Adjustments for disabled(neurodiversity)

This lists of adjustments that have been agreed for dyslexia by different organisations and so will normally be consider reasonable without a justifiable reason to refuse in their particular circumstances .

From Equal treatment bench book( what courts would consider reasonable in a court )

•    Putting any written instructions in plain English.

•   Staggering instructions and Orders.

•    Not expecting the individual to formulate complex further particulars, schedules of loss,    Scott schedules etc. Asking for information in bite sizes.

•   Clear formatting on correspondence: font size at least 12, clear typeface, greater spacing, sometimes coloured paper (often yellow, but the particular colour might matter). Beware loss of formatting on emails.

•   Electronic communication helps those who rely on speech recognition software.

•   Reminders of time-limits and dates

•   Providing clear directions to the venue, with local landmarks and public transport details.

•   Regular short breaks to help sustain concentration.

•   Explanations and instructions given slowly and clearly.

•   Providing a ruler on the witness stand, as an aid to focused reading.

•   Dealing with heating and lighting if hypersensitivity is an issue.

•   Patience – accepting the individual will provide unimportant detail together with important points; waiting for the person to process a question and respond.

•   Adjustments to cross-examination style including:

◦  Questions asked singly.

◦  Thinking time allowed to assimilate information and produce a considered response.

◦  Not asking the person to read through large parts of a document and comment on it.

◦  Providing questions in advance of the hearing. If ‘mental overload’ has been reached and the individual is unable to participate in the process, he or she will need to be given sufficient time to recover. It is of paramount importance that adults with SpLDs are reassured that:

• They may seek clarification at any stage by asking for a question to be repeated or re-phrasing it to check understanding.

• They can take their time when considering responses and can inform the judge when they are no longer able to maintain concentration.

• Misunderstandings on their part will not be treated as evasiveness and inconsistencies will not be regarded as indications of untruthfulness.

• They are not expected to rely on their memory alone for details of dates, times locations and sequences of events.

• They will not be expected to skim through and absorb new documentation or locate specific pieces of information in the court bundle.

• Simplifying wording of correspondence or court orders, if necessary, departing from standard forms.

• Providing documents / guidance leaflets in Easy Read format if available. Many of these are used in the criminal justice system.

• When composing letters, these adjustments may help for many learning / developmental disabilities:

* Short sentences and simple punctuation.

* Use uncomplicated language.

* Avoiding all jargon.

* Using ‘you’ and ‘we’ rather than third person.

* Writing rather than spelling numbers.

* Using bullet points for key points.

* Using sub-headings and allowing white space between sections.

* Using larger print, clear typeface, greater spacing, coloured paper.

* Using photos / drawings / concrete symbols to support text.

* Being careful about loss of formatting on emails.

• Where written or telephone communication is difficult, confusing or stressful, holding additional case management preliminary hearings. Mental Disability Equal Treatment Bench Book 122

• Being more explicit with instructions, i.e. stating what appears to be obvious (e.g. precisely to whom documents should be sent; explaining that ‘send to the respondent’ means ‘send to the respondent’s solicitor’ if the respondent is represented.)

•   Avoiding referring to parties by their status, eg ‘claimant’, ‘respondent’, ‘appellant’, ‘party’, ‘counsel’, and using their actual names.

•   Avoiding making too many orders or giving too many instructions and tasks at once, or which are to be completed at one time.

•   Extending time-limits for taking action.

•   Allowing longer for case management / preliminary hearings.

•   Making necessary adjustments to any case management / preliminary hearings (eg a suitable room). Many of the adjustments which would be needed at a full hearing / trial may be necessary at preliminary hearings, but can be overlooked at that stage.

•   Ensuring case management preliminary hearings have a fixed start time, to avoid exacerbating any underlying stresses that person may have. If several are listed together, taking the disabled person’s preliminary / case management hearing first.

•   Holding telephone case management rather than requiring the disabled party to travel and attend.

•   Expediting the final hearing date.

•   Bearing in mind that mental ill health might affect an individual’s attitude towards and ability to participate in forms of mediation.

