Providing services to customers with disabilities 008-01030000

Common medical conditions can be categorised into physical disabilities, cognitive impairments and illnesses.

Common medical conditions that customers may have include:

• arthritis, rheumatism and osteoporosis, with associated pain
• digestive and urinary disorders
• visual loss
• deaf, have hearing loss or, have a speech disability
• dementia and Alzheimer’s disease
• Parkinson’s disease
• heart disease
• diabetes (Type II)
• respiratory disorders
• urinary disorders
• age related skin changes such as skin thinning and a thinning of the fat layer under the skin

Common ailments that customers may report to a Service Officer include:

• joint pain
• reduced physical tolerance
• restricted mobility and dexterity
• anxiety, fear and insecurity
• visual loss
• deaf, have hearing loss or, have a speech disability
• skin ulcerations, abrasions and temperature sensitivity
• shortness of breath
• short term memory loss
• confusion and disorientation
• incontinence
• involuntary shakiness or freezing of the legs (hesitation to move when beginning to walk or a sudden inability to move the feet) associated with Parkinson’s disease

It is important to be sensitive when dealing with aged customers or their carers when they are providing information about their medical conditions. When speaking to a customer:

• be patient, respectful and courteous
• seek permission before calling the customer by their first name
• listen fully to what the person is saying before speaking
• do not interrupt, explain information clearly (without talking down to the customer)
• read and offer to complete forms for the customer
• reduce the customer’s waiting time as much as possible
• ensure that comfortable seating is available
• provide private interview facilities if requested

Many medical conditions or disabilities can affect children. They can be categorised into physical or learning disabilities and illnesses, which may include cerebral palsy, Down Syndrome and cancer.

Some common medical conditions that a child may have include:

• cerebral palsy
• autism
• Attention Deficit Hyperactivity Disorder (ADHD)
• asthma
• acute illnesses such as cancer, leukaemia
• psychiatric illnesses
• genetic and/or chromosomal disorders including Down Syndrome
• visual loss
• deaf, have hearing loss or, have a speech disability
• haemophilia

As child disability can be an emotive issue, it is important to be sensitive when dealing with parents, who may experience a range of emotions, including:

• shock, especially where the diagnosis is recent
• grief, especially when a baby is born with a disability
• fear
• stress
• fatigue
• guilt
• denial

When interviewing parents of a child with a disability, be mindful of:

• remaining non-judgemental
• relying on facts
• acknowledging personal feelings in an appropriate way
• seeking information from appropriate sources

If there is a need to book an appointment, make sure it is at an appropriate time, taking into account the caring role the parent needs to maintain.

A social worker interview may also be beneficial.

There are varying degrees of hearing loss and speech disability.

Hearing loss can be complete or partial. The age of the person at the onset of hearing loss can also affect the person’s ability to hear and speak.

People who do not have hearing loss often use the term ‘deaf’. It is more appropriate to use the term deaf for people who are born deaf or became deaf prior to language acquisition and whose preferred method of communication is sign language.

Speech disability can develop in adults gradually, but they can also develop suddenly, such as in the case of stroke or medical procedure. Disorders can include the loss of ability to express or understand language, problems making certain sounds or words (for example, slurring) and changes to the rhythm or speed of speech.

People affected with speech disability are more likely to have mental illness, learning difficulties, behavioural disorders or may be socially isolate.

Tinnitus is where the person hears a sound, a ringing, or a noise when no external noise is present. The noise can be intermittent or constant, mild or severe and may vary from a low roar to a high-pitched sound.

Noise induced hearing loss (sensorineural hearing loss) usually develops over a period of years, although it can occur more rapidly following exposure to a loud noise. A noise which is regular and of a continuing frequency or pitch level can result in this kind of hearing loss.

Meniere’s disease is progressive disease of the inner ear in which the first symptom is usually vertigo (dizziness). Over time tinnitus and hearing loss can develop.

