Customer Service

Standard For the

AODA Accessibility for Ontarians with Disabilities Act

A GUIDE TO DISABILITY AND PERSONS

WITH DISABILITIES Adapted from: Barrie Community Health Centre. (2011, October). “People first – a guide to disability and those with disabilities.” & North Simcoe Muskoka Local Health Integration Network. (2011, April). Some images and information have been taken from the “Understanding Accessibility” PowerPoint Presentation.

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"We know that equality of individual ability has never existed and never will, but we do insist that equality of opportunity still must be sought."

Franklin Delano Roosevelt People with disabilities face challenges in accessing the necessities of daily living. Too often, we see the wheelchair or the white cane or the hearing aid first – as if the disability defines the person. The Accessibility for Ontarians with Disabilities Act requires all service providers to remove barriers faced by people with disabilities. In the coming years there will be regulations regarding:

• Customer Services • Transportation • Information and Communications • Employment • Built Environment

This training guide was developed to:

1. Provide an overview of the purposes of the Accessibility for Ontarians Disabilities Act, 2005.

2. Provide guidelines on how to interact or communicate with people with various types of disabilities, including individuals who use an assistive device or require the assistance of a service animal or support person.

3. Provide information on how to use the assistive devices available at the Centre’s office and otherwise made available by the Centre for persons with disabilities.

4. Highlight what to do if a person with a disability is having difficulty in accessing the Centre’s policies, practices and procedures relating to the provision of goods and services to the public.

Out of necessity, disabilities are categorized and grouped. This is not intended to be a detailed discussion of the many opportunities to provide for accessibility, but rather to give you a brief understanding of the steps the Centre de santé communautaire CHIGAMIK Community Health Centre has taken to ensure full accessibility. You can do your part by understanding and taking the time and effort to treat people with respect. “Placing one foot in front of the other, I've climbed to higher lengths. Reaching beyond my own limitations, to show my inner strength. No obstacle too hard, for this warrior to overcome. I'm just a man on a mission, to prove my disability hasn't won.”

Robert M. Hensel

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Table of Contents Did You Know? .................................................................................................... 4 Accessibility at CSC CHIGAMIK CHC ................................................................. 4 What is a “disability”? .......................................................................................... 5 General Communication Tips .............................................................................. 5 People who are culturally deaf or have hearing loss ........................................... 6 People who stutter or have trouble speaking ...................................................... 8 People who are blind or have low vision ............................................................. 9 People who have physical or mobility issues .................................................... 11 People with developmental disabilities .............................................................. 12 People with psychiatric disabilities………………………… ................................. 13 People who are anxious or agitated .................................................................. 14 People with learning disabilities ......................................................................... 15 Services and Accommodations ......................................................................... 16 Services and Accommodations Available at CSC CHIGAMIK CHC ................. 18 Your Role and Responsibility ............................................................................ 20

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Did You Know?

• 4.4 million Canadians report having a disability that restricts them in their daily

activities – about 1 in every 7 people. • Disability rates increase with age – 56.3% of persons aged 75 years and over

reported having an activity limitation.

• 70% of all persons with disabilities report needing support with daily activities.

• Over half a million Canadians report having some form of vision loss and over a million report some form of hearing loss – not corrected by eye wear or hearing aids.

• 57% of adults with disabilities require some type of aid or assistive device.

• Among children aged 0 to 14 years, 3.7% reported a disability, with this rate rising to nearly 11.5% among adults aged 15 to 64 years and to 43.4% among persons aged 65 years and over.

