involve some level of risk assessment and risk management every day. Choice about whether to take a risk is usually based on our own judgement. Most people learn how to balance those risks, by recognising the dangers that may be involved, and by trying to be prepared for them where we can. There are usually some things that can be done to manage risks.
Most adults:
 anticipate the possible consequence of an action and the likelihood of any harm from it
 identify what they need to do to minimise, avoid or prevent the risk
 balance this against the possible benefits of taking the risk
 make a judgement about whether to accept the risk (with or without minimising it)
Positive risk-taking means:
 making choices about what people would like to do in their lives
 identifying the risks involved
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 developing plans and actions that will both enable the choice and include ways to minimise, avoid or prevent harm (safeguards)
When supporting people with a disability we need to make sure that everyone thinks realistically and positively about how to manage risk when assessing care needs, and to enable positive risk management wherever possible.
What is Risk Management?
Risk management is the way in which adverse effects from risk are managed and potential opportunities are realised. The potential cascade effect of a failure to address a safety issue may affect the level or type of risk experienced in all areas of the organisation. It is essential that all your risk management processes and systems complement one another, fit within your organisation’s culture and work in synergy towards the same goals.
That may involve a combination of preventative, responsive and supportive actions to reduce the potential negative consequences of risk, and to promote the potential benefits of taking appropriate risks. Sometimes these might require temporary or longer term limitations where the risk of harm may have suddenly increased or become so serious that protective safeguards are needed.
Risk management means making sure a duty of care has been considered and applied where risks
(positive and negative) are identified.
What is Reasonable Risk?
Reasonable risk is about the balance between empowering people to make informed choices about services that will meet their specific needs, and ensuring that there are also safeguards to prevent harm, abuse or neglect.
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Some people may not fully understand or be aware of the risks in their lives. People who care about them (carers – and for vulnerable people also paid care workers and other health and social care staff) need to work together to overcome this.
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Some people may make informed but risky choices and they have the right to do that. But this might be an unacceptable risk for others. People who care about them (carers – and for vulnerable people also paid care workers and other health and social care staff) need to work together to ensure the consequences are fully understood and risks are minimized to be reasonable.
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There may be circumstances where the risk of harm is too great. We have a responsibility to ensure that vulnerable people are safeguarded so, after exploring all possible ways of reducing the risk, it may not always be possible to support a choice.
Assessing and managing risks in a proportionate way
Risk is a common issue that arises around decision making for people with a disability. People with a disability should be able to do things that have a level of risk involved. This is sometimes referred to as dignity of risk. It assumes that a person has explored and understands the pros and cons of a decision or experience, including possibility of personal loss or injury, and still wants to go ahead.
It is important to remember that risk can be an experience in itself. Exploring, understanding and finding ways to address risk can be challenging but also highly rewarding.
Approaches to risk should be undertaken positively and in partnership with the person and, where relevant, their supporters. This means working together to understand the nature of potential risks, consider creative measures to minimise any risks and determine the agreed action. Any measures taken should be appropriate to the size of the risk and the activity. Your agency’s risk management framework offers a way to assess risk and develop strategies to reduce the impact of any identified risk.
Workers and supporters need to be thoughtful about their own fears and anxieties and whether
they are in perspective.
DEFINING BOUNDARIES AND ESTABLISHING TRUST AND RESPECT
What is your role?
It is very important that you are clear about your role and the legal basis of your organisation’s involvement with that client when you are working with a client. For example, if you are working with a client and you are concerned about their safety you will need to:
 Identify the person in your office who has the authority to take action. (It could be you or your supervisor.)
 Ensure that the statutory agency is contacted through the correct procedure to provide the necessary information for appropriate action to be taken.
Having a clear understanding of what you can and cannot do enables you to communicate this clearly to your client and significant others. It helps to avoid misunderstandings, breakdowns in communication and unreal expectations being placed on you and the client.
As a support worker, you are likely to be spending a lot of time with your clients so you need to remember that, whilst you are part of the client’s support network, and probably a very important part, you are not there to be their best friend.
To be effective in your work, you need to be clear about your role and boundaries and be able to get this across to the client. The following considerations may be useful.
 Identify the information you need to know.
 Only seek the information you need, not what you would like to know.
 Be clear with them about why you need the information.
 Be clear about the system you are part of. Let the client know what you can and cannot offer.
 Be aware of your own limitations as a person and a worker.
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 Establish ground rules about your working relationship with the client from the outset,
 depending on the culture of your organisation.
Be aware of your own feelings about the client and how those feelings may affect your
 working relationship with them.
Be consistent with ground rules and applying boundaries.
Many people have attempted to clarify this issue of boundaries through the development of guidelines for workers and clients, such as:
 contracts
 codes of ethics
 manuals of practice
Remember that, without information, clients will not know what they need to do or how they can participate in any planning aimed at resolving their issues or at supporting them so they can function effectively independently of service providers.
They depend on you to provide them with this information, to empower them in the process. It is very important that this information is presented to the client in simple, clear language without jargon and in a manner that they feel comfortable with.
DUTY OF CARE
CASE STUDY
You are a support worker working with Mary who has an ABI who loves buying shoes. Unfortunately
Mary spends all her disability pension on shoes and often does not have enough money left for food or to pay the bills. As Mary’s support worker, you are required to assist her to budget weekly to ensure she has enough money for food and to pay her bills.
How might you work with Mary that still allows her choice, dignity of risk and fulfilling your duty of care?
Many workers take on a caring role when supporting someone with a disability. They bring to their work values that have developed in their own culture and family. They are aware of their duty of care that is a significant legal responsibility.
As previously mentioned in section one (1) a duty of care is a duty to take reasonable care of a person. A disability support worker has a duty of care to anyone who is reasonably likely to be affected by their work activities. These are likely to include the person with a disability that they are the support worker for, the families and carers of clients other support workers and the general community when working within a community environment. A duty of care is breached if a person behaves unreasonably, fails to act (which can also be unreasonable in a particular situation). A duty of care can be breached either by action or inaction.
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Source: Department of Families, Housing, Community Services and Indigenous Affairs
What is reasonable care?
Reasonable care is the standard of care that a reasonable service provider would provide in that situation - not perfect, not poor. Reasonable care is care balanced against other, sometimes competing, responsibilities, such as:
 the safety of other people (other clients, workers, yourself etc.)
 privacy and confidentiality
 the needs of clients (e.g. recreation, socialisation, opportunities to develop skills, selfresponsibility and decision-making)
Each situation (and sometimes each client) is different. You must assess the situation and act accordingly. In other words, use your eyes and ears, and your brain!
Whose duty is it?
All people owe a duty of care in some situations. In work situations, it is mainly the responsibility of the employer (the organisation). Employees are generally protected by their employer as long as they follow policies and instructions.
Your duty of care is not an absolute duty to prevent all possible harm. It is a balancing act: weighing up a range of issues before deciding what level of precautions is reasonable in the circumstances
Advocate, Advocacy and Self-advocacy
An advocate is someone who acts on behalf of another person in the best interest of that person.
Advocacy means acting on behalf of another. Self-advocacy means acting on behalf of oneself.
Some key elements are:
 advocacy is on the side of the disadvantaged person/parties
 advocacy focuses on the needs and rights of the person
 advocacy is based on the principles of social justice and equity
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 advocacy is not service provision
 advocacy should be free from conflict of interest
Advocates can be family members, friends, or an independent third party. The important thing to remember is that the advocate must be free from conflict of interest and have the best interests of the person at heart. Advocacy becomes very messy and runs the risk of being ineffective or exploitative if the person doing the advocacy has something to gain or lose from their actions.
Types of Advocacy
 individual advocacy- representing another or speaking on behalf of an individual
 self-advocacy- speaking on your own behalf
 group advocacy- representing a group or speaking on behalf of a group
 citizen advocacy- representing a friend or member of the family without receiving any form of funding (voluntary)
 parent advocacy- seeking on behalf of parents, generally to government bodies, on issues related to the parents’ or primary caregivers children
 family advocacy- representing another member of the family, e.g. child, sibling or parent
 professional advocacy- any advocacy that involves representing another in return for payment
 case advocacy- advocacy related to specific issues. It can involve one individual or several individuals who require advocacy for the same issue or situation
 public interest advocacy- representing the general interests of the public; e.g. in government where they are making decisions that favour the largest section of the population
Support workers as an advocate
Support workers have an important role to play in promoting and facilitating the rights and interests of the people with a disability they support. To support and guide staff in this role, service agencies need to provide clear guidelines to ensure staff:
• understand the responsibilities of their advocacy role
• understand and are alert to potential conflicts of interest
• recognise situations which might require the involvement of independent advocacy
• can identify relevant sources of independent advocacy for people they support
• support the involvement of independent advocates
One of the most important ways support workers perform this empowering role is through the provision of information. The Disability Act 2006 requires that information is provided to people with disabilities in ways that best assist them to understand their rights and responsibilities. Support workers should ensure they are familiar with the different communication requirements and the individual needs of all clients, and provide appropriate forms of ‘enabling’ information.
While this is a role that is typically performed by many support staff, it is also an advocacy support role that in certain situations might give rise to accusations of manipulation, undue influence or conflict of interest. Support workers assisting a person with disability to assert his or her rights or interests should recognise the risk of their own more powerful interests or values being projected.
This is not to say that support workers should not ‘stand beside’ people with a disability, for the reality is that such assistance is often an essential part of their general support role. Rather, it
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highlights the need for support workers to be conscious of the potential for conflict of interest and the need to minimise such risk.
Support workers therefore need to be constantly ‘mindful’ of their own influence and power, and avoid situations in which they might be perceived as having undue influence or a possible conflict of interest. Support workers should also be constantly mindful that the assistance and advice they provide, and the ways in which they provide it, is aimed at supporting the person with disability to develop and assert his or her own views and opinions, freely and independently.
Where there is a potential conflict of interest, disability support workers need to adopt strategies for minimising that risk. For example, by ensuring important issues are canvassed within the individual planning process, by involving others in providing advice or assistance, by seeking guidance from supervisors, family and or independent advocates.
Where a person with disability does not have the capacity to self-advocate, it is generally accepted that parents or family members will provide informal representation on their behalf. The Disability
Act 2006 requires that the role and contribution of family members be invited and respected at all times.
Where a person with disability does not have the capacity to self-advocate, and where informal advocacy support arrangements are considered inadequate to properly represent his or her rights and interests, the engagement or appointment of an independent advocate might be necessary.
Where to find an advocate
Advocates can be located through regional and state advocacy organisations and in some regional areas the local State Disability Office may have contact details of appropriate advocates. Advocates can be voluntary or financed through State and Commonwealth advocacy role.
If you are required to approach an advocate on behalf of a client always ensure you seek permission if appropriate and ensure your clients’ privacy and right to confidentiality.
Indicators of harm, neglect, abuse or risk of harm
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CASE STUDY
‘A disabled woman who could not speak spent almost three days with broken legs before she received appropriate treatment’.
‘In another case, a paraplegic living in disability accommodation almost had to have her leg amputated due to ''poor manual handling practices by staff.’
Source: The Age- October 2012
All support workers are aware that their client group often contains marginalised and disadvantaged adults and children. The duty of care and ethical guidelines that govern most community and disability service positions highlight a responsibility to be vigilant in ensuring this disempowered client group is not abused or treated unfairly by others – whether family, friends, co-workers, or the system.
Seeking help for someone you know that is being abused or neglected is a courageous decision.
Let’s start with some definitions:
Abuse is the ‘violation of an individual’s human or civil rights, through the act or actions of another person or persons ‘ .
Types of abuse include:


 physical abuse - such as punching, hitting, slapping, burning etc. sexual abuse - forcing someone to take part in sexual activity against their will psychological or emotional abuse - threatening, harassing or intimidating a person
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 constraints and restrictive practices - restraining or isolating people other than
 for medical necessity or to prevent immediate self-harm financial abuse - the wrongful use of another person's assets or denying a person the use of their own assets
 legal or civil abuse
 systemic abuse
Neglect is a ‘ failure to provide the necessary care, aid or guidance to dependent adults or children by those responsible for their care.
’
Types of neglect include:
 physical neglect - failure to provide adequate food, shelter, clothing and

 protection. Supervision medical or dental care that places people at undue risk through unsafe environments or practices passive neglect - withholding or failure to provide the necessities of life wilful deprivation - wilfully denying a person assistance and thereby exposing that person to the risk of physical, mental or emotional harm
 emotional neglect - restricting the social, intellectual and emotional growth or wellbeing of a person
Workers need to know what their responsibility is in any identified case of harm or risk of harm. They should clarify their reporting requirements within their organisation. Hence, when a client presents with an issue, you respond to the presenting issue but must always be sensitive to any indicators that abuse or neglect may be occurring in the client’s life. This relates not only to physical harm, but also to emotional, psychological, sexual and financial harm. Of course, a client can also threaten harm to other people; you need to be vigilant in examining your responsibility to assess the risk and take necessary action, in these cases as well.
Some major indicators of risk include:
 physical symptoms such as injuries or loss of weight
 existing self-harming
 impaired cognitive functioning caused by brain injury, such as loss of memory and inability to concentrate
 no parent or carer available to care for a child
 injury requiring hospital attention and investigation
 disclosure of abuse
 significant history of substantiated abuse
 serious past offences by a significant other
 family violence
 parental illness (including mental health issues)
 continued alcohol and other drug abuse by parents/carers http://www.disabilityhotline.net.au/what-is-abuse-and-neglect/
Interventions
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• Determine the level and urgency of safety concerns.
• Identify risk that is life threatening, including risk of homicide.
• Identify risk of suicide or self-harm.
• If the person is at risk of serious harm or death, advise the older person of concerns and contact the police.
• Contact the Elder Abuse Helpline, Disability Hotline and/or relevant agencies such as social workers and mental health services.
• For all other safety concerns, seek consent to refer and discuss a safety plan and referral options with your manager/employer.
Disability Service Standard 12: Protection of human rights and freedom from abuse
The service provider acts to prevent abuse and neglect and to uphold the legal and human rights of service recipients.

