Accessible Abortion Provision to People with Disabilities

TASHANI: We are gonna get started. I’m Tashani Alanga.  I know many or most of you and I direct our grand round series. I’m so pleased to introduce our fantastic speakers this morning. But before we start, I’d like to provide our land acknowledgement.

We would like to acknowledge the Ramaytush people who are traditional custodians of this land. We pay respects to the Ramaytush elders, past, present, and future who call this place, the land that UCSF sits upon their home. We are proud to continue their tradition of coming together and growing as a community, and we thank the Ramaytush Ohlone community for their stewardship and support and we look forward to strengthening our ties as we continue our relationship of mutual respect and understanding. And if you’d like to learn more about how about the Ramaytush people and how to contribute to their cause you can see the links in the chat as well as on this screen.

With that, I’m really excited to present our two speakers this morning who are joining us on Zoom. First, I’d like to present Amanda Spriggs Reed. She’s currently the strategy officer for Women Enabled International (WEI) where she focuses on trend analysis and data mobilization at the intersection of gender and disability issues. Prior to this position, Amanda was an Equal Justice Works legal fellow at WEI, where her project advocated for abortion access for disabled people through impact, litigation, technical guidance on disability rights for abortion care professionals and educational training on the intersections of disability and reproductive rights and justice. Amanda received her J.D. from Wake Forest University of Law in 2023 where she was awarded the Smith Anderson Pro Bono Award for Exceptional Service and the Miriam E. Mickey L. Felenberg Award recognizing exceptional leadership in the area of social justice.

Next, I’d like to introduce Jillian MacLeod. Jillian MacLeod engages in litigation, legal advocacy, policy advocacy and education to fight for the rights of people with disabilities to have equitable access to health care and make self-determined decisions. Her work is largely focused on advocating for the bodily and decisional autonomy of people with disabilities. And since beginning at DREDF, Jillian has filed amicus briefs for the Supreme Court and cases dealing with issues of bodily autonomy, worked on cases dealing with access to health care and public services for disabled people, led many trainings for medical providers on improving the accessibility of their practices, advocated against cuts to Medicaid and Medi-Cal, and conducted a national nationwide survey of people with disabilities who have sought reproductive health care with the goal of educating providers about how to make their care more accessible.

We are just so I’m pleased to have them join us here for our grand rounds and speaking to us about accessible abortion provision to people with disabilities. Welcome.

AMANDA: Awesome. Thank you so much for that introduction Tashani and we’re so glad to be here. My name is Amanda Spriggs-Reed. I use she/her pronouns and as a visual description, I am an Asian-American woman with long dark hair that’s pulled back from my face and I am wearing a plaid blazer, and I have a blurred background behind me. I am the strategy officer at Women Enabled International, as Tashani mentioned, and we’re excited to be sharing some information with you all about providing accessible abortion provision to people with disabilities.

As a disclaimer, as you might have heard from both of our bios, we are lawyers, not doctors, so we’re providing more of a legal lens as well as a lens of disability and accessibility knowledge. We are not providing information about medical provision of care. So I will also turn it over to my co-host Jillian to introduce herself and then we’ll get started.

JILLIAN: Hi, everyone. I’m Jillian MacLeod. I use she/her pronouns. I’m a Staff Attorney at Disability Rights Education and Defense Fund or DREDF. We are a national legal and policy center that works to advance the rights of people with disabilities and I work in particular on improving access to reproductive health care. Much of my bio is also Amanda’s bio because we work together on many of our projects. And another disclaimer: none of this is legal advice. We’re excited to talk to you today about the law and how you can make your practices more accessible for people with disabilities.

