Accessibility Initiatives for Deaf and Hearing Impaired People by hjkuiw354


Initiatives for
Deaf and Hearing
Impaired People
2   Accessibility Initiatives for the Deaf and Hearing Impaired
Accessibility Initiatives for
Deaf and Hearing Impaired People
This brochure is a supplement to the seminar on best practice accessibility
initiatives for Deaf and hearing impaired people held on 20 March 2007
at Brisbane’s Princess Alexandra Hospital.
Prior to the seminar a presentation and morning tea was held in
recognition of Princess Alexandra Hospital’s efforts and successes in
this area, with an address given by Graeme Innes AM, Human Rights
& Disability Discrimination Commissioner from the Human Rights and
Equal Opportunity Commission.

Contributors to this brochure include:
The Deafness Forum
Princess Alexandra Hospital – Audiology Department
Princess Alexandra Hospital – Division of Mental Health
Queensland Health - Consumer Health Council Project
Media Access Australia

    About the Deafness Forum
    Deafness Forum is the peak body for deafness in Australia. Established
    in early 1993 at the instigation of the Federal government, the Deafness
    Forum now represents all interests and viewpoints of the Deaf and
    hearing impaired communities of Australia (including those people who
    have a chronic disorder of the ear and those who are DeafBlind).
    The Deafness Forum is divided into four classes of membership:
    Consumers, Consumer Associations, Service Providers, and Service
    Provider Associations.
    The Deafness Forum exists to improve the quality of life for Australians
    who are Deaf, have a hearing impairment or have a chronic disorder of
    the ear by:
    • advocating for government policy change and development
    • making input into policy and legislation
    • generating public awareness
    • providing a forum for information sharing and
    • creating better understanding between all areas of deafness.
    Deafness is a serious health issue. Deafness Forum aims to exercise
    leadership in influencing communication access, noise prevention
    and other deafness issues. They do this through government lobbying;
    systemic advocacy; generating community awareness and supporting at
    a more macro level, the interests of the underlying constituency.
    Deafness Forum run a number of key national events including:
    • National Deafness Sector Summits (every second year)
    • The Libby Harricks Memorial Oration
    • Captioning Awards
    • Hearing Awareness Week
    Deafness Forum of Australia
    218 Northbourne Avenue
    Braddon ACT 2612
    Tel 02 6262 7808
    TTY 02 6262 7809
    Fax 02 6262 7810
    Web site

4   Accessibility Initiatives for the Deaf and Hearing Impaired
Tips for implementing access
initiatives in your organisation
- the PAH experience
In Australia it is only recently we have seen significant action towards
addressing the communication barriers faced by Deaf and hearing
impaired people interfacing with health services. A major redevelopment
at Princess Alexandra Hospital (PAH) completed in 2001 provided the
impetus to examine services and facilities in a systematic way with the
aim of ensuring equal access opportunity for Deaf and hearing impaired
patients, staff and visitors. At the time PAH became the most developed
model in Australia for addressing access issues and removed one of the
initial barriers to progress - the lack of a hospital model.
This leads to one of the key pieces of advice in improving access in
your facility or service-
Utilise the knowledge and experience of others: In addition to
PAH a number of very good models now exist including St Vincent’s
Private and the Royal Eye and Ear Hospitals in Melbourne and more
recently the Royal Brisbane Hospital. While it is acknowledged that
every organisation has its own unique environment and issues, the tips
below may assist you in your problem solving.

Tips for success
Know and apply your organisational values: Access initiatives
achieve a number of key health initiatives. They demonstrate
commitment to achieving equitable health outcomes for all, they
involve patients in the treatment and care they receive, and they show
commitment to continuous improvement which are often key principles
in health care delivery. Access improvement achievements can be
used as evidence of compliance with a number of the national health
standards which form part of the health service accreditation process.
Be guided by legislation and policies: The Disability Discrimination
Act (DDA) 1992, The Disability Services Act 2006, The Queensland
Government Captioning Policy 2007 and the Queensland Health
Language Services Policy Statement 2000 are all relevant. As an example
the service delivery principles in the Disability Services Act 2006
encourage service providers to consider the needs of people with a
disability when they design and deliver services. Excellent resources are
also available on the Australian Human Rights and Equal Opportunity
Commission web site including guides for developing DDA action plans.

