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For many people living with disabilities, the National Disability Insurance Scheme has increased access to allied health services - but there’s potential for further growth and for more input from dietitians.

The 47% of NDIS participants not meeting current diet recommendations could benefit hugely from dietetic support - and for those with specific dietary requirements or conditions that impact nutrition, this support could be the difference between surviving and thriving. 

Here are Jayne Curlewis’s tips for working as a dietitian in disability.

• Identify the highest priority intervention. People with a disability often have a number of complex medical and mental health symptoms, as well as living in complex situations. Start with the highest priority intervention and gradually work through the rest.
• Do your research - but remember that disability dietetic literature is limited. Research is important but its application to your individual situation will need some tailoring, e.g. when you’re managing conditions like Huntington’s disease, dementia or dysphagia, while also considering medications and untrained staff. You may need to research nutrition supplements individually to develop a diet plan combining safe texture foods the person likes with liquid oral supplements to prevent weight loss and muscle wasting, including cases where tremors increase requirements.
• Assess each client with a disability as you would any other client… Always check that their weight and blood pathology are within normal parameters, as you would any other client… 
• …but remember there’ll be times when you have to be flexible. Sometimes you’ll need to tailor interventions and services to the person in front of you, rather than what research or reports indicate. If they’re consuming the recommended caloric intake but still losing weight, increase their intake until stabilised, for example. Or if someone is happier, safer, easier to transfer and comfortable at a specific weight, let them maintain that ideal weight or weight range.
• Be an advocate for people with a disability when dealing with family, carers, the multidisciplinary team and health services. There are unconscious biases and discrimination towards people with a disability and providing hope and validation is very important for developing a deep rapport. Listen to the person with a disability (and/or family and staff) on what they expect and need from your service.
• Family and support staff will need some training. Your recommendations and interventions must be practical and easy to understand by a range of people in a variety of situations.
• You’ll need a solid knowledge of disease processes, anatomy, physiology and biochemistry. In disability, there are diseases that have trends and complications, as well as medication side effects, and, in some cases, a person’s diagnosis may not be exact. 
• Know how the NDIS works. If you work within the NDIS it’s important to understand how the funding, reporting and contract system works. At times, the funding will be inadequate for the requests or needs of a person with a disability - as a dietitian you need to be clear about the expectations and services you can deliver within the funding period.
• Be mindful of your own wellbeing -mentoring and support from others can help. Working in disability is rewarding but can be challenging too. There’ll be times when you have to form a cohesive picture from only vague information, or there could be a confronting history, challenging consults, rare disorders or complications. All this can be draining. Talking with a mentor to help you process this.  

Jayne Curlewis is an Accredited Practising Dietitian passionate about working with people with a disability and delivering a high-quality service. Working exclusively in the National Disability Insurance Scheme (NDIS) offers a range of experiences, from Autism and Intellectual Disability to rare chromosomal genetic conditions. Great job satisfaction comes from providing clients, parents, and carers with the tools and confidence to improve their self-care and self-management skills.

She has a specific interest in the field of paediatric disability and is committed to expanding her knowledge in this area. Jayne is dedicated to providing a holistic service to improve functional outcomes through nutritional health and wellbeing. She is currently working full time in private practice for Advantage Nutrition, providing telehealth and direct services to rural, regional and metropolitan clients.