AMANDA: We’’re going to go over a lot of topics today and we’re going to try and cover them in the short amount of time that we have. As a note, we’re not going to be able to read every single thing that is on the slides that we’re presenting, but you’re going to be receiving the slides in an email afterwards so that you can refer back to them.  We’re going to go over a quick introduction of what is disability, what do we mean when we’re talking about “access” as both reproductive rights advocates and disability advocates, and how are disability justice and reproductive justice related. We’ll also be going over the legal responsibilities of health care providers including reasonable accommodations with a spotlight on providing supported decisionmaking for patients. We’ll also be covering effective communication and accessible facilities and medical equipment for disabled patients. And then finally, we will round things off with some readily accessible medical practices that ensure your services and your facilities are accessible for everyone regardless of whether or not they have a disability or not. Moving to the next slide.

Some of you may be familiar with a program called Slido, but this will allow some audience participation during our presentation. So if you join at Slido.com and enter this code number you’ll be able to interact with us during the presentation. So the code number is 1282 354 and I will give everybody a minute to join in the Slido.

JILLIAN: I can also drop the joining link in the chat.

AMANDA: Yeah, that would be great. And then we can go ahead and start with our introductory section. And if we want to just start at the next slide, Jillian.

So, disability is a really broad umbrella. And we wanted to start off with a understanding that we as self-advocates as well as reproductive health care providers in the room might have different ideas about what disability can look like because it’s very broad. Under the U.S. law, the Americans with Disabilities Act, and there’s a lot of common conditions that people wouldn’t think about as a disability that would qualify you for protection from discrimination under the ADA.  Not everybody who would qualify for protection under the ADA might refer to themselves or identify themselves as a person with a disability. But that doesn’t mean that just because they don’t self-identify as disabled that they don’t qualify for protection under the ADA,  including things like reasonable accommodations.

So on the slide we have a very non-exhaustive list of different conditions or identities that might qualify you as a person with a disability including: mental health and psychiatric disabilities, intellectual and developmental disabilities, physical and mobility disabilities. sensory disabilities like deafness or blindness, neurological disabilities, and also a lot of chronic conditions. For example, things like diabetes or long COVID might not make you immediately think of disability, but there are lots of conditions that might qualify for ADA protection and require accommodations.

So, I want to pause and just check if people are surprised by anything on this list. Or if anybody has any questions around disability or best practices when speaking about disability.  You are welcome to drop any of those questions into the chat as well. And I think that the most important thing is just making sure that you’re asking people how they would like to be referred to or what language they would prefer. Some people prefer person-first language, so being referred to as a “person with a disability.” Others prefer identity-first language, so being a “disabled person.”  It really comes down to preference and trying to avoid stigmatizing language when possible. So, if we want to go to the next slide here, I will turn it over to Jillian.

JILLIAN: Thanks, Amanda. So if folks would like you can participate on the Slido by entering some ideas when we ask “what does the word access mean to you?”  One of the reasons we wanted to talk about this is,  in our work as disability rights and justice lawyers in reproductive rights and justice spaces, we’ve actually noticed that the meaning of access is slightly different in reproductive rights and justice spaces and in disability spaces. So,  we wanted to kind of talk a little bit about the different meanings and why that’s important as it relates to people with disabilities.  I’m not seeing any answers on the Slido or anyone typing. So, I can move forward, which is no problem.

When we talk about access in these different contexts they mean kind of different things but they’re related. So in the abortion and reproductive rights and justice advocacy spaces, access often refers to a person’s ability to get an abortion, which might be influenced by, for example, the laws in their state,  the distance they need to travel to a clinic, the cost of the abortion, or the administrative burdens of accessing care. But in the disability community context, access and accessible mean that people with disabilities are afforded the same opportunities as non-disabled people to acquire information, move through spaces, access services, interact with others, communicate with others in an equally effective and integrated manner. Integration is also a really important concept in the disability rights world–this idea that folks should be integrated in their communities instead of segregated, and with a similar ease of use of these services and communications. And obviously people with disabilities experience some of the same access barriers as non-disabled people and sometimes those access barriers are compounded by disability. So for example, traveling a very long distance can be more difficult when you have a disability and maybe you don’t drive because you’re blind or you don’t drive because you have a mobility disability.  So these concepts are related in that people with disabilities can experience the same access challenges as non-disabled people.  So we just wanted to talk a little bit about the meaning of accessibility in the disability context because we’ll be saying that a lot.  so we want to have the same understanding.

