Caring for Patients with Special Needs – Interview with Michelle Allen

communication dental anxiety special needs teamwork

Today I want to talk about caring for patients with special needs with our guest Michelle Allen.

Michelle Allen is a speech-language therapist and has been working in the field for 10 years. Her main focus has been working with patients and individual clients that have a variety of special needs.

From toddlers, children, adults, and teenagers, as well as the geriatric age group, the whole wide range of disorders and disabilities with a focus on managing their cases in regards to communication.

Did you know that one in six people has a form of disability?

About 15% of the population is suspected or diagnosed to have some sort of special need.

A lot of the cases can go undetected or undiagnosed, while others have received a diagnosis or have been identified with special needs.

Special needs encompasses many different areas. It could be a physical disability. It could be a mental health disorder or behavioral issue.

This also includes communication disorders, things that are acquired later on in life or developmentally, as well as issues that an individual is born with.

Sometimes it may be obvious when a person has a disability, whether it's a physical or mental challenge that is easy to detect.

What do you look out for to know when someone may require special care if it is suspected but not easily identified?

It is important to remember that when it comes to individuals that have special needs, there's a wide range in terms of severity.

There may be severe or moderate to severe, but it can be very clear and we can make the adjustments that we need to because it's so obvious.

But there are also those that have mild to moderate cases where it can be really difficult for them because sometimes people aren't understanding or they may think it's just their personality when really, there might be something deeper than that in regards to learning difficulties or mental health issues.

You might notice decreased attention to tasks or difficulty with following instructions, or you notice that their comprehension might be a bit off.

You may be explaining something to them and they may be referring to something that's off topic that has nothing to do with what was being discussed.

Notice if they appear to be disorganized, confused, forgetful, or agitated.

For example, if you’re providing instruction for dental care and they seem agitated, or they fold up the written instructions and put it in their purse without asking any follow-up questions, that could be an indicator.

Those are just a few different signs that they're actually struggling with understanding what's going on.

Let’s assume, as a dental assistant, you suspect a patient may need special care. How do you go about reassuring them and walking them through the process?

It depends on what concerns or issues you have noticed.

So if they're having difficulty with communication or with comprehension, it would be helpful if you decreased your rate of speech when you're explaining the procedures.

You could also repeat and rephrase what you're trying to communicate to them.

It's challenging when someone has difficulty with communication or comprehension and they're used to relying on facial expressions, but in the medical field, all the time you have a mask on and they're not able to pick up on those cues.

Knowing that they can't see your facial expressions and don't have that information, you can try to emphasize this by using a caring, empathetic tone of voice.

When they can't see your smile, a simple tactile cue like placing your hand on their shoulder for reassurance can make all the difference.

What's really important is making sure that you're explaining everything.

It is important to remember that we are poking around in their mouth or doing things that they might not be used to having done to them in a medical setting. Oral hygiene and oral care are very personal and feel very intrusive.

So name the steps before you do them, go through it beforehand with them so that they're prepared and aware.

Also, allow them to ask questions, anything that they didn't quite understand, checking in with them to make sure.

Just because they're nodding their heads up and down doesn't mean that they're actually getting a feeling of what's going on.

So check in with them verbally so that they have an opportunity to say I'm not quite sure or can you go over that one more time?

I previously interviewed Shelley Renee. She uses an acronym: WINR.

W for the welcome, creating a nice fuzzy, warm welcome.

I for information, making sure that the patient is well informed as to what is happening.

N for next, let them know what's upcoming so that they're not anticipating but that they have a clearer picture as to what the next steps are.

And finally, R: reassure the patient about whoever the next team member is, rave about your team member. It seems to fit so comfortably into what you've just described.

Great. I've heard of the tell-show-do approach where you explain and then you give a visual showing with any kind of a model to show what it is that you're going to be doing beforehand and then you do, so tell show do.

Should dental teams encourage parents who have children with disabilities to start early?

It's critical for dental team members or any medical professional to understand that many families with children or adults with disabilities can be very hesitant and apprehensive about taking their loved ones to these appointments because they know what challenges may arise, whether behavioral or simply confusion.

Sometimes, family members avoid these visits.

Things like dental hygiene can get put on the back burner because to them it might not seem as essential.

We know that dental hygiene is extremely important.

And it does almost require some outreach to let these families know that your practice cares for all types of patients and that they are welcomed into the office and that your team will meet them where they are.

Be able to work through their challenges and work with their challenges instead of skipping over procedures or thinking that they're not going to be allowed in the office and things like that.

So the dental team should be aware that the families might be kind of apprehensive and just let them know that their loved ones are welcome there.

Caregivers are also such a valuable source of information as to what challenges the individual has so that your office can be prepared for the things that might come up.

Additionally, I think that sometimes on intake forms, there's a question that says, "Does this individual have any kind of medical, physical, developmental, cognitive, or psychological challenges?"

The family has an opportunity to disclose that information beforehand.

Because if they're not directly asked, they just might not mention it, and then the patient comes in and the team is not fully prepared for what's coming their way.

Be clear about when the appointment is being scheduled, what's going to happen, how long it's going to take, and how many assistants need to be in the room, because sometimes you need more than one assistant to keep the patient calm to help the doctor.

So you really have to plan the appointment based on the patient; to see patients who need a little more care and time earlier in the day because they're less tired and more tolerant.

It’s also important to realize that...

there is a correlation between decreased oral hygiene and those that have special needs

...because of their challenges with attention, fine motor skills, or if they have a learning disability that prevents them from realizing the importance of brushing thoroughly.

So, in terms of self-care, make sure that not only the patient but also the caregiver, understand that what appears to be something as simple as brushing your teeth may be difficult for them.

If you're seeing that this patient has more significant dental challenges or issues, it could be because the patient is not able to grip the toothbrush in the correct way or they don't have the attention span to spend the time on all the different areas of the mouth.

There are a few different adaptations that can be made, like extenders for the toothbrush or handles that have thicker grips that can be attached to them to help with the dexterity, and an electric toothbrush can help with just being more thorough.

So the dental team might need to recognize that some adjustments have to be made that are not typical of what you would instruct a typical patient for self-care.

What a wonderful session with Michelle Allen, full of so many pearls.

Today’s quote comes from Bob Marley:

“The greatness of a man is not how much wealth he acquires

but his integrity and his ability to affect those around him positively.”

We certainly can affect those around us positively by just thinking through how we approach what the visit should look like.

The bottom line is, if you're prepared for something, even if it doesn't go 100%, it is so much less stressful than if you have no idea.

Our patients may have learning disabilities, and developmental or mental challenges.

Michelle Allen reminds us of the importance of slow and deliberate communication.

✔️ They rely a lot on facial cues, and if we're wearing masks, it really dampens the experience for those patients.

✔️ So we have to think of other ways to let them feel comfortable; our tone, the rate at which we speak, a touch in a non-threatening zone depending on the patient, as some patients may not want to be touched at all.

✔️ Michelle also reminded us that their home self-care may need to be customized.

✔️ They may need extenders for their toothbrush or something that would specifically assist the patient with being able to manage their home care regime.

✔️ Also, be sure to schedule the appointment appropriately, allowing adequate time to care for the patient.

✔️ And best of all is to include on the intake form, questions about mental and developmental challenges so that hesitant parents can share about their disabled child without having to explain too much.

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This is Episode 11 of my Irreplaceable Dental Assistant podcast.

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