1. Staff Training Guide Accessibility for Ontarians with Disabilities Act

2. Dedicated to Doctors. Committed to Patients. Introduction Effective January 1, 2012, a new law comes into effect that requires specific customer service standards when dealing with members of the public with disabilities. Staff are required to adhere to this new law. Training staff in this new standard is part of the requirement under the new law. This presentation will cover what you need to know to fulfill these obligations.

3. Dedicated to Doctors. Committed to Patients. Purpose of the AODA The purpose of the Accessibility for Ontarians with Disabilities Act (AODA) is to recognize the history of discrimination against persons with disabilities in Ontario and to benefit all Ontarians by developing, implementing and enforcing accessibility standards in order to achieve accessibility for Ontarians with disabilities with respect to goods, services, facilities, accommodation, employment, buildings, structures and premises.

4. Dedicated to Doctors. Committed to Patients. AODA Summary: Ontario enacted the Accessibility for Ontarians with Disabilities Act in 2005. This creates mandatory accessibility standards for all businesses across Ontario. The aim is to ensure that the roughly 1.85 million Ontarians with a disability are given the same level of accessibility as the rest of the population. This affects doctors who provide health services as they will be required to operate in a way that eliminates barriers faced by persons with disabilities. The Act lays the groundwork for five accessibility standards: Standards: –Customer Service – Provide accessible goods and services to people with disabilities. –Built Environment – Remove physical barriers by providing facilities such as ramps, parking spaces, and signs. –Employment – Ensure equal employment opportunities by setting out specific requirements for recruitment, retention, and accommodation of people with disabilities. –Information and Communications – Change the way businesses create, provide and receive information and communications. –Transportation – Will only apply to public transit operators. The only requirement that comes into force on January 1, 2012, is the Customer Service standard.

5. Dedicated to Doctors. Committed to Patients. Requirements of the Customer Service Standard: Overview Workplaces must establish policies, practices and procedures governing the provision of your goods and services to persons with disabilities. These policies, practices and procedures must be consistent with the following principles: 1.Goods and services must be provided in a manner that respects the dignity and independence of persons with disabilities. 2.Provision of goods and services to persons with disabilities and others must be integrated. 3.Persons with disabilities must be given an opportunity equal to that given to others to obtain, use and benefit from your goods and services. Communication with a person with a disability must be done in a way that takes into account the person’s disability.

6. Dedicated to Doctors. Committed to Patients. Requirements Overview- Continued People with disabilities who require a guide dog or other service animal must be allowed to bring the animal onto the premises. People with disabilities who require a support person must not be denied access to the support person while on the premises. Notice must be given to the public of any disruptions in service that are caused by the temporary unavailability of facilities usually used by persons with disabilities. –Notice must include: The reason for the disruption. The anticipated duration. A description of any available alternative facilities or services. –Notice may be given by: Posting the information in a conspicuous place on premises owned or operated by you. Posting the information on your website. Any other method that is reasonable in the circumstances.

7. Dedicated to Doctors. Committed to Patients. Requirements – Continued As required now by law, our office will establish a process for receiving and responding to feedback about the manner in which we provide goods and services to persons with disabilities and make information about the process available to the public. The feedback process will permit persons to provide their feedback in person, by telephone, in writing, or by delivering an electronic text by email or on diskette or otherwise. The feedback process will specify the actions that we are required to take if a complaint is received. Our feedback process is detailed on the next slide:

8. Dedicated to Doctors. Committed to Patients. Feedback Process [Physician to add details regarding office Feedback Process]

9. Dedicated to Doctors. Committed to Patients. Policies, Practices and Procedures [Physicians – this is a good opportunity to introduce the policies (etc) you have prepared for your office. They should be included here.]

10. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities - General If you are unsure what to do, ask the patient, “May I help you?” A person with a disability will know if they need help and how you can provide it. Speak directly to a patient with a disability, not to his or her support person or companion. Avoid stereotypes and make no assumptions about what type of disability or disabilities the patient has. Take the time to get to know the patient’s needs and focus on meeting those needs just as you would with any other patient. Be patient – people with some kinds of disabilities may take a little longer to understand and respond. A good start is to listen carefully.

