Disability Guide Practitioner

Disability Guide
A practical guide for practitioners working directly with

disabled people and those with long-term health conditions in
employment related services
Introduction
At Remploy we are driven by
the fundamental belief that
every disabled person can, with
appropriate support and specialist
advice, secure sustainable
employment.
Across the UK today, almost 80% of adults of working age
without a disability are in employment. For those with a disability
or long-term health condition, its less than 50%. Thats a huge
inequality and is a priority for anyone working in the employment,
skills and health arenas.
Gareth Parry
Disability Capability
Director
Providing great advice, guidance and support for disabled

people is all about being confident and open, but that can be
challenging for many of us especially those with limited
experience of dealing directly with disabled people. Disability
confidence comes with know-how and experience. This guide is
designed to provide simple but effective advice and guidance to
any practitioner in the field of employment related services who
works with people with a wide range of disabilities - wherever
they are in their journey towards or in employment.
The guide gives a broad overview of 17 core disability areas
including learning disabilities, learning difficulties, mental health,
physical disabilities, neurological conditions and sensory
impairments. This guide aims to cover practical advice and
adjustments that can be made in an employment-related setting.
This booklet makes it easy for every practitioner to access
simple disability guidance. It will not answer every question on
every disability, but provides a great source of basic information
certainly enough to provide confidence for those first or
occasional interactions. Once the basics are understood,
disability confidence will grow with experience and learning.
I hope you find this guide useful.
1st Edition
Febuary 2016
Guide to working with disabled clients
Contents
Acquired Brain Injury
Anxiety Disorders/Stress
Attention Deficit Hyperactivity Disorder
Autism
10
Bipolar Disorder
12
Depression
14
16
Disfigurement
18
Dyslexia
20
Dyspraxia
22
Epilepsy
24
26
Hearing Impairment
28
Multiple Sclerosis
30
Musculoskeletal Disorders
32
Schizophrenia
34
Visual Impairment
36
Equality Act 2010
38
Diabetes
General Learning Disabilities
All considerations subject to Copyright Remploy Limited 2016
Acquired
Brain Injury
Acquired Brain Injury (ABI) is
the result of damage to the
brain and can result in a range
of impairments.
Acquired brain injury can be caused by a traumatic injury such as an accident or surgery, or a
non-traumatic injury such as a stroke or brain tumour. Impairments can be permanent or
temporary and can be physical, emotional, behavioural or cognitive or a combination of
impairments.
Traits
Symptoms and severity of
ABI vary widely depending
on which area of the brain
has been damaged, but
can include:
- Short-term memory
difficulties
- Difficulties with speech
- Personality changes
- Physical mobility
Potential impact on daily life

and employment
The impact of ABI can also affect friends and family. An
individual may feel responsible or guilty for this.
The effect of ABI on employment will depend on the symptoms
and severity of brain damage. A tailored package of support will
be required to meet each individuals needs.
The cause of ABI may also result in other difficulties. For
example, a soldier wounded in service or a person who has
been in a car accident might experience post-traumatic stress
disorder.
- Neurological difficulties
(such as epilepsy).
Effects of ABI can be life
changing so people may
experience depression
or other mental health
conditions.
Solutions
Tailor support to meet a clients needs.
Offer aids and adaptations as appropriate.
Considerations
Case Management
Find out about the clients injury and
what caused it.
Does the client have an assessment
report? For example a functional
capacity evaluation or psychological
assessment? Anyone leaving the
Armed Forces with ABI will have one
of these. With the clients
permission you can scan the
document and attach it to your Case
Management System.
Further assessments can give you
useful information about the impact
of ABI.
What medication is the client
taking? Are there any side effects?
Make sure you have the time to fully
understand the complex barriers a
client with ABI may have.
Some people may tire easily so it
might help to conduct shorter
meetings.
If the client has problems with short
term memory, keep action plans
limited to one or two actions at a
time and issue appointment cards or
diaries to support them.
Development
Recruitment
Consider
Consider job
adjustment as
roles which
identified by case
minimise the
management.
impact of the
disability.
If a work
In-Work
Ensure an
appropriate
support
package is in
place.
What
placement is
appropriate make
reasonable
sure that any aids
adjustments
or adaptations are
are needed for
in place. This will
interview and in
ensure that the
work?
client has a useful Is Access to
experience and
Work required?
allows the
employer to gain a Is everyone
(including the
meaningful
client and the
assessment of the
employer) aware
person.
of the support
During and/or
package
after, consider
required?
using handouts
or work sheets to
aid memory and
learning.
Complete of any
relevant
paperwork your
company
requires.
Is a risk
assessment
required?
Ask about what existing coping

strategies the individual has already
developed and used successfully.
Useful Contacts
General Checklist
Be prepared. Read the client profile, case management notes and
any reports or assessments attached to the client record.
Make adjustments as required/specified within their record.
Where appropriate source support from a specialist partner, for
example Headway.
There are a number of

specialist organisations
who can produce further
information, including:
www.headway.org.uk
www.shaw-trust.org.uk
Please note that this information is not definitive and may not be appropriate for every client.
Anxiety Disorders
and Stress
Anxiety, including stress, fear and
worry, is something that most people
experience at some stage in their lives.
Types of anxiety
disorders:
Phobias.
Social phobias.
Agoraphobia.
G
eneralised Anxiety Disorder (GAD).
O
bsessive-Compulsive Disorder (OCD).
Physical problems.
H
ealth Anxiety (Hypochondriasis).
In certain circumstances a person may experience anxiety in situations that should not be
perceived as threatening or dangerous and may be constant or caused by specific triggers.
Traits
Physical symptoms:
- Heart palpitations or
heart in throat
- Tense muscles
- Sweating
- Dizziness or fainting
- Stomach problems
- Hypersensitivity to noise,
smells, taste or touch.
Changes in thought patterns:
- Sudden excitement
- Sudden or marked irritability
- Feeling of time going slowly
- Excessive worrying or
anticipating a problem
- Extremely focused thinking
- Experiencing feelings of
dread or impending doom.
Changes in behaviour:
- Sudden bursts of energy,
speed or strength
- Experiencing shakiness
and/or feeling tired
- Being very still or frozen
- Difficulty concentrating
- Difficulty sleeping.
Potential impact
on daily life and
employment
Inability to function in routine
activities, for example driving, work
tasks or social situations.
Raised blood pressure.
Changes in the digestive system.
May feel as if they are having a
heart attack and as such feel panic
and confusion.
Avoidance of certain situations.
Low self confidence.
Poor concentration and feeling
unable to perform tasks.
Feeling problems are impossible to
solve.
Overestimating danger and/or
underestimating the ability to cope.
Thoughts becoming increasingly
and persistently negative.
Constant worrying.
Constant fidgeting.
Changes in eating patterns (too
much or too little).
Using substances, for example
taking drugs or smoking or
drinking excessively.
Solutions
Once the problem has
been identified the
person can visit their
GP for medication.
Cognitive and
Behavioral Therapy
can be helpful.
The individual may
already be under the
care of a specialist
mental health service
like a psychiatrist or
a CPN (Community
Psychiatric Nurse).
Find an environment
that is suitable for the
individual.
Avoid triggers or
manage them in a
controlled way.
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Considerations
Case Management
Development
Recruitment
In-Work
Arrange for the

Check with the client
client and trainer
before booking job
to meet before any
search groups.
What support does the client
group
sesssion
and
When looking at
feel he/she needs?
agree an exit plan
vacancies think
Are there any triggers for the
i.e. what to do if the
about:
anxiety?
client feels
Is there flexi time
overwhelmed/upset.
What awareness does the
available?
client have of the triggers?
Consider holding a
Do the hours
one to one session
What are the warning signs
suit the clients
afterwards to get
that they are struggling?
needs? If they
their feedback
Understand the history of their
have disturbed
about how they felt
anxiety, for example have they
sleep then early
working in a group
had previous episodes of
starts may not be
setting.
anxiety or the result of a
convenient.
If undertaking a
specific situation.
Is there scope to
work-placement,
What treatment do they have?
be flexible with
are there natural
Are they taking medication? If
the clients duties
supports in place?
so are there any side effects?
if they are
Would they
unwell?
Dont avoid talking about the
benefit from a
clients anxiety.
mentor or buddy?
Would
structured or
Find out what works well Look out for the
routine work be
what aids recovery?
client showing signs
better to minimise
of Stress e.g.
What are the clients
or avoid
agitation /
requirements at work?
workplace
fidgeting. Let the
Consider voluntary work or
surprises or
group take a break
work experience to ease the
changes in levels
and check the client
client back in to work.
of pressure?
is okay.
Where possible consider
Practice mock
incorporating physical activity
interviews.
into action plans.
Consider privacy when
meeting.
How can the

client be supported
in work?
Is a mentor or
buddy required?
It can be you, a
colleague or for a
client with higher
support needs, a
bought in service
such as MIND or
Rethink might be
needed
Does the employer
understand how the
clients anxiety
manifests itself? Be
sure you have the
clients permission to
discuss this and
agree how that is to
be presented.
Getting a new job
is stressful so be
prepared for a higher
level of support
during the first few
weeks.
Be there on the first
day!
Useful Contacts
General Checklist
Avoid phrases such as pull yourself together, youll get over it,
its not as bad as you think.
In anxiety related situations understand how the person manages
their anxiety. What coping strategies do they already use and how
can these be adapted?

