Professionals can support inclusion of the person in their health care by speaking directly to them (not just to their supporters) and using their preferred language. You can ask the person and their support network whether they prefer person-first language or identity-first language.

• Person-first language places the individual first rather than their disability or impairment. It describes what they have, rather than who they are, i.e. a person with intellectual disability. The person-first language reminds people that we are talking about individuals and contributes positively to community attitudes about people with a disability.

• Some people may prefer identity-first language, for example, ‘autistic person’ rather than ‘person with autism’. 

Professionals can also support inclusion by using the preferred communication methods of the person with intellectual disability and, if required, request assistance from a support person or carer to interpret the person’s communication methods. People communicate in different ways. Augmentative and Alternative Communication (AAC) is any communication strategy used by people with communication difficulties. AAC methods can be an alternative or addition to speech. Communication tools and accessible information are examples of ACC. AAC can be unaided or aided.

Unaided AAC

• Body movements
• Facial expressions
• Pointing and finger spelling
• Sign language
• Natural gesture or natural sign language
• Key Work Sign combines signing and natural gestures
• Idiosyncratic signals (someone’s personal signs or behaviours)

Aided AAC

• Written text
• Pictures and symbols
• Communication boards, cards, or books
• Real objects (e.g. a water glass to take medication)
• Electronic talking devices
• Visual representations of words/concepts e.g. Picture Exchange Communication System (PECS)

Speaking directly to the individual with intellectual disability is central to person-centred care. It also facilitates improved information gathering and helps to build rapport.

You can find out more about communication tools and making information accessible below.

To find out more about adapting your communication to the individual, see Autism Association of Western Australia’s video on Total communication.

You can support the person with intellectual disability’s understanding by speaking clearly and using short sentences. You can communicate clearly by:

• breaking down ideas into key points and presenting each point separately (or using a separate sentence for each point for written text)
• speaking at an average speed
• being specific and avoiding jargon, technical words or concepts
• supporting language with gestures and facial expressions
• using an interpreter to support your appointments, if required and with permission of the person or their guardian
• using an age-appropriate tone
• rephrasing what you are trying to say if the person does not understand you
• talking at an appropriate volume.

Accessible information is important to assist people with intellectual disability to participate in and make decisions about their mental health care and wellbeing supports.

Easy Read and plain English information can help your expressive language and facilitate the person’s understanding of services and care. For more information on making information accessible, see 3DN’s Making mental health information accessible for people with intellectual disability – A Toolkit.

Building rapport is important. People with intellectual disability report that they find it easier to talk to professionals if they feel comfortable and trust them. [1]

You can build rapport by:

• engaging the person before asking more formal questions
• having a positive and patient attitude towards working with the person
• speaking directly to the person
• speaking and asking about something that is of interest to the person.

People have a diverse range of communication abilities and strategies so it is important to be flexible and make adaptations to your approach. Some strategies you could use include:

• allowing extra time for the person to process and respond 

• minimising distractions in the environment

• using a whiteboard or drawings and Easy Read to explain complex concepts (see Making information accessible below).

• using a graphic organiser such as a visual schedule of what will be covered in the appointment and other visual aids; this can create structure and predictability in your sessions

• using first–then language; first, can we talk about X and then return to Y. This helps discussions to remain on topic.

• explaining concepts in a way that is relevant to the individual (e.g. using specific events or activities the person enjoys or dislikes to begin discussions about feelings).

The way you ask questions is important to support the person’s comprehension.

Ask one question at a time and try to use open-ended questions. Some people with intellectual disability will say ‘yes’ to closed questions, even if it does not reflect how they feel or what has happened. This may be because the person wants to provide the ‘correct’ answer, please you, or does not understand the question. 

Open-ended questions are generally preferable. However, they can be difficult for some people with intellectual disability to understand. If this is the case, you could offer several alternative options.

You can check in with the person with intellectual disability (and, if necessary, their support networks) to confirm that:

• your interpretation of their communication is accurate
• the person has understood what you were trying to convey.

There are several methods to confirm understanding. Some strategies you could use include:

• clarification (e.g. could you tell me in your own words?)
• the naïve questioner (e.g. I do not know much about X, could you tell me about it).

People with weaker receptive communication sometimes rely on routines and environmental cues to know what to expect or understand what is being said. Consistency in your communication can support individuals in what may be a novel situation. You can prepare by finding out about the person’s communicative strengths and common terms and phrases they use. For some individuals, finding out about cultural norms can help to facilitate good communication.

When supporting people with intellectual disability who have a vision impairment it is important to:

• verbalise more and inform the individual when entering and leaving the room as they cannot rely on the same non-verbal cues as people without vision impairment
• ensure there is good lighting.

When supporting people with intellectual disability who have a hearing impairment it is important to:

• ensure good lighting on your face
• face the person directly
• ensure your mouth is visible
• avoid exaggerating mouth movements, as this can make lip-reading more difficult
• capture their attention before communicating. You can discuss with the person how they would prefer you gained their attention (e.g. saying their name or gaining their attention visually).

Some people may use sign language such as Auslan. If appropriate, involve family members and interpreters. If the interpreter is not a family member, it can be beneficial to have the same interpreter attend each session to support the development of short-hand and rapport between the interpreter and the person. Short-hand is a method of interpreting quickly by substituting different expressions without losing the message.

It is a NSW Health policy that professional interpreters, rather than family members, are used for health consultations. However, for other services, some people may request that a family member acts as their interpreter. If this is the case, you may still want to recommend to the person the use of a professional interpreter, as family members may be reluctant to pass on negative messages or may have a lack of understanding of medical terminology that could lead to inaccuracies in the interpretation.

COVID-19 has brought about many changes to care and service provision.

In some health settings, in-person care requires facemasks for professionals and, where appropriate, people with intellectual disability. Facemasks can prove especially difficult for people who have a hearing impairment, due to an inability to lip-read and the distortion of speech sounds and muffling created by the physical sound barrier. For professionals, it may be helpful to use an accessible mask with a transparent front to support lip-reading during appointments, make a conscious effort to articulate, and allow for longer appointments.

Teleconferences present potential communication barriers for both professionals and people with intellectual disability. For example, non-verbal cues are more difficult to observe virtually. While practice and support (e.g. correct camera positioning) can help people become familiar with teleconferencing, there are additional cognitive demands that can be challenging and tiring for the person. There is also a risk that the person with intellectual disability will not be ‘seen’ or will be excluded during phone calls. Families and support networks may play a more active role in teleconferences, but it is still essential to include the person with intellectual disability.

The following actions can help support people during teleconferences:

• turn on your video. This allows people to read your lips and see your facial expressions and gestures while you speak.

• use mute when you are not talking. This reduces background noise that may be distracting and supports the person to focus on the speaker.

• use the ‘raise hand’ function or type a comment in the chat if you would like to notify the facilitator that you would like to speak.

• perform a roll call at the beginning of meetings with multiple members. This ensures people with a vision impairment are included from the start.

• introduce yourself when you start speaking or have a question in meetings with multiple members. This ensures people with a vision impairment are aware of the speaker.

• use interpreters and captioning, where appropriate.

• send an agenda or supporting documents before the meeting.

You can find out more about how you can make this information accessible below.

For more information and resources to support making teleconferencing more accessible see the Disability Advocacy Resource Unit micro course on accessible online meetings.

1. Whittle EL, Fisher KR, Reppermund S, Lenroot R, and Trollor J. Barriers and Enablers to Accessing Mental Health Services for People With Intellectual Disability: A Scoping Review. Journal of Mental Health Research in Intellectual Disabilities. 2018;11(1): 69-102.