Communication Access Literature Review

Report commissioned by Speech Pathology Australia on behalf of the Communication Access Alliance

December 2018

Disclaimer: To the best of The Speech Pathology of Australia Limited’s (‘the Association’) knowledge, this information is valid at the time of publication. The Association makes no warranty or representation in relation to the content or accuracy of the material in this publication. The Association expressly disclaims any and all liability (including liability for negligence) in respect of use of information provided. The Association recommends you seek independent professional advice prior to making any decision involving matters outlined in this publication.

Acknowledgements

Executive summary

Background

Method

Findings

Evidence Based Practice and Communication Access

Existing communication access standards

Conclusion

References

Appendices

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Acknowledgements

Project Consultant
Dr Meredith Prain

Reference Group
Gail Mulcair, CEO, Speech Pathology Australia
Mary Gornik, National Advisor – Education, Early Childhood and Projects, Speech Pathology Australia
Dr Barbara Solarsh, Communication Access Co-ordinator, Scope Australia
Dr Robyn O’Halloran, Senior Lecturer, La Trobe University

With thanks to the following people and organisations who were consulted and contributed information for this report:
Dr Paul Hart, Sense Scotland
Atul Jaiswal and Sven Topp, Deafblind International Research Network
Cathy Basterfield: Access Easy English
Deafblind Ontario Services
Royal College of Speech Language Therapists
Speech-Language & Audiology Canada
New Zealand Speech-Language Therapists Association

Executive summary

In 2017 Speech Pathology Australia hosted an inaugural meeting of interested organisations and stakeholders to explore collaboration in the promotion of communication accessibility and to scope the potential development of Australian communication access standards. Subsequently, the Communication Access Alliance (CAA) was formed and initial meetings undertaken to establish key priorities and activities, to ultimately foster communication accessible communities. Recent work has seen Speech Pathology Australia, on behalf of the CAA, commission a literature review to determine the current legislative and policy context for communication support needs and to inform and guide the development of national communication access standards. The intention of this report is to provide an overview of the current situation in relation to communication accessibility in Australia and overseas, to describe the breadth of definitions currently in use, and identify where communication accessibility is cited and the context in which it appears.

Since its inception in 2006, the United Nations Convention on the Rights of Persons with Disabilities (United Nations, 2006) has increased awareness and understanding of the rights of people with disabilities generally, both in Australia and internationally. Specifically, Article 21 of this convention has precipitated activities to uphold the rights of people with communication support needs resulting from disabilities.

Rights of people with disabilities is firmly aligned with the concept of access; the extent to which a range of barriers in society are removed to enable people with different disabilities to access the community and achieve full citizenship. At present, in most western societies, physical access is well entrenched in legislation, standards, and is evident in communities. However, communication access, a relatively new concept which focuses on social access when communicating with people, is largely unrecognised and therefore there is an absence of support at all levels for identifying and achieving communication access standards.

A literature review on communication access is challenged by inconsistency in use of terminology nationally and internationally. In addition, defining and quantifying the population for whom communication access is relevant also remains challenging.

A review of legislation nationally and internationally highlights that Australia is lagging behind some other countries with regard to legislation which specifically addresses the human rights of citizens with communication support needs. Australia would benefit from adopting legislation, for example, such as that in Scotland and the United States, which makes specific provisions for people with communication support needs.

A review of research and grey literature regarding communication access reveals numerous challenges facing practitioners and researchers in this area. These include:

challenges in sourcing relevant literature
limited research evidence to support effectiveness of projects aimed at increasing communication access
limited research evidence regarding best practice in relation to producing accessible written information.

There is increasing consistency in the argument for including all those who experience barriers to communication access when defining the population of people with communication support needs. This inclusive approach would include people with sensory disabilities and people from cultural and linguistically diverse backgrounds.

Similarly, there is an argument for including all forms of communication when considering communication access. This would include face to face communication, written communication, telephone and digital communication, and communication mediated by an interpreter or communication support person.

It is promising to see practitioners and researchers advocating for an increase in practices, research and evaluation related to communication access, as at this stage, this area remains poorly addressed in the literature.

There are some positive preliminary findings regarding outcomes of implementing communication access projects. It will be important to build upon the learning and current resources developed through these projects, as well as applying evidence as it becomes available to ultimately achieve communication accessible communities.

Summary of key issues

Lack of consistency in terminology nationally
Lack of information regarding preferred terminology nationally
Challenges in identifying prevalence of people with communication support needs
Lack of terms or standards used in Australian legislation or policy to specifically address communication access of Australians with communication support needs
Considerable variability between states and sectors with regard to recognition of need for awareness raising and guidelines relating to communication access for people with communication support needs
Need for increase in practices, research and evaluation regarding communication access, including face to face, written, and digital mediums
Need for consistency and clarification of meaning of terms, including population of people with communication needs in research
Considerable variability in the communication access standards and guidelines which are currently available.

Summary of recommendations

Determine preferred terms with relation to communication access for use in Australia and the definition of these terms
Advocate for preferred terms to be used by governments, peak bodies, service providers, and other relevant agencies
Adopt a broad definition of communication support needs which will

include and benefit the most people experiencing barriers to communication access
identify specific subgroups of people who have communication support needs, noting those with a communication disability being of a particular focus for this work
ensure the data collected on people identified with communication support needs is consistent and comprehensive, thus strengthening advocacy to meet the needs of this diverse group

Advocate for specific practices to address the communication access needs of Australians with communication support needs in the next National Disability Strategy and State disability plans
Promote examples of legislation, policies and practices which advance the rights and address the communication access needs of people with communication support needs nationally and internationally. These could be highlighted, recognised and shared with governments, government agencies, peak bodies and service providers to raise awareness of good practice.
Advocate for evaluation of practices supporting communication access to be prioritised on the research agenda in Australia
Communication standards and/or guidelines should:

Involve a broad range of people with communication support needs in their development
Be supported by government, ideally by legislation
Support communication access for a wide range of people in a broad range of contexts including a range of communication modalities (for example, face to face, written, telephone and online including media)
Be evidence based.

Conclusion

In recent years there have been increasing efforts to raise awareness, and develop programs, resources, standards and guidelines to improve communication access for people with communication support needs nationally and internationally. These efforts have effected changes in legislation in some countries to better uphold the human rights of people with communication support needs, though legislation in this area in Australia remains limited with ‘access’ tending to focus on physical access, or general access to information and communication technologies.

Despite numerous activities to promote communication access, there remains lack of clarity and consistency regarding terminology and the population of people included when considering people with communication support needs. There is also inconsistency in the existing communication access standards and guidelines.

Considerably more research and evaluation are required to determine which strategies and approaches result in the best and most sustainable outcomes for the broadest most inclusive group of people with communication access needs. Strategies and approaches need to be clearly described and documented in detail for replicability.

This Literature Review does not claim to be an exhaustive review of all possible literature and evidence and was conducted as part of a time-limited project.

Within those boundaries, this report provides a platform for future work in defining the scope, context and application of communication access standards to support full and effective participation within society of those with communication support needs.

