Educational and reflective resource. You can use this resource independently or discuss it with a practitioner. It does not provide an individual assessment or establish a therapy relationship.
- For
- Managers, access leads and staff of therapy and counselling services; disabled people checking a service
- Time
- About 20 minutes to read; the full audit is a team task over a few weeks
- Format
- Audit with ten stages, scoring and an action plan
- Prints
- Yes
- Evidence
- Accessibility standards and law; the audit itself is this site’s own
Service accessibility audit and action plan.
A working audit for therapy and counselling services, built around the whole range of disabled people who might use you: physical, sensory, intellectual, communication, neurodivergent, cognitive, fluctuating and psychosocial. It turns “we’re accessible” into evidence, and evidence into a plan.
What this is: about 80 checks across ten stages of the client journey, from finding you to leadership. Each check is tagged with who it mainly helps.
How it works: score each check against what actually happens, not what the policy says. Then sort what you find into fix now, plan, and structural change.
What it isn’t: a legal compliance check, or a certificate. It’s a way of finding barriers and deciding what to do about them.
One thing to take away: do it with disabled people, and pay them.
I manage or lead a service
I work on my own
- The ten-point self-audit is shorter and made for you
- Then use stages 2, 5, 6 and 7 here
- Therapy Access Agreement
I’m a disabled person checking a service
- How to run it
- Who it has in mind
- Scoring
- The ten stages
- Action plan
- Quick wins
- Involving disabled people
- Example
- Ireland and the UK
- Sources
How to run the audit
- Form a small audit group. Include a manager who can make decisions, frontline and admin staff, and disabled people who use, or have tried to use, the service. Pay the people who aren’t staff.
- Walk the journey, don’t just read the policies. Phone the service, fill in the form, use the website with a screen reader, wheel the route from the bus stop, sit in the waiting room at a busy time.
- Gather evidence, not intentions. “We would book an interpreter” isn’t a Yes. “We booked twelve last year, and here’s the process” is.
- Score each check using the four options below, and note your evidence.
- Prioritise. Sort what you find into fix now, plan, and structural change.
- Act, publish and review. Tell people what you’re changing and what you can’t yet offer. Repeat the audit within a year.
Design for the range, not the label. Many people have more than one impairment, many have no diagnosis, and many don’t call themselves disabled. The groups below are there to widen your thinking, not to sort people into boxes. Ask everyone what helps, and don’t ask for proof.
Who this audit has in mind
Disabled people are not one group. The same service can be fully accessible to one person and impossible for another. Read across these before you start, so you can see who your current setup works for, and who it quietly leaves out.
Physical disability and mobility
Wheelchair users, people who walk with difficulty or use aids, people with limited hand use or dexterity, people of short stature.
BarriersSteps, heavy doors, a reception desk at standing height, an “accessible” toilet used as a store room, paper forms, chairs with no arms.
What helpsA step-free route checked in practice, a usable toilet, a range of chairs, space to turn, forms that can be filled in digitally or by conversation.
Blind and partially sighted people
Including people with low vision, sight loss that changes, and colour vision differences.
BarriersWebsites and forms that don’t work with screen readers, PDFs that are pictures of text, poor signage and contrast, being shown things.
What helpsTested websites and forms, large print, audio, Braille or accessible Word on request, being oriented to the room, assistance dogs welcome, visual materials described.
Deaf sign language users
A linguistic and cultural minority. Irish Sign Language (ISL) in Ireland, British Sign Language (BSL) in Britain.
BarriersPhone-only contact, no interpreter, written English assumed as a first language, family members asked to interpret.
What helpsText, email and video relay contact, qualified interpreters booked and paid for by the service, the same interpreter where possible, signed information, Deaf therapists or Deaf-led services as an option.
Hard of hearing and deafened people
Including people with tinnitus, cochlear implants or hearing aids, and people who lost hearing later in life.
BarriersBackground noise, phone calls, faces in shadow, masks, group rooms, video calls without captions.
What helpsA working, tested hearing loop, quiet rooms, light on faces, captions online, live speech-to-text, key points written down.
Deafblind people
Combined sight and hearing loss, from birth or acquired. The needs aren’t simply those of Deaf people plus blind people.
BarriersServices planning for one sense only, unfamiliar rooms, rushed appointments, no communicator-guide.
What helpsCommunicator-guides or tactile and hands-on interpreters, much more time, consistent rooms and people, planning with the person in advance.