KPI 12.1 The service provider takes all practical and appropriate steps to prevent abuse and neglect of its service recipients.

KPI 12.2 The service provider upholds the legal and human rights of its service recipients.
Emergency situations
In case of life threatening situations call 000 for attendance by Ambulance, Fire or Police services.
WORKPLACE HEALTH AND SAFETY
Work health and safety is the responsibility of everyone. Your employer has a duty of care for workplace health and safety to provide a safe working environment for workers and clients. All employers are required to consult with staff on any issues which may affect their health and safety.
Under the Work Health and Safety Bill 2011, each state and territory regulates its own health and safety legislation. There should only be very slight variations to that legislation between the states and territories. All states and territories and the Commonwealth have worked together to develop and implement model Work Health and Safety (WHS) legislation as the most effective way to achieve harmonisation of WHS laws in Australia. By reducing costs and eliminating unnecessary administrative processes, harmonisation is designed to make it easier for workers and for employers who conduct business across multiple states.
Risk Management has become an integral part of Work Health and Safety (WHS) Management. This has been driven by the need to meet legislative requirements and the recognition that risk management is good practice. An effective WHS Management program is an integral part of any successful organisation. It ensures that the health and safety needs of employees are properly addressed and can provide a range of benefits including:
 reduced injuries and illnesses
 compliance with WHS legislation
 reduced workers compensation costs
 reduced employee turnover and improved morale
 improved operational efficiency
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 better corporate governance
 increased stakeholder confidence
WHS risks within the disability sector are common with some other sectors such as aged care, HACC programs and a range of industrial sectors depending on the Disability Enterprise activities. What is unique for the disability sector is the potential need for a particular organisation to be able to address WHS obligations across such a range of industry types which often include uncontrolled environments whilst working with service users who may have unforeseen or unpredictable functional restrictions or behaviours. The disability sector also has to address the potential mismatch between risk minimisation and the disabled person’s desire to take risks.
Workplace Health and Safety Considerations for People who have a Disability:
Source: Community Services and Health Industry Skills Council Ltd.
Mobility aids
An area that support worker in the disability sector need to understand are mobility aids and specialist equipment, how these impact the client and others and the manual handling of this equipment.
It is important that you handle any equipment carefully and sensitively as it is a personal belonging that is often necessary to your client’s independence and/or wellbeing. The equipment is also likely to have been designed and/or fitted to suit the person’s individual needs and to repair or replace the item would be costly and inconvenient.
Clients Home and public places
Support workers often confront additional risks when working in public places and in client’s homes, as these environments are less predictable than centre-based environments.
Working in a client’s home is a common and significant part of many services provided by workers in the disability industry. The homes of clients are workplaces whenever a worker is present during work hours. Consequently organisations and workers have workplace safety obligations under the
Work Health and Safety Act and Work Health and Safety Regulation.
Suggested controls depending on the risk include:
Buddy system – some jobs present such a high level of risk that workers should not work alone, for example working with clients with high manual handling or behaviour issues.
Workplace layout and design – workplaces and their surrounds can be designed to reduce the likelihood of violence, for example by installing physical barriers, monitored CCTV and enhancing visibility.
Communication systems – the type of system chosen will depend on the distance from the base and the environment in which the worker will be located or through which he or she will be travelling.
Community Places
Working in the community is a regular and significant feature of support workers. Working with clients in the community, irrespective of disability type, has inherent challenges. When supporting clients to participate in community activities, there is only limited control over the external environment and there is an additional variable of interacting with members of the public. These challenges are heightened when supporting clients with complex or high behavioural support needs.
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Location assessment
There are many variations when working in the community. You may be supporting clients on a oneto-one basis or in group activities. One of the issues for workers in the disability industry is the genuine desire to assist clients integrate and participate in community activities like everybody else.
Any location that is used regularly in service delivery should be formally assessed with some type of documented checklist and preferably by more than staff member for suitability for your client group.
Client transport
Working in the community also includes transportation of clients to venues which adds new considerations regarding safety.
Transport: How are clients travelling to the venue? Are clients being transported by disability service worker? Are they travelling independently using private or public transport? Transport may be required to support clients attending workplaces, medical or dentist appointments or to go shopping.
An assessment of transport needs and a safe work procedure for client transfers should be undertaken where a hazard exists.
Activities
What is the focus of the activity? Is it predominantly social with a community participation objective or is it a training component of a client’s individual plan? An activity risk assessment as part of the venue assessment should be undertaken.
Variables
Variables may include noise or crowds due to school holidays or the time-of-day in which activities take place. Climatic conditions may affect individual client’s capacity to manage in the environment.
These and similar issues need to be considered in relation to a client’s management plan or behaviour support plan, to identify potential triggers and alternate actions if required. Workers regularly identify risk associated with tasks which form part of formal learning activities. Most are familiar with the need to analyse and assess tasks to assist the client to acquire skills and move towards independence. The risk identification process used in formal training processes can be adapted to social activities for clients. This is particularly so when working with clients with an intellectual disability.
Whilst community locations are varied, a number of simple practices can be implemented to ensure the safety of workers. These practices are the same irrespective of the location. The key is to include risk assessment processes as part of everyday practice.
Remember you may arrive at a location you use regularly to find there has been a substantial change to the location. Flexibility and understanding the basics of risk assessments to keys to such unexpected dilemmas and may not mean any activity needs to be cancelled if modifications can be made.
Source: Disability Safe is a project supported by ADHC to inform the establishment of a consistent approach to reasonably practicable risk management in the disability service environment
Once basic safety training has been completed, specific training for individual tasks and specific hazards should be conducted to help workers understand how and why a job must be done safely.
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Where work poses a risk to the health and safety of workers make sure safe work procedures are prepared and communicated.
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Many disabled people have had to learn to be patient. When you need to wait for someone to assist you across the road, up some stairs, to be dressed or to be fed, one of the things you learn is to be patient. As frustrating as this can be at times, it begins to become part of your character. There are other characteristics that you can acquire, such as discovering who your friends really are, learning to ask for help, discovering new ways to do things, pushing back your own or others’ boundaries, listening to other people, valuing others that society may choose to ignore or devalue, acquiring a new skill, feeling or attitude.
There have been people with a disability who said that their ‘quality of life’ had improved considerably since they became disabled. This was because they had to re-evaluate their life, and explore its meaning. This in turn led to new interests, stronger relationships and a greater appreciation of who their friends really were.
All humans face challenges, it's just that people with disabilities face different challenges.
IN THIS SECTION WE WILL LOOK AT:

Access and equity

Transportation and getting around

Technology

Networks and support groups

Employment

Disability and personal relations

Research strategies
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ACCESS AND EQUITY
 Access - fair access for all people to economic resources, services and rights essential to their quality of life
 Equity - fairness in the distribution of resources, particularly for those in need
People who experience disabilities have equal rights to access the physical environment, information, communication and services including education, employment, recreation, rehabilitation, participation as citizens, health and accommodation services and the right to a meaningful and adequate income.
There are many situations where people with a disability are not given access to things they should.
Sometimes this is because buildings have been poorly designed and there may not be a lift or a door that is wide enough for a wheelchair. Sometimes it is because buildings have been designed many years ago before there were rules about providing access for people with a disability. Sometimes access is denied because people are not comfortable being around people with a disability. For example, they may not choose them for a job, they may make access to a school difficult or they may not want a person with a disability as a tenant when they are renting out a house.
Ensuring equity
Equity is about making things equal. It means not making one set of rules or decisions for someone with a disability and another set for someone without a disability. People with disabilities should have equity, regardless of gender, ethnicity, type of disability and when the disability was acquired.
For example, people with a disability should have equal access to work opportunities. They should be equally able to go to school and use community services.
In short, Access and Equity means:
• Ensuring that all Australians, regardless of racial, religious, cultural or language backgrounds enjoy full access to services they are entitled to. It is NOT about special services for people of culturally and linguistically diverse background, or people with a disability.
• That Access and Equity is about identifying and removing barriers, which prevent people from knowing, using and participating in a service that they wish to utilise.
• An equitably, fairly and justly distribution of resources amongst all eligible clients, even if it
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means providing additional services or seeking additional resources to do so.
• That Access and Equity is an integral part of ‘core’ service delivery. It should not be an ‘extra’ responsibility on top of existing workloads and practices for agencies. Core services are defined as those services that an agency is established and funded to provide.
• Access and Equity is also about ensuring that staff, management and other personnel acquire the knowledge and skills to feel confident and capable of working with the person with a disability.
Access and equity is about being fair to everyone. It means not discriminating against someone because they have a disability. You need to think about how you treat others. Make sure you understand your work role and your responsibilities, what is expected of you at work and how your actions and words can affect others. Think about how to be fair, equal and just in your decisions and actions. Do not discriminate or treat anyone unfairly. Treating people with a disability unfairly or not as equals, disempowers them. This deprives them of having power and influence over their own lives.
For further information research the following links. Disability standards ensure that people with disabilities have the access they need to live, work and participate in their communities. These standards include:

Disability standards for accessible public transport – providers and operators of public
 transport must comply with these standards that set out the minimum requirements for access by people with disabilities, their families and carers.
Disability standards for education – these standards aim to ensure that students with disabilities are able to access and participate in education and training free from
 discrimination, and on the same basis as other students.
Disability standards for premises – these standards aim to give people with disabilities better access to a wider range of public buildings.
ACTIVITY
People with a disability should be able to access all the places and services that can be accessed by people without disabilities, in the table below list the potential barriers the person with a disability may experience.
AREA POTENTIAL BARRIERS
Trains
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Cinema
Shopping Centres
Church
Aeroplanes
Holidays
Night Clubs
Library
TRANSPORTATION
Transportation presents a significant barrier to participation in community life for many people, leaving them isolated and without access to services, shopping and social activities. Lack of access to public transport was identified as one of the most serious issues in people’s lives.
The Disability Standards for Accessible Public Transport 2002 set out the minimum accessibility requirements that providers and operators of public transport must comply with, as well as ensuring that access to transport is consistently improved.
The transport standards recognise that access to public transport enables people with disabilities, their families and their carers to fully participate in community life and also benefits many older Australians and parents with infants in prams.
The transport standards apply to:
• trams
• trains
• buses and coaches
• taxis
• ferries
• aeroplanes
The transport standards also set out minimum standards for premises including:
• access paths
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• manoeuvring areas
• ramps and boarding devices
• allocated spaces
• handrails and grab rails
• doorways, lifts, stairs, toilets, symbols and signs
• the payment of fares
• access to information about transport services
Further information about the Transport Standards can be found at http://www.comlaw.gov.au
GETTING AROUND
How the person with a disability gets around varies from person to person and also depends on where they live. They might opt for a form of public transport, such as taxis, trains and/or buses, or they might be able to choose private transport – driving themselves around in a car with modifications.
There are a variety of options available for people with limited mobility. These include designated disabled parking bays, accessible public transport, vehicle and taxi hire, and centres where walking sticks, scooters and wheelchairs can be hired for getting around the city.
The common thing is that they will need to have some way of finding and using transport that suits their needs. What they need to do is think about what they want to do, how they want to do it and work from there.
By reading through the information on public and private transport, they will be able to make an informed choice. However, whichever form of transport they use, there will be things that impact upon their individual needs. Always remember that there are ways of working with most things and achieving ways to ‘get out' and do what they want.
These websites have a wealth of information on transport options:
South Australia: http://www.sa.gov.au/subject/Transport
Western Australia: http://wa.gov.au/governmentservices/lifestyleenvironment
New South Wales: http://www.cityofsydney.nsw.gov.au/explore/getting-around/accessibility http://www.visitnewcastle.com.au
Queensland: http://www.business.nsw.gov.au/live-and-work-in-nsw/getting-around http://www.qld.gov.au/disability/out-and-about/transport/ http://www.tmr.qld.gov.au/Travel-and-transport/Disability-access-andmobility
Tasmania: http://www.discovertasmania.com/travel_information http://www.transport.tas.gov.au
Victoria: http://www.melbourne.vic.gov.au/CommunityServices/DisabilityService http://ptv.vic.gov.au/getting-around/accessible-transport
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Remember ‘getting around’ will give you more freedom and choices
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TECHNOLOGY
‘For most people, technology makes things easier. For people with disabilities, technology makes things possible.’
Mary Pat Radabaugh
Many of us rely on technology such as microwaves, computers, mobile phones and remote controls to perform simple activities in our daily lives.
Assistive technology (AT) is any device, system, or design used by individuals to perform functions that might otherwise be difficult or impossible. Such technology may be something as simple as your common household items such as a carrot peeler to the more complex products such as pressure care mattress for the prevention of pressure sores. In short, anything that assists individuals continue to carry-out daily activities can be considered assistive technology.
For people with any physical or cognitive difficulties, impairments, or disabilities, AT can be critical to assisting people learn and communicate more effectively, participate in the work environment, achieve independence, and improve their quality of life.
There are many different categories of Assistive Technology available ranging from simple ‘low-tech’ devices such as pencil grippers to more ‘high-tech’ items such as voice-control software used to control a computer instead of a keyboard.
Finding the ‘best match’ between a person, their environment, and technology requires careful input from the person with the disability, and possibly family, carers and relevant professionals. It is an involved multi-step process requiring understanding of the individual's needs - resulting in an informed decision about the best possible solutions.
Making sure the technology matches an individual's needs in the best possible way is critical as poorly chosen AT may be of little assistance to the user, or even end up abandoned in a cupboard.
When considering AT it is important to remember that AT is part of an ongoing therapeutic process to assist a person achieve their goals.
TYPES OF ASSISTIVE TECHNOLOGY
Augmentative Communication: The term Augmentative really means to supplement, aide or add to.
Therefore augmentative communication means to add to or supplement an existing communication system, including any type of spoken, gestural, and / or written abilities the person may have.
Aids for Daily Living: Daily living aids can be a beneficial, and often essential, part of a person's everyday life. ADLs can help sustain a safe and healthy lifestyle, ADLs are ideal for people who may have trouble with reach, hand dexterity, limited mobility and other common ailments.
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Source: Scope Victoria for people with disability
Computer Access Aids: Accessible computer equipment and PC access aids for the disabled computer user, includes software, computers and programs for those with disabilities as well as big letter keyboards and assistive technology such as trackball programmable button mice and aids for the blind and visually impaired pc user as well as speech dictation software for those having problems using keyboards and mice.
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Source: Scope Victoria for people with disability
Home/Workplace Modifications
Structural adaptations that remove or reduce physical barriers: ramps, lifts, bathroom changes, automatic door openers, expanded doorways.
Environmental Controls
Electronic systems that assist people control various appliances, switches for telephone, TV, or other appliances which are activated by pressure, eyebrows or breath.
Mobility Aids
Devices that assist people move within their environments: electric or manual wheelchairs, modifications of vehicles for travel, scooters, crutches, canes and walkers.
Recreation
Devices to enable participation in sports, social, cultural events.
Examples include audio description for movies, adaptive controls for video games, adaptive fishing rods, cuffs for grasping paddles or racquets, seating systems for boats.
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Seating and Positioning
Adapted seating, cushions, standing tables, positioning belts, braces, cushions and wedges that provide body support to assist people perform a range of daily tasks.
Sensory Aids for Vision/Hearing Impaired
Aids such as magnifiers, Braille and speech output devices, large print screens, hearing aids, visual alerting systems, telecommunication devices.
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Source: Scope for people with disability
EMPLOYMENT
The most significant barrier for people with disabilities still appears to be the stereotypical assumptions and attitudes of employers about what people with a disability can and cannot do.
Further employer misconceptions preventing the full inclusion of people with disability in the workforce include:
 the perceived cost in terms of employing a person with a disability in terms of possible workplace adjustments
 the lack of awareness and confidence in creating a workplace which is inclusive of people with disability
 the perceived impact on workers compensation, sick leave and OH&S regulations
 the belief people with disability will take up too much time to manage
 the fear of other people in the workplace doing or saying the wrong thing
The principles of employment are the same for people with disability as those without disability. The main focus should be on the skills, talents and capabilities the person with disability can bring to the workplace.
People with a disability have a fundamental right to participate in, and fully contribute to, the life of our society. Employment not only represents economic independence but an increased sense of self-
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worth, the opportunity to contribute to society and a sense of belonging and connection with other people.
There are numerous Employment Services that provides and offer a range of services to support individual needs, including:
 help to prepare for work, including training in specific job skills
 job-search support, such as résume development, training in interview skills, and help in
 looking for suitable jobs support when initially placed into a job, including on-the-job training and co-worker and employer support
 ongoing support in a job if required
 the purchase of vocational training and other employment-related assistance
 access to help with workplace modifications; support services; and Auslan interpreting in the workplace
People with a disability seek employment which is continuing and meaningful, and with employers who can provide a supportive work environment, opportunities for skill development and a career pathway.
NETWORKS AND SUPPORT GROUPS
People with disabilities are unique individuals with varied interests, abilities, needs, cultural backgrounds, likes, dislikes, and motivations just like us. Taking the time to discover more about the individuals that you are supporting will give you a better understanding or each person's individual:
 abilities - strengths capabilities and skills
 relevant interests - what they like to do
 requirements - what they need to be able to do the things they want to do
 needs - areas of development or change
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People require a range of supports and the ability to access mainstream community services and facilities in order to have a full life in the community. This should be underpinned by individual planning and support, with the ability for the person to be as self-directed as possible and have the availability of facilitation and co-ordination where required.
Creating and supporting socially valued social roles and the good things in life involves providing people with a disability with:
 dignity
 respect
 acceptance
 a sense of belonging
 an education
 opportunities to develop and exercise their capacities
The good things in life also include being supported to achieve a reasonable standard of living, a place to live, and opportunities for employment and recreation with less reliance on services for daily living.
SUPPORT THE CLIENT TO DEVELOP AND OR MAINTAIN NETWORKS
The definition of support is: To aid the cause, policy, or interests of ………
Some people are very clear about what they want to do in life, while others might explore their goals and ambitions as part of planning processes.
Some people, however, are unaware of the choices and opportunities that might be open to them. In these circumstances it is important that supporters and workers work with the person to develop interesting, creative and appropriate ways to identify and meet their goals. Discuss activities, including:
 what types of things they like to do
 whether they do enough of the things they like
 whether they still enjoy the activities they do
 if there are new things they’d like to try
 any worries about trying new things
 any information you can provide
 any activities linked to long term goals and ambitions
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Social Networks
Social networks include:
 family groups
 support groups
 neighbourhood or local community groups
 workgroups
 sports and other recreation groups
 age-related groups (youth or senior citizens)
 community centres
 clubs
 church groups
Social networks assist in community participation and inclusion with all the resulting benefits from the ‘good things in life’, and can also provide additional personal support for people with a disability.
The term social network was originally coined to distinguish between networks that were used for business purposes and those that were used for socializing. The term has been extended to include interactive websites with message boards, chat rooms or the ability to leave comments and have a discussion with other people. Examples of websites that are primarily used for socializing include
Facebook and MySpace. https://www.facebook.com
http://www.myspace.com
The websites are supposed to be fun; that was the original purpose. But many concerns have arisen as they have become more popular. There have been instances of bullying. A young gay man was outed on Facebook and later committed suicide. A woman used the site to harass a female teenager who also committed suicide.
There are also privacy concerns. Your information can be viewed not only by your friends, but also by companies, spammers, thieves and perhaps your potential boss. There are ways to reduce your risks and still use the social networking sites but you have to be careful.
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The good news is that there are hundreds of social networking and informational sites created for the softer side of humanity. Networking sites where peace and love are promoted; helping the jobless find work, activism in food industry, specific topics, educational issues and dating sites
What you'll most likely learn is that you're not alone - and that's what social networking is all about, right?
Expanding social networks
A valuable outcome from supporting someone to try new activities is meeting people with common views and interests. By meeting people through shared interests, people can make friends and naturally develop social networks. People with similar views and experiences might be better placed to understand their point of view and may be able to help them with their decision making as peers.
One of the best ways of expanding your social network is finding a new activity, and if you can think of an activity that also involves other people, such as joining a group of some sort, even better!
You can try different internet tools to help you find something you may enjoy doing. And remember, if it looks even remotely interesting, try it! Nobody is going to force you to come back and do it again, if you don't enjoy it!
Support Groups
In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic. The help may take the form of providing and evaluating relevant information, relating personal experiences, listening to and accepting others' experiences, providing sympathetic understanding and establishing social networks. A support group may also work to inform the public or engage in advocacy.
Joining a support group can also lead to other friendships and supportive relationships and can help to deal with issues such as moving on with life and re-establishing contact with other people.
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It is important to understand though that many people join support groups to gain information only.
They are not necessarily seeking enduring relationships or commitment. If you find a person that you would like to get to know better, start slow, ask them if they'd like to keep in touch or meet up sometime. If they do not seem ready just yet, don't take it personally. People who join support groups often have a lot of things going on in their lives.
When it comes to support groups it's important that all people feel comfortable choosing their own level of involvement. People feel comfortable when they can give what they have to give and not be expected to give more. In this way, it is important to have a plan about how often you should call someone, not too often, but also not too rarely. Give people space, but let them know you're available and interested if they ever want to catch up. By doing this, the social and support networks will have a chance to grow wider and enrich all areas of their life as well as other people's lives.
The important thing to remember is that support groups are for support. Although you may be lucky to find enduring friendships through support groups, it is generally better to look for social contact through social clubs, work, study, community courses or community activities and through getting out and having fun.
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Since at least 1982, the Internet has provided a new venue for support groups.
Support workers help clients to develop their social skills by encouraging their involvement in a community. A community may be a disability support group, family gathering or group of friends.
Support workers are responsible for transporting the client to and from the gathering place. By facilitating the client's integration with friends and family, disability support workers emphasize the importance of meaningful relationships between community members.
DISABILITY AND PERSONAL RELATIONSHIPS
Sex is very much associated with youth and physical attractiveness, and when it is not, is often seen as ‘unseemly’. If we accept that sexual expression is a natural and important part of human life, then perceptions that deny sexuality for disabled people deny a basic right of expression.
People who have a physical or intellectual disability, whether from birth or through accident or disease later in life, might find it difficult to express their sexuality in satisfying ways. Their sexual function or feeling might be limited and they might have concerns about their body image. They might also be unsure about how to negotiate relationships and express their sexuality because of a lack of knowledge or physical or cognitive limitations.
People with a disability might also have limited opportunities for sexual relationships for a number of reasons, including a lack of privacy and being dependent on others for daily living. Finding ways to
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express sexuality can be a key part of rehabilitation when someone has acquired a physical disability in adulthood.
If you don’t have a disability it may surprise you to hear that the biggest obstacles to exploring sex when you live with a disability are not specifically related to the disability. The guy who has a spinal cord injury and cannot get an erection still has a thousand ways to have sex and feel sexy. The bigger problem is finding someone to have sex with since most people (regardless of disability) don’t see someone with a disability as a potential sexual partner.
Talking about disability and sex can be hard because neither is a simple concept and both are intimately tied to our sense of self and how we interact with others.
Physical Disability and Sex
Physical disability can impact your sex life in many ways. If you live with a physical disability, particularly a mobility disability it can impact:
 the way you engage in sexual activities, the kinds of activities you do, and how long you can do them for
 the way sex feels, including changes in orgasm, arousal, and the feeling of release after sex play
 your access to sexual partners, particular out in public where most spaces are not fully accessible and meeting people and flirting can be difficult or impossible depending on your disability.
When thinking about physical disability and sex one of the biggest barriers is a lack of imagination and creative sexual problem solving. If you believe that the only way to have sex is the physical contact, you may be out of luck. When you realize that sex is so much more than intercourse, greater opportunities and fewer obstacles present themselves.
Social Impact of Disability on Sex
What makes living with a disability and having sex difficult has a lot more to do with society than it does with the person living with a disability. There are so many ways that individuals, institutions, and social systems make the life of a person with a disability more difficult when it comes to sex, but here are few examples:
 lack of access to sex education
 fewer opportunities to seek out and enjoy sexual entertainment
 even if you can physically get into a social space like a club or bar, the social norms about how to meet people, flirt, and pick up exclude most people with disabilities who may need more time, quiet, and focus in order to make a connection
 having to meet social expectations, particularly around gender, when it comes to sexual activity can impact the chances of finding a sexual partner in the first place and then having mutually satisfying sex
Psychological Impacts of Disability
If there is someone who acquired a disability (as opposed to being born with a disability) there may be a psychological adjustment process in addition to a physical one. How they think and feel about themselves and their disability will have many impacts on the person as a sexual person.
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can help.
Talking with other people who have overcome body image concerns or a counsellor
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RESEARCH STRATEGIES
Research is motivated by curiosity or a need to know about how things are, and what they do or may do.
Part of your role as a support worker is to identify community activities or services that may be of interest to your client. This may include but not limited to social activities, recreational, employment.
Depending on where you live your approach may vary. For instance if you live in a country town you may be very familiar where to go to find the information you require.
In the city it may be a very different story.
To find local services the best approach is to start in the local area, where your client lives or the region they want to access. For example if you wanted to try wind surfing you would need to be near water either the sea, lake or very large dam!
A good place to start is your local council and or library. The majority of councils do have quite a lot of information on their websites. This may include information about access, services available including care and recreational and local service providers. Libraries, in addition to having information about local area activities and resources, often also have computers and internet access that are available to the public to use for research.
The majority of councils have some type of resource directory available or community development workers you may be able to speak to. Remember local government is there to provide support and services to their local government area, so a great place to start.
If you are not sure what council/local government area you fall into the following websites will be of assistance.
Council information [NT]
Find information and contact details for local councils in Northern Territory. http://www.localgovernment.nt.gov.au/council_information
Council map and contacts [Tas]
Find information and contact details for local councils in Tasmania. http://www.lgat.tas.gov.au/site/page.cfm?u=221
Council websites [WA]
Western Australian government page listing local councils and their websites. http://walga.asn.au/AboutLocalGovernment/CouncilWebsites.aspx
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Councils [SA]
Find information and contact details for local councils in South Australia. http://www.lga.sa.gov.au/site/page.cfm?u=210
Find your local council [Vic]
Find contacts, links, demographic and general information about each of Victoria's local councils. http://www.dpcd.vic.gov.au/localgovernment/find-your-local-council
Local council search [NSW]
Find your local New South Wales council. http://www.dlg.nsw.gov.au/dlg/dlghome/dlg_SuburbLookup.asp?ba=a&mi=0&ml=8
Local government directory [Qld]
Find information and contact details for local councils in Queensland. http://www.dsdip.qld.gov.au/local-government-directory.html
Territory and Municipal Services [ACT]
Find information and contact details for municipal services in the Australian Capital Territory. http://www.tams.act.gov.au/
Recreational activities: if you are accessing recreational activities – sometimes mainstream group’s activities should be approached, as with the support of a carer, mainstream services may be accessible and suitable for your client.
Accessing these services may require some phone calls and asking questions, remember most people are more than happy to help!
Study or Further Education
Clients may need you to investigate different courses or study they may be interested in. ADCET –
Australian Disability Clearinghouse on Education and Training http://www.adcet.edu.au
The Australian Disability Clearinghouse on Education and Training (ADCET) provides post-secondary education, training and employment information and resources for people with disability or ongoing medical conditions.
TAFE (Technical & Further Education) colleges have specialist disability services to support students undertaking study.
Support is available for people with:
 deafness or hearing impairment
 intellectual disability
 learning disability
 neurological disability
 physical disability
 psychiatric disability
 vision impairment
What support is available?
 pre-course counselling
 assistance with course selection and enrolment
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 assistance to identify the most appropriate classroom support and assessment modifications
 access to tutorial support, adaptive technologies, sign language interpreters, note-takers or disability assistants.
Fee exemptions and concessions
Students with disabilities may be eligible for a fee exemption or concession fee.
TAFE NSW Disability Services https://www.tafensw.edu.au/services/disability/index.htm
TAFE NT Disability Services 
 http://www.cdu.edu.au/cduvet/index.html?q=vet/index.html
TAFE Queensland Disability Services http://www.tafe.qld.gov.au/students/support/disability-services.html
TAFE South Australia - Disability Support 
 http://www.tafesa.edu.au/services/disability-support
Tasmanian Polytechnic Disability Support 
 http://www.polytechnic.tas.edu.au/design-disabilitysupport.aspx
Victorian TAFE Colleges
Bendigo Regional Institute of TAFE 
 Disability Support: http://www.bendigotafe.edu.au/Students/StudentSupport/Pages/default.aspx
Box Hill Institute 
 Disability Liaison Service: http://www.bhtafe.edu.au/students/services/Pages/disability-liaison-service.aspx
Central Gippsland Institute of TAFE 
 Disability Support: http://www.gippstafe.vic.edu.au/current_students/student_support_services/disability_officer
Chisholm Institute of TAFE 
 Disability Support Service: http://www.chisholm.edu.au/About/Going_all_in
East Gippsland Institute of TAFE (Advance TAFE)Disability Support: http://www.advancetafe.edu.au/pages/achieve/support.htm
Gordon Institute of TAFE - The Gordon 
 Disability Support Services: http://www.thegordon.edu.au/StudentSupport/LearnerSupport/Disability/Pages/Home.aspx
Goulburn Ovens Institute of TAFE 
 Disability Support: http://www.gotafe.vic.edu.au/page.cfm?ID=42
Holmesglen Institute 
 Disability Support: http://www.holmesglen.edu.au/services/student_services/disability_support_service
Kangan Batman Institute of TAFE 
 Disability Support: 
 http://www.kangan.edu.au/services/student-support-recreation/disability-support/
Northern Melbourne Institute of TAFE 
 Disability Support: 
 http://www.nmit.edu.au/about/student_services/#disability_support
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RMIT University (TAFE Division) Disability Liaison Unit: http://www.rmit.edu.au/browse/Current%20students%2FStudent%20services%2FDisability%20Liais on%20Unit/
South West Institute of TAFE 
 Disability Support: http://www.swtafe.vic.edu.au/students/studentsupport/
Sunraysia Institute of TAFE 
 Disability Support: http://www.sunitafe.edu.au/services/studentsupport.aspx
Swinburne University of Technology (TAFE Division) Disability Services: http://www.swinburne.edu.au/stuserv/disability/
University of Ballarat (TAFE Division) Disability Support: http://www.ballarat.edu.au/currentstudents/support-services/disability-support
Victoria University (TAFE Division) 
 Student Equity and Disability: http://www.vu.edu.au/facilitiesand-services/student-equity-and-disability-support
William Angliss Institute of TAFE 
 Disability Liaison: http://www.angliss.edu.au/Disability-Liaison
Wodonga Institute of TAFE 
 Disability Liaison: http://www.wodongatafe.edu.au/audience/information/learner-services/disability-liaison.aspx
Western Australia TAFE Colleges
Central Institute of Technology 
 Disability Services: http://www.central.wa.edu.au/Current_Students/ServicesandSupport/Pages/default.aspx
Challenger Institute of Technology 
 Disability Services: http://www.challenger.wa.edu.au/StudentServices/disabilityservices/Pages/DisabilityServices.aspx
Polytechnic West 
 Disability Services: http://www.polytechnic.wa.edu.au/pwa/current-students/services-for-current-students/disabilityservices/
West Coast Institute of Training 
 Disability Services and Support: http://www.westcoasttafe.wa.edu.au/StudentInformation/CurrentStudents/StudentCentro/Pages/D isabilityServicesAndSupport.aspx
Regional TAFE
Durack Institute of Technology 
 Student Services: http://www.durack.edu.au/studentservices/Pages/studentservices.aspx
C.Y. O'Connor Institute: http://www.cyoc.wa.edu.au
Great Southern Institute of Technology 
 Disability Support: http://gsinstitute.wa.edu.au/studentservices/Pages/StudentServices.aspx
Kimberley TAFE 
 Disability Services and Support:
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http://www.kimberley.tafe.wa.edu.au/studentinformation/currentstud/studservices/Pages/disabser vsup.aspx
Pilbara TAFE 
 Disability Services: http://www.pilbaratafe.wa.edu.au/site/API/disability.aspx
South West Institute of Technology 
 Disability Services: http://www.swit.wa.edu.au/facilitiesandservices/services/studentsupportservices/Pages/accessibilit yforstudentswithadisability.aspx
University Education
Universities also offer a range of support services to students with disabilities. The websites listed will provide further information about the university in your state or research the university of interest.
The support services and physical access may differ from institution to institution, but the services generally offered include: note takers, personal readers, examination provisions, assistance in the library, learning assistance, alternative assessment methods, and provision of academic material in alternative formats. Some institutions may provide parking for holders of mobility access permits.
Information for students with a disability: ( NSW/ACT): www.uac.edu.au/undergraduate/apply/disability.shtml
NT University Admissions Centre ( Northern Territory): www.satac.edu.au/
QLD Tertiary Admissions Centre: 
 www.qtac.edu.au/
SA Tertiary Admissions Centre: 
 www.satac.edu.au
Tasmanian Admissions Centre: 
 www.studentcentre.utas.edu.au/admissions/
Victorian Tertiary Admissions Centre: 
 www.vtac.edu.au
Tertiary Institutions Service Centre (WA): 
 www.tisc.edu.au/
RESOURCES FOR PEOPLE WITH DISABILITIES
Better Start for Children with Disability
The Better Start for Children with Disability initiative aims to assist eligible children with developmental disabilities to access funding for early intervention services. http://www.fahcsia.gov.au/our-responsibilities/disability-and-carers/program-services/for­ people-with-disability/better-start-for-children-with-disability-initiative
Carers (DHS)
There are payments and services to support people who provide full-time care to someone else with a disability, illness or medical condition.
http://www.humanservices.gov.au/customer/themes/carers
Clean Energy Future Household Assistance Package
The Household Assistance Package will ensure that those Australians that need help the most, particularly pensioners and low and middle income households, will get assistance for the cost of living impact of the carbon price.
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http://www.humanservices.gov.au/customer/subjects/clean-energy-future
Commonwealth Respite and Carelink Services Directory
Do you need to know about which community, residential aged care, disability and other support services are available in your area? Search this directory for an extensive list of service providers- including the range of services they offer and their contact details. http://australia.gov.au/service/commonwealth-respite-and-carelink-services-directory
CRS Australia
CRS Australia delivers vocational rehabilitation services to Australian citizens or residents who have an injury, disability or health condition. We assist people who have a disability or injury to get a job or return to their job. This service is free to people receiving income support payments from
Centrelink. http://www.crsaustralia.gov.au/
CRS Australia - send a referral
CRS Australia provides vocational rehabilitation and assessment services to people with a disability, injury or health condition. Use the online referral form to request a service, refer someone to CRS Australia or find out more about CRS Australia's services. http://australia.gov.au/service/crs-australia-send-a-referral
Disabilities
Healthlnsite topic page linking to information about physical and mental disabilities, as well as information on rehabilitation and caring for people with disabilities. Healthlnsite provides links to some of Australia's most authoritative health organisations and their websites. http://www.healthinsite.gov.au/topics/Disabilities
Disability and Carers
The Department of Families, Housing, Community Services and Indigenous Affairs manages and funds a range of programs to support people with disabilities, and their families and carers. http://www.fahcsia.gov.au/our-responsibilities/disability-and-carers/overview
Disability Employment Services
The Disability Employment Services helps people with disability find work and keep a job. http://deewr.gov.au/disability-employment-services
Disability Parking Scheme
The Australian Disability Parking Scheme is gradually being implemented across Australia from
September 2010, to streamline the distribution and use of disability parking permits. Australian
Disability Parking Permits will be recognised in all states and territories. A list of relevant authorities in your state or territory authority is available for enquiries about permit applications, cost, eligibility and permit use. http://www.disabilityparking.gov.au/
Disability rights
The Australian Human Rights Commission provides a range of resources and links on disability discrimination and other human rights and disability issues. http://www.humanrights.gov.au/disability_rights/
International Day of People with Disability
International Day of People with Disability (IDPwD) is a United Nations sanctioned day that aims to promote an understanding of people with disability and encourage support for their dignity, rights and well-being. This site is the central source for all information about IDPwD in Australia. http://www.idpwd.com.au/
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JobAccess
JobAccess is a free information and advice service which offers practical workplace solution for people with disabilities and their employers. The service includes a comprehensive, easy to use website and a free telephone information and advice service where you can access confidential, expert advice on all disability employment matters. http://www.jobaccess.gov.au/
Livewire (community for young people with chronic illnesses)
Livewire is a safe and fun online community designed for young people living with a serious illness, chronic health condition or disability. It also caters for their siblings and parents. It allows members to share experiences. http://www.livewire.org.au/
Living with a disability
Healthlnsite topic page linking to a range of information about living with a disability, including advice, services, support groups and day to day issues such as dressing, driving and safety.
Healthinsite provides links to some of Australia's most authoritative health organisations and their websites. http://www.healthinsite.gov.au/topics/Living_with_a_Disability
National Auslan Booking and Payment Service
The National Auslan Interpreter Booking and Payment Service (NABS) is funded by the Department of Families, Community Services and Indigenous Affairs. NABS is based at the corporate office of
Wesley Mission Brisbane, in Brisbane, but it will provide services Australia wide. NABS provides interpreters to Deaf and hard of hearing people who use sign language and would like an interpreter for private medical appointments. It is free of charge to Sign Language users and medical practitioners. http://www.nabs.org.au/
National Companion Card
The National Companion Card Scheme brings together State and Territory Companion Card programs that enable eligible people with lifelong disability to participate at venues and activities without incurring the cost of a second ticket for their companion. http://www.companioncard.gov.au/
National Disability Insurance Scheme
A National Disability Insurance Scheme is about ensuring people get the individualised care and support they need over the course of their lifetime, so they can exercise more choice an< control in their lives. http://www.ndis.gov.au/
National Disability Organisations' Clearinghouse
Provides easier access to disability sector information and facilitates communication between the
National Disability Organisations. Thirteen national disability organisations contribute to government policies on issues affecting people with disability. http://ndoch.govspace.gov.au/
National Information Communication Awareness Network (Nican)
The National Information Communication Awareness Network (NICAN) is a free information service that lists accommodation venues accessible to people with disabilities. Their database has information on recreation, tourism, sport and the arts for people with disability for all of Australia. http://www.nican.com.au/
National Public Toilet Map
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iPhone, iPod touch, iPad, Android and other apps - Find the location of more than 14,000 public and private public toilet facilities across Australia. http://www.toiletmap.gov.au/
National Relay Service
The National Relay Service (NRS) is an Australia-wide telephone access service provided for people who are deaf or have a hearing or speech impairment. It is also available to anyone who wants to call a person with a hearing or speech impairment. http://www.relayservice.com.au/
People with a disability
Services and payments are available to help people who have an illness, injury or a disability. There is also support to assist their families or carers.
http://www.humanservices.gov.au/customer/themes/peopie-with-a-disabiIity
Public toilet map
The National Public Toilet Map (the Map) shows the location of more than 14,000 public and private public toilet facilities across Australia. Details of toilet facilities can also be found along major travel routes and for shorter journeys as well. Information is provided about each toilet, such as location, opening hours, availability of baby change rooms and accessibility for people with disabilities. http://australia.gov.au/service/public-toilet-map
Shut Out: The Experience of People with Disabilities and their Families in Australia
The National Disability Strategy Consultation Report prepared by the National People with
Disabilities and Carer Council 2009. The report provides detail on the key barriers and issue facing people with a disability, their families and carers and highlights the solutions offered b) the submissions. The report also compares the level of interest against a range of themes and issues that have emerged, and identifies the existing strategies that submissions suggest are working well. http://www.fahcsia.gov.au/our-responsibilities/disability-and-carers/publications-articles/polic)
-research/shut-out-the-experience-of-people-with-disabilities-and-their-families-in-australia
Young Carers
The Young Carers website provides contacts and support for children and young people, families and primary teachers. Their respite and information services program assists young carers to complete their education. http://www.youngcarers.net.au
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Being an effective support worker in the new disability care environment calls on us to have the ability to communicate well, listen, negotiate, advocate and be aware of others moods and feelings.
We also need to know how to be self-directed, manager our time efficiently, demonstrate flexibility, deliver a professional service and respond appropriately to both the client and family. No small feat!
Community and disability service workers spend their working lives interacting with people in many stressful and emotionally charged situations. Hence, these workers need to explore their own emotional intelligence and work at developing areas of themselves that may affect their ability to communicate effectively with clients.
The ability to know when you need talk to someone or debrief after a challenging day at work, while maintain client privacy and confidentiality, is also crucial. Also, knowing when you need a break, a holiday or to seek some help when you are going through challenging times, is important. This unit explores some ways to help us be the most effective and enabling support worker we can be in the new disability care environment.
The first step to doing this is knowing how we ourselves communicate, react and behave and how
others perceive our communications and behaviours. Being more self-aware is key to achieving this.
IN THIS SECTION WE WILL LOOK AT:

Self-awareness and emotional intelligence

Dealing with emotions

Building rapport

Self-awareness in conflict situations

Debriefing

Time management and effective work habits

Code of conduct

Professional development

Glossary
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Self - Awareness and Emotional Intelligence
There is quote from Anais Nin
This is why we need to make that journey inwards to look at our perceptions, reactions, cultural heritage, feelings and learned habits which affect how we hear and perceive things; how we communicate and how we behave. Knowing how we feel is part of self-awareness.
To become self-aware is to know your strengths and weaknesses, your triggers, your beliefs and prejudices. Self-awareness is an essential underpinning skill in an effective communication. Tools like the Johari Window can help you understand yourself and the way you interact with others. The more we are aware of our feelings, the better we can adapt our behaviours and understand the behaviours of others.
We all perceive and react differently to things. Different life experiences and habits we’ve developed all throughout our life can sometimes impact upon our current communication and perception styles. We may even be unaware that people perceive the way we communicate, listen and behave, as unhelpful. By understanding why and how we react and what triggers our emotions, we can better ‘deal’ with our unhealthy reactions or behaviours in conversations and relationships with others. We may also react or become defensive if someone says they don’t like what you are doing, as we can feel this is a personal attack on ourselves.
With our busy schedules it might be difficult to find time to think about who we are; our strengths and challenges, our drives and personalities, our habits and values. Besides, many of us just aren’t inclined to spend much time on self-reflection. Even when personal feedback is presented to us, we’re not always open to it, because honest feedback isn’t always flattering. Consequently, many of us have a pretty low level of self-awareness.
It is good to end each day with a small reflection time to think about how you listened and communicated with the client. If there was a problem it is also good to think about if you contributed to this perception or communication difficulty. If so, see if you can work on this to improve.
Check out Johari Window at http://kevan.org/johari or Self Awareness test at http://www.hermes-press.com/CCC/SA_test1.htm
.
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Good Emotional control:
Support workers who understand and manage their emotions effectively, generally don’t verbally attack others, react to criticisms by others, stereotype people, or compromise their values. This ability to understand and manage your emotions well is often related to good self-esteem. Our clients are going to have days where they are tired, in pain, frustrated, feeling vulnerable and may not do what is in their care plan. Remember, the support workers are the ones who are there to enable the client and we need to understand where the client’s frustration, anger or unwillingness to engage is coming from. Generally, the frustrated communication and behaviour is not a personal attack on the support worker – it is aimed at an action the support worker is doing, which may be causing the client distress, therefore, we need to correct the action (if appropriate) and not feel personally insulted and react. Some strategies to improve emotional control are to practice being calm when you perceive you are being insulted, and focus on the act that the person disagrees with.
Well motivated:
Support workers who are self-aware are generally well-motivated as they are aware of their ‘sense of purpose’ and this gives them energy to get through the days and weeks, despite multiple challenges.
They know they want to make a difference to the lives of others, and the clients will notice this enthusiasm and positiveness. The last person a client with a disability wants to see is someone turns up to their house that is miserable and lacking commitment to their job.
Have empathy:
Sympathy refers to making it known that you aware of another person’s distress and have compassion for them, whereas empathy goes ‘deeper’ and refers to the ability to put yourself in someone else’s ‘shoes’. In empathy you enter into a deeper level of understanding of the person’s experience. Those that empathise often have an ability to listen well, and understand that other people see/perceive things and situations differently. This support worker is not threatened by different feedback from their client and often pays attention to body language and feelings of clients.
Self-awareness and a good emotional intelligence are linked. Emotional Intelligence is far more than just how you feel or what mood you are in. In the world we live in, it is vital that we have a high level
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of emotional resilience, otherwise we could fall prey to stress, fatigue, burnout, failure and sickness in many areas of our life. It is essential for workers to have the necessary emotional skills to perform their work effectively.
Managing our emotional response to a situation we find ourselves in can have a profound effect on the outcomes.
Let's take a simple example: How do you feel when someone cuts in front of you when you are
driving or changes lanes without indicating?
Your first reaction should be to do what you can to ensure there is no danger of a collision. Maybe that process is as simple as slowing down a little. And hopefully that reaction should almost be instinctive.
However for some people the reaction - often a first reaction - is one of abuse and anger directed at the person who moved in front of them. So they direct their anger at the person by yelling, tooting the car horn, even speeding up to ‘reclaim' their position, to re-assert themselves.
Emotional Intelligence is the ability
 to identify your own and other people's emotions
 to understand the source of those emotions,
 to manage them in a way that achieves the best possible results for relationships with other people and for your own emotional wellbeing, and
 to manage those emotions in a way that is consistent with your goals and values
Research has indicated that employees and leaders with higher levels of emotional intelligence skills produce vastly better outcomes in the workplace. Higher level emotional intelligence skills have been linked to longer workplace retention rates, less sick leave, improved teamwork outcomes, higher levels of profitability, higher rates of second interviews in job applications and even better health.
Emotional responses will happen, but the nature of the response and the level at which you experience it is entirely up to you. Real-time emotional self-regulation is at the core of the emotional intelligence. And it's a positive impact that can affect every aspect of our lives.
GROUP DISCUSSION
Consider the following situations and reflect how you feel when people have given you feedback. To be discussed in class.
1.
A client tells you are not doing something properly? How do you feel? What is important to consider? What do you say?
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2.
3.
A family member tells you the other support workers are doing their tasks better than you.
How do you feel? What is important to consider? What do you say?
Your supervisor tells you off for something you forgot to do. How do you feel? What is important to consider? What do you say?
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Discussion: In these situations and others when you’ve been given feedback or criticised, can you do the following:

Respect other people and their feelings?

Identify your own feelings?

Take responsibility for your own emotions?

Maintain control of your own emotions?

Validate other’s feelings and values?

Not rush to judge or label other people and situations?

Not manipulate, criticise, blame or overpower the client and family?

Challenge your habitual responses and consider alternative responses?