    Look at all aspects of access: Assistive technology, processes,
    education, environment and services. For example the establishment of
    the PAH Statewide Consultation Service for Deaf and Hearing Impaired
    People occurred in recognition of the fact that the mental health needs
    of these groups were not being met. Consider an audit of your facility
    and services- an example of an audit is contained in the PAH Project
    Report (1999) by Susan Forster which is available electronically from*
    Gain a sponsor within your organisation’s executive: Enlisting
    an executive sponsor can provide invaluable guidance in identifying
    and applying for funds and providing input into policies and procedures.
    Enlist champions: Foster involvement and education of staff who
    show enthusiasm and interest in access - they will become champions
    in the workplace and make the process sustainable over time.
    Promote successes: Write articles and present at seminars and
    conferences both within your organisation and externally. External
    recognition is a positive reinforcer for your organisation
    Form partnerships: Multiple patient and staff educational materials
    at PAH were captioned through a successful grant application submitted
    by Media Access Australia in partnership with the hospital. Working
    with Reporters Ink a patient with a severe hearing loss associated with
    a traumatic brain injury could be involved in their care planning via
    the use of real time captioning. This was a first for the hospital and the
    patient’s participation could not have occurred without the technology.
    Look for links with other services within your organisation:
    In 2006 close to 100 frontline staff were trained in communication
    strategies and the use of interpreters in health. This occurred through
    a joint project between the Audiology Department and Patient
    Administrative Services (incorporating interpreting and administrative
    support services) and is continuing in 2007.
    Opportunities arise during new building and redevelopment:
    Assistive technology and environmental considerations are often ideally
    addressed at the design phase- input into the process! Costs may be less
    and organisational readiness for change is enhanced at this time.
    Incorporate access requirements in tenders: Provision of caption
    channels on the patient education network and the inclusion of volume
    control phones and telephone typewriters (TTYs) were mandatory
    system requirements at PAH when tender documents were developed
    for these utilities.
    Some things are for free: Negotiation with Telstra resulted in the
    provision of special public payphones with telephone typewriters for
    the main foyer, the Emergency Department and in the Mental Health
    building at PAH.

6   Accessibility Initiatives for the Deaf and Hearing Impaired
Incorporate technology into standard processes: An example is
the use of the audioloop in the Russell Strong Auditorium at PAH. The
loop is automatically engaged when the microphone is switched on.
Solutions to improve accessability are more likely to be sustainable if
they form part of a standard process.
Put in place systems to track and maintain equipment:
Equipment such as personal listening devices are easily misplaced and
require checking prior to re-issue. We have utilised colour-coded plastic
boxes which are clearly labeled. Instructions are included in the boxes
and a tracking process is in place.
Seek feedback from the experts: Advice from technical experts has
informed the selection of assistive technology for patients and provided
solutions to address reasonable adjustment for staff in the workplace.
Cheaper devices may prove expensive in the long term if they
breakdown frequently and/or if local repair is not possible. An acoustics
engineer may be required to solve complex issues with noise such as
reverberant environments.
Enlist staff in an area to problem solve: Staff know their own
area and their ideas will form part of the solution. The other part of the
solution is contained in consumer feedback. This brings us to another
key success factor- consumer participation.

The role of consumers
Involve consumers in an audit of your facilities: Research
and experience show that engaging consumers improves the
appropriateness of health services and complaints management.
The Emergency and Outpatient Service Improvement Working Party
at PAH is an alliance of staff and consumers which has contributed
to resource development, education programs and process change.
Examples include an outpatient alert so that patients are not missed
in waiting areas as a result of not hearing their names called and the
communication sticker for the patient chart so that sign language
interpreters are booked when needed.
Advertise assistive technology to consumers: Include information
in bedside booklets and on the entertainment network. Clearly identify
equipment such as audioloops and TTYs by way of signage. Inform
support groups about the technology you have available and consider
running tours of the facility for group representatives. PAH ran special
site tours prior to the official opening of the new facility. Groups were
kept small, guides were given training in communication strategies and
sign language interpreters were employed for the day.

    Educate consumers on their rights and responsibilities:
    Include in your presentation ways that consumers can give feedback to
    your organisation. Encourage consumers to use assistive technology and
    provide education where needed.
    Staff education using real life examples: Feedback from staff has
    clearly indicated that listening to consumers report on their experience
    of a service is a powerful tool in motivating change. This leads to a big
    key to success- staff education.

