Physician Educa-on in Developmental Disabili-es Webinar Series Patient, Caregiver and Professional Communication August 7 th, 2012 Carole Zangari, PhD, CCC- SLP Jean Sherman, EdD, RN Curtis Stine, MD
Carole Zangari, Ph.D., CCC- SLP
Learning Objec-ves 1. Modify one s communication approach and utilize alternative modalities, as appropriate. 2. Communicate directly with patients in a respectful and supportive manner. 3. Check with the patient throughout the encounter to ensure that the patient understands questions, is comfortable and understands all aspects of the encounter. 4. Ascertain the most effective communication method, utilizing assistive technologies, as appropriate, with both patients and ancillary informants.
Communication with people who have developmental disabilities often presents multidirectional challenges. Provider communicates to the patient. Patient communicates to the provider. As the healthcare provider, you are both the sender and receiver in any interaction.
People with developmental disabilities are a diverse group. They vary widely in their comprehension of language & how they communicate Understand Very Little Understand Everything
Easier to Understand Natural Speech Speech from a device Writing, drawing Communication boards/books Manual signs Idiosyncratic gestures More Difficult to Understand Vocalizations Movement
EXPRESSIVE ABILITIES Patient is: Easier to understand More difficult to understand RECEPTIVE ABILITIES Patient has: Stronger recep+ve language Weaker recep+ve language 1 Little/no support needed 2 Moderate support needed 2 Moderate support needed 3 Lots of support needed
Providers Need to Know How much the patient understands + How the patient communicates What we need to do to make communication effective
How do we get this information? Ask, preferably in advance Consider using some tools for asking & collecting this information in advance (e.g., intake forms, checklists, questionnaires) Communication Passport Observe
Communication Passport (CALL Centre, 2006) A guide to communicating with the patient
See the resource sheet for free download informa+on.
Do Speak directly to the patient. Speak normally. Treat them like adults. Be respectful. Respect and use patient s communication system Watch for signs of confusion or comprehension. Provide clarification, when needed Make language visible. Use gestures, pictures, and objects in the room to support what you are saying. Be redundant. Limit the amount of information shared at one time. Don t Avoid the patient & speak to caregivers instead. Talk about the patient to others without permission. Speak louder or use an exaggerated tone. Ignore signs of confusion, fear, & anxiety. Use the term mental retardation. Use medical language or jargon. Ask Do you understand? (Use openended questions instead.)
Make Language Visible Using pictures and gestures increases comprehension Show what you say.
Visual Schedule Visual representation of what will happen Used to provide structure, ease transitions, make expectations clear, and reduce anxiety Pictures and text representing each step in a way the person understands E.g., Change clothes; Check my body; Listening game; Blood draw; Change clothes; Go home Reviewed prior to starting and throughout the experience. Follow the schedule
First/Then Visual representation of what is happening now and later Used to ease transitions, make expectations clear, and reduce anxiety. Helps them deal with an activity that is non-preferred. Reviewed prior to starting and throughout the experience. Can be made with pictures, photos, or print
Supporting Communication Consider: Speaking a little more slowly Using simple, direct statements Using the Teach-Back strategy Limiting information and being redundant Developing and using visual supports and strategies See the project website for links to resources & downloads that you can use in your practice
Does it take more +me & effort? - - - But it also prevents errors and saves money. Pa+ents with communica+on problems are three +mes more likely to experience preventable adverse affects. (BartleH, Blais, Tamblyn, Clermont, & MacGibbon, 2008)
Possible modifica+ons Assess the person s level of understanding and simplify language accordingly Still adult-oriented but shorter sentences and simple vocabulary. Eliminate jargon. Simple, direct sentences. If the patient does not seem to understand, repeat, and provide clarification. A slightly slower rate of speech may also help.
