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Draw on some of the following techniques to facilitate comprehension as appropriate:

• Use language that is appropriate to the age and abilities of the patient/client.
• Use language that is appropriate to the linguistic and cultural background of the patient/client as outlined in the Position Statement on Service Delivery to Culturally and Linguistically Diverse Populations"  .
• Explain all concepts as simply as possible.
• Ensure that the patient/client can hear sufficiently to participate in the discussion. Provide accommodations as necessary, such as assistive listening devices, supplementary written information, adequate lighting, and a quiet environment.
• Provide alternative methods of communication for patients/clients whose competence to provide consent may be masked by a communication disorder.
• Provide visual aids throughout the discussion to support conversation, accommodating for any visual difficulties. These can include the following:
  • using large materials with sufficient contrast to accommodate acuity or placement to accommodate visual field deficits;
  • providing prepared written materials to support the discussion;
  • writing down the main points during the discussion;
  • providing pictorial support for the discussion using age-appropriate pictographs, symbols, or storybook formats; and
  • using any combination of the above that is best suited for the patient/client.
• Allow the patient/client to paraphrase the discussion to confirm comprehension. Techniques to facilitate this expression are below listed in point c below.
• Provide the patient/client with sufficient time to process the information and ask any questions. In some instances, it may be helpful to allow the patient/client to contact you following the session to review any issues or ask about issues that did not come up during the face-to-face session.
• Verify that the patient/client has demonstrated comprehension after each component has been presented, to minimize the effect of memory difficulties.
• Encourage the patient/client to allow others to participate in these discussions for support but ensure that the discussion is targeted to the patient/client. It is the patient/client who must ultimately make the informed decisions regarding the services offered.
• Provide communicatively accessible handout information following the discussion to allow the patient/client to review the material in his or her own environment and own time. Depending on the communication abilities of the patient/client and his or her significant others, such information may be provided in alternative formats such as written, picture symbols, tape recording, and computer-assisted presentation.

Draw on some of the following techniques to facilitate expression as appropriate

• Structure the dialogue to allow the patient/client every opportunity to ask questions and add perspectives to the discussion. Techniques to facilitate this may include
  • direct (“What do you think?”) and indirect (“I wonder what you are thinking”) invitations to participate in the discussion; and
  • pausing frequently for sufficient durations to allow an unsure or reluctant patient/client the opportunity to participate and ask questions.
• Use techniques to support communication, such as interactive drawing, pointing to relevant pictorial or symbolic representations, pointing to key words provided, gesturing, age-appropriate play activity or enactment, use of yes/no responses.
• Allow the patient/client to express his or her understanding of the assessment and treatment alternatives at each stage of the discussion (e.g., present each option visually and allow the patient/client to indicate what was understood using his or her preferred communication modality).