Not live in the past, learn from this experience and not carry negative feelings forward?
GROUP DISCUSSION
As a group discuss responses and other real life situations for 10 mins. Things to discuss. How do you feel when a SW or family criticises what you are doing? What should you do or say? This exercise is to get staff to learn to not take things personally and keep focused on the client and situation. Learn how to debrief outside the situation and to reflect on how they can handle a situation better. Deescalate, empathise and act.
DEALING WITH EMOTIONS
Life is full of frustrations - from the minor irritation of losing your car keys to the major anxieties of continued failure towards a goal. Frustration is not a pleasant emotion
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Generally carers and support workers tell us that caring is a role they find rewarding and satisfying but many also face challenges that they did not originally expect to face as a carer. Each caring relationship will be different and the impact of the caring role will differ from one situation to the next, and alters over time.
When you’re burned out, problems seem insurmountable, everything looks bleak, and it’s difficult to muster up the energy to care—let alone do something about your situation. The unhappiness and detachment burnout causes can threaten your job, your relationships, and your health. But burnout can be healed. You can regain your balance by reassessing priorities, making time for yourself, and seeking support.
Compassion fatigue is a term used to describe the feeling of frustration, emotional distress and sorrow that you might feel when working with your clients. These symptoms are also referred to as secondary post-traumatic stress disorder and it's different from burnout caused by job stress.
Compassionate fatigue involves emotional, physical and spiritual exhaustion caused by witnessing and absorbing the problems and suffering of others – a key concern when you're involved in support work. Managing compassionate fatigue can be challenging and involves being able to develop proper boundaries and put aside your personal issues and feelings in the best interest of your clients.
BUILDING RAPPORT
Rapport describes a positive relationship that forms between two or more persons. Once you have identified the possible barriers to effective communication and considered some strategies to overcome these, you can then look at how to build rapport with the client. Establishing good rapport with others is an essential skill for community and disability support workers.
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Rapport is the ability to make others feel comfortable with you. This starts at the beginning of each interaction with a smile, handshake and direct eye contact, as well as knowing the client’s name, something about their business, and their organisation or industry. Every interaction you have with the client is an opportunity to build rapport.
Strategies for building good rapport include:
 being clear about your role and the purpose of the interaction
 using a person's preferred name when speaking with them
 paying attention to making them comfortable
 using a pleasant tone that is clear and precise
 explaining words and expressions that may be unfamiliar and not using jargon
 asking simple and clear questions
 explaining what you already know
 explaining clearly any mandated position you have. For example, you may have to report to other authorities any disclosure of abuse
 explaining the actions that are undertaken both during the interview and as a result of the interview
 using age-appropriate language and avoiding jargon and use words familiar to the other person
 conveying acceptance by showing interest and concern
 being sincere and realistic in praise and goal-setting
 not promising anything that cannot be delivered when the interview is over
Personal attributes that will assist support workers to be responsive to client needs include:
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 sincerity - to be genuine and honest
 confidence - being self-assured or confident in one's own ability
 enthusiasm - to show interest, displaying good knowledge
 efficiency - capable of producing the required result with minimum waste or effort
 empathy - identifying oneself mentally with the client in order to fully comprehend their needs
 interest in other people - showing concern for their needs
Once you have developed a good rapport, it is important to build on this by continuing the communication. It's all about attitude, developing a rapport, adopting a win-win approach, communication, and being client focused.
Self-awareness in conflict situations
When a conflict is developing between yourself and a client or colleague, anger is usually present. It is important to examine where that anger is coming from and what needs are not being met – both within yourself and within the client's situation.
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You need to be very honest in acknowledging personal limitations and prejudices, and avoid imposing your own personal values and beliefs on others. These could include:
 feeling threatened by the other person
 commitment to personal values or beliefs
 being unsure of your information
 being unassertive, aggressive, talkative, or having low self-esteem
 being judgmental or having expectations
 using inferences rather than facts or observations
Feelings can bubble up unexpectedly and you may not be prepared for their intensity. This can exacerbate the potential for conflict developing with clients or co-workers. It is vitally important for you to be able to examine your responses to others and to be constantly aware of what your feelings and perceptions tell you, about your needs and those of your client, and whether these are being met.
People in conflict can approach the situation competitively or they can attempt to cooperate, while still acknowledging the existence of a conflict. When people compete in a conflict, they usually perceive that there will be an outcome in which one side wins and the other loses. If people attempt to approach a conflict cooperatively, they try to find a solution both parties can be satisfied with.
People's behaviour in conflict falls into five styles described below:

 avoiding – withdrawing from the conflict smoothing – finding common interests or areas of agreement
 compromising – bargaining so that each side gets a part of what they want
 forcing – one side causes the other side to change
 problem Solving – attempting to find a solution that meets both needs
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Most of us regard conflict as something to be avoided. Conflict is not particularly healthy; however conflict can also be viewed as a necessary stimulant for development and change. Conflict is not a problem in itself. It is what we do with it that counts.
It is important that we do something because whether we like it or not, conflicts demand our energy.
In fact, an unresolved conflict can call on tremendous amounts of our attention. We all know how exhausting an unresolved conflict can be. It is not always easy to fix the problem but a great energy boost can come when we do. Resolving conflict requires skills.
DEBRIEFING
The technique of debriefing is useful for anyone following the completion of an activity, mistake, event or critical incident. Debriefing can serve as an opportunity to reflect on an experience and make it meaningful by identifying what we learned about ourselves and others.

Debriefing is telling our story, complete with experiences and feelings, from our point of view. It is a verbal processing of past events

Debriefing includes both the facts and emotional responses, and invites feedback

Debriefing is an opportunity to share in depth recent experiences with someone who is willing to listen and care, without judgment or criticism

Debriefing allows you to let go of emotions and clarify your boundaries, which is important for avoiding burnout
Debriefing can answer questions including:

Who was involved?

What happened?

Where did it happen?

Why did it happen?

