Effective Communication For Health Care Providers: A Guide To Caring For People With Disabilities

Effective Communication
for Health Care Providers

A guide to caring for people with disabilities
ii | Effective Communication for Health Care Providers
Acknowledgements
Thanks to the members of the Healthy Delawareans with Disabilities
Advisory Council who contributed their experience and knowledge to
this guide.
Suggested Citation
Riddle, I., Romelczyk, S., & Sparling, E. (2011). Effective Communication
for Health Care Providers: A Guide to Caring for People with Disabilities.
Newark, DE. Center for Disabilities Studies, University of Delaware.
Alternate Formats
For additional copies or alternate formats please visit the Healthy
Delawareans with Disabilities website at www.gohdwd.org or contact
the Center for Disabilities Studies, University of Delaware at (302) 831-
6974.
Funding Source
This report was supported by Grant/Cooperative Agreement Number
5U59 DD000277-02, Centers for Disease Control and Prevention (CDC),
National Center on Birth Defects and Developmental Disabilities
(NCBDDD). The content of this report is the responsibility of the authors
and does not necessarily represent the views of CDC.
Center for disabilities studies | University of Delaware | iii
CONTENTS
Introduction . . . . . . . . . . . . . . . . . . . 1
PART 1 THE REQUIREMENT FOR EFFECTIVE
COMMUNICATION. . . . . . . . . . . . . . . . 3
Provider Duty . . . . . . . . . . . . . . . . . 3
Limits . . . . . . . . . . . . . . . . . . . . . 5
Tax Incentives for Improving Access . . . . . . 6
PART 2 COMMUNICATION BEST PRACTICES. . 8
Practical Solutions . . . . . . . . . . . . . . . 9
Respectful Language. . . . . . . . . . . . . 10
Telecommunication Services for Patients . . . 12
Sign Language Interpreters. . . . . . . . . . 13
Accessible Materials. . . . . . . . . . . . . . 14
Alternate Formats. . . . . . . . . . . . . . . 17
Accessible Meetings . . . . . . . . . . . . . 20
PART 3 WORKING WITH PEOPLE WITH
DISABILITIES. . . . . . . . . . . . . . . . . 23
About Hearing Loss . . . . . . . . . . . . . . 24
About Vision Loss . . . . . . . . . . . . . . . 26
About Communication Disorders. . . . . . . 28
About Intellectual, Cognitive, and

Developmental Disabilities . . . . . . . . . 30
About Physical and Mobility Disabilities . . . . 32
About Mental Health Disorders . . . . . . . . 34
Additional Resources. . . . . . . . . . . . . 36
iv | Effective Communication for Health Care Providers
Center for disabilities studies | University of Delaware | 1
Introduction
About 50 million people in the United States have a disability. According
to the U.S. Public Health Service and the Department of Health and
Human Services, this represents more than 20% of Americans (Office of
Disability, 2008). In Delaware, there are about 179,000 individuals with a
disability.
Disability, as defined in the Americans with Disabilities Act, is any

physical or mental impairment that substantially limits one or more
major life activities, including but not limited to walking, talking,
breathing, hearing or caring for oneself. There
are many types of disabilities and they can vary
in duration and severity. Some individuals are
born with a disability; others acquire a disability
during their lifetime. Some disabilities are visible;
others are not easy to see. It is likely that everyone
will experience a disability at some point in their
lifetime.
Communication is an important part of any

relationship but especially between physician
and patient. Effective communication is critical to
proper diagnosis, appropriate medication dosing
and ensuring patient compliance with a treatment
regimen.
Disability can impact communication. Identifying

a patient’s disability and its potential impact
on effective communication is the first step in
reducing the risk of miscommunication. The type
of disability – whether intellectual, sensory, mobility or mental health –
will help determine the kind of accommodation needed. Usually minor
accommodations can be made to ensure effective communication.
There are many options for auxiliary aids and services to ensure effective
communication. Health care providers and their staff can develop
skills and acquire tools that will allow them to successfully provide
accommodations to patients with disabilities.
This guide will provide information to help you communicate effectively

with your patients with disabilities.
PART 1 REQUIREMENT FOR EFFECTIVE COMMUNICATION

This section provides an overview of a health care provider’s
responsibility to provide “effective communication” as required by the
Americans with Disabilities Act.
2 | Effective Communication for Health Care Providers
PART 2 COMMUNICATION BEST PRACTICES

This section outlines best practices that providers can use to establish
communication policies in their practices to achieve effective
communication with patients. There are suggestions for respectful
language, website accessibility, preparing materials in alternate formats,
and the use of auxiliary aids.
PART 3 WORKING WITH PEOPLE WITH DISABILITIES

This section provides practical tips on providing accommodations to
individuals with different types of disabilities.
PART 1
THE REQUIREMENT FOR
EFFECTIVE COMMUNICATION
The Americans with Disabilities Act (ADA) is civil rights legislation that
prohibits discrimination against individuals with disabilities.
“A public accommodation shall take those steps that may

be necessary to ensure that no individual with a disability is
excluded, denied services, segregated or otherwise treated
differently than other individuals because of the absence of
auxiliary aids and services unless the public accommodation
can demonstrate that taking those steps would fundamentally
alter the nature of the goods, services, facilities, privileges,
advantages, or accommodations being offered or would result in
an undue burden, i.e., significant difficulty or expense."
Americans with Disabilities Act

28 C.F.R. s. 36.303(c)
This applies to state and federal agencies (Title II) and to places of
public accommodation (Title III), which includes most businesses. The
professional office of a health care provider and hospitals are specifically
mentioned in the regulation.
Provider Duty
For health care providers and facilities, there is a duty to provide
effective communication to all patients and their families or caregivers,
including people with disabilities.
The nature of health care elevates the magnitude of consequences for

miscommunication. A misdiagnosis or inaccurate medication dosage
can be serious or even fatal.
Some specifics about providing effective communication
• Providers are responsible for ensuring effective communication,

regardless of the size of the office or the number of employees.
• This duty extends to “companions” – not just the patient – if it
will impact the patient’s care. For example:
• a father who is deaf in a childbirth preparation class, or
• a parent who is deaf when the child is the patient.
• Providers cannot rely on family members or friends to interpret
when a sign language interpreter is requested. There are
two exceptions to this requirement: 1) when the patient’s
preference is to have a family member or friend interpret, and
2) in an emergency involving an imminent threat to the safety
or welfare of an individual or the public where there is no
interpreter available.
• Providers cannot charge patients for the cost of supplying
auxiliary aids or services.
Deciding what accommodation is needed
The U.S. Department of Justice expects that the health care provider will
consult with the patient and carefully consider his or her self-assessed
communication needs. The ultimate decision as to what measures to
take rests with the provider, provided that the method chosen results in
effective communication.
Health care providers and their staff must decide what assistance is
appropriate, depending on the nature of the communication and the
patient’s preferred method of communication.
The rules are intentionally flexible. Different health care settings —

a dentist‘s office, a surgery center, and a home health agency, for
example — may need different solutions, because the nature of their
communications are different. Also, different patients need different
solutions, because the nature of their disabilities will be different. Some
factors that can influence the selection of the accommodation are:
• the nature, length and importance of the communication;