Background

The Communication Access Alliance (CAA) was established in July 2017, following a meeting held to determine the interest of organisations and stakeholders to consider advocacy efforts to promote communication accessibility in Australia. This was initiated by Speech Pathology Australia (SPA), aligned with a key strategic objective of SPA to foster ‘Communication accessible communities’.

The vision, values and key objectives of SPA are detailed in SPA’s Strategic Plan 2017 – 2019, and Speech Pathology 2030: Making futures happen (see Speech Pathology Australia, 2016, 2017). The key aspiration and strategic goal of ‘Communication accessible communities’ is outlined in both documents.

The development of national communication access standards has been explored through meetings of the CAA, with it established that the current context of legislation, policies and standards with regards to communication access first needed to be understood. This literature review is the first step in this process.

Since the United Nations produced the Convention on the Rights of Persons with Disabilities (United Nations, 2006) in 2006 , there has been growing awareness in Australia and internationally that considerably more work is required to uphold the rights of people with communication support needs resulting from disability.

A number of projects both within Australia such as the Communication Access Symbol (see Scope Australia, n.d.), and Internationally such as the International Communication Project (see International Communication Project, n.d.) , aim to increase awareness and improve communication access for people with communication support needs. However, it is unclear what evidence is available to support existing or developing communication guidelines or communication access standards.

The intention of this report is to provide an overview of current legislation, policy, and evidence regarding communication access, and to describe the breadth of definitions, identify where communication access is cited and the context in which it appears. The report focuses on access to communities and fostering of social inclusion rather than access to services, technology and resources.

Method

The integrative review framework described by Whittemore and Knafl (2005) was used, as this method of literature review allows for the inclusion of diverse data sources in order to provide a comprehensive and holistic understanding of the topic being researched.

The review method was also informed by the procedures outlined by Schlosser, Wendt, Angermeier, and Shetty (2005), who identify that because of the interdisciplinary nature of communication access, the relevant literature is scattered across numerous sources in a variety of larger fields. This makes searching for evidence and best practices challenging, so a number of sources are required. In compiling the information reported in this review, sources included:

a search of relevant databases (specified below);
a review of government legislation, policy and planning documents nationally and internationally
personal contact with certain members of the International Communication Project, International Society for Augmentative and Alternative Communication, Access Easy English, Deafblind International Research Network, and the reference group.

Literature Search

The following databases were searched from October to December 2018: EBSCOhost, Cochrane Library, Scopus, ProQuest and Google Scholar.

Combinations of search terms included:

"communication disability" OR "communication disorder" OR "communication impairment" OR "communication difficulty" OR "complex communication needs" OR "communication support needs" OR "complex communication support needs” OR “communication”, AND access* OR friendly, AND "social inclusion" OR "inclusive communication" OR "communication participation" OR inclus*

Searches in ProQuest and Google Scholar were limited by searching for key words in abstract only, or title only.

A search for relevant Australian legislation was undertaken using google with search terms that included “Australia/n” OR “(name of State e.g. Victoria/n” AND “law” OR “legislation” OR ‘act”, AND “disability”. Specific searches were also made for each State and Territories current disability action plan, as well as State specific communication standards or guidelines.

Each government document was searched using the terms ‘communication access, and ‘communication’.

Finally, information from personal contacts listed above, was requested regarding current legislation, policies, standards, guidelines and research evidence relevant to communication access.

Inclusion Criteria and Selection Process

Studies were included if they:

had a specific focus on communication access
were written in English

Studies were excluded if they were:

primary research
a conference abstract

Next, an iterative process commenced during which additional references were identified by searching the reference lists and citations of relevant papers. Relevant ‘grey literature’ such as project reports found through internet searching was also included.

The database searches yielded 33 results, 9 of which were duplicates. The 24 articles were reviewed in relation to the study’s inclusion / exclusion criteria, leaving 16 articles for analysis. Iterative searches of reference lists of included articles (snowballing), author searches and internet searches for “grey literature”, as well as references provided by the reference group and personal contacts yielded a further 14 references, making a total of 30 for review. The list of included references and sources are included in Appendix A.

Data evaluation

As the current integrative review used a diverse sampling frame and included empirical, non-empirical and theoretical sources, an approach to evaluating quality similar to historical research, as described by Whittemore (2005) was applied. The authenticity, methodological quality, informational value, and representativeness of the data sources was evaluated. No articles were excluded based on the data evaluation, however, articles evaluated as less strong on the abovementioned features contributed less to the process of analysis.

Data Analysis

Information was extracted from the included documents on population, terminology, and evidence-based practices to facilitate communication access, as well as any reference to the concepts of communication access or communication access standards, and key discussion points.

Findings

Terminology

There are two aspects of terminology which need to be considered with regard to communication access. The first is to define what is meant by the different terms currently in use, and the second is to decide on the term to be used within the Australian context.

When discussing communication access, there are two aspects which need to be defined and agreed upon. The first is to define and name the population of people who experience barriers to communication, and the second is to define and name the features of a communication accessible environment.

There are a variety of terms used internationally and nationally to refer to people, processes, and environments related to communication access. Solarsh and Johnson (2017b) identified 12 terms; 6 which refer to communication characteristics of the individual, and 6 which refer to the environment.

Table 1. Terms identified by Solarsh and Johnson (2017b)

Term used to refer to the person	Terms used to refer to the environment
Communication disorder	Aphasia friendly
Communication difficulty / impairment	Autism friendly
Communication difficulty	Dementia friendly
Complex communication needs	Communication friendly
Communication support needs	Communication access
Complex communication support needs	Inclusive communication

Terms used to describe individuals who experience barriers to communication access

This report identified 6 terms used to describe individuals who experience barriers to communication. These are people with / a; communication disability, communication impairment, communication disorder, communication difficulty, communication support needs, complex communication needs, complex communication support needs.

Tables 2 and 3 show the variety of terms currently in use, and the countries, organisations and authors using them.

Table 2. Term used to describe people experiencing barriers to communication access

	Communication disability	Communication difficulty	Communication impairment	Communication disorder	Communication Support Needs	Complex Communication Support Needs
SPA	X	X	X	X	X	X
Australian Bureau of Statistics	X
Scope / Communication Access Network		X				X
Royal College of Speech Language Therapists					X
National Disability Strategy (Australia)		X	X
International Communication Project	X
Americans with Disabilities Act	X
Scottish government					X
New Zealand Speech-Language Therapists Association	X				X

Note: All Australian State and Territory disability acts refer to reduced capacity for communication resulting from disability rather than referring to communication disability, impairment, difficulty or support needs.

Terms used to describe process of removing barriers to communication access

Solarsh and Johnson (2017b) in their review of terminology, included terms that referred to specific communication disorders such as ‘aphasia friendly’, and ‘autism friendly’. The current review is taking a broader approach, so only terms relevant to the broader population of people with communication support needs are included below.

