Easing the Stress of Healthcare Encounters for Children with ASD

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Easing the Stress of Healthcare Encounters for
Children with ASD

• 2008 Collaborative Conference on ASD
• For Parents, Teachers, Therapists Healthcare
  Staff
• Cincinnati Childrens November 8, 2008
• Presented by
• Gail Klayman, MEd, CCLS
• Child Life Specialist III
• Cincinnati Childrens Hospital Medical Center

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Objectives

• Participants will be aware of the vulnerability
  risk for psychological upset from healthcare
  encounters for children with ASD.
• Participants will identify strategies to
  introduce healthcare topics/activities to reduce
  stress during the healthcare encounter and the
  behavior changes after the experience.
• Participants will learn resources and
  collaborative processes available to prepare and
  support children for healthcare encounters to
  promote their emotional and physical recovery.

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What are parents goals when taking their
children to healthcare appointments?
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What is the mission and goal of an
educator/therapist?
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Who has witnessed a childs behavior and learning
receptiveness affected by a healthcare encounter?
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A large number of school age children will
experience healthcare encounters.

• doctor visits

• dental visits

• emergency settings

• hospitalizations

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All children are at risk for psychological upset
and regression from these encounters.
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Psychological state affects

• Ability to cope

• Ability to manage behavior
• Ability to return to routine
• Ability to perform

• Receptiveness to learning

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Children with ASD are at higher risk . . .

• Unfamiliar routines

• Transitions

• Waiting

• Communication issues

• Sensory issues
• High anxiety

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Factors that can affect a childs coping in
healthcare

• Developmental level
• Temperament
• -Trait anxiety

• Communication abilities (receptive and
  expressive)

• Preparation

• Previous experiences

• Support system
• Parental stress

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How can parents/teachers/therapists help reduce
the trauma of healthcare encounters which can
affect a childs emotional equilibrium, behavior
and learning ability?

• List Examples

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Incorporate Health Themes(items or pictures)

• Obtain medical equipment from friends,internet,hea
  lth professionals
• Doctor visit- paper thermometer, tape measure,
  stethoscope, blood pressure cuff, band-aids,
  tongue depressor, reflex hammer, scale, gloves,
  otoscope

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Health themes (continued)

• Dentist- bib, mirror, nitrous mask, toothettes,
  toothbrush, toothpaste, staff mask and gloves,
  chair photo,
• x-ray apron photo
• Eye doctor- sunglasses, pictures, patch, letters,
  occluder, flashlight

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Health themes (continued)

• Hospitalization I.D. bracelet, pill cup,
  pajamas/gowns, staff masks/hats/gloves,
• (if appropriate-anesthesia mask,
• IV arm board, tape, tourniquet, syringe
  without needle, pulse oximeter)
• For specific procedures (cast, EEG)
• -Use healthcare setting website or parent
  knowledge
• -Contact setting
• -Contact a Child Life Specialist

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Health themes (continued)

• books
• art collage
• DVDs
• video modeling films
• social stories
• visual schedules
• writing tasks
• medical/dental items
• sensory tub

• vocabulary
• matching games
• sequence board
• sentence strips
• word find
• crossword puzzles
• I Spy
• visiting professionals

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Job task to learn and practice a routine

• Examples-
• Bin of healthcare materials
• -match to picture
• -practice on doll/self
• Speech Generating Device (SGD)
• - I sit in the dentists chair
• - I open my mouth.
• -The hygienist puts a small mirror in
• my mouth.
• -The hygienist brushes my teeth.

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Numbing CreamPut the cream on the areas marked
with an X

• If creams and bandages are hard for your
  child, you might practice a few times using
  lotion instead of the numbing cream. Have the
  whole family put hand lotion on the areas marked
  above. If the numbing cream directions require a
  covering, then practice putting clear tape or
  clear food wrap (e.g. saran wrap) over the
  lotion. You can draw something fun on the
  tape/wrap. This practice may make it easier when
  you need to put on the numbing cream. It can be
  helpful to wear long sleeves to keep the cream
  out of sight. Follow the directions for the
  numbing cream. It takes a certain time to numb
  the skin, so apply before the procedure time
  according to how long it takes to work. If the
  cream needs to be covered on the skin, call your
  pharmacist to order a few cream covers (called
  occlusive dressings or Tegaderm).

