When making color recommendations to a client it is important to ensure that you both are speaking?

Developing genuine relationships with clients is a cornerstone to improving communication. There are also some universal strategies you can use, and with a number of clients you can help by using strategies to improve their memory and attention.

Having a genuine, hopeful and empathetic client/worker relationship makes a difference to the lives of clients. When you're working with people with complex needs, this relationship is particularly important as it's likely the person will have experienced 'service system fatigue' and feel that services they've been involved with in the past have given up on them. Developing solid engagement and rapport and developing and maintaining boundaries are key components of developing this relationship.

Rapport and engagement

Establishing solid engagement and rapport with your client cuts across all theoretical approaches and is one of the most important tools in successfully supporting someone to participate in a drug and alcohol program. When supporting a person with complex needs, use the following engagement strategies:

• Get to know them. Learning information about a person, such as what they like or what they're interested in, can help you develop engagement and rapport. The better you know the person, the easier you'll find it to identify when they need additional support and how to help them work through particular impulses or challenging behaviours.
• Time and patience. It may take more time and perseverance than usual to develop a solid level of engagement with a person with complex needs. Don't give up!
• Be present. Focusing on being emotionally present is particularly powerful and effective and is essential to a genuine, empathetic and hopeful worker/client relationship. Minimising the possibility of distraction and staying completely present with the person will show your commitment to supporting them.
• Focus on the positive. Use a strengths-based approach, focusing on achievements and acknowledging that setbacks are part of the change process. People with complex needs may take longer to achieve their goals. It's likely they'll have more setbacks on their path to change than other clients. Celebrate all the effort and small achievements and allow the person time to learn from their mistakes.

"As we gradually get an understanding of the person we are able to have a much more personalised approach" (Staff member, Karralika Programs Inc, April 2012).

Boundaries

Developing and maintaining professional boundaries is an important part of a genuine, hopeful and empathetic relationship between worker and client. Consider the following points when working with people with complex needs:

• Understanding boundaries. People with complex needs are likely to have difficulty understanding, setting and maintaining personal boundaries. This may be because of a cognitive impairment or may be in response to having personal boundaries damaged or violated during their life.
• Time to learn. Knowing what boundaries are appropriate and acting accordingly is something we learn over time. Some people with complex needs may need support and time to learn what is appropriate in your service, in the community and in their personal relationships. This may mean resetting the boundaries every day, sometimes more than once a day, and being consistent with what the boundaries are.
• Modelling boundary-setting. Modelling effective boundary-setting is a useful tool in helping people see how they can respectfully deal with situations where their personal boundaries are being threatened. This can mean showing a person how to set limits, demonstrating that you're able to say, for example, "No thanks. I don't feel like doing that now", or "Would you mind stepping back a little bit - you're standing a little bit close", or "I'm not sure about that - I'll think about it and get back to you".
• Communication. Showing people that you can communicate in a respectful way what you're thinking and feeling, even if this is different from what they want and is difficult for them to hear, demonstrates that it's okay to tell them what you need, and provides a model of how to achieve this.
• Feedback. Give the person clear and straightforward feedback on inappropriate behaviour and you and your service's future behavioural expectations. Help the client to identify the consequences of their actions for themselves and for other people.

Universal communication strategies are beneficial to all service users and are particularly valuable when working with people with complex needs. They support service access and participation for all people using your service, and many of these strategies cost little or nothing to implement.

Strategies include modifying language, establishing rapport and involving clients in their care and service planning. Having universal communication strategies in place helps you and your service comply with legislation and accreditation standards relating to access and equity.

Face-to-face communication is the most effective way of communicating with someone. If it's not possible to communicate face to face and you have to rely on phone or email communication, be aware of the communication challenges that present when cues like body language and facial expressions are not available.

For example, if you know or suspect someone has specific cognitive functioning difficulties related to communication and comprehension and you have to speak to them over the phone, use strategies to make sure they've understood what you've said. This may include having a support person or advocate for the client involved in the phone conversation. Also, be aware of how you're communicating, including your use of complex words, or long sentences in which multiple pieces of information are included.

Verbal communication tips

• Keep your language simple by using short sentences and avoiding jargon. This will increase the likelihood that the person will understand directions or questions.
• Raise only one topic at a time. Clearly signpost changes in topic to avoid confusion.
• When explaining tasks, make sure you break the task into a step-by-step process, as these are easier to both understand and remember.
• Ask the person to explain in their own words the information you're giving them - don't just ask 'Do you understand?' (If you do this, they may automatically say 'yes' because they think this is the 'right' response and/or what you want to hear.)
• Allow more time than usual for a response.
• Encourage the person to ask for information to be repeated if they haven't understood fully.
• Minimise distractions in the immediate environment.
• When language is a barrier, use action-based strategies to help the person understand, such as demonstrating what needs to be done or asking them to demonstrate their understanding of a direction or question.
• Support verbal communication with audiovisual, written and pictorial resources where possible.

"With this approach [universal design] there doesn't have to be a separate program or special testing or treatment for people with cognitive impairment - programs are already suitable." (The Lyndon Community staff, 2012)

The Intellectual Disability Rights Services has developed a guide called Introduction to Intellectual Disability (IDRS 2009) that contains a summary of communication tips to use when working with people with intellectual disability and people with cognitive impairment. It was developed by Robert Strike, a leading advocate for people with intellectual disability in NSW and gives the following advice:

• "Talk to us, not at us or through others."
• "Hearing is not enough. Listen to us and respect what we say."
• "Do things with us, not for us."
• "Explain things slowly and get straight to the point."
• "Talk to us face to face."