Next, we wanted to touch really quickly on how disability justice and reproductive justice are related and similar. So I will assume that all of you are very familiar with reproductive justice and its principles and beliefs. But we want to talk a little bit about disability justice principles in case you were less familiar with the disability justice principles. So,  I won’t read all of them, but I’ll highlight a few that are unique or important.  They’re all important. They’re all awesome. I just want to say that I love the disability justice principles, but we’ll highlight a few that are maybe like unique. So, for example, number three is an anti-capitalist politic. That’s really important as it relates to disability because in a capitalist society—where people are only viewed as valuable if they are able to work or produce on behalf of an employer or people are only seen as valuable if, for example, they’re not utilizing government benefits and they’re completely independent—people with disabilities are less valued in a society that is capitalist and are viewed as less whole. So it’s really important that we have an anti–capitalist politic as it relates to disability justice to ensure that people with disabilities are seen as fully valuable in our society.

Further: recognizing wholeness. This means recognizing that people with disabilities are whole and valuable as we are.

A commitment to interdependence and cross-disability solidarity. So in the early disability rights movement independence was a really important concept. This idea that people with disabilities could live on their own, could do things on their own, because for a long time people with disabilities lived in institutions. We’ve evolved in the movement to rely more on interdependence as this idea that we don’t need to do things on our own to be valuable or to have a wonderful life. In fact, relying on other people and having community is what creates a wonderful life.

Also, collective access. This is a really important one in this current context that we are talking about because it’s this idea that all of us are responsible for creating access for people with disabilities. People with disabilities are not the ones that are required to break down the door for themselves every time they need access to something. So it’s everyone’s responsibility to ensure access before someone asks and to collaborate with people with disabilities to ensure that access.

Before we get into our discussion of legal responsibilities of providers and staff, we wanted to highlight a couple of resources of ours that we’ve developed that might be helpful to you all. And they’re going to be QR codes at the end of the presentation. We created a report based on the national survey that we facilitated that collected stories from people with disabilities who sought abortion care.  The “Lessons From the Disability and Abortion Access Survey: Responses and Recommendations” is a comprehensive resource that uplifts the voices of people with disabilities in their own words and then creates recommendations for providers based on folks experiences of barriers.  We also created a resource that’s kind of a shorter version, but it’s a “checklist” for reproductive healthcare providers and staff for ensuring that your practices are made more accessible. So it can it’s the type of thing that can be printed out and kept in an office and it has basically a simplified list of things that can be done to make practices more accessible. All right.

AMANDA: Definitely recommend checking out the report and the stories that were shared there. They were really impactful for us, and I think that we’re all aware that abortion storytelling is a really powerful tool for advocacy and including diverse stories like the stories of disabled people seeking abortion helps us create policies and advocacy ideas that are meeting the needs of a wide variety of people. So if we want to go to the next slide here, we would love to hear from you all how familiar you are with disability rights laws and what they require of medical providers. We hear pretty regularly that disability rights laws are not something that is covered in medical training very often. And so it can be kind of confusing or intimidating for people who aren’t aware what the laws are or have like a deep familiarity in interacting with them regularly. What’s required of them as providers or staff also

JILLIAN: I’ll note I see in the chat some folks said that they saw answers on the Slido but I just checked in on my end I couldn’t see them.  Amanda, if you’re logged into the Slido on your phone, would you be able to check there? I’m not sure what’s going on on my end.

AMANDA: Yes.  I can see it looks like people were submitting them in the Q&A function of the Slido, not in the like question itself.

JILLIAN: Okay.

AMANDA: I think you have to open the poll in Slido for people to be able to participate in this one, Jillian, because it’s not currently showing up as open on mine.

