Insights From Our Editors

How to Best Care for Patients with Special Needs

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

Oct. 17, 2018

About 56.7 million people–19 percent of the population– have a disability, according to the most recent data from the U.S. Census. That means many of your patients probably have special needs. How is your practice serving these individuals?

Let’s start with the definition of special needs:
“… any of various difficulties (such as a physical, emotional, behavioral, or learning disability or impairment) that causes an individual to require additional or specialized services or accommodations (such as in education or recreation).”i

The overall percentage of students being served in the U.S. in programs for those with disabilities is approximately 13 percent. The prevalence of autism in the U.S. is estimated at 1 in 59 births (CDC, 2018) and more than 3.5 million Americans live with an autism spectrum disorder (Buescher et al., 2014).

I [Dr. Burns] was first introduced to patients with special needs during my Pediatric and Vision Therapy residency at the State University of New York. There I diagnosed and treated the visual problems of many patients who had special needs. It was there that I learned how to create an atmosphere where these patients are loved and not just tolerated.

When I moved to private practice, we made sure it was special needs friendly. Here are some examples of how we did that.

• The reception area allows for patients to sit in age-appropriate chairs or on the floor (if they want to), and has movies and popcorn.

• Our office is wheel chair friendly. This is different than just making the practice wheel chair accessible. The exam room chair is easily removed and a wheelchair put in its place so the patient can be examined in a full-length room without the need to transfer into an exam chair.

• Every staff member is trained on how to provide care to patients with special needs. For example, all doctors and staff speak directly to the patient even if the patient does not respond.

• All equipment is geared toward patients of all abilities, including handheld autorefractors, handheld tonometry, handheld slitlamp, as well as acuity that can be taken with eye contact only (does not require a verbal response).

• All staff and doctors are trained to work with patients who become agitated and combative.

• We have eyewear for our patients with special needs that is flexible, durable and virtually unbreakable.

With the increased incidence of patients being diagnosed with autism, there is an increased need for these patients to receive care. While other offices may find these patients challenging, we actively recruit. We do this by providing in-services in schools dedicated to children with autism. Once you begin serving patients with autism, parents share your name with other parents through social media.

We also care for patients with traumatic brain injury (TBI) and/or concussion. These patients with special needs require different testing due to symptoms of photophobia, diplopia, disequilibrium and executive function impairment. VOMS for Concussion (vestibular ocular motor screening) and RightEye are two tools that we’ve found are very helpful with these conditions.

Not only do we test, but we also treat the unique visual problems seen in these populations.

A side benefit is that once these children are cared for in our practice in a loving environment, often the rest of the family will seek care with us too.

We have years of experience working with children with special needs, and this experience let us develop a unique understanding of how to make patients with special needs feel at home during testing and treatment.

References
i. https://www.merriam-webster.com/dictionary/special%20needs
ii. https://nces.ed.gov/fastfacts/display.asp?id=64
iii. http://www.autism-society.org/what-is/facts-and-statistics/

 

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