Accessibility at Centre de santé communautaire CHIGAMIK Community Health Centre The Ontario Government recognizes that persons with disabilities are no different than anyone else in terms of the services they have a right to access. It was this recognition that gave rise to the 2001 Ontarians with Disabilities Act (ODA), and more recently, the 2005 Accessibility for Ontarians with Disabilities Act (AODA). Through the development, implementation and enforcement of accessibility standards, the main objective is to have a barrier free and fully accessible Ontario by 2025. The accessibility standards apply to the Centre de santé communautaire CHIGAMIK Community Health Centre and as such, the Centre must produce an annual report on the current year’s accomplishments and the subsequent year’s strategies with respect to accessibility. CSC CHIGAMIK CHC has been successful in the implementation of several accessibility strategies, and continues to receive and act upon suggestions for improvements. For more information about AODA and the Customer Service requirements, please see the two webcasts entitled “Providing Accessible Customer Service for January 1, 2012” at http://www.mcss.gov.on.ca/en/mcss/programs/accessibility/customerService/.

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What is a “disability”? Disability and handicap have two very different meanings. Disability refers to a restriction in a person’s ability to participate in a specific activity. This can include the presence of a mental, physical or health condition that reduces the kind of activities that a person can do or requires that they do it differently. Disabilities can be visible or invisible. Handicap refers to an environmental or attitudinal barrier that prevents the person with a disability from participating to his/her maximum potential. For example, a disability is the restriction of a person who is deaf has in his/her ability to hear spoken conversation. A handicap would be another person’s reluctance to use means other than speech to communicate with that person. General Communication Tips

• Focus on the person, rather than the disability. • Approach the person from the front, where they can see you. This position

allows you to communicate with expressions or body language that often times speak louder than words.

• Speak directly to the person, rather than to an attendant, companion or interpreter.

• Speak in a normal voice. It can be insulting to speak loudly or slowly to a person with a disability, they will let you know if they have difficulty hearing or understanding you.

• Avoid actions and words that suggest the person should be treated differently. It is fine to invite a person in a wheelchair to ‘go for a walk’ or to ask a person who is blind if they ‘see what you mean’.

• Listen to what people say. Do not assume you know what they want or what is best for them.

• Don’t hesitate to offer assistance if the situation warrants. Respect the person’s right to accept or refuse your offer.

• If you are unsure how to act appropriately – ask the person.

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People who are culturally deaf or have hearing loss People who have hearing loss may be deaf, oral deaf, deafened or hard of hearing. People who are profoundly deaf may identify themselves as culturally deaf or oral deaf. In deaf culture, indicated by a capital “D,” the term is used to describe a person who has severe to profound hearing loss, with little or no hearing. Culturally deaf persons are members of a cultural or linguistic minority group whose language is a signed language (i.e. American Sign Language, Langues de Signes Quebecois). This person’s first language is a signed language and therefore signed language interpretation services are required. The printed use of a spoken language will vary depending on the individual and situation.

Oral deaf is a term describing a person who was born deaf or became deaf before learning to speak, but is taught to speak and may not typically use American Sign Language. People who are hard of hearing or deafened are those that have a loss of hearing sound that can range from mild to profound, and whose language is spoken language (i.e. English, French). The term deafened describes a person who has lost their hearing slowly or suddenly in adulthood. The person may use speech with visual cues such as captioning or computerized note-taking, speech reading or sign language. The term hard of hearing describes a person who uses their residual hearing (hearing that remains) and speech to communicate. The person may supplement communication by speech reading, hearing aids, sign language and/or communication devices. Others may hear some sounds but may not be able to understand speech.

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Types of assistance your client might use: • Hearing aid • Paper and pen • Personal amplification device (e.g., Pocket Talker), phone amplifier • Relay Service • Teletypewriter (TTY) • Hearing Ear Dog • Support person

Myths & Misconceptions

• Hearing aids correct hearing loss. • Speechreading provides 100% comprehension. • People with hearing loss are more prone to accidents. • All people with a hearing loss will know they have one. • Cochlear implants will allow all people to hear perfectly. • If someone does not hear/understand you, just speak louder. • Accessibility is always expensive and only a few people will benefit • It is okay to speak to a Hearing Ear Dog. • Literacy skills.

Tips for Effective Communication

• Determine the language to be used and what personalized accommodations are required.