Presbycusis is a progressive, high frequency hearing loss that is associated with increasing age. It can be complicated not only by a decrease of the nerve cells in the inner ear available for transmission of auditory signals, but also the additional loss of hearing receptors in the brain in which results in poorer speech discrimination than might be expected from the degree of hearing loss.

Outer/middle ear infections may be caused by the build-up of wax in the outer ear cancel, which can lead to a reduction in hearing acuity. Medical treatment to remove the wax is usually all that is required. Middle ear infections can lead to permanent damage if not treated. These are common in young children. Chronic ear infection may result in ‘glue ear’, which affects the ability of the tiny bones of the middle ear to transmit sound to the inner ear.

The age at onset of hearing loss has significant implications for a person. A hearing loss is described as either:

• prelingual (no exposure to oral language). Prelingual deafness or hearing loss may be present before birth or before language is developed, or
• acquired (some exposure to oral language)

Hearing loss can also be acquired postlingually (after language has developed). However, the important difference between prelingual deafness and an acquired hearing loss is that the person has had exposure to the spoken language and, therefore, has had an opportunity to develop an appreciation of the sound and structure of language.

A hearing aid is a device used to improve hearing that a person wears in or behind the ear. The type of hearing aid a person has will be dependent on their lifestyle and situation.

A cochlear implant is an implanted electronic hearing device. It works by electronically stimulating the nerves inside the inner ear. This is different to a hearing aid.

• Lip reading and speech reading is a skill of understanding speech by interpreting the shape of the lips and the visual movements of the muscles involved in speech production. Speech reading is the ability to understand the intent of a speaker by watching the movements of the face and body by using information and language used by the situation
• Manual communication refers to communication which is achieved by the use of the hands rather than verbal communication
• Finger spelling (not to be confused with sign language). In finger spelling, signs represent letters of the alphabet. The person writes in the air using their finger, spelling words out letter by letter. In Australia finger spelling is used more extensively by older members of the community
• Mime is a way using gestures and bodily movement, without speech or sound, to act out something
• Gesture is movement of the body and especially the hands and arms which express an idea, emotion or attitude
• Signs is the most commonly series of movements used by people who are deaf
• Sign language. The native sign language of Australia is Auslan. To increase the person’s exposure to English, various methods have been devised for sign language. Some people will use just the 26 hand configurations to represent the letters of the alphabet while others use a combination of signs and finger spelling
• Writing is a common form of communication that can be used either via a device or pen and paper

Available options include:

• Internet, customers who can access the internet may prefer to conduct their business online
• Assistive technology, a range of assistive technologies is available to help customers with hearing loss hear the telephone, television or doorbell. See the Resources page for links to the Department of Infrastructure, Transport, Regional Development and Communication’s Accesshub, Services Australia’s Accessibility webpage and other useful links
• Hearing Augmentation Devices (also known as Hearing Loop, and Audio Loop technology), some form of these devices are available in all Services Australia service centres for customers or staff that have compatible hearing aids to assist with face to face communication. Some sites have a permanent hearing loop system and other have portable sound shuttles. See supplied office instruction for appropriate set up and use
• Teletypewriter communication (TTY), these messages are sent via telephone lines. The person who is deaf or has a hearing loss types their message via a keyboard and these messages are then decoded by a TTY at the other end of the phone line and displayed as a written message. When communicating with someone via the TTY, use simple language and ensure the message is short. For contact details, see Hearing loss
• Services Australia has a direct TTY number and use the National Relay Service (NRS) for help making or receiving calls through the NRS to people who are deaf, have hearing loss, or speech disability
• National Relay Service (NRS), the NRS is managed by the Department of Infrastructure, Transport, Regional Development and Communications. It allows people who are deaf, have hearing loss or, have a speech disability to make and receive calls with different technologies. This includes TTY and Video Relay (for Auslan users)
• Hearing Services Program, provides information about the Australian Government Hearing Services Program (Department of Health and Aged Care)
• Hearing Australia, provides hearing services for children and young adults under 26. Aboriginal and Torres Strait Islanders, pensioners and veterans can be contacted through National Relay Service
• Interpreter, see Interpreter Services for customers who are deaf or hard of hearing