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SNAPSpecial Needs Advocacy Partners
Cincinnati Childrens Initiative

• Supporting children with autism and other
  developmental disabilities through healthcare
  encounters

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Healthcare Staff Preparation Before Visit

• Develop system to identify patients with special
  needs on the schedule
• Identify team of key staff to facilitate
  sensitive care (Child Life Specialist, Social
  Worker, Nurse, etc.)
• SNAP Team
  (Special Needs Advocacy Partners)

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Preparation

• Contact family before visit, if possible, to
  complete Psychosocial Plan of Care
• Explore previous experiences
• (stressors and successes)
• Determine coping and comfort measures
• Provide visual supports/schedules, wording,
  social stories, video modeling
• Discuss desensitization visit
• Discuss pre-medication option with APN/MD

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• Psychosocial Plan of Care for Patient with
  Special Needs
• Todays date _____ Completed by (and contact
  info) ___________
• Date and time of appointment Department
  Procedure
• Patient name DOB MR Phone numbers
• Parents/Guardians Address
  Email
• Special needs description
• Usual anxiety level on a typical day using 0-10
  scale
• 0 is no anxiety -- 10 is extreme anxiety
  ________
• Describe past healthcare experiences (and
  reactions)
• Preferred communication (e.g., ask if child uses
  a visual schedule)
• Sensory issues
• Stressors and the reactive behaviors (e.g.,
  bites, kicks, etc.)
• Interests/Motivators
• Other helpful information
• Pharmacy name and number
• Staff and parent recommendations (note any other
  labs needed if sedated, pre-medication needed,
  etc.)

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Appointment Visit

• Ensure all staff interacting with patient are
  aware of the Special Needs Plan of Care
• Pre assign key staff when possible who are
  notified immediately of patients arrival
• Avoid any waiting time when possible (or use a
  separate space)
• Transitions are difficult
• If prior contact was not made, ask parent success
  strategy information

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Tools for the job

• SNAP Magnet
• Child life materials on site
• Preferred distraction tools (DVD, music, etc.)
• Sensory supports available, as appropriate
• Weighted vest/blanket
• Warm blanket
• Deep pressure/massage (avoid light touch)
• Rocking chair/motion
• Resistive chewing theratubing, washcloth, gum,
  fruit snacks, crazy straws
• Incentives/certificates to acknowledge efforts
  and end on a positive

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Family-Centered CollaborationsDOChange the
Outcome________________________________________
__________________________________________________
__________________________________________________
________
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REFERENCES Hudson, J. (2006). Prescription for
Success Supporting Children with Autism Spectrum
Disorders in the Medical Environment. Shawnee
Mission, KS Autism Asperger Publishing
Co. Koller, D. (2007). Child life council
evidence-based statement preparing children and
adolescents for medical procedures. Retrieved May
14, 2008, from http//childlife.org/Resource20Lib
rary/EBPSStatements.cfm. Manning-Coutney, P.,
Brown, J., Malloy, C.A., Reinhold, J., Murray,
D., Sorensen-Burnworth, R., Messerschmidt,
T. Kent, B. (2003). Diagnosis and treatment of
autism spectrum disorders. Current Problems in
Pediatric Adolescent Health Care, 33 (9),
283-304. Souders, M.C, Freeman, K.G., DePaul, D.
Levy S.E. (2003). Caring for children and
adolescents with autism who require challenging
procedures. Pediatric Nursing, 28 (6),
555-562. Van Der Wal, J.H. Moran, C. (2001).
An audit of perioperative management of autistic
children. Paediatric Anaesthesia, 11, 401-408.
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QUESTIONS ???????????????