2023 14th Annual NUBE Conference

When we think of behavioral health emergencies, most people think of suicidal ideation mania or psychosis, but there is a population that presents its own unique challenge. Patients with an Autism Spectrum Disorder and patients with Intellectual Disability commonly present in crisis and require a specialized assessment and management. These patients have moments of emotional dysregulation, sensory overload, self-injurious behavior that require medication intervention, period of respite, evaluation or de-escalation by staff out of the home. At times the behaviors make them unsafe in their current living situation but do not rise to the level of requiring inpatient psychiatric admission. This can result very long lengths of stay in Emergency Departments. This is a unique situation for us as providers and we must consider the ethical ways to treat and accommodate these patients within the limitations of the walls of our hospitals. In this presentation we will consider what causes these patients to end up in our care for such an extended period of time, including the systemic implications and barriers, ways to advocate for patients with their providers and families, and how to best serve them while they are residents of a hospital emergency department. We will look at considerations to ensure these patients have their needs met in a very basic way (clothing, food, shelter) and higher needs like emotional support, comfort, social interaction, boredom. Explorations of sensory considerations, medications, and restraints will also be considered.

Learning Objectives:

1. Attendees will learn the challenges of long-term management of patients with Autism Spectrum Disorder (ASD) and Intellectual Disabilities (ID) in an Emergency Department Setting.
2. Attendees will be able to develop a plan for the management of patient with ASD and ID in Emergency Departments.
3. Attendees will understand the risks and benefits of creating safe and comforting environment for patients with ASD and ID.