Speech differences and AAC users
People with cerebral palsy, motor neurone disease, a stammer, a laryngectomy and more, and people who use communication aids (AAC).
BarriersPhone triage, being rushed, sentences finished for them, staff talking to a companion instead, speech mistaken for intellectual disability.
What helpsTime, text options, asking before helping, devices charged and positioned, longer sessions, never judging understanding by speech.
Aphasia and acquired language difficulties
Language affected after a stroke, brain injury or other neurological condition. Thinking is often intact.
BarriersDense letters, fast talk, assessments and therapies that rely on words.
What helpsAphasia-friendly information (short sentences, key words, pictures), supported conversation techniques, written key words, yes/no checks.
Developmental language disorder (DLD)
A lifelong difficulty understanding or using language. Often hidden: people may seem to follow when they don’t.
BarriersComplex wording, abstract questions, being judged as unmotivated or oppositional.
What helpsPlain language, visuals, asking the person to explain back in their own words, extra processing time.
Intellectual disability
Called learning disability in the UK. Ranges from mild to profound.
BarriersBeing told therapy won’t work, diagnostic overshadowing, consent processes no one has adapted, talk-only therapy, conversation aimed at carers.
What helpsEasy read, more and longer sessions, adapted and creative methods, supported decision-making, supporters involved with the person’s agreement, speaking to the person first.
Specific learning differences
Dyslexia, dyspraxia (DCD), dyscalculia and related differences.
BarriersLong forms, written homework and worksheets, timed tasks, complicated booking systems.
What helpsOptions that don’t need writing, audio, readable fonts and backgrounds, reminders, help with forms.
Autistic people and people with ADHD
Neurodivergent people, diagnosed or not.
BarriersUnpredictable processes, phone calls, busy waiting areas, eye-contact and “engagement” assumptions, rigid lateness rules, therapy that treats difference as disorder.
What helpsClear information in advance (photos, who you’ll meet, what happens), written agendas, choice of contact method, reminders, quiet waiting, flexibility, neurodiversity-affirming practice.
Sensory processing differences
Over- or under-sensitivity to light, sound, smell, touch or movement. Common across many disabilities.
BarriersFluorescent or flickering lights, noise, strong scents, scratchy or rigid seating.
What helpsAdjustable lighting, a scent-free approach, choice of seat, fidgets welcome, permission to move.
Brain injury, memory and cognitive impairment
Acquired brain injury, dementia, cognitive effects of illness, treatment or medication.
BarriersForgetting an appointment and being discharged, fatigue, complex letters, changing staff.
What helpsReminders in the chosen format, written summaries, shorter sessions, the same therapist, supporters involved with consent.
Chronic illness, pain and fatigue
ME/CFS, long COVID, MS, arthritis, EDS, Crohn’s and many more. Often fluctuating and often invisible.
BarriersRigid attendance rules, early slots, long waits, long assessments, stairs and standing, being doubted.
What helpsOnline as a real option, flexible cancellation, rest breaks, the option to recline or lie down, energy-aware scheduling, being believed.
Mental health and psychosocial disability
Long-term mental health conditions and the barriers around them. Some people don’t identify as disabled; that’s their call.
BarriersBeing “too complex” for one service and “not unwell enough” for another, discharge for disengagement, past coercion, unclear rules about risk and records.
What helpsNo wrong door, trauma-informed processes, clear explanations of confidentiality and risk, peer support, a planned way back.
Epilepsy and other episodic conditions
Including seizures, fainting conditions and migraine.
BarriersFlickering lights, no plan for an episode in a session, fear and over-caution.
What helpsA plan agreed with the person, staff trained in first aid, steady lighting, no assumption that the person can’t take part.
Visible difference
Facial difference, scarring, skin conditions, limb difference and other visible conditions, disabled or not.
BarriersStaring, intrusive questions, assumptions about what therapy is “really” about.
What helpsStaff training, letting the person lead on what’s relevant, images in your materials that include visible difference.
Multiple and complex needs
People with several impairments, people who need personal care during a visit, people who use PAs, people living in residential settings.
BarriersServices designed for one need at a time, no changing facilities, no privacy from staff or family.
What helpsPlanning with the person, PAs welcome, a Changing Places toilet or knowing the nearest one, private time with the therapist, joined-up support.
Also think about
- People who speak another language as well as being disabled: you may need a spoken-language interpreter and an accessible format at once.
- Disabled children and young people, and the adults around them, if your service sees them.