11. Dedicated to Doctors. Committed to Patients. General - Continued Make an effort to learn about appropriate language and terminology to use when referring to people with disabilities. –Use “disability” or “disabled,” not “handicap” or other derogatory language. –It is proper to say “person with a disability” rather than “disabled person.” If you cannot understand what a patient is saying, politely ask them to repeat themselves. Do not touch or speak to service animals. Do not touch assistive devices, including wheelchairs, without permission.

12. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Vision Loss Types of assistance the patient might use: –Braille –Large print –Magnification devices –White cane –Guide dog –Support person Do not assume the individual cannot see you. Do not touch the patient without asking permission. Offer your elbow to guide the person. If he or she accepts, then walk slowly, but wait for permission before doing so. Lead, do not pull. Identify landmarks or other details to orient the patient to the environment around him or her.

13. Dedicated to Doctors. Committed to Patients. Vision Loss - Continued Do not leave the patient in the middle of a room. Lead him or her to a chair or a comfortable location. If you need to leave the patient, let him or her know you are leaving and will be back. Identify yourself when you approach a patient and speak directly to him or her, even if he or she is accompanied by a companion. There is no need to raise your voice. Be clear and precise when giving directions – “two steps behind you” rather than “over there.” If you are uncertain about how to provide directions, ask the person how to do so. Do not be afraid or embarrassed to use words such as “see,” “read” and “look.” When providing printed information, offer to read or summarize it.

14. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Hearing Impairments Types of assistance the patient might use: –Hearing aid –Paper and pen –Personal amplification device –Phone amplifier –Relay Service –Teletypewriter –Hearing ear dog –Support person Attract the patient’s attention before speaking. The best way is by a gentle touch on the shoulder or with a gentle wave of your hand. Ask how you can help. Do not shout. Move to a well-lit area where the patient can see your face.

15. Dedicated to Doctors. Committed to Patients. Hearing Impairments Do not put your hands in front of your face when speaking as this makes it difficult to read lips. If necessary, ask if another method of communicating would be easier, such as using pen and paper. Be patient if you are using a pen and paper to communicate. American Sign Language, which may be the patient’s first language, has its own grammatical rules and sentence structure. Look at and speak directly to the patient. Address the patient, not the support person. Be clear and precise when giving directions, and repeat or rephrase if necessary. Confirm that the patient understands you. If the patient uses a hearing aid, reduce background noise or move to a quieter area so the patient can hear or concentrate better. Do not assume that a patient knows sign language or reads lips.

16. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Hearing and Visually Impaired Types of assistance the patient might use: –Braille –Large print –Print on paper (using black felt marker on non-glossy white paper or using portable white and black boards) –Communication boards –Hearing aid with built-in FM system –Magnification equipment such as a monocular or magnifier –Teletypewriter (TTY) –White cane –Service animal –Support person

17. Dedicated to Doctors. Committed to Patients. Hearing and Visually Impaired - Continued Do not assume what a person can or cannot do. Some deaf-blind individuals have some sight or hearing. A patient who is hearing and visually impaired is likely to explain to you how to communicate with him or her or give you an assistance card or a note explaining how to communicate with him or her. Identify yourself to the support person when you approach a patient who is both hearing and visually impaired, but then speak directly to the patient as you normally would, not to the support person. Do not suddenly touch a person who is hearing and visually impaired or touch them without permission.

18. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Physical Disabilities Types of assistance a patient might use: –Elevator –Mobility device (such as a wheelchair, scooter, walker, cane, or crutches) –Support person Speak naturally and directly to a patient, not to his or her companion or support person. If you need to have a lengthy conversation with someone in a wheelchair or scooter, consider sitting so that you can make eye contact. Ask before you help – people with physical disabilities often have their own ways of doing things. Respect your patient’s personal space. Do not lean over him or her or on his or her assistive device.

19. Dedicated to Doctors. Committed to Patients. Physical Disabilities - Continued Do not move items or equipment, such as canes and walkers, out of the patient’s reach. Do not touch assistive devices without permission. If you have permission to move a person in a wheelchair, remember to: –Wait for and follow the person’s instructions. –Confirm that your patient is ready to move. –Describe what you are going to do before you do it. –Avoid uneven ground and objects. –Do not leave the person in an awkward, dangerous or undignified position such as facing a wall or in the path of opening doors. Let your patient know about accessible features in the immediate area (such as automatic doors, accessible washrooms, elevators, ramps, etc.).

20. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Mental Health Types of assistance the patient might use: –Service animal –Support person Treat a person with a mental health disability with the same respect and consideration you have for everyone else. Be patient. Be confident and reassuring. Listen carefully and work with your patient to try to meet their needs. If someone appears to be in a crisis, ask him or her to tell you the best way to help.

21. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Intellectual or Developmental Disabilities Types of assistance the patient might use: –Communication board –Speech generating device –Service animal –Support person Do not assume what a person can or cannot do. Use plain language and speak in short sentences.

22. Dedicated to Doctors. Committed to Patients. Intellectual or Developmental Disabilities – Continued To confirm if the patient understands what you have said, consider asking the patient to repeat the message back to you in his or her own words. If you cannot understand what is being said, simply ask again. Provide one piece of information at a time. Be supportive and patient. Speak directly to your patient, not to their companion or support person.

23. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Learning Disabilities Types of assistance the patient might use: –Alternative technology for writing –Calculator –Scanning or reading technology –Tape recorders, mini pocket recorders When you know someone with a learning disability needs help, ask how you can help. Speak naturally, clearly, and directly to your patient.

24. Dedicated to Doctors. Committed to Patients. Learning Disabilities – Continued Allow extra time if necessary – people may take a little longer to understand and respond. Remember to communicate in a way that takes into account the patient’s disability. Be patient and willing to explain something again, if needed.

25. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Speech or Language Impairments Types of assistance the patient may use: –Communication board –Paper and pen –Speech generating device –Support person Do not assume that because a person has one disability, they also have another. Ask your patient to repeat the information if you do not understand.

26. Dedicated to Doctors. Committed to Patients. Speech or Language Impairments – Continued Ask questions that can be answered with a “yes” or “no” if possible. Try to allow enough time to communicate with your patient as they may speak more slowly. Do not interrupt or finish your patient’s sentences. Wait for them to finish.

27. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Talking on the Phone to Patients with Disabilities Speak naturally, clearly and directly. Do not worry about how the person’s voice sounds. Concentrate on what they are saying. Do not interrupt or finish the patient’s sentences. Give the patient time to explain or respond. If you do not understand, simply ask again, or repeat or rephrase what you heard and ask if you have understood correctly. If a telephone patient is using an interpreter or a Relay Service, speak naturally to the patient, not to the interpreter. If you encounter a situation where, after numerous attempts, you and your patient cannot communicate with each other due to the patient’s disability, consider making alternative arrangements.

28. Dedicated to Doctors. Committed to Patients. Interaction and Communication with People with Disabilities – Home Visits Confirm the details of your arrival time in advance. Do not arrive unexpectedly. Be patient. You may need to wait a few moments for the patient to answer the door. Introduce yourself clearly. If you need to move some of the patient’s possessions, make sure you return them to their original position.

29. Dedicated to Doctors. Committed to Patients. Interaction with Patients who use an Assistive Device Do not touch or handle an assistive device without permission. If you have permission to move a person in a wheelchair: –Wait for and follow the patient’s instructions – confirm that they would like your assistance. –Confirm that the patient is ready to move. –Describe what you are going to do before you do it. –Try to avoid uneven ground and objects. –Do not leave the patient in an awkward, dangerous or undignified position such as facing a wall or in the path of opening doors. Do not move items or equipment, such as canes and walkers, out of the patient’s reach. Respect the patient’s personal space. Do not lean over him or her on his or her assistive device. Let the patient know about accessible features in the immediate environment.

30. Dedicated to Doctors. Committed to Patients. Interaction with Patients who Require a Service Animal Remember that a service animal is not a pet. It is a working animal. Avoid touching or addressing service animals. Avoid making assumptions about the animal. If you are not sure if the animal is a pet or service animal, ask the patient. Remember the patient is responsible for the care and supervision of their service animal. You are not expected to provide care or food for the animal. However, you could provide water if the patient requests it.

31. Dedicated to Doctors. Committed to Patients. Interaction with Patients who Require a Support Person A patient with a disability might not introduce their support person. If you are not sure which person is the patient, take your lead from the person using or requesting the goods or services or simply ask. Once you have determined who the patient is, speak directly to them, not to their support person.

32. Dedicated to Doctors. Committed to Patients. Available Equipment [Include instructions on any equipment available at your office.]

33. Dedicated to Doctors. Committed to Patients. When a Person with a Disability Cannot Access your Services Be positive, flexible, and open to suggestions. Ask your patient for their input. Simple solutions are often the most effective.