Autism Friendly Hospital
Improving Access to Care for Children and Families
Carrie Mauras, PhD, Carolyn Bridgemohan, MD, Laura Weissman, MD
Background
Hospital visits and procedures can be very
stressful for children with Autism Spectrum
Disorders (ASD) and their families.
Fears about these stressors and difficult
behaviors during procedures can lead to
medical needs not being met.
Children with ASD are frequent visitors to
BCH (>17,000 encounters/year).
Children with ASD make up almost 40% of
calls to our hospitals behavioral response
team.
Goal
Improve care access and quality at Boston
Childrens Hospital (BCH) through
multimodal Autism Friendly Hospital
initiatives
Preparation
Care Plan
Training
Team
Psychologists, MDs, Speech Pathologists,
Nurses, Social Workers
ChildLife, Resource Specialists, Support
Staff
Innovation and Digital Health Accelerators
Patient Training
Preparation Implemented and evaluated a training curriculum on
working with children with ASD for BCH front-line and
non-clinical personnel.
Hospital Narratives prepare children and their families
for visits and procedures 8 High-Yield departments over 12 sessions
Step-by-step photos accompanied by text from the Needs assessment and pre-training survey
childs perspective
Online module with basic ASD knowledge
Downloadable PDFs (over 30 stories) available on
BCH website Customized in-person department training
Mobile website which allows access to stories from Post-training survey and program evaluation
any device (https://iap.tch.harvard.edu/MyStory)
Post-training survey at 1 month
Care Accommodation 85% -- Overall rating of Excellent or Very Good
95% -- Appropriate complexity of material
Plan 87% -- Ability to apply information immediately
Three Time Point Training Survey Comparison
Proactive Behavior Plan co-created by parents and 5
ASC staff called Precaution B 4.5
p < 0.001
p < 0.001
Mean Responses
p < 0.001
Located in the electronic medical record 4
ASC staff run weekly report and alert providers when
patient with Precaution B is coming for visit/procedure 3.5
p = 0.04
3
Supports caregivers by valuing their expertise and
reducing patient distress Pre-training
Immediate Post Delayed Post
2.5
What helps your child stay calm? Attitudes Comfort Knowledge Self-reported Behaviors
What could upset your child? N = 38
!
When upset, what does your child do?
What are effective ways of distracting your child?
Feasible and led to short-term improvement in
Creating a safer, more supportive environment attitudes, comfort, knowledge and behavior
Improved access and increased quality of care for
over 600 children. Over 250 personnel trained