www.rethink.org
www.mind.org.uk
www.anxietyuk.org.uk
Attention Deficit
Hyperactivity
Disorder (ADHD)
ADHD is typically known to be a
common disorder starting in childhood,
however many symptoms continue into
adulthood.
The definitions of ADHD are based on high levels of impulsivity, hyperactivity and inattention
which cause difficulties at home, in education, work and social settings. The symptoms of ADHD
may vary depending on the demands of personal life and the environment the individual is
working in (eg. noisy, busy etc.).
Traits
Impulsivity, such as;

speaking and acting
without thinking,
interrupting others,
difficulty waiting their
turn, being oblivious to
danger and not learning
from experience.
Lack of awareness of the
needs of others.
Inability to sit still.
Poor attention - making
it difficult to finish tasks.
Some people with ADHD
may also have reading
and writing difficulties,
for example, dyslexia and/
or dyspraxia.
Poor concentration may
lead to becoming easily
bored or having poor
organisational skills.
Disruptive behaviour.
Potential impact
on daily life and
employment
Difficulty in telling others
about their ADD/ADHD and
recognising it is classed as a
disability.
May appear anxious.
Difficulty waiting for things.
May tend to agree to things
impulsively to get the
appointment over with.
May have difficulty dressing/
presenting themselves
appropriately.
May find it difficult staying calm
and can be confrontational.
May require the job to be
broken down into tasks through
the day to remember all the
parts of the job.
May seem distracted,
disinterested or disorganised.
Solutions
Tell the individual about any
delays with their appointment.
Tell them the consequence of
agreeing to things impulsively.
Summarise actions on the
action plan.
Provide guidance on
appropriate dress.
Arrange a mentor for a short
time each day to go through
daily tasks.
Check completed tasks and
write down any unfinished
tasks for the next day.
Write down a list of what they
need for the next meeting.
Go through forms step by
step.
Use electronic or phone diary
reminders.
Be clear about work rules and
code of conduct.
Be clear about expected
deadlines.
Considerations
Case Management
Development
Find out who provides support Minimise

to the client such as
distractions
professionals, family or friends Try to ensure the
and what they help with.
client is seated
Explore previous
next to a good role
experiences such as school,
model
previous workplaces or social Set out rules at the
activities.
beginning of the
Recruitment
Understand the
individuals support
needs.
Matching the client
to a suitable job is
vital.
A degree of routine
will be beneficial.
Try to keep to one or two
session, for example
However, repetitive
regular advisors.
ask for no
work such as on a
interruptions
production line will
Understand any restrictions
probably not be
such as organisational skills or Provide written
suitable.
speed of reading.
instructions
Make sure the client
wherever possible
Try to make a regular slot for
gets to meet the In
Give advice and
review meetings.
Work Support
information in a
You may get more missed
advisor before
calm and clear
appointments than you would
moving into a job.
manner
normally expect, or turning up
May need short,
Check with the
very early.
frequent breaks to
client if they want
Consider reminder calls or
help the client focus.
to have a break,
texts.
move to a quiet area Flexible working
or rearrange the
hours would be
appointment if they
helpful.
appear restless and
May need help filling
inattentive.
in application forms.
In-Work
Be prepared to
highlight
inappropriate
behaviour where
necessary use the
action plan to help
with this
Client will benefit
from a buddy in the
workplace
Try to ensure a
degree of
consistency in
location and
colleagues within the
workplace
Consider ways in
which core
workplace rules can
be easily explained
and regularly
reminded
Does the employer
need to be made
aware? (with the
clients permission)
General Checklist
Make sure that meeting, development session and workplace environments are suitable for the
individual. A quiet environment will help to minimise distractions.
Find out what coping strategies the client has already developed and, where possible, adapt
these to the workplace.
Be prepared. Read the client profile, case manager notes and any reports or assessments
attached to the client record.
Useful Contacts
There are a number of specialist organisations who can produce further information including:
www.nhs.uk/Conditions/Attention-deficit-hyperactivitydisorder/Pages/Introduction.aspx
www.addiss.co.uk
www.dyscovery.org
www.aadd.org.uk
www.netdoctor.co.uk/adhd/workandadhd.htm
www.danda.org.uk
Autism
Autism Spectrum Disorder
(ASD) is a spectrum of lifelong
developmental disabilities
that affects how a person
communicates with, and
relates to, other people.
ASD includes Autism, Asperger Syndrome and Pervasive
Development Disorder. While all people with ASDs share certain
difficulties, their condition will affect them in different ways and at
varying levels. ASDs are often hidden disabilities and many people,
particularly those with Asperger Syndrome, may appear very able
yet may face real difficulties in getting to appointments on their own,
coping with a change to routine or performing well at interviews.
The three main areas of

difficulty are:
Traits
Solutions
Need for routine or

structure
Difficulty making eye
contact
May display inappropriate
behaviour, for example,
interrupting conversations
An eye for detail;
meticulous in execution of
tasks
Literal interpretation of
language
Difficulty with social
interaction and
communication
Limited imagination,
for example, difficulty
imagining what other
people are feeling
Sensitivity to bright lights,
noises, smells, textures or
tastes
Poor motor skills
Poor organisational ability
Positive traits include
honesty, reliability,
dedication and
determination.
10
Potential impact
on daily life and
employment
May need to undertake certain

routines, for example, before leaving
the house.
May be uncomfortable if not able to
fully complete a task.
May be unable to make judgements
about the amount of work appropriate
for a task.
Communication difficulties
Work environment will need to be
considered if sensitive to light, noise or
smell.
May have personal hygiene issues
due to sensitivity to toiletries or lack of
grooming time in daily routine.
Difficulty with expressing empathy.
May dominate conversations or discuss
inappropriate topics / special interests.
Difficulty forming friendships.
May have repetitive speech patterns.
Poor non-verbal communication.
Intense absorption in certain subjects.
Movements, postures and gait may
seem uncomfortable.
Social interaction
Social communication
Social imagination
Provide structure and

routine for tasks.
Ensure conversation is
factual and avoid sayings
such as, he threw his hat
in the ring - which could be
confusing to someone with
ASD. Likewise be conscious
using jokes and sarcasm
which may be taken literally.
In some cases you may
need to source some
specialist support.
Choose appropriate
communication style.
Ensure confidence is built
and any issues with low
self-esteem addressed.
Support individual to
organise daily routines to
factor in essential grooming
and personal development
activities.
Sentences should be kept
short be concise and
clear.
Consider accessing some
Autism training.
Considerations
Case Management
Development
Recruitment
In-Work
Explain what will happen when Watch the dynamics Understand

Ensure structure of
getting started.
of group activity as
individual support
work is understood.
the individual wont
needs and, in
Be patient if individual has to
Ensure
pick
up
the
vibes.
particular,
strengths
go into a lot of detail.
appropriate
(of
which
there
will
Set out rules at the

environment for
Be prepared to highlight
be many).
beginning
of
the
meetings and work.
inappropriate behaviour where
Consider job carving.
session, for
necessary.
Be prepared to
example, no
Consider
work
highlight
Processing time may be
interruptions.
experience or a work
inappropriate
slower avoid rephrasing
Use visual prompts.
trial to help individual
behaviour where
questions as processing will
experience the job.
necessary.
May need to follow
start again.
Consider if job
up group activity on Give clear and
Find out who provides support
one to one basis.
concise instructions.
coaching is required.
to the client, for example,
Would they benefit
You may want to
family, friends or professionals Avoid sarcasm or
and what support they
ambiguous sayings
speak to the
from a mentor or
provide.
or phrases.
employer in advance
work buddy?
of any interview (with Is awareness training
Explore life experiences such Use open questions
the clients
as school, previous workplacto establish
needed for
permission).
es and social activity.
individuals
employer?
understanding of
Any previous reports or
content.
assessments could highlight
specific issues and/or traits.
Individual may need

more breaks than
usual.
Consider work
placement to
assess the client in
the workplace.
General Checklist
Be prepared. Read the client profile, case management notes and any reports or assessments
Remember eye contact may be minimal.
Make sure the environment is appropriate for the client. For example, a quiet meeting room or
minimal distractions.
Useful Contacts
There are a number of specialist organisations who can produce further information, including:
National Autistic Society - www.autism.org.uk
Autism West Midlands - www.autismwestmidlands.org.uk
11
Bipolar Disorder
Bipolar disorder is a treatable illness
and can affect a persons ability to
experience a normal range of mood.
It is marked by extreme changes in
mood, thought, energy and behaviour.
Bipolar disorder usually begins in late