    Staff education
    Staff education is one of the most important but challenging of issues.
    There are many competing demands for staff education including
    mandatory training and ongoing education in new procedures and
    therapies. Other challenges in education include the sheer number
    of staff (in our hospital well over 5000), covering part-time and shift
    workers and staff turnover. Some pearls of wisdom include-
    Ask staff about the format in which they like to receive their
    education and resources: On-line, face to face, posters, handouts,
    pocket guides, stickers. Be responsive to time constraints- a day
    workshop may not be possible in some areas while several shorter
    presentations may be successful. Utilise special events like Hearing
    Awareness Week and National Week of Deaf People to promote your
    Engage consumers to tell their story: As stated earlier the real
    life experience of the consumer is often powerful in engaging staff in
    education. Alternatively build up some good examples to illustrate why
    improving accessability is important. Case studies are contained within
    the Deafness and Mental Health Guidelines (2004), a Queensland
    Health publication.
    What’s in it for the staff: Let staff know if the training will make their
    job easier and have improved outcomes for patients. Make training
    relevant to the area- where possible use examples from that area.
    Staff want to do a good job and letting them know some strategies to
    enhance communication is a good way to begin.

    When do you know that you
    are finished?
    Just like the quality cycle there is always room for improvement.
    Technology is changing, the environment changes and new processes

8   Accessibility Initiatives for the Deaf and Hearing Impaired
are instigated some of which will impact positively or negatively on
access for Deaf and hearing impaired people.
Here are some examples:
The nurse call system containing the bedside speaker was replaced
and the earphone jack was removed from the design. Cochlear implant
users could no longer use direct auditory input to listen to the patient
entertainment system. Solution: the provider supplied some modified
systems with the jack in place.
The hospital changed to a digital switchboard and telecommunication
system. TTYs require an analogue line. The problem was addressed with
separate analogue lines being made available where TTYs were in place.

Ceiling tiles in a rehabilitation area were replaced with a highly
reverberant material creating a very difficult communication
environment. A new type of tile is being trialled in selected areas
at the advice of an acoustics engineer.
Sometimes we have to revisit issues as problems are identified or
opportunities to improve arise. One example is in the use of TTYs.
The experience of individual staff in the use of TTYs is limited due
to relatively low call numbers. It can be difficult to maintain staff
competence. An alternative is a unique telephone number for TTY
users which automatically connects the caller to the organisation via
the National Relay Service.

A thought for the future
Consumer engagement provides a real opportunity for organisations
and consumers to work together in achieving services and facilities truly
accessible to Deaf and hearing impaired people.

*Biography for Evelyn Towers
Evelyn is Director of Audiology at Princess Alexandra Hospital and
an advocate for equitable access to health services for Deaf and
hearing impaired people. Evelyn has presented on access at national
and international conferences and consumer forums and has written
a number of articles promoting awareness of communication access
issues. In addition to major access projects at PAH, Evelyn has worked
with health service providers and consumers across Queensland and
nationally to improve facilities and services for Deaf and hearing
impaired people.

     Princess Alexandra Hospital,
     Division of Mental Health
     Centre of Excellence -
     Deafness & Mental Health
     Statewide Consultation Service for Deaf
     and Hearing Impaired People
     It is estimated that up to 2 million Australian people experience some
     degree of hearing loss (AIHW, 2004) and estimates of the signing Deaf
     community range between 6,500 (Johnston, 2004) and 15,400 (Hyde
     & Power, 1991). It has been reported that up to 70% of adult aboriginal
     and Torres Strait Islander people have hearing problems and deafness,
     often relating to poorly managed childhood infections.
     It has been well established that the mental health needs for this group
     of people are not being adequately met. Identified barriers to service
     provision in Australia include, inappropriate assessments and service
     providers’ lack of awareness of deafness related issues (Briffa, 1999). A
     Queensland Health report (Briffa, 2001) confirmed that mental health
     services provided to this group were often inefficient, inappropriate
     and inequitable. Worldwide there is a growing appreciation for the
     specialised skills required to work in mental health settings with Deaf
     and hearing impaired people.
     The Princess Alexandra Hospital Health Service District (PAHHSD),
     Division of Mental Health, working in partnership with other groups
     (eg. Deaf Services Qld, Australian communication Exchange, etc),
     developed a Centre of Excellence for Deaf and Hearing Impaired People
     that was launched in November 2004. As a Centre of Excellence the
     PAHHSD Division of Mental Health now offers a State-wide psychiatric
     consultation service that strives to ensure that appropriate and
     accessible mental health care is provided to Deaf and hearing impaired
     people throughout Queensland via face to face consultation or by video
     An extensive set of resources and training has also been developed to
     assist mental health professionals to provide appropriate, accessible and
     equitable care to this cultural and linguistically diverse group.

