Guidelines for Accessible Questionnaire Screenings

Image of the Guidelines for Questionnaire Screenings cover.

Purpose:

This resource provides healthcare professionals with practical, disability‑and trauma‑informed guidelines for administering health screening questionnaires in an accessible, ethical, and patient‑centered manner. It addresses accessibility, communication, informed consent, follow‑up, and referral practices for screenings such as depression, anxiety, substance use, sexual health, and intimate partner violence.

This resource uses both ‘patients with disabilities’ and ‘disabled patients’ interchangeably. While person-first language (patients with disabilities) may be more common in clinical contexts, identity-first language (disabled patients) is preferred by many within the disability community. Our use of both reflects respect for diverse preferences and the evolving language norm in both the medical and disability communities. Preferences vary by person, and best practice is to use whatever language your patient uses and/or ask which they would prefer.

Introduction

Preventive health screenings questionnaires, such as those used for anxiety, depression, substance use disorders, intimate partner violence, sexual health evaluations, and routine intake, are essential tools in health care. However, for people with disabilities, these questionnaires can present significant barriers that compromise both the accuracy of collected information and the quality of care provided.

Validated questionnaires are designed to be given with their exact wording. Changing the format— reading questions aloud, large print, extra time, or letting a patient point or use a communication device — is an accommodation that keeps the questionnaire valid and its scores comparable. Changing the wording of a question is a modification. For clinical screening this is sometimes appropriate when a patient cannot understand a question, but it should be documented, and results should be read as a clinical signal rather than compared directly to standard cut‑off scores. Copyright terms may also restrict altering some questionnaires.

With approximately 61 million adults in the United States living with a disability, ensuring accessible screening processes is both a legal requirement and a clinical necessity.

Accessible screening processes benefit everyone involved: patients can provide more accurate information in a comfortable environment, healthcare providers can make better-informed clinical decisions, and healthcare systems can improve efficiency while demonstrating their commitment to inclusive care.

The Americans with Disabilities Act (ADA) requires healthcare systems to ensure equitable access to healthcare for people with disabilities, which includes making screening tools and questionnaires accessible through reasonable accommodations and effective communication strategies.

Best Practices

The Ideal Questionnaire Process

The following process represents best practices for inclusive screening that respects patient autonomy while ensuring clinical effectiveness. The strategies outlined in this guide will help healthcare providers work toward achieving this ideal process:

Pre-screening Preparation

Review any accommodations listed in the patient’s file and appropriately adjust the appointment, such as increasing visit length, preparing alternative questionnaire formats, making additional staff available to assist, or providing a quiet, less distracting room.

For patients with PTSD, autism, or intellectual and developmental disabilities, consider briefing the patient (and caregiver where appropriate) on the nature and purpose of any sensitive screening questions before they encounter them.

Frequency Consideration

Administer questionnaires no more than once every six months unless clinically indicated. Repeating the same screening too often can cause survey fatigue and erode trust.

Clear Explanation

Before administering the questionnaire, introduce it and briefly explain the purpose. Explain what will be done with the results and any legal reporting requirements.

Informed Consent

Ask for the patient’s and/or guardian's consent and offer the option to opt out of the questionnaire.

Supported Completion

Allow the patient to complete questionnaires with any supports they may need.

Results Discussion

Explain results in plain, nonjudgmental language and check for understanding.

Collaborative Follow-up

Work with the patient to develop a follow‑up plan based on results when needed, including referrals to accessible specialists experienced in working with people with disabilities.

The strategies for removing barriers and communication techniques described in this resource provide practical tools to implement these best practices in your clinical setting.

Creating Accessible and Inclusive Screening Environments

People with disabilities face significant barriers when completing screening questionnaires in healthcare settings. These barriers can create gaps in care and ultimately impact health outcomes for populations already experiencing health disparities. Addressing these barriers requires comprehensive changes in how healthcare providers approach screening, communicate with patients, and follow up on results.

Potential Fear & Mistrust

The Barriers

Patients may avoid honest responses due to well‑founded fears about consequences, including getting in legal trouble, having results follow them through their medical records, receiving disapproval from caregivers, or having screening results derail their appointment. Cultural factors may also influence their responses. Patients may not trust that healthcare providers will help them properly, and some have been hurt by the healthcare system before. This distrust can be particularly heightened with screening questionnaires that ask very personal questions.

What Healthcare Providers Can Do:

Implement disability and trauma-informed care.