British Dyslexia Association suggested adjustments

Reading

•   Give verbal as well as written instructions Highlight important points in documents

•   Use voicemail rather than written memo

•   Supply screen-reading software or a Reading Pen

•   Print resources on coloured paper, and change background colour of computer screens and presentations#

Reading and writing

•   Allow plenty of time to read and complete a task

•   Discuss the material with the employee, giving summaries and/or key points

•   Present information in other formats e.g. audio or video, drawings, diagrams and flowcharts

• Offer/use mind-mapping software

• Offer/use digital recorders

• Offer/use speech to text software

• Ask someone else to take the Minutes of meetings

Spelling and grammar

• Spell checker on all computers

• Offer assistive text software on all applications, where possible

Computer work

• Change background colour of screen to suit individual preference

• Supply anti-glare screen filter

• Allow frequent breaks, at least every hour

• Alternate computer work with other tasks where possible

• Avoid continuous all day computer work

Verbal communication

• Give instructions one at a time, slowly and clearly without distractions

• Write down important information or encourage the employee to take notes

• Write a memo outlining a plan of action

• Provide a digital recorder to record presentations/training

• Check understanding

Concentration

• Make sure there is a quiet space available away from distractions such as doors, busy phones, loud machinery

• Allocate a private workspace if possible

• Allow an employee to work from home occasionally, if possible

• Use a “do not disturb” sign when tasks require intense concentration

• If interrupting, allow the person to pause and write down what they are doing to refer to when resuming work

Appointments and deadlines

• Remind the person of important deadlines and review priorities regularly

• Encourage the employee to use the daily calendar and alarm features on his/her computer or work phone.

Tips for organisation of property

• Ensure that work areas are organised, neat and tidy

• Keep items where they can be clearly seen for example shelves and bulletin boards

•   Ensure the team returns important items to the same place each time

•   Colour code items, if appropriate

•   Ensure work areas are well lit

Organising workflow

•   Prioritise important tasks

•   Create a daily, dated “To Do” list

•   Use and share diaries

•   Write a layout for regular tasks with appropriate prompts for example for meetings or taking notes

•   Build planning time into each day

Supporting directional difficulties

•   Always try to use the same route

•   Show the route and visible landmarks

•   Give time to practise going from one place to another

•   Supply detailed maps

•   Supply GPS car navigation system

Surrey & Sussex Healthcare NHS Trust Non Specific

Examples of common reasonable adjustments

•   A phased return to work - starting with part-time working and building up. Perhaps you could look at aspects of the job that the person finds particularly stressful and rearrange responsibilities.

•   Adjusting the content of the job.

•   Additional training around specific job requirements and/or around skills enhancement such as: communication skills, time management, etc.

•   You could offer the option of working at home for some of the time; time off for attending therapeutic sessions. (This should be allowed for all medical problems); changing shift patterns or exploring different work options such as: part-time, job-share; flexible working around agreed outputs.

•    You might offer a later or earlier start to avoid rush hour travel and review if any provisions are necessary or useful in terms of their physical health.

•   Minor physical adjustments such as: additional lumbar support, an ergonomic mouse, installing hand rails.

•   Using language interpreters such as British Sign Language.

•   Providing some additional training or re-training. It may be necessary for someone to develop new skills to be able to continue to carry out their existing role. In some circumstances it may be reasonable to provide some training for an employee to undertake a new role.

•   Adaptive software such as “speech to text” packages can remove barriers to using ICT.

Royal College of Nurses (RCN) 1 (74)

Strategies to help colleagues

•   Allow extra time for reading.

•   Present the individual with essential reading well in advance of meetings

– highlighting important parts if appropriate.

•   Provide opportunities to discuss reading.

•   When producing word processed documents try to make it ‘dyslexian friendly’ in other words: – write in a logical sequence

– avoid small print (use font size 12 or above)

– use a dyslexia friendly font (for example arial, verdana, tahoma or lucinda sans are best)

– use bullet points in preference to sentences where possible

– use simple words/avoid overuse of jargon or uncommon words

– do not justify the right hand margin – this makes the spaces between words uneven and harder to read if you are dyslexic

– space the information so it is not cramped, use short paragraphs to break up dense text

– where possible print documents on off white/cream paper.

