Available online 3 January 2026, 103205

Author links open overlay panelKatie Pierson MA, Rashedat Oshodi MD, Iris Borowsky MD, PhDShow moreAbstract

Unambiguous federal policy support of accessible public spaces and communications for individuals with disabilities has been in place for 35 years. Rigorous models of accessibility best practices, such as Universal Design (UD) and Human Centered Design, have existed for nearly as long. Despite the Americans with Disabilities Act’s clear requirements, health care equity for disabled individuals – a large minority of the population – is still out of reach. Research shows that increasing health care professionals’ broader understanding of accessibility best practices for adults is an important step toward creating more welcoming health care settings, yet medical schools continue to exclude disability education from their curriculum, and physicians continue to report discomfort with providing care for all ages of this population. Thoughtful, dignifying best practices in creating and evaluating supportive health care environments for children with disabilities are well documented, but there is little in the literature on tactical steps toward implementation or impact of these adapted environments. This article shows child health care professionals how to apply Universal Design theory to one’s everyday practice, beginning with a single patient and her care team.

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Access through your organizationSection snippetsTranslating Accessibility Theory into Daily Practice

Over three million children (4.3% of the under-18 population) in the United States had a disability in 2019, up 0.4 percentage points since 2008,1 and one in four American adults has a disability.2 Unambiguous federal policy3 in support of accessible public spaces and communication4 for individuals with disabilities makes this group the largest protected class in the United States. Yet, the persistent negative effects of inaccessible health care and inaccessible health care communication on

Universal Design is established best practice for accessibility

Universal Design (UD) is the antidote to designs that prioritize “the temporarily-abled”12 (non-disabled) in health care settings and then, retroactively, and often inadequately, backfill the specific gaps. It is the national and international gold standard in encouraging all individuals’ full participation. Since architect Ron Mace coined the term in the 1960s, UD has become widely-accepted as best practice for designing built environments and, more recently, communication practices and

Disability Rights Literature Guides Next Steps

Fortunately, the disability community’s half century of scholarship and activism maps out feasible, sequential steps.28 First, health care professionals must commit to shifting from the field’s and culture’s conventional medical model of disability to a more respectful social model of disability.29 The medical model of disability posits that it is primarily an individual’s medical problem in need of treatment. A social model of disability makes a relatively sharp distinction between impairment

Starting Small: Welcoming Abena

The literature on patient and family-centered care coordination affirms that partnering more strategically and effectively with disabled individuals and their families is the essential first step in providing them with great health care.33, 34, 35

Six-year-old Abena thrives with the support of her attentive family and well-resourced adjunctive care team. Her mother describes her as having a “happy-go-lucky” personality: “If she’s being whiny, something is up.” She has near blindness caused by

Improving Communications Accessibility for AbenaAgain, Abena’s family and adjunctive care team are the experts on meeting her specific, daily communication needs. Consider their suggestions for welcoming Abena to her appointment:1.

Ask the person making the appointment for Abena if she uses any augmentative communications tools. If the answer is yes, ask if they can bring the device – such as a touchscreen tablet – to the appointment to facilitate communication.

2.

Ask family members and adjunctive team members, “How can we best communicate with

Thinking Big while Starting Small

These tangible practices demonstrate how a health care setting can actively welcome Abena and her care team. Work with front desk staff and tech staff to determine a sustainable electronic health record (EHR) practice that protects patient privacy (such as using the Synopsis tab) while also cueing clinicians to welcome her more personally and effectively at the next appointment. They also serve as an actionable starting point for evaluating and prioritizing which practices support and reflect

Implementing Small Tactics to Support Universal Design ObjectivesAs with quality improvement practice,49 providers and staff must remain open to feedback and willing to adjust to create a more inclusive and supportive environment for all. The following plan-do-study-act (PDSA) methodology formalizes this feedback process. It also satisfies the American Board of Pediatrics’ Maintenance of Certification Part 4: Improving Health and Healthcare (MOC4).•

Plan by engaging clinicians and staff in decision-making around new internal documentation and communications

Conclusion

Universal Design’s accessibility framework offers health care professionals a reassuring roadmap for not only build a more welcoming, innovative health care setting but a more welcoming mindset. These changes start with the understanding that the physical and social (communications practice) environment needs to be improved, not the child, and that the patient and their care team are the experts in the room on what those improvements look and feel like.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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