When speaking to a person with hearing loss or speech disability:

• get the person’s attention before starting a conversation
• make sure the person can see your face without any obstructions. For example, do not cover your mouth while speaking. Many people use lip reading to help understand what is being said
• reduce any background noise or try to find a quieter place to have a conversation
• do not shout or speak loudly to the person unless requested, as this can be confusing and uncomfortable for a person wearing a hearing aid
• speak clearly and slowly but do not exaggerate mouth movements
• use natural gestures and facial expression to enhance the meaning of the discussion and to keep the listener interested
• look directly at the person. This is so the person is able to lip-read. Do not move around whilst talking to a person who is trying to lip-read
• use short and straightforward sentences and repeat or rephrase sentences if the person misunderstands. If words need to be used that a person may not understand, write them down and explain to the person what it means

When listening to a person who is deaf or has a hearing loss or speech disability:

• encourage the speaker to use their preferred method of communication
• listen carefully to what the speaker says/signs
• pay attention to the speaker’s facial expressions and gestures to gain extra information about what is being conveyed
• ask for information to be repeated if it is not understood and always encourage the speaker to continue the conversation even if it is difficult to understand each other
• always double check information to make sure the message is understood

Writing information for a person who is deaf or has a hearing loss or speech disability is extremely useful but remember:

• the most important information needs to be written first and only introduce one idea at a time
• write ideas down as they are discussed or as they occur
• write details about time, place and person at the beginning of a sentence wherever possible and do not use unnecessary words
• only use words that are common and understood by most people and always break long sentences into short and concise sentences
• if jargon or a technical term is required, explain the words and make sure that they are understood

Human Immunodeficiency Virus (HIV) is a virus which harms the immune system by destroying the white blood cells that fight infection. Acquired Immune Deficiency Syndrome (AIDS) occurs when the immune system has been permanently damaged by HIV and is no longer effective at protecting the body.

HIV and AIDS are not the same. HIV is the virus that leads to AIDS. Not everyone who has HIV will develop AIDS.

In the early 1980’s, when the HIV/AIDS epidemic began, patients rarely lived longer than a few years. But today, there are many effective medicines to fight the infection, and people with HIV have longer, healthier lives.

These medicines help people with HIV, but do not cure HIV/AIDS. People with HIV infection still have the virus in their bodies.

The Service Officer should relate to the person with HIV/AIDS as they would any other person. Do not show reluctance to handle the person’s papers. Recognise that the person may be dealing with a lot of personal and social issues, and endeavour to make interactions with Services Australia as positive and painless as possible.

Provide information about appointing a nominee or authorised person, if appropriate. Be sensitive to any privacy concerns. Respect the privacy and confidentiality of the information they are handling. The HIV status must not be disclosed to employers, Employment Service Providers or anyone else.

Sensitive medical conditions such as HIV/AIDS should not be recorded on a DOC.

A person with an intellectual disability can be affected in the following ways:

• reduced learning capacity, comprehension, memory and communication ability
• have difficulty in understanding a string of instructions, abstract concepts and information

To determine if a person has an intellectual disability an intellectual assessment is done. This involves a standard assessment where the results of the tests can be compared to an average and an Intelligence Quotient (IQ) is determined.

Prenatal causes

The cause is considered to have occurred prior to birth but the actual cause may not be known. Some causes of intellectual disabilities at the prenatal stage are:

• chromosomal disorders
• Down Syndrome (trisomy 21) occurs when a person has an extra chromosome
• Klinefelter’s Syndrome (XXY Syndrome) occurs when a male has an extra ‘X’ chromosome
• inborn errors of metabolism - where the body cannot absorb and/or process chemical substances naturally present in the food and necessary for the health of the body and brain. For example, if the thyroid gland is absent or is only partially functioning at birth
• developmental disorders of brain formation – these abnormalities that occur in the development of a person’s brain prior to birth, e.g. incomplete closure of the neural tube which results in anencephaly and the condition where the size of the person’s head is significantly affected (hydrocephaly or microcephaly)
• environmental influences
• maternal malnutrition
• the effects of drugs or alcohol
• some maternal diseases

Perinatal causes

Some perinatal causes of intellectual disability include:

• intrauterine disorders – these are conditions within the uterus such as toxaemia, complications of labour or multiple births
• neonatal disorders – these conditions arise from trauma or damage to the newborn brought about by things such as abnormal bleeding, respiratory problems and infections.