10   Accessibility Initiatives for the Deaf and Hearing Impaired
The Service has provided assistance by way of support, information
and resources for 56 deaf or hearing impaired people since the service
Resources developed include ‘fact sheets’ and educational booklets on
‘schizophrenia’ and ‘depression’.
Presentations including a one day workshop for service providers
who work with deaf clients have been developed and have proved
A newsletter is distributed statewide to keep people working in this area
connected. Past editions can be accessed via the PAH website.

Customer focus
Our Steering Committee participants include not only mental health
professionals but Deaf and hearing impaired people, consumers, carers
and other experts in the field of deafness.
We aim to provide a service that is flexible and meets the need of the
individual. Preferred interpreters are booked when necessary.

This Statewide Consultation Service is the only service of its kind in
Australia and with Deaf Children Australia and Deaf Services Qld
hosting the next European Society of Deafness and Mental Health
Congress in Brisbane in 2009, we plan to showcase our service.

     Continuous improvement

     Regular service reviews and a 5 year plan have been developed.
     Funding has been approved to ensure that staffing levels will increase to
     meet the future needs.
     Data is collected on service utilisation, as well as consumer outcomes
     and we are using an outcome rating scale in Auslan that Louise has
     been using as part of her PhD.
     Future plans include providing information not only in pictorial form
     but on DVD as well. The information will be in Auslan, with voice-over
     and captioning.

     Striving for best practice

     Communication is absolutely critical in mental health settings. Second
     to communication is a knowledge and understanding of deafness
     and Deaf culture. It is rare to find a signing or Deaf mental health
     professional in Queensland. We use staff with appropriate language and
     cultural skills and if not already using sign language, staff members take
     classes to learn Auslan.
     Consultations are carried out in such a way as to provide the best
     possible communication between all parties. All interpreters are
     NAATI accredited and where possible, we try to get a client’s preferred
     interpreter. Our staff attend professional development to maintain
     up-to-date knowledge on what is happening in the field and we also
     provide staff education


     Deaf and hearing impaired mental health consumers in Queensland
     have not previously had access to this type of service before. This
     Service is Queensland’s first deafness and mental health Centre of
     Excellence. As resources for deaf people are difficult to find, our Service
     has found a need to develop resources.
     These resources are available through our website.

12   Accessibility Initiatives for the Deaf and Hearing Impaired
Frances Dark is a senior consultant psychiatrist at the PA Hospital
and has been working with the Statewide Consultation Service since its
inception in 2004. During this time she has gained an understanding
and appreciation for Deaf culture and is one of the rare clinicians who
can provide culturally and linguistically relevant assessments, diagnoses
and referrals. Despite a busy schedule Frances attends weekly sign
classes to improve her Auslan skills.

Dianne Briffa* is Clinical Nurse Specialist with the Princess Alexandra
Hospital Deafness and Mental Health service, and is also a NAATI
accredited Auslan interpreter (level 2). She has a special interest in
ensuring that Deaf people have access to and receive appropriate
treatment in mental health settings. Since beginning her journey
with the Deaf community in the USA more than 20 years ago, Di has
also been involved in a number of research projects for Queensland
Health and has published journal articles and research reports for both
government and non-government organisations.