adolescence (often appearing as depression
during teen years) although it can start in
early childhood or later in life. An equal
number of men and women develop this
condition and it is found among all ages,
races, ethnic groups and social classes.
The condition tends to run in families and
appears to have a genetic link.
Bipolar disorder was known as manic
depression because a persons mood can
alternate between the poles - mania (highs)
and depression (lows). These mood swings
can last for hours, days, weeks or months.
Experiencing symptoms at one pole for at least
one week is called an episode.
Experiencing four or more episodes in a year is
called rapid-cycling bipolar disorder.
Potential impact on daily

life and employment
May need to take daily medication.
Possible debt and other consequences of
reckless behaviour.
May find it difficult to find the motivation to
apply for jobs.
Tiredness.
May have difficulty with relationships.
Other people may have difficulty in
understanding and knowing how to react to
mood swings.
May have difficulty sustaining employment due
to fluctuating nature of condition.
May display extreme behaviour.
Solutions
Traits
The traits depend on the severity of the
condition. In most cases the client will be
fine for most of the time.
Individuals may lose his/her inhibitions, for
example, reckless spending.
May lack motivation.
Mood swings.
May have disrupted sleep patterns.
Low self-esteem and confidence.
12
Make sure any development or work activity fits

around the need to take medication.
Explore potential barriers by using further
assessment tools.
If the client appears to lack motivation discuss
how they are feeling - it may be that they
are feeling affected rather than a lack of
commitment.
Avoid known triggers.
Consider avoidance of early starts.
Considerations
Case Management
Development
Understand how client has

Look out for client
been affected by the condition
becoming affected
in the past.
as this could have
an impact on the
Understand any side-effects of
group.
medication.
Recruitment
Consider jobs with
highly flexible hours,
or annualised hours
contracts.
In-Work
Will you need
specialist support on
hand for times when
individual is
affected?
Consider
Regular monitoring
If the client appears
self-employment
Find out whether they are
affected take a
as an option if this
visits are essential.
accessing any other
break and talk to
allows the client to
A buddy or mentor
health-related services at
them
to
decide
how
be
more
flexible
in
present (such as Cognitive
could provide
best
to
continue
the
focusing
more
on
Behaviour Therapy or the
additional support.
session.
working
when
they
support of a Community
Consider trigger
are not affected.
Recognise that the
Psychiatric Nurse).
points and action
client may feel they If the client is prone
Ask the client how they would
planning for when
cant
attend
to
severe
mood
like us to respond if they
the client or
regularly
at
times
swings
then
they
may
appear affected.
employer can see
when they are
experience some
the triggers
Find out how the client is
experiencing
difficulties during
emerging.
affected by good / bad events.
episodes.
recruitment activity
and/or when starting
Understand the level of insight Regularly review
a new job.
the individual has into the
the confidence level
condition.
Fully understand
of the client and
Explore existing coping

strategies.
Ensure you access any stress

and anxiety resources or
assessments.
refer back to case

management if no
positive impact is
occurring.
workplace support
requirements.
Make sure you are
aware of any triggers
that could cause the
client to become
affected.
General Checklist
Understand any coping strategies the client uses and look at ways to adapt them to the
workplace.
What specialist support is available? They may be able to offer support and advice.
Useful Contacts
There are a number of specialist organisations who can
produce further information including:
Rethink - www.rethink.org
Mind - www.mind.org.uk
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13
Depression
Depression is a very common
human experience, which can
be extremely debilitating to
those experiencing it.
It affects one in five people at
some point in their lives.
For some people it may occur just once and
they recover very quickly, usually with little or
no help, but for others depression may last
longer or recur on several occasions and need
treatment.
Traits
Feeling low, miserable

hopeless, irritable bleak, numb
or empty.
Feeling that they are bad,
useless and worthless.
Expecting things to go wrong
and predicting disaster.
Losing interest and enjoyment
in activities they previously
enjoyed.
Poor motivation, no interest
and no sense of fun.
Has a negative outlook on
things, often fears the future
and feels that they have no
control.
Tired all the time.
Withdrawal from social
activities.
Difficulty in concentrating.
Memory difficulties.
Difficulty sleeping or waking
early.
Changes in appetite and
weight.
Little interest in sex.
Thoughts of death or making
plans for suicide.
14
Many people attempt to hide the fact that they

are depressed and it is not uncommon for their
condition to not be diagnosed by their general
practitioner until it recurs and they are in need
of treatment.
Potential impact on daily life and

employment
Low mood and poor motivation affects relationships and
the ability to manage tasks.
Sleep and tiredness affects day to day functioning.
Hypersensitive to comments or constructive criticism and
may believe that they are wrong, failed or being pressured.
There may be over anxiety that work is not good enough
Needing assurance from peers and managers is not
uncommon
There may be some difficulties working with colleagues.
The client may be secretive as they are embarrassed or
ashamed about their condition.
Solutions
Support / treatment from GP.

They could be referred to IAPT (Improving Access to
Psychological Therapies) for Cognitive and Behavioural
Therapy (CBT) or counselling or other organisations like
Changes for help with anger, or social inclusion.
Physical activity and goal-oriented plans and activities are
known to help.
Work with the employer and individual to establish
appropriate support mechanisms. This should include clear
guidelines and coping strategies.
A mentor or buddy at the work place is often a good idea but
on occasions may find it embarrassing.
Considerations
Case Management
What are the triggers for the
depression? It could be
environmental, emotional,
being out of routine, poor
sleep and/or diet.
Development
Be vigilant of group
dynamics and how
they may affect the
client.
Recruitment
Consider
self-employment
as an option if this
allows the client to
be more flexible in
focusing more on
working when they
are unaffected.
Have some
Understand key coping
one-to-one time
strategies.
after a group
session to get
Establish what treatments the
Consider
clients feedback
client has used.
and discuss any
employment
Understand any side effects of
difficulties.
requiring physical
medication the client is taking.
work as regular
Make sure that
exercise is known to
Find out what has helped
natural supports are
help depression
recovery and what maintein place during any
nance strategies have been
Is flexi time available
work trials or
used.
placements.
in a role?
Incorporate recovery
Regularly review
Do the hours of
techniques into action
the confidence level
working suit the
planning.
of the client and
clients needs, for
refer back to case
example sleep
Consider voluntary work or
management
if
no
disturbances and
work experience to assist the
positive impact is
tiredness?
individual back into work.
occurring.
Can you offer
Be clear and specific about
awareness training
the clients needs in the
to the employer? Be
workplace.
mindful that if you are
Be open and dont avoid
discussing specifics
talking about the persons
of the clients mental
depression.
health you must gain
Many clients will be more
his/her consent to do
comfortable when they are
so before talking to
not overheard as there is still
the employer about
a stigma attached to mental
it.
health.
In-Work
How will the client
be supported at
work?
Is a mentor or buddy
required? This could
be you, a colleague
or for someone with
greater support
needs, someone
from a bought-in
service such as
Rethink or MIND.
Does the employer
understand how
depression
manifests itself?
Check with the client
before speaking to
the employer.
Getting a new job is
very stressful
especially if it is
some time since the
person has worked.
Be prepared to offer
a higher level of
support during the
first few weeks.
Be there on the first
day.
Consider trigger
points and action
planning for when
the client or
employer see the
triggers emerging.
Useful Contacts
NHS - www.nhs.uk/pathways/depression
15
Diabetes
Diabetes is a condition where a
person is not able to naturally
control the level of glucose in
their blood as their body cannot
effectively make or absorb insulin.
There are two types of diabetes: Type 1 and Type 2. Type 1 develops when the body is unable to
produce any insulin and symptoms often develop over a short period of time. Type 2 develops
when the body cannot make enough insulin, or when the insulin produced doesnt work properly.
The onset of Type 2 is slower and the symptoms more subtle.
Traits
Excessive thirst.
Need to urinate regularly.
Tiring easily.
May need to check blood
sugar levels throughout the
day .
Need to eat at regular times to
maintain blood sugar levels.
People with diabetes may
experience hypos which can
cause hunger, sweatiness,
dizziness, difficulty with
concentration, trembling or
changes in mood.
Long term complications
can include blindness, heart
disease, kidney failure or the
need for amputation.
Type-2 diabetes is often linked
to obesity, lack of exercise and
poor diet.
t more
ated tha
im
t
s
e
is
It
le in
16 peop
in
e
n
o
than
tes
as diabe
h
K
U
e
th
ed or
(diagnos
osed).
undiagn
lion
e 3.9 mil
There ar
ving with
people li
.
in the U K
diabetes
16

employment
Diagnosis may have an emotional impact.
People with diabetes are protected under the Equality Act
2012.
The Armed Forces are the only organisations who are
allowed to impose a ban on the recruitment of people with
diabetes.
Some employers may impose restrictions or clients may
need to pass a health check for certain jobs.
The need to eat at regular times can cause some
difficulties although these can usually be managed.
Working a rotating shift pattern may not always be
suitable. For example, a job where the lunch break is at
midday one day and 3pm the next could make it difficult to
maintain blood sugar levels.
Solutions
Most people will manage their diabetes well and need

minimal support from others.
Clients may benefit from healthy eating advice and podiatry
care and also need to attend regular eye screenings and
blood tests.
Many people with diabetes will carry glucose tablets/drinks
or something similar. If a client has a hypo, ask them if they
have any of these things and sit with them while they eat or
drink the glucose. After 15 minutes they should eat a light
snack but avoid fatty foods.
Considerations
Case Management
Development
Recruitment
In-Work
Understand the history

