Visiting the doctor can be intimidating. And when you are a child with autism, fear of check-ups can be even bigger.

Amy Vo knows that all too well. Her son, Vincent, has autism and was terrified to go to the doctor. That is, he was until Park Nicollet Clinic in Bloomington and HealthPartners Institute’s Patient Education team started using a tool to help kids like him.

The tool is a special pack of flash cards that show pictures of different parts of the clinic. There’s a card that shows the reception desk. There are others of the waiting and exam rooms. And there are still more that show things like a stethoscope and tongue depressor.

Families are given these cards so they can practice walking through the process of an office visit at home. And that gives children like Vincent a chance to go over what to expect before he arrives.

“Before we had the cards, Vincent would get very scared in the parking lot. He would refuse to open the car door and get out,” Amy says. “But the cards have helped a lot. We flip through them together and talk about how the clinic is where doctors are and that they love you and take care of you. And now when we go for a visit, Vincent knows that he is going to be okay. He knows the building and he is able to walk in without fear.”


Visual schedules: Making doctors’ appointments easier for children with autism and other special health care needs

Our organization calls these cards “visual schedules.” And we are using them in response to a growing number of children with special health care needs and behaviors.

“The behaviors seen in clinic range from kids refusing to be weighed or have their blood pressure checked to crying, kicking and screaming during the exam,” said Debra Hildenbrand, PNP, who spearheaded the visual schedules project. “All of these behaviors are disruptive to the visit. They make it hard for families to routinely get in for important well-child check-ups. And they make it difficult for providers to deliver excellent care.”

So Hildenbrand and Park Nicollet-Bloomington Clinic Manager Vicky Schneider started asking families a question: “What parts of a clinic visit trigger anxiety or stress in your child?”

And as they got answers, they worked with the Patient Education team. They started taking the photos that now make up the flash cards being distributed to families of children with autism.

“These cards have made a world of difference,” Hildenbrand says. “In Vincent’s case, he is able to now participate in visits. He can have small conversations and does not get upset. There is no crying. For him and his mom, it’s really been a success.”

Park Nicollet Clinic-Bloomington has also stocked its lobby with flash cards, and welcomes patient feedback on them.

“I was just about in tears when I heard how big of a difference the cards had made for Vincent and Amy,” said Maryann Esh, a Patient Education project manager. “We know the work we do in Patient Education is very important. But it is especially amazing when we hear about specific individuals whose lives have changed so positively. These are the stories that make all the work worth it.”

The team is now exploring the idea of spreading the visual schedules concept to other patients. And one of the possibilities they’re most excited about is how much similar flash cards could help people with dementia.