• For signed language, secure services of a professional interpreter. For spoken language make available print transcription, assistive listening devices.

• Calmly get the person’s attention before speaking and maintain eye contact. • Face the person when speaking and talk directly to them. • Speak and/or write to the person in a visually and auditory quiet area, if possible.

When speaking, do so slowly and clearly, being careful not to over-emphasize words or distort lip movements. When writing, use plain language and graphics. As required, do both.

• For conversations, choose a well lit room and avoid standing in front of a window. Keep your face visual – don’t cover with hands or masks.

• Use pantomime, body language and facial expressions – these are vital communication tools.

Enabling Access in Group Settings

• In group meetings, have one person speaking at a time and discourage side conversations. Provide computerized note takers and/or interpretation services.

• Ensure any film/DVD used has open captioning. • Have printed materials available in plain language, and offer text to text

communication.

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People who stutter or have trouble speaking Stuttering is a pattern of speech where the speaker repeats or prolongs sounds for an unusually long time. Stuttering may be aggravated by anxiety or stress. Profoundly pre-lingualy deaf people are those who were born with insufficient hearing to enable them to acquire speech normally; or who lost their hearing prior to the age at which speech is required and thus have difficulty forming the words the way they are commonly heard. Neither situation is indicative of a developmental or psychiatric disability. Tips for Effective Communication

• Listen patiently and do not finish their sentences. • Listen to what they are saying, rather than how they are saying it. • Do not interrupt the person, but ask for clarification if needed. • Attempt to create a relaxed environment where both of you feel at ease. • Do not suggest that they slow down or start over. This can call attention to the

disability and increase anxiety.

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People who are blind or have low vision Vision loss reduces a person’s ability to see clearly. Few people with vision loss are totally blind. Many have limited vision such as tunnel vision, where a person has a loss of peripheral or side vision, or a lack of central vision, which means they cannot see straight ahead. Some people can see the outline of objects while others can see the direction of light. Vision loss can restrict your customers’ abilities to read signs, locate landmarks or see hazards. Some of these customers may use a guide dog or white cane, but others may not. Sometimes it may be difficult to tell if a person has vision loss. Low vision denotes a level of vision that is 20/70 or worse, and cannot be fully corrected with glasses – indicating you see at 20 feet what a person with good vision sees at 70 feet. Low vision is not the same as blindness – a person with low vision has some residual sight and usually requires adaptations for the performance of daily activities such as reading. A person is considered legally blind when the best corrected central acuity is 20/200 (normal acuity is 20/20) or the peripheral vision is narrowed to 20° or less in the better eye. Types of assistance your client might use:

• Braille • Large print • Magnification devices • White cane • Guide dog • Support person such as a sighted guide

Tips for Effective Communication

• Always introduce yourself. A person may not recognize your voice. • Speaking directly to the person, not a family member or friend. Speak in a

regular tone of voice – vision loss does not mean hearing loss. • Don't assume the individual can't see you. • Provide orientation of the surroundings. Don’t use “over there” or point in the

direction – be specific. Don’t touch your client without asking permission. Offer your elbow to guide the person. If he or she accepts, walk slowly, but wait for permission before doing so.

• Let them know of possible hazards, such as doors, steps, changes in terrain (concrete to gravel or grass), etc.

• If you’re uncertain about how to provide directions, ask the person how to do so.

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• Do not be afraid or embarrassed to use words such as “see”, “read” and “look.” People with vision loss also use these words.

• When providing printed information, offer to read or summarize it. • Never interfere with a guide dog by petting or distracting it. A guide dog

provides a service to the owner and when working should not be distracted. Do not pet or speak to a service animal (dog) unless you have permission.

• Let the person know when you are leaving and will be back. Show him or her to a chair, or guide them to a comfortable location. This will eliminate the problem of leaving them in an open space with no point of reference.