Plan the
Consider if the client Are all the supports
session around
needs to take a break
in place before the
someone who has had
any breaks the
diabetes from childhood is
in recruitment
person starts work?
client made need
likely to have adapted to it
sessions for food
For example, regular
to meals and/or
more than someone who has
and/or medications.
timetable for breaks
medication.
recently been diagnosed.
or any aids.
Providing the clients
Get a feel for how well the
If Access to Work
Provide aids or
job goal is
adaptations if
individual manages the
appropriate there
has been used check
required. For
condition or how stable it is.
should be few
everything is in place.
example,
text
considerations apart If the client controls
Ask about hypos does the
enhancing
from hours of work
client carry around glucose
their diabetes by
software or
and regular mealsweets etc.? What do they
using injections,
information
in
times.
want you to do if it appears
ensure the employer
alternative
Some people may
they are having a hypo? You
is clear and that use
formats.
may need to note this in the
have had their
is in line with any drug
client record.
driving licenses
taking policies that
revoked.
Transport
to
may exist in the
Is the client experiencing any
and from work needs
workplace.
other side effects, for
to be considered.
example, problems with sight
or circulation?
Is Access to Work
required?
Provide aids or
adaptations if
required. For example,
text enhancing
software or
information in
alternative formats.
Check the job
description for any
restrictions.
General Checklist
Check about meal times to make sure appointments dont fall at the
wrong time.
If attending group activity organised by Remploy make sure lunch
breaks are scheduled as appropriate.
If youve organised lunch make sure any special dietary requirements
are catered for and food put to one side for the individual.
Look out for signs of a hypo.
Useful Contacts
www.diabetes.org.uk
www.diabetes.nhs.uk
17
Disfigurement
A disfigurement is the generic
term for the aesthetic effect or
visual impact of a scar, burn, mark,
asymmetric or unusually shaped
feature or texture of the skin on the
face, hands or body.
A disfigurement may be acquired from birth, an accident, disease or through surgery. Some
examples of this are congenital conditions such as cleft palate, birthmarks or neurofibromatosis,
scars from burns, palsies or paralysis such as from a stroke or scars from cancer surgery.
Although the term disfigurement is used in the Equality Act 2010, some people prefer to use
the phrase visible difference or the name of their condition.
Traits
Some disfigurements
may be visible while
others may be
hidden, disguised or
camouflaged.
The reaction of
other people has a
big impact on how
individuals cope with
their disfigurement.
Some people may
feel uncomfortable
revealing their
disfigurement.
Some disfigurements
are the result of
self-harm.
Potential impact
on daily life
and employment
Disfigurements affecting the face or hands may present some
difficulties, as these are areas of the body that are also used for
communication.
Individuals may experience low self-esteem which can affect
relatively routine activities such as shopping or taking the bus.
May experience bullying or hate crime.
People who have acquired a disfigurement later in life may
experience depression or other mental health conditions.
Some people use skin camouflage creams and may therefore
take longer to get ready.
Some conditions, and a persons ability to cope with them, can
fluctuate from day-to-day.
Solutions
Make sure appointment times and working hours are
suitable for the client.
Where needed, make sure the client receives
support from professionals.

Be mindful about the clients wishes in managing the
subject of their disfigurement.
18
There
are ov
people er a million
in the
UK
who h
ave a
disfigu
remen
t
to thei
r face
and/o
r body
.
Considerations
Case Management
Development
Recruitment
In-Work
Understand clients
Make sure the
Some clients may be Where required is the
experiences, for example
client is
undergoing treatment
person getting the
family life, school and
comfortable in
is there anything
time needed to follow
previous workplaces. This will
the given
in their regime that
a treatment regime?
help you to understand how
environment.
could affect the hours Is the employer aware
they have adapted to their
they can work or the
Ask how they
of support and
disfigurement.
type
of
work
they
can
would like the
guidance relating to
undertake?
What coping strategies do
subject of their
managing
they already use? Can these
condition to be Do they have a
disfigurement in the
be adapted to the workmanaged and
specific request with
workplace?
place?
what to do if
regard to managing
Without making the
people
stare
or
the
subject
of
their
Ask about any medication
client feel
make
comments
disfigurement?
For
and side effects.
uncomfortable it may
in a group
example some people
be wise to ensure
What support do they already
setting.
may want to talk to
that the employer has
receive?
their colleagues as a
suitable policies for
group but others will
If their condition is a result
bullying and
be less comfortable
of trauma, for example a car
harassment in the
with that or may not
accident or soldier injured on
workplace and that
feel there is a need
active service, they may also
the client know what
for it.
experience other physical or
to do should they
mental issues. However, do
Consider later start
experience such
not assume this is the case
times if it takes longer
behaviours.
and talk to your client.
to get ready.
General Checklist
Although the term disfigurement is used in the Equality Act 2010
some people prefer to use the phrase visible difference or the
name of their condition. It is important to check if the client has a
preference
How comfortable is the individual in a group environment or in
being introduced to a group of strangers?
If the client takes part in group activities or a group interview ask
how they want to manage the subject of their disfigurement
Advisors and employers should be extra-vigilant for inappropriate
comments or behaviour from fellow clients, colleagues etc.
Useful Contacts
There are a number of specialist
organisations who can produce
further information, including:
Changing Faces www.changingfaces.org.uk
19
Dyslexia
Dyslexia causes difficulties in learning to read,
write and spell. Short-term memory, mathematics,
concentration and personal organisation may
also be affected. Dyslexia usually arises from a
weakness in the processing of language-based
information. The effects of dyslexia can be largely
overcome by skilled, specialist teaching and the
use of compensatory strategies.
The Dyslexia Institute
It is worth bearing in mind that many of our clients, particularly those aged 40 or over, may never
have been tested for dyslexia despite displaying some typical traits.
Traits
Literacy and
numeracy difficulties.
Poor handwriting.
Difficulty with
short-term memory
they may only
remember one or
two things at a time.
Poor organisational
skills.
Poor timekeeping.
Limited
concentration.
Often undiagnosed,
especially in adults.
Potential impact
on daily life
and employment
Solutions
May have had bad experiences resulting

in low confidence or self-esteem.
Sometimes have difficulty organising
day-to-day activities, such as preparing
meals or paying bills.
Often have other, positive characteristics
such as: creativity, imagination and strong
problem solving skills.
Good at verbal communication and
practical tasks.
May use different

aids to overcome the
impact of dyslexia.
This could be a diary
to organise their day,
a coloured overlay or
computer software
to assist with literacy
and numeracy.
Use a variety of
communication
styles to keep the
client engaged.
Difficulties in reading, writing or working

with numbers can often lead to low
confidence and self-esteem.
10% o
popula f the British
tion ha
s
4% sev Dyslexia;
erely.
20
Considerations
Case Management
Development
Recruitment
When taking
Most clients with
part in a group
dyslexia will need
activity
some adjustments
Understand the impact of life
encourage them
when applying for
experiences, for example at
to
sit
at
the
front
jobs. For example:
school.
to minimise
- Filling out
Ask how dyslexia affects the
distractions.
application forms.
individual and what previous
If online training
support they have received
- Creating a CV.
is
used
which worked well for them.
- Psychometric
consider what if
Avoid complex or multiple
testing.
any adjustments
instructions as it is likely a
are needed to
- Interview
client will only remember the
enable people
techniques and
last one or two things.
to complete it
preparation.
Meet in an area where
distractions are minimal.
Keep action plans to one or

two actions for the client to
complete at a time.
fairly.
Consider giving
a client
information in
Regularly check they have
advance of
understood and get them to
training
paraphrase points you have
sessions to help
agreed.
them take on
Ask to see any recent
board
assessments or reports. If the
information.
client has not had an assessment this may be something Find out if the
client would
that is needed.
benefit from
handouts on
coloured paper.
General Checklist

