Training Medical Providers to Care for Patients with ASD: Autism in 3-D

Background: The social communication, restricted interests and repetitive behavior deficits that are core features of ASD may create challenges for patients, families and health care providers during routine and sick health visits as well as during emergent or acute medical care. In addition, ASD is often associated with medical and mental health co-morbidities and/or safety risks, which may further increase the need for medical visits beyond those of typically developing peers.

Objectives: To create multi-dimensional training and resources to improve the knowledge, comfort and effectiveness of medical providers in caring for patients with ASD in the medical setting.

Methods: Medical providers in a large health system were surveyed regarding their knowledge, comfort and concerns related to treatment of patients with ASD. Specific issues and scenarios were also solicited to help design training. Trainings were developed and implemented with varied audiences including primary care and acute care nurses, pediatric residents and pediatricians, inpatient multidisciplinary pediatric chronic illness management team, other service providers, and families. Resources developed included patient health and wellness passports, visual schedules, pictorial social narratives, and sensory toolkits.

Results: Baseline concerns included how to identify patients with ASD, handling communication and behavioral challenges, how to modify medical education for the patient, and coordination of care.

Five workshops were highlighted. For four of the five, training was provided by a multidisciplinary team which included psychologists, behavior analysts, parents, and nurse practitioners. The fifth workshop was provided by a psychologist. Participants reported improvements in knowledge and comfort in providing care, and improved ability to recognize individual/family strengths and challenges. The chronic illness management team successfully adapted their patient goals and training materials to better match patient skill level and learning style. One year follow up data for the nursing workshop will be reviewed to examine long-term impact. As a result of the trainings, one hospital initiated a system-wide process for identifying, preparing for and addressing needs of patients/families and staff.

Conclusions: Given the prevalence of ASD, nearly all medical providers involved in primary, specialty, emergent and acute care will be involved in caring for this population. Training that combined the perspectives and skills of families, health, and behavioral/mental health providers effectively improved knowledge and comfort of medical providers and helped arm them with strategies to implement in their respective medical homes.