•   Provide a list of common terminology in your area for new staff and students.

•   Help colleagues to feel able to ask if there is a word they are uncertain about the spelling of.

•   Help a student/colleague to invent and use mnemonics.

•   Encourage the individual to use ‘to do’ lists rather than trying to remember.

•   Don’t give too many instructions at once.

•   Prepare printed ‘handover sheets’ covering core information – the individual can add to these but it will reduce the amount they need to write down and avoids things being missed.

•   Make sure that there is always something to write on (and a pen) near the phone.

•   Help a colleague to draw up a plan highlighting important tasks/ deadlines.

•   Set clear, measurable targets.

•   Allow enough time for the person to grasp key information, try not to rush them.

•   In the case of procedures allow the person a chance to practice (ideally as close as possible to when you explained it or demonstrated it).

•   Explain things more than once if required.

•   Where possible give instructions in written and verbal form (you could consider using a digital voice recorder to record sets of instructions).

•   For students or new staff create an orientation pack for your area, outlining useful information and routines.

•   Allow colleagues quiet time where possible to complete tasks such as paperwork.

•   Avoid interrupting a colleague if it is at all possible

•   Help colleagues to build up a list of how long things take to do.

•   For students/new staff set achievable time related tasks, for example don’t expect them to plan a whole day at first, start with a few hours/morning and build up.

•   With students ask them to tell you what the key activities are at the beginning of the shift – remind them of things they have forgotten.

•   Provide opportunities for practice.

•   Explore availability of specialist/alternative equipment which might be easier to use (providing this could constitute a reasonable adjustment)

•   Present information more than once and ideally in different formats

•   Provide frequent opportunities for practice

•   Help a student or colleague to invent and use mnemonics

•   Encourage use of reflection to help individuals to transfer previous learning.

•   Allow enough time for the person to grasp key information, try not to rush them.

•   Create flow charts/protocols to help colleagues to learn procedures.

•   Try to create an environment which helps colleagues to feel comfortable – anxiety will only make problems worse.

•   Don’t let people draw attention to mispronounced words, even inadvertently.

•   Try not to use abbreviations as some people find them difficult to interpret and they may mean different things to different people.

•   Do not ask someone with dyslexia to read aloud unless you have given them the material well in advance.

•   Do not put others on the spot. If someone appears reluctant to act as scribe or note taker, don’t push them into it.

Hardware support

•   Computers – whether desktop, laptop or netbook.

•   Digital voice recorders – can be used to record audio files which can then be uploaded into a computer (see also voice recognition software).

•   Electronic dictionaries – standard or medical version.

•   Mobile phone – particularly the new style smart phones.

•   Personal Digital Assistant (PDA).

•   Digital cameras – when used with appropriate software (see below) these can be used to take pictures of text, select an area and have it read back to you. Digital pens – used to highlight areas of text. Depending on the software used, individual words can then be explained or even synthesised into speech to aid pronunciation. Areas of scanned text can also be uploaded into a computer.

•   Electronic note making devices such as Digiscribble or a tablet PC – these work with a digital pen and can be used to transfer a hand drawn mind-map into the computer.

Software available

•   Note taking programmes such as Audio Notetaker (lansyst) – help students to organise recordings from a digital voice recorder and add annotation.

•   Reading programmes such as Texthelp Read and Write Gold, ClaroRead Plus orKurzweil 3000 – read scanned or typed text out loud.

•   Voice recognition software such as Dragon Naturally Speaking – allows the person to dictate notes into a computer.

•   Some programmes also transcribe from a digital voice recorder, however as the software needs to be trained to recognise the individuals voice it does not always cope well with a variety of voices such as from lectures and meetings.

•   Claroview – a coloured overlay feature for computer screens.

•   Mind mapping software such as Inspiration, Mind Genius, Claro Mindfull, Spark Learner and Mind Manager – can be used to create mind-maps in a range of styles.