Table 3. Terms used to describe process and experience of removing barriers to communication

	Communication access (ible)	Inclusive communication	Communication friendly	Effective communication	Successful communication
SPA	X	X
Scope / Communication Access Network	X
Royal College of Speech Language Therapists	X	X
Americans with Disabilities Act				X
Canadian Government					X
Scottish Government		X
New Zealand Speech-Language Therapists Association	X

Note: No Australian government legislation or planning documents reviewed make any mention of ‘communication access’, ‘inclusive communication’, or ‘communication friendly’ environments.

Use of terminology in this report

In this report, the term ‘communication support needs’ will be used to describe people experiencing barriers to communication access and the definition used by Law et al. (2007) will be adopted:

“People with communication support needs have difficulties associated with one or more aspects of communication. Communication refers to all aspects of interpersonal communication. This includes verbal understanding, expressive language, speech and the capacity to understand someone’s intended meaning rather than the words themselves. It also refers to literacy and other means by which individuals interact with one another.”
(Law et al., 2007, p. 6)

The term ‘communication support needs’ better reflects the social model of disability in contrast to the medical model which rests the disability with the individual rather than their environment. This term has the benefit of emphasising the needs arising out of the communication disability rather than the disability itself, and places the onus on others to find ways to communicate with, listen to, and find out the preferences of the individual. Finally, it emphasises the fact that there may be more differences within any group of people with disability ie. at the level of the individual than between different diagnostic group. Thus, it emphasises person-centred rather than generic models of care.

The term ‘communication access’ will be used as this is the term currently most used in Australia by SPA, Scope, and the Communication Access Alliance.

It is important to note that these are not necessarily the terms which will ultimately be used in Australia by Speech Pathology Australia or the Communication Access Alliance.

It remains unclear what terminology is being used most commonly by speech pathologists, disability peak bodies, disability service providers, and people with communication support needs across Australia. It is also unclear whether regional differences in terminology use exist across Australia as was found in a survey of terminology use across the United Kingdom (see Money et al., 2016).

Money et al. (2016, p. 37) make the important point that “using common terminology and standards locally will make it easier to compare service evaluations, audits and research findings”.

KEY ISSUES

Lack of consistency in terminology relating to communication access nationally and internationally
Lack of information regarding preferred terminology nationally

RECOMMENDATIONS

Determine preferred terms relating to communication access for use in Australia and the definition of these terms.
Advocate for preferred terms to be used by governments, peak bodies, service providers, and other relevant agencies

Population

While use of terminology is inconsistent, there is some statistical data on numbers of people within subgroups of individuals who make up the broader group of people with communication support needs.

Law et al. (2007) list potential subgroups of people with communication support needs. These are listed in Appendix H with more current or Australian terminology in brackets.

Some examples of subgroups include people with:

Neurological disorders
Sensory disorders
Neurodevelopmental disorders
Syndromes and birth defects
Language, learning and literacy disorders and difficulties
Communication disorders

Data on prevalence on all of these groups was not sought, and what is reported here is data which were reported in the documents reviewed.

Law et al. (2007) note four challenges in obtaining definitive numbers of people with communication support needs:

While data are available for the prevalence of communication need in some of the sub groups identified, there is not yet a recognised definition of communication support needs developed sufficiently to be used at a population level.
The definition of ‘communication support needs’ is, to a large extent, socially rather than objectively determined, so the extent to which something is a need is partially determined by the individual’s recognition that they have such a need and this is partially a function of the extent to which their community responds to that need.
The pattern of difficulties experienced can change across time as the need increases or decreases, and
Any estimate of communication support need is related to the existing services and whether they seek to identify the group concerned.

The National Disability Strategy stipulates that Australian data collected regarding disability must include figures about communication disability. This data is collected through the Australian Bureau of Statistics’ Survey of Disability, Ageing and Carers.

In 2015 it was estimated that 1.2 million Australians had some level of communication disability, ranging from those who function without difficulty in communicating every day but who use a communication aid, to those who cannot understand or be understood at all (Australian Bureau of Statistics, 2017).

A trend has been noted over the past 15 years, that correlates an increase in the number of people with communication support needs with the increases in the aging population. Enderby, Judge, Creer, and John (2013) identify that 45.9% of the total number of people who could benefit from Augmentative and Alternative Communication (AAC) consist of people with Alzheimer’s/Dementia and those with Parkinson’s disease, both conditions associated with an older population. Given the population is ageing, and that there are other conditions associated with ageing that result in communication support needs, it is probable that numbers of people with communication support needs will rise considerably. This trend is reflected in data from the 2015 Survey of Disability, Ageing and Carers which indicates the number of people with a communication disability has increased, from 883,600 in 2003 to 1,175,200 in 2015, driven largely by an increase in the number of people aged 65 years and over with communication disability from 511,500 people in 2003 to 753,400 people in 2015 (Australian Bureau of Statistics, 2017).

The percentage of those with a communication disability in a given population will vary based on condition type (for example, the percentage of people who have autism) or setting (for example, the percentage of children who start school with a speech, language and communication need).

Law et al. (2007) note that while the prevalence of people with diagnosed communication disabilities may be between 1 and 2% of the population, up to 20% of the population could benefit from communication support at any one time. However, this figure does not include those people with literacy difficulties, despite access to literacy being included in the definition of people with communication support needs used by Law et al. (2007)

The potential population of Australians with communication support needs rises considerably if people with low literacy, and those from culturally and linguistically different backgrounds, are included.

The Programme for the International Assessment of Adult Competencies, Australia, 2011-12, identifies 44% of Australians aged 15 to 74 years have non-functional literacy and experience difficulty accessing most written public information. (Australian Bureau of Statistics, 2013; Basterfield, 2014).

“As there is limited evidence as to the differential benefits of communication supports, it is valuable to consider the communication supports that will achieve social inclusion for a maximum number of people with a variety of communication difficulties.” (Solarsh & Johnson, 2017b, p. 127).

Issues related to the population of people with communication support needs are addressed further below in the section on face to face communication.

KEY ISSUES

Challenges in identifying the prevalence of people with communication support needs

RECOMMENDATIONS

That a broad definition of communication support needs is adopted which will

include and benefit the most people experiencing barriers to communication access
identify specific subgroups of people who have communication support needs, noting those with a communication disability being of a particular focus for this work
ensure the data collected on people identified with communication support needs is consistent and comprehensive, thus strengthening advocacy to meet the needs of this diverse group

Legislative, strategic and policy context

It is important to examine Australian legislation, policies and guidelines that are relevant to communication access as this legislation sets the context for practice and research related to communication access.

Figure 1. provides an overview of the legislative, strategic and policy context relevant to communication access in Australia.

This graphic displays an overview of the legislative, strategic and policy context relevant to communication access in Australia. The left column is headed legislative context and the right is titled, strategic and policy context.

(Australian Local Government Association, 2016, p. 10)

National government

United Nations Convention on the Rights of Persons with Disability (UNCRPD)

Australia is a signatory to the UNCRPD, of which Article 21 is the most relevant to communication access.

