Initiating the session

Outline the structure of the consultation at the start. Doing this means that you can summarise at points and let the person know what is coming next.

People who have a learning disability may feel uncomfortable or anxious in new or busy environments. Think about how well the person will cope with waiting in the facilities that you have available. Consider making reasonable adjustments, such as giving the person the first appointment of the day. If there are unavoidable delays, keep the person informed so that they know what to expect. Some people with autism are hypersensitive to noise and others fearful of crowds. They may be anxious while waiting their turn.

Consider the environment that the consultation should take place in. Taking on complex information in a busy or unknown environment can be overwhelming for the person. Allow the person some time to settle into the new environment. Think about whether your usual practice environment is suitable, or if it is better, or possible, to visit the person in their own home or a neutral and familiar environment such as a day centre.

Building relationships

You will need to build rapport with the person just as you would with anyone else. Focus on the person rather than the disability.

Consider your own verbal communication. Tone and speed of speech is important to consider. Aim to speak more slowly and clearly using a soft yet reassuring tone, without being patronising.

Non-verbal communication skills are just as important. Demonstrate active listening by facing the patient as you speak. This will help people who may have hearing difficulties understand what you are saying. In the same way that your body language is important, think about that of the person with the learning disability. Signs of anxiousness and frustration may become apparent if a person is having difficulty understanding you, or is unhappy in the situation of the consultation. Be prepared to respond to that by allowing the person a pause or time to tell you how they feel.

Be approachable and genuine. Welcome the person with a smile and introduce yourself by your first name and role. If the person has come along with a parent, carer or support worker, then address the person first. Parents, carers and support workers can offer a wealth of information in the consultation but it is important to always bring the discussion back to the patient; they should be the focal point of the discussion.

Encouraging the person to take part and engage right from the start is an important step. Some people may need 'permission' to join in the discussion and to ask questions as you move through the conversation.

Structure

Refer back to the consultation structure you explained at the start as you progress through the session.

It might be appropriate to use something visual, for example, a leaflet with pictures as a way to structure the consultation. You can refer to the leaflet to illustrate to the person where the consultation is going, and to support you to keep the consultation on track.