Postnatal causes

Intellectual disabilities can also occur after birth. For example, in early childhood due to diseases and/or environmental factors. Some postnatal causes of intellectual disability include:

• infections. For example, encephalitis and meningitis
• demyelinating disorders
• degenerative disorders which affects intellectual and often physical functions over a period of time
• seizure disorders
• toxic-metabolic disorders
• accidents resulting in oxygen deprivation. For example, near drowning
• head injuries
• malnutrition - the inadequate dietary intake of essential nutrition
• environmental deprivation includes disabilities due to psycho-social disadvantage such as poverty, child abuse, neglect and social deprivation

Do not talk down to a person with an intellectual disability. The same amount of respect is to be displayed as when talking to anyone. Use a normal tone of voice and avoid using jargon. It is a good idea to use short, straightforward sentences.

Often a person with an intellectual disability is accompanied by a nominee or support person. Speak directly to the person and not to their nominee/ support person. The person needs to be acknowledged as any other person would be. If they are unable to comprehend or communicate, the nominee/ support person will advise the Service Officer.

Service Officers may help the customer by:

• being patient, respectful and courteous
• using a calm tone of voice and avoid using jargon
• ensuring the customer understands what is expected or involved
• recording appointment times or tasks so they are not forgotten
• using plain English to facilitate understanding
• interpreting written material which may be complex and summarising key point for the customer
• assistance with completing forms
• Promoting nominees where appropriate

A person is considered to have a mental health condition when their thoughts, behaviour and feelings cause acute stress to themselves or others and interfere with their social or occupational functioning.

Customers with psychiatric and psychological conditions may suffer from episodes of being unwell in between periods of good health and functioning, while others may be continually unwell.

Types of psychiatric and psychological conditions

Depression is a common mental health condition which can sometimes be associated with other medical conditions. The symptoms include changes in emotion/mood, impaired cognitive functioning, reduced motivation and changes in physical functioning such as weight loss/gain, reduced energy levels and sleep disturbance. Some people can feel suicidal.

Anxiety disorder may be associated with panic attacks. A panic attack characterised by sudden onset of intense fear accompanied by symptoms such as rapid heartbeat, shortness of breath, sweating, dizziness, trembling and feelings of unreality. The intensity of the attack can vary.

Phobias are an excessive or unreasonable fear of certain objects or situations. Agoraphobia is a fear of being in a situation from which it would be difficult to escape or where help might not be readily available.

Obsessive compulsive disorder involves repeated, intrusive thoughts or compulsive behaviours which are usually known to be irrational. Obsessions may focus on a fear of harming others, acquiring or spreading contamination, doubt about having performed a task. Compulsions can involve rituals of cleaning, repeating, checking, hoarding or avoiding.

Post-traumatic stress disorder (PTSD) is a severe reaction to a traumatic event often involving actual or threatened death or serious injury to themselves or others. Post-traumatic stress disorder occurs where a person experiences persistent and intrusive recollections or dreams about the event. They often try to avoid situations that are associated with the trauma.

Bipolar affective disorder is a mood disorder characterised by a person experiencing both episodes of depression and extreme elation or mania. During a manic phase, a person is often highly excited, over-active, over-confident, over-talkative and may lose touch with reality. In the depressed phase, a person can become sad, pessimistic about the future, withdrawn, underactive or have feelings of guilt. In either mood, people may experience hallucinations/delusions, sleep disturbance, frequent tearfulness, loss of concentration, a short attention span, confused thinking, and mood swings from a general hyperactive state to a flattened mood.