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People with physical or mobility disabilities Physical disabilities occur widely and can range from arthritis to paralysis. Physical disability goes beyond having to use a wheelchair or wear a back brace. There are many medical conditions, such as multiple sclerosis and chronic fatigue syndrome which may affect a person’s mobility. Physical disabilities cannot be generalized because each person will have different causes, symptoms and management strategies. Physical disabilities do not necessarily indicate other disabilities as well, such as difficulty hearing or a developmental disability. Tips for Effective Communication • Try to sit or crouch so that you are speaking at eye level, or stand further away

so they do not hurt their neck looking up at you. • Speak directly to the person with the disability, not their companion. • Respect personal space. A person’s wheelchair is essentially an extension of

their body. Do not lean on it or move them without their permission. • Do not assist without asking if your help is needed or assume help is needed and

accept that person’s right to refuse. • Make sure you take direction regarding assisting from the person. • Do not worry about using words like ‘walk’ or ‘run’ – everyone uses these same

words. • Be aware. Take notice of what is accessible and inaccessible to people in

wheelchairs.

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People with developmental disabilities A developmental disability should not be confused with a psychiatric or mental illness (i.e. Down syndrome – developmental disability; Schizophrenia – psychiatric disability). A developmental disability is characterized by a difficulty in understanding, communicating, and mobility, controlling behaviour or a combination of these. These disabilities can be developed or the person may have been born with it. A developmental disability does not necessarily mean the person is of low intelligence. People with developmental disabilities may have difficulty with both receptive and expressive language (communicating and understanding what is being communicated). Sensory issues (over or under stimulated senses) are a problem with many types of developmental disabilities. Tips for Effective Communication

• Do not be offended by lack of response(s), inappropriate response(s) or unconventional behavior.

• Be supportive and patient. • Maintain eye contact. This shows respect and that you are genuinely listening

and trying to help. • Do not use complex terminology or jargon – use simple sentences. Use concrete

examples. • Give one piece of information at a time. • Don’t assume what anyone might be able to do. • Clearly identify yourself, your role and that you are trying to assist or help them. • Offer physical assistance and direction where necessary. • Address any inappropriate behavior immediately – explain any rules/regulations

or behavior expectations. It can be more difficult to explain why behavior is inappropriate if it is not dealt with the first time.

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People with psychiatric disabilities A psychiatric disability refers to a range of syndromes and conditions characterized by different types and degrees of emotional, developmental, cognitive and/or behavioral manifestations. Degrees of this disability exist varying from mild to severe. Numerous psychological or mental health disorders fall under this heading. Many forms of this disability interfere with a person’s ability to function within society which causes them to have problems coping with day to day activities. A significant barrier a person with a psychiatric disability will face is social stigma. Tips for Effective Communication

• Create a calm and relaxed atmosphere. • Accept the person as they are: listen carefully, take them seriously, don’t analyze

or diagnose, and work with them to learn as much as you can about the challenges they may be facing.

• Be supportive and patient. • Pay attention to body language and other clues about their state of mind (e.g.

fearful, angry, withdrawn, etc.)

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People who are anxious or agitated People become anxious or agitated for a variety of reasons. Some may be under a great deal of stress; some may have experienced a loss and are grieving; others may have a mental illness and are experiencing some symptoms. Tips for Effective Communication

• Use clear, straightforward language – rephrase if necessary. • Be clear about whom you are and your role. • Check to make sure they understand – do not try to talk over them. • Recognize the individual’s stress level and try to help calm them. • Eliminate (if possible) physical or sensory barriers which may be causing a

problem. • Try to relocate (if possible) the person to areas where there are fewer onlookers

if they seem agitated or uncomfortable. • If the request is beyond your control, explain that it is and ask how you can best

help the person – avoid involving too many people.