JILLIAN: Okay. Apologies everyone. [pause] Yeah. And if folks for now just want Okay, I think I opened it up. Apologies.

AMANDA: Yes, I can see it now on polls as an option to vote on.

JILLIAN: Okay, great. So the options are: I’m very knowledgeable about disability rights laws; I’m somewhat familiar with disability rights laws; and I am not familiar with disability rights laws. And yes, I will drop the link in the chat again.

AMANDA: I got you, Jillian.

JILLIAN: Oh, perfect. Thank you. [pause]

AMANDA: All right. It looks like people are currently voting, but I also see that a lot of people put their answers in the Q&A as well. I see a lot of “not familiar”  which is very in line with what we have experienced in the past, and so that’s why we’re glad that we’re able to come here today and help provide a basic overview for you all and help support your important work by giving you some background information.

JILLIAN: Yeah, so on my end I’m seeing at this point 72% I’m not familiar with disability rights laws, 28% I’m somewhat familiar with disability rights laws and 0%, I’m very knowledgeable. Thanks for sharing everyone.

AMANDA: Yes, thank you all for participating. So if we want to go to the next slide here. This is a basic overview of three of the biggest federal disability laws that cover medical care and the provision of like medical services.

So, the first one we’re covering is the Americans with Disabilities Act. It is a pretty well probably like the most well-known disability rights law and it is a huge landmark law that inspired a lot of other countries after the U.S. to enact similar disability rights laws. So, we’re very proud of the ADA. It is the federal civil rights law that prohibits discrimination on the basis of disability in everyday activities including medical care. So, publicly owned and operated entities like UCSF are covered by Title II of the ADA as public entities.

Then, we also have Section 504 of the Rehabilitation Act which is like the grandfather of the ADA, it came first. But that is the federal law that prohibits discrimination on the basis of disability by the federal government, federal employers and organizations that receive federal financial assistance. So that covers most healthcare providers with things like Medicare and Medicaid, and that creates an obligation under Section 504 for those healthcare providers.

And then the last one is Section 1557 of the Affordable Care Act, which is the most recent of these laws. And similarly, that’s a federal law that prohibits discrimination on the basis of race, color, national origin, age, disability, or sex in health programs or activities that receive HHS funding. So similarly, most healthcare entities are receiving some form of HHS funding and so have obligations under 1557.

There’s also going to be state-specific laws that prohibit disability discrimination as well. California has some, but these are the three largest federal laws, and there are administrative regulations that rely on these laws to create obligations.

So if we go to the next slide here, you’ll see all of these have in common that they require medical providers to make their services available in an accessible manner. And those usually fall into kind of three main big buckets.

That includes providing reasonable accommodations, ensuring effective communication, and having accessible facilities and medical equipment.

So, a reasonable accommodation as a definition is a change to the usual way of doing things to include people with disabilities and provide equal opportunity for them to benefit from those services. Health care offices are required to provide a reasonable accommodation unless it would meet both of these… which is a fundamental alteration of the nature of the service provided and result in an undue burden. So, to fund a fundamental alteration is like a very specific legal term, and it means that it would change the essential nature of the program, or service, or activity which is a pretty high burden to reach because most things can be altered without changing the nature or the specific essence of that service or activity.

And an undue burden again is also a high bar to reach. So that is a significant difficulty or expense, and that significant expense is considered in light of the entity’s entire budget. So it’s not just that it has to be expensive to provide that accommodation for that particular like provider but it’s looked in light for example in this case it would be looked in light of UCSF’s entire budget which is, you know, a huge amount of money. So even if something sounds a little bit expensive to implement as a reasonable accommodation, it would have to be considered a pretty large burden in light of that entire budget.

And so a reasonable accommodation is retroactive or like reactive. So, it’s the person or the patient requesting that change or working with the service provider to come up with a way for them to access those services and change what is the baseline of the service.