Schizophrenia is characterised by social withdrawal, reduced emotional expressiveness and perceptual distortions. A misconception about schizophrenia is that the person has a split personality. The cause of schizophrenia is unknown and it has many varied symptoms, such as:

• delusions
• hallucinations – auditory and visual
• disordered thinking and attention
• bizarre behaviour
• emotional withdrawal
• loss of motivation

An acute schizophrenic episode is characterised by such things as:

• alterations in the senses. For example, hearing voices
• changes in emotional responsiveness
• changes in behaviour such as neglect of personal health care, hygiene and presentation
• having an altered sense of self and others e.g. may have unrealistic ideas about their own importance or unreasonable fears that others are trying to influence or harm them in some way
• having impaired concentration and cognitive functioning resulting in an inability to respond appropriately

Service Officers may help the customer by:

• being patient, respectful and courteous taking into account their individual circumstances
• not talking down to a person with mental health conditions.
• using a calm, normal tone of voice and avoid using jargon
• giving the person time to respond
• asking specific questions, redirect the conversation if the person wanders off the topic
• making it clear what the customer needs to do by providing accurate and consistent information
• ensuring the customer or their nominee understands what is expected or involved
• allowing time for the customer to mentally process information and for them to respond
• promoting nominees where appropriate
  

Neck and back pain are the most common forms of musculoskeletal conditions. Some causes of neck and back pain are:

• muscle and ligament strain
• direct trauma
• fractures and whiplash
• disc damage (ruptured or a prolapsed disc)
• arthritis and osteoporosis
• nerve or nerve root damage (sciatica)
• congenital deformity or disease
• spondylosis and disease

A person with a neck or back condition may have some or all of the following reduced abilities or limitations such as:

• reduced tolerance to sit and stand
• reduced capacity to work or drive
• reduced ability to walk, inability to run, climb, squat or bend
• inability to lift or carry moderate to heavy objects
• reduced range of movement, sensation or strength in the neck, back, arms or legs
• mobility restrictions on public and private transport
• social isolation with a reduced capacity to be with other people due to restrictions, pain or medication
• some confusion and/or difficulty remembering things due to the effects of medication
• loss of self-esteem or low mood due to chronic pain, inability to participate in the workforce and/or participate in family and social functions
• grief over loss and/or reduced financial independence

Most causes of spinal cord injury (SCI) are traumatic. For example, motor vehicle accidents, falls, water sports and crash injuries. Non-traumatic causes are less common and include infections and tumours.

The types of SCI are:

• complete injury – this is the loss of all movement and sensation below the level of the SCI
• incomplete injury – there may be some sensation or muscle movement below the level of injury
• quadriplegia – injury is at the level of the cervical (neck) cord segments. Quadriplegia means paralysis or weakness in all four limbs and trunk
• paraplegia – the level of injury is below the cervical (neck) cord segments. Paraplegia means paralysis or weakness in the legs and sometimes the trunk (depending on the level of injury)

Paraplegia or quadriplegia can be complete or incomplete. Not all people in wheelchairs have an SCI and not all people with an SCI use wheelchairs.

Service Officers need to be aware of the customer’s disability and the limitations that may impact the way Service Officers help the customer. This can include:

• advising the customer to feel free to sit, stand and or move about if they are in discomfort
• offering to write down key information and/or appointment times if they are experiencing difficulty concentrating
• promoting nominees where appropriate
• considering liaising with the hospital social worker if the customer is in hospital

Blindness is the loss of normal or correct vision. A person may be classified as legally blind but may have some residual or remaining vision (low vision). The type and extent of the visual loss will determine the amount of residual vision.

A person may need assistance, such as the prescription of appropriate low vision optical resources (magnifiers and telescopes), and training in their use.

