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We reviewed the literature from 2017 to 2022 on autistic adults' use of mental healthcare and barriers to care. To encourage immediate improvement in mental healthcare, we provide five strategies mental health providers can use to better care for autistic adults.Most autistic adults use mental healthcare and use it more often than non-autistic adults. Autistic adults' experiences with mental healthcare are characterized by (1) lack of providers knowledgeable about autism, (2) use of treatments that may not be accommodating to individual needs, and (3) difficulty navigating the complex healthcare system. These barriers contribute to prevalent unmet needs for mental healthcare. Autistic adults use mental healthcare frequently but have unmet mental health needs. As necessary systemic changes develop, providers can begin immediately to better care for autistic adults by learning about their needs and taking personalized care approaches to meet those needs.

Obesity is linked with health and psychosocial outcomes among many populations. However, it is unclear the extent to which obesity is linked with these outcomes among autistic adults. We searched seven research databases for articles examining the association between obesity and autistic adults' health and psychosocial outcomes. Three studies found that obesity was associated with health outcomes, including: in-hospital mortality, risk of type II diabetes, cardiovascular disease, and number of co-occurring medical conditions. One study found no significant association between autism diagnosis, mental health conditions, and body mass index. Obesity increases the risk of in-hospital mortality and some chronic conditions among autistic adults, highlighting the need for clinicians trained to promote weight management among autistic adults.

While the medical home has proven effective at improving continuity of care among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. We conducted a retrospective cohort study to compare the continuity of care of autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the Center for Autism Services and Transition (CAST), to propensity score matched national samples of autistic adults with private insurance or Medicare. The unadjusted median Bice–Boxerman continuity of care index was 0.6 (interquartile range = 0.4–1.0) for CAST patients, 0.5 (interquartile range = 0.3–1.0) for Medicare beneficiaries, and 0.6 (interquartile range = 0.4–1.0) for privately insured autistic adults. In multivariable models controlling for demographic characteristics, on average, CAST patients had continuity of care indices that were 10% higher than national samples of autistic adult Medicare beneficiaries (p Lay abstract There is a nationally recognized need for innovative healthcare delivery models to improve care continuity for autistic adults as they age out of pediatric and into adult healthcare systems. One possible model of care delivery is called the “medical home”. The medical home is not a residential home, but a system where a patient’s healthcare is coordinated through a primary care physician to ensure necessary care is received when and where the patient needs it. We compared the continuity of care among autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the CAST, to matched national samples of autistic adults with private insurance or Medicare. Continuity of primary care among CAST patients was significantly better than that of matched national samples of autistic adult Medicare beneficiaries and similar to that of privately insured autistic adults. Our findings suggest that medical homes, like CAST, are a promising solution to improve healthcare delivery for the growing population of autistic adults.

We examined how sharing autism research articles via social and news media was associated with citations and downloads. We included articles published in 2019 from three autism-focused journals. Every 10 Twitter shares yielded a 4.4% increase in article downloads and 5.2% increase in citations. Articles with at least one Facebook post had 23.3% more downloads than those without. Articles with at least one news story had 56.9% more downloads and 39.3% more citations than those without. Descriptive analysis indicated the most shared, downloaded, and cited articles focused largely on treatments or interventions. Autism researchers should continue sharing articles via Twitter and news media because it increases the reach of their work and may better engage research and autism community members. Supplementary Information The online version contains supplementary material available at 10.1007/s10803-022-05464-8.

In 2017, the Interagency Autism Coordinating Committee, a federal advisory panel consisting of autism researchers and community members, recommended that funders of autism research prioritize research projects on: (1) treatments/interventions, (2) evidence-based services, and (3) lifespan issues. We sought to describe research funding since this recommendation was made. We searched the databases of the three largest federal funders of autism research in the United States (National Institutes of Health, Department of Education, and Centers for Disease Control and Prevention) for grants awarded during 2017–2019. We categorized grants as follows: autism screening and diagnosis, biology, risk factors, treatments and interventions, services, lifespan issues, or infrastructure and surveillance. We found that funding patterns remained largely consistent during 2017–2019. Biological research received a relative majority of funding (32.59%), followed by treatments and interventions (22.87%). While given higher funding priority by the Interagency Autism Coordinating Committee’s recent budget recommendation, fewer funds were awarded to research areas like services (5.02%) and lifespan issues (2.51%), indicating a misalignment between funding patterns and the Interagency Autism Coordinating Committee budget recommendation. These findings emphasize the need for autism research funding to align with the Interagency Autism Coordinating Committee budget recommendations to best meet the needs of the autism community, particularly autistic younger, middle-aged, and older adults. Lay abstract In 2017, an advisory board consisting of autism researchers and community members recommended that funders of autism research prioritize research projects on: (1) treatments/interventions, (2) evidence-based services, and (3) lifespan issues. To describe funding in these areas since this recommendation was made, we searched the databases of the three largest federal funders of autism research in the United States. We found that the largest portion of federal funding during 2017–2019 was awarded to research on the biology of autism (32.59%) and treatments and interventions for autism (22.87%). Less funds were awarded to research areas that are high funding priorities by the Interagency Autism Coordinating Committee budget recommendation including services (5.02%) and lifespan issues (2.51%). Our findings emphasize that autism research funding is not consistent with the Interagency Autism Coordinating Committee budget recommendation to increase funding particularly to services and lifespan issues. We recommend that funding patterns should shift to better align with these priorities so that autism research may better serve the needs of the autism community.

