Testing Implementation Strategies for the Autism Support Checklist: - - PowerPoint PPT Presentation

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Testing Implementation Strategies for the Autism Support Checklist: A Pilot Study

Coral Bays-Muchmore, BSc Developmental and Behavioral Pediatrics, Boston Medical Center

Health

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Acknowledgements

• Thank you to the BMC Autism Program for their continued support
• Belinda O’Hagan, MA
• Pooja Sonikar
• Alexander Friedman, MPH
• Shari King, MA MPH
• Lauren Bartolotti, MA
• Marilyn Augustyn, MD

Needs of Patients with Autism Spectrum Disorder (ASD)

• Patients with ASD have higher rates of 1–4:
• Various medical conditions
• Usage of healthcare services
• Associated costs of healthcare services
• However, patients with ASD and families reported lower satisfaction with the care

they receive 5–8, despite this higher use.

Needs of Patients with Autism Spectrum Disorder (ASD)

• Lower satisfaction partly due to unique unmet needs in a typical hospital

environment 9–11.

C

• mmunication

S ensory

The Autism Friendly Initiative at Boston Medical Center

• Launched in 2017 to improve the

hospital experience for patients with Autism Spectrum Disorder (ASD)

• Data gathered from
• Hospital-wide Steering Committee
• Patient ethnographic study
• Healthcare utilization record review
• Caregiver focus groups
• Three key categories of challenges

for patients with ASD:

Challenging Patient Experience Gaps in Clinician/Staff Knowledge Sensory Needs of Patients Communication challenges between provider and patient

Knowledge Interventions

Training Engagements – Staff

• Ongoing trainings delivered to clinical and non-clinical staff in order to

improve familiarity and comfort in caring for patients with ASD Training Engagements – Students

• Training for medical students, dental students, and genetics students

providing a foundational understanding of ASD to inform future clinical practice, which includes a facilitated caregiver panel Training Videos

• Four short, professionally-produced training videos on the following

topics:

• Fundamentals of ASD
• Communication Strategies
• Sensory Needs
• Safety Considerations

Conferences & Publications

• Presentations at local, regional and national conferences:
• Pediatric Academic Societies (PAS)
• HRSA MCHB Autism CARES
• New England Pediatric Hospital Medicine
• AFI findings published in JAMA, Autism: International Journal of Research

and Practice, with additional manuscripts in progress

Sensory and Communication Interventions

Autism Support Checklist (ASC)

• Individualized care plan that collects information about a patient’s communication style,

triggers, safety concerns and de-escalation techniques

• Logged into a patient’s Electronic Health Record (EHR) and prominently displayed so that

all providers, regardless of prior relationship with a patient, can understand how to most successfully care for them Sensory Toolbox

• Integrated into about 20 different hospital departments in collaboration with the

Department of Child Life

• Contains items meant to calm, distract, and redirect patients who may struggle with the
• verwhelming sensory experience in a health care setting

Healthcare Social Stories App

• Presents interactive, BMC-specific “social stories”, which can help patients with ASD

navigate and understand new situations

• Takes patients through BMC-specific bus stops, garages, campus buildings, and procedures

in order to prepare them for their visit Visual Schedules

• Helps patients with ASD understand the nature of upcoming events through pictures
• Implemented in various adult and pediatric inpatient and outpatient departments

The Autism Support Checklist (ASC)

Does the patient communicate using spoken language? Yes/No

The Autism Support Checklist (ASC)

Does the patient have sensory triggers/needs? Avoid bright lights Avoid loud noises Avoids touch Seeks pressure

The Autism Support Checklist (ASC)

Does the patient engage in behaviors that could be a safety concern? Bolting Self-injurious behaviors Hitting/Kicking

Study Objectives

• Evaluate two implementation strategies for ASC uptake
• High-intensity and low-intensity
• Determine the acceptability of the ASC by clinicians
• Collect patient caregivers’ feedback

Methods

• Design: Mixed methods design (QUAN + qual)
• Procedure:
• Search for upcoming appointments for patients who had ASCs

– Database had ~300 patients

• Randomly assign their clinicians to either a high-intensity/active (in-person)

training or low-intensity/passive (email only) approach

Methods

High Intensity Low Intensity Received email with invitation to participate and ASC FAQ ✓ ✓ Randomized before response ✓ ✓ Received in-person 15 min session to explain ASC and answer questions ✓ Received a post-appointment survey link ✓ ✓

• Procedure (cont):
• Comparison of high-intensity intervention to low-intensity intervention

Methods

• Procedure (cont):
• After the appointment:

– Clinicians completed a web-based survey with quantitative and qualitative items – Patients’ caregivers completed a phone survey

Clinicians Patient Caregivers Incentive None $15 Amazon e-gift card Survey method Online via REDCap Phone call Survey components QUAN + qual QUAN + qual

Assessed patient for eligibility Identified clinician for upcoming appointment (n=80)

Enrollment Allocation

High-intensity (n=40)

• Agreed to participate (n=16)
• Declined to participate (n=24)