What did we learn?
The debrief should always take place in an appropriate environment and initially be on a one-to-one basis. The tendency in groups is for there to be peer pressure which may bias or influence response.
Inevitably in a group debrief session there will be assertive and passive respondents.
It is also best to debrief with a peer, either with your facilitator or a colleague who has an interest. It may be tempting to debrief with your wife or husband or even a friend, however, they may not have the emotional distance, skills or knowledge to allow you to properly debrief and might feel overburdened by the information you need to share. Breaching confidentiality is also more likely if you are debriefing with a partner or friend.
Time Management and effective work habits
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Self-awareness is also an essential first step toward improving our management skills. Self-awareness can improve our judgment and help us identify opportunities for professional development and personal growth. As discussed earlier, with our busy schedules it might be difficult to find time to think about who we are, our strengths and weaknesses, our drives and personalities, our habits and values. Consequently, many of us have a pretty low level of self-awareness.
That's unfortunate, because self-awareness is an essential first step toward maximizing management skills.
The management of self, time and workload essentially is the management of one's self. We don't manage time: we manage our use of it. Time cannot be expanded, reduced, suspended, stored up, distorted or discontinued - or even put off until tomorrow.
Making the best use of our time is, therefore, not just a good idea, it is essential. Frustration over having too much to do, and too little time to do it, is a sure sign that you are not managing your time effectively. Time management is the pathway to accomplishment.
Time management addresses four essential processes:
1.
planning
2.
3.
4.
organizing developing good work habits and eliminating bad work habits
Planning: Take charge of how you will be using your time. Planning is the key. As with so many other things in life, time can either be our benefactor or nemesis, it depends entirely on whether we are willing to control time through planning, or allow time to control, victimize and frustrate us. It is up to you.
Organizing: Being highly organized does not necessarily translate into being effective. Some people are extremely organized, but they are not particularly efficient. Some may be able to function well - be it at the job or in their personal lives, with sound procedures in place, yet, they still may not be successful in accomplishing their goals.
Developing good work habits: It's not enough to know your job; you have to know yourself. What are your strengths and weaknesses? What situations do you rise above, and under what circumstances do you fail?
Eliminating bad work habits: Achieving this is dependent on the following factors: self-awareness - knowing and understanding yourself; acknowledgment - accepting the truths about yourself. It's no easy task, however, to really know and accept the truth about ourselves, and then take charge to become the person we are capable of becoming and to accomplish what we are capable of achieving.
Procrastination is the greatest time management problem of all. If effective time management simply were a matter of prioritizing our objectives and identifying what needs to be done to achieve them, there would be no issue in time or workload management. Where there is procrastination, there is some combination of fear, doubt, confusion, frustration and anger.
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Schedule some time to be alone each day. Time spent with yourself can be very beneficial. Try finding a place where the likelihood of interruption is remote. Understand that your email and voicemail can take over for a while. This is important time just for you.
ACTIVITY
Which of the following is a time saver?
1.
2.
3.
Procrastination
Leaving task unfinished
Inability to say no
4.
Delegation of tasks
Doing which of the following will not help you organize your time better?
1.
2.
Prioritizing
Organising
3.
4.
Economizing
Socializing
Which of the following will help you organize your time better?
1.
2.
3.
4.
Procrastinating
Streamlining
Socialising
Holding many meetings
Which of the following can help you save time in regard to e-mail?
1.
2.
Allot specific times of the day to check and respond to e-mail
Make sure a chime or alarm beeps when you receive an e-mail message
3.
4.
Don’t get a junk mail filter
Check your e-mail as soon as you receive it.
Which is a true statement?
1.
Travelling is not a time waster
2.
Finish tasks to completion before moving on to the next
3.
Leave as many tasks undone as possible
4.
An open door policy is usually best
Which of the following can be huge time wasters if not handled effectively?
1.
The telephone
2.
E-mail
3.
Both 1 and 2
4.
Neither 1 or 2
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Establishing goals is an important step for effective time management
1.
True
2.
False
Communication isn’t a factor in managing your time.
1.
True
2.
False
Making a check list is a waste of time?
1.
True
2.
False
3.
Both 1 and 2
4.
None of the above
What would be a great tool to utilize when trying to manage time effectively?
1.
Book
2.
Timer
3.
Patience
4.
Pencil
Which of the following can help you save time when it comes to holding meetings?
1.
Hold as many meetings as possible
2.
Make sure everybody is allowed to speak at meetings
3.
Hold only necessary meetings and keep them on schedule
4.
Make meetings a gripe session
What are the top time wasters at work?
1.
‘Water-cooler conversations’ or chatting with co-workers
2.
Computer and software problems
3.
Meetings
4.
Web surfing
CODE OF CONDUCT
The Code of Conduct and Ethics is designed to assist staff in providing clients with the best possible service and to manage and resolve workplace issues. As well as setting out the legal guidelines for complying with rules and directions, the Code of Conduct and Ethics encourages staff to aspire to high standards of professional and personal conduct to maintain integrity in the important work we do. Staff members should be aware that the Code of Conduct and Ethics sets out a number of obligations and standards that, if breached, can lead to further action up to and including formal discipline.
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The Code of Conduct and Ethics is simply a guide; it cannot address all the possible ethical challenges that you may face in your employment, therefore your organisation provides more specific policies and guidelines for certain matters. You should refer to those documents as well.
If you are unsure about whether the Code of Conduct and Ethics applies to a particular situation, or what the appropriate course of action to be adopted is, discuss the matter with your supervisor or the service coordinator. Ultimately, all staff need to be responsible for their own behaviour and work in an ethical way.
PROFESSIONAL DEVELOPMENT
Professional Development is an integral component of support workers development. The principal purposes of professional development are to optimise the quality of working life and to achieve excellence by enhancing and supporting the existing strengths and potential contributions of all support workers.
Professional development has traditionally been thought of in terms of training and development. It is true that skills training and capacity building, by-products of professional development, lead to an increasingly sustainable and capable workforce. However, professional development is now seen to include a range of options which develop workers’ knowledge, skills and attitudes in order to ensure that they can work confidently and effectively, thus improving service provision. Professional development incorporates supervision and mentoring opportunities, on-the-job training, leadership training, and organisational structures to ensure the creation of a learning culture that embraces the principles and practices in the workplace.
Professional development is a crucial part of staff development. Managers in the community health sector cite as one of their greatest needs access to appropriate and affordable training opportunities that has a community delivery focus and that allows people to learn in more flexible ways. It is important that managers work together with staff, clients and carers to recognise current skills and knowledge, identify areas for development, and then help staff to incorporate support/care practices into professional development goals.
Example of a Career Pathway in Disability Support Work
Certificate III
Disability
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Further Study
Certificate IV in Disability
Certificate IV in Health
(Nursing)
Other Specialisations
Available
Certificate IV in Community
Services (Lifestyle and
Leisure)
Certificate IV in Aged Care
Certificate IV in Home and
Community Care
Further Study
Diploma of Disability
Diploma of Nursing
Further Study Coordinator
Degree in Nursing
Disability
Youth Worker
Employment
Enrolled Nurse
Social Work Opportunities Endorsed Enrolled Nurse
Registered Nurse role/responsibility, are not always feasible in the community disability sector. If people are satisfied in their job, and feel ‘safe’ in their work environment, then career pathways become less of an issue.
Reflective Practice
The process of reflective practice, both personal and organisational, is part of promoting well-being at work. If the organisation is mirroring the individual’s reflective practice, and vice versa, and each are responding to changing needs, then the worker is likely to feel greater satisfaction with their job role and professional goals, and more efficient.
Multi Skilling
Providing opportunities to multi-skill staff enables sideway movements within the organisation. For example, staff can nominate to fill positions as they become vacant or if someone is absent/un-well.
By enabling staff to become multi-skilled and try working in different areas staff learn what they are good at and enjoy most.
Higher education
There are a range of higher education courses available in areas such as, but not limited to, Social
Work, Nursing, Psychology, Occupational Therapy, Applied Social Science, Behavioural Health
Science, Counselling and Communication, Health Sciences, Management and Governance.
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Courses are available at the Bachelor, Masters, Doctorate,
Graduate Certificate, Diploma or Graduate Diploma level. It is a case of contacting the relevant institution for further information and course outlines.
Vocational education
Vocational Education Training (VET) is vocational/skill-based, and as such, provides a wonderful opportunity for managers to sit down with their employees, and speak directly about their job roles and responsibilities to identify competencies they are already using and competencies they would like to develop. The focus is on the work they do, and supporting workers to do their job well.
Managers can then recognise current competencies and suggest particular training for further development which may be vocationally based and part of the Australian Qualifications Framework
(AQF).
As part of review, managers should spend time with staff developing their professional and personal well-being - asking staff their training needs, looking ahead to where they see themselves in five/ten years time, and then helping them to achieve this. This symbolic gesture by management shows that they are taking the time to listen to the needs of the staff, getting to know staff, and helping them to achieve their goals.
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GLOSSARY
Abuse
Abuse is the deliberate improper treatment of an individual or group by another individual or group.
Abuse can be physical, sexual, emotional, verbal or financial. Abuse can be extremely harmful to the mental and physical health and wellbeing of the victim/s.
Act
An Act is a piece of legislation (a law) passed by parliament. An Act describes what people must do.
Activities of daily living
(ADLs) are the tasks people do every day, such as cooking a meal, looking after pets, shopping and cleaning.
Augmentative and alternative communication supports people who have a severe communication disability to communicate and interact with other people.
Addiction
A state of dependence produced by the habitual taking of drugs, including alcohol, characterised by compulsion, loss of control and continued patterns of use despite negative consequences.
Adolescence
Period of growth and development from puberty to maturity.
Adulthood
Stage of growth and development that follows adolescence.
Advocate
Person who intercedes for and acts on behalf of a client when the client is unable to do so, and may be a professional or lay person.
Aggression
Physical or verbal behaviour that is forceful or hostile and enacted to intimidate others.
Authority
The right of designated people to make decisions and issue commands.
Best Practice
Best practice means using the best skills and ideas available at the time to do a task.
Bereavement
A reaction to the death of a loved one (e.g. feelings of sadness and associated symptoms such as insomnia, poor appetite and weight loss).
Case management/Case co-ordination
The mechanism for ensuring continuity of care across inpatient and community settings, for access to and co-ordination of the range of services necessary to meet the individual and identified needs of a person within and outside the mental health service.
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Client
A recipient of services: may be a person, family, group or community.
Counsellor
A health professional that helps clients and families evaluate their patterns of problem solving and develop more effective ones.
Catheter
A catheter is a small, flexible tube inserted into the body to inject or remove fluids.
Chat Book
A chat book allows people with communication difficulties to convey information about activities and events they have experienced using words, objects, photos or pictures.
Chronic Disease
Chronic Disease is ‘characterised by complex causality, multiple risk factors, a long latency period, a prolonged course of illness, functional impairment or disability, and in most cases, the unlikelihood of cure.’
Chronic Disease Self- Management
Involves [the person with the chronic disease] engaging in activities that protect and promote health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes.
Client-directed care
Client-directed care is when the person with a disability decides how and when tasks and activities are carried out. The worker follows the directions of the client. The client decides what needs to be done. The client decides in what order and how a task will be done.
Code of Conduct
A code of conduct is a set of rules that underpin the professional practice and provision of care.
Code of Ethics
Defines the core values of the field and provides guidance for what professionals should do when they encounter conflicting obligations or responsibilities in their work.
Code of Practice
A code of practice is an industry guideline to help in the management of operations based on regulation or best practice. A code of practice is not law but should be followed unless there is an alternative course of action that achieves the same or better standards. These can also be used where no legislation exists.
Collaboration
To co-operate or work with one another to achieve a goal or outcome.
Complex Needs
Complex needs are when a person has been diagnosed with two distinct conditions or more.
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Community
A specific group of people, often living in a defined geographical area, who share a common culture, values, and norms, are arranged in a social structure according to relationships, which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values, and norms, which have been developed by the community in the past and may be modified in the future. They exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them.
Communication
Communication is the transfer of meaning and understanding from one person to another. This can be via words, body language, visually or by signing.
Compliant
Making a complaint means saying what you think is wrong and asking for it to be fixed.
Compromise
A compromise is when two or more people have different opinions but work out how to agree on a solution. No one gets exactly what they want or need, but they work out a way that everyone can be happy with the solution.
Condition
Condition is a disease or illness.
Conflict
Conflict is a disagreement that occurs when two people have different opinions, values and beliefs.
Content
Content means feeling happy, safe and at peace with life.
Coping Strategies
Coping strategies are strategies that clients can use to distract themselves or obtain support to prevent themselves thinking about suicide. They include going for a walk, writing in a journal or calling a supportive friend.
Core Values
Commitments held by a profession that are consciously and knowingly embraced by its practitioners because they make a contribution to society. There is a difference between personal values and the core values of a profession.
Courtesy
Courtesy means being polite. It means using good manners.
Cultural diversity
Cultural diversity refers to the many different cultures that make up a society.
Debriefing
Debriefing is when people get the opportunity to talk about something that has happened so they can understand it better.
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Dignity of Risk
Dignity of risk means a person has the right to make their own choices and to take risks. It is the role of the community worker to ensure the individual understands the risks they are taking and therefore is making an informed choice.
Disclosure
Disclosure means to reveal information, either voluntarily or to comply with legislation or workplace policies and procedures.
Disempowered
Disempowered means to take power away from a person; for example, by making decisions for them, rather than in collaboration.
Documents
Documents are written records or reports. They may contain details of events that have taken place or action that needs to be taken.
Dysfunctional
Dysfunctional means not behaving normally. A dysfunctional family is one in which conflict abuse in the family occur continually and regularly.
Emotional Needs
Emotional needs are the things that help a person feel safe, secure and happy within themselves
Empower
Empower means giving people authority and autonomy.
Empowerment
Empowerment means helping clients to develop a sense of control over their lives and to actively participate in decisions that affect them.
Encouragement
Encouragement means being positive and cheerful about an idea, and saying things that will help the older person want to join in.
Environmental Factors
Environmental factors are all the things in the world around us that affect our daily lives, such as air pollution, where we live and work, the school we attend, our friendship circle or peer group.
Environmental Health
The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health.
Ethics
The study of right and wrong, or duty and obligation, that involves critical reflection on morality and the ability to make choices between values and the examination of the moral dimensions of relationships.
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Ethical Dilemma
A moral conflict that involves determining appropriate conduct when an individual faces conflicting professional values and responsibilities.
Ethical responsibilities
Behaviours that one must or must not engage in. Ethical responsibilities are clear-cut and are spelled out in the Code of Ethical Conduct (for example, early childhood educators should never share confidential information about a child or family with a person who has no legitimate need for knowing).
Facilitator
A facilitator is a person who is not connected to the situation or the people involved. They are openminded and will make a judgement based on what they hear.
Funding
Funding is money that pays for the cost of the service. The government usually provides the money.
Genetics
Genetics means the way genes or biology determines how people develop.
Goal
A goal is the desired outcome. It is an improvement or change to work towards
Grievance process
A grievance process is the way the workplace wants you to deal with problems at work.
Hazard
A hazard any situation that has the potential to cause (or lead to) harm to people or property.
Hazard report
A hazard report is a form that records information about risks and hazards. It is used to record the details of hazards, such as what the hazard is, where it is and the risk involved.
Hazard report form
A hazard report form is a form that you complete if you think there is a danger or risk in the workplace.
Hereditary
Hereditary means that something is passed from one or both parents to the baby through genetic makeup.
Holistic