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People with a learning disability

A learning disability may be subtle or pronounced. Some conditions may interfere with a person’s ability to receive, process or express information (e.g. concentration, sequencing, memory, personality, ability to read, write, following directions). These may also have an impact on relationships and personal interactions. A learning disability is invisible, however, some people may display different actions or behaviors. It is important to remember that a learning disability has nothing do to with intelligence or psychiatric conditions. Tips for Effective Communication

• Do not make assumptions – Always ask for the best techniques to use to accommodate the person’s needs.

• Be familiar with and provide information on alternative formats that are available to them.

• Be patient, optimistic and willing to find creative solutions to communicating or working with your client.

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Services and Accommodations What is a service animal? Think of a service animal as an animal with a job to do for a person with a disability. Examples include guide dogs and animals trained to alert an individual to an oncoming seizure and lead them to safety. The Accessibility for Ontarians with Disabilities Act, 2005 refers to the definition of “guide dog” under the Blind Persons’ Rights Act, which states that: a guide dog is a dog that has been trained as a guide for a blind person at one of the facilities listed in Ontario Regulation 58 under the Blind Persons’ Rights Act. The Ministry of the Attorney General may issue identification cards to identify a person who is blind and his or her guide dog. The customer service standard requires you to let people with disabilities use their service animals on the parts of your premises open to the public or to third parties unless the animal is otherwise excluded by law from the premises. Under the standard, an animal is a service animal if it is readily apparent that the animal is used by the person for reasons relating to his or her disability, or if the person has a letter from a physician or nurse verifying that the animal is required for reasons relating to his or her disability. If it is not obvious that the animal is a service animal, you are not required to allow the animal on your premises if the person does not have a letter from a physician or nurse, or an identification card from the Ministry of the Attorney General. The following chart lists some types of service animals, key tasks they perform and those who use service animals.

Service Animal Key Tasks Users § Autism assistance

or service dog. § Keeps a child from running

into danger and provides assistance when sensory stimulus is heightened. Dog is attached to the child’s waist by a belt and a leash held by an adult.

§ People with autism or other developmental/ intellectual disabilities

§ Guide dog, dog guide or seeing eye dog

§ Follow directions of owner to changes in elevation(e.g., curbs, stairs) and obstacles

§ People with vision loss

§ Hearing ear, hearing, sound alert or hearing alert dog, cat or animal

§ Alerts owner to sounds often by a nudge or pawing and leads him/her to the source of the sound.

§ May use special signal to alert

§ People who are deaf, oral deaf, deafened or hard of hearing

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owner to fire alarm § Psychiatric

service dog § Retrieves and prompts the

person to take medicine, retrieves or activates medical alert, leads person out of crowds, etc.

§ People with mental health disabilities

§ Service or mobility dog or animal, special skills dog or animal

(Small ponies or miniature horses are used but are not as common).

• Many pull wheelchairs, carry objects, pull items, turn handles or push buttons such as door openers. Larger dogs may provide balance support.

• People with physical disabilities

• Seizure, seizure alert, seizure assist or seizure response dog or animal

• Steers owner from danger during a seizure, activates medical alert

• Can alert owner to an oncoming seizure

• People who have epilepsy or other seizure disorders

Who is a support person? A support person is an individual hired or chosen to accompany a person with a disability to provide services or assistance with communication, mobility, personal care, medical needs or access to goods or services. Personal care needs may include, but are not limited to, assistance with eating or using the washroom, and medical needs.

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Services and Accommodations Available at the CSC CHIGAMIK CHC Printed Floor Plans Printed copies of the floor plans are available throughout the building, near the exits. Accessible Entrance The main entrance facing King Street is an accessibility entrance – it has accessibility buttons which open both doors and lead to the front desk. Accessible Parking There is one accessible parking spot located near the main entrance. Accessible Washrooms All washrooms are accessible – some are marked and others have an accessible stall. Wheelchairs A wheelchair is available at the main entrance doors. American Sign Language (ALS) Interpreters American Sign Language (ALS) Interpreters are not available at CSC CHIGAMIK CHC. This service can be arranged by contacting Ontario Interpreting Services (OIS) at 705-737-3190 or TTY 705-737-4911 Monday to Friday 9am to 5pm. Accessibility Point Staff Person CSC CHIGAMIK CHC has appointed an accessibility point staff person. Their responsibilities are to: (a) respond to comments received by clients or community members pertaining to the accessibility of the Centre, and (b) create and distribute notices in disruption of services and facilities as they pertain to accessibility.