- Disabled parents and carers, who may need adjustments to bring or support someone else.
- People who’ve been harmed by services before. Previous experiences of coercion, segregation or not being believed shape whether someone will trust you.
Scoring each check
Each check is tagged with the groups it mainly helps. A check tagged Almost everyone is about the system as a whole.
- Mobility & dexterity
- Sight
- Deaf & hearing
- Deafblind
- Speech & language
- Learning
- Autistic, ADHD & sensory
- Memory & cognition
- Fluctuating & fatigue
- Mental health
- Almost everyone
You can fill in this page on screen and print it, but it won’t save. For a team audit, use the Word workbook, which has columns for evidence, action, owner and date.
Stage 1 of 10
Finding the service and information
Evidence and notes for stage 1
Stage 2 of 10
First contact and referral
Evidence and notes for stage 2
Stage 3 of 10
Assessment, intake and consent
Evidence and notes for stage 3
Stage 4 of 10
Getting there and the building
Evidence and notes for stage 4
Stage 5 of 10
Online and phone sessions
Evidence and notes for stage 5
Stage 6 of 10
In sessions
Evidence and notes for stage 6
Stage 7 of 10
Attendance, cancellation, waiting and discharge
Evidence and notes for stage 7
Stage 8 of 10
Feedback, complaints, advocacy and safeguarding
Evidence and notes for stage 8
Stage 9 of 10
Endings, records and follow-up
Evidence and notes for stage 9
Stage 10 of 10
Staff, training and leadership
Evidence and notes for stage 10
From findings to an action plan
Go back through every Partly and Not yet. For each one, name the barrier in plain words, who it affects, and which of these three it is.
Fix now
Low or no cost, within your control, doable in weeks. Usually policies, information, wording and habits. A missed-session rule, a contact route, an access statement.
Plan
Needs money, training, procurement or time, within the next year. A new video platform, easy-read materials, staff training, a hearing loop.
Structural
Needs funding, commissioning or building change. Name it, record it, and tell people honestly what you can’t offer until then, and where else they can go.
What to do first
Start with barriers that stop people getting in at all: phone-only contact, an inaccessible front door, exclusion criteria, automatic discharge. A barrier that keeps someone out entirely matters more than one that makes the service harder to use.
| Barrier | Who it affects | Action | Fix now, plan or structural | Owner | By when | How we’ll know |
|---|---|---|---|---|---|---|
“How we’ll know” should be something you can check: an interpreter booked within a week, no automatic discharges in six months, a disabled reviewer confirming the form works with a screen reader.
Ten quick wins for this month
- Publish an honest access statement: what you offer, and what you don’t yet.
- Add a way to contact you that isn’t the phone.
- Replace automatic discharge after missed sessions with “contact first, ask why, offer alternatives”.
- Add an access question to your referral form, saying why you ask and who sees the answer.
- Test the hearing loop, and clear anything stored in the accessible toilet.
- Put photos of the building, the entrance and the route online.
- Let people choose how they get reminders: text, email, letter or call.
- Rewrite one key letter in plain language, and make an easy-read version.
- Set up a central budget code and a simple process for booking interpreters.
- Pay three disabled people who use, or tried to use, your service to walk one stage with you.
Involving disabled people properly
- Pay people for their time and expertise, at a fair rate, and cover travel and support costs.
- Make the involvement itself accessible: formats, meeting times, online options, breaks, interpreters, papers sent in advance.
- Reach beyond your current clients. The people who couldn’t get in, or left, often know the most. Disabled people’s organisations and Deaf-led organisations can help you reach them.
- Don’t ask one person to speak for all disabled people. A wheelchair user can’t tell you what works for an autistic person or a Deaf ISL user.
- Don’t rely on disabled staff as unpaid consultants. If it’s part of their role, recognise it in their workload.
- Close the loop. Tell people what changed, what didn’t, and why.
If you’re a disabled person checking a service
You don’t have to audit anyone. But these questions can tell you a lot, quickly. A good service will be glad you asked, and honest about what it can’t do.
- Can I contact you without using the phone?
- Can you tell me exactly how to get from the street to the therapy room?
- Do you book and pay for interpreters or communication support?
- Can sessions be online, shorter, longer or at a different time if I need that?
- What happens if I miss a session because of my health or transport?
- Can I bring a supporter or PA, and can I also have time alone with the therapist?
- Will my access needs be passed to my therapist, so I don’t have to explain again?
- What can’t you offer yet?