Many patients with disabilities have experienced trauma within healthcare systems, including discrimination, dismissal of their concerns, painful procedures without adequate support, or being treated as less than human. Recognize that a patient’s reluctance or anxiety may stem from previous harmful healthcare encounters rather than the current screening itself.

Healthcare providers should:

Complete disability and trauma‑informed training. Visit our Resource Library to explore trainings.
Recognize that people with disabilities may have experienced medical trauma, discrimination, or abuse.
Understand that screening questions may trigger anxiety, fear, or past traumatic experiences.
Approach each patient with respect, patience, and cultural humility.

Build trust through clear communication.

Transparency about the screening process and its purpose can help reduce patient anxiety and build rapport.

Healthcare providers should:

Clearly explain the purpose of the screening and how results will be used. Use plain, easy-to-understand language, avoiding medical jargon and acronyms.
Clarify who will see the results, including any mandatory reporting requirements before the screening.
Emphasize confidentiality protections.
Provide information about available support resources.

Respect patient autonomy.

Giving patients control over their participation in screening demonstrates respect for their decision‑making capacity and can improve engagement.

Healthcare providers should:

Respect patient decisions without judgment or pressure.
Provide clear opt‑out options on both digital and paper versions and allow patients to opt out at any time, even after starting the screening.

See below for two examples of informed consent and opt-out options:

Example 1: Digital Platforms

“We are using this screening to better understand your health needs and connect you with appropriate resources. Completing this screening is optional and will not affect your care if you choose not to participate.

If you would like to complete the screening, click [CONTINUE]
If you have already completed this screening or prefer not to participate, click [SKIP]”

Example 2: Paper Forms

☐ I have already completed this screening recently or prefer not to complete this screening at this time”

Note: When screenings are required by Centers for Medicare and Medicaid Services (CMS), insurance, or clinic policy, clearly explain this requirement and work with patients to identify accommodations that will support them completing the questionnaire.

Assumptions, Stigma, and Ableism

The Barriers

Healthcare providers may incorrectly assume that people with disabilities, particularly those with intellectual and developmental disabilities, do not engage in sexual activity or other health behaviors that warrant certain screenings. They may think anxiety and depression are normal parts of having a disability, or that people with intellectual disabilities cannot have mental health conditions. The assumption that disabled people do not need or desire to function at their highest capacity or cannot benefit from treatment represents discrimination that leads to health disparities.

Healthcare providers may make assumptions about patients when they do not complete the questionnaires, thinking they are being difficult or have something to hide, without realizing the patient may be experiencing distrust due to being harmed by the healthcare system or a former healthcare provider. Additionally, healthcare providers may attribute symptoms or concerns to a patient’s disability rather than investigating potential underlying health conditions (i.e., diagnostic overshadowing).

What Healthcare Providers Can Do

Maintain a standard of care.

People with disabilities deserve the same standard of care as all patients. Screenings should be offered to everyone who meets clinical criteria; don't skip this test simply because a patient has a disability.

Do not skip screenings based on assumptions.

When conducting screenings that may involve stigmatized topics, such as sexually transmitted infections (STI) testing, substance use, or intimate partner violence, avoid making assumptions about a patient’s experiences based on their disability. Disabled people, including those with intellectual disabilities and communication differences, engage in the full range of human experiences and deserve respectful, nonjudgmental screening.

Do not assume that a patient with a disability is not sexually active or does not engage in behaviors that warrant screening. Skipping screenings based on these assumptions is a form of discrimination that can lead to worse health outcomes.

A practical approach is the CDC Five P's, adapted for accessibility: Partners, Practices, Protection from STIs, Past history of STIs, and Prevention of pregnancy.

Use concrete, specific wording (e.g., 'Do you have a boyfriend or girlfriend?' rather than 'Are you in a relationship?').
Use simple yes / sometimes / no formats where possible and avoid compound or negatively phrased questions.
Normalize the questions ('I ask all my patients these questions').
Offer confidential, one-on-one time separate from caregivers. A patient may not disclose sexual activity or abuse in a caregiver's presence.
An STI can prompt consideration of abuse, but STIs also result from consensual relationships; do not assume.

For more guidance on disability-inclusive sexual and reproductive health care, check out the National Coalition for Sexual Health's Clinician's Guide to Disability‑Informed Care.

Take extra care with patients who may be distressed by sensitive screening questions.

