Preparing Physicians to Care for People with Disabilities: 
Core Competencies and the ADA

Susan M. Havercamp, PhD, FAAIDD, NADD-CC
The Ohio State University Nisonger Center

Ohio State University Nisonger Center
University Center for Excellence providing the highest quality interdisciplinary training, clinical care, and research to support the inclusion of 
people with developmental disabilities
 in all aspects of community life.

Objectives
Learners will recognize:

•	Although overall healthcare is improving, health inequities exist for disadvantaged groups, including Americans with disabilities.
•	The Americans with Disabilities Act requires health care entities to provide full and equal access for people with disabilities through reasonable accommodations, effective communication, and accessible facilities.

Improvements in population health and health equity depend on 
training the health care workforce 
to provide care across populations [1]

The World Health Organization defines disability as denoting impairments of body functions and structure, limitations in activity, and 
participation restrictions. [2] 

26% of adults in the U.S. has a disability [3]

At 26% of the population, people with disabilities represent the largest minority group in the country, 

yet the health care system is not prepared to meet their needs
People with disabilities
•	Overrepresented in health care system
–	 health needs related to disabling condition
–	high rates of chronic health conditions [4]

•	Despite the high need for health care, people with disabilities report barriers to quality care [5]

World Report on Disability
People with disabilities report
•	poor access to healthcare compared to people without disabilities
•	high rates of unmet healthcare needs
•	dissatisfaction with the healthcare they receive [6]

•	People with disabilities were more than            as likely to report finding healthcare provider skills inadequate to meet their needs [6].

•	People with disabilities were nearly           times more likely to report being denied care [6].

•	People with disabilities were more than         times more likely to report being treated badly [6].
Health care providers
•	Report feeling uncomfortable and unprepared, 
•	significant training gaps contribute to health care disparities [7]
Health Care Providers tend to
•	Underestimate the size and diversity of the disability population
•	Underestimate the health, and quality of life of people of disabilities
•	Hold inaccurate assumptions about current/future functional status 
•	Overlook cultural, economic, social determinants of health
•	Overlook health issues not having to do with the disability

What are training barriers?
•	Inclusion of disability content has relied on the advocacy efforts of individual champions in health education [17]
•	Constraints on time and resources, 
	competing priorities
•	School accreditation requirements and professional licensure exams lack disability
•	Lack of systemic organizing framework
Lack of systemic organizing framework
•	Innovative disability curricula have been developed, evaluated, and published [8-13]
•	Learning objectives, curricular content, and evaluation measures were developed independently for each. 
•	Agreement on what to teach about disability remains has not been reached
Milestones toward Disability- Competent Healthcare Workforce [18]
•	Collectively decide what health care providers need to understand about disability (core competencies)
•	Change training and licensure requirements to ensure students receive disability training
•	Develop evidence-based curricula
•	Develop robust protocols to evaluate disability competence
•	Evaluate the impact of disability training on the delivery of disability-competent care and the impact of competent care on patient health outcomes
•	Explore health care delivery models and incentive structures to promote disability competent care
Competency-based education
•	allows us to develop learning objectives based on the health needs of the community, people with disabilities. 
•	The first step is to explicitly map the specific health needs of people with disabilities to a set of competencies for the workforce in training [19]

Alliance for Disability in Health Care Education
•	Asked,  What do health care professionals 
	need to understand about disability to provide 
	quality care to patients with disabilities?”

2. Competency = desired knowledge, skills, and behaviors required to successfully perform the healthcare role.

3. Drafted core competencies on disability

See Alliance website, www.adhce.org 	
The Ohio Disability and Health Partnership Sought Broader Input [20]
go.osu.edu/disabilitycompetencies

Disability stakeholder consensus

•	The six core competencies define the standard for disability training to improve healthcare for people with disabilities [20]

Contextual and Conceptual Framework
•	Describe the civil rights and independent living history of people with disabilities and their access to services. Understand how such history has both informed current thinking and improved access to care and equal rights for people with disabilities. 
•	Describe how social determinants of health directly impact people with disabilities (e.g., discrimination, employment, education, transportation, housing, poverty, access to healthcare). 

Professionalism and patient-centered care
•	Demonstrate communication strategies to best meet the needs of the patient. Seek out and implement appropriate resources, including interpreter services, to communicate effectively using clear language at an appropriate level of health literacy. Adjust schedule to allow extra time as needed.
•	Discuss issues of trust, confidence, and confidentiality with patients who receive support with personal care during health care encounters related to their disability.

