The Americans with Disabilities Act (ADA) and Section 504 of 1973’s Rehabilitation Act requires that physicians and all other healthcare providers effectively communicate with people with disabilities. But for those working in IDD care settings, communication barriers may arise. This is because the language and communication skills of each person with IDD are unique. IDD healthcare providers, therefore, need to provide persons served with individualized treatment and support.
This is crucial, as research has found that an individual’s level of life functioning improves when the correct personalized supports are regularly provided.
In this post, we’ll review the communication barriers that individuals with IDD may encounter and how providers can help.
Despite barriers, effective communication in care settings is possible
Unless an individual with an IDD displays an obvious communication barrier, you should never assume one exists. Even if an individual displays difficulty communicating, the type of barrier and ways to address it often varies from one person to the next.
When an individual does have communication barriers, caregivers should keep several things in mind:
- Communicating with people with mild, moderate, and severe communication difficulties will differ greatly; therefore, assessing the language skills of each person helps caregivers use an appropriate level of language.
- Additional time for information exchange may be necessary.
- Many individuals can understand what is being communicated to them easier than they can express themselves. But sometimes individuals’ expressive speech gives the impression that they comprehend something better than they actually do; therefore, caregivers need to take the time to ensure the individual truly does understand.
- Some people with disabilities may find it difficult to give an accurate picture of how they are feeling and what symptoms they are experiencing (e.g., feeling anxious, tired, hungry, the need to urinate, etc.). New caregivers should speak with others who are familiar with the individual as this may assist the caregiver in understanding the person being cared for; however, caregivers must continue focusing their communication efforts on the individual.
- Some people with intellectual and developmental disabilities are delayed when responding to questions; this delay may be significant.
10 tips for effective verbal communication in care settings
1. Simplify communication
Use simple sentences, speak slowly, and pause frequently.
2. Avoid jargon
In this case, jargon refers to terms used in the medical profession that others may have difficulty understanding.
3. Use concrete language instead of abstract language
All concrete terms should be accompanied by a gesture.
Concrete language terms include:
- “Show me.”
- “Do this.”
- “Tell me.”
Here are some examples of concrete language vs. abstract language:
- Concrete language: “Are you sad (happy, upset, angry, etc.)?”
- Abstract language: “How do you feel?”
- Concrete language: “Put your shoes on.”
- Abstract language: “Get ready to go.”
4. Do not shout
Shouting is a trigger that can heighten the tension of communication among anyone; for certain individuals with IDD, this response can become heightened. Make sure to keep your communication calm and clear.
5. Listen intently
Caregivers need to:
- Allow enough time for the person to respond.
- Remain sensitive to the nonverbal cues and person’s tone of voice. Muscle tone differences can complicate a caregiver’s ability to read an individual’s body language or facial expressions; therefore, caregivers need to check/validate their perceptions.
- Inform the person when they do or do not understand something.
6. Clear explanations are essential
Before performing a task, explain what is being done and why: demonstrate the action before performing the task.
A caregiver that is going to comb/brush a person’s hair should do the following:
- State: “I need to comb/brush your hair” while mimicking this action on himself/herself. “After I finish combing/brushing your hair, your hair will look nice.”
7. Ensure understanding of what was said
If the person being cared for can speak in sentences, ask him or her to repeat what was just said. If about to perform a task, caregivers should ask the individual what is about to be done and why the caregiver is doing it.
8. Avoid interrupting or finishing sentences
Proper communication in care settings relies on respect between caregiver and persons served. By not interrupting, you can demonstrate the respect your clients deserve.
9. Ask for clarification
When unsure, it is appropriate for a caregiver to repeat what a person with disabilities says for verification purposes. If necessary, a caregiver may request that the person communicates in a different manner (e.g., writing as opposed to speaking, etc.).
10. Complete one topic before moving on to another
This can help to keep communication clear. Make sure the person you are working with understands what you are telling them before moving on to the next topic.
Communication in care settings is not necessarily verbal
Communication encompasses much more than speech alone. Augmentative communication is another form of language that people with intellectual disabilities can use to communicate what they want or need in a healthcare situation. Augmentative communication in care settings can include sign language, gestures, and the use of pictures.
Caregivers can also communicate:
- Using visual aids, such as pictures and diagrams.
- By acting or using demonstrations.
- With gestures.
- In writing, when applicable.
Frameworks for communication in IDD care settings
Several different frameworks have been developed to facilitate appropriate and productive communication with persons served, even when verbal communication is difficult or impossible.
The Picture Exchange Communication System (PECS)
The PECS communication method uses applied behavior analysis principles to teach individuals (frequently children) with under-developed verbal abilities to communicate using pictures. Over time, the individual learns how to use pictures as a means to express their thoughts and desires; moreover, they learn how to create sentences and answer questions using multiple pictures.
Augmentative communication does not necessarily replace speech; children with autism still learn to talk. As such, evidence suggests that the use of PECS may actually stimulate the child to learn speech because they already understand what symbolic communication entails.
Take advantage of Individualized Education Programs (IEPs)
When applicable, caregivers and health care providers should take the time to review a copy of each individual’s Individualized Education Program. IEPs are ideal for determining what a person’s interests and strengths are, thus providing the information necessary to emphasize these areas and create opportunities for the person to be successful.
The National Dissemination Center for Children with Disabilities (NICHCY) states that communication should include several approaches. For example, use a picture in conjunction with relaying new information verbally. Furthermore, instead of just showing a picture, use a hands-on approach, providing materials, experiences, and an opportunity to try new things.
Final thoughts on proper communication in care settings
Caregivers should regularly share information about progression with the parents, guardians, and teachers of the person receiving care.
These tips are just a guideline. Caregivers and health care providers will need to adapt these tips based on the needs and abilities of each individual.
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