•   It should also be noted that commonly used software packages such as Microsoft Windows or Apple Mac offer the facility to change background colours and the appearance of the screen. Even straightforward procedures such as changing font size and style can make a dramatic difference.

Other equipment

•   Coloured overlays – semi-transparent tinted sheets used to reduced visual disturbances by placing them over a page of text.

·        Tinted glasses – same principle as coloured overlays but in spectacle form.

General Medical Council(GMC)

Expectation of adjustment for Doctors in all training grades

This is a list of all the things the GMC think could be appropriate depending on the disability involved.

Reasonable adjustments involving documents

·        Plans, summaries, notes, handouts, and overheads available in advance of lectures.

·        Prioritised reading list.

·        Glossary of technical terms/specialist vocabulary.

·        Copies of overheads, diagrams and so on created in class provided also in paper form.

·        Additional inter-library loans.

·        Documents printed on different coloured paper.

·        Documents printed with larger font.

·        Subtitled / transcribed video material where this is used in lecture situations.

·        Availability of notes in electronic format to enable use of assistive software (such as text to speech; speech to text; mindmapping software).

·        Intranet material that meets established guidelines for compatibility with specialist software.

·        Availability of searchable reference texts.

·        Written materials available in audio format.

·        Comments on course work in alternative formats.

Reasonable adjustments through human assistance

·        Proof reader for written assignments.

·        Note-taker to attend lectures.

·        Teaching staff asked to face the class at all time when giving a lecture.

·        Additional regular 1:1 tutorial support.

·        Support in researching booklists for those unable to ‘browse’ in the library.

·         Provision of study skills support covering essay writing or dissertation skills.

Reasonable adjustments through allowances

·        Extensions to deadlines.

·        Extended library loans.

·        Permitted periods of absence.

·        Breaks permitted in teaching sessions.

·        Assignment work marked with a yellow sticker and appropriate guidance issued to markers.

Reasonable adjustments through equipment

·        Staff using a microphone for all lectures.

·        Permission to record lectures.

·        LOOP system during teaching.

·        Laptop to take notes.

·        Use of an amplified stethoscope.

·        Stethoscope linked to a display screen.

·        Chair available in teaching sessions.

·        Hand-held devices for taking notes.

·        Spell checkers.

·        Screen readers.

·        Microscopes linked to CCTV screens.

·        Compatibility of online teaching resources with the student's software magnification programmes.

Reasonable adjustments to the teaching and learning environment

·        Good lighting during lectures.

·        Elimination of background noise.

·        Adjustments to the physical environment.

·        Additional training for teachers in making teaching and learning more accessible to disabled students.

Assessments

Reasonable adjustments involving documents

·        Coloured overlays.

·        Exam papers on coloured paper, for example pale yellow, cream, salmon pink or grey.

·        Exam papers in larger or non-serif font.

·        Single side papers.

·        Larger size papers or exam sheets.

·        Instructions in written form.

Reasonable adjustments through allowances

·        Extra time in written or oral exams.

·        Additional reading time to view exam paper.

·        Breaks permitted in exams for example for rest or toilet breaks.

·        Permitted to use eat, drink or use insulin, medication, eye drops or inhaler.

·        Extensions to individual assessment deadlines.

·        No penalty for poor spelling, grammar, punctuation, syntax or structure where the meaning is clear.

Reasonable adjustments through equipment

·        Computers for exams or in-course assessments.

·        Spellchecker.

·        A3 optical mark reader for MCQs or slides (the marks then transposed onto A4 sheets for marking).

·        Special lighting.

·        Desk with extra space.

·        Writing slope.

·        Supportive furniture or cushion or lumbar support.

Reasonable adjustments relating to locations

·        Private rooms or separate supervision, for example so questions can be read aloud.

·        A smaller, separate venue.

·        Seat near the door to allow student to have toilet breaks.

·        Seat at the front or the back of the examination room.

Other reasonable adjustments to written exams

·        A scribe.

·        A reader.

·        Scrap paper available.

·        Student circles answer on question paper and after the exam has finished sits with a member of staff who completes the optical mark sheet with them.

·        Gap of at least two hours between exams.

·        Scheduling so that student did not take two exams in one day.

