1 Building Capacity to Make Decisions About Health Care NeedsAnn Mahon, Mary Davis, & Aisling Dolly Brothers of Charity Services Galway

2 Members of the Research GroupDr. Mary Davis, Principal Clinical Psychologist Ms. Aisling Dolly, Speech and Language Therapist Ms. Ann Mahon and Service User Council Members Dr. Mary Keys, School of Law, NUI Galway Dr. Hazel Moore, Senior Clinical Psychologist Ms. Mary Clare Sutton, Assistant Psychologist Mr. Maurice Healy, Clinical Nurse Specialist

3 Why this Project? Feedback from Service Users Council to Senior Management at BOC Galway Report by the Irish Human Rights Commission Status of Capacity Law in Ireland

4 Why this Project? Some work done in the area of sexuality and personal development which shows that capacity building is possible (McGuire and Dukes, 2009) Lack of guidelines in how to support people to build capacity in the area of health care decision making

5 How the Project Started?Meeting with the Service User’s Council (Ann Mahon) ASK ME (Board maker picture here)

6 How the Project Started?My Experience (HELP ME) Picture of Ann and Aisling

7 How the Project Started?Being Responsible about Decision Making (Ann Mahon) Take home message: ASK ME HELP ME

8 How to Build Capacity? Communication : What works best for the personTotal Communication Approach advocates that all modes of communication be made available to the person

9 Total Communication ApproachSlide of total communication approach to be inserted

10 Total Communication ApproachAll aspects of the project were adapted based on each person’s optimal communication approach from the approach used to obtain informed consent to the areas of: Understanding Appreciation Reasoning Expressing a choice

11 Building Capacity to Visit DentistAn individualised approach was used with each participant based on the total communication approach. Some people clearly benefited from an approach which used pictures to support and build their decision making capacity

12 Building Capacity to Visit DentistInsert Picture of dental items

13 Building Capacity to Visit DentistAdapted the MacArthur Competence Assessment Tool – Treatment (MacCAT-T) Having cognitive challenges does not mean that a person cannot make key decisions (Grisso, Appelbaum, Mulvey, & Fletcher, 1995)

14 Building Capacity to Visit DentistAppreciating a visit to the dentist Giving information about treatment need (dentist visit) and how treatment could be beneficial

15 Building Capacity to visit DentistUnadapted MacCAT-T Item “Now that is what we think is the problem (dirty teeth). If you have any reason to doubt that I’d like you to tell me so. What do you think?” Adapted MacCAT-T item Do you sometimes have dirty teeth?

16 Building Capacity to Visit DentistUnadapted MacCAT-T Item “Now that is what we think is the problem (dirty teeth). If you have any reason to doubt that I’d like you to tell me so. What do you think?”

17 Factors that can affect decision making (multiple)For example: Communication style of the person Memory Anxiety about going to the dentist Specially factored in dental related anxiety for each person tailoring how this information was obtained using the Total Communication Approach.

18 What we found? Participant John Participant Sarah

19 What Next? GENIO Application SubmittedDevelopment of a manual – a practical guide to support people Practical guides that can be used when the new Capacity Legislation is available