What coping strategies do they already use? Can

these be adapted to the workplace?
Has client been confirmed as having dyslexia? If not
is an assessment needed?
Have you read any reports to understand specific
support needs and solutions?
Make sure all training is delivered in a range of
communication styles, not just written or verbal.
Demonstrations are often useful.
What support, if any, will they need in the
workplace? A job coach or crib sheet may assist
with short term memory issues. Specialist computer
software can provide support if the job requires
use of a computer. A support worker can help with
organising their workload.
In-Work
Are support needs

being met?
Are the right
adjustments in place?
For example, an
induction may need to
be delivered slightly
differently to
accommodate the
impact of dyslexia.
Take the time to help

managers and
employers
understand dyslexia.
Some situations may
- Training and
make the client feel
practice for
uncomfortable, for
telephone interviews.
example reading
Identify any reasonaloud, taking minutes
able adjustments
or giving
before an interview.
presentations.
Make employers
Encourage the
aware (always agree
employer to provide
this with the client
dyslexia awareness
first).
training to a clients
Put in place support
colleagues.
to make sure the
Consider Access to
client arrives on time
Work for solutions
for their interview.
where adaptive
Understand the
technology may be
clients specific
needed to help in the
support needs and
workplace.
offer support to any
prospective employer.
Useful Contacts
There are a number of specialist organisations who
can produce further information, including:
www.dyslexia-help.org
www.beingdyslexic.co.uk
www.dyslexia-inst.org.uk
www.adult-dyslexia.org
www.bdadyslexia.org.uk
21
Dyspraxia
Dyspraxia or Developmental
Coordination Disorder (DCD) is a
common disorder affecting motor
coordination in up to 6% of children, of
whom 70% will experience some level
of difficulties into adulthood.
Traits
Difficulty with large and/
or small movements which
may affect balance, fatigue
levels, hand-eye coordination,
rhythm, hand movements or
manipulation skills.
Clumsy gait and movement, for
example knocking things over
or bumping into people.
Poor handwriting may use
either hand reading difficulties.
Some people may also
have Dyslexia or ADHD
Oversensitive to taste, light,
touch or noise.
Poor sense of time, speed,
distance or weight.
Poor sense of direction,
organisational or planning
difficulties.
Poor short term memory
Difficulties with accuracy,
concentration or following
instructions
Sleep problems
Tendency to become
depressed, stressed or
anxious
Slow to adapt to new or
unpredictable situations
22
Many of our clients, particularly those over the age of 30

may never have had a formal diagnosis of Dyspraxia. These
solutions may be helpful for anyone displaying similar
behaviours.

employment
May have difficulty telling others they have Dyspraxia.
Difficulty remembering appointments and / or finding
their way around unfamiliar buildings or areas.
May forget things (e.g. paperwork).
May find learning new skills or completing a task difficult
May lose things.
Some may find it difficult to dress or present themselves
appropriately if it requires extra effort.
Solutions
Hold appointments on the same day and time each week

Explain how long each appointment will last so they know
the timescale they are working to
Use the action plan to list actions or things they need to
bring to the next appointment
Use a diary to help organise their time
Text message or phone call reminders
Complete forms step by step. Where possible use an
electronic form
Give guidance on appropriate dress for interviews and the
workplace
Outline tasks clearly. May need to limit actions to one or two
If learning new skills additional time and support may be
needed. Be positive and encouraging.
Considerations
Case Management
Development
Recruitment
Understand the clients life

experiences. For example,
at school how did they cope
with sports.
Are they
Find out about the
comfortable in a
team and workplace
group setting?
the client is applying
to. Is it sympathetic
If they have
to their needs or is
Are there any environments
difficulty
a support package
they find uncomfortable, such
concentrating
required?
as too noisy or too light?
seat them in a
Is job-coaching
place with
Do they become easily
minimal
required?
distracted?
distractions. For If the route to work or
Consider the best way to
example, at the
an interview is
introduce them to a new job
front or away
complex make sure
or situation. A work trial or
from windows
the client knows
working interview could be
and doors.
about any buses etc.
appropriate.
Reinforce
they need to catch.
Is there any impact on mental
learning with
Ask them to show you
health?
handouts or
their planned route.
information
in
Does the client have any
If the client has
other formats
reports from education which
difficulty organising
such as DVDs
could help you to understand
tasks make sure that
and CDs to
their needs?
a proper routine and
overcome short
structure is in place.
What activities do they
term memory
normally get others to help
Ensure that a suitable
issues.
them with?
risk assessment is
Talk about the
carried out with any
routine they
potential job role to
will need to go
ensure the
through to get
individuals health and
to an
safety. Work trials
appointment /
would be
interview / job
recommended.
on time.
General Checklist
May need support filling in forms, particularly if they are
handwritten.
Group environments, for example in development sessions, may
not always be suitable.
What coping strategies do they already use? Can these be
adapted to the workplace?
Make tasks and actions clear.
Understand the clients learning style and adapt their journey to
suit this.
In-Work
Make sure a high
level of support is
available if needed
during the early
stages of employment
- a visit on the first
day is essential.
Anticipate / pre-empt
difficulties which have
been raised in profile
by ensuring support
is in place.
Induction sessions
sometime contain a
lot of information.
Discuss adjustments
that make it more
accessible for your
client.
Is training delivered in
an appropriate
format? The client
may need extra
support or additional
materials to assist
their learning.
Talk about
strategies they can
put in place to
prevent them losing
or forgetting things.
Support the client to
develop work
routines.
Useful Contacts
www.dyscovery.org
www.dyspraxiafoundation.org.uk
23
Epilepsy
Epilepsy is a neurological condition where an
abnormal electrical activity happens in the brain
causing seizures (also known as fits). What people
experience during a seizure depends on where
the epileptic activity takes place in the brain.
It affects up to 1% of the population and, for some people, there is no known cause;
however a head injury, brain infection or stroke can cause epilepsy.
Traits
There are two types of seizure partial and

generalised (often referred to as petit mal
and grand mal).
In simple terms, with partial seizures the
person will remain conscious and may report:
- Changes in the way things look, feel, taste,
smell or sound
- Feelings of dj vu
- Tingling in arms or legs
- Feeling of stiffness in the muscles.
In a more complex partial seizure, a person
will be unaware of what is happening and will
not be able to remember afterwards. They may
display behaviour such as:
- Smacking lips
- Rubbing hands or moving arms around
- Making random noises
- Picking at clothes or fiddling
- Adopting an unusual posture
- Swallowing or chewing
- Short periods of loss of concentration or
absences.
In a generalised seizure a person will become
completely unconscious.
In people with photosensitive epilepsy,
seizures are triggered by flashing or flickering
light.
Often people will report a warning of imminent
seizure or their behaviour will be recognisable
by those who know them as the onset of
seizure.
24
Potential impact Solutions

Call an
on daily life and ambulance
if
employment
someone is
Diagnosis may have an
emotional impact.
Diagnosis will normally lead
to an individuals driving
licence being withdrawn.
People may be nervous
going out in public in case
they have a seizure, or
experience significant lack
of self-confidence.
Side effects of medication
can include tiredness,
confusion or in some cases
the appearance of being
drunk.
Some people may be
advised to avoid certain
types of work. (eg.
working at heights or with
machinery).
People with photosensitive
epilepsy may have difficulty
working under fluorescent
lights or with standard
computer screens.
unconscious.
If a person has
a generalised
seizure, try
to remove
surrounding
objects which
could cause an
injury and call for
first aid. Try to
hold their head
but never put
anything in their
mouth. Where
possible, help
the individual
into the standard
recovery position.
If a client is
photosensitive,
filters are
available for
lights and
computer
screens to
reduce the
impact of
flickering.
Considerations
Case Management
Development
Recruitment
In-Work
Understand the history of

If client needs to Some people may
Are all aids and
their condition. Someone who
take medication
have had their driving
adaptations in place
has had epilepsy from childat a certain time
licenses revoked, so
before the person
hood is likely to have adapted
or needs to eat
transport to and from
starts work? Are they
to it more than someone who
to take medicawork needs to be
effective?
has recently been diagnosed.
tion make sure
considered.
Is Access to Work
any sessions
It may be advisable
Some people go through
support needed?
have
a
break
a spell of thinking they no
for the client to
A health and safety
factored into it.
longer need to take
discuss a potential
review must be
medication. Encourage
job with their GP
completed before the
clients to talk to their doctor
Lone working may
client begins
before making any changes.
not be advisable for
employment.
How does epilepsy affect
safety reasons.
them?
What adjustments to
Are there any particular
triggers such as light or lack
of sleep?
If epilepsy is the result of

an accident or illness, other
mental or physical issues may
also be need to considered.
work may be needed?