Jean Sherman, Ed.D., RN
Learning Objectives Understand key players in patient s support network Appreciate need to review patient s written health record Determine if accompanying person is primary caregiver Assess caregiver health literacy, level of understanding Recognize role of caregiver as health advocate Understand need to address patient & caregiver together Appreciate the importance of effective listening
Patient Health Record Request record be sent prior to appointment. Understand disability is not an illness Bring health record with patient if not sent Review record & ask caregiver about: Existing medical conditions Allergies Current treatment regimen Potential medication interactions, polypharmacy
Interview Strategies Involve both patient & caregiver in discussions; should remain with patient Do not hurry the visit (time- based codes) Avoid medical jargon Keep terminology simple, speak clearly Give caregiver written instructions Have caregiver repeat in own words
Questioning the Caregiver Allow time for questions Establish eye contact with patient & caregiver Shake hands at beginning & end of visit Presume patient competence (unless legal guardian present) Speak to & encourage patient to answer first Caregiver clarifies if needed, does not answer FOR patient
Health Care Advocate Caregiver that: Knows patient best (history & daily routine) Acts as bridge between patient and health care providers; a collaborating partner Will be actively involved in assuring adherence to treatment plan or Passes along treatment instructions to the primary caregiver Helps/maintains the patient s health record
Communication Tips Treat BOTH patient & caregiver with respect Schedule first AM appointment when possible Listen effectively to what is being said + what is not said Treatment/referral follow- up by practitioner or staff Limit long waits in waiting or exam rooms Allow sufficient time for visit, obtaining all info Become familiar with disability community resources
Professional Communica-on Curtis C. Stine, MD
Professional Communica-on Objectives: Collaborate as a member or leader of a health care or interdisciplinary team in the comprehensive care of patients. Proactively share patient information with health and non- healthcare professionals involved in providing care or supports, while maintaining adherence to HIPAA compliance.
Team: Defini-on A group of people organized to work together to accomplish a common purpose or goal. For the purpose of this presentation, that group of people includes health care professionals and service providers; and, that common purpose or goal, is the comprehensive care of a patient ID/DD.
Team: Defini-on How that group is organized to work together determines whether the team is multidisciplinary or interdisciplinary. Both have people from different disciplines working in a coordinated fashion to improve patient care. Higher degrees of coordination, collaboration and accountability characterize the interdisciplinary team.
Group ( Team ) Members Family member- guardian- caregiver Case Worker (often an RN or MSW) Teacher Physician Primary care Specialty care Therapists: Physical Occupational Speech and Language Psychologist Home care support Others, based on patient needs
Pa-ents as Team Members Patients contribute to team outcomes and team success by: Identifying preferences Identifying concerns Providing feedback to team Encourage both patients and their families/guardian/ caregiver to participate in patient care.
Characteris-cs of Effec-ve Teams Clear and shared vision (Care/support of pt.) Clear roles and responsibilities Strong team leadership Communicate/share information regularly High levels of coordination and cooperation ( teamwork ) Mobilize resources Use performance measures to track success
Team Tasks Identify members/assemble the team Identify the team s purpose and goals Identify the team s leader Assign roles and responsibilities Actively communicate with members of team (Utilize communication tools) Provide feedback to other team members Hold team members accountable
Importance of Communica-on and Informa-on Sharing Communication: the process by which information is exchanged between individuals and/or organizations. Goal: That team members and other stakeholders have access to the information they need to monitor and improve the quality of provided services.
HIPAA Privacy Rule HIPAA aka, the Health Insurance Portability and Accountability Act The Privacy Rule standards address the use and disclosure of individuals health information (called protected health information ) by organizations subject to the Privacy Rule (called covered entities ) as well as standards for individuals' privacy rights to understand and control how their health information is used.
Who are the covered en--es? Health Plans Health Care Providers Health Care Clearinghouses Business Associates of covered entities
What is protected health Information that relates to: informa-on? the individual s past, present or future physical or mental health or condition, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe can be used to identify the individual. Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).
Purpose of HIPAA A major purpose of the Privacy Rule is to define and limit the circumstances in which an individual s protected heath information may be used or disclosed by covered entities. A covered entity may not use or disclose protected health information, except either: (1) as the Privacy Rule permits or requires; or (2) as the individual who is the subject of the information (or the individual s personal representative) authorizes in writing.
PermiTed Uses and Disclosure A covered entity is permitted, but not required, to use and disclose protected health information, without an individual s authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3) Opportunity to Agree or Object; (4) Incident to an otherwise permitted use and disclosure; (5) Public Interest and Benefit Activities; and (6) Limited Data Set for the purposes of research, public health or health care operations.
Authoriza-on A covered entity must obtain the individual s written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule. A covered entity must obtain an individual s authorization to use or disclose psychotherapy notes
Summary Quality care for patients with DD can best be accomplished when teams (multidisciplinary or interdisciplinary) of professionals and support personnel coordinate, monitor and evaluate care. Communication between and among team members is a key to success. HIPPA puts limits on but does not impede team communication.
Thank you! Questions? Dr. Carole Zangari - zangaric@nova.edu Dr. Jean Sherman - jsherman@med.miami.edu Dr. Curtis Stine - curtis.stine@med.fsu.edu www.praacticalaac.info
Link for CME Credit 1) Go to: bitly.com/pedd2012 2) Sign in/register 3) Check your spam folder if you do not receive the confirmation email 4) If there are issues go to www.aadmd.org/contact 5) Complete Survey 6) Complete Quiz (7/10 is passing) 7) Certificate will be displayed and emailed to you automatically