So, going to a list of common reasonable accommodations. This is a non-exhaustive list because reasonable accommodations can truly be anything that makes the service easier and more accessible for that person to access. So, that can include things like reserving additional time for appointments because someone might need additional time to work with an interpreter or may need additional time to have the care explained to them in a way that’s accessible with plain language, and use methods to ensure understanding. It can also include things like delivering information in multiple ways like both written and verbal. Reserving a room that has accessible equipment, being able to turn down the brightness of the exam room for sensory reasons, performing a pelvic exam in alternate positions. So on the slide here, we have some images courtesy of the Reproductive Health Access project with some alternative pelvic positions, and RHAP also has like many more different diagrams and options as well on their website if that’s something that’s interesting to you. And it can also include things like allowing time for physical transfer, taking breaks to allow time for understanding, or wearing a mask.

So, this is something that you can ask the patient from the beginning of their care experience if they have any reasonable accommodations or access needs that they have. Ideally, those notes and those requests would be following the patient throughout their entire care experience from the first point of contact to the end of their care experience. And they wouldn’t need to repeat them over and over again to different providers or different staff members by noting them. For example, in their electronic medical records.

JILLIAN: Thanks, Amanda. And so one of one reasonable accommodation that we wanted to highlight is supported decision-making as a reasonable accommodation.  Supported decision-making is a less restrictive alternative to guardianship for people with disabilities who need support when making big decisions. It’s an individualized arrangement where a disabled adult chooses one or more people they trust as supporters to help them understand, communicate, make, or act on their own choices.

And when we talk about supported decision-making really anyone can use supported decision-making we all rely on people that we trust when we’re making big decisions about our lives, our healthcare, but supported decision-making may be especially helpful for people who need additional help with identifying or weighing their options, understanding the risks and benefits of the options, choosing between the options, communicating their choice.

So, for example, if they maybe have a disability that affects their speech and they need someone familiar with their speech to respeak their words to the provider, then they can use a supporter to do so. Or even acting on the choice if they need support acting on their choice. And supported decision-making can be a formal agreement that is written. That being said, there’s no like particular form that must be filled out. It can be a simple form that says, “My name is Jillian and I want Amanda to help me with my reproductive healthcare decisions.” So it can be written or it can be informal, and supported decision-making can strengthen capacity and avoid the need for a conservator or guardianship in decision-making, and many states including California recognize supported decision-making as a alternative to conservatorship and guardianship.  And supportive decision-making is something that DREDF does a lot of education around because guardianship can and conservatorship can be a very restrictive structure that takes the decision-making power away from people with disabilities. Oftentimes parents of people with disabilities are told that the only option to keep their child safe when they’re exiting the school system is to put them in a conservatorship and they’re not given a lot of information about alternative, less restrictive options that protect their child’s decision-making capacity and autonomy. And so, this is a really important option to be aware of, and it keeps the decision-making capacity and autonomy in the disabled person’s hands. They just get support with that decision.

And when we’re talking about capacity to make decisions, a few things to remember as it relates to people with disabilities: Decision-making capacity is a spectrum. It’s not a yes or no question. It can change with context, topic, emotional state, physical state, and that’s true for everyone. And a person may have the capacity to make a medical or mental health decision without understanding every aspect in detail of the diagnosis or treatment. So as long as they understand like the basics, they can make a decision about their medical care.

Capacity is flexible and it can also be strengthened through things like plain language and effective communication, reasonable accommodations and in particular supported decision-making. And capacity to consent to medical decisions should always be considered with the person’s preferred supports in place.

So moving on to effective communication. Effective communication is the kind of second bucket of requirements that federal disability rights laws lay out. And effective communications definition is communication that is as effective as communication with non-disabled people. It allows a person with a disability to receive information from, understand information from, and convey information to others. And oftentimes effective communication will relate to people with hearing, vision, speech disabilities, or intellectual and developmental disabilities, as it relates to plain language.

