Behavioral Management Strategies
Individuals with intellectual disability may experience difficulty understanding
instruction across various settings, especially settings which may be
very foreign to them, such as the healthcare/clinical treatment arena.
When combined with the communicative difficulties prevalent in this population,
the patient with intellectual disability often presents a unique challenge
for the healthcare practitioner.
As with all patients, it is important to establish rapport and gain trust.
Patients with significant intellectual disability, however, typically
require more time for treatment, and thus ample time should be allotted
to perform needed care in an unhurried manner.
Some simple strategies which may prove useful for gaining cooperation
in the patient with intellectual disability are listed below.
- Patients are likely to appreciate a practitioner who takes the time
to speak directly to them about their past experiences. If the patient
is not able to communicate her needs or experiences directly to you,
her caregiver/guardian may be able to offer helpful information about
the patient's history with women's health appointments.
- Find out what time of day would be best to schedule the gynecological
appointment; some individuals may be more cooperative either in the
morning or afternoon.
- Make sure the entire office/clinic team has been educated concerning
the proper attitude and treatment of patients with special needs. The
continuum of care should begin with the office receptionist and extend
to the nurses, physicians, and other ancillary staff.
- Praise, praise, praise! Most individuals respond to compliments and
praise, and persons with intellectual disability are no exception. Reward
good behavior and maintain a patient and positive affect.
- Attempt to reduce distractions as much as possible.
- Make every effort to provide consistency in routine, staff, and location
when working with individuals with intellectual disabilities. All patients
tend to be more cooperative in a familiar setting with familiar faces.
- DO NOT use physical restraint or sedation merely
as a convenience. The healthcare provider should always use the least
restrictive technique that will allow the patient to be treated safely.Include
the individual with intellectual disability, whenever possible, in all
healthcare instruction and discussion.
- Remember that individuals with intellectual disability may experience
difficulty processing sequential information; thus it is important to
break any instructions down into succinct parts pertinent to the task
at hand.
Pre-visit Strategies
- Social stories are short stories, often with visual
or pictorial prompts, designed to improve communication and behavior
in persons with special needs and/or children, by presenting social
situations in simple, concrete terms. Social stories may be written
specifically for an individual to help them deal with new experiences-or
may be purchased commercially. If the patient is not capable of reading
the social story, the caregiver/guardian may read and discuss the story
with the patient. A pre-visit social story depicting both the environment
and procedures typically encountered in a gynecological visit may relieve
a degree of patient anxiety.
- Pre-visit Instructional Videos are available commercially
and may prove to be an excellent investment for the primary care provider
who routinely cares for women with intellectual and/or developmental
disabilities. Excellent multimedia instructional videos- tailored to
varying degrees of intellectual ability- are now available for purchase
online. Patients who may benefit from such intervention may be afforded
the opportunity to view the materials in the office setting before the
day of the visit, rather than taking the materials home. This strategy
not only prevents potential loss of the video investment (in the event
patients fail to return them) but also allows the individual to readily
ask questions which may arise.
- Desensitization visits involve exposing the patient
with special needs (or an apprehensive child) to the clinical examination/treatment
area, as well as to staff members who are likely to be involved in their
care, a few days before the actual visit. During this time the individual
should ideally be introduced to the primary care provider as well and
allowed to ask any questions. Furthermore, a tour of the waiting area
and actual examination area often helps to familiarize the patient with
the clinical setting and thus allay some anxiety/fear on the day of
the actual appointment.
Kemp,
Fred. (2005). Alternatives: A review of non pharmacologic approaches to
increasing the cooperation of patients with special needs to inherently
unpleasant dental procedures. Behavior Analyst Today, 6(2), 88-108.
NIDCR
National Institute of Dental and Craniofacial Research (2005). Behavioral
management. Practical oral care for people with Down syndrome. Retrieved
online 6/17/05 from http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/
DevelopmentalDisabilitiesAndOralHealth/PracticalOralCarefor
PeopleWithDownSyndrome.htm
Pilcher,
E.S. (1997). Behavior management in dental care for the patient with
Down syndrome (Paper presented at the 6th World Congress on Down
Syndrome, October 1997). Retrieved online 6/17/05 from http://www.ds-health.com/dental.htm
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