Article 21 – Freedom of expression and opinion, and access to information, states
“parties shall take all appropriate measures to ensure that persons with disabilities can exercise the right to freedom of expression and opinion, including the freedom to seek, receive and impart information and ideas on an equal basis with others and through all forms of communication of their choice, as defined in article 2 of the present Convention, including by:

a. Providing information intended for the general public to persons with disabilities in accessible formats and technologies appropriate to different kinds of disabilities in a timely manner and without additional cost;

b. Accepting and facilitating the use of sign languages, Braille, augmentative and alternative communication, and all other accessible means, modes and formats of communication of their choice by persons with disabilities in official interactions;

c. Urging private entities that provide services to the general public, including through the Internet, to provide information and services in accessible and usable formats for persons with disabilities;

d. Encouraging the mass media, including providers of information through the Internet, to make their services accessible to persons with disabilities;

e. Recognizing and promoting the use of sign languages.”
(United Nations, 2006)

Disability Discrimination Act (1992)
The Disability Discrimination Act (DDA) is an act passed by the Parliament of Australia which prohibits discrimination against people because of their disabilities. It is supplemented by a series of Disability Standards. Areas covered by these standards are employment, education, public transport services, access to premises, accommodation, and the administration of Commonwealth laws and programs (Australian Human Rights Commission, n.d.).

While communication access intersects with all of these standards, no explicit mention of communication or communication access is made with relation to the standards.

National Disability Strategy (2010 – 2020)
This National Disability Strategy is a significant move forward in achieving inclusion for people with disabilities. It has been developed in partnership under the auspices of the Council of Australian Governments and therefore has national application. It requires all state governments to be committed to a national approach to supporting people with disability to maximise their potential and participate as equal citizens in Australian society (Australian Government, 2016).

The development of this National Disability Strategy (2010-2020) is the first time in Australia’s history that all governments have committed to a unified, national approach to improving the lives of people with disability, their families and carers, and to providing leadership for a community-wide shift in attitudes (Australian Government, 2016).

The purpose of the National Disability Strategy is to:

establish a high level policy framework to give coherence to, and guide government activity across mainstream and disability-specific areas of public policy
drive improved performance of mainstream services in delivering outcomes for people with disability
give visibility to disability issues and ensure they are included in the development and implementation of all public policy that impacts on people with disability
provide national leadership toward greater inclusion of people with disability.

The Strategy will be revised and updated over its ten year life span in response to reviews of progress.

The National Disability Strategy proposes six outcome areas:

Inclusive and accessible communities.
Rights, protection, justice and legislation.
Economic security.
Personal and community support.
Learning and skills
Health and wellbeing.

Like the DDA Disability Standards, while communication access is relevant to all six outcome areas, communication is only referred to in relation to outcome 1, and this is only in relation to access to digital and telecommunication for people with disabilities generally, rather than communication access at the interpersonal level for people with communication support needs.

The National Disability Strategy identifies several challenges facing people with communication support needs.

“Those with disability are likely to experience multiple disadvantages. Lack of accessible information, communication difficulties or cultural sensitivities and differences can create barriers to services and support.” (Commonwealth of Australia, 2011, p. 14)

“Some consumers benefit from a combination of signing, lip reading, text display and enhanced audio. This type of multi-modal communication is sometimes referred to as ‘Total Conversation’ … Deaf people, people with hearing impairments and Deaf-blind people make especially good use of Total Conversation. People with communication impairments would also benefit from this multi-modal communication (Australian Communications Consumer Action Network, 2010, p.36)” (Commonwealth of Australia, 2011, p. 33)

“People with disability should receive the same preventative health care as others, but this does not always happen for reasons including physical barriers, lack of knowledge by health providers, stereotyping or communication difficulties.” (Commonwealth of Australia, 2011, p. 61).

Despite these limited mentions of ‘communication difficulties’ and ‘communication impairment’, there is minimal specific guidance within the document to address these issues beyond improving access to information and digital and telecommunication systems.

Strong advocacy is required to improve future National Disability Strategies by specifically acknowledging and addressing the needs of Australians with communication support needs.

State and Territory governments

In addition to the Disability Discrimination Act, and commitment to the National Disability Strategy, all Australian States and Territories have equal opportunity or anti-discrimination laws, which include discrimination on the basis of disability. These laws could potentially be used in an instance of communication access being denied, though no specific reference to communication access is made in these laws.

All State and Territory disability acts mention ‘communication’ when defining disability e.g. “disability, in respect of a person, means a disability .… - that results in - (i) a substantially reduced capacity of the person for communication, .….” (ACT Government, 1991, p. 20). Yet none of the State or Territory acts or disability plans make any specific mention of ‘communication access’. For example,

The following acts make no mention of communication with regard to communication access:

Australian Capital Territory Disability Services Act (1991)
New South Wales Disability Inclusion Act (2014)
Northern Territory Disability Services Act (2017)
Queensland Local government Act (2009)
South Australia Disability Inclusion Act (2018)
West Australia Disability Services Act (1993)

The Queensland and Victorian government disability acts do make some mention of communication as it would relate to communication access.

Queensland Disability Inclusion Act (2006)
This act reflects some recognition of the need to communicate appropriately with people with communication disability within the framework of disability services. An example of this is explaining the use of restrictive practices to a person with behaviours of concern. However, there is no reference to using appropriate communication in a social setting outside of this framework.

The act states:

“What are disability services

Disability services, for people with a disability, means 1 or more of the following - …

... (e) advocacy or information services or services that

provide alternative forms of communication; …” (Queensland Government, 2006, p. 22).

In relation to assessment of adults with an intellectual disability,

“….(b) developing theories about the factors that contribute to the adult’s behaviour mentioned in paragraph (a);

Examples of factors that might contribute to the behaviour - …

… • psychological or cognitive factors, such as low communication skills” (Queensland Government, 2006, p. 147).

With regard to requirement to give statement about use of restrictive practices

“ …. the relevant service provider must explain the statement to the adult ….. in a way that has appropriate regard to the adult’s age, culture, disability and communication ability” (Queensland Government, 2006, pp. 187-188).

Victorian Disability Act (2006)
This act does make a reference to social communication access in the statement below, but largely refers to communication related to behaviors of concern or disability services.

“Persons with a disability have the same right as other members of the community to - … access information and communicate in a manner appropriate to their communication and cultural needs;” (Victorian Government, 2006, p. 14).

“Provision of advice, notification or information under this Act. 1. (1) The contents of any advice, notice or information given or provided to a person with a disability under this Act must be explained by the person giving the advice, notice or information to the maximum extent possible to the person with a disability in the language, mode of communication and terms which that person is most likely to understand. (2) An explanation given under sub-section (1) must where reasonable be given both orally and in writing. (3) If a person appears to be incapable of reading an understanding information provided under this Act, a disability service provider must use reasonable endeavours to convey the information to the person in the language, mode of communication or terms which the person is most likely to understand. (4) For the purposes of sub-section (3), the disability service provider may give a copy of the advice, notice or information—

(a) to a family member, guardian, advocate or other person chosen by the person with a disability; or

(b) if no person is chosen under paragraph (a), to a person who the disability service provider considers can assist the person with a disability and is not employed by, or a representative of, the disability service provider.” (Victorian Government, 2006, pp. 19-20).

While very few and far between, these considerations required for Australians with communication support needs, recognised in legislation are a step in the right direction towards communication accessible communities, however considerably more breadth and specificity in legislation is required.

