Hospital team gains insight to make stay positive and effective

At Arkansas Children's Hospital (ACH), a screening for patients who have autism spectrum disorder (ASD) or an intellectual disorder helps the hospital do a better job serving these children, which results in the hospital stay being a less stressful experience for the children.

"The screening is a communication tool we use to enhance the patient experience," said Child Life Specialist Rachel Stewart, CCLS, one of the child life specialists who administers the survey on the ACH campus. "We ask questions to help us take better care of the child. Based on those responses, we can do a more thorough assessment to find ways to enhance the hospital experience since being in the hospital can be a stressful experience."

Stewart said their goal is to make a child's hospital stay as comfortable as possible. They do that by recognizing that the child has special needs and that the parents know their children best.

Rachel Stewart, CCLS

"So, we ask a set of questions in order for parents to give us insight into how we can make the child's hospital stay as positive and safe as possible," Stewart said. "Some of those areas that we ask questions include about how their child communicates. For example, does he use single words, sentences, sign language or a communication device? Can he accurately respond to 'yes' or 'no' questions? Is he able to respond to verbal instructions? Does he respond to his name when called? Does he follow commands? Can he follow multi-step commands?"

A second area in the questionnaire is related to how the child processes sensory input. Some children who have ASD can be overstimulated by certain triggers. It is important to know how the child processes the senses of touch or tactile sensations. Parents are asked if their child has any problems with the sense of touch. Does he avoid some type of touch? For example, maybe the blood pressure cuff squeezing on his arm is a problem for them, which might make it hard to get a blood pressure reading in hospital.

"That is good for us to know so we can minimize that or find another way to get their blood pressure taken," Stewart said. "Also, kids with sensory processing disorders or autism respond to senses differently. Sometimes they seek out certain sensations and sometimes they avoid different sensations. We use this tool to access what these things are. That is different for each patient."

Other issues covered in the sensory portion of the questionnaire include questions about hypersensitivity to sounds and lights. Certain lights are very overstimulating for some kids. Dimming the lights can help a child remain calm.

"We ask about their oral sensations," she said. "Some children like chewing on things. We can provide certain tools so they can chew on something safe here in the hospital. Then we ask about different things about smelling and movement. Some children like movements like rocking back and forth."

The questions help spur conversations about what helps the child cope with the illness or hospitalization. Sometimes children with ASD can't verbally communicate.

"Using a parent for the questionnaire gives us insight into what their life looks like outside of the hospital and how we can better meet their needs individually," Stewart said. "All those kids are somewhat different, so what might be helpful for one child might trigger unwanted behavior in another child. We always want to best meet the patient and family where they are at."

With one patient she worked with recently, she was able to identify an item that really helped with the hospitalization. Without the questionnaire, she wouldn't have known.

For another patient, the color red was a trigger. Avoiding a red toothbrush for that patient was helpful.

Another section of the assessment covers safety. Does the child exhibit any self-injurious behaviors, injurious behaviors for others, does he tend to run away, and does he have a poor awareness for danger? Responses help keep children safe and help keep other people in the hospital safe, as well.

"We have multiple questions that we ask throughout this assessment, which goes into an electronic chart so the entire medical staff has access to the information so we can better serve the patient and family," Stewart said.

The questionnaire helps parents feel like they are being heard. "They know things about their child we will never know," Stewart said. "It allows parents to feel a part of the team in taking care of their child. In the hospital, the term we use for that is family-centered care."

Stewart said she is really thankful they have this questionnaire tool because it is such an important piece of her work in the hospital.

"My job as a child life specialist is to reduce anxiety and to increase coping," she said. "Specifically, with children with autism or any other sensory disorder, this is a huge tool for me to find out how I can best meet that child's needs."

For more information, go online to:

Arkansas Children's Hospital Neurodevelopmental & Neurobehavioral Clinic

Arkansas Children's Hospital Dennis Developmental Center

A Research Study Of CM-AT for the Treatment of Autism in Children