Does an Autism Spectrum Disorder Care Pathway Improve Care for Children and Adolescents with ASD in Inpatient Psychiatric Units?

Abstract

Youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates. Though specialized psychiatric units are effective, few specialized units exist. The ASD Care Pathway (ASD-CP) was developed as a scalable approach to improving care in general psychiatric units through staff training and a package of autism-specific intervention strategies. An evaluation of the effectiveness of the ASD-CP in a public hospital child psychiatric service compared 18 months (n = 17) versus 18 months (n = 20) post implementation. Average length of hospital stay decreased 40% (22.4-13.4 days) and use of crisis interventions decreased 77% (holds/restraints; 0.65/day to 0.15/day), though each result only approached statistical significance (p = 0.07; 0.057). This study provides preliminary evidence for improved outcomes after implementation of an ASD-CP.

Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care

“…We also found five additional studies that met our inclusion criteria, through scrutinizing the reference lists of other articles, resulting in a total of 18 papers in the review. Four of the articles described the same two facilities but were included since the evaluations in the studies were made months/years apart [32][33][34][35]. Data extracted from the articles included type of interventions, study design, setting, context, and outcome.…”

“…According to Kuriakose et al [35], the Autism Spectrum Disorder Care Pathway (ASD-CP) was developed as an approach to improving care in psychiatric units through autism-specific intervention strategies. Individuals with autism may have limited ability to communicate their symptoms, due to difficulties with social communication or intellectual deficits.…”

“…Without sufficient understanding and clinical experience of autism in psychiatric units, this can lead to an increased risk of harm for both patients and staff. This in turn can increase the risk of inappropriate crisis intervention, like seclusions, restraints, or PRN medication administration [35].…”

The Severe End of the Spectrum: Insights and Opportunities from the Autism Inpatient Collection (AIC)

“…Research on psychiatric hospitalization of children with ASD as an intervention is generally minimal, and is an area of opportunity as use of this intervention is common and costly (Croen et al 2006). Access to the type of specialized inpatient units where the AIC is being conducted is very limited, leading some researchers to develop recommendations for best practices (McGuire et al 2015) and clinical care pathways (Kuriakose et al 2018) that seek to improve the care that youth with ASD and other developmental disabilities can access in the much more prevalent non-specialized psychiatric units. As a public policy matter, further research is needed to assess the specific treatment and environmental factors that lead to better outcomes in either specialized or general settings, and may engender comparative effectiveness research on the two settings.…”

Child inpatient treatment: Moving it out of the shadows

“…Recent research exists on the child characteristics that influence their hospitalization (particularly length of stay; Reynolds et al, ) and treatment planning for select diagnoses (e.g. Kuriakose et al, ). There is a little recent explication of how to care during inpatient treatment positively or negatively impacts children, and even less detailing care processes implemented by the nursing staff.…”