Possible Barriers Possible Solutions Vision Loss Staff is not aware of the need to describe goods or services when a person cannot read a sign.

• Make it standards practice to describe to customers the goods or services offered if they are unable to view them due to vision loss

Deaf, deafened, oral deaf or hard of hearing Telephone services not accessible for customers who are Deaf, deafened, oral deaf or hard of hearing

• Incorporate use of TTY and Relay services in your telephone service policies.

• Ensure staff is trained in, and practice using, TTY and Relay Services.

Staff is not aware of the need to paraphrase or repeat more slowly what is said to customers when the customer had not understood the message.

• Establish the practice of paraphrasing and repeating communications more clearly to customers upon request or using other means such as passing notes back and forth.

Speaking to customers with • Establish the practice of speaking clearly and

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hands covering the mouth which does not allow for lip-reading

making sure that nothing is covering the mouth when communicating with customers who lip-read.

Loud music or poor acoustics, making hearing difficult for people using hearing aids

• Establish the practice of having pen and paper available and communicate through note-writing.

Intellectual/Developmental disability

Use of complicated or technical language in healthcare

• Establish the practice of using plain language and avoid technical language when communicating

Ignoring customers who are more reserved or afraid to ask for help

• Establish the practice of building in extra time to deal with customers who need it and adjust the availability of other staff to help out as needed.

Learning disability Providing complicated documents to customers without explanation or opportunity to discuss or ask questions

• Establish the practice of discussing and explaining any documentation provided to customers.

Employees who are not flexible in offering alternative communication strategies or adequate time in providing services

• Make it a standard procedure to break up lengthy conversations into a series of shorter ones. This may assist customers who need additional time to process certain types of information.

Mental Health (or psychiatric) disability

Negative stereotypes about people with mental health disabilities resulting in disrespectful or impatient treatment.

• Add training components to the regular training that staff receive on the needs of people with mental health disabilities

• Make it a standard procedure to break up lengthy conversations into a series of shorter ones and speak more slowly so that some customers will not feel overwhelmed with the information. This may help to prevent anxiety in some customers.

Physical disability Failure of staff to offer assistance when some services require particular agility and/or motor skills

• Develop a policy that requires staff to assist customers in handling or reaching goods when requested

Failure of staff to set aside convenient seating (close to rest rooms or exits)

• Establish the practice of setting aside convenient seating for people with physical disabilities.

Speech impairment Verbal speech is the only form of communication used to interact with customers

• Develop a policy that requires staff to have pen and paper on hand and communicate through note-writing when requested to do so.

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Your Role and Responsibility

Please remember…

• Watch your own attitude. • Treat the person with a disability with respect and dignity. Treat them as you

like to be treated. • Do not feel slighted if you offer help and it is refused. • Become familiar with roadblocks that people with disabilities encounter daily. • Be an advocate and help remove barriers! • Believe that YOU can make a difference.

YOUR NEXT STEPS…

1. Watch the first video under the section “Talk to Me – Serving Customers with Disabilities at the following weblink: http://www.mcss.gov.on.ca/en/mcss/programs/accessibility/understanding_accessibility/howto_videos.aspx. Feel free to explore and watch any other video on the webpage.

2. Become familiar with the Centre’s accessibility point staff person. They are the point person responsible for responding to the comments the Centre receives pertaining to accessibility. They also create and distribute notices in disruption of services and facilities as they pertain to accessibility.

3. Complete the Accessibility Quiz

4. Print your certificate, read, sign and submit it to the Office Manager Certificate of Completion - Accessibility.pub