Is Access to Work
required?
A health and safety
review must be
completed before the
client begins a work
placement.
General Checklist
Be prepared. Read the client profile, case
management notes and any reports or assessments
attached to the client record
Make sure you know about any warning signs they
get and how long a seizure may last. Some people
may experience seizures more at a certain time of day.
Depending on the frequency of seizures you may want
to record this in your Case Management System, but
remember to get the clients permission first.
Consider the side effects of any medication. It may
affect the hours a person can work and/or the type of
work they can undertake.
Useful Contacts
www.epilepsy.org.uk
www.epilepsysociety.org.uk
25
General Learning Disabilities

A learning disability is a lifelong intellectual impairment which makes
most everyday tasks harder than they are for other people. People
with a learning disability take longer to learn new things and are likely
to need support with things like travel or managing money. A learning
disability is acquired at birth.
A learning disability does not fluctuate and cannot be treated. Dyslexia is described as a learning
difficulty because its impact is limited to a specific area of functioning, and does not affect
intellect. There is a high incidence of mental health conditions among people with a learning
disability. Many people with autism also have a learning disability. The more severe someones
learning disability, the more likely they are to have physical disabilities alongside their learning
disability.
Potential impact
on daily life
and employment
Traits
Limited or no literacy /
numeracy skills.
Difficulty in
understanding and
interpreting situations
- slower to process
information.
May need to implement structure
coaching. Possible
development of instructions
in a pictorial format or, for
example, colour coding of
products or tasks.
May have reduced confidence in
Poor short-term
memory.
social situations which, in turn,

may result in some inappropriate
behaviour.
Emotional immaturity.
Will take longer to learn new tasks.

May misinterpret criticism.
Limited ability to
articulate or express
themselves effectively.
May be accompanied by other
Limited ability to
concentrate for any
length of time.
May have some
difficulty travelling
independently.
One to one support for forms.
into their day and may struggle

with situations which require
a great deal of flexibility or
judgement.
Poor organisational
skills and time
management.
disabilities, for example, mental

health conditions, hearing
impairment or epilepsy.
Useful Contacts
In the workplace job
Ensure a clear structure of

working day is provided.
Regularly check
understanding of the task.
Provide simple instructions.

Performance review
meetings should be
constructive and sensitive
to the individuals ability to
interpret criticism.
Establish links with specialist

support agencies/partners.
Travel coaching if unable to

travel independently.

organisations who can produce further information, including:
www.landau.co.uk
26
who supports them e.g.

family, friends, Remploy
advisor.
Will need support with form filling.

Will need support with interpreting
written instructions or reading
warning signs.
Poor motor
co-ordination.
Solutions
Ask the individual to identify
www.mencap.org.uk
www.bild.org.uk
Considerations
Case Management
Development
Consider length of appointments due to concentration

difficulties.
Find out about school and life
experiences.
Explore how individual learns
best.
Find out about who supports
the client and what they
support with. Does the client
want them to be involved in
appointments?
Repeat key points throughout
your meeting.
Give an appointment card at
each meeting.
Ask about time how does
individual plan time to get to
meetings/work?
Find out how the individual
manages money.
Ensure support needs are
understood and
communicated to colleagues.
How do they cope with
unexpected situations?
Establish preferred
communication style may
need to avoid lengthy emails
or texts.
Is the client able to travel on
their own?
Recruitment
In-Work
The place and

Ensure support needs Make sure
appropriate support is
train model of
are understood and
in place from
support may be
explained to the
beginning.
the best way
anyone offering
of developing
recruitment support, Identify natural
someone with a
and the employer.
supports in the
Learning
Is the recruitment
workplace such as
Disability.
work buddy or
process accessible
Consider
mentor.
for the individual? If
delivery of
not, what
Ensure induction
sessions and
reasonable
meets the learning
whether they
adjustments are
style and any H&S
meet the clients
required and discuss
information is fully
learning style.
these with the
understood. Visuals
employer.
may be needed.This
How does the
client may need more
client react with Ensure support needs
visits in the early days
other members
are addressed and in
of their job.
of the group?
place on day one.
Feedback to
Correct job match is Establish preferred
Case Advisor.
communication style
absolutely vital job
may need to avoid
Schedule an
placements or work
lengthy emails or texts
appropriate
trials prior to
number of
appointment are
When handing over to
breaks within
highly
a colleague or service
development
recommended.
for ongoing support
sessions.
make sure the pro Roles with structure
cess is understood.
After breaks
and routine are
It is good practice to
recap learning.
usually
introduce the client
recommended.
Where possible
to any new person
use pictorial
supporting them.
information.
When the client no
Ensure
longer needs hands
instruction is
on support make sure
straightforward
the employer has your
and avoid
companys contact
multiple
details in case further
questions.
support is needed in
future.
Remember, job
coaching should
always be available to
support changes in
the workplace.
27
Hearing
Impairment
Deafness can be described as a
partial or complete hearing loss.
Hearing impairment can be caused by a range of factors such as genetics, infection, damage to
the ear or environmental factors such as noise or drugs or age. Otitis media is a common cause
of hearing loss in children as it predominantly affects young people.
Traits
Some people may
be able to hear, but
have difficulty picking
out sounds in a noisy
environment.
Use of sign language
or a hearing aid.
People with tinnitus may
have difficulty sleeping
and experience tiredness
during the day.
Communication
difficulties. Not all people
with a hearing impairment
will use sign language,
a hearing aid, or be able
to lip read.
May have difficulties with
written instructions. For
some hearing impaired
people, sign language is
their first language.
Hearing impairments
as a result of their
environment, for example
noisy machinery, can
affect the range of
hearing, such as difficulty
in hearing certain pitches
in speech.
28
Potential
impact on
daily life and
employment
A sudden or unexpected
loss in hearing can have
an emotional or negative
impact on their mental
health.
Workplaces and homes
may need aids and
adaptations, eg. to fire
alarms or the way
a job is carried out.
Frustration in
communicating - dont
assume someone with
a hearing aid has full
hearing.
Solutions
Create an environment that
minimises the impact of the hearing
loss.
Meet people in an environment they
find comfortable. This could be
somewhere quiet.
If an client is using a cochlear
implant, make sure that meetings
are held in an area with a hearing
loop system.
Always face the client when
speaking to them. Where an
interpreter is present, speak
directly to the client and not to the
interpreter.
It doesnt help to shout!
Useful Contacts
There are a number of specialist organisations who can produce
www.nrcpd.org.uk
www.actiononhearingloss.org.uk
www.actiondeafness.org.uk
Considerations
Case Management
Development
Make sure you

If you have
enough
understand the
Has the client had a hearing
clients it may be
clients support needs
impairment from birth or has it
worth
running
at interview and in the
developed since then?
development
workplace.
Did they attend a mainstream
sessions,
May need supporting
or specialist school?
supported by
completing
one or two
Are they comfortable with
application forms.
interpreters,
being with people who do not
Remember the written
specifically for
have a hearing impairment?
word may not be the
clients with a
clients first language.
How does the client like his/
hearing
her deafness to be
Always ensure that a
impairment.
supported?
full risk assessment
The interpreter
has been carried out
If a client has lost hearing
may help you to
prior to placing the
their grasp of language will
create an
client.
usually be different to those
effective layout
who have had a hearing
Offer to support the
of the room.
impairment from birth.
employer in
Make sure the
arranging an
interpreter isnt
interpreter for
silhouetted
interviews should they
against a bright
need one.
light.
Discuss life experiences.
Recruitment
In-Work
Make sure all support

aids and adaptations
are in place.
Give consideration to
induction, company
handbooks etc. and
how the client can
access these.
In particular it is vital
they have understood
H&S requirements.
Consider referral to
Access to Work for
any workplace
solutions that may be
needed.
Written
material should
be supported
with verbal or
visual media
where possible.
General Checklist
If a client uses a hearing aid or cochlear implant meet them in an area with a hearing loop system. If one
isnt available try to access a portable system.
Before meetings check the referral to find out if a client needs a British Sign Language (BSL) interpreter
and arrange one if needed.
Make sure you have access to partner who can provide properly qualified interpreters. Refer to NRCPD
register Level 3 as a minimum.
When working with a person who requires an interpreter make sure you talk to the client and not the
interpreter.
Make sure all aids and adaptations are in place before the start of a meeting, development session, work
placement or employment.
How would the client like to be contacted? For example, email, TypeTalk, minicom, fax, letter, text
message or video relay interpreter (VRI).
Make sure communications styles meet the clients needs. You may need to deliver information or training
in a range of methods.
What coping strategies do they already use? Can these be adapted to the workplace?
29
Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a neurological condition
which affects around 100,000 people in the UK. It
is the most common disease of the central nervous
system (brain and spinal cord) affecting young
adults.
The term multiple sclerosis relates to the numerous scars or lesions which affect the nerve
fibres protective layer; a protein called myelin. This damage disrupts the way in which messages,
or nerve impulses, are carried to and from the brain, and so can interfere with a range of the
bodys functions.
85% of people diagnosed have relapsing MS, where the symptoms appear and then fade away
partially or completely. This could develop into secondary progressive MS if there is a sustained
build-up of disability completely independent of any relapses. A third type of MS is known as
Primary Progressive MS (PPMS) where symptoms gradually get worse over a period of time,
rather than appearing as sudden attacks. Once diagnosed, MS cannot be cured but medication
can generally manage the symptoms.
Traits
Impaired vision,
dizziness and
poor balance.
Difficulty
with bladder
and bowel
management.
Stiffness
and spasms,
restricted or
loss of mobility.
Fatigue.
Difficulty in
swallowing.
Tremors.
Loss of
memory.
Slurred
or difficult
speech.