Background: Little is known about the extent to which patient-centered medical homes meet the needs of autistic adults. Materials & methods: We conducted a cross-sectional survey of autistic adult patients (n = 47) and caregivers of autistic adult patients (n = 66) receiving care through one patient-centered medical home specifically designed to meet the needs of this population. We performed post hoc comparisons of our results to previously published data from a national sample of autistic adults. Results: Participants reported high levels of satisfaction with care, frequent preventive healthcare use and few unmet healthcare needs. Autistic adults in our sample reported significantly higher satisfaction and fewer unmet healthcare needs. Conclusion: A patient-centered medical home tailored to the needs of autistic adults is a promising approach to healthcare delivery for meeting this population’s needs.

Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. We conducted a cross-sectional retrospective cohort study of Medicare claims data from 2016 to 2017 to compare the prevalence of physical and mental health conditions among autistic older adults (age 65+ years) with intellectual disability ( N = 2054) to autistic older adults without intellectual disability ( N = 2631). Medicare claims data consisted of records from inpatient hospitalizations and institutional outpatient visits (i.e. visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers). Examination of the largest between-group differences revealed that autistic older adults with intellectual disability had 350% greater odds of epilepsy (odds ratio = 4.5, 95% confidence interval = 3.9–5.2), 170% greater odds of osteoporosis (odds ratio = 2.7, 95% confidence interval = 2.3–3.2), and 100% greater odds of gastrointestinal conditions (odds ratio = 2.0, 95% confidence interval = 1.8–2.2) but 80% lower odds of attention deficit disorders (odds ratio = 0.2, 95% confidence interval = 0.1–0.3), 70% lower odds of substance use disorders (odds ratio = 0.3, 95% confidence interval = 0.2–0.4), and 60% lower odds of suicidal ideation or intentional self-injury (odds ratio = 0.4, 95% confidence interval = 0.3–0.6). These findings highlight the importance of developing tailored health management strategies for the autistic older adult population as a function of intellectual disability status. Lay abstract Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. Our study is the first, to our knowledge, to use US national data to compare physical and mental health conditions among autistic older adults with and without intellectual disability. The data analyzed in this study consisted of records from inpatient hospitalizations as well as “institutional outpatient” healthcare visits, which include visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers. Autistic older adults with intellectual disability were significantly more likely to have thyroid disorders, epilepsy, respiratory infections, gastrointestinal conditions, osteoporosis, cognitive disorders, and schizophrenia/psychotic disorders. In contrast, autistic older adults without intellectual disability were significantly more likely to have obesity, diabetes, high blood pressure, cerebrovascular disease, chronic obstructive pulmonary disease, arthritis, back conditions, attention deficit disorders, substance use disorders, and suicidal ideation or intentional self-injury. These findings highlight the importance of developing distinct, tailored health management strategies for the autistic older adults with and without intellectual disability.

While the use of restraints is seen as a last resort inpediatric practice, it is the responsibility of the RN to use effective decisionmakingtoolssuch as algorithms to effectively determine when Background PEDIATRIC PATIENTS HAVE unique safety needs based on their developmental age. Patient rights related to restraints delineate that healthcare workers use alternative methods to reduce the use of restraints whenever possible. Examples of alternative methods include family member presence, the use of sitters, distraction, and placing the patient near the nurses' station. When alternative methods are deemed ineffective or the actions of the patient indicate immediate need for restraints, the least restrictive type of restraint should be utilized and only as a last resort. Additionally, restraints should be removed at the earliest opportunity. The importance of de-escalation cannot be underestimated. The Crisis Prevention Institute (2015) stresses the devices arebeingused as restraints. Patient/ family education help to insure safe use of restraints. importance of learning the skill of empathic listening. As Stephen Covey would say, “Seek first to understand, then be understood” by giving the person undivided attention; be nonjudgmental; focus on the person's feelings, not just the facts; allow silence; and use restatement to clarify messages. De-escalation skills must be practiced by staff on a regular basis due in part because of how staff communicate with each other and socially (texting, all forms of social media, documenting online) which may be leaving patients with the sense of a lack of focus on their needs (Dufresne, 2015). Restraint use is not without risk. The Joint Commission sentinel event restraint related events data (2015) from 2004-Q22015 notes a total of 128 events. Injuries and deaths have occurred while patients are in restraints. The risk of death and injuries while using restraints has provided the regulatory