• the individual´s communication skills and knowledge;
• the patient´s health status;
• the patient´s and/or companion´s request for an interpreter or
other specific auxiliary aid or service;
• the reasonably foreseeable health activities of the patient; and
• the availability at the required times, day or night, of
appropriate auxiliary aids and services.
Examples of auxiliary aids and services
There are many options available for creating effective communication

with a patient with a disability. The choices can be simple — paper
and pen — or they can be more sophisticated technology, such as
video relay services. Some examples include: qualified sign language
interpreters, notetakers, computer-aided transcription services,
written materials, telephone handset amplifiers, assistive listening
devices, assistive listening systems, telephones compatible with
hearing aids, closed caption decoders, open and closed captioning,
telecommunications devices for deaf persons
(TDD's), videotext displays, qualified readers,
taped texts, audio recordings, Brailled materials,
or large print materials.
Limits
The ADA has limits on how far a business must
go in providing effective communication.
Businesses are not expected to provide any
services that would “fundamentally alter” the
business’s goods and services or that would
cause an “undue burden.” Many providers are
unsure about how to interpret these concepts.
A fundamental alteration is a change that is so significant that it

alters the essential nature of the goods, services, facilities, privileges,
advantages or accommodations offered by a business. In health
care settlements, the Department of Justice has indicated that very
rarely will this be a legitimate defense for failing to provide effective
communication.
The ADA does not require businesses to furnish any communication

aids or services that place an undue burden on the business. An undue
burden is defined as “significant difficulty or expense.” It is evaluated on
a case-by-case basis, relative to the business’s overall resources.
Settlement agreements negotiated with the Department of Justice are

clear. Being reimbursed less than the cost of services for a sign language
interpreter is not considered an undue burden.
It is important to note that, even when a particular communication aid

or service would cause an undue burden, a business still has a duty to
provide another communication aid or service that is effective but is less
difficult or costly, if one is available.
Tax incentives for improving access

Businesses can take advantage of two federal tax incentives available to
help cover costs of improving access for customers with disabilities:
• A tax credit for small businesses who remove access barriers
from their facilities, provide accessible services, or take other
steps to improve accessibility for customers with disabilities
• A tax deduction for businesses of all sizes that remove access
barriers in their facilities or vehicles.
A business that annually incurs eligible expenses to bring itself into

compliance with the ADA may use these tax incentives every year. The
incentives may be applied to a variety of expenditures; however, they
may not be applied to the costs of new construction. All barrier removal
must comply with applicable federal accessibility standards.
Tax Credit
Small businesses with 30 or fewer employees or total revenues of $1

million or less can use the Disabled Access Credit (Internal Revenue
Code, Section 44). Eligible small businesses may take a credit of up to
$5,000 (half of eligible expenses up to $10,250, with no credit for the
first $250) to offset their costs for access, including barrier removal from
their facilities (e.g., widening a doorway, installing a ramp), provision
of accessibility services (e.g., sign language interpreters), provision of
printed material in alternate formats (e.g., large-print, audio, Braille), and
provision or modification of equipment.
Tax Deduction
Businesses of all sizes may take advantage of this tax deduction. Under
Internal Revenue Code, Section 190, businesses can take a business
expense deduction of up to $15,000 per year for costs of removing
barriers in facilities or vehicles.
Tax Incentives in Combination
These two incentives can be used together by eligible businesses if the

expenditures qualify under both Sections 44 and 190. If a small business’
expenses exceed $10,250 for the maximum
$5,000 tax credit, then the deduction equals
the difference between the total spent and the
amount of the credit claimed.
For further details and information, review

these incentives with an accountant or visit the
Internal Revenue Service website at www.irs.
gov. Request IRS Publications 535 “Business
Expenses” (tax deduction) and 334 for further
information on tax incentives, or Form 8826
(Disabled Access Credit) to claim your tax credit
(http://www.irs.gov/pub/irs-pdf/f8826.pdf ).
Questions for the IRS can be directed to 800-
829-1040 (voice) or 800-829-4059 TDD.
Source: Expanding Your Business, Tax Incentives for Businesses, U.S.

Dept. of Justice, Civil Rights Division, Disability Rights Section (http://
www.ada.gov/taxincent.pdf ).
PART 2
COMMUNICATION BEST PRACTICES
Good communication is an essential part of any successful relationship,

especially in relationships between health care providers and their
patients.
The following suggestions will help your staff to provide the best
communication possible to people with disabilities. Suggestions for
communicating with individuals with specific types of disabilities are
found in Part 3.
• Speak directly to the patient rather

than through a companion.
• If you offer assistance, wait until
it is accepted before touching the
patient.
• Explain all procedures and exams
as many times as necessary. Use
verbal cues or models when
necessary.
• Ask the patient what positions are
most comfortable, what is the best
way to transfer, and if assistance is
needed.
• Remember, the patient knows their
needs and preferences better than anyone else.
• Consider that individuals with disabilities are at a higher risk for
abuse and neglect, which can come from the caregiver. Always
give your patient with a disability a chance to speak with you
alone.
• Individuals with disabilities need regular check-ups, screenings
and health education. Not every visit may be related to an
individual’s disability.
• Seek out the newest medical information regarding the
relationship between relevant health conditions and your
patient’s specific disability.
• Ask your patients with disabilities to give you regular feedback
and suggestions to help you provide the best care possible.
Not all disabilities will impact communication. If you are not sure,
ask. Once you know, usually simple accommodations can be made to
achieve effective communication.
Practical solutions
The aim is to figure out practical solutions that allow you to
communicate with patients who have disabilities, fit with your type
of business, and comply with the ADA. Some easy solutions work
in relatively simple and straightforward situations. Other, more
sophisticated solutions may be needed if the information being
communicated is more extensive or complex.
For relatively simple transactions
You can speak or read information to a patient who is blind or has low
vision.
You can use facial or body gestures that express information, point to
information, or write notes to communicate with a patient who is deaf
or hard of hearing.
You can read notes written by a patient who has a speech disability,
or read or listen to the words the patient selects on a “communication
board.”
Patients who are blind may also need assistance in finding an item or in
manuevering through your office.
For more extensive or complex communications
For people who are blind or have low vision, printed information can
be provided in large print, in Braille, on a computer disk, or in an audio
format (such as an audio CD or MP3 player), depending on what is
usable for the particular patient. A magnifying glass can also help a
person with low vision to read printed materials.
For people who are deaf or hard of hearing, spoken information can be
provided using a sign language interpreter, an oral interpreter, a printed
transcript of the words that are usually spoken, or a service called “real-
time captioning.”
Many people who have been deaf since birth have limited literacy skills.
Keep that in mind if the communication method you consider using
relies on reading and/or writing.
Ask. Accommodate. Communicate.

One way to be aware of any barrier to effective communication or to
delivering proper care is to routinely ask patients if they will need an
accommodation during their visit. Usually the patient will be the best
source of information about any accommodation needed.
Consider asking the following question when scheduling every

appointment:
“Do you have any special needs related to

a disability that we can assist you with
during your visit?”
Examples:
• Help with dressing or undressing
• Understanding medical information
• Positioning during a procedure
• Help with completing forms
• A sign language interpreter
• Adjustable medical equipment that goes low enough
for someone seated in a wheelchair
Respectful Language
People First Language
Our spoken language often conveys more than the words themselves.
It is important to speak appropriately and respectfully with and
about an individual with a disability. When addressing people with
disabilities, it is important to refer to the person first rather than their
disability. People’s disabilities are only one part of them; they are not
their defining characteristic. Therefore, when speaking to people with
disabilities consider using what is called People First Language. Table 1
offers suggestions on how to communicate with and about people with
disabilities.