employment
Blurred or double vision (temporary or permanent) can affect a range of

day-to-day activities.
May need to avoid working at heights or in other environments where loss of
balance could be dangerous.
May develop some incontinence or, conversely, constipation.
Spasms can be painful and may cause difficulties with sleep.
There may be an overwhelming sense of tiredness which may cause some
difficulties in the workplace.
May have some difficulty eating.
MS most commonly affects remembering recent events and remembering to do
things, but most people do not develop severe cognitive conditions.
In cases of severe tremors (usually many years after diagnosis) eating, drinking
and other day-to-day tasks may be affected.
If speech is affected (40-50% of people with MS), the individual may feel
uncomfortable in certain social situations.
Useful Contacts
There are a number of specialist organisations who can produce further
www.mssociety.org.uk
30
Solutions
May need aids and adaptations in the workplace and possibly a support worker.
Flexible working arrangements may help the individual work with the fluctuating nature of the
condition.
Where appropriate, ensure the individual has easy access to toilet facilities.
Eating in a relaxed environment will minimise swallowing difficulties (no lunch on the go!).
Flexibility in tasks may be necessary if the individual is affected by fatigue. Working
relationships will need to be monitored.
Develop coping strategies for poor memory such as writing things down, using mobile phone
etc. for reminders.
Consider the impact on training courses etc. - are photos or other visual reminders required?
For those affected by speech difficulties consider any impact in the work place and avoid work
where communication is key (e.g. .call-centre work).
Considerations
Case Management
Development
Find out when the condition

was diagnosed.
How well has the individual
adapted to the diagnosis
emotionally?
At what stage is the MS?
Recruitment
Make sure you Will any aids and

understand
adaptations be
the fluctuating
required in the
nature of the
workplace?
condition and
Does the client need
agree with the
to apply for Access to
individual how
Work?
What symptoms do they
that will be
accommodated Make sure you
experience?
understand the nature
in development
Does the condition fluctuate
of their condition.
activity.
and, if so, how?
Ensure there is the
What coping strategies does Ensure you
capacity to implement
understand how
the client have?
appropriate coping
the MS affects
Find out about side effects of
strategies within the
the individual
job role.
the medication.
and make
Are there any activities the
client has been advised to
avoid?
Will any adjustments be
needed in the workplace or
while you are helping them to
find work?
In-Work
Is everything in place
to allow the individual
to undertake the role
effectively?
If needed has job
coaching been
arranged?
Monitor changes in
the clients
requirements in the
work place.
In more extreme
cases, applications
for a support worker
may be appropriate.
appropriate
If the client has a poor Ensure a full risk
adjustments e.g.
memory, is job
assessment is
writing may be
coaching required?
completed.
difficult so you
Part-time roles may
.
could make this
be particularly
activity pairs
suitable.
work instead
of an individual
Almos
t twice
task.
as man
wome
n than
y
men h
a
v
e
M S.
31
Musculoskeletal
Disorders (MSD)
The disorder occurs when a body part
repeatedly works harder, stretches
further or receives more impact than it
is prepared for, causing damage. It
affects the muscle and bone and is
often focused on a joint.
Musculoskeletal disorders are the most common work-related illness in Britain (HSE 2006). Some
common examples of musculoskeletal disorders are RSI, Vibration White finger, Scoliosis and shin
splints. An estimated 9.3 million working days were lost through work- related musculoskeletal
disorders in 2009/10. Each person who has a work-related musculoskeletal disorder took an
average of 16.3 days off in 2009/10.
Risks
There are a number of risk factors
assiciated with MSD such as:
Traits
Pain.
Joint stiffness.
Repetitive and/or heavy lifting.
Redness and swelling of affected area.
Bending and twisting.
Pins and needles and/or numbness.
Repeating an action too frequently.
Skin colour changes.
Uncomfortable working position.
Decreased sweating of hands (upper limb

disorder).
Exerting too much force.

Working too long without break.
Adverse working environment (e.g. hot
or cold.
Symptoms often worsen as condition

progresses.
Psychosocial factors (e.g. high job

demands, time pressures and lack of
control).
Potential impact on daily life

and employment
Not receiving and acting on reports of

symptoms quickly enough.
Inability to undertake day-to-day tasks eg.

undo a lid on a jar, walk without pain, use a
keyboard or write.
Inability to lift, bend or carry.
May have difficulty sleeping or carrying out basic
day-to-day tasks.
Slow mobility.
* Source: www.hse.gov.uk
32
Solutions
Medication or alternative treatment to manage pain.
Aids and adaptations to overcome the difficulties faced.
Avoidance of certain exacerbating activities or strenuous
or physical demands.
O
muscu n average 4
3% of
loskele
tal dis
by wor
o
rders c
k affec
au
t the u
neck a
p
per lim sed
nd 17%
bs or
affect
lower
limbs.
Considerations
Case Management
Find out how long the

condition has been
present.
What caused the
condition to develop?
Development
Is there any
adaptation or aid
required to help the
customers
development?
Recruitment
Is a package of
Access to Work
(ATW) support
required in the
workplace?
In-Work
If aids/adaptations
are required are they
in place and are they
effective?
If risk assessment has

May need to support
The individual may
been undertaken have
Find out about coping
need
to
have
regular
the
individual
with
an
resultative actions
strategies.
breaks or to adjust
ATW application.
been followed?
Has the individual used
his/her position
A task analysis may
Make sure you
aids and adaptations in
periodically.
be required to ensure
understand the detail
previous jobs.
If undertaking a
there are no aspects
of how the individual
Does the individual
placement ensure the
of the job which are
undertakes the job.
have regular GP or
role accommodates
going to exacerbate
Ensure agreements
hospital appointments?
any restrictions or
the condition.
are in place to allow
adjustments.
Are there any side
Consider if or how the
the client to attend
effects from medica Client may use
clients disability may
future doctor or
tion?
walking aids or
fluctuate between
hospital
wheelchairs to aid
seasons and how this
appointments.
Is there a restriction
mobility ensure that
may potentially impact
on the length of time
development
on work performance.
the client is able to sit,
.
environments are
stand, walk etc.?
It is advisable for the
appropriate to
company to undertake
accommodate any
a risk assessment.
adjustments.
80% o
f adult
s
will ex
perien
c
e
back p
ain at
th
some
le wi
p
o
e
time.
e
of p
72%
eet th
m
s
i
it
of
arthr
nition
fi
e
d
led
legal
disab
g
n
i
.
be
ir life
in the
Useful Contacts
There are a number of specialist organisations who
can produce further information, including:
www.hse.gov.uk/msd
www.arthritisresearchuk.org
33
Schizophrenia
Schizophrenia typically first presents
itself in adolescence or early adulthood
and is charactarised by positive psychotic
symptoms including hallucinations,
delusions and thought disorder as well
as negative symptoms such as emotional
blunting, paucity of speech, loss of
motivation and social withdrawal.
Hallucinations are most commonly auditory, such as hearing voices, but can also be visual,
tactile or involve smell or taste. Visual hallucinations occur in fewer than 10% of people with
schizophrenia.
Delusions can present in a number of ways but may result in the individual believing that ordinary
events have an unusual meaning specifically for them. They have delusions whereby they believe
their thoughts or feelings are being controlled or read by other people.
While there is evidence that genetic factors have a role in developing schizophrenia, other
unknown causes play a significant part as well.
Traits
Client may appear
distracted at times.
Conversation may be
disjointed with no obvious
connection between
sentences.
May demonstrate poor
motivation.
Disrupted or deprived
sleep patterns, resulting in
tiredness.
Depending on medication,
the individual may
demonstrate a pattern of
irrational behaviour.
May have started to avoid
social interaction.
34
Potential impact
on daily life
and employment
Solutions
This can vary massively

depending on the severity
of the condition, but can
lead to social exclusion.
Appropriate job match is

