Difficult conversations about disability: an inclusion perspective
The Moment of Truth: How to have a difficult conversation and why it is absolutely necessary
By Lisa Raffoul · Originally published 14 December 2016
Prepare the conversation around what the person needs to know
Check who should be involved, the person’s preferred communication and what privacy they want. Explain the relevant information plainly, allow questions and confirm what the next step is. Delivering a message is different from checking that it has been understood.
Use rights and responsibilities guidance to keep dignity, privacy and involvement central. If the conversation concerns clinical findings, stay within your role and arrange appropriate practitioner input. Avoid presenting personal courage as a substitute for accurate information and a supported follow-up.
Original article and dated context
This post first appeared on Lisa Raffoul’s website, which you can find here.
It’s not easy to share bad news. If you are a health care professional, an educator or a counsellor, it’s likely that at some point in your career, you have approached someone and said, “I am concerned, can I speak with you for a moment?”
Whether it is about a serious illness, extraordinary diagnosis, or a personal loss, having that conversation is difficult – there is a good chance that the information you deliver may be a life-altering event for the person to whom you are speaking.
If you have ever been in this position, I am sure you would agree that providing this kind of information is no easy task. In anticipation of the other person’s reaction, your heart rate may speed up and your palms may become moist. You may be unsure exactly how you are going to deliver the news.
Somehow, you do it and the message is transmitted.
I call this, The Moment of Truth.
The moment of truth is a critical turning point for all the people involved.
Without a doubt, the information will bring on a flood of emotions, both from the giver, and the receiver. However, this pivotal moment is integral to the person’s well-being and to the well-being of his or her family.
It represents a starting point for prescribed treatment, modifications to learning, job adaptations or specialized equipment, set up to support the person at home, school, work or play.
[Clickability update, October 2026: The original passage includes ableist language as examples of stigma. The author’s claim about diagnosis is an opinion, not a rule that support or inclusion must wait for a diagnostic label. Current assessment guidance describes referrals based on identified needs.]
Information Leads to Inclusion
One of the barriers to approaching the moment of truth is that people are reluctant to attach a label to their child or loved one. They fear that the label can be a limiting factor and that it may be a cause for discrimination or segregation. A diagnosis of Autism, Epilepsy, Language Processing Disorder, or Dyslexia, while all serious matters, are nowhere near as damaging as the labels of idiot, moron, and retard, words that unfortunately are still widely used.
I believe that the absence of a diagnosis, results in a lack of understanding and it is this kind of ignorance that is discriminatory and generates non-inclusive outcomes.
So how do you start the conversation?
Your Personal Values
The approach depends upon your personal values and your own fears. Ask yourself the following questions…
What is keeping me from starting the discussion?
What are my top 3 personal values?
What feelings or thoughts am I experiencing?
What internal messages arise as I try to begin the conversation?
What act of self-protection do I use?
What do I have to do to initiate the dialogue?
How do I start the conversation; what do I say?
Courage
It takes a lot of courage to have a difficult conversation. Courage is defined as, “strength in the face of pain or grief”. Courage is the key to moving forward.
Responsibility
I emphasize that,“It is our responsibility to have those difficult conversations, so that we can create an environment of positivity and inclusion, that provides all people with an opportunity to belong, participate and embrace their individuality”.
Think about the consequences if you don’t have the conversation.
Lisa Raffoul
Lisa Raffoul specializes in family coaching, training and planning in the social profit sector. As the parent of a child who had multiple disabilities, she is passionate about working with people and organizations to realize new possibilities and implement ideas for transformation and change. She is a dynamic public speaker and has offered workshops and seminars to human services professionals, emergency response teams, health care workers, University and College students, teachers, municipalities and families.
Lisa holds a Bachelor of Human Kinetics in Applied Kinesiology, and a Bachelor of Education, and has additional teaching qualifications in Special Education. She has received certification in Alternative Dispute Resolution (and is a Certified Master Coach Practitioner). She is a a trained Community Conversations Facilitator and a graduate of Leadership Windsor Essex, Class of 2015.
Clickability editorial update: October 2026
Allow time for a conversation to develop
Ask what the person wants explained and what they want help with. A difficult discussion may need more than one meeting or a format they can review later. Listen for practical questions rather than assuming the emotional response will match your own.
When discussing a child’s assessment, Autism CRC family guidance can help prepare questions for the practitioner. The purpose is shared understanding and useful support, not persuading the child to accept a particular interpretation of their identity.
Questions readers ask
Must support and inclusion wait for a diagnosis?
No. Identified needs can lead to support referrals while assessment is underway. Official guidance
Should a provider deliver clinical conclusions outside their role?
Use appropriate practitioner input and communicate within the provider’s role.
Find services that explain and listen clearly
Describe your disability support needs through Clickability. Compare reviewed and rated profiles and ask how providers involve people in important conversations.