Only refer to the disability if it is relevant to the conversation. Avoid
using words such as “victim,” “unfortunate,” and “afflicted.” In addition,
when referring to people without disabilities use “people without
disabilities” as opposed to “normal” or “able-bodied.”
TABLE 1 COMMUNICATING WITH AND ABOUT PEOPLE WITH DISABILITIES
PEOPLE FIRST LANGUAGE LANGUAGE TO AVOID

Person with a disability The disabled, handicapped
Person without a disability Normal person, healthy person
Person with an intellectual, cognitive, Retarded, slow, simple, moronic,
developmental disability defective, afflicted, special person
Person with an emotional or behavioral
Insane, crazy, psycho, maniac,
disability, or a mental health or a
nuts
psychiatric disability
Hearing impaired, suffers a hearing
Person who is hard of hearing
loss
Person who is deaf Deaf and dumb, mute
Person who is blind or has vision loss The blind
Person who has a communication
disorder, is unable to speak or uses a Mute, dumb
device to speak
Confined or restricted to a
Person who uses a wheelchair wheelchair, wheelchair bound; a
cripple
Person with a physical disability, Crippled, lame, deformed, invalid,
physically disabled spastic
Person with autism Autistic
Person with epilepsy or seizure disorder Epileptic
Person with multiple sclerosis Afflicted by MS

Person with cerebral palsy CP victim
Accessible parking or bathrooms Handicapped parking or bathroom

Person of short stature Midget
Person with a congenital disability Birth defect
Person with Down syndrome Mongoloid
Has overcome his/her disability, is
Person who is successful, productive
courageous
Source: “Communicating With and About People with Disabilities,” National Center on Birth Defects and
Developmental Disabilities, http://www.cdc.gov/ncbddd/disabilityandhealth/pdf/DisabilityPoster_Photos.
pdf
Describing accessible features
When speaking about services or features designed to accommodate

the needs of individuals with disabilities, such as parking spaces,
bathroom stalls, or vehicles with lifts, use the word “accessible” instead
of “handicapped.”
Telecommunication Services for Patients with

Hearing Loss
Individuals who are deaf or hard of hearing have a range of services
available to provide accommodation. Accommodations may include
the use of paper and pencil, cell phone text messaging, the use of
assistive technology or the services of
a sign language interpreter.
RELAY SERVICES
Delaware Relay
Delaware Relay is a free service that
provides full telephone accessibility
to people who are deaf, hard of
hearing, deaf-blind, or have speech
or communication difficulties. Relay
service is available 24 hours a day,
seven days a week and 365 days a
year. Using this service, the operator voices everything you type and
types everything you say. Free equipment is available for eligible
parties. The operator is available by dialing 7-1-1 on any phone or
cellphone.
Sprint Video Relay Service

Video Relay Service (VRS) allows natural telephone communication for
individuals who use American Sign Language (ASL). Service is easily
accessible from nearly anywhere. Communication flows through a
qualified video interpreter via a stand-alone videophone appliance or
desktop or laptop with video conference capability. This service requires
high speed internet service. Learn more about this service at
www.sprintvrs.com.
Voice Carry Over

Voice Carry Over allows users who are hard of hearing to speak directly
to people with hearing. When a person with hearing speaks to a caller
with hearing loss, an operator serves as the “ears” and types everything
said to the caller’s TTY or VCO phone.
Hearing Carry Over

Hearing Carry Over (HCO) allows hearing users with a speech disorder
to listen to the person they are calling. The HCO user types his/her
conversation for the operator to voice the conversation to the party on
the line.
TTY
A person who is deaf, hard of hearing, deaf-blind or has a speech
disorder uses a text telephone, or TTY, to type his/her conversation to an
operator. The operator then reads the typed conversation to a hearing
person. Then the operator relays the hearing person’s spoken words by
typing them back to the TTY user. Dial 711 or 800-232-5460.
Sprint IP Relay
You can place a relay call from any internet connection with a computer
or wireless device that has AOL Instant Messenger (AIM) access. Visit
www.sprintip.com for more information.
Spanish Relay
TTY users can type in Spanish and the conversation will be relayed in
Spanish. TTY users can also request Spanish to English or English to
Spanish translation via relay. To make a Spanish relay call, dial 877-335-
7595 and instruct the operator how you want your call translated.
For more information on any of these services, visit the Delaware Relay
Services website at: http://www.delawarerelay.com/about/what.php.
Sign Language Interpreters

Some individuals with hearing loss use sign language to communicate.
They may request a sign language interpreter as their preferred
accommodation during a health care visit. In most cases, it is the
provider’s duty to secure and pay for these services.
Interpretation is the process of translating spoken English into sign

language and/or gestures for communication between deaf and
hearing individuals. Interpreters are trained professionals who are fluent
in both languages, understand the process and cultural issues, and who
are bound by a professional code of conduct.
To locate a certified sign language interpreter, you can ask the patient
if they have a suggestion for an interpreter they have used before, or
you can visit the Registry for Interpreters for the Deaf at www.rid.org.
This website hosts a searchable database for finding a certified sign
language interpreter in your area.
Accessible Materials
When not speaking face to face with patients, providers often rely on
printed materials, voice recordings and websites to
convey critical information about practice procedures
or guidelines for seeking emergency treatment. These
messages should be accessible and take into account
the needs of people with disabilities. Although it is
nearly impossible to create documents that consider
each person’s unique abilities, you can increase access
to education and information by designing materials
with the broadest range of user abilities in mind. Try to
present the same content in multiple formats.
PRINT
The following guidelines will increase usability of your
print materials for many patients.
• Use simple and direct language. Keep the
reading level at an elementary level. There are
simple ways to check reading level, including a
feature in Microsoft Word.
• Use large font, at least 12-point with extra space between the
lines.
• Use clean, simple fonts. Avoid fancy fonts and italics LIKE THIS
or LIKE THIS.
• Do not clutter text with shading, overlays, or use pictures
behind text in documents.
• Avoid glossy white paper; instead use matte, off-white paper.
• Make sure there is sufficient contrast between text and
background colors. It is generally better when there is a dark
font on a light background, as opposed to the alternative.
• Include photos of individuals with disabilities in your
publications.
See illustrations of these principles developed by Lighthouse

International at http://lighthouse.org/accessibility/design/accessible-
print-design/making-text-legible.
WebAim has an online tool to assist with assessing if your color choices
provide sufficient contrast. Try it at
http://webaim.org/resources/contrastchecker.
WEBSITES
Designing accessible websites with understandable language and

clear, easy-to-read text is an important part of removing barriers to
communication. The internet is now a widely used tool for gaining
information, and can be made accessible to people with different
disabilities through assistive technology. Reference the resources below
to ensure that your website material is accessible to all viewers.
Web Content Accessibility Guidelines have been developed to assist
web developers in the features that will improve accessibility. The Web
Content Accessibility Guidelines Work Group has identified four design
principles to include when designing your web content. It should be:
Perceivable
• Provide text alternatives for non-text content.
• Provide captions and other alternatives for multimedia.
• Create content that can be presented in different ways, including
by assistive technologies, without losing meaning.
• Make it easier for users to see and hear content.
Operable
• Make all functionality available from a keyboard.
• Give users enough time to read and use content.
• Do not use visual features that could trigger seizures.
• Help users navigate and find content.
Understandable
• Make text readable and understandable.
• Make content appear and operate in predictable ways.
• Help users avoid and correct mistakes.
Robust
• Maximize compatibility with current and future user tools.
For more information on how to evaluate your website, you can visit:
www.webaim.org and use the WAVE evaluation tool at http://wave.
webaim.org/.
The ADA Best Practices Tool Kit for State and Local Governments
provides an easy to understand overview of the elements of
accessibility. See the section titled, “Website Accessibility” Under Title II
of the ADA at http://www.ada.gov/pcatoolkit/chap5toolkit.htm.
POSTERS
Posters are often used to promote healthy behaviors or special events.