See also Maximise People's Ability to Make Their Own Decisions (IDRS 2004)

Written and visual materials

Many people find it difficult to understand complex text, so it's essential to consider the literacy needs of your client group.

The Australian Bureau of Statistics (ABS) has identified that almost half of Australian adults have literacy skills considered inadequate to meet the demands of common daily activities. This includes understanding narrative texts and completing forms. See the figure below for the results of the 2006 Adult Literacy and Life Skills Survey conducted by the ABS (ABS 2006, reissued 2008).

Literacy levels are affected by a range of factors, including school leaving age, quality of education, having English as a second language, and learning disabilities or cognitive impairments. People with a disadvantaged background are more likely to have literacy problems.

Adult literacy in Australia

Preparing written materials that are easy to understand will ensure they're accessible to a wider audience and will lessen disputes or difficulties that can occur through misunderstandings. 'Plain English' and 'Easy English' (see below) can both be used to make written material more accessible.

What is plain English and when should I use it?

Plain English is a flexible and efficient writing style that readers can understand in one reading. It combines clear, concise expression, an effective structure and good document design (Plain English Campaign).

Plain English should be used for any information that's in the public domain and that the public uses to make decisions.

What is Easy English and when should I use it?

Easy English (also known as 'easy read' or 'easy to read') is a simple and controlled writing style developed for people who have difficulty reading and understanding information. Easy English identifies the key points a person needs to know and the most direct and concise way to say it, and includes the use of relevant images.

Easy English documents are usually developed for a specific target audience. Documents that provide essential information that helps a person make an informed decision or where action is required should be developed using Easy English.

There are a number of resources available to help people develop documents that use plain English and Easy English. The types of written materials that may need to be modified in a drug and alcohol service are:

• Forms
• Information sheets
• Brochures
• Booklets
• Reports
• Policies and procedures
• Signage
• Websites.

Services often already use signage that incorporates plain or Easy English, usually for health and safety. For examples of signs to promote fire exits, hand washing and cough etiquette refer to the figure below.

Easy English signage examples

You should make sure all materials meet plain English requirements at a minimum, and consider when Easy English should be used. All clients will benefit from the use of both plain and Easy English, whether or not they have literacy problems.

Staff may feel uncomfortable using Easy English, thinking they are being condescending or patronising. But anecdotal evidence shows this is not the case, and people are happy to receive materials in this format. By developing materials in consultation with the target audience, and being sensitive and responsive to their needs, you will ensure this doesn't happen.

The NSW Council of Intellectual Disability (NSW CID) partners with Scope Victoria to facilitate Easy English writing courses in NSW. These courses cover the essential skills to develop written information for people with limited literacy. For more information contact NSW CID.

Written materials tips

• Use plain English
• Consult with the target audience when developing materials to ensure appropriate content and design
• Consider people's literacy levels when distributing written materials in your service
• Supplement written materials with a face-to-face explanation to ensure key messages are easily understood
• Use images or audiovisual materials to support written materials
• Get ongoing feedback from the target audience when using written materials, and adapt as needed.

Using visual aids to support written materials

The use of visual aids (images, symbols, illustrations) and audiovisual materials can help the reader understand and remember key information. Incorporating images into text can be done for minimal or no cost and commercial software is available to assist you develop visual aids, including:

• CHANGE Picture Bank©
• Valuing People ClipArt, from Inspired Services Publishing Pty Ltd©, and
• Bonnington Symbols.

A wide range of stock images can be sourced from a number of websites such as Shutterstock. Microsoft Office software also includes a searchable range of ClipArt images. You can also use images relevant to your service by creating photos or drawings.

When using visual aids:

• Consider how relevant the image is to what you're trying to represent and whether it could be confused with something else.
• Make sure images are not overused, or used inconsistently, in a document (e.g. the same image being used to refer to multiple concepts).
• Consider the acceptability of the image for the target audience (e.g. in terms of culture, age and life experience).
• Consider getting staff and clients involved and using real images from your service to complement stock and ClipArt images.

A person who has difficulty remembering, concentrating or paying attention may use specific compensatory strategies to improve their functioning. You should support the use of these positive compensatory strategies and, if the person hasn't developed their own strategies, work with them to test a range of strategies they could use.

Compensatory strategies include (Synapse 2011a, 2011b):

• Using external memory aids, including writing lists, keeping a diary or wall calendar, using a mobile phone alarm or alarm clock for reminders, using a dictaphone or an electronic organiser
• Using specific memory techniques such as repeating and rehearsing key information and using visual or verbal associations to help recall information and categorise information into groups
• Organising the environment to reduce the demand on the person's memory; this may include having noticeboards with tasks and reminders, labelling or colour-coding cupboards and tying objects to things (e.g. tying a pen to the phone)
• Developing a structured daily routine.

The Intellectual Disability Rights Services (IDRS) has developed a guide called Introduction to Intellectual Disability (IDRS 2009) that contains a summary of points to consider when working with people with intellectual disability and people with cognitive impairment.

See also the fact sheet Maximise People's Ability to Make Their Own Decisions (IDRS 2004)

For further information on what written materials and information may suit your service see Making Your Service Complex Needs Capable.

See also scopevic.org.au for a range of resources on easy english.