28 May 2021
In part two of her article, Penny Clarke uses the success of the Hidden Disabilities Sunflower scheme to consider how the profession can support these clients, particularly those who are autistic.
Penny Clarke
Job Title
Image: Hidden Disabilities Sunflower
According to the Government’s Family Resources Survey, about 14 million people in the UK live with some form of disability1.
Around 80% of these disabilities are invisible, meaning some of our clients may experience difficulties when visiting our practices that we are unaware of2.
We are used to making adjustments for our clients with physical disabilities, but how good are we at recognising and helping those whose needs are less visible?
In 2016 Gatwick Airport launched the Hidden Disabilities Sunflower scheme in response to the question: “How can we recognise that one of our passengers may have a non‑obvious disability?”3 The airport provided passengers (or family members) with a sunflower-patterned lanyard (pictured) that let staff know they needed “additional support, help or a little more time”.
The initiative was so successful it has been adopted by businesses around the world. In the UK all airports now recognise the scheme, and many large supermarket chains and businesses have signed up.
Many people benefit from this scheme, including those with:
The Hidden Disabilities Sunflower website contains information for businesses that would like to register their support for the scheme.
The adjustments mentioned in this article are veterinary‑specific and focus on supporting neurodivergent clients, particularly those who are autistic.
Everyone has different strengths and experiences different difficulties; it’s what makes our personalities unique.
Autism is described as a spectrum condition because huge variation exists in how people experience things.
Some autistic people have a behavioural profile called pathological demand avoidance. An autistic person with pathological demand avoidance may have different difficulties to those with other profiles of autism.
If a client asks for additional support, find out exactly what he or she finds difficult about visiting your practice and what specific help he or she needs.
Many neurodivergent people have difficulties around social interaction and communication, as well as sensory sensitivities.
Visiting a veterinary practice presents an immediate expectation to participate in social interactions – in the waiting room receptionists ask questions, while other clients may start conversations. For those with sensory sensitivities it can feel quite overwhelming, with barking dogs, soiled cat carriers, bright lights and loud telephones.
The challenges continue in the consult room, with a time pressure to answer questions and process all the information given. Strong odours may exist to contend with, in the form of heavily scented disinfectants and air fresheners. It can be confusing when complex conditions and medications are discussed in a very short amount of time.
No prescriptive list of adjustments can be made within a practice to support every neurodivergent client. Many of the following suggestions could be used to improve the quality of service we provide to all of our clients.
Someone’s tolerance for pressure may vary on a daily basis – so what helps someone one day may be inadequate, or not needed at all, another day. It’s important to check each time we see a client that we are helping him or her in the best way for that particular day.
Hidden disabilities, including neurodevelopmental conditions, are included in the Equality Act 20104. This law says it’s a requirement for businesses to make reasonable adjustments to ensure their products and services are accessible to all.
The three categories of possible adjustments are:
It’s a personal choice whether clients tell you they are autistic or have a hidden disability. If they do tell you, it’s important to comply with General Data Protection Regulations and ask permission before storing details on their record card5.
Some neurodivergent people experience high levels of anxiety before visiting an unfamiliar place.
Many tourist attractions now produce guides for visitors with additional needs so they can plan their trip in advance. A good example of this is the guide produced by Warner Bros Studio for the Harry Potter Tour6. It gives a clear idea of what’s expected along the tour and highlights areas that could be challenging from a sensory point of view.
Producing a visual guide of your practice helps to explain the entire process of bringing an animal in for an appointment. A video on the practice website or a pictorial paper guide are both effective ways of introducing the sights and sounds of your practice. The guide should show each stage of a visit to the practice and include:
It’s impossible to anticipate every eventuality (such as an animal needing a blood test), but giving a basic idea of the appointment process is still helpful as it reduces fear of the unknown.
Many shops and businesses now run an “autism hour”7, which aims to reduce the sensory overload some customers may experience. Music is turned down and lights are dimmed, making the environment quieter and calmer.
This exact model could be tricky to replicate in a veterinary practice, but one alternative is to offer appointments at the quietest times.
Long waiting times may increase anxiety for some people; scheduling appointments for the start of an appointment block can help prevent this. Vets and nurse could also prioritise the order they see their clients.
It is useful to display signs in the waiting room advising all clients of the adjustments the practice is making to accommodate people with hidden disabilities.
Some people may prefer to wait outside and avoid the waiting room completely; receptionists can communicate this to veterinary staff or add a note to the waiting list.
When the waiting room is busy and noisy, an alternative waiting area could be offered, such as a spare consult room or quiet corridor.
Receptionists could provide clients with additional information about their appointment, such as which consult room they will be seen in and the expected waiting time.
Some autistic people (and parents of autistic children) carry autism alert cards. These may be handed to reception staff to explain autism and why certain behaviours may be displayed. Providing your client has given permission, this information could be shared with the clinical staff who will be seeing him or her.
Open-ended questions may be difficult for a neurodivergent client to process. Some people prefer being asked only short, necessary questions. Find out what works best for your client, but, either way, give your client plenty of time to think of his or her answers.
Don’t rely on body language to gauge how your client is feeling; use less non-verbal communication such as eye contact, facial expressions and hand gestures. These are especially difficult for an autistic person to process if he or she is feeling anxious.
Ask if your client would like a nurse in the consult room to help him or her handle his or her pet.
Consider how your consult room appears to someone who has sensory sensitivities. Try to ensure interruptions are kept to a minimum, avoid strongly scented disinfectants, but also remove unpleasant animal smells.
Use clear language to explain treatment plans or diagnoses; avoid sarcasm, idioms and figurative speech. For example, “keep your eyes peeled for any more vomiting” sounds like a scary prospect if taken literally.
Draw diagrams and/or provide a written summary of the consultation, including planned treatment and details of future appointments. Your client can take these away and process the information you gave at his or her own pace.
At the end of the appointment, accompany your client to the reception desk and personally speak to the receptionist so he or she is clear what future appointments need to be made.
Some people have a preference to see the same vet, so, where possible, try to accommodate this. If it’s not possible, make sure your client knows who he or she will be seeing next time.
Some clients may appreciate a telephone call or email in the days following the appointment, especially if complex diagnoses have been discussed.
It is widely observed that some autistic people have a particular affinity with animals. Maureen Bennie, an advocate for autistic people and founder of the Autism Awareness Centre, wrote: “Animals don’t judge and accept people’s differences. Because communication with them is non-verbal, it can alleviate the stress of having to talk and converse.”8
The charity Dogs for Good has helped many families of autistic children by introducing dogs into their households. Summaries of recent research carried out into this special dog/human bond can be found on its website. Many of these papers found that interacting with dogs actually lowered the amount of cortisol produced by the body and, therefore, reduced anxiety9.
Most clients have a strong bond with their pet, but it can be a particularly powerful one for someone who is autistic. If you anticipate an emotionally challenging conversation, make sure you’re prepared. Book a longer appointment time where possible.
It can be helpful for another member of staff to be present if your client is alone. Stay calm if your client becomes upset and try not to become overly emotional yourself. Avoid physically touching your client when comforting them.
If autistic children become upset, stay calm and ask their parents what you can do to help. If children (or adults) are having a meltdown it’s usually because they are feeling overwhelmed. Providing a calm, private environment can help de‑escalate difficult situations.
Our world is slowly becoming more accepting of neurodiversity, but there’s still work to be done.
Signing up to the Hidden Disabilities Sunflower scheme is a great way of demonstrating to clients how committed you are to being a more inclusive practice.
It’s not an exaggeration to say that small changes you make for someone in your practice can have a big impact on his or her quality of life.