They should be created with accessibility guidelines in mind to
maximize access and allow for effective communication. Posters should
generally have:
• Large font that is legible from a distance of 3 to 6 feet
• Sans serif fonts like Arial or Verdana
• High contrast between poster text and poster background
• Properly spaced text characters
• Vertical line spacing should be anywhere between 1.2 and 2.0
to allow for easier focus
• Horizontal line spacing, or “tracking,” adjusted to +3 so that
characters are not overcrowded.
Using Images or Graphics on Posters

Place images or graphics with consideration to where in the sequence
of text they belong.
• Do not place text over images

• Refer to image or graphic titles in the text
• Clearly explain any data charts (i.e. pie charts) with text on the
poster.
For more information on poster accessibility, please see the source

document, Guidelines for Creating Accessible Printed Posters, Gilson,
Stephen F. Ph.D. and Robert M. Kitchin Jr., MSW (2007). http://www.
aucd.org/docs/annual_mtg_2008/accessibility_posters_gilson2007.pdf
SLIDE PRESENTATIONS
PowerPoint slides are commonly used in presentations as an effective

way to display ideas and data. Because PowerPoint is a visual medium,
presenters should be sure to make presentations accessible to all
audience members.
Text content
Keep the text on your slides clear and simple.
• Title fonts should be 44 point or greater. Text fonts should be 36

point or greater.
• Don't try to cram too many slides into your presentation. Allow
your audience time to read slides.
• Place no more than 6 lines of text on a slide.
Graphic content
Note that graphics often cannot be read with screen readers and other
text-based devices.
• Replace graphics with text whenever possible.

• If graphics are used, include a detailed explanation of the
meaning of the chart or graphic in a
descriptive text-only slide included
immediately after the graphic slide.
Note that the meaning of the graphic is
needed, not a description.
An example that doesn’t illustrate the

meaning of the graphic would be: "Chart
with blue and red bars." An example that
conveys the content would be: "Data
from this chart illustrates that people
with disabilities report spending more
time in the emergency room than people
without disabilities."
Avoid:
• Slide transitions
• Busy slide backgrounds and chart filler patterns
• Over-crowding text
• Color schemes providing low contrast
• Charts without text descriptions
• Videos that are not captioned.
For more information on creating accessible PowerPoint presentations,

including an accessible template, please view the source document
from the Association of University Centers on Disability at http://www.
aucd.org/docs/annual_mtg_2008/accessibility_ppt_apha2007.ppt
Alternate formats
Even when print materials are designed for maximum usability, not
everyone will be able to access information in the same way. Providers
need to be prepared to provide information in alternative formats.
Examples of alternate formats include: Braille, audio recording, and
electronic pdf or text file.
LARGE PRINT
Individuals who have low vision may not be able to read standard sized
print on your handouts.
Large print should be printed on single-sided 8.5" by 11" paper and

stapled at the top left corner.
Use “portrait” or “letter” orientation, unless a visual

element requires “landscape,” to achieve maximum
visibility.
Left justify all paragraphs and do not use columns.
Keep a one-inch margin on all sides.
Use 18-point font for all text. Larger fonts may be

used for headings. Individual users may request
fonts larger than 18-point as an accommodation.
Use a bold serif font (such as Times New Roman) for body text and
a bold simple sans-serif font (such as Arial) for headings and other
information that is set apart from body text. Do not use any compressed
or condensed fonts.
Use a minimum of 1.5 line spacing; use double spacing when possible.
Do not use small caps, italics, or all caps for text. Use initial caps and
lower case for titles and text.
Use underlining for emphasis instead of italics.
Delete decorative graphics that do not contribute to the meaning of the

information being presented.
Source: AUCD Accessiblity Guidelines http://www.aucd.org/conference/

template/page.cfm?id=50041#handouts
ELECTRONIC FILES
These files may be available for email or delivered on a CD or a flash

drive. Individuals who are blind or have low vision may prefer to have
text files of your materials and have their screen readers or other
computer software convert the materials. When converting documents
to an electronic file:
• Use simple, standard page layout.

• Keep background simple and seek high visual contrast between
text and background.
• Use captions or “alt text” to describe any graphics.
• Use a simple font; no italics or compressed fonts.
• A text file format will be a good choice for many documents.
Note that PDF files are often not readable by screen reader technology.
When posting documents on the web, it is a good idea to make them
available in more than one format, such as PDF, HTML and a text version.
AUDIO RECORDING
Providing an audio recording is one way to deliver information to

patients who cannot see or read your printed materials. For documents
with several chapters, double beep the beginning of each chapter
before you say the title and single beep
each page so readers can find their
place in the document as they follow
along.
Make sure the CD presents clear, high-

quality sound.
Label the cassette with both Braille and

print labels.
Include an option of a text version with

an audio recording.
BRAILLE
Put page numbers at the top right-hand corner.
Margins should be wider on the left side.
If using a Braille printer, have someone check for accuracy as misprints

can occur.
Accessible Meetings
Any person hosting a meeting should consider the needs of all
meeting participants. It is important to host meetings in a usable and
comfortable environment for everyone. When planning a meeting,
there are some basic considerations to ensure
that the meeting is accessible to people with
disabilities.
Consider the following:

The facility should meet basic accessibility
standards (ADA requirements) so that people
with a variety of disabilities are able to move
around without physical barriers. This includes
parking, pathways and restrooms.
The meeting room itself, including seating,

should be accessible to allow access for
participants with sensory, physical, and
communication disabilities.
All meeting activities such as breaks,

off-site tours, social activities, etc. should be
accessible to ensure that everyone is an active
participant.
Information should be presented in such as

way that it is easily understood by individuals
with a variety of abilities.
DETERMINING WHAT THE AUDIENCE NEEDS
It is easy to include a simple question to determine accommodation

needs through the registration or RSVP process. Create a
standard question to ask each meeting participant or have a list of
accommodations that the participant can check off.
Make alternate formats of handouts available. See section above

for information on alternate formats. Participants can be given the
opportunity to request accommodations (e.g., large print, assistive
listening devices, interpreters) that they might need to participate in the
meeting and planners should make every effort to fulfill those requests.
GUIDELINES FOR SPEAKERS
• Use a microphone during the presentation. This is important for

persons who may be using assistive listening devices that rely
on a sound system.
• Before answering any questions, repeat the question into the
microphone.
• Provide verbal descriptions of any overheads, slides, or charts,
reading all text on the visual aids.
• Present key points in multiple ways, including visual, auditory
and tactile approaches.
• Handout materials should be made available to meeting
planners in advance so alternate formats can be produced if
requested, or the speakers should bring their own copies in
alternate formats.
Excerpted from: Planning Meetings That Are Accessible To All

