When considering autism in the context of hospital security, it’s crucial for hospital staff and security personnel to be aware of and sensitive to the unique needs and behaviors of individuals with autism spectrum disorder (ASD). ASD is a neurodevelopmental condition characterized by challenges in social interaction, communication, and repetitive behaviors. Whether it’s because of better diagnostic techniques or an actual rise in incidence, the prevalence of ASD is rising, and healthcare settings are seeing an increase in individuals seeking care.
“Children and adults with ASD are more likely than their counterparts without ASD to use the emergency department. The average number of emergency department encounters is approximately 30% higher for children with ASD, 70% higher for teens with ASD from ages 15 to 18, and twice as high for adults with ASD,” said the Organization for Autism Research.
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Training hospital staff to effectively interact with individuals with autism is crucial for providing high quality care and preventing avoidable escalation.
Here are some considerations for incorporating autism awareness into hospital staff and security protocols.
Train Staff on Autism Acceptance
Provide comprehensive training sessions to educate hospital staff about autism spectrum disorders, including common characteristics, sensory sensitivities, communication differences, and potential behaviors they may encounter. Staff should also learn de-escalation techniques tailored to individuals with ASD.
Provide ongoing education and opportunities for staff to further develop their understanding and skills in working with individuals with autism. This can include workshops, seminars, and access to resources and support networks. Training is the first step toward improving the experience for staff and autistic patients alike.
A simple example of this might include creating a check list with tips for staff to use when caring for an individual with autism. The check list can include definitions, such as “stimming,” or “echolalia,” and could remind providers of specific techniques they could use when caring for the individual.
- Stimming is short for “self-stimulatory” behavior and is a repetitive action or movement of the body that an individual uses to regulate their emotions.
- Echolalia is the repeating of words, sounds, or phrases that were just spoken by another person.
How Can We Effectively Communicate with Individuals with Autism?
Teach staff effective communication strategies for interacting with individuals with autism, such as using clear and concise language, avoiding figurative language, and providing visual support when possible. Visual supports such as pictorial or written instructions can help individuals with autism understand security procedures and expectations. Clear signage can also aid in navigation and reduce anxiety.
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Security personnel should communicate clearly and calmly with individuals with autism, using simple language and avoiding complex instructions or ambiguous statements. An example of this might include not trying to force any eye contact with the individual or being sure to speak clearly and use direct language.
Instead of asking “What’s wrong today?” or saying, “Sit on the bed,” instead ask “What is hurting you right now?” or give an option to sit on the chair or on the bed. These techniques can lead to improved cooperation and can reduce some of the potential triggers.
Adopt Visible Identification to ID Patient Conditions
Hospitals can offer optional identification cards or wristbands for patients and visitors with autism. These identifiers can alert security personnel and other staff members to the individual’s specific needs and facilitate appropriate interactions.
Implement discrete patient identification methods that could include electronic medical records or wearable identifiers that indicate the individual’s condition. An example of this might include having a wristband that is a different color to indicate their condition to trained staff.
Patients with ASD Usually Have Sensory Sensitivities
Raise awareness among staff about sensory sensitivities and how environmental factors such as noise, lights, and textures can impact individuals with autism. Hospitals should strive to create a sensory-friendly environment, minimizing loud noises, bright lights, and other sensory triggers that may agitate individuals with autism.
Security personnel can help by providing a designated quiet space where patients with ASD can retreat if they become overwhelmed or overstimulated. Hospitals may consider the use of sensory kits. Sensory kits for individuals with autism are designed to provide a range of tools and resources to help manage sensory sensitivities and promote self-regulation. These kits can be customized to meet the specific sensory needs and preferences of each individual.
An example of incorporating sensory awareness might include different clothing/gown options for the patient. Gowns can be hot or cold, smelly, and scratchy to someone who has a heightened sensory awareness, so if it’s safe to do so, consider keeping the patient in their own clothes instead of changing them. Another example is to intentionally use a lower volume for your voice and avoid abrupt directions so that communication can actually be received better.
Train Staff to Understand Behaviors
Help staff members understand the behaviors individuals with autism may exhibit, such as repetitive movements, difficulty with transitions, or heightened anxiety. It is also common for individuals with autism to try to run or elope. This can be fear-based or because they want to get somewhere else, but most often, it’s due to a lack of understanding of the need to be in the hospital or healthcare setting.
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It’s important to provide additional training strategies for de-escalating and responding to these situations with empathy and patience. It’s also essential for security staff to understand that sometimes individuals with autism will be delayed in their response or may pull away from a procedure, but these actions should not be confused as displays of refusal. Instead, this behavior could be happening due to a sensory or processing issue.
Try to have patience with behaviors that are exhibited, and work to understand WHY they may be exhibiting a particular behavior.