Holistic health is a concept upholding that all aspects of people's needs including psychological, physical and social should be taken into account and seen as a whole. This involves addressing more than just immediate and core issues of a client’s health and to engage in a broad realistic sweep of stakeholders, across all sectors, focusing on the physical, spiritual, cultural, emotional and social wellbeing of the individual, family and community.
Holistic Approach
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A holistic approach is care that is responsive to a person’s emotional, psychological, physical, cultural and spiritual needs. It means looking at the whole picture. In aged care, it means helping with all the older person’s needs, not just one or two.
Holistic Care
Holistic care meets the needs of the whole person, rather than just treating a particular problem or focusing on one area.
Holistic Care
Holistic care meets the needs of the whole person, rather than just treating a particular problem or focusing on one area.
Home and Community Care (HACC)
Home and community care is funded by the government. The program provides basic support and maintenance to people living at home who are finding it difficult to maintain their independence because of their ageing, a condition or disability.
Hydration
Hydration means keeping the body’s water at a safe and healthy level.
Health
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Thus the emphasis is on the viewing health positively rather than simply in terms of an absence of disease or disability. Increasingly, the attention of health practitioners is being directed towards illness prevention and health promotion strategies, rather than focusing only on curative approaches.
Health Care
Services Provided to individuals or communities by agents of the health services or professions to promote, maintain, monitor, or restore health. Health care is not limited to medical care, which implies therapeutic action by or under the supervision of a physician. The term is sometimes extended to include self-care.
Identity
Identity means how you see yourself. It has to do with all the different parts of your life.
Inappropriate behaviour
Inappropriate behaviour is unsuitable or improper behaviour or behaviour outside what is socially acceptable.
Inappropriate physical touching
Inappropriate physical touching means touching that is not liked or wanted by the other person. It can also mean touching that is not suitable to the situation.
Incident Report
An incident report documents any unusual problems, incidents or other situations that may lead to undesirable effects or do not comply with workplace policies and procedures or practices.
Individual Needs
Individual needs are the particular needs of each person. Everyone has different likes and dislikes.
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Individual Plan
An individual plan is a care plan that describes the support given to an individual
Informed Choice
Informed choice means knowing what choices they have. It means being given information to understand all the choices. It means being allowed to make the choice.
Integration
The linking together by various means of two or more service providers and/or agencies to address the individual’s or family’s preventive, treatment, and maintenance health needs in a more coordinated and comprehensive manner.
Interpersonal Skills
Interpersonal skills are communication skills that show respect, understanding, interest and trust.
These skills help to develop and maintain relationships with other people.
Interpreters
Interpreters are people who are trained to understand and speak two or more languages. They listen to one person speaking a language and then translate the words into the other person’s language so that both people understand each other.
Intervention
An intervention is treatment, including taking steps to address problems, conditions or complaints.
Jargon
Jargon is a specialist language used by a particular group or industry.
Job Description
A job description is a document that explains your role and responsibilities, the tasks you have to do and who you report to.
KPI
Key performance indicators are the areas a person will be measured on in terms of whether they are undertaking their job effectively.
Kind
Being nice to another person.
Legal Guardian
A legal guardian cares for a person usually because they are unable to look after themselves. The guardian is given legal permission to perform this responsibility.
Life Experiences
Life experiences are the events that have happened during our lives. They often help us form views and values.
Loss
Loss occurs when a person loses someone or something that is important or significant to them.
Mainstream
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Mainstream means the most common trend. For example, mainstream schools are the schools that most people attend. They are the regular primary and high schools, not special schools just for people with disabilities.
Mandatory reporting
Mandatory reporting is the requirement by law to report suspected cases of abuse and neglect.
Mandatory reporting requirements differ from state to state.
Medical Terminology
Medical terminology is special language used in health care to accurately identify and describe the body, its systems and various illnesses and disease.
Mentor
A mentor acts as a sounding board for ideas or plans that may affect your career. Mentoring fosters the development of relationships that benefit both parties. The mentor provides insight and guidance to another and contributes to their goals and aspirations.
Misinterpret
To misinterpret is to incorrectly understand, explain or interpret.
Morality
Peoples’ views of what is good, right, and proper; their beliefs about their obligations; and their ideas about how they should behave.
Morally Wrong
To be morally wrong means to act in a way that is considered wrong by most people. For example, most people think it is wrong to treat others unfairly because of the colour of their skin.
Multilingual
Multilingual means ‘many languages’. People who speak a number of languages are called multilingual. Brochures and signs that are written in different languages are referred to as multilingual.
Mutual
Mutual means something that is shared between two people.
Myth
A myth is something that is not true but is widely believed.
Neglect
Neglect means ignoring or avoiding.
Negotiating skills
Negotiating skills involve communication intended to resolve disputes, to produce an agreement upon courses of action, to bargain for individual or collective advantage, or to craft outcomes to satisfy various interests.
Networks
Networks are groups of people who are linked together in some way.
Next of Kin
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A person’s next of kin is their nearest relative.
Non judgemental approach
A non-judgmental approach means that you communicate in a balanced way; your responses are not informed by your personal opinions or prejudices.
Nutrition
Nutrition means keeping the right level of food types in a person’s body.
Objective
To be objective is to be free from personal feelings or prejudices.
Observing
Observing means watching, listening and remembering details
Ombudsman
An Ombudsman hears, investigates and resolves complaints from citizens or consumers about agencies, departments or service providers. An Ombudsman may be appointed by the government or funded by the industry sector required to have a disputes-resolution process.
Outcome
An outcome is what happened after an event. For example, if the older person told you they’d like to join a club, the outcome would be that you or the older person contacted the club.
Pain Threshold
The amount of pain a person needs to feel before the sensation of pain is experienced.
Palliative Care
Palliative care is the care of a person who is dying. It means making sure they suffer as little as possible when medical care cannot make them better.
Passive Activity
A passive activity doesn’t take much energy. It doesn’t need physical activity to join in.
Patience
Patience is being able to stay calm, especially when it is difficult. Patience includes listening closely when people speak to you, taking the time to understand what they want, not getting upset if they are unreasonable or angry.
Person-centred approach
A person-centred approach to service delivery ensures that the person accessing a service is central to service delivery; responds to the whole person and focuses on a social model of care rather than a medical model of care.
Person-centred therapy
Person-centred therapy focuses on developing a personal relationship with the client to help them help themselves. It is based on what the client wants and needs. The counsellor encourages the client to express their feelings by listening, mirroring what the client has revealed then helping them to explore and understand their feelings for themselves.
Personal Care
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Personal care means helping with tasks such as washing, dressing and undressing, grooming, hair and nail care, toileting, eating and drinking.
Personal Care Support
A personal care support plan spells out the tasks a person needs help with, such as washing, dressing and undressing, grooming, hair and nail care, toileting, eating and drinking.
Personal Hygiene
Personal hygiene includes washing, showering, toileting and looking after your hair and teeth.
Personal protective equipment
Personal protective equipment is used to prevent the worker’s skin, hair and clothing coming into contact with surfaces where there may be disease causing bacteria and viruses. PPE includes gloves, helmets, earplugs, masks, aprons and goggles.
Personal Safety
Personal safety means your own safety.
Personal space
Personal space is how close you can stand to someone and still feel comfortable.
Perspective
Perspective is your individual point of view, which encompasses the context for opinions, beliefs and experiences.
Physical Restraint
A person is physically restrained when they are held, tied or locked up.
Policy and Procedures
A policies and procedures manual is a set of rules, guidelines and instructions to help you do your work correctly.
Policy
A policy is a line of action adopted from other considerations such as government legislation, to guide and determine present and future decisions. Policies provide an overall plan with general goals.
Population
Population means the number of people living in a country or area.
Positive Outlook
To have a positive outlook means to be happy and think about the good aspects of a situation.
Position Description
A position description is usually provided before you accept a position. It details your duties and responsibilities.
Potential
Potential means the chance of something happening.
Power of Attorney (POA)
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If you appoint someone a power of attorney this allows them to make decisions on your behalf. A financial power of attorney gives the person the power to make financial and legal decisions. A medical power of attorney gives the person the power to make medical decisions.
Preference
Preference means someone likes to do one thing more than another.
Privacy
Privacy can mean a similar thing to confidentiality. It can mean making sure you do not share information with others that it is not their business to know. Privacy can also mean respecting the right of a person to have their care done in a private way. Privacy also refers to person and access of others to themselves and their space, possessions and self.
Professional
Being professional means to act in a correct manner at all times. It means to say and do the things you have been taught to do.
Professional Ethics.
The moral commitments of a profession that involve moral reflection that extends and enhances the personal morality practitioners bring to their work, that concern actions of right and wrong in the workplace, and that help individuals resolve moral dilemmas they encounter in their work.
Psychologist
A psychologist is a health professional who specialises in treatment of emotional and mental-health issues.
Psychosocial
Psychosocial relates to the influence of social factors on an individual’s mind or behaviour.
Public Advocate
The Public Advocate is an organisation that is responsible for helping people who are not able to act for themselves, particularly disabled people, by promoting and protecting their rights and dignity.
Quality of Care
A level of performance or accomplishment that characterises the health care provided. There are measures of the quality of care that can be measured objectively. These include structure, process, and outcomes.
Quality of Life
Quality of life is defined as individual’s perception of their position in life in the context of the culture and value system where they live, and in relation to their goals, expectations, standards, and concerns. It is broad ranging concept, incorporating in a complex way a person’s physical health, psychological state, level of independence, social relationships, personal beliefs and relationship to salient features of the environment.
Rapport
Rapport relates to building relationships based on mutual understanding and trust. To build rapport you need appreciate the perspective of others.
Reasonable adjustment
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Reasonable adjustment refers to changes made to make sure care is provided in an inclusive way for all people regardless of their culture, language or disability.
Records
Records are usually written documents that detail information about the workplace, the people who work there and people who receive a service.
Recreation
Recreation means the activities people do for enjoyment.
Regulations
Regulations are the rules, procedures, guidelines, codes of practice and so on, that are written by a body that has its authority given to it by an Act of Parliament. The Work Cover Authority in your state is an example of a body authorised to make regulations.
Reminiscence
Reminiscence means remembering things from the past.
Reminiscence therapy
Reminiscence therapy is used to support older people and those with cognitive impairment. It is about respecting the life and experiences of that person to help them maintain their mental health.
Respect
To treat someone thoughtfully, be polite, listen carefully and think about their feelings.
Respite
Respite means time away from normal caring duties. Respite means carers (such as family members) can do things like go shopping, see a movie or visit a friend.
Respite care
Respite care means giving unpaid carers a rest by providing care for a short time.
Review
Review means to check what has happened in order to find out what worked well and where you need to improve.
Risk
A risk is the chance, high or low, that a hazard will cause harm, injury or ill health.
Risk Factor
Social, Economic or biological status, behaviours or environments, which are associated with, cause increased susceptibility to a specific disease, ill health, or injury.
Risk management
Risk management means understanding the situation, deciding the best action to take and making a plan to deal with the risk.
Routine
A routine is the usual way a person arranges tasks and activities. It may involve a certain time, place and method used to complete each task.
Segregated
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Segregated is when people are removed from the main community to live separately.
Self-destruction
Self-destruction is when people deliberately harm themselves.
Self-destructive behaviour
Self-destructive behaviour means a person hurts themselves.
Self-determination
Self-determination means having freedom and independence. It means being able to do things of your own free will.
Self-esteem
Self-esteem means how you feel about yourself and your own value as a person.
Self-reflection
Self-reflection is a form of self-evaluation that a worker usually carries out by themselves. Selfreflection involves thinking about your work practice and identifying areas for improvement. Many workers use a journal to reflect on their daily practice.
Sense of Humour
A sense of humour is the ability to see the funny side of a situation.
Sensory Systems
Sensory systems refer to the eyes, nose, mouth, ears and nerve endings that provide the sense of sight, smell, taste, hearing and touch.
Sensitivity
Sensitivity means understanding and respecting a person’s beliefs. It means not doing anything without thinking about the other person’s feelings.
Service standards
Service standards are standards that particular parts of the community sector must attain. Usually standards are used to assess whether services meet their obligations.
Shock
Shock is a physical condition. It occurs when a person has experienced a loss or other emotional or physical trauma.
Sign
An indication of illness or disease that is visible or measurable
Slide boards
Slide boards are rigid, flat boards that are used to help a person transfer from one place top another more easily.
Social
Being social means spending time with other people.
Social changes
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Being social means being with friends and family. Social changes are the changes that take place in a person’s life in regard to their friends, hobbies and entertainment.
Social devaluation
Social devaluation is when someone thinks of someone else as having little or no value because of some characteristic such as a physical or intellectual disability, or an impairment.
Social interactions
Social interactions are informal meetings and communications between individuals and small groups of people for enjoyment and friendship.
Socially isolated
Socially isolated means a person being on their own a lot and do not do social activities.
Socially Network
A social network is a group of people who know each other, share a common link and meet regularly.
Stakeholder
A stakeholder is a person or group with a direct interest in or that is affected by a particular issue, enterprise or person.
Standard precautions
Standard precautions are the work practices required to achieve a basic level of infection control and are recommended in the care of all clients.
Stereotype
A stereotype is a belief or idea about a person or a group of people.
Stereotyping
Stereotyping is presuming that someone or something fits a certain convention or standard.
Stress
Feeling stressed is the opposite of feeling relaxed. When a person is feeling stressed, they usually experience a heightened level of physiological arousal.
Supervision or ‘professional guidance’
Is the process of being given guidance and advice by someone who has experience or expertise in your field regarding problems and difficulties that arise in your work.
Supervision can allow better understanding of your facilitator practice, by becoming more aware of your own reactions and examining alternative ways of educating the group. There are three functions of supervision – educational, management and supportive.
Symptom
A symptom is a sign of an illness or disease that is not measurable or readily observable; it may be based on how the patient feels.
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Terminal Illness
A terminal illness is an active disease that cannot be cured and is expected to lead to death.
Tolerance
Tolerance means accepting other people’s rights to uphold and practice their ideas, beliefs or customs.
Tolerant Accepting
Tolerant Accepting the way another person thinks or behaves.
Trigger
A trigger is the cause of difficult or challenging behaviour from the older person. The trigger is what sets off the behaviour.
Understanding
Knowing why a person feels and acts in a certain way.
Unethical behaviour
Unethical behaviour means choosing to do something that is wrong.
Universal Declaration of Human Rights
The Universal Declaration of Human Rights describes the rights that should be attributed to all humans.
Universal precautions
Universal precautions assumes blood and body fluids of all clients and individuals are potentially infectious and responds by applying a set of precautions designed to prevent transmission of infectious diseases to all situations.
Valid
An assessment method is considered valid if measures what it set out to Measure
Values.
Qualities or principles that individuals believe to be desirable or worthwhile and that they prize for themselves, for others, and for the world in which they live.
Verbal report
A verbal report means it uses spoken words rather than writing the details down.
Volunteer
A person who works for no payment. There are many volunteers in the aged care industry.
Wellbeing
Wellbeing means being healthy and feeling good.
Western culture
Western culture describes the cultures of Europe and similar countries in other parts of the world, such as North America and Australasia.
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Work colleagues
Work colleagues or co-workers are the people employed at your workplace. They are the people in your team, such as other workers, your supervisor and your manager.
Working relationship
A working relationship means how you work together with someone.
Written Report
A written report means it has been written down. It has not just been spoken about.
Zero tolerance
Zero tolerance approaches favour strategies that promote abstinence over harm reduction and view illicit drug use as a moral and criminal issue that must be managed by strict law enforcement rather than public health initiatives.
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