• Cataracts are a clouding of the lenses within the eyes, which is normally clear and transparent
• Diabetic retinopathy is directly related to diabetes mellitus and involves the retina and can include haemorrhage, swelling, detachment and growth of new blood vessels which leads to the progressive blurring of vision
• Glaucoma involves a rise in the level of pressure within the eye which leads to damage of the optic nerve. This in turn can result in the loss of peripheral (side) vision and, unless detected early, can lead to blindness
• Cone dystrophy results in the damage or breakdown of cone cells in the macula (this is the small central spot on the retina responsible for detailed vision). This condition does not result in total blindness, as peripheral vision remains intact
• Retinitis pigmentosa is an inherited degenerative condition which affect the retina. It particularly affects the rods which are the receptors in the retina responsible for night vision and detecting movement in the peripheral vision
• Hemianopia is caused by a Cerebral Vascular Accident (CVA) which is more commonly known as a stroke. The condition can vary in severity and may be temporary or permanent

A customer with a disability or medical condition affecting their vision can request to have their letters converted to large font, floppy disk or Braille. Customers may also be contacted by phone if a letter has information that is considered urgent, important or will affect payment.

Customers interested in this service should be advised that an administrative requirement of the process is that a customer must agree to have the 'Accessible Letters Manager, P.O. Box 7833 Canberra BC ACT 2610' recorded as their postal address. This arrangement enables relevant letters to be identified.

See Accessible letters for customers with vision loss for information on the process to add the Accessible Letters Manager mailing address to the customer’s record.

If a person is incapable of completing forms due to their disability and does not have a nominee or another person who is able to help them, a Service Officer can complete the form on their behalf.

If a person contacts by phone and requests help to complete a form, they should be directed to their local service centre.

If their disability allows, ask the person to provide an acceptable form of identification. Alternatively, ask them to provide personal information (e.g. contact details, date of birth) and compare the information given with the information held on their record to confirm their identity.

Note: note on the form that the person is unable to complete the form and briefly explain why.

The Service Officer should:

• tell the customer who they are and let them know when entering or leaving their presence
• not give visual hand signals in the place of words when providing instructions or directions
• ensure they face the customer and speak in a clear, normal voice
• describe seating to the customer, such as whether the chair has arms and a back
• not leave them sitting or standing on their own without explaining what is happening
• verbalise thoughts and feelings that would usually be sent through non-verbal mannerisms and cues
• ask them if they need help or further explanation of a task
• not assume they need help or help them without telling them what is about to happen
• talk to them about the surrounding environment and what movements are required to get from point A to B
• initially offer the back of their hand, thus indicating the location and position of their body. If the Service Officer is uncomfortable with where the person is gripping them, they should let them know so they are able to select a more appropriate/comfortable location
• inform the customer of any obstacles such as a narrow doorways or blockages and provide specific details of how to get around this
• offer to help them leave the office

A developmental disorder begins during the developmental period and may impact day-to-day functioning by impairing physical, learning, and language or behaviour areas. The disorder usually lasts throughout the person’s lifetime.

Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is a lifelong developmental condition that impairs the ability to communicate and interact. The range and severity of symptoms can vary widely between individuals.

Common symptoms include:

• difficulty with communication
• difficulty with social interactions
• obsessive interests
• repetitive behaviours
• sensory sensitivities – for example individuals may get easily upset by certain sounds or textures

Attention deficit/hyperactivity disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) is a pattern of behaviour that begins in childhood, and in most cases continues throughout the person’s life. Key features of ADHD are inability to concentrate and easily distracted, as well as hyperactivity and impulsiveness.

Do not talk down to a person with a developmental disorder. The same amount of respect is to be displayed as when talking to anyone. Use a normal tone of voice and avoid using jargon. It is a good idea to use short, straightforward sentences.

Service Officers may help the customer by:

• being patient, respectful and courteous
• using a calm tone of voice and avoid using jargon
• ensuring the customer or their nominee understands what is expected or involved
• recording appointment times or tasks so they are not forgotten
• using plain English to facilitate understanding
• interpreting written material which may be complex and summarising key points for the customer
• assistance with completing forms
• promoting nominees where appropriate