State Disability Plans

The following disability plans make no mention of communication with regard to people with communication support needs or communication access:

NSW Disability Inclusion Plan 2014
Victorian State Disability Plan 2017 – 2020

Though limited, the remaining State governments’ disability plans include some mention of ‘communication’ with regard to communication access, focusing predominantly on access to written information or language translation.

Queensland Disability Service Plan 2017 – 2020
“Action: Government services and funded non-government services provide access to language, translating and communication services (whole-of-government, Department of Local Government Racing and Multicultural Affairs lead) and specifically “Provide advice to other government agencies about communication with people with disability.” and “Provide advice to other government agencies about requirements of the language services policy and how to access interpreter and translation services. Provide advice to Department of Communities, Disability Services and Seniors staff (with a priority for front-line staff) on how to access a range of interpreter and translation services. Provide advice to other government agencies about “ (Queensland Government, 2017, pp. 15-16).

Note: These actions are repeated across multiple years of the plan.

Two action items stated in the Queensland government’s disability plan are highly relevant to communication access, but do not include the word “communication”. These are:

“Action: Work towards ensuring all Queensland Government information is accessible and provided in multiple formats (whole-of –government, Department of Communities, Disability Service’s and Seniors lead).” (Queensland Government, 2017, p. 11).

and

“Action: Government policies require Queensland Government websites to meet contemporary Australian Web Content Accessibility Guidelines. Work continues to be undertaken to provide transcripts and/or captions are available for newly created time-based media (i.e. pre-recorded video/audio) (whole-of-government, Department of Housing and Public Works lead).” (Queensland Government, 2017, p. 12).

This separation of different actions for different groups highlights the multifaceted nature of communication, and challenges faced when attempting to address communication access needs of all people with communication support needs. It also highlights a lack of understanding and awareness of what communication access is within a social model of disability.

South Australian Disability Access and Inclusion Plan 2014 – 2018
Under a heading of “Smart living for independence “

“Eight new “smart living” apartments were opened in 2013 to support people with disability to lead more independent lives. ……

The cutting-edge technology includes a call system, environmental controls and communications devices such as smart phones, which are all integrated into one system.” (Government of South Australia, 2014, p. 6).

Tasmanian Government Disability Services Strategic Plan 2015 – 2018
As well as identifying that people with disabilities may face barriers to accessing communication, the only other point relevant to communication access in the Tasmanian Government’s Disability Services Strategic Plan 2015-2018 is “Goal 3 People with disability have access to the services they need to live as independently as possible and to maximise wellbeing. Action area: Access to services … - Information and communication activities are undertaken using accessible and fully inclusive formats” (Tasmanian Government, 2015, p. 6).

A more current document from the Tasmanian Government titled “Accessible Island: Tasmania's Disability Framework for Action 2018” does not mention “fully inclusive formats”.

Western Australia Disability Access and Inclusion Plans
The Government of Western Australia rather than having a State Disability Plan, requires all local governments and selected government agencies to develop and implement Disability Access and Inclusion Plans. Activities and outcomes of these plans are reported annually. The 2016 – 2017 report had only two mentions of communication with regard to communication access; the first noting that people with disabilities may experience barriers to communication and the second reporting on an activity to raise awareness of communication access for people who are Deaf (Government of Western Australia, 2017).

State government services

As well as State governments having their own disability action plans, it is increasingly common that State governed services also have their own disability action plans, for example the South Australia Police Disability Access and Inclusion Plan 2017-2020, and the West Australian Country Health Service Disability Access and Inclusion Plan 2015 – 2020. The documents examined only mentioned communication in relation to being affected by disability, or aiming for ‘collaboration for effective communication’, but did not outline any strategies to improve communication access.

Some State governments have developed documents or websites to provide information about communication access for people with communication support needs. For example the Victorian Government Accessible Communication Guidelines 2014, and the Queensland Government’s ‘Better communication’ website (See www.qld.gov.au/disability/community/communicating). These resources provide useful information for communicating with people with a variety of different communication support needs, but are for the most part not evidence based.

Key legislation and planning documents, as well as examples of government services and resources across Australia, for the most part do little to address communication access. While most documents address the fact that disability can result in communication limitations, very few goals or strategies are documented to address these.

Local government

Western Australia, Victoria, and New South Wales State governments as part of their disability action plans (required by the federal government as part of the National Disability Strategy) require all local governments to also develop disability action plans. These have different names in different States e.g. Disability Access and Inclusion Plan in Western Australia, and Disability Action Plan in Victoria.

The Disability Inclusion Planning - Guide for Local Governments (2016) highlights two practical examples of activities undertaken by local governments as part of their disability action planning, which have relevance to communication access.

1. Examples of social inclusion for people with an intellectual disability:

“Providing training to staff working with children who have developmental delays and disabilities that affect communication and behaviour. Ku-ring-gai Council in NSW provides Inclusion Support Training to empower staff with the knowledge and confidence to engage and appropriately communicate with children with conditions such as Autism, ADHD, anxiety disorders and developmental delays. Goals of the training, which is provided and funded by Lifestart, include increasing awareness of the challenges faced by children with disabilities, educating staff on effective communication strategies that enable inclusion and providing guidance on best practice tools and techniques. The Council provides training for Ku-ring-gai Wildflower Garden staff who provide tours and workshops for various groups, landscape architects, local aquatic and fitness centre staff and staff who run a range of community events and programs.” (Australian Local Government Association, 2016, p. 5)

2. “The City (of Melville in WA) established Melville’s Age-Friendly Accessible Businesses Network (MAFAB) for businesses within the shopping centre…….. The City collaborated with AMP Capital Shopping Centres (Garden City) to produce a booklet for 280 retailers which included tips on how they can implement more inclusive practices, within the physical environment such as: colour contrast, clear signage and wide aisles and customer service and communication.” (Australian Local Government Association, 2016, p. 49)

See Appendix B for links to resources listed in the Disability Inclusion Planning – Guide for Local Governments on communication and inclusive consultation.

Communication access standards and guidelines in Australia

This review yielded two standards and two guidelines currently used in Australia, though it is likely there are others. It is important to note that there is no requirement to comply with these, as without legislation, services voluntarily opt to meet these standards and guidelines.

Communication Access Standards, Scope Australia (See Appendix C and https://www.scopeaust.org.au/service/communication-access/ )
Victorian Government Accessible Communication Guidelines 2014 (See Appendix D)
Auslan – English translation and video production standards, Australian Consumer Communication Action Network, (See https://accan.org.au/grants/completed-grants/621-what-standards-the-need-for-evidence-based-auslan-translation-standards-and-production-guidelines)
Australia.gov.au is currently compliant to Level A of the Web content accessibility guidelines version 2.0 (WCAG 2.0) standard. (See https://www.w3.org/TR/WCAG20/ )

International perspective

In the search for evidence to support communication standards for the Australian context it is valuable to examine what legislation and policies are guiding practice and research in communication access internationally.

Key legislation, policies and guidelines relevant to communication access from countries where these have been developed are outlined here.