With the increase in interdisciplinary bedside rounds, shared governance, and other leadership opportunities, nurses find themselves in positions requiring the creation and delivery of oral presentations. This is not a skill that comes naturally to most nurses and is often noted as the one leadership skill that causes the most personal discomfort. Today educators are in a position to coach inexperienced staff in developing their presentation skills. This article presents recommendations for designing and delivering winning presentations.

One pediatric hospital addressed the challenges of registered nurses (RNs) transitioning to new roles by developing a year-long residency for experienced RNs, whether newly hired or transitioning to another role within the hospital. The evidence-based program's goal is for the participant to demonstrate effective decision-making skills, applying principles into his or her practice at the point of care. Objectives of the program are measured using pre/post tool and through the use of reflective journaling. The article provides a framework to develop an experienced RN residency program that supports transition from competent to proficient in a new work environment.

Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice. Operational definitions for the 5 levels of her original Novice to Expert Theory were used by the study participants in a large Midwestern pediatric hospital to self-identify their level of practice. The frontline clinical managers of these direct care registered nurses (RNs) used the same tool to rate their direct reports. The aim of this portion of a larger study was to determine if the clinical manager’s perception of their direct reports was the same as that of the RNs. The results of this study are being used by one study unit’s clinical managers as the basis for implementing the Hersey and Blanchard Situational Leadership Model. The clinical managers work with their direct reports depending on the level of practice and the details of the task to be performed. One example is creating therapeutic relationships with each other and with families to ensure a safe environment for all.

Further research on cost-effective techniques to verify enteral tube placement is warranted using a variety of pediatric populations with differing conditions that may impact gastric pH. It is imperative that clinical facilities review current policies and procedures to ensure that evidence-based findings are guiding nursing practice. Many nurses continue to rely on auscultation to verify NGT placement. Education and competency validation can assist with current practices for NGT placement being consistently incorporated by all personnel in the health care setting. Continuing to search for evidence related to nursing care will guide the direct care RN in providing best practice.

The key for nurses to meet the educational requirements of regulatory institutions such as The Center for Medicare/Medicaid is in identifying whether a planned education program has changed practice. THE USE OF restraints has become a high-priority issue to assure appropriateness of treatment and protect patient rights (Centers for Medicare and Medicaid Services [CMS], 2006). The term restraint is defined in the literature as referring to the physical restriction of movement that may involve restraining all limbs (Jacobi, Fraser, and Coursin, 2002; Mohr, 2010). Restraints may be an intervention for children and adolescents to reduce the risk of treatment interference or to prevent abrupt discontinuation of medical devices used for diagnosis or monitoring. Restraints are also used to prevent patients from harming themselves or others (American Academy of Pediatrics, 1997). The Centers for Medicare and Medicaid's requires that all clinical staff with direct patient contact have ongoing education and training in the proper and safe use of restraints. Performance improvement processes through education of staff allow for ongoing opportunities to improve care and reduce risk associated with restraint use. Commitment to patient and staff safety is a top priority for health care organizations. To comply with regulatory initiatives in reducing the use of restraints, education and training for health care workers on safe application, reassessment, documentation guidelines, and alternatives to restraint use are necessary (Joint Commission of Accreditation of Healthcare Organizations, 1996). A review of the literature was conducted to uncover how other organizations have successfully implemented and evaluated restraint education and reduction programs.

Parent surveys typically ask about aspects of care nurses think are important. The Parent Satisfaction Survey at a 250-bed children's hospital was revised based on what parents thought was most important for a nurse to do for themselves and their children. This report is based on a retrospective review of 1,405 self-reported parent surveys collected as a performance improvement activity over a 12-month time period. Surveys were distributed to parents of hospitalized children and were returned anonymously to mailboxes on the units. Using content analysis, a group of pediatric nurses reviewed the parents' comments to determine major themes. The themes were caring, communication, safety, environment, and appreciation. The parent survey was revised to include the themes parents identified as important.