A specific example of being proactive by understanding potential behaviors might include moving a patient with ASD to a room that is by the nurse’s station and out of view of a door or exit to help prevent elopement. Being thoughtful and proactive can help prevent and avoid negative outcomes.
Avoid Using Restraints
Unfortunately, avoiding the use of physical restraint or forceful measures with individuals with autism may not always be possible. However, avoiding the use of restraints is ideal. Individuals with autism may be overly sensitive to touch. A simple touch on the arm or head may trigger a “fight or flight” response.
Additionally, a large percentage of the population with autism suffer from seizures. A physical altercation may trigger a seizure.
Hypotonia — a condition of low muscle tone and strength — is a common characteristic of autism. Some individuals with autism may exhibit signs of hypotonia such as floppiness or poor muscle tone. This can also affect their motor skills, posture and coordination. Hypotonia can also lead to positional asphyxia if placed chest down, so individuals with autism are at a greater risk when restrained, restricted, or held down.
Instead, focus on de-escalation techniques, calming strategies, and creating a safe environment for all involved.
An example of working to avoid restraint might include the overall understanding that when an autistic individual is self-injuring, it usually means they are in pain, and they are turning their behavior inward and hurting themselves instead of someone else. The immediate response is to restrain them from self-harm. However, if possible, try using distraction to keep them safe, or use a pillow as a cushion if they are hitting their head, instead of trying to grab them. A direct, hands-on approach could likely lead to the individual resisting and flailing, resulting in a physical restraint.
Use Positive Reinforcement
Positive reinforcement is a highly effective strategy for supporting individuals with ASD in learning new skills, modifying behaviors, and increasing motivation. Reinforcers can be anything that the individual finds rewarding, such as verbal praise, preferred items or activities, tokens or points towards a reward, or social interactions like high-fives or hugs. Acknowledge and celebrate small successes to build rapport and trust.
An example of this might include asking about an individual’s special interests and taking a genuine interest in that by allowing them to tell you about them. It could also be allowing them to have items present that they find comforting, showing them your ID card every time you enter the room, or praising them after they successfully completed a task.
Approaches Must Be Individualized
This could include advance preparation, such as offering pre-visit materials or tours of the hospital to familiarize patients with ASD with the environment and procedures beforehand. Recognizing that individuals with autism vary widely in their needs and abilities, hospital staff and security personnel should approach each situation with flexibility and empathy. Tailoring responses to the specific needs of each individual can help prevent misunderstandings and minimize stress.
In collaboration with the individual and their caregivers, these plans should outline specific accommodations, communication preferences, and strategies for managing behaviors.
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An example of this might include using a health information passport that details the person’s medical history and triggers and then quickly moving the individual to a more private location to wait, instead of in a busy waiting room that might trigger their social anxieties.
Maintain flexibility in procedures to accommodate the diverse needs of individuals with autism. This may include allowing additional time for screening, providing alternative screening methods, or offering accommodations such as a private screening area.
Individuals with autism often learn best through visual examples. Consider demonstrating a procedure on someone else so the patient can observe the procedure. Explain what is going to happen.
For example, “I am going to take your blood pressure. You are going to feel a squeeze on your arm.”
Another example of flexibility might include the option to just hold up an oxygen mask to their face instead of fitting it around their head/nose as that can feel painful.
Patients with ASD Often Have Other Medical Conditions
Individuals with autism have additional medical conditions that can be masked or that can complicate their care if there is no awareness of these. It is estimated that 40% of individuals with ASD also have epilepsy or seizure disorders, and up to 90% of adult women with developmental disabilities will be sexually assaulted at some point in their lives. These two things alone can make it challenging to provide high quality care.
There are also other known complications associated with ASD, such as gastrointestinal issues, breathing and cardiac conditions, and mental health and behavioral diagnoses. In addition, autistic individuals’ body language and facial expressions often do NOT reflect the amount of pain they are feeling. Many people are over/under sensitive to pain. Because of this, underlying medical issues can be masked, get missed, or even go ignored. It’s important for staff to understand that when under stress, individuals with autism can have elevated difficulties breathing or communicating.
Some examples of proactively considering these medical conditions might include asking the family/caretaker about the possibility of these conditions, ensuring the patient is not placed or held in a prone position, and proactively putting seizure precautions in place.
Hospital Security Officers Must Collaborate with Clinicians, Families, and Caregivers
Hospital security teams should collaborate closely with healthcare providers, including autism specialists if available, to develop and implement protocols for interacting with individuals with autism in a healthcare setting. Foster open communication and collaboration between hospital staff and the individual’s caregivers.
We often forget that our best resource to gather information about an individual is from the family or caregivers. Solicit input from caregivers, as they can provide valuable insights regarding the individual’s preferences, triggers, and effective strategies for communication and care. Collaborate with them to develop personalized security plans that address the individual’s needs.