United Kingdom
The Equality Act 2010 protects and promotes the rights of people with disabilities in the United Kingdom.

The Royal College of Speech Language Therapists has in recent years developed a position paper on Inclusive Communication, and five good communication standards (see Appendix E). In December, 2018, after extensive consultation, the Royal College of Speech-Language Therapists launched a communication access symbol and checklist to determine whether a service or organisation is communication accessible (see Appendix F and Money et al., 2016; Royal College of Speech and Language Therapists, 2018)

Scotland
Underpinned by the United Nations Convention on Rights of Persons with Disabilities, and the Equality Act 2010, the Scottish Government in 2011, developed a resource titled: Principles of Inclusive Communication: An information and self-assessment tool for public authorities (See Appendix G). This document provides six principles of inclusive communication with good practice examples for each, and ten performance indicators.

There are two new pieces of legislation in Scotland that include specific reference to inclusive communication. In March 2018 the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 came into force. This act includes guidance on the provision of communication equipment and support in using that equipment and states:

“Scottish Ministers must, to such extent as they consider necessary to meet all reasonable requirements, provide or secure the provision of

a. communication equipment, and

b. support in using that equipment, to any person who has lost their voice or has difficulty speaking.”

(Scottish Government, 2016, p. 23)

The Social Security (Scotland) Act 2018 is legislation that will provide Social Security benefits to be devolved to the Scottish Parliament. Included in this act are the following clauses:

“4. Recognition of importance of inclusive communication

(1) In fulfilling their duty under section 3(a), the Scottish Ministers must have regard to the importance of communicating in an inclusive way.

(2) In subsection (1), “communicating in an inclusive way” means communicating in a way that ensures individuals who have difficulty communicating (in relation to speech, language or otherwise) can receive information and express themselves in ways that best meet each individual’s needs.

5. Recognition of importance of accessible information

(1) In fulfilling their duty under section 3(a), the Scottish Ministers must have regard to the importance of providing information in a way that is accessible for individuals who have a sensory, physical or mental disability.

(2) The steps taken by the Scottish Ministers under section 3(b) must include steps in relation to ensuring that—

(a) the information this Act requires the Scottish Ministers to give to an individual is given in a format that is accessible to the individual, and

(b) all information which this Act requires the Scottish Ministers to make publicly available is available in formats that are accessible to individuals who have a sensory, physical or mental disability.”
(Scottish Government, 2018)

While this new legislation is a positive step in the right direction towards communication access for people with communication support needs, they focus on the person with the communication support needs and not on the environment and the responsibility of services, organisations and communities to take action to support communication access.

Canada
Not every province in Canada has accessibility standards. At the time of writing, Ontario, British Columbia, Manitoba, Quebec and Nova Scotia have accessibility standards (Deafblind Ontario Services, 2018).

The existing standards with regard to communication access focus on the need to provide information in ‘accessible formats’ or provide ‘communication supports’.

Communication Canada’s Successful Communication Toolkit: Literacy and You (2003), provides an overview of straightforward communications practices in a variety of formats, and identifies some of the common barriers to good communication. (See http://publications.gc.ca/collections/Collection/PF4-16-2003E.pdf)

Canada is in the process of developing Federal Accessibility Legislation. On November 27, 2018, Bill C-81, the proposed Accessible Canada Act, passed third reading in the House of Commons, and at the time of writing had moved on to the Senate.

United States
The Americans with Disability Act (1990) has rules and guidelines regarding ‘effective communication’. For example:

“People who have vision, hearing, or speech disabilities (“communication disabilities”) use different ways to communicate. For example, people who are blind may give and receive information audibly rather than in writing and people who are deaf may give and receive information through writing or sign language rather than through speech.

The ADA requires that title II entities (State and local governments) and title III entities (businesses and nonprofit organizations that serve the public) communicate effectively with people who have communication disabilities. The goal is to ensure that communication with people with these disabilities is equally effective as communication with people without disabilities. …

The purpose of the effective communication rules is to ensure that the person with a vision, hearing, or speech disability can communicate with, receive information from, and convey information to, the covered entity.”

Covered entities must provide auxiliary aids and services when needed to communicate effectively with people who have communication disabilities.

The key to communicating effectively is to consider the nature, length, complexity, and context of the communication and the person’s normal method(s) of communication.

The rules apply to communicating with the person who is receiving the covered entity’s goods or services as well as with that person’s parent, spouse, or companion in appropriate circumstances.”
(U.S. Department of Justice, 2014)

New Zealand
In December 2018, the New Zealand Government approved a work programme to thoroughly explore how full accessibility can be achieved for disabled people and all New Zealanders. This work programme will focus on accessibility for disabled people but will also look at how accessibility can be improved for other groups such as seniors, carers of young children, people with English as a second language, and those with temporary injuries (New Zealand Government, 2018)

With regard to communication access, the New Zealand Speech-Language Therapists' Association have focused on raising awareness through a process of Communication Access Awards (10 were awarded in 2018) and through awareness campaigns such as Giving Voice Aotearoa. Organisations or individuals who have provided a positive experience for those who have communication disabilities or needs, can be nominated by consumers and Speech Language Therapists for Communication Access Awards.

The New Zealand Speech-Language Therapists Association has also consulted with consumers by conducting focus groups and interviews for the Capturing Voices project, and have developed a Communication Access Checklist for members to assess their workplaces (New Zealand Speech-Language Therapists Association, 2018).

India
India has relatively recently ratified the Rights of Persons with Disabilities Act 2016. This act makes numerous mentions of ‘communication’ with regard to communication access and explicitly notes specific means of communication for face to face, written and online communication, and is inclusive of a broad range of communication support needs.

For example, the act states:

“In this act …

(c) “barrier’’ means any factor including communicational, cultural, economic, … which hampers the full and effective participation of persons with disabilities in society; …

(f) ‘communication’ includes means and formats of communication, languages, display of text, Braille, tactile communication, signs, large print, accessible multimedia, written, audio, video, visual displays, sign language, plain-language, human-reader, augmentative and alternative modes and accessible information and communication technology: …

(n) ‘information and communication technology; includes all services and innovations relating to information and communication, including telecom services, web-based services, electronic and print services, digital and virtual services; … “
(Government of India, 2016)

Of all the legislation examined in this review, India’s Rights of Persons with Disabilities Act (2016) makes the most comprehensive and explicit inclusion of people of the diverse group of people with communication support needs.

From the review of legislation nationally and internationally it is apparent that legislation in Australia is lacking with regard to upholding the human rights of people with communication support needs relative to other countries such as the United States, Scotland and India.

KEY ISSUES

Lack of terms or standards used in Australian legislation or policy to specifically address communication access of Australians with communication support needs
Considerable variability between States and sectors with regard to recognition of need for awareness raising and guidelines relating to communication access for people with communication support needs

RECOMMENDATIONS

That advocacy is undertaken to include specific practices to address the communication access needs of Australian’s with communication support needs in the next National Disability Strategy and State disability plans
That examples of legislation, policies and practices which promote the rights and address the communication access needs of people with communication support needs nationally and internationally, are highlighted, recognised and shared with governments, government agencies, peak bodies and service providers to raise awareness of good practice.