Participants, created by the North Carolina Office on Disability and
Health. See the source document at http://www.fpg.unc.edu/~ncodh/
pdfs/rbmeetingguide.pdf
PART 3
WORKING WITH PEOPLE WITH
DISABILITIES
There are many types of disabilities, such as those that affect a
person’s hearing, vision, movement, thinking, remembering, learning,
communicating, mental health, and social relationships.
Disability can impact communication. Providers and their staff can learn
about each patient and the impact of their disability and make simple
accommodations to ensure effective communication.
Ask. Accommodate. Communicate.
One way to be aware of any barrier to effective communication or to

delivering proper care is to routinely ask patients if they will need an
accommodation during their visit. Usually the patient will be the best
source of information about what accommodation will work best.
Consider asking the following question when scheduling every

appointment:
“Do you have any special needs related to a

disability that we can assist you with during
your visit?”
Examples include:
• Help with dressing or undressing
• Understanding medical information
• Positioning during a procedure, such as a mammogram
• Help with completing forms
• A sign language interpreter
• Adjustable medical equipment that goes low enough for
someone seated in a wheelchair.
Be prepared to make accommodations. This will make the patient visit a

better experience for staff and patients. The following information offers
suggestions and resources for accommodating patients with different
types of disabilities.
ABOUT HEARING LOSS
Hearing loss is a full or partial decrease in the ability to detect or

understand sounds.1 It can range from a mild hearing loss to total
deafness. According to the 2008 American Community Survey,
approximately 10.4 million individuals in the U.S., or 3.5% of the U.S.
population, have hearing loss.2 In Delaware, approximately 31,000
individuals (3.6% of all Delawareans) have hearing loss.
Caring for people with hearing loss
With appropriate auxiliary aids and methods, it is possible to

communicate with people with hearing loss. Ask about the patient’s
preferred method of communication. Explore if the person reads lips,
uses a hearing aid, sign language interpreters, writes, speaks, or gestures
by following cues. Some people who have significant hearing loss may
use cochlear implants that help them receive sounds.
• Ask persons with hearing loss what kinds of accommodations

they will need when scheduling an appointment.
• Explore different types of assistive technology, such as captions,
video phones or Teletype (TTY) that may assist your patients.
• Do not rely on family members or children to interpret, but
provide a sign language interpreter if one is requested.
• Speak in a normal tone of voice directly to the person.
• Always direct the conversation to the person with the hearing
impairment even if a family member, caregiver, or sign language
interpreter is also present.
• To get the attention of a person who has a hearing impairment,
tap the person on the shoulder.
• Make sure you have the person’s full attention before speaking.
• Ensure that the individual can always see your face. Your mouth
and your facial expressions carry a lot of helpful information.
• Have conversations in a one-on-one setting without
background noise whenever possible.
1
U.S. Legal. Retrieved from www.definitions.uslegal.com
2
Erickson, W., Lee, C., von Schrader, S. (2010, March 17). Disability Statistics from the 2008 Ameri-
can Community Survey (ACS). Ithaca, NY: Cornell University Rehabilitation Research and Training
Center on Disability Demographics and Statistics (StatsRRTC). Retrieved from www.disabilitysta-
tistics.org
Relay Delaware
Free telecommunication services for
communication between people who are
deaf, hard of hearing, deaf-blind, have a
speech disorder and hearing.
Call 7-1-1
800-232-5470 Toll Free
800-232-5460 TTY
877-335-7590 Voice Carry Over
800-232-5460 Hearing Carry Over
877-335-7274 Speech To Speech
877-335-7595 Spanish
http://www.delawarerelay.com
National Association of the Deaf

8630 Fenton Street, Suite 820
Silver Spring, MD 20910
301-587-1788 Phone
301-587-1789 TTY
http://www.nad.org
Resources Questions and Answers for Health Care
Providers:
Delaware Office for the Deaf and Hard of http://www.nad.org/issues/health-care/
Hearing (DODHH) providers/questions-and-answers
4425 North Market Street
Wilmington, DE 19802-1307 Hearing Loss Association of America
302-761-8275 Phone 7910 Woodmont Avenue, Suite 1200
302-761-8336 TTY Bethesda, MD 20814
302-761-6611 Fax 301-657-2248 Phone
http://www.delawareworks.com/dvr/ http://www.hearingloss.org
dodhh.shtml
Delaware Assistive Technology Initiative
Registry of Interpreters for the Deaf Locations in New Castle, Kent and Sussex
333 Commerce Street Counties
Alexandria, VA 22314 800-870-3284 Toll Free (Delaware only)
703-838-0030 Phone 302-651-6790 Phone
703-838-0459 TTY 302-651-6794 TDD
703-838-0454 Fax 302-651-6793 Fax
https://www.rid.org/acct-app/index. http://www.dati.org
cfm?action=search.members
To find a sign-language interpreter through
the online, nationwide registry go to
https://www.rid.org/acct-app/index.
cfm?action=search.members
ABOUT VISION LOSS
Vision loss or low vision is a reduction in vision that can’t be corrected

with standard glasses or contact lenses and it reduces a person’s ability
to function at certain or all tasks. It includes:
• inability to see images clearly and distinctly;

• loss of visual field;
• inability to detect small changes in brightness;
• color blindness; and
• sensitivity to light.3
Blindness means no vision or vision that, even with correcting glasses, is

so limited that it prevents the performance of ordinary activities.
According to the 2008 American Community Survey, approximately
6.8 million individuals in the U.S., or 2.3% of the U.S. population,
have a visual disability4. In Delaware, 22,600 individuals (2.6% of all
Delawareans) have a visual disability.
Caring for people with vision loss
Ask persons with vision loss what kinds of accommodations they will
need when scheduling an appointment.
Every person with a visual impairment has a different level of sight.
Good lighting is essential. Avoid any type of glare that can disturb
people’s vision.
Make alternate formats of your practice’s printed materials available

such as brochures and care instructions. Alternate formats may include
large print, Braille or audio versions.
Arrange to have intake forms available either online for improved

accessibility and for use with screen readers or in large print format.
3
U.S. Legal. Retrieved from www.definitions.uslegal.com
4
Erickson, W., Lee, C., von Schrader, S. (2010, March 17). Disability Statistics from the 2008 Ameri-
can Community Survey (ACS). Ithaca, NY: Cornell University Rehabilitation Research and Training
Center on Disability Demographics and Statistics (StatsRRTC). Retrieved from www.disabilitysta-
tistics.org
5
Partially excerpted from Disability Etiquette, Tips On Interacting With People With Disabilities,
United Spinal Association (2008). New York.
Resources
Delaware Division for the Visually Impaired

Biggs Building
1901 North DuPont Highway
New Castle, DE 19720
302-255-9800 Phone
302-255-9854 TDD
http://www.dhss.delaware.gov/dvi/
Delaware Association for the Blind

800 West Street
Wilmington, DE19801
302-655-2111 Phone
888-777-3925 Toll Free
302-654-1376 Peer Support
302-655-1442 Fax
http://www.dabdel.org
National Federation for the Blind