An example of personalizing a security plan might include allowing the patient to have something with them that might not normally be allowed. Of course, these allowances can only be made after a careful assessment of the risk versus the benefit. However, if an individual with autism gets comfort and joy out of having their phone or iPad or some other technology and the risk of injury with this item is low, it should be considered to make this allowance.
Have Patience and Empathy
Approach interactions with autistic individuals with patience, understanding, and empathy. Recognize that they may have difficulty processing information or responding to commands in stressful situations. It’s important to not mistake processing difficulty with someone being defiant. When giving an order, don’t expect immediate compliance. Allow some time for the person to cooperate.
An example of this might include intentionally sharing as much information as possible about a test or what to expect during their visit. People with autism thrive on routine and predictability, so take the time to give ALL of the details and then be willing to repeat the same information multiple times. This can help build some familiarity for them in what to expect.
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By prioritizing de-escalation, communication, and understanding, hospital staff and security personnel can better support individuals with autism. By equipping hospital staff with the knowledge and skills to effectively support individuals with autism, hospitals can create a more inclusive and supportive environment for all patients.
Consider This Real-World Scenario
In a scenario involving an autism patient in a hospital, let’s consider the following situation:
Emily, a young adult with autism, has been admitted to the hospital for a medical procedure. Due to her sensory sensitivities and difficulty with communication, Emily becomes overwhelmed and agitated in the hospital environment. She struggles to understand the medical staff’s instructions and becomes increasingly anxious and distressed.
Here’s how the hospital might respond to ensure Emily receives appropriate care and support:
- Initial Assessment: Upon admission, the hospital’s healthcare team conducts an initial assessment to gather information about Emily’s medical history, sensory sensitivities, communication preferences, and any specific support needs related to her autism. A note is entered into Emily’s chart, and she is given a hospital bracelet indicating her autism diagnosis.
- Person-Centered Care: The hospital adopts a person-centered approach to care, taking into account Emily’s individual needs, preferences, and strengths. This includes providing accommodations to address her sensory sensitivities, such as minimizing noise and bright lights in her room and providing sensory-friendly materials if needed. Emily’s personalized care plan is communicated to everyone on her care team so there is consistency in her care on all shifts and in all areas. Staff also incorporate a trauma-informed care approach, understanding that there may have been previous negative experiences or abuse. Attempts are made to have physical exams conducted by similarly gendered staff and as comfortably as possible.
- Communication Support: Recognizing that Emily may have difficulty with verbal communication, the healthcare team uses alternative communication methods, such as visual aids, written instructions, or assistive technology, to communicate with her effectively. They also allow Emily extra time to process information and express herself. Staff will document necessary information on the communication white boards in Emily’s room so she is aware of next steps.
- Behavioral Support: If Emily exhibits behaviors related to her autism, such as agitation or self-stimulation, the hospital’s behavioral health team, crisis response team, or a trained autism specialist provides support and guidance to help manage her behavior in a calm and respectful manner. This may include implementing calming techniques, the use of a sensory kit, providing a safe space for Emily to retreat to, or offering sensory tools to help regulate her emotions. Emily is provided with positive reinforcement when she calms her body and begins to regulate her emotions. Procedures are explained and modeled for Emily so that she is aware of what is going to occur during her treatment.
- Family Involvement: Emily’s family members or caregivers are actively involved in her care and decision-making process, providing valuable insights into her needs and preferences. The hospital communicates openly and transparently with Emily’s family, keeping them informed about her treatment plan and involving them in care discussions whenever possible.
- Staff Training: The hospital provides training and education to its healthcare staff on autism awareness, understanding sensory sensitivities, effective communication strategies, and best practices for supporting individuals with autism in a healthcare setting. This ensures that all staff members are equipped to provide sensitive and appropriate care to patients like Emily.
By taking a holistic and person-centered approach to Emily’s care, the hospital can create a supportive and inclusive environment where she feels understood, respected, and well-cared for during her hospital stay.
Kimberly A. Urbanek, BA NREMTP is a Workplace Violence Prevention expert with over 25 years of healthcare, security, and first responder experience. She is a nationally sought-after speaker, a #1 best-selling author, and the founder of K4 Consulting. She is an award-winning leader for “Excellence in Security Operations,” and a Master Level Instructor in Crisis Prevention. Kim is an industry recognized thought-leader and her unique approach offers a broad perspective, as she combines her years of clinical experience with her years of security leadership expertise. Kim authored the “Workplace Violence Prevention Handbook for Healthcare,“ a groundbreaking, first-of-its-kind publication that is being used internationally to successfully reduce violence.
Stefan Bjes is founder and CEO of Flue Line Spectrum Safety LLC, which provides first responders with training on autism and developmental disabilities. He is also currently assistant director of campus safety and North Central College. Previously he was an SRO for the Addison (Illinois) Police Department.
Note: The views expressed by guest bloggers and contributors are those of the authors and do not necessarily represent the views of, and should not be attributed to, Campus Safety.