For help raising this once you’ve started, see the Therapy Access Agreement.
An example
Fictional teaching example
Róisín manages a university counselling service. She runs the audit with two staff and four disabled students, who are paid: a wheelchair user, a Deaf ISL user, an autistic student and a student with ME/CFS.
In the first two stages they find that triage is by phone only, the online form doesn’t work with a screen reader, and students are discharged after one missed session. The hearing loop in reception hasn’t worked for a year. Interpreter costs come out of the counselling team’s small budget, so staff quietly avoid booking them, and Deaf students are steered towards email counselling.
Their plan:
- Fix now: text and email triage, contact before discharge, the loop repaired, interpreter costs moved to the university’s central disability budget, and an honest access statement.
- Plan: a new accessible form, easy-read information, and training co-delivered by disabled students.
- Structural: one therapy room is up a flight of stairs. It’s no longer used for first appointments, and a step-free room is in the next building plan.
Six months later, more students ask for adjustments, because they now know they can. Róisín reads that as the service getting better, not busier.
Róisín and her service are invented for teaching. They are not real.
Ireland and the UK at a glance
This is orientation, not legal advice. Law and guidance change, so check the current position for your setting.
Ireland
- Equal Status Acts 2000–2018: service providers must make reasonable accommodation for disabled people, unless it would cost more than a nominal amount.
- Disability Act 2005, Part 3: public bodies must make their services and information accessible. The National Disability Authority’s Code of Practice explains how.
- Irish Sign Language Act 2017: public bodies must do all that’s reasonable to provide free ISL interpretation for people using statutory services, using accredited interpreters.
- Assisted Decision-Making (Capacity) Act 2015: capacity is presumed, and people have a right to support to make decisions.
UK
- Equality Act 2010 (England, Scotland, Wales): service providers must make reasonable adjustments, and the duty is anticipatory: you should plan ahead, not wait to be asked. Northern Ireland has the Disability Discrimination Act 1995 instead.
- Accessible Information Standard (England): NHS and publicly funded adult social care must identify, record, flag, share and meet people’s information and communication needs.
- British Sign Language Act 2022: recognises BSL in law and requires government reporting and guidance. Day-to-day duties on services come mainly from the Equality Act. Scotland also has the BSL (Scotland) Act 2015.
- Mental Capacity Act 2005 (England and Wales): capacity is presumed, and people must be given support to decide.
In both, the UN Convention on the Rights of Persons with Disabilities sets out the right to accessible services and health care, and WCAG 2.2 is the reference standard for websites.
Related on this site
- Making a Therapy Service Accessible: the short stage-by-stage checklist
- Accessibility in Psychotherapy Practice: the ten-point self-audit for individual therapists
- Therapy Access Agreement
- Assessment Bias and Diagnostic Overshadowing
- Accessible Placement Agreement: for disabled trainees on placement
Sources
- RightsUnited Nations (2006). Convention on the Rights of Persons with Disabilities, Article 9 (Accessibility) and Article 25 (Health).
- StandardWorld Wide Web Consortium (2023). Web Content Accessibility Guidelines (WCAG) 2.2.
- IrelandEqual Status Acts 2000–2018; Disability Act 2005, Part 3; National Disability Authority, Code of Practice on Accessibility of Public Services and Information Provided by Public Bodies.
- IrelandIrish Sign Language Act 2017; National Disability Authority, A Brief Summary of the Irish Sign Language Act.
- IrelandAssisted Decision-Making (Capacity) Act 2015.
- UKEquality Act 2010 (Great Britain); Disability Discrimination Act 1995 (Northern Ireland); Mental Capacity Act 2005 (England and Wales).
- UKNHS England, Accessible Information Standard (DCB1605).
- UKBritish Sign Language Act 2022, with Explanatory Notes; British Sign Language (Scotland) Act 2015.
- Our frameworkThe ten stages, the checks, the tags, the scoring and the action plan are this site’s own, building on Making a Therapy Service Accessible. They haven’t been formally tested.
- Fictional exampleRóisín and her service are invented for teaching.
Law summaries are this site’s own wording and not legal advice. For every source cited across the site, see Sources and Bibliography.
Last reviewed: November 2026.
How to cite this page: Donaghey, C. (2026). Service Accessibility Audit and Action Plan. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/for-referrers-and-services/service-accessibility-audit/ (Accessed: [date]).
Shared under CC BY-NC 4.0, with extra permissions for teaching, supervision and therapy. Credit the site. See Reusing This Material.