Good planning is extremely important because it contributes to a good consultation for both the clinician and the person with intellectual disability, and results in a better experience and clinical outcome.

Stop and think

Before starting the engaging with the person, pause and take a moment. A short amount of time planning BEFORE can be extremely valuable later. A moment to think can be worth the time taken.

Have a plan on what should happen during an appointment or ward visit, for example:

• Does the person require a particular physical space?
• Do they need a longer appointment?
• How will you explain information in a simple way?

Ideally, planning to meet the needs of people with disability should start when your practice is first designed. Universal design is the design of buildings, products or environments to make them accessible to most people, regardless of age, disability, background or any other factors. However, you can make many adjustments within your existing physical and organisational structures.

New or emergency presentations can bring different challenges to planned visits to a regular practice. Remember that this goes both ways, and that a new situation will also be more stressful for the person and their support person.

Physical environment needs

• Consider the physical environment from the perspective of the person or their support person.  For example: Is there accessible parking?
• Is the room accessible?
• Do you need to remove items for safety if the person becomes dysregulated?
• Is there a way of reducing light or sound levels? For example, turning off an overhead fluro light and instead using an examination lamp pointed away from the person. 

Identification of needs

Consider how you would identify that the person has an intellectual disability. Is it evident from the medical notes? Do you usually read the medical notes before starting the consultation? 

Should you plan to implement a system to identify people who may need reasonable adjustments? Should you record their individual requirements or preferences for future visits?

Time considerations

Is a longer appointment required? Using a communication device or interpreter takes more time. Complex medical and social issues may also require more time. 

Will the person need to wait long to see you? Are you able to modify any waiting time if this is an issue? Where can they wait for you? Are busy or loud spaces a problem for them? Do you have a separate space where they can wait if needed? Can they wait outside or elsewhere? 

Consider modifying your usual appointment structure if appropriate. Consider giving yourself extra time to read and analyse their results before the consultation.

Consider if the person needs time to settle into the space and conversation, or if they would prefer to attend only part of the consultation (this may suit them if they have a substitute decision maker). It may be appropriate to consider a two-part staggered appointment. This can be a joint decision with the person and their support person if appropriate but remember to respect the person’s decision-making capacity.

Communication needs

Consider your plan around communication. Are communication aids required? Is an interpreter required for AUSLAN or a language other than English?

Consider using modified language or accessible information. Do you need to speak more slowly? Consider using basic language and allowing additional time to ensure the person understands you.

How will you interact with a person with limited or no verbal communication skills?

Engaging with the person and their support team, using direct communication and using communication aids leads to improved quality of history and increased diagnostic accuracy.

Baseline function

As with any chronic condition, change from baseline is an important indicator. To be able to evaluate this, you must have an accurate assessment of the person’s usual baseline, and the best way of doing this is to ask the person or their support person, “What has changed?” or “Is there something that is worrying you?”

A change from the person’s baseline function or behaviour is an important clinical indicator. However, check if a symptom is new before relying on it for a diagnosis. For example, laughing while looking at the ceiling may be a long-standing behaviour rather than a sign of hallucinations or a manic episode.

Supported decision-making

Shared decision making involves discussion and collaboration between you and your patient. The focus is on the patient’s values, goals and preferences in order to reach the most appropriate healthcare decisions for that person, considering the best available evidence about any treatment’s benefits, risks and uncertainties.