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t m c » p u l s e | s e p t e m b e r 2 0 1 9 29 From contained to fragmented care Some adult patients with intellec- tual disabilities may not know how to read signage, understand the after-visit summary or comprehend the next steps needed for further care, Peacock explained. "Pediatric systems are con- tained. If you want to see a specialist in the pediatric system, you go to the children's hospital. Once you get into adult care, it's fragmented and you can go anywhere and estab- lish with anybody," she said. "The problem with somebody coming out of the pediatric health care system with Medicaid and an intellectual disability—they are going to strug- gle finding new providers." With the exception of students studying pediatrics, medical stu- dents are not trained to work with individuals with disabilities because it is not a requirement in most schools, an issue that resonates in the dental community, as well. "Pediatric dentists are trained to work with patients with autism and they are comfortable treating a person with autism even when they become an adult. But at a certain time, adult dental disease is quite different than treating baby teeth," said David Fray, D.D.S., associate professor at The University of Texas Health Science Center at Houston's School of Dentistry. "Pediatric den- tists don't feel comfortable treating gum disease and doing certain procedures like root canals and molar teeth, and general dentists are usually not trained to work with that population." Most children with intellectual disabilities transition well into adult dental care, Fray said, but some struggle. "Maybe 20 to 30 percent of children in a pediatric office have trouble transitioning to adult dental care after the age of 30, and we are working to try to improve that," he added. Patients with autism can experi- ence sensory overload when visiting the doctor. Having sensitivity to light, being touched or experiencing a break in their routine can present major challenges. "Just to come at them and stick the blood pressure cuff on them, can send them into … they don't know why they are being approached," Peacock said. "You just need to show them what it looks like and say we are going to put this on your arm and then they are OK because they've seen it before." Building a strong doctor-patient relationship is the key to success for caring for adults with intellectual disabilities. "We want our patients to get used to us," Peacock said. "We might see them two or three times before we draw blood." Because medical and dental schools don't offer specialties in treating adults with intellectual disabilities, these individuals fall C M Y CM MY CY CMY K Houston TMC Pulse_ad_8_2019.pdf 1 8/13/19 2:27 PM through the cracks. "It's a forgotten population," Peacock said. "Once they get out of school, if they are not employed, who is going to notice if they aren't getting any health care? Fray and Peacock are working together to change that in the Texas Medical Center. "To have an academic clinic like ours that just sees people with intellectual disabilities—they are relatively few and far between. There are maybe 20 across the country," Peacock said. "We're are seeing more schools incorporate training into their curriculum. In our transition clinic, we train nursing students, social work students, residents in primary care, internal medicine, fellows who are doing adolescent medicine, pediatrics, neurology. It will be interesting if we can increase longevity for these individuals by increasing screen- ings and access to care."