200 East Wells Street at Jernigan Place
Baltimore, MD 21230
410-659-9314 Phone
Introduce yourself to a patient with vision 410-685-5653 Fax
loss upon entering the room. If you leave http://www.nfb.org
the room, inform the person first. If leaving
the person in the room, be sure to orient American Optometric Association
them to the layout of the room and make 1505 Prince Street, Suite 300
sure they are aware of landmarks - tables, Alexandria, VA 22314
doors, or equipment. 800-365-2219 Toll Free
http://www.aoa.org
Explain any procedure or treatment before
you execute it so the person knows what to Delaware Assistive Technology Initiative
expect. Locations in New Castle, Kent and Sussex
Counties
If the person has a guide dog, walk on the 800-870-3284 Toll Free (Delaware only)
opposite side of the dog. Do not touch the 302-651-6790 Phone
dog, as the dog is working and needs to 302-651-6794 TDD
concentrate on his/her task. 302-651-6793 Fax
http://www.dati.org
If the person uses a cane, do not touch the
cane. The cane is considered part of the
individual’s personal space.
If the person needs to be guided, offer your

arm but don’t take his/her arm. The person
may need his/her arms for balance.5
ABOUT COMMUNICATION DISORDERS
Speech and language disorders refer to problems in communication

and related areas such as oral motor function. These delays and
disorders range from simple sound substitutions to the inability to
understand or use language or use the oral-motor mechanism for
functional speech and eating. Some causes of speech and language
disorders include hearing loss, neurological disorders, brain injury,
intellectual disabilities, drug abuse, physical impairments such as cleft
lip or palate and vocal abuse or misuse.6 Since causes of communication
disorders vary greatly and there are few published data, it is difficult to
determine how many Americans cope with a communication disorder.
Approximately 1% of the U.S. population stutters and about 1% of
the U.S. population have aphasia (partial or complete impairment of
language and expression, often due to a stroke).7
Caring for people with communication disorders
When interacting with people with communication disorders, it is

important to:
• Speak as you would to anyone else, using normal tone of voice.
• Give the person your undivided attention.
• Keep your manner encouraging rather than correcting.
• Tell the person if you do not understand and ask them to clarify
any information they have given you.
• Ask short questions that require brief answers or head nods.
• Make pen and paper available, if useful.
• Become familiar with and be patient with any communication
devices patients may be using.
6
Kennedy Krieger Institute. Communication/Speech/Language Disorder. Retrieved from http://
www.kennedykrieger.org/kki_diag.jsp?pid=1079
7
American Speech-Language-Hearing Association. Retrieved from http://www.asha.org/re-
search/reports/speech_voice_language.htm
Resources
Delaware Speech-Language-Hearing
Association
P.O. Box 7383
Newark, DE 19711
For information, email dsha@dsha.org.

Locations in New Castle, Kent and Sussex
Counties
800-870-3284 Toll Free (Delaware only)
302-651-6790 Phone
302-651-6794 TDD
302-651-6793 Fax
http://www.dati.org
American Speech-Language-Hearing
Association
2200 Research Boulevard
Rockville, MD 20850
301-296-5700 Phone
301-296-5650 TTY
301-296-8580 Fax
http://www.asha.org
National Institute on Deafness and Other

Communication Disorders
National Institutes of Health
31 Center Drive, MSC 2320
Bethesda, MD 20892
800-241-1044 Toll Free
800-241 1055 Toll Free TTY
http://www.nidcd.nih.gov/
United States Society for Augmentative and

Alternative Communication
100 E. Pennsylvania Avenue, Courtyard
Towson, MD 21286
http://www.ussaac.org
info@ussaac.org
ABOUT INTELLECTUAL, COGNITIVE

AND DEVELOPMENTAL DISABILITIES
An intellectual disability is a disability characterized by significant
limitations both in intellectual functioning (reasoning, learning,
problem solving) and in adaptive behavior, which covers a range of
everyday social and practical skills and originates before the age of 18.8
Cognitive impairments are not caused by any one disease or condition.
Alzheimer’s disease and other dementias and conditions such as stroke
and traumatic brain injury can cause cognitive impairment. Some
causes of cognitive impairment are related to treatable health issues
(e.g., medication side effects, vitamin B12 deficiency, and depression).9
A developmental disability means a severe,

chronic disability of an individual 5 years of age
or older that 1) is attributable to a mental or
physical impairment or combination of these,
2) manifests itself before an individual turns 22
years of age, 3) is likely to continue indefinitely,
4) results in substantial functional limitations
in three or more areas of major life activity (e.g.
self-care, language, learning, mobility) and 5)
requires services, supports or other assistance
for a lifelong or extended duration.10
Developmental and intellectual disabilities are

not exactly the same. Developmental disability
is used as an umbrella term that includes intellectual disability but
also includes physical disabilities. Some developmental disabilities
are only physical, such as blindness from birth. Some individuals have
both physical and intellectual disabilities stemming from genetic or
other physical causes (e.g., Down Syndrome, fetal alcohol syndrome).
Sometimes intellectual disabilities can stem from nonphysical causes,
such as the level of child stimulation and adult responsiveness.11
8
American Association on Intellectual and Developmental Disabilities. FAQ on Intellectual Disability.
Retrieved from http://www.aaidd.org/content_104.cfm
9
Centers for Disease Control and Prevention. Healthy Brain Initiative. Retrieved from http://www.cdc.gov/
aging/healthybrain/
10
Abbreviated from the definition of developmental disability as outlined in the Americans with Disabili-
ties Act (ADA), Section 102 (8)
11
American Association on Intellectual and Developmental Disabilities, FAQ on Intellectual Disability.
Retrieved from http://www.aaidd.org/content_104.cfm
12
Erickson, W., Lee, C., von Schrader, S. (2010, March 17). Disability Statistics from the 2008 American
Community Survey (ACS). Ithaca, NY: Cornell University Rehabilitation Research and Training Center on
Disability Demographics and Statistics (StatsRRTC). Retrieved from www.disabilitystatistics.org
According to the 2008 American Community Resources

Survey, approximately 13.5 million individuals
in the U.S., or 4.8% of the U.S. population, Delaware Division of Developmental
have a cognitive disability.12 In Delaware, Disabilities Services
approximately 36,000 individuals (4.5% of all Woodbrook Professional Center
Delawareans) have a cognitive disability. 1056 South Governor’s Avenue, Suite 101
Dover, DE19904
Caring for people with intellectual/ 1-866-552-5758 24-Hour Toll Free
cognitive and developmental 302-744-9600 Phone
302-744-9632 Fax
disabilities
http://www.dhss.delaware.gov/dhss/ddds/
index.html
The following are some suggestions for having
successful interactions with individuals with American Association on Intellectual and
intellectual/cognitive disabilities. Developmental Disabilities
501 3rd Street NW, Suite 200
• Allow plenty of time to teach a new Washington, D.C. 20001
task. 800-424-3688 Toll Free
• Use repetition with precise language 202-387-1968 Phone
and simple wording. 202-387-2193 Fax
• Treat adults as adults and children as http://www.aaidd.org
children.
• Do not pretend to understand if you Delaware Assistive Technology Initiative
do not. Ask additional questions to Locations in New Castle, Kent and Sussex
clarify any information a patient may Counties
be sharing with you. 800-870-3284 Toll Free (Delaware only)
• Reduce distractions. 302-651-6790 Phone
• Use pictures or objects to convey 302-651-6794 TDD
meaning, if appropriate. 302-651-6793 Fax
• Allow a “wait time” for the patient to http://www.dati.org
process information or respond to a
question or to make a comment. “Overcoming Communication Barriers:
• Many people with cognitive/ Working with Patients with Intellectual
intellectual disabilities try to give the Disabilities”
answer that they think you want to A reprint from Australian Family Physician, 38,
hear. Phrase questions in a neutral way 1-2, January/February 2009
to get accurate information and verify http://www.racgp.org.au/
responses by asking each question in afp/200901/200901chew.pdf
a different way.
ABOUT PHYSICAL
AND MOBILITY DISABILITIES
A physical or mobility disability means that a person has limited fine
or gross motor ability function of a limb that necessitates the use
of adaptive equipment such as a cane, crutches, walker, wheelchair,
scooter or other assistive device. Mobility impairments may result
from a number of different medical conditions, such as multiple
sclerosis, cerebral palsy, spina bifida, diabetes, muscular dystrophy, and
paraplegia13 or from injuries sustained in motor vehicle crashes or falls.
Mobility limitations can be temporary or permanent and vary greatly in
their extent. It is important to assess each individual’s abilities on a case-
by-case basis.
According to the 2008 American Community Survey, approximately 19.2

