Overcoming challenges: Developing rapport and making a connection

Today we are going to explore practical tips that will help you as a health professional build expertise with communication. And while this may not resolve all cases you encounter, it will promote best practise with communication. It will lay the foundational blocks of making your clinical practise accessible for all citizens, not just people with an intellectual disability. To begin, we must remember as health professionals we have an obligation to communicate well with all our patients and in a way that is best suited to meet their needs. People with an intellectual disability have individual needs when it comes to communication.

However, unless the communication need is obvious, do not assume that one exists unless the patient, a family member, or other caregiver tells you. Even when a communication difficulty exists, the exact challenge, and the best way to address this challenge will differ. Before the appointment establish the communication needs of the person through contact with them, and their family, or carer, prior to the appointment. Find out if the person uses augmentative alternative communications systems such as picture boards, or electronic devices. If so, become familiar with the system and ensure the person brings it with them to their appointment.

Ensure the appointment is scheduled at a point when you have time, when there are fewer distractions at the clinic, and when the person won’t feel rushed. Integrate as many communication choices into your repertoire. For example, picture cards, print drawings signs, signs and symbols. This will offer the person control over how they would prefer to communicate, as well as over the choice of how they would like to relay their information. Understand that the appointment will need probably more time than is usual and that you may need a number of consultations to complete the full assessment. Develop rapport. Making connection with the person starts way before they arrive at your clinic or office.

Consider placing your picture on their appointment card, so they can begin building familiarity with whom they are going to see. This connection will also support you in building knowledge of the person beforehand it reaches out, and you will be able to develop an understanding of the person’s expectations, abilities, and capabilities. On the day of the appointment, greet the person warmly. Don’t sit behind the desk expecting the person to come in and take a seat. Avoid creating this barrier by greeting the person from the waiting room, inviting them in, and sitting with them to begin the consult. Greet the person with the intellectual disability first.

It is their appointment and while some may not be able to return your greeting, including them first respects their dignity. If you wear a white coat consider removing it if it is not necessary. Begin the connection. Place the person at ease. Welcome them. And begin with clear, simple less demanding questions directed to them. Remember, people with an intellectual disability may have difficulty in processing information, and may be slow to reply. Therefore give them time to respond. Don’t talk to the person in a patronising or childish manner. Use appropriate plain language that is clear, simple and concise. Ask the person if they want their carer to stay in the room for the visit. Be attentive to the person’s non-verbal cues.

These could include hand gestures, body orientation, facial expression, and our eye gaze or movement. Be aware that people may also communicate through vocalisations that are not words. Explain clearly and listen carefully. Tell the person what you are going to do. Explain clearly before you begin. Use visual aids or pictures, and demonstrate where appropriate. Tell them why you are going to do this, and get their permission. Verify they understand by asking them simple questions, and getting their affirmation by repeating in their own words what you have asked. Use their medical file to support information required. Use a system of continuous process consent, whereby you are checking continuously at each phase of the assessment that it is OK to continue.

That they understand, and that they are comfortable with you proceeding. Use supporting pictures or diagrams to assist you. Check you have understood them by repeating key words back to them again, using pictures or drawings to assist you. Some people with severe or profound level of intellectual disability may have difficulty providing you with a clear picture of their symptoms. They may have limitations in interpreting internal cues, for example, anxiety. Including their carer, who is very familiar with the person to support you with interpretation, may help you better understand. However, to the best of your ability, keep the focus on the person with an intellectual disability as opposed to the carer.