Louise Munro is a Psychologist and has been working with the Deaf
community for 4 years. Louise began working with the PA Service in
January 2006 on a part-time basis while pursuing her PhD research
at the Queensland University of Technology where she also teaches
part-time in the Psychology and Counselling School. Her PhD research
has produced Auslan versions of outcome and therapeutic alliance
measures for use with deaf clients in counselling settings. Louise has
conversational signing skills

Lara Denman began working in the deafness and mental health arena
in 2003. Her last project in this area explored how the accessibility of
Qld Health’s mental health care services could be enhanced to met the
needs of deaf people from an Indigenous Australian or culturally and
linguistically diverse background.
Some of the highlights in her career include: piloting the use of video
conference technology to enable Deaf people in Queensland’s rural and
remote areas to gain access to a wide range of appropriate health care
and contributing to the establishment of the PA Hospital’s deafness and
Mental Health Centre of Excellence.
Lara is now working full time with the Qld Transcultural Mental Health

     Briffa, D. (1999). Deaf and mentally ill: Are their needs being met?
     Australasian Psychiatry, 7(1), 7 - 10.
     Briffa, D. (2001). Deafness and mental health: A report on the mental
     health needs of Deaf and hearing impaired people in Queensland.
     Brisbane Queensland: Queensland Government Health.
     Hyde, M., & Power, D. (1991). The Use of Australian Sign Language
     by Deaf People. Research report 1. Nathan, Queensland, Australia:
     Griffith University, Faculty of Education, Centre for Deafness Studies and
     Johnston, T. (2004). W(h)ither the Deaf community? Population,
     genetics, and the future of Australian Sign Language. American Annals
     Of The Deaf, 148(5), 358 - 375.

     *Biography for Dianne Briffa
     Dianne Briffa achievements include:

     • Qld Health Report “Deafness and Mental Health – A report on the
       Mental Health Needs Assessment of Deaf and Hearing Impaired
       People in Qld. 2001
     • “Deaf and mentally ill: Are their needs being met?” Australasian
       Psychiatry 1999, 7 (1) 7-10
     • “Hallucinations in Deaf people with mental illness: Lesson from
       Deaf clients: Australasian Psychiatry 1999 7, (2) 72 - 74

     • Silver Award for Achievement – Organisation Improvement Day, The
       Park 2002
     • The Sunflower Award – Schizophrenia Fellowship of South Qld Inc
       1999 for research into Deafness and Mental Health

     Conferences on Deafness and Mental Health
     • Comet Velim Conference, Sydney 2005
     • Aslia Qld Spring School October 2003
     • Sharing the Road Conference – Townsville July 2003

14   Accessibility Initiatives for the Deaf and Hearing Impaired
Engaging Queensland Consumers
in Health Care: 20 March 2007

*Susanna Doyle, Principal Project Officer -
Consumer Health Council Project

A. Current Opportunities for Queenslanders to Engage in Health
Service Provision and Policy Development:
Health Quality and Complaints Commission: Established on 1
July 2007 as a statutory authority, following the Queensland Health
Systems Review conducted in 2005, and has three main purposes: i)
to monitor and assist to improve the safety and quality of health care
in Queensland; ii) to respond to and investigate serious consumer
complaints and; iii) to encourage consumer engagement in health care.
One of the key roles in assisting consumer engagement is to undertake
the recruitment of members of the Health Community Councils, and
make recommendations to the Minister regarding appointment to these
Councils. (for more information see:
Health Community Councils: Will replace the current 37 District
Health Councils and appointments to these new councils are expected
around July 2007. Expressions of Interest for membership on these
councils closed on 12 February 2007. These new councils will have a
role in monitoring the safety and quality of local health services and
engaging with local communities regarding health care.
Consumer and Carer Consultants in Mental Health services:
Queensland Health has employed both Care Consultants and Consumer
Consultants (currently about 12-15 across Queensland). Their role is to
provide the consumer and/or carer perspective in service planning and
policy development, and provide support and information to consumers
within services, and their carers. Also have consumer representatives
sitting on committees in Health Service Districts and Areas, and at
the State wide level. These representatives provide the carer and/or
consumer perspective in service planning and policy development.
Local District and Health Service Engagement Strategies:
Each health service and District may have its own engagement strategies
and/or consumer engagement network. There may also be a person
within the District who undertakes a key role in fostering consumer
engagement in that area. It will be important to find out if your local
District office has a person identified who can provide information on
current engagement strategies or events that consumers may become
engaged in, for example a District or hospital committee.