Ensuring effective communication may require aids and services and additional strategies for communication, and some of these include qualified interpreters, which can be provided in person or through video remote interpreting. I will note that for ASL interpretation, in-person is often times preferred for deaf folks, not for everyone, but ASL is a three-dimensional language and sometimes VRI can be difficult to facilitate or understand, especially if like internet connection isn’t great or if it’s not possible to have the patient’s face and hands in the in the square of the screen for the entire communication. And then also some people who use non-standard sign language may need a team that includes a Deaf interpreter and a hearing interpreter because Deaf interpreters are more familiar with non-standard signs, because they are native sign language users and so they are able to better adjust their sign language to the person with a disability’s sign language if they use non-standard signs. You may be required to provide an interpreting team if that person uses non-standard sign language.

Real-time captioning, particularly for video telemedicine, assisted listening devices, offering written materials in alternative formats like Braille or large print, using plain language, using the teach back method, using visual aids, and these services must be provided free of charge. So, people with disabilities cannot be asked to bring an interpreter with them to their appointment or to bring an aid to their appointment. Some people with disabilities may have their own things like pocket talkers and things like that or may just use hearing aids, but generally these effective communication services must be provided free of charge.

The kind of final like bucket large, large overarching bucket of requirements under federal civil rights laws are that medical providers give disabled people full and equal access to their facilities and to their medical equipment.  So, government providers that receive federal funds must make their programs as a whole readily accessible to and usable by people with disabilities. And so non-discrimination in this context may include removing architectural barriers, acquiring accessible medical equipment, which is actually now required under updated Section 504 regulations that came out in 2024. The citation for the regulations is on the slide. There’s a lot of really good stuff in there that I would actually really encourage you to take a look at. But, essentially by July 8th, 2026, every clinic will be required to have at least one accessible table that is adjustable in height, and has adjustable grab bars for gynecological offices, that would require a table that has leg rests that support the entire leg as opposed to just stirrups. And every clinic will also be required to have an accessible weight scale that a person who is a wheelchair user can roll onto, if that clinic uses a weight scale regularly. And there are scoping requirements. So, bigger facilities will need to have a larger amount, but every newly acquired piece of medical equipment going forward must be accessible starting in 2024. So, if you’re requiring any new medical equipment, it needs to require it needs to comply with the access standards as it relates to medical equipment that are incorporated in these new, these updated 504 regulations. And where barrier removal would be an undue burden, services must be made available through an alternative method or location if that is possible.

And on this slide, we just have a couple of images of accessible exam rooms and accessible equipment. So on the left here, we have an accessible exam room that has enough floor space for a wheelchair user to move around and also to allow for a person to be transferred onto an exam table that’s accessible. Sometimes it’s good to actually have the exam table not right next to the wall so that a staff member can stand on the other side to help with transfer. Here you can see there’s like a wide enough door, there’s enough maneuvering space in the room, there’s accessible equipment, there’s a way to get in and out of the room for the wheelchair user. And then, on the right here we have an accessible gynecological exam table that has supports for a person’s legs if they have a mobility disability that makes it so that they can’t like hold their legs up on the stirrups, or you can provide the exam in alternative positions. And then the accessible weight scale is here as well. And there’s a lot of good information on ADA.gov resources, medical care, mobility disability. On the bottom here, you can see that the list of the link because yeah, there’s a lot of good information on this page. I will say they probably have something about how Democrats shut down the government on there. So you know, just… know that that will probably be on there. And then I’ll pass it to Amanda.

AMANDA: Yes, so I’m noticing time, and so I’m going to try and go through just a couple of these tips for accessible practices quickly, with again a reminder that you’ll be provided our slides through an email afterwards, and we would really encourage you to look through these suggestions afterwards because I really want to get to your questions.

So, just as a reminder, we covered what a reasonable accommodation was, and that is a change to the environment service or policy. But, readily accessible means that these are practices that are already in place whether or not someone discloses a disability or requests that these services or policies be changed. So, accessibility refers to the whole group whereas a reasonable accommodation is made by an individual. So going to the next slide.

