ASD in the Hospital: Making It Easier for Children, Families, and Staff

Background: Given the rising prevalence of ASD, health care systems are challenged to safely and expertly interface with this growing patient community.   Unfortunately, many characteristics of ASD can interfere with the efficient and effective delivery of almost all aspects of health care.  From routine health care encounters to more highly specialized evaluations and interventions within a hospital-based setting, individuals with ASD can become easily overwhelmed and distressed during a health care encounter.  This can make providing health care difficult for the patient, family, and staff, and over time make it less likely that individuals with ASD will receive or seek necessary medical treatments.   Health care systems and individual providers of medical services are largely unprepared to adapt to the needs of these individuals, and need training on alternative technologies, adapted instruments, and accommodations within standard practice. 

Objectives: This presentation will outline how we have worked to translate the model of Positive Behavioral Support, used successfully within education and treatment settings for individuals with autism, to an acute medical setting in order to predict and prevent problem behaviors that challenge delivery of safe, quality care.  We will introduce a series of strategies tailored to address how to identify patients who may need special assistance, how to prepare children with ASD and their families in advance of a hospital visit, and how to help providers  organize and structure a patient encounter.

Methods: Suggested interventions include: identifying patients who may need special accommodations through the electronic medical record, priority scheduling to reduce wait times, room assignment to quieter areas, developing materials to create visual schedules within patient care locations, recommendations for environmental modifications to patient care areas; tools to improve accuracy of pain assessment, discrete modifications to bedside care, and methods to more successfully share information among providers and with families.  Direct training of staff on characteristics of ASD and the use of targeted interventions to adapt standard practice is also necessary. 

Results: Targeted interventions can facilitate staff communication and improve the interaction with individuals with ASD, which will in turn lead to more successful health care encounters.  Better understanding of how children with ASD experience and communicate about pain will help health care providers make more accurate assessments of pain, which will also increase the quality of care. 

Conclusions: It is critical to consider how we provide health care to individuals with ASD.  We found it possible to replicate a PBS model of intervention within an acute medical setting that is easily self-sustaining at low cost, and generalizable to different health care settings.  Training staff on how ASD can impact a health care visit and how to make accommodations within standard practice can empower hospital staff to provide an excellent patient experience to individuals with ASD and their families.