     Support or Advocacy Groups/Organisations across Queensland:
     These may include health condition or community specific groups or
     organisations (for example the Asthma Foundation etc). On the whole,
     consumers need to meet eligibility criteria to receive support from these
     groups and funding is limited so only certain kinds of support can be
     provided, although consumers can have a role in representing people
     from their support group at a local or state-wide level through these groups.
     Consumers Health Forum of Australia: A national health
     advocacy and support organisation that focuses on representing and
     involving consumers in health policy and program development. Also
     has a consumer representative program where consumers can train up
     to sit on national committees to provide the consumer perspective, and
     represent the consumer perspective. Voting members are organisations
     with aims and objectives which represent consumers’ views and
     interests. (see:
     Proposed Queensland Consumer Health Council: A proposed
     organisation that may represent consumers’ interests and perspectives
     in health service planning and policy development at the state-wide
     level. It may also potentially provide individual advocacy; support and
     training to Health Community Councils; and train consumers to perform
     a range of consumer representation roles. (see website: http://www.

     B. Strategies for Health Services to achieve Consumer Engagement
     Know your current key policies, standards and legislation:
     Key legislation supporting consumer engagement in Queensland
     includes the Anti-Discrimination Act 1991 (ADA), The Disability
     Discrimination Act 1992 (DDA) and the Disability Services Act 2006
     (DSA). Most health areas also have key policy or standards documents
     available either at the national or state-wide levels that often contain
     policy statements or principles regarding consumer engagement and
     participation (for example the National Mental Health Plan 2003
     – 2008 and the National Standards for Disability Services).
     Most health services are also required to undergo an accreditation
     process and these nationally based standards often have specific
     standards that require services to engage with their consumers or to
     establish participation strategies (for example the Australian Council for
     Healthcare Standards). Evidence of this participation must be provided
     at the time of accreditation of each service.

16   Accessibility Initiatives for the Deaf and Hearing Impaired
Planning for consumer engagement: Services often need to
consider a number of factors to enure that consumers are able to
participate in service planning, and monitoring of the quality of
health care. This will include for example, considering the level of
involvement (i.e. do they need involvement at the local health service
or state wide levels); the type of engagement (i.e. is a consumer
representative on a committee more effective or is a satisfaction survey
or public consultation process required to reach a broader number of
people?). Most services need to consider a range of different types of
strategies to ensure they are up to date with what their consumers want
from their health services.
Services will also need to consider the practical needs of consumers
when planning engagement strategies. Considerations may include:
what financial support a consumer may require (for example
reimbursement of expenses for participants including travel costs, meals
etc). Some representation roles on committees now provide sitting fees.
People who have disabilities may require reasonable adjustments and
modifications to enable them to participate. This could include access
to information in modified formats (e.g. larger print), meetings to be held
in areas that have adequate physical or sensory access strategies in
place (eg technology such as real time captioning, and audio loops etc),
or sign language interpreters. People from culturally and linguistically
diverse communities may require access to language interpreter and
translation services. People from indigenous communities or rural
and remote areas may also require assistance to attend meetings or to
have consultations held in an environment that is more accessible to
their local communities. As a general rule, consumers require a clear
statement on their roles and responsibilities as well as orientation and
training to perform their roles effectively. Training may also be required
to health service staff and to ensure they know how to interact and
communicate with consumers, and to use their skills and knowledge
Selection processes for consumer representatives can include criteria
such as ascertaining the persons skills, knowledge and experience
(may not necessarily be evidenced through formal qualifications);
communication skills; the person’s ability to represent their group and
keep in contact with them; and evidence of the endorsement by this
group or community for them to be their representative.

Key Strategies for Consumer Engagement Include:
• The Consumer Representative Role: a widely spread strategy, where
  one or more consumers will be elected to sit on a committee,
  steering group, or working party etc, and their role is to specifically
  represent the views and perspectives of consumers of that service or
  organisation. Often they are elected by a consumer organisation or

        community to represent people within that group. It is important that
        representatives do undertake to represent their group perspective and
        do not only speak from their own experience or opinion and avoid
        conflicts of interest1.
     • Deliberative Techniques: usually characterised by a process of
       reasoning and consumers are given an opportunity to contribute to
       discussions on a topic. May include deliberation forums; meetings;
       round tables; focus groups; consensus conferences; and citizen
       panels etc.
     • Broader Engagement Techniques: may include engagement via
       internet or email technology (eg online discussion groups), calls for
       submissions; questionaries; community or public meetings or forums;
       panels; workshops etc.

