Association for Behavior Analysis International

Determining successful pathways to improve accessibility to and quality of care for individuals diagnosed with neurodevelopmental disorders (e.g., autism spectrum disorder) remains a major challenge for health care providers and society at large (Waxegard & Thulesius, 2016). That is, although timely diagnosis and entry into early intervention services is recommended for these individuals (Elder et al., 2017), caregivers often experience barriers when attempting to access this initial level of care. Further, barriers to accessing appropriate care become more complex throughout the individual’s life course (Malik-Soni et al., 2021) and caregivers find themselves continually faced with navigating a variety of challenges when attempting to secure services and resources to meet the needs of their family. The presentations within this symposium will highlight several of these challenges and discuss potential solutions that families might encounter when attempting to access initial care (i.e., waitlists and caregiver training) up until when they need to access emergency or intensive services (i.e., boarding patients with severe challenging behavior in the emergency department and inpatient units). A discussant will review how understanding these barriers is crucial for developing effective solutions and will offer strategies for improving access to services.

Basic

Individuals with autism spectrum disorder (ASD) who engage in severe problem behavior are often brought to the emergency department (ED) by their families when there is no other option to ensure safety. Individuals may remain in the ED for extended periods. We executed a grant with a local ED to decrease the length of stay of these individuals by arriving to the ED within 24 hours of admission to conduct functional behavior assessment, develop treatment recommendations, and train parents, caregivers, and/or staff to implement them. This presentation will describe the results and focus heavily on the barriers experienced in providing said service. We will discuss the ramifications for future projects of this nature and ways to approach removing those barriers.

Boarding has been defined as “the practice in which admitted patients are held in hallways or other emergency department (ED) areas until inpatient beds become available” (U.S. Department of Health and Human Services, 2008) and represents a widespread challenge to accessing appropriate care for individuals with psychiatric needs. Several published articles (Nicks & Manthey, 2012; Nolan et al., 2015) have described the prevalence of boarding and provided guidelines related to decreasing boarding in EDs. However, less research has examined preventing and addressing a related challenge of patients boarded for extended periods of time on inpatient psychiatric units without a clear disposition plan. This presentation will describe a treatment model for individuals boarded on psychiatric inpatient units. The treatment model consists of (a) modifications to common psychiatric and behavioral treatments to enrich the patient’s time on the inpatient unit and (b) strategies to interact with external team members (e.g., Medicaid) to facilitate a timely transfer from the unit to an appropriate level of care. Initial results showed improved duration between aggressive outbursts and improved staff safety while caring for these patients for extended periods. Recommendations will be made for future research dedicated to understanding and preventing boarding on psychiatric inpatient units.