Low-intensity (n=40)

• Agreed to participate (n=16)
• Declined to participate (n=24)

Follow-up

Lost to follow-up (n=3)

• Patient no-show (n=2)
• Clinician did not respond to

survey (n=1) Lost to follow-up (n=6)

• Patient no-show (n=4)
• Clinician did not respond to

survey (n=2) Analyzed (n=13) Analyzed (n=10)

Analysis

Analyzed (n=13) Analyzed (n=10)

Analyzed (n=13) Analyzed (n=10)

Enrollment

Patient Caregivers Contacted (n=13) Patient Caregivers Contacted (n=10)

High-intensity Low-intensity

Lost to follow up (n=4)

• Declined to participate

Lost to follow up (n=2)

• Declined to participate

Analyzed (n=8) Analyzed (n=9)

Follow-up Analysis

Clinicians:

Results

Clinician Survey Items High-intensity Low-intensity P-value n Clinicians who reported reading the ASC in full 100.00% 70.00% 0.068 23 Clinicians who reported finding the ASC useful 61.50% 60.00% NS 23 Reported obstacles for ASC: Lack of time 69.20% 30.00% 0.10 23 Information is not useful/relevant to my practice 23.10% 10.00% NS 23 Information is too long 15.40% 20.00% NS 23 Unsure where to located ASC in EPIC 7.70% 30.00% 0.28 23 Clinicians who reported changing their behavior because of the ASC 30.80% 14.30% NS 20

Table 1 – Results from clinician surveys. Data were analyzed using Fisher’s exact test.

Results

Clinician Survey Items High-intensity Low-intensity P-value n Clinicians who reported reading the ASC in full 100.00% 70.00% 0.068 23 Clinicians who reported finding the ASC useful 61.50% 60.00% NS 23 Reported obstacles for ASC: Lack of time 69.20% 30.00% 0.10 23 Information is not useful/relevant to my practice 23.10% 10.00% NS 23 Information is too long 15.40% 20.00% NS 23 Unsure where to located ASC in EPIC 7.70% 30.00% 0.28 23 Clinicians who reported changing their behavior because of the ASC 30.80% 14.30% NS 20

Table 1 – Results from clinician surveys. Data were analyzed using Fisher’s exact test.

Results

Table 2 – Results from caregiver surveys. Data were analyzed using Fisher’s exact test.

Caregiver Survey Items High-intensity Low-intensity P-value n

Clinician understood that patient was trying to communicate

77.80% 100.00% NS 17

Clinician communicated in a way that met patient’s needs

100.00% 87.50% 0.47 17

Clinician used actions/items to meet patient’s sensory needs

66.70% 60.00% NS 8

Clinician avoided actions or phrases identified as triggers for patient

85.70% 50.00% 0.42 9

Clinician offered explanations of medical procedures based on patient’s communication preferences

83.30% 85.70% NS 13

Results

Caregiver Survey Items High-intensity Low-intensity P-value n

Clinician understood that patient was trying to communicate

77.80% 100.00% NS 17

Clinician communicated in a way that met patient’s needs

100.00% 87.50% 0.47 17

Clinician used actions/items to meet patient’s sensory needs

66.70% 60.00% NS 8

Clinician avoided actions or phrases identified as triggers for patient

85.70% 50.00% 0.42 9

Clinician offered explanations of medical procedures based on patient’s communication preferences

83.30% 85.70% NS 13

Table 2 – Results from caregiver surveys. Data were analyzed using Fisher’s exact test.

Results

• 71% of clinicians reported reading the ASC in full and among these clinicians, 70%

reported finding it useful.

• Potential barriers to ASC:
• 43% of clinicians reported “lack of time”, 14% reported “information is irrelevant”, 14%

reported “information is too long”, and 17% reported “unsure where to locate”

• 18% of clinicians reported changing their behavior because of the ASC

Results

• There is a trend in which high-intensity group clinicians were more likely

than low-intensity group clinicians to report reading the ASC in full (p = 0.068) and lack of time as a potential barrier for using the ASC (p = 0.10).

• Patient caregivers reported similarly positive outcomes across both clinician

groups regarding clinicians’ ability to communicate with the patient and address their sensory needs.

Study Objectives

• Evaluate two implementation strategies for ASC uptake
• High-intensity and low-intensity
• Determine the acceptability of the ASC by clinicians
• Collect patient caregivers’ feedback

Conclusion

• An active training component may be helpful in increasing clinician

engagement, but this does not translate to an increased likelihood that the clinician will rate the ASC as more helpful or report behavior change.

• The Autism Support Checklist (ASC) was generally well-received by clinicians.
• Overall, patient caregivers were generally satisfied and did not report major

differences in experience between intervention strategies

Conclusion

• Further research is needed to explore other potential implementation

strategies for the ASC and its longitudinal impact and effectiveness on improving care delivery and patient/family-related outcomes across departments.

References

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THANK YOU!

• Coral Bays-Muchmore, BSc, Autism Friendly Initiative
• Boston Medical Center

@ DoctorCoral