     Key Resources and Websites:
     1. Engaging Queenslanders: a guide to community engagement
        methods and techniques, 2004, Department of Communities.
     2. Engaging Queenslanders: Introduction to working with Aboriginal
        and Torres Strait Islander Communities, 2004, Department of
     3. Cultural Competency in Health: a guide for policy, partnerships
        and participation. December 2005, National Health and Medical
        Research Council and Australian Government.
     4. One talk: Queensland Health’s Aboriginal and Torres Strait Islander
        Community Engagement manual, 2005, Queensland Health.
     5. Culturally Responsive Service Delivery: information for service
        providers. Compiled by Irene Opper, Multicultural Advocate, April
        2006. Ethnic Communities Council of Queensland.
     6. World Health Organisation and United Nations web sites.
     7. Australian Human Rights and Equal Opportunity Commission:
     8. National Standards for Disability Services:
     9. Appropriate legislation (eg DDA, ADA and DSA Qld), and Australian

       Dr Judy Gregory, August 2006, Conceptualising Consumer Engagement:
     A review of the literature. Australian Institute of Health Policy Studies

18   Accessibility Initiatives for the Deaf and Hearing Impaired
*Biography for Susanna Doyle
Susanna is a qualified Occupational Therapist with experience in the
areas of disability, housing, mental health and aged care. She has a
Master of Public Health and is currently studying a Doctorate at the
Queensland University of Technology. Her doctorate is in the area
of aged care with a particular interest in consumer participation in
the research process. She also has experience in managing aged care
services in a non-government organisation, and more recently has been
working in health policy and project areas.
Susanna currently works for Queensland Health, in Corporate Office, in
the area of safety and quality. Her current project is about the proposal
to establish a Consumer Health Council for Queensland. She has had
an interest in consumer empowerment and participation for some years
and has been investigating theories and models in this area.
Phone: (07) 3636 9887, Email:

Media Access Australia
Using captions in the health industry
Using captions as a tool to access health education material is a
relatively new area but it has great potential to improve the way health
education is delivered.
Media Access Australia is a not-for-profit organisation that assists a range
of community, government and commercial services in developing
captioned health education audiovisual material. This can include some
financial assistance in captioning health education DVDs. We also
provide advice to hospitals and other health care facilities on the use of
captioning equipment and accessing already captioned material.
A general misconception is that providing captioning is an expensive
undertaking. DVDs can be captioned for a few hundred dollars and
televisions may need an inexpensive add-on to make them accessible.
In some cases it can be as simple as an adjustment to your current set
up and a basic education campaign for staff.
Hospitals and health services we have worked with include:
• Princess Alexandra, QLD
• Nambour General, QLD
• Charles Gairdner, WA
• Fremantle, WA
• Royal Prince Alfred, NSW
• Wollongong General, NSW
• Auburn, NSW                                                                 19
     • Liverpool, NSW
     • Westmead, NSW
     • Dubbo Base, NSW
     • Orange Base, NSW
     • St Vincent’s Private, Bathurst, NSW
     • Mona Vale, NSW
     • Murwillumbah, NSW
     • Manning Base, NSW
     • Port Macquarie, NSW
     • Port Macquarie Community Health Centre, NSW
     • Forster Tuncurry Community Health Centre, NSW
     • Geelong, VIC
     • Barwon Health, VIC
     • Australian Hearing
     • Cochlear
     • Shepherd Centres
     • Better Hearing Australia
     • Deafness Forum
     • Australian Association of the Deaf
     • State Deaf Societies
     • Anyone else who delivers audiology or hearing test services?
     Below is some advice on why captioning is important, the benefits
     beyond simply providing access and how you can become involved.

     Getting the message across
     Better dissemination of information: Your health messages
     have the potential to reach a wider audience by picking up the group
     of patients who, for disability or language reasons, are unable to
     understand a message that is only written or spoken. By combining
     audio, video and text in a DVD or CD-Rom, health messages can be
     better understood. This is further explained in Hints and Tips.
     Back up verbal discussions between staff and patients: A
     captioned DVD can be used to back up information on a medical
     condition, treatment or surgical procedures that have been discussed
     between patients and health care professionals. The combination of
     audio, visual and print delivers a very strong message that is more likely
     to be understood.