Evidence Based Practice and Communication Access

Before examining evidence of approaches which facilitate communication access, it is important to highlight some key challenges faced when reviewing literature in this area. Four issues in particular are evident:

The topics of communication disorders in general and AAC in particular are not well represented, so specialised databases housing evidence-based practice are of limited value to AAC practitioners and researchers (Schlosser, 2005). To further highlight the currency of this point for the current project, 4 databases were searched yielding 16 relevant articles from 11 different sources.
The complexity of the multifactorial impairments often with associated cognitive, sensory and environmental factors have an impact on study design and generalisability of the findings (Enderby et al., 2013)
“While inclusive communication practice is increasing, the impact of communication access practices have not been the focus of formal primary research to date.” (Money et al., 2016, p. 37)
Communication Access is a relatively new field of research, so it is challenging to find established communication accessible environments to evaluate. Communication access requires social change which takes time.

Despite these challenges, the below outlines evidence to support communication access standards and practices. It is acknowledged this review is far from exhaustive due to the abovementioned challenges in sourcing data and the limited time frame for this project.

Communication with people with communication support needs

The key themes identified from reviewing the literature sourced through data base searches and relevant documents shared by the reference group (see Appendix A.) are 1. the need for a two-pronged approach by service providers; 2. the value of communication partner training; 3. the need to consider people with communication support needs broadly; and 4. the need for specific research and evaluation regarding communication access.

1. The need for a two-pronged approach by service providers

The evidence of benefit for individuals with communication support needs resulting from a broad range of underlying conditions, by providing AAC is strong (Enderby et al., 2013; Howery, 2015). However speech pathology service models for people with communication support needs, that focus on capacity building to develop welcoming and inclusive communities, are rarely reported in the literature (Johnson, Solarsh, Bloomberg, & West, 2016).

Most of the evidence of the impact of strategies to improve communication access comes from project evaluation, or is anecdotal. The Royal College of Speech Language Therapists member survey revealed that 15% of respondents had developed local inclusive communication standards, and more than half had audited their standards to measure how successfully standards have been implemented, highlighted areas of good practice and helped share information. One third reported positive findings and one third reported anecdotal/informal positive evidence (Money et al., 2016).

Similarly, “V/Line, a major transport company that became communication accessible in 2016, has reported its highest ever satisfaction rating by the Public Transport Victoria customer service monitor. V/Line has attributed this positive result as a direct outcome of becoming communication accessible” (Solarsh & Johnson, 2017a, p. 61). While anecdotal evidence like this is positive, more rigorous and systematic evaluations are required to better understand the processes and mechanisms which lead to change, whether the outcomes are sustained, and most importantly whether the service users experience has changed for the better.

Despite the strong evidence for individualised therapy, Johnson et al. (2016) highlight that a focus on only providing individualised services for people with communication support needs, risks their further isolation and lack of community inclusion and experience of citizenship.

A two-pronged approach is therefore necessary, to both develop the communication competencies of the individual with communication support needs, and simultaneously build capacities of the communities in which they interact. It is contended however that rigorous and methodical evaluation of both is required.

Hewitt and Pound (2013) note five barriers to communication access; environmental, structural, attitudinal, informational and temporal, while Duchan (2006) identifies barriers related to knowledge and skill, use of communication devices, and discourse related to communication access. Similarly, O'Halloran, Grohn, and Worrall (2012) identified two major barriers to communication access; communication partners, and service structures and processes, through undertaking a meta-synthesis of communication environments for all types of communication disability in hospitals.

In developing a set of questions to assess communication accessibility, the Victorian Communication Access Network were cognisant of the need to address multiple communication barriers. “The Communication Access Assessment Checklist now consists of 26 questions in five categories of questions including (a) 10 questions about staff interpersonal communication, (b) four questions about the display and information about products and services, (c) four questions about the communication environment, (d) six questions about signage and wayfinding, and (e) two questions about the communication outcome” (Solarsh & Johnson, 2017a, p. 60)

In developing the capacities of the communities in which people with communication support needs interact, the multiple potential barriers to communication access identified above need consideration.

2. Value of communication partner training

Numerous studies report the efficacy of communication partner training in improving the communication experience of people with communication support needs (Balandin & Duchan, 2007; Cruice, Blom Johansson, Isaksen, & Horton, 2018; Howery, 2015; Johnson et al., 2016; Parr, 2007; Simmons-Mackie, Raymer, Armstrong, Holland, & Cherney, 2010; Simmons-Mackie, Raymer, & Cherney, 2016; Togher & Power, 2010). While communication partner training tends to focus more on training familiar communication partners, both familiar and unfamiliar partners demonstrate improvements after communication partner training. (Simmons-Mackie et al., 2010).

In a special edition of the Journal of Intellectual and Developmental Disability, Balandin and Duchan (2007) note that four of the seven articles focus on communication partner training. However, many different methods and approaches to communication partner training are reported, and often lack detail, thus limiting replicability (Cruice et al., 2018).

3. Need to consider people with communication support needs broadly.

Smyser-Fauble (2015) argues the benefits of intersectional methodologies (combining lenses of inquiry), to further the pursuits of social justice, and create a stronger focus on deconstructing social barriers of exclusion through emphasising the value of embodied experiential knowledges and patient narratives. For example, not observing individuals through the lens of what has caused their barrier to communication access e.g. deafness, cerebral palsy, low literacy) but rather recognising that their stories and experiences and responses have common themes.

Lending weight to this argument, increasingly authors are noting similarities between the experiences of people from culturally and linguistically diverse backgrounds and those whose communication support needs result from disabilities (Booth, Armstrong, Taylor, & Hersh, 2018; Solarsh & Johnson, 2017a). Booth et al. (2018) suggest that because of these findings, a broader group of people could potentially benefit significantly from policy development that acknowledges the centrality of communication access for social inclusion and well-being. Similarly, Bunning and Horton (2007, p. 19) argue for the need for service providers working with people with aphasia and those working with people with learning disabilities to “pool energies and to galvanise resources for the common good.”

As discussed previously in the section on population, there is general agreement that there is value in including all people who experience barriers to communication access, and not just those with disabilities (Law et al., 2007; Money et al., 2016; Smyser-Fauble, 2015; Solarsh & Johnson, 2017a).

Finally, it is important to note that people with sensory impairments will invariably experience barriers to communication access, though the specific needs of these groups is not always considered when addressing communication access. It is important to always consider people with sensory impairments (Deafness, hearing impairment, blindness, low vision and deafblindness) when addressing communication access, as while these groups experience barriers to communication access, there is more likelihood that people with intellectual disabilities and older people will have sensory impairments, compounding their communication support needs.

4. Need for further research and evaluation

There is little question that considerably more research and evaluation are required to identify effective strategies and practices to improve communication access, and evaluate outcomes of applying these.