Essentially, ensuring practices that are readily accessible take time and create require consistent implementation, and that means that institutions need to provide their staff and providers with the resources, and the training, and the policies that can be implemented regularly. So things like making sure that your website is accessible for screen readers and provides information in plain language, which plain language is usually anywhere between a 5th to 8th grade reading level. And it also is ideal to have information relevant to people with disabilities (like what accessible services you have, what accessible medical equipment you have) on your website. So that way people can make informed decisions about pursuing care with you ahead of time. And online resources should go through an accessibility review before circulation, and providing information in multiple formats like plain language or large text or Braille is critical to ensure effective communication.

I think that a lot of people aren’t aware necessarily that things like PDFs are not accessible to a screen reader unless you have specifically gone through a process to make that PDF accessible, because otherwise the screen reader will read things out of order. Often times Word documents are a lot more accessible because it is a lot easier for people with screen readers to have a Word document open and have it read the information accurately. So, that’s just a note because I think that that’s something that a lot of people don’t necessarily realize when they put PDFs on their website. And providing as much information about your services and procedures ahead of time allows people that might need to process information in different ways a lot easier. So, going to the next slide.

Staff should be trained about how to collect information about access needs from the first point of contact, like we talked about, and be able to have those notes follow people throughout. Something that we heard in our survey was that it was really helpful for people to have consistent staff members that they worked through through their entire process so they didn’t have to adjust to different communication styles and that that staff person was aware of their needs throughout the whole experience. It’s also important that staff are trained on how to use the accessible equipment in their facilities. If you don’t know how to use the equipment, then it doesn’t really do a lot of good for you to have it sitting in your exam room. And being trained how to assist people safely onto exam tables and communicate with people, such as assuming capacity, doing effective communication using some of the auxiliary aids that we talked about earlier, etc..

And then on the last slide here… yeah, these are just a couple more tips about effective communication and common accommodations in the exam room,  that we have discussed before, like having ASL interpreters and ideally having captioners. I saw a little bit of talk in the chat about whether or not your telehealth platform allows for captioning. And if it does not, then I would suggest checking out a different platform because having captioning is like a huge part of effective communication for a lot of people, and not just deaf people, but also for example, for people with intellectual or developmental disabilities, it might be really helpful to have captioning for processing information, and it is ideal to have a live captioner providing captioning instead of relying on generative captions or automatic captions because sometimes those are inaccurate or might be delayed, and for medical care specifically and medical care that’s as sensitive as reproductive health care and abortion care, it’s critical that the information is provided to people accurately. And so again, please check out these slides afterwards, but I want to be able to move into questions for everybody.

You can present questions into the Slido if you have questions here. You’re also able to put them in the chat if you want to unmute, or you’re welcome to do that too. Whatever is the easiest and most accessible for you all. So we will open things up here, and we’ll go ahead and leave the QR code up to our two resources as well, and those provide a lot more in-depth recommendations on providing care.

JILLIAN: This is Jillian. I’ll note that someone I saw in the Slido asked whether “different abilities” is ever preferred as language to “disability.” Generally, no. Everyone’s different, but the community has moved more towards people with disabilities or disabled people because “different ability” is kind of seen as, like, a little bit paternalistic and not very direct. Disability is not a bad word. So, the community is generally moving away from things like that. Happy to answer. I’m sorry, you go.

AMANDA: I was just going to say, I see here a question. Any thoughts about assisting people with intellectual or mental health disabilities as they find phone calls to be complicated or find a phone tree to be too difficult? Yes, ideally, you would have alternative ways for people to get in contact with you beyond just phone calls. Whether that’s maybe like an email that people can contact or a form on your website that people can utilize, and this again goes into trying to have your websites to be as accessible as possible and include what your alternatives to phone calls would be in order to make appointments or in order to ask questions. If you have an alternative communication method available, you would want to have that clearly posted on your website. [pause] Do all rooms or tables need to be accessible, or some of the rooms and equipment?