million individuals in the U.S., or 6.9% of the U.S. population, have an
ambulatory disability, meaning they have difficulty walking or climbing
stairs.14 In Delaware, approximately 53,000 individuals (6.7% of all
Delawareans) have an ambulatory disability.
Caring for people with physical or mobility disabilities
The following are some suggestions to improve interaction with

individuals with physical/mobility impairment.
• Ensure that spaces, entrance ways, walkways and restrooms are

accessible and free of potential barriers (e.g. boxes, equipment,
chairs in the hallway, etc.).
• Attempt to provide accessible exam tables (e.g. exam tables
that are height-adjustable) and medical equipment (e.g.
accessible scales, mammography equipment).
• Always ask permission to move a person’s assistive device.
• Always ask how the device should be moved.
• When speaking with a person using a wheelchair, kneel or
attempt to speak at the person’s eye level.
• Offer assistance, but wait for acceptance before assisting.
• Do not lean on any part of a wheelchair when speaking. The
chair is considered part of the individual’s personal space.
• Before transferring, always ask the individual the best way
to transfer. If the individual uses a wheelchair, make sure the
wheels are locked prior to the transfer.
Resources
Delaware Division of Services for Aging and

Adults with Physical Disabilities
Main Building, First Floor Annex
800-223-9074 Toll Free
302-255-9390 Phone
302-255-4445 Fax
http://dhss.delaware.gov/dhss/dsaapd/index.
html
Delaware Aging and Disability Resource

Center (ADRC)
800-223-9074 Toll Free
302-391-3505 or 302-424-7141 TDD
http://dhss.delaware.gov/dsaapd/adrc.html

Locations in New Castle, Kent and Sussex
Counties
800-870-3284 Toll Free (Delaware only)
302-651-6790 Phone
302-651-6794 TDD
302-651-6793 Fax
http://www.dati.org
U.S. Department of Justice, Civil Rights

Division, Disability Rights Section
Americans with Disabilities Act (ADA)
Access to Medical Care for Individuals with
Mobility Disabilities (July 2010)
http://www.ada.gov/medcare_mobility_ta/
medcare_ta.pdf
13
Adapted from Those of Us DisLabeled: A Guide to Awareness and Understanding. University of Kentucky Human Develop-
ment Institute, Cooperative Extension Service. Retrieved from http://ada.ky.gov/mobility_imp_def.htm
14
Erickson, W., Lee, C., von Schrader, S. (2010, March 17). Disability Statistics from the 2008 American Community Survey (ACS).
Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics (StatsRRTC).
Retrieved from www.disabilitystatistics.org
ABOUT MENTAL HEALTH DISORDERS

According to the National Alliance on Mental Illness, mental illnesses
are medical conditions that disrupt a person’s thinking, feeling, mood,
ability to relate to others and daily functioning. Mental illnesses often
result in a diminished capacity for coping with the ordinary demands of
life. Serious mental illnesses include major depression, schizophrenia,
bipolar disorder, obsessive compulsive disorder (OCD), panic disorder,
post traumatic stress disorder (PTSD) and borderline personality
disorder.
Mental illnesses are treatable. Most people diagnosed with a serious

mental illness can experience relief from their symptoms by actively
participating in an individual treatment plan. In addition to medication
treatment, psychosocial treatment such as cognitive behavioral therapy,
interpersonal therapy, peer support groups and other community
services can also be components of a treatment plan and assist with
recovery. The availability of transportation, diet, exercise, sleep, friends
and meaningful paid or volunteer activities contribute to overall health
and wellness, including mental illness recovery.15
According to the 2008 National Survey on Drug Use and Health, which
is administered by the Substance Abuse and Mental Health Services
Administration (SAMHSA), 13.4% of adults in the U.S. received treatment
for a mental health problem in either inpatient or outpatient settings.16
Caring for people with mental health disorders
The following are some suggestions to improve communication with

individuals who have a mental health disorder.
• Avoid using words like “crazy,” “wacko,” or “loony.”

• Do not define a person by his/her diagnosis but treat each
person as an individual.
• Ask a person what makes him/her most comfortable and
accommodate needs to the greatest extent possible.
• Create an environment that builds on people’s strengths and
promotes understanding.
• Try to keep a situation as stress-free as possible.
• Stay calm and supportive in a crisis situation. Ask the person
how you can assist and try to identify who his/her support
person/system is so you can involve them for help.17
National Alliance on Mental Health in

Delaware
2400 West 4th Street
Wilmington, DE 19805
888-427-2643 Toll Free
302-427-2075 Fax
http://www.namidelaware.org
Mental Health Association in

Delaware
100 West 10th Street, Suite 600
302-654-6833 or 800-287-6423 Phone
302-654-6838 Fax
http://www.mhainde.org
Resources
Substance Abuse and Mental Health
Services Administration
Delaware Division of Substance Abuse and
SAMHSA’s Health Information
Mental Health
Network
Herman M. Holloway, Sr. Campus
P.O. Box 2345
Rockville, MD 20847
Main Building
877-726-4727 Phone
800-487-4889 TTY
302-255-9399 Phone
240-221-4292 Fax
302-255-4428 Fax
http://www.samhsa.gov
800-652-2929 Crisis Intervention only
http://www.dhss.delaware.gov/dhss/dsamh/
National Suicide Prevention Lifeline
800-273-8255 Phone
Contact Lifeline in Delaware
888-628-9454 Spanish
P.O. Box 9525
800-799-4889 TTY
http://www.suicidepreventionlifeline.
302-761-9100 Phone
org
800-262-9800 Toll Free in Kent and Sussex
302-761-9700 Deaf Helpline (TDD)
302-761-9800 Administrative Office
302-761-4280 Fax
http://www.contactlifeline.org
15
National Alliance on Mental Illness. What is Mental Illness: Mental Illness Facts. Retrieved from http://www.nami.org/
template.cfm?section=about_mental_illness
16
National Institute of Mental Health. Use of Mental Health Services and Treatment Among Adults. Retrieved from http://
www.nimh.nih.gov/statistics/3USE_MT_ADULT.shtml
17
Partially adapted from United Spinal Association, Disability Etiquette: Tips on Interacting with People with Disabilities (2008). Jackson
Heights, NY.
Additional Resources
Below are resources to strengthen accessibility and effective
communication in your practice.
ACCESSIBILITY
Access to Medical Care for Individuals with Mobility Disabilities

This document, developed by the Department of Justice in 2010,
outlines important considerations for providers in creating accessible
exam rooms and gives an overview of accessible medical equipment
including accessible exam tables and chairs, lifts for transferring patients
and accessible mammography equipment.
http://www.ada.gov/medcare_mobility_ta/medcare_ta.pdf
How Usable are Your Facilities for Patients with Disabilities?