In particular, the following gaps in the literature are identified:

Public awareness and understanding of communication disability and public attitudes towards people with communication support needs (Booth et al., 2018; Law et al., 2007)
The costs of communication support needs to the individual and to society as a whole
The relative value and outcomes of an enhanced “communication accessible” model of service delivery across sectors (Law et al., 2007; Money et al., 2016)

Propose need for further research in 3 areas:

Expectations of service users with communication support needs
Public attitudes to and understanding of people with communication support needs
Developing and evaluating a communication friendly environment across local services

Money et al. (2016) identify methods speech pathologists in the UK can employ to contribute to the evidence base indicating the efficacy of strategies to support communication access (see Appendix I).

While documents like the Principles of Inclusive Communication An information and self-assessment tool for public authorities (Scottish Government, 2011), and Speech Pathology 2030 (Speech Pathology Australia, 2016) propose ‘communication access for all’, it is important to acknowledge that best communication access for some people will always be mediated by human support. In particular, Australians who are Deaf or deafblind and require Auslan interpreters for best communication access, or those with limited or no symbolic communication who communicate idiosyncratically and require skilled human communication support, should be provided with these supports wherever possible. These human supports are not well addressed in the literature regarding communication access, and are not always noted in communication standards and checklists, but it should not be assumed that they will necessarily be provided or available.

Written communication

While numerous guidelines exist for creating accessible written information, and some studies which look at aspects of accessible written information, there is very limited evidence regarding how effective these guidelines are in increasing access to print information (Anderson et al., 2017; Basterfield, 2017)

As with ‘communication access’, there are numerous terms used to refer to accessible written information. These terms include: Information for all, Information friendly, Accessible information, Easy read, Easy English, Aphasia friendly, Medical literacy, Legal literacy, and Plain language (Basterfield, 2017), and the similarities and differences between these is not always clear.

Guidelines for accessible written information focus on:

Page layout
Text alignment and hyphenation
Font and the use of contrast and coloured text
Highlighting important points
Paper
Number of letters and words
Images
Format
Words per page
Language
Grammar
Punctuation
Numbers
Nature size and placement of images
(Anderson et al., 2017; Basterfield, 2014, 2017)

Anderson et al. (2017) highlight the importance of considering individual differences and needs stating that:

“making information accessible involves more than following a set of recommendations from a guideline. It also means delivering that information in a way that suits the needs and preferences of the person with ID, and maximises the person’s choice and control over the information. … Communication is highly individualised, so it follows that tailoring information to reflect the needs and preferences of the intended audience, and delivering it in a way that best suits the individual with ID, offers the greatest chance of providing information that is accessible and which will promote an inclusive society.” (Anderson et al., 2017, p. 11)

It is common to read in government documents that ‘print material should be provided in alternative formats’. This typically refers to accessible formats for those who are blind and vision impaired, e.g. braille, large print, audio or electronic. When developing or evaluating standards or guidelines for accessible written information the needs of those with low literacy and reduced language competence as well as the needs of those with low vision should be considered and included.

Online communication

Online communications have become ubiquitous and are critical to social inclusion and participation for all. While there is still relatively little information regarding communication access in relation to online communication, preliminary studies support the inclusion of Internet-based communications when considering the communication access of persons with communication support needs (Bay, 2017; Caron & Light, 2015; Hynan, 2013; Hynan, Murray, & Goldbart, 2014; Moisey, 2007).

Not only is equal access to online critical, but research suggests that people with complex communication needs can benefit from Internet-based communications such as social networking sites to support communication and improve upon social participation (Caron & Light, 2015)

Accessibility standards for online communication has tended to focus on the needs of people with vision impairments. See the World Wide Web Consortium https://www.w3.org/standards/, though standards are being developed for people with cognitive impairments to access online content.

KEY ISSUES

Need for increase in practices, research and evaluation regarding communication access, including face to face, written, and digital mediums.
Need for consistency and clarification of meaning of terms, including population of people with communication needs in research

RECOMMENDATIONS

Advocate for evaluation of practices supporting communication access to be prioritised on the research agenda in Australia

Existing communication access standards

While several communication standards and guidelines exist there is some variation between them with regard to process of development, target audience, and government support.

See Table 4, for a summary of key features of some of the standards and guidelines currently in use.

Table 4. Comparison of existing communication standards and guidelines

Communication standard or guideline	Developed in collaboration with people with communication support needs	Includes face to face, written, telephone, and online	Supported by evidence, or legislation	Inclusive of broad range of communication support needs	Broad target audience
Communication access for all 2015 (Scope, Australia)	Yes.	Only partially addresses online communication	Yes, References UNCPRD (2006), Disability Discrimination Act, National Disability Strategy, Victorian Charter of Human Rights and Victorian Disability Act.	Yes.	Yes.
Victorian Government Accessible Communication Guidelines 2014	No specified	Yes.	Yes. References The Disability Act 2006 (Vic), The Equal Opportunity Act 2010 (Vic), The Charter of Human Rights and Responsibilities Act 2006 (Vic), The Disability Discrimination Act 1992 (Cwth)	Yes.	Yes.
Five good communication standards (Royal College of Speech and Language Therapists, 2013)	Yes	Unclear. Potentially, but appears to focus on face to face communication. Telephone and online communication not specified.	No.	No, Designed for people with a learning disability and / or autism.	No. Designed specifically for health and social care providers.
Principles of Inclusive Communication An information and self-assessment tool for public authorities (Scottish Government, 2011)	Yes	Yes	Yes. References Equality Act (2010) and UNCRPD (2006)	Yes	Yes
Royal College of Speech Language Therapists Annex 2 (Royal College of Speech and Language Therapists, 2018) (See Appendix G)	Yes	Unclear. Potentially, but appears to focus on face to face communication. Telephone and online communication not specified.	Not specified	Yes	Yes

Note: Of the five standards and guidelines reviewed, the Victorian Government Accessible Communication Guidelines 2014 are the most broadly inclusive with specific acknowledgement of and strategies for different types of communication support needs.

KEY ISSUES

Considerable variability in the communication access standards and guidelines which are currently available

RECOMMENDATIONS

Communication standards should:

Involve a broad range of people with communication support needs in their development
Be supported by government, ideally by legislation
Support communication access for a broad range of people in a broad range of contexts including face to face, written, telephone and online.
Be evidence based.

Conclusion

This Literature Review does not claim to be an exhaustive review of all possible literature and evidence and was conducted as part of a time-limited project.

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Appendices

Appendix A – I This graphic is associated with the hyperlink that precedes it and indicates the document is in PDF.

Communication Access Literature Review

Contents

Acknowledgements

Executive summary

Summary of key issues

Summary of recommendations

Conclusion

Background

Method

Literature Search

Inclusion Criteria and Selection Process

Data evaluation

Data Analysis

Findings

Terminology

Terms used to describe individuals who experience barriers to communication access

Terms used to describe process of removing barriers to communication access

Use of terminology in this report

Population

Legislative, strategic and policy context

National government

State and Territory governments

State Disability Plans

State government services

Local government

Communication access standards and guidelines in Australia

International perspective

Evidence Based Practice and Communication Access

Communication with people with communication support needs

Written communication

Online communication

Existing communication access standards

Conclusion

References

Appendices