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Invisible to Visible: Tips for Working with People Who Have Cognitive Impairments
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Here are some helpful tips for homeless service providers and their organizations to work more effectively with people who have problems with remembering, thinking, or understanding due to mental illness, substance use, head injury, fetal alcohol exposure, or other causes.
Invisible to Visible: working with people who have problems with memory, cognition, and organization

General Tips
·    Be present.
·    Be authentic.
·    Always use person first language
    (e.g. “someone suffering from schizophrenia” rather than “a schizophrenic”)
·    Let people finish their sentences, even if it takes some time.
·    Agree with what you can agree with.
·    Listen to the person’s story.
·    When the client is seated, sit down when interacting with them…
     Don’t put yourself at a higher level.
·    Come out from behind the desk and sit next to the person.
·    Recognize and advocate against stigmatizing language.

Specific Tips
·    Write down what the person needs to remember.
·    Put it where a daily activity occurs, such as in the bathroom.
·    Ask people to repeat back what they heard.
·    Frequently repeat directions and plans.
·    Break down instructions into tiny steps.
·    Respect the person’s inability to focus for a long time by
     keeping appointments short.
·    Remind clients by using instant message on their phones.

Assessment Tips
·    When explaining procedures or rules, ask “What does that rule mean to you?”
     and after they have answered, then ask, “Show me how you would do that rule.”
·    To determine level of education, ask “How long were you in school?”
·     In determining a plan, ask “What do you want to do?” and
     “How can I help you achieve that?” 
·    Ask people to read to you to find out their reading abilities.

Tips for Organizations
·    Keep rules few, simple and flexible.
·    Assume that inability following a rule is not deliberate
·    Write down names of medications and contact information for providers.
·    Ask for cell phone numbers and email addresses from clients.
·    Require welcoming skills as a competency for all front desk staff.
·    Decrease stimuli in environment to reduce attention overload.
·    Schedule an appointment for the client before the office gets too busy.

Source: Homelessness Resource Center. (2008). Invisible: Cognitive impairment and homelessness. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Available here.

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