Functional Capacity Assessments: Understanding information & facts

Within the Assisted Decision-Making (Capacity) Act (2015), there are four areas which need to be addressed when conducting a Functional Capacity Assessment. These are that the relevant person can:

• understand information and facts relevant to the decision
• retain that information long enough to make a voluntary choice
• use or weigh up that information as part of the process of making the decision
• communicate the decision by any means, including by assistive technology.

A relevant person will be considered to lack capacity if they fail to meet one or more of the above criteria in relation to a specific decision.

(Reference: Codes of Practice | Decision Support Service)

In this article I look at the first area, which centres on understanding. As is the case with all aspects of a Functional Capacity Assessment, when looking at understanding, it is in relation to the specific decision to be made within a specific timeframe.

Ironically what we mean by ‘understanding’, can be misunderstood, particularly when we are basing it upon how a person responds. It is very easy to simply answer, “yes,” when someone asks whether we have understood something…just think to the pre-Google Maps days when you would stop someone on the road to ask directions, and then nodded whilst internally having no idea where they were sending you! (Or maybe that was just me!)

Anyway, I thought I would unpack the term ‘understanding’, from a speech and language perspective. In addition to ‘understanding’ and the other everyday term 'comprehension', a frequently used term used by SLT’s is ‘receptive language’. It can refer to the ability to understand spoken, written and/or signed language.

When I think of receptive language, below are the key areas that come to mind.

1. Vocabulary: Vocabulary is about word knowledge, and includes not just nouns, but other aspects of language such as verbs, adjectives (e.g. beautiful), and adverbs (e.g. quickly). It can include knowledge of concepts, which can range from quite concrete (e.g. full) to quite abstract (e.g. integrity). SLT’s use the term ‘semantics’ as a broader term which encompasses vocabulary, as well as the knowledge of words, word meanings and relationships.
2. Sentence structure and grammar: We speak in phrases and sentences of varying lengths and complexity. How a message is put can affect how easy or difficult it is to understand. While straightforward sentences follow a linear word order, such as, "Go to the post office and get me some stamps," other sentences use more complex sentence structure, and require the person to process the sentence in order to understand what is being said. Take for example, "Before you sign the form, you need to get it witnessed by someone you know, but is not related to you."
3. ?Length and complexity: As language becomes longer and/or more complex, it can be more challenging to understand. A longer sentence is not automatically more complex, as there can be a lot of redundant information. Taking the previous example, of "Go to the post office and get me some stamps," you really only need to listen to 'get me some stamps' to follow it. The less familiar a statement is, and the more ‘critical’ or ‘key’ information that is embedded in it, the higher the demand on a person’s short-term memory and working memory (a type of short-term memory that allows us to store and manipulate temporary information).
4. Degree of abstractness: It is only when a person's ability to understand language breaks down that we can see how complex our everyday language can be. This is particularly the case in formal situations, such as legal proceedings.?

Broader considerations

In looking at understanding, it is important to consider broader components which could affect it. These include:

1. Attention and listening: Is the person able to focus on what is being said? Are they feeling stressed or anxious, and is this impacting on their ability to take in what you are saying? (Just think about how much you would take in at a medical appointment if you were feeling worried.)
2. General wellness: Are there any issues with fatigue, pain and/or discomfort which may impact on their ability to focus? Does this fluctuate depending on the time of day?
3. Familiarity with the topic: When something is familiar to us, we do not need to try too hard to understand it, whereas when we have little knowledge or experience, then we are relying a lot more on what is being said. So, is this something that the person can already relate to?

Demonstrating understanding

While it is easy to tick the box in relation to the question, "Do you understand?" demonstrating understanding, requires a bit more than that! Some things that could be considered:

• Asking the person to explain what they have understood.
• Asking specific questions relating to what you have discussed. Make a point of jotting these down and noting responses.
• Remembering that the person does not necessarily need to understand all of what you have said, but rather the key information which is relevant to the decision.
• If a person has difficulty with speaking, it may be that they are supported to communicate their understanding by pointing to written information, pictures and/or symbols.

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Concluding thoughts

As can be seen, there is a bit to it when it comes to looking at understanding, and so it can be helpful to give it some thought, and to do some preparation when conducting a Functional Capacity Assessment. It is always helpful to consult a Speech & Language Therapist for advice.

#functionalcapacityassessment #assisteddecisionmaking #slt #admca

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