·        Visual prompts given to signal the start and end of exams.

·        Oral instructions given individually.

Reasonable adjustments for practical assessments such as OSCEs

·        Chairs.

·        Gloves.

·        Ear defenders.

·        Sphygmomanometer with a red flipper valve for a blood pressure station.

·        Amplified stethoscope.

·        Student permitted to summarise verbally at the end of each station.

·        Student permitted to use an agreed alternative word or expression.

·        Student permitted to write down a word if unable to verbalise it.

·        Extra question reading time.

·        Paper copies of the instructions for each station.

·        Extra time at station assessments that do not directly replicate clinical practice.

·        Student individually timed at each station once they had entered that station.

·        Physical stations in OSCE to be followed by a rest station or placed at the end of the exam.

·        Where OSCEs are being held at more than one location, efforts made to place candidates at the site which is easiest to navigate.

·        Allocation to a specific morning or afternoon slot.

·        Face to face interaction ensured with student positioned suitably for all sessions.

·        A reader.

·        A 'competent other' provided in the station who could be instructed by the student in conducting the resuscitation task.

·        Additional practice sessions and support given prior to the OSCE.

·        Timing of OSCE exams to earlier rather than later in the day

·        Individual circuit for OSCE assessments.

·        OSCE stations made more accessible, for example a resuscitation manikin placed on a couch.

·        Examiners briefed about individual doctor in training requirements.

·        A signer entering the assessment cubicle with the student to place a microphone on the manikin while the student reads the instructions.

Other reasonable adjustments to assessments and examinations

·        Appropriate timing during the day.

·        Flexibility in ways of enabling students to answer, such as: an oral rather than written assessment; a written exam, extended essay, or powerpoint presentation rather than a verbal presentation.

·        Partial retakes and deferred exams for those with illness.

·        Extension of the registration and completion period for royal college examinations.

Clinical placements

·        Avoidance of immuno-suppressed patients.

·        Placements arranged close to student’s home.

·        Car parking.

·        Placements with good transport links or which are otherwise easy to access.

·        Taxis to placements.

·        Rotations in more manageable order.

·        Additional coaching and mentoring.

·        Opportunities to sit down.

·        Additional support for students in finding placements that meet their requirements.

·        Buildings made accessible for wheelchair users and others with mobility impairments.

·        Checking of lighting and obstacles.

·        Alternative learning opportunities where placements cannot be made accessible.

·        An electric scooter for getting around a hospital.

·        Replacement sets of wheels for entry to the operating theatre.

·        Training of work placement providers in disability equality and how to work with disabled students.

·        Increased supervisory support.

·        Slowing of ward rounds, help in carrying notes

·        Arrangements made to ensure that disabled people can take personal assistants or assistive technology with them where necessary.

·        Amplified stethoscopes.

·        Compatibility of patient records, x-rays and test results with the individual’s software magnification programmes.

·        Flexible working hours.

·        Adjustments to working hours, for example reduced hours, reduced daytime on-call duties, fewer or no night time duties or weekend calls.

·        Adjustment made to duties, for example no crash calls for wheelchair users.

·        Part-time placements.

·        Extra time and time out.

·        Time off to fit treatment schedules, therapy and out-patient appointments.

·        Placements modified to allow attendance at signing and lip reading classes in the evening.

Other support

·        Mock PBL session set up for applicants to medical school.

·        Tutors made aware of student’s condition.

·        Student allowed to wear medic alert and carry medication at all times.

·        Student Support ID card asking for reasonable adjustments.

·        Specialist ICT equipment in accommodation.

·        Option to use personal radio system in exams, taught sessions, ward rounds and theatre sessions.

·        Time out from studies for those with illness.

·        Appropriate treatment assured.

·        Links with specialist organisations if help is needed, for example by dyslexic students.

·        A mentor or additional mentoring.

·        Local ‘buddy system’ between disabled and non-disabled students.

·        Disability-awareness training for staff to increase awareness of common disability related issues.

·         Staff in accommodation blocks made aware of the disabled student’s needs

Staff trained in communication with a hearing impaired person