ACQ Vol 12 No 3 2010

governance, communications and marketing, the Centre for Promoting Health Independence (CHPI), service redesign and the Project Unit. Clinical expertise is drawn from speech pathology, audiology, occupational therapy and nursing. Having a broad membership allows us to tap into opportunities the clinicians in the group may not ordinarily be exposed to. Similarly the non-clinical/managerial staff in the group take away with them an improved understanding of the clinical issues for our patients. Networks formed through our members have been instrumental in raising the group’s profile within the organisation, forging links and partnerships, creating opportunities and broadening the perspectives of everyone involved. 4. We have a mandate Having an awareness of the relevant anti-discriminatory legislative acts of parliament as they relate to people with a communication disability is an important tool in lobbying for change. These include the federal Disability Discrimination Act (1992), the Human Rights and Equal Opportunity Commission Act (1986) and Racial Discrimination Act (1975), and the Victorian state Disability Act (2006). We know that communication disability is a hidden disability in many ways and the specific needs of those with communication problems can be lost within broad overarching guidelines. Healthcare organisations may well be meeting requirements of those with physical disabilities but groups like the CACIG can highlight where our interpretation of the legislation has fallen short for those with communication support needs. In addition to the legislation we have found it useful to be aware of our own organisational vision and mission statements, our charter of patient rights and responsibilities, documented models of care, and overarching accreditation standards and guidelines. The principles of equity of access and patient participation are certainly embedded in many of Barwon Health’s healthcare policy documents, as they would be in many organisations. Where this is the case we can assist decision-makers to make the next step in defining what such principles mean specifically for those with communication support needs. 5. Use conceptual models Using conceptual models that utilise a common language and help simplify things for others was another useful strategy. We understood the broader conceptual framework of the ICF but we needed to simplify things for our colleagues and ourselves. In practical terms most people don’t have time to engage in the kind of discussion necessary to fully appreciate the ICF, let alone apply this to CA. This time the work of Susie Parr and her colleagues helped to simplify and visually conceptualise where the barriers might be. With the Communicative access triangle (Parr et al., 2008) it is possible to show that the barriers to communicative access potentially occur in three main areas: in our interactions with others, in the documents we produce and in the physical and attitudinal environment where we offer our services. Kagan and her colleagues have now developed the Living with Aphasia – Framework for Outcome Measurement (A-FROM; Kagan et al., 2008). The A-FROM is a user-friendly framework adapted from the ICF (World Health Organization, 2001) and is a conceptual guide for thinking about outcomes of aphasia interventions. The A-FROM can be used to provide a common platform for thinking about outcomes but is also potentially a valuable visual tool for communicating to clients, clinicians and managers about communicative access.

a different way and saw that a significant number were unable to understand the information they received on their journey along the continuum of care. We could see that this situation made people feel frustrated, embarrassed, and incompetent and that some were simply excluded from activities. This included people like Lila in the palliative care unit who got a packet of pepper for lunch, because she could not read the menu or write her choices. Or Edward, who was assessed as having a potential delirium until his wife came in with his hearing aids. The authenticity of these stories moved us and helped focus our attention. Sharing these with leaders in our organisation has proven to be one of our most powerful tools in motivating for change. To keep close to the experiences of real people using our health services we invited Elizabeth, an interested consumer, to join the CACIG. Elizabeth has continued to provide the group with her essential and unique viewpoint, drawing on her own experiences as carer for her husband who is hearing impaired. She continues to keep the group accountable and focused on the user’s experience and her input has been invaluable. 2. Make it values driven and evidence based Embedded in the task of introducing the concept of communicative access to decision-makers is the challenge of convincing others that CA deserves serious consideration alongside the ever-pressing issues of reducing length of stay, managing beds, and balancing the healthcare budget. Articulating the importance of CA for ourselves was vital before we made any attempt to convince others. This required a solid understanding of the values and evidence that ignited our passion in the first place. Through our reading of the literature we were able to elucidate our values and realised in the process that these values were consistent and fundamental to major trends in healthcare reform internationally. We realised that the basic values of equity, solidarity (societies’ collective responsibility to care for others) and participation were fundamental to CA just as they are fundamental to the provision of quality healthcare overall (World Health Organization, 2005). We could argue that universal accessibility comprised of at least four dimensions including communication access (access to information) and we could argue with confidence because the WHO said so (World Health Organization, 2000, 2005)! In reviewing the evidence around CA it soon became obvious that issues were complex and wide ranging with literature spread across many seemingly disparate fields. Our starting point was in the aphasia literature, in particular the work undertaken by researches and clinicians in the United States (Chapey et al., 2001; Simmons-Mackie, 2001), Canada (Kagan, Black, Duchan, Simmons-Mackie, & Square, 2001) and the United Kingdom (Byng, Farrelly, Fitzgerald, Parr, & Ross, 2005; Byng, Pound, & Parr, 2000; Parr, Byng, Gilpin, & Ireland, 1997) and at home in Australia (Howe, Worrall, & Hickson, 2008; Rose, Worrall, & McKenna, 2003; Worrall, Rose, Howe, McKenna, & Hickson, 2007). The work of these seminal authors work continues to inform our practice and guide our decisions. 3. Collaborate with key people and look for opportunities A strategically important feature of the CACIG is that it is multidisciplinary, drawing clinical and non-clinical professionals from across the continuum of care. Members come from areas including: ethnic services, quality and

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ACQ Volume 12, Number 3 2010

ACQ uiring knowledge in speech, language and hearing