Women's Health Module
Project Objectives/Competencies

In designing the case module included in this program, our goal has been to teach several core objectives regarding the treatment of women with developmental disabilities in a health care environment. While in many ways these are similar to the objectives that are taught for the treatment of any patient, we believe that they bear specific relevance to the needs of women with developmental disabilities.

Student Cognitive Competencies

The student will:

1. Characterize the emotional, cognitive, physical, and medical circumstances typically associated with providing reproductive health care to a woman with developmental disabilities. Observe in the module as the Primary Care Provider (PCP) is careful to both respect Carrie's autonomy and interact at a pace comfortable for Carrie.
2. Effectively query patients with developmental and/or intellectual disabilities about their medical history and current symptoms. Notice that although the PCP begins the health history with Carrie's staff member present, she specifically verifies the information with Carrie, while offering to conduct the history alone should Carrie so desire.
3. Demonstrate an awareness of the healthcare issues associated with menarche that may present in women with developmental disabilities. Note that issues surrounding oral hormonal regulation of menstruation are addressed within the module's clinical interaction.
4. Effectively and cautiously consider all appropriate options when a patient demonstrates resistance to the examination. Observe the PCP's calm and attentive behavior regarding Carrie's past negative experience with gynecological exams. The PCP's acknowledgement of Carrie's concerns helps foster a cooperative attitude.
5. Demonstrate an awareness of the problem of sexual abuse of women with developmental disabilities, including physical signs of abuse, prevalence of abuse, and mandated reporting requirements. The PCP in this clinical interaction is careful to query Carrie about inappropriate touch and/or unwanted sexual overtures.
6. Develop pre-visit strategies to assist patients in preparing themselves for the exam prior to the appointment. Notice how the module includes information about the use of social stories as an intervention to help diminish anxiety about the gynecological exam.
7. Demonstrate comfort and competence when providing reproductive health and sexual education to patients with developmental and/or intellectual disabilities and their families. Observe as the clinician discusses issues surrounding Carrie's sexual activity and knowledge of sexual healthcare both non-judgmentally, and at a level Carrie can understand.
8. Demonstrate an awareness of the judicious use of sedation during examination, as well as alternatives to sedation. Students will read information points regarding sedation in the module and be queried concerning their comprehension of this topic.
9. Assess for and implement common and necessary accommodations for the examination of women with developmental and/or intellectual disabilities.

See the resource document in the module titled "Accommodating Patients." Notice that the PCP in the video portion of the module has been careful to allow more time for Carrie's examination.
10. Demonstrate an understanding of the complexities of informed consent as they relate to the provision of care with women who have intellectual disabilities.

Note that the issue of informed consent is directly addressed within the module dialogue, as well as supported by the module resource document "Legal and Ethical Issues."

Student Attitudinal Competencies

The student will:

1. Be sensitive and empathic to the emotional barriers and cultural considerations of women with developmental disabilities with regard to reproductive health care. Observe as the PCP in this module demonstrates empathic understanding as Carrie relays that she "doesn't want it to hurt!" Furthermore, the PCP is careful to provide the opportunity for Carrie to see her privately.
2. Recognize that normal, healthy sexuality is possible for persons with developmental disabilities. The PCP in the video conducts a non-judgmental, supportive conversation with Carrie regarding her desire to engage in sexual activity with her boyfriend - at the same time offering sound patient education concerning the prevention of pregnancy and disease.
3. Strive to create an atmosphere of acceptance and competence for women with developmental disabilities in the office setting. Notice in the module that the office staff treats Carrie with genuine, friendly respect. Observe as the nurse helps Carrie to relax via casual conversation and breathing techniques during the difficult portion of the exam.
4. Recognize the importance of screening for sexual abuse and the impact of sexual abuse on women with developmental disabilities. Students will read resource materials on sexual abuse in women with intellectual disabilities and be queried regarding their understanding of the significance of this issue.
5. Apply congruent, profession-specific ethical guidelines/ considerations when caring for women with disabilities. Observe as the PCP in the Women's Health Module treats Carrie with the same concern and dignity as any other patient by respecting Carrie's right to sexual healthcare privacy and sexual self-determination.