key.
Understand the triggers to

becoming affected, if there
are any.
Impact can be minimal and

individuals may sustain a
successful career.
Diagnosis may have an
emotional impact on the
individual and/or their family
and friends.
Social isolation-behaviour
can be considered to be
unconventional.
It is es
timate
dt
the wo
rlds po hat 1% of
pulatio
schizo
n has
phreni
a.
Considerations
Case Management
Development
Be mindful that
the client may
be uneasy in
Understand the clients
group situations.
insight into their
Watch for signs
schizophrenia.
of client being
There may be triggers to
distracted you
being affected - ask what
may need to go
they are.
over some of the
Ask the client how they would
session again
like us to handle times when
with the client.
they appear to be affected.
Regularly check
Understand the impact of
understanding.
the schizophrenia and any
Focus on
medication taken. e.g. can
building
the client work early in the
confidence and
morning?
self-esteem.
Understand how the client
manages his/her condition.
Can these strategies be
adapted for the workplace?
Ask the client about side

effects of medication.
Recruitment
In-Work
Make sure individually

tailored supports are
in place
Make sure you understand support needs With the clients
at work. This could be
approval, educate the
a mentor or buddy.
employer on the
individuals condition
Consider jobs with
and how it affects
highly flexible hours,
them.
or annualised hours
Correct job match is
key.
contracts.
Source a specialist
partner to support the
client and the
employer if needed.
Explain the clients

support needs to a
prospective
Identifying a
employer. Discuss
with the client how
workplace buddy or
they would like you to
mentor is
do this.
recommended.
Discuss any medical

interventions, such as
frequency of appointments.
Find out which specialist
partners are available to
support the client if needed.
General Checklist
Understand any medication regime and possible side effects and how this could impact
employment.
Useful Contacts
35
Visual Impairment
(Blindness)
The term visual impairment refers to
people with irretrievable sight loss and
does not include conditions which can be
corrected by glasses or contact lenses.
Visual impairments can be caused by a range of conditions and each person will have different
needs depending on their condition and what they can and cannot see. Many people will have
a perception of light and shape and as many as 75% of people with learning disabilities are
thought to have a visual impairment.
Traits
Some people may
use a guide dog or
white cane.
Clients may have
been referred
on the basis of a
particular condition.
Some clients may
be starting to
experience some
difficulties but do
not realise they
are developing a
visual impairment.
For example, losing
peripheral vision,
vision becoming
cloudy or holes in
their vision.
up to two
There are
nd and
million bli
ighted
partially s
the U K
people in
36
Potential impact
on daily life
and employment
Use of non-text based information.
Support with daily living.
Sudden or recently acquired
visual impairments can have a
significant emotional impact and
may also effect family and personal
relationships.
Individuals can experience social
isolation or a loss of independence.
Solutions
Adaptations may be
required in the workplace
(eg. voice activated
software, screen readers,
alternative formats such as
Braille, or accommodation
for a guide dog).
Counselling for emotional
support needs.
Access support from
specialist organisations.
Useful Contacts
There are a number of specialist organisations who can produce
www.mib.org
www.mcb.ac.uk
www.actionforblindpeople.org.uk
www.abilitynet.org.uk
Considerations
Case Management
Development
Recruitment
Think about how Make sure you fully

to deliver
understand the
development
clients support needs
sessions. There
and offer a package
is a legal
of support to the
requirement to
employer.
make them
Inform the employer
accessible.
of any access
Work placement
requirements before
Is the condition affected by
or work trials
the interview.
light? How does it vary from
with support are If the employer
day to day?
recommended.
requires you could
Is the impairment
arrange for a
degenerative?
communications
session to support
Are there any situations the
them in working with
client is uncomfortable with?
a client with a visual
This may affect appointment
impairment. RNIB
times or the hours the client
may be able to assist
is available to work.
with this.
Do they get support from
Is Access to Work
friends, family or
required?
organisations? If so what do
they help with?
In-Work
Talk about the history of their

visual impairment. The
emotional impact and ability
to overcome barriers will be
different for someone who
has had the impairment from
birth to a person who has
developed a condition later
in life.
Make sure all aids,

adaptations and
support are in place
on the first day.
Equipment, such as
software packages,
will often come with
a training package to
help the client get the
most support.
How will the induction

be delivered? If it text
based make sure it is
made accessible to
the client.
If the impairment is
degenerative
remember to review
support periodically
to make sure that it
is still appropriate to
their needs.
Have they worked since

developing the visual
impairment? What aids did
they use?
Think about how to deliver
text based information, such
as contractual paperwork.
Someone who has had some
sight even if they lost their
sight at a young age will
have a different
understanding of the world
around them than someone
who has been totally blind
from birth.
General Checklist
What coping strategies do they already use? Can these be adapted
to the workplace?
Make sure specialist partners are lined up to support the client. This
could be delivery of training or the provision of aids and adaptations if
needed.
If the client uses a guide dog make sure that arrangements are in
place for food, water and to take it out.
Make sure fellow clients and colleagues are aware that they must
not fuss or feed a guide dog. The client may wish to have this
conversation themselves.
37
Equality Act
2010
The Equality Act 2010 aims to prevent unlawful discrimination against a person, or group of
people, because of:
Age
Race
Disability
Religion
Gender Reassignment
Sex
Marriage and Civil Partnerships
Sexual orientation
Pregnancy and Maternity
Reasonable Adjustments
Under the Act employers have a duty to make reasonable changes to applications, interviews and
work, so that people with disabilities or health conditions are not disadvantaged. These are known as
reasonable adjustments.
The aim of reasonable adjustments is to make sure that a disabled person has the same access to
everything that is involved in getting and doing a job as a non-disabled person.
Types of adjustments can include:
Allocating some duties to another person.
Adjustments to the premises, for example, a ramp.
Changes to the disabled persons working hours.
Training to help them to do their job.
Allowing the person to be absent during work or training hours for rehabilitations, assessment or
treatment.
Acquiring or modifying equipment to support them, for example, screen reader software.
Adapting instructions or reference manuals.
Providing a reader or interpreter.
Providing supervision or other support, for example a mentor or buddy.
Training of managers and co-workers.
Useful Contacts
For more information about the Equality Act 2010 please visit:
www.homeoffice.gov.uk/eualities/equality-act/
38
Other Factors
The employer only needs to make a reasonable adjustment
if they know or can be reasonably expected to know that an
employee is disabled and is likely to be at a disadvantage as a
result of their disability.
A number of factors may have a bearing on whether an
adjustment is reasonable, these include:
The effectiveness of the adjustments in preventing
disadvantage
Practicality of the adjustments
The extent of the employers resources, for example, financial
Financial and other costs of the adjustments to the employer
and the extent to which it would disrupt their activities
Financial or other assistance available to the employer to
help them implement the adjustment
The Access to Work service can provide advice and financial
support towards implementing adjustments. An Access to
Work advisor or the DEA from your local Jobcentre Plus will be
able to provide more information about this service.
39
This guide was designed and written by Remploy Limited of Remploy House, 18c Meridian East,
Meridian Business Park, Leicester, LE19 1WZ. All rights reserved. No part of this publication may
be produced, stored in a retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise without the prior permission of Remploy Limited.
Disclaimer: Remploy Limited has taken all reasonable care in the preparation of this guide. The
contents of this document have been produced in good faith and should not be deemed as formal
advice or recommendation of any kind. It is strongly advised that you seek legal advice prior to
taking any action in order to ensure compliance with the Equality Act 2010.
Please note Remploy Limited does not guarantee the accuracy or validity of the information
contained herein and accepts no responsibility for any damages, claims or costs incurred as a
result of the use of or reliance upon any information contained within this guide. The information
contained herein is subject to copyright where indicated.
For more information, please get in touch

with your local Remploy contact.
www.remploy.co.uk
Remploy Limited, Remploy House, 18c Meridian East,
Meridian Business Park, Leicester, LE19 1WZ Ref: 156

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Disability Guide

A practical guide for practitioners working directly with

Providing great advice, guidance and support for disabled

I hope you find this guide useful.

Guide to working with disabled clients

Attention Deficit Hyperactivity Disorder

Equality Act 2010

General Learning Disabilities

All considerations subject to Copyright Remploy Limited 2016

Potential impact on daily life

Guide to working with disabled clients

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Guide to working with disabled clients

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Many of our clients, particularly those over the age of 30

Potential impact on daily life and

Hold appointments on the same day and time each week

Guide to working with disabled clients

Understand the clients life

There are two types of seizure partial and

Impulsivity, such as;

May have had bad experiences resulting

May use different

Difficulties in reading, writing or working

There are two types of seizure partial and

Blurred or double vision (temporary or permanent) can affect a range of

Redness and swelling of affected area.

Pins and needles and/or numbness.

Skin colour changes.

Decreased sweating of hands (upper limb

Symptoms often worsen as condition

Inability to undertake day-to-day tasks eg.

This can vary massively

Appropriate job match is

Understand the triggers to

Impact can be minimal and