20   Accessibility Initiatives for the Deaf and Hearing Impaired
Ability to revisit at a later date: Patients will have the ability to
revisit an educational DVD at a later date. When a patient is first
diagnosed with a particular condition they may be in a state of shock
or confusion, therefore anything told to, watched or read by them may
not be taken in. Revisiting information through a combination
of formats will assist understanding of a message.
Beyond the hospital walls: Captioning can also be delivered using
remote live text. A service such as this, where a centrally located
captioner transcribes consultations in real time for a hearing impaired
patient, can be used for consultations that are conducted via video
conferencing, expanding the potential of remote services to include
hearing impaired patients, in particular, non-signing patients. For
example, Queensland Health’s Telehealth, a service which allows
professionals in rural and remote areas to access support and share
information relating to patient care and emerging health trends, could
find that a live text delivery service complements the services they
currently have.

Hints and tips
A wider audience: The primary audience for captioning is Deaf and
hearing impaired people. But captions assist other audiences, such
as people from a non-English speaking background and people with
learning difficulties. For people from a NESB, the use of captioned
material in educational settings enhances comprehension and language
learning through multi-sensory processing of the audio, video and print
components of captioned programs. Also, for people with learning or
language processing difficulties, the use of captions can often assist
them in understanding a video message.
Age and hospital admittances: Sensory abilities deteriorate with
age, therefore hearing loss affects a majority of the senior population.
A considerable proportion of people admitted to hospital have a hearing
loss and this number will continue to grow. Service providers need to
recognise these changes and adapt how they provide for patients’ needs.
Public waiting areas: Take a pen and paper and do a tour of your
facility. How many televisions are there in public waiting areas? How
many of these televisions are showing captions? Contact your television
service provider and ask if they can be adapted to receive captions.
For stand-alone televisions (not connected to a main system) they may
already be caption capable, or would simply require an inexpensive
digital set-top box to access captions. More than half of free-to-air
television programs, on all channels, show captions.

     Noise control: Many televisions in public areas have their sound
     turned low or off as the constant noise annoys staff and visitors. Captions
     allow people to enjoy the television service even without the sound.
     DVD versus video: Video is an obsolete medium. A single DVD can
     hold many different language subtitles and captions – all of which can
     be easily accessed through the DVD menus using a remote control.
     Another benefit is that a standard DVD player will play captions, unlike
     captioned videos which required a special closed caption VCR.

     Best practice advice
     Remember the rules: If you are a government agency you are
     required to caption all television programs, television commercials,
     videos, DVDs and CD-Roms you produce. Refer to your State or
     Territory Government’s policy at
     Captions only: If you are offered a DVD from a supplier (such as a
     pharmaceutical company), insist on a captioned version, even if it’s
     meant for only staff education purposes. If you are purchasing DVDs
     for your facility, insist on captioned versions. Look for opportunities
     where refurbishments or new building works will mean the installation
     of television sets. These should be capable of showing captions.
     Join forces: Discuss media access with colleagues, not only within
     your own area but across the organisation. Having a consistent policy
     ensures that you deliver a high standard of patient service.
     Keep abreast of technology: Much of the equipment used for
     accessing captions is commercially available and not specialist medical
     equipment. For example, DVD captions can be accessed using a
     standard DVD player. DVD players can be bought for under $100.
     Check with organisations like Media Access Australia and Deafness
     Forum before you purchase equipment to make sure that you are
     selecting the most cost-effective solution for your facility.

22   Accessibility Initiatives for the Deaf and Hearing Impaired
Lessons learnt by Media Access Australia
Perseverance pays: Perseverance is very hard to ignore. Continue to
ask questions of providers, offer suggested contacts or provide examples of
access in other facilities or on other DVDs. Eventually you will get a result.
From little things big things grow: Results you achieve from your
perseverance may seem small but offer potential for bigger and better
projects. A small project with potential to be expanded is often easier
to achieve than trying to make changes at a national industry level. For
example, a geriatric rehabilitation ward is an ideal ward to start making
changes, as this is where a majority of patients will have a hearing loss
and benefit from captions. From this success, move to other wards
you’d consider would benefit the most, e.g. wards that may have long-
term patients who are more likely to access any entertainment resources
available to them.
Get to know the right people: Every major hospital has a medical
illustrations or a technical department responsible for the production
of in-house DVDs for educational purposes. These are the people
that particularly need to be made aware of Government policy on
captioning as they are ultimately responsible for audiovisual product
produced in-house, which, under government policy, must be
For further information on captioning including caption suppliers,
Ph/TTY: 02 9212 6242
Fax: 02 9212 6289
Postal address:
Suite 4.05, 22-36 Mountain St
Ultimo NSW 2007


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