Some screening questions, particularly those about suicidal ideation, self‑harm, trauma, or intimate partner violence, may trigger PTSD symptoms, significant anxiety, or prolonged distress in certain patients. This risk is heightened for patients who have experienced prior trauma, including medical trauma, and for autistic patients or those with intellectual and developmental disabilities, who may perseverate on distressing content well after the appointment ends. Before administering mental health or trauma‑related screenings to these patients, healthcare providers should:

Preview the nature of the questions with the patient and, where appropriate, their caregiver or support person, before the screening. Ask if any topic areas might be triggering.
Explain why the questions are being asked and what will be done with the responses.
Offer the option for the caregiver/support person to complete the questionnaire if clinically appropriate.
Check in during and after the screening for signs of distress, confusion, or fixation on specific questions.
Document any notable reactions so that pre‑screening preparation at future visits can account for them.

Use inclusive communication practices.

How healthcare providers communicate, including through body language, can significantly impact a patient’s comfort level and willingness to honestly participate in screenings. Healthcare providers should:

Speak directly to the patient, not to support people or interpreters.
Do not assume a patient needs help or what would best support them. Ask them if and how they would like to be supported.
Listen to how patients describe themselves. Some identify as ‘disabled person’ (identity first) while others prefer ‘person with disabilities’ (person first). Ask them if you are unsure.
Do not assign disability labels. Some patients may not identify as having a disability even if they receive disability‑related services.
Respect chosen names and pronouns and update electronic health records when possible.

Implement a support person protocol.

Before beginning sensitive screenings, clarify with the patient whether they want their support person to remain present. Use clear, direct language: “Some of the questions in this screening are more sensitive and private. Would you prefer to continue this portion of the screening alone?”

Respect the patient’s choice and provide private space when requested. Remember that some patients may need their support person for communication or mobility assistance while still wanting privacy for sensitive topics.

Navigate guardianship and conservatorship appropriately.

Some patients with disabilities may have a legal guardian or conservator. Healthcare providers should be aware that guardianship arrangements can vary significantly. Healthcare providers should:

Review the patient’s file before the appointment to understand any guardianship or conservatorship arrangements.
Where appropriate, speak directly to the patient.
Consult with your clinic’s legal or compliance team if you are uncertain how guardianship arrangements affect informed consent requirements in your setting.

To learn more about your state’s specific laws, connect with your state’s Protection & Advocacy organization.

Consider using validated alternative mental health screening questionnaires for patients with disabilities.

For patients with intellectual and developmental disabilities: validated alternative screening questionnaires exist for patients with IDD that can be completed by the patient or a caregiver. They can be printed out, completed and scanned into the patient's chart. Alternative screening questionnaires include:

Glasgow Depression Scale for People with a Learning Disability (GDS-LD) (self-report)
Glasgow Anxiety Scale for People with an Intellectual Disability (GAS-ID) (self-report)
Adapted versions of PHQ‑9 and GAD‑7 (self-report)
Anxiety, Depression, and Mood Scale (ADAMS) (caregiver report)
Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD) (self-/caregiver report)
Reiss Scale for Maladaptive Behavior (caregiver report)

For patients with any disability:

Abuse Assessment Screen–Disability (AAS-D) (self-report)

If using a standard questionnaire, consider modifications.

Use short words, simple sentences, and single‑clause phrasing in the active voice.
Keep questions affirmative rather than negative (e.g., 'I am often tired' rather than 'I have no energy').
Replace abstract wording with concrete, specific wording (e.g., 'What is your job?' rather than 'What do you do for a living?').
Use situational anchors instead of dates (e.g., 'since your birthday' rather than 'in the past two weeks'), but note this changes the time window and the comparability of scores.
Offer simple response formats (yes / sometimes / no) and picture options where possible.
Avoid questions that require abstract or socially reflexive reasoning.
Document any change you made and why so results can be interpreted with that in mind.

Inadequate Follow-up

The Barriers

Healthcare providers may fail to properly follow up based on questionnaire results. They may not give the full screening, ignore positive results, or give medication without offering counseling. While wait times for mental health appointments may be exceedingly long, and there may not be enough mental healthcare providers, providers may not take the time to explain this to the patient, leaving them wondering what the next steps are. Additionally, some patients are asked to complete the questionnaire at every visit without any follow‑up, creating additional distrust.

What Healthcare Providers Can Do

Review screening results with the patient.