Teams and systems based practice
•	Demonstrate skills in teamwork including flexibility, adaptability, open communication, assertiveness, conflict management, referral, use of evidence-based practice to support decision-making and mutual goal-setting with patients with disabilities and other team members.

Clinical Assessment
•	Respond competently to a patient’s language, race, ethnicity, sexual orientation, gender, gender identify and expression, health literacy, and other cultural factors. 

•	Apply strategies or supports that could be used in a healthcare setting to accommodate patients with functional limitations

Clinical Care over the lifespan and during Transitions
•	Tailor recommended supports and interventions to the patient’s cultural beliefs and values, time, resources, and preferences. Be prepared to propose constructive solutions to possible conflicts between patient, caregivers, and other professionals about goals and treatments. 
•	Demonstrate skill in identifying, coordinating, referring, and advocating for access to community and health care resources needed to support treatment plan objectives.

Accommodations are 
civil rights, not merely the right thing to do
Doctors think...
•	Myth - A doctor who does not specialize in a patient’s disability does not have to provide care to that person.
•	Myth - Patients who want sign language translators can be expected to make those arrangements and pay for them
•	Myth – The ADA is not my responsibility in private practice/ in leased space
The ADA requires that health care entities provide full and equal access to people with disabilities
Providers must ensure that communication with patients with hearing, vision, and speech disabilities are as effective as communication with other patients 
•	Provide qualified sign language interpreter for patients who request this
•	For a person with low vision, providing a qualified reader for written information and providing post- op discharge instructions and medication management in large print
•	Digital accessibility is also required for effective communication
Legal Obligations and Responsibilities
•	Identify the physical access requirements (e.g., accessible exam table, mammography equipment, etc.) of the ADA, Rehabilitation Act, and related laws and policies that apply to health and the provision of health care. 
 
•	Ensure that healthcare providers and support staff members are trained to provide services that meet the needs of the patient with a disability (e.g., knowing how to appropriately transfer a patient with a mobility limitation to an exam table). 
Accommodation examples: 
•	When scheduling, ask all patients if they require any accommodations or assistance to fully participate in care.  Note responses in chart.
•	Granting an early appointment and allowing the patient to go directly to the exam room to avoid the waiting room
•	Assisting a person with a mobility disability onto the exam table
•	Sending intake paperwork to the patient in an accessible format to be completed independently before appointment
•	Scheduling extra time for exams with patients whose disability requires it

Students Value Disability Training Opportunities
More Comfortable with Patients 
Students Recognize Personal Bias 
Increased Understanding
Nothing About Us Without Us
Disability Resources for 
Health Care Providers
Fact Sheets
•	ADA National Network, Health Care and the Americans with Disabilities Act, https://adata.org/factsheet/health-care-and-ada 
•	Pacific ADA Center, Health Care and the ADA, https://www.adapacific.org/healthcare  
•	US Department of Justice, Access to Medical Care for Individuals with Mobility Disabilities, https://www.ada.gov/medcare_mobility_ta/medcare_ta.htm 
•	U.S. Department of Justice, ADA Requirements: Effective Communication, https://www.ada.gov/effective-comm.htm 
Fact Sheets
•	Centers for Disease Control and Prevention, Disability and Health Information for Health Care Providers, https://www.cdc.gov/ncbddd/disabilityandhealth/hcp.html
•	American Foundation for the Blind, ADA Checklist: Ensuring Access to Services and Facilities by Patients who are blind, deaf-blind, or visually impaired, https://www.afb.org/blindness-and-low-vision/your-rights/advocacy-resources/ada-checklist-health-care-facilities-and 
•	American Medical Association, Access to care for patients with disabilities Strategies for ensuring a safe, accessible, and ADA compliant practice, https://www.ama-assn.org/media/24926/download 

Online Training
•	State University of New York, Disability Integration Toolkit, https://www.upstate.edu/pmr/education/toolkit/index.php   
•	Ohio State University Nisonger Center, Disability Trainings for Healthcare Providers, https://nisonger.osu.edu/education-training/ohio-disability-health-program/disability-healthcare-training/ 
•	American Foundation for the Blind, Serving the Needs of Individuals with Visual Impairments in the Healthcare Settings, https://www.afb.org/research-and-initiatives/serving-needs-individuals-visual-impairments-healthcare-setting 
•	Centers for Disease Control and Prevention, Mark’s story, https://www.youtube.com/watch?v=4D_wsryhBXY 
We Must Include Disability Competencies in Professional Standards 
for Accreditation and Licensure

Thank you!
References

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•	Alliance for Disability in Health Care Education (2019). Core Competencies for Disability in Health Care Education. Peapack, NJ. Alliance for Disability in Health Care Education. http://www.adhce.org.