Passport to Success: Hands-On Strategies for Delivering Health Care to Children with Special Needs

Introduction: The primary focus of “passport” is to improve the patient experience for patients and families with special needs, with a focus on autism spectrum disorder (ASD). Special needs and the demands of a medical visit intersect to make for a more challenging experience for the child, parent, and medical staff. Children with ASD tend to have social and communication deficits as well as difficulty reading non-verbal interactions. Thus, an educational program - “passport”- was created to teach techniques and provide tools for clinical staff to utilize with children with ASD to help them move through their medical visit in the safest and calmest manner possible.

Methods: A multidisciplinary steering committee was formed to identify and meet the needs of special needs children within medical visits at a subspecialty outpatient clinic. The overall goal was to minimize ASD-related barriers to care and to create an excellent patient experience for these patients and families. The first step was to develop reliable processes to identify children with special needs and to designate it in the electronic medical record (EMR). Secondly, a hands-on seminar was developed for medical staff to instruct them on the characteristics of ASD, techniques for minimizing/handling issues within a visit, and tools that they could use to facilitate a safer and more satisfactory visit. Thirdly, tools were purchased and distributed in a “toolbox” to each clinic along with instructional reminders.

Results: Educational sessions were held at three clinic locations to instruct clinical staff on identifying and assisting children with special needs/ASD throughout all aspects of their visit. For example, a clinic-specific passport in which the patient receives a stamp for each completed step of the visit can be a helpful visual guide so the patient knows how they are progressing. The tools or techniques that were identified during the visit to be successful for the patient are documented in the EMR and shared with other clinics to benefit the child and family. The committee continues to hold meetings to monitor the progress of the passport program as well as to expand educational offerings related to medical care of children with special needs

Discussion: This hands-on seminar provided useful techniques and tangible tools for medical staff to immediately put into place. Although all medical staff were invited to these educational sessions and there was excellent participation, few of the attendees were provider-level staff. Thus, the passport program will be presented to provider-level staff at existing meetings, both for the purpose of learning ways they can facilitate the visit of a child with ASD as well as to help providers understand and support the extra time that clinic staff may need when they facilitate care for patients with ASD per the passport model. At the end of each seminar, participants were asked to commit to doing three things differently moving forward. Objective measures of use of these techniques, effectiveness of the toolbox, as well as family perception of the care they receive will be completed in 2019.