Prepared by the The Center for Universal Design and the North Carolina
Office on Disability and Health, Chapel Hill, NC.
http://www.fpg.unc.edu/~ncodh/pdfs/rbhealthcare.pdf
BUSINESS
Expanding Your Market - Tax Incentives for Businesses

http://www.ada.gov/taxincent.pdf
Mid-Atlantic Disability and Business Technical Assistance Center

(DBTAC)
This regional center provides information, guidance and training on
the Americans with Disabilities Act (ADA), tailored to meet the needs of
businesses, government entities, organizations, and individuals in the
Mid-Atlantic Region.
http://www.adainfo.org/
ADA Best Practices Tool Kit for State and Local Governments
Website Accessibility Under Title II of the ADA
Although designed for municapalities, this document provides an
overview of basic accessibility issues.
http://www.ada.gov/pcatoolkit/chap5toolkit.htm
Reaching out to Customers with Disabilities

This online course is a good overview of the implications of the ADA for
small business. Lesson 2 addresses customer communication.
http://www.ada.gov/reachingout/intro1.htm
COMMUNICATION AND LANGUAGE ISSUES
Plain Language: A Promising Strategy for Clearly Communicating

Health Information and Improving Health Literacy
Office of Disease Prevention and Health Promotion, Dept of Health and
Human Services
http://www.health.gov/communication/literacy/plainlanguage/
PlainLanguage.htm
Removing Barriers: Tips and Strategies to Promote Accessible

Communication
North Carolina Office on Disability and Health (2002). Chapel Hill, NC.
http://www.fpg.unc.edu/~ncodh/pdfs/rbtipsandstrategies.pdf
Language Line Services

Language Line Services is the leader in over-the-phone interpretation
and document translation services in more than 170 languages.
1-800-752-6096
http://www.languageline.com
DISABILITY ETIQUETTE
Disability Etiquette: Tips on Interacting with People with

Disabilities
United Spinal Association (2008). Jackson Heights, NY.
http://www.unitedspinal.org/pdf/DisabilityEtiquette.pdf
Ten Commandments of Disability Etiquette

United Cerebral Palsy (2011). Washington, DC.
http://www.ucp.org/resources/disability-etiquette
PROVIDER TRAINING
“Healthcare Access for Persons with Disabilities,” A Continuing

Education Course for Physicians, Nurses, Social Workers, Other
Healthcare Professionals and Medical Office Staff.
University of Kansas Disability and Health Program
http://www.kdheks.gov/disability/download/KS-TRAIN_course_HC_
professionals.pdf
Access to Medical Care: Adults with Physical Disabilities and Access

to Medical Care: People with Developmental Disabilities.
World Institute on Disability. Oakland, CA.
http://wid.org/access-to-health-care/health-access-and-long-term-
services/access-to-medical-care-adults-with-physical-disabilities
Notice of Non-Discrimination,
Equal Opportunity and Affirmative Action
The University of Delaware does not discriminate on the basis of

race, color, national origin, sex, disability, religion, age, veteran status,
gender identity or expression, or sexual orientation in its programs
and activities as required by Title IX of the Educational Amendments
of 1972, the Americans with Disabilities Act of 1990, Section 504 of the
Rehabilitation Act of 1973, Title VII of the Civil Rights Act of 1964, and
other applicable statutes and University policies. The following person
has been designated to handle inquiries regarding the Americans
with Disabilities Act, the Rehabilitation Act, and related statutes and
regulations: Tom Webb, Director, Office of Disabilities Support Services,
240 Academy Street, Alison Hall Suite 119, University of Delaware,
Newark, DE 19716, 302-831-4643. The following person has been
designated to handle inquiries regarding the non-discrimination
policies and to serve as the overall campus coordinator for purposes
of Title IX compliance: Bindu Kolli, Chief Policy Advisor, Office of Equity
and Inclusion, 305 Hullihen Hall, University of Delaware, Newark, DE
19716, 302-831-8063. The following individuals have been designated
as deputy Title IX coordinators: for Athletics, Jennifer W. Davis, Vice
President for Finance and Administration, 220 Hullihen Hall, University
of Delaware, Newark, DE 19716, 302-831-2769; and for Student Life,
Dawn Thompson, Dean of Students/AVP for Student Life, 101 Hullihen
Hall, University of Delaware, Newark, DE 19716, 302-831-8939. Inquiries
concerning the application of anti-discrimination laws may be referred
to the Title IX coordinators or to the Office for Civil Rights, United
States Department of Education. For further information on notice of
nondiscrimination, visit
http://wdcrobcolp01.ed.gov/CFAPPS/OCR/contactus.cfm for the address
and phone number of the U.S. Department of Education office that
serves your area, or call 1-800-421-3481.
Center for Disabilities Studies • University of Delaware • College of Education and Human Development
461 Wyoming Road • Newark, DE 19716
302-831-6974 • 302-831-4689 TDD • www.udel.edu/cds

Effective Communication For Health Care Providers: A Guide To Caring For People With Disabilities

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Effective Communication For Health Care Providers: A Guide To Caring For People With Disabilities

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Effective Communication

for Health Care Providers

PART 1 THE REQUIREMENT FOR EFFECTIVE

Tax Incentives for Improving Access . . . . . . 6

PART 2 COMMUNICATION BEST PRACTICES. . 8

Telecommunication Services for Patients . . . 12

Sign Language Interpreters. . . . . . . . . . 13

PART 3 WORKING WITH PEOPLE WITH

About Hearing Loss . . . . . . . . . . . . . . 24

About Vision Loss . . . . . . . . . . . . . . . 26

About Communication Disorders. . . . . . . 28

About Intellectual, Cognitive, and

About Physical and Mobility Disabilities . . . . 32

About Mental Health Disorders . . . . . . . . 34

Disability, as defined in the Americans with Disabilities Act, is any

Communication is an important part of any

Disability can impact communication. Identifying

This guide will provide information to help you communicate effectively

PART 1 REQUIREMENT FOR EFFECTIVE COMMUNICATION

PART 2 COMMUNICATION BEST PRACTICES

PART 3 WORKING WITH PEOPLE WITH DISABILITIES

“A public accommodation shall take those steps that may

Americans with Disabilities Act

The nature of health care elevates the magnitude of consequences for

Some specifics about providing effective communication

• Providers are responsible for ensuring effective communication,

Deciding what accommodation is needed

The rules are intentionally flexible. Different health care settings —

• the nature, length and importance of the communication;

Examples of auxiliary aids and services

There are many options available for creating effective communication

A fundamental alteration is a change that is so significant that it

The ADA does not require businesses to furnish any communication

Settlement agreements negotiated with the Department of Justice are

It is important to note that, even when a particular communication aid

Tax incentives for improving access

A business that annually incurs eligible expenses to bring itself into

Small businesses with 30 or fewer employees or total revenues of $1

Tax Incentives in Combination

These two incentives can be used together by eligible businesses if the

For further details and information, review

Source: Expanding Your Business, Tax Incentives for Businesses, U.S.

Good communication is an essential part of any successful relationship,

• Speak directly to the patient rather

For relatively simple transactions

For more extensive or complex communications

Ask. Accommodate. Communicate.

Consider asking the following question when scheduling every

“Do you have any special needs related to

TABLE 1 COMMUNICATING WITH AND ABOUT PEOPLE WITH DISABILITIES

PEOPLE FIRST LANGUAGE LANGUAGE TO AVOID

Person with multiple sclerosis Afflicted by MS

Accessible parking or bathrooms Handicapped parking or bathroom

Describing accessible features

When speaking about services or features designed to accommodate

Telecommunication Services for Patients with

Sprint Video Relay Service

Voice Carry Over

Hearing Carry Over