JILLIAN: So, as it relates to the new section, or, not new, the updated Section 504 regulations, they’ve been around since the 70s, but the Biden administration released updated regulations in 2024. As it relates to accessible exam tables, and weight scales, like I said, most clinics will only be required to have at least one exam table and one weight scale that are accessible. That being said, the requirements for buildings are a little bit more complicated. Buildings that were built like after 1993 I believe [correction: 1992], are required to be fully accessible. But, buildings that were built before that generally are supposed to be altered to provide access to most public spaces. So, there needs to be a way for folks to move through public areas and get from the outside of the clinic to the exam room essentially.  So that doesn’t mean that every single room necessarily has to be accessible, but it means that there needs to be a route from the front door to the exam room and to a bathroom and other public spaces that other people are utilizing. So, building codes are a little bit complicated. There’s a lot of different regulations that apply to different things. I would reach out to maybe like UCSF Counsel about that if you’re concerned because it’s kind of complicated.

KATIE: Hi, I was hoping to ask a question just about the supported decision-making. First of all, I also wanted to say thank you. This is incredibly helpful and made me realize how much I don’t know. But yeah, my question was just about the supported decision-making and like in what context do people get that? Like do they have to be at there’s like a question of their capacity, or just like anybody with a disability would have access to that or have the right for that by law.

JILLIAN: Yeah. So, great question. Supported decision-making is something that anyone can utilize, even a person without a disability. But under the law, if we’re viewing supported decision-making as a reasonable accommodation, which it–I can’t think of a context in which it wouldn’t be viewed as a reasonable accommodation—then yes, people with disabilities are entitled to utilize supported decision-making.  How it might happen is that someone might come to the office and say, “Hey, I have a disability. I want to bring a supporter.” And then you would facilitate that happening. Or if a person with a disability comes in and maybe there is concern about their capacity, you’ve tried providing like other types of accommodations like using plain language, using visual aids, and it seems like they might need additional support, as a provider, you could suggest, “hey, have you considered supported decision-making? Have you considered bringing a supporter that you trust to your appointment to help you walk through some of your options and think about your options and think about how you might act on your options?” So that’s another possibility. Hopefully, that answers your question.

KATIE: And does that apply to inpatient settings, too?

JILLIAN: That’s a that’s a good question. I’ve actually never been asked that before. but I would think that as a reasonable accommodation it would like Amanda said there’s certain limitations so for example if the accommodation is seen as a fundamental alteration to the program or the service then it might not need to be provided but like she said like providing something like supported decision-making… I personally don’t necessarily necessarily see that as like creating a complete change to the service being offered. So, I will say, I’m not completely sure and I can look into that for you and send you an email about it. But my sense is that it is probably a reasonable accommodation that should be provided if if folks ask for it and want that accommodation.

AMANDA: Yeah. And I think that this also speaks to a question that was maybe put in the Slido. There’s some acronyms in there or like some shorthand in there that’s asking about like certain times when services don’t allow visitors for staff safety. If someone needs a supporter there as a reasonable accommodation, unless that provider has like a really clear reason why that would fundamentally alter the service by having that supporter there… they should be providing that reasonable accommodation. Even if it’s the general policy to not have visitors in the facility. [pause]

TASHANI: Thank you both so much. I think there’s probably more questions that we come up with. I have a few of my own, but I think that in the effort of getting people to the next thing that they have and also to get you guys on your way for your morning, we’ll end our grand rounds. Thank you both so much for coming today and speaking. we appreciate your expertise. and it looks like you provided your contact so perhaps many some of us will be reaching out to you. Thank you both so much.

AMANDA: Yeah, thank you so much for having us and yes, please feel free to email us and hopefully we can do more trainings like this in the future.

Thanks.

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