Regardless of whether results are positive or negative, review the screening results with the patient. Use clear, nonjudgmental language to explain what the results mean and what the next steps are. Healthcare providers should:

Compare the patient's current presentation to their own usual baseline (new or worsening symptoms, or symptoms in new situations) rather than relying only on standard cut-off scores, especially if any wording was modified.
Ask open-ended questions to better understand specific needs and concerns: “Your screening shows that you may be experiencing some symptoms of anxiety. Many people find it helpful to talk with a counselor about these symptoms. What are your thoughts about this?”
Validate their experiences and emphasize that help is available, and they deserve support.
Clearly address mandatory reporting by telling them what you are required to report, what the reporting process is, and how they will be supported.

Develop a comprehensive follow-up plan.

Work with the patient to develop a follow‑up plan that respects their preferences and needs. If time is prohibitive, healthcare providers can collaborate with staff members, such as social workers, case managers, or care coordinators, to develop a follow-up plan, including:

Ask about their goals and what type of support they would find most helpful.
Consider the patient’s disability‑related needs when making referrals or recommendations.
Include the patient’s support system if they wish and if appropriate.

Make appropriate referrals.

Effective referrals require understanding both the patient’s needs and accessibility of available resources. Healthcare providers should:

Consider offering several types of support, including counseling, support groups, peer support, and medication management.
Consider telehealth services if transportation is a barrier.
Find mental healthcare providers experienced in working with people with disabilities.
Create a referral network of healthcare providers who understand the intersection of disability and mental health, substance use, and/or intimate partner violence.
Verify that healthcare providers in your referral network are accessible in terms of physical accessibility and communication methods.
Remind patients to check with their insurance if specialists are in‑network before their appointment.
Explain what will happen next and any expected timelines while being transparent about wait times and system limitations.

Access & Accommodations

The Barriers

Appointments may be too short for patients to complete the questionnaires with enough time to discuss results or the primary purpose of the visit. The questionnaire may pose accessibility challenges if the office is unprepared to provide assistance in reading or answering questions.

What Healthcare Providers Can Do

Optimize your communication approach.

Clear, accessible communication is fundamental to successful screening and can reduce barriers for most patients. Healthcare providers should:

Use plain, easy-to-understand language, and avoid medical jargon and acronyms.
Speak at a moderate pace to allow for processing time.
Pay attention to your body language. Maintain open posture, appropriate eye contact, and a calm demeanor.
Respect communication preferences and styles. Some patients may need more time to process, use different communication methods, or show stress through body language.
Check your understanding regularly: “Let me make sure I understand what you’re telling me…”
Regularly check the patient’s understanding using the teach-back method, adjusting the approach to the patient's abilities and, when appropriate, confirm understanding with a support person.
Be aware that patients may feel embarrassed when they do not understand medical terminology, and may not volunteer that they are confused. Check for understanding proactively rather than waiting for a patient to ask.
Pay attention to patient body language as a signal that they may not understand or may need additional support. Ask open ended questions like "How can I best support you?"

Watch for response bias.

Some patients may answer in patterns that do not reflect what they actually think or feel. Watch for these and adjust:

Acquiescence (yes-bias): a tendency to agree or say 'yes.' Confirm by asking a pair of opposite-meaning questions, ask the same question in a different format (yes/no, then open-ended), compare self-report with an informant where appropriate, or ask a factual question about everyday activities as a comprehension check.
Recency bias: picking the last option said. Present answer options visually (e.g., a card showing Yes / Sometimes / No) so the patient can see all choices at once.
Social-desirability bias: giving the 'expected' answer. This is most likely to happen when questions are read aloud on sensitive topics. Use a neutral tone and normalize ('I ask everyone these questions').

Provide adequate time and support.

Screenings may take additional time, particularly for patients who need additional support. Healthcare providers should:

Anticipate an extended appointment to complete the screening and discuss results. If a longer appointment is not possible, consider having patients complete questionnaires prior to visit, delegate follow‑up discussion to a care coordinator or social worker, or schedule a follow‑up call to review results.
Be prepared to provide assistance with reading or answering questions, including offering a qualified reader.
Allow flexibility in how and when questionnaires are completed. Consider offering patients the chance to complete questionnaires prior to the appointment.
Offer multiple formats and accommodation options, as needed.

Conclusion

Creating accessible screening environments is not only about compliance, but also provides equitable, high‑quality care that meets the needs of all patients. When healthcare providers implement these strategies, they contribute to a healthcare system that serves everyone equally, regardless of disability status.

Download Resource (PDF)