'Autism-friendly' ER rooms provide soothing environment for children

June 1, 2019


Bright lights. Alarms. Sporadic overhead pages. A parade of unfamiliar clinicians. Patients who are stressed, maybe demonstratively so.

The abundance of sensory stimulation in the average mental health emergency department can feel overwhelming to children and young adults with autism spectrum disorder. To better care for these patients, Saint Mary's Hospital in Waterbury, Conn., offers two "autism-friendly" exam rooms set apart from the cacophony.

Autism Friendly ER
Ava Boornazian, a psychiatric nurse practitioner, stands at the threshold of an "autism-friendly" room in the mental health emergency department at Saint Mary's Hospital in Waterbury, Conn. The sound-proof room has low lighting and bare walls. Boornazian says the reduced stimulus environment can lessen the amount of medication needed to calm a young patient in the throes of a mental health crisis.

"The emergency department can be a terrifying experience for anybody, but particularly terrifying for kids with autism, whose perceptual experiences are different," says Ava Boornazian, a psychiatric nurse practitioner affiliated with Saint Mary's.

"As we saw more children start to panic in that environment, we realized we needed to help make coming to the hospital a little easier on these patients." She added that clinicians also wanted to create environments that were conducive to engagement with the patient's family. "Autism really is a family illness," she says.

A member of Livonia, Mich.-based Trinity Health, Saint Mary's has the fourth-highest pediatric volume emergency department in Connecticut. Two years ago, the hospital redesigned two traditional rooms in the emergency department to accommodate young patients with autism. The rooms are in a recessed area in the behavioral health emergency department, which is behind a wooden door.

A report from the federal Agency for Healthcare Research and Quality shows that nationwide the number of people with an autism diagnosis who were seen in hospital emergency rooms nearly doubled from 81,628 in 2009 to 159,517 in 2014. Today, the Centers for Disease Control and Prevention reports that autism is the fastest-growing developmental disability in the U.S., and one in 59 children has been identified with autism spectrum disorder.

In 2017, the emergency department at Saint Mary's had 900 adolescent/pediatric behavioral health assessments. Last year, the department charted more than 1,350.

"Behavioral issues are part of this illness, and more and more emergency departments are seeing high numbers of children and young adults with autism coming in because it's hard to get appointments with outpatient practitioners," says Boornazian. "Our two autism-friendly rooms are used almost every day, and we have found that the lower level of stimulation eliminates the need for physical restraints and decreases the amount of medication needed" when a child is in crisis.

Easy does it
What does an autism-friendly room look like?

Painted a soft beige, the rooms are larger than other exam rooms in the department. The walls are bare and sound-proofed; the lights are kept low. "The bed is a normal bed, not a hospital bed, and the staff doesn't wear lab coats," Boornazian says. "We have chairs that can't be thrown by a frightened child and the televisions are encased in protective, nonbreakable enclosures. And we can offer iPads so the kids can download their favorite songs or games, to give them a sense of control and security."

The staff is trained to take individual needs into consideration, Boornazian says. "Autism has many different presentations, from individuals who are nonverbal to those who are extremely high-functioning and verbal. They all perceive the world differently, and each person has a different thing that is disturbing or comforting."

The staff also speaks at length with parents to learn the patients' preferences and devise individualized treatments. "One child may be sensitive to touch, but others may run at you. You might perceive that as kids coming to hit or attack you, but they may throw their arms around you, seeking the comfort of hugs," Boornazian says. "Others may want a teddy bear or stuffed animal from home, or a stress ball. We also find out preferences for snacks."

Overnight and extended stays
The trend to provide autism-friendly rooms appears to have begun on the East Coast more than three years ago. Aurelia Grayson, a spokeswoman for Autism Speaks, a national advocacy organization based in New York City, reports that "while many hospitals make accommodations, we are not aware of any statistics on autism-friendly emergency rooms."

Newspapers have reported on such rooms in hospitals in Washington, D.C., New Jersey, New York, Pennsylvania, Indiana, Florida and South Carolina. Emergency room staff in other hospitals, including St. Joseph Mercy Ann Arbor in Ypsilanti, Mich., provide children and young adult patients with items "to help decrease agitation."

Jennifer Dunn, director of emergency services for Trinity Health's St. Joseph Mercy Ann Arbor, notes that those items include "an iPad with games and movies, board games, cards and fidget spinners that can help, depending on the child." She adds, "We also remove things from the typical emergency department exam room that could cause an unintended injury for these patients and allows the child to pace if needed."  

How long are young patients in the rooms? "That can vary, but often we get children out after they are stabilized during an overnight stay," Boornazian says. "Sometimes it may be a week or 10 days as we wait to admit children with real challenges to a mental health facility, because the facilities available do not match the need."

Boornazian notes that families tell staff at Saint Mary's they feel better knowing their child is being taken care of in a space sensitive to individuals on the autism spectrum who can't always communicate their feelings.


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