ORLANDO, Fla. – When Bella Montalvo walked into the emergency department of Nemours Children’s Hospital recently, she was ready for the stares from other parents and the little fingers of other kids pointing at her son, asking why he was screaming and yelling.

She walked up to the reception desk and told the triage nurses that her son was sick. She also told them that Luis, 10, had autism.

And then things took a different turn.

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“Immediately after, someone approached me and asked, ‘Are you comfortable waiting out here or do you want to go to the waiting room in the back which is more intimate and has sensory toys for your kids?’ And I was like, ‘Oh, you have that kind of service?’ So I said, ‘OK, I go back and check it out,'” she said.

Since last October, Nemours has been rolling out a program in its emergency department that aims to eliminate unnecessary stimulation for kids who have autism spectrum disorder or other behavioral and developmental conditions.

Called REACH, or Respecting Each Awesome Child Here, the program identifies kids who have autism from the moment they enter the emergency room and accommodates their special needs until they leave.

“Studies have shown that the emergency room environment can be agitating for children with autism,” said Cara Harwell, a nurse practitioner at Nemours emergency department who developed the REACH program. “They’re in a new place and there are more people. There are more sounds. There are kids crying and screaming. So we take them to an alternative waiting area and take it from there.”

It’s not clear how often kids with autism visit the emergency room, but it’s not uncommon to have one or more kids with autism go through the ER daily, Harwell said.

Colorful REACH signs alert the parents of the program. The word REACH is added to the kids’ chart to alert the staff. Families are offered a separate – and much more quiet – waiting area, where kids have access to toys, sensory brushes, iPads and headphones. A small REACH sign is hung from the kid’s exam room to let the staff know the little patient in the room has autism or other sensory or behavioral conditions.

Two of the nurses’ stations have boxes with sensory toys – toys that are designed for kids with autism. Depending on the child’s needs, staff can also bring into the room a music box or a projector that illuminates the walls with soothing colors and stars.

There is no data available on the number of kids’ emergency departments in the nation that offer programs similar to REACH. But there are examples here and there. For instance, All Children’s Hospital in St. Petersburg has a program called Sensational Kid, which alerts the staff to ask parents for tips before starting to treat the child. In her research, Harwell found a hospital in New Jersey that she used as a model to establish REACH.

Many hospitals have child-life specialists who can be called upon to help with kids who have special needs. But by then the child has already spent some time in the emergency room, and “it’s usually too late,” said Emily Bradley, the co-lead of REACH and a certified child-life specialist at Nemours. “Many times the patient is already overstimulated and agitated.”

Before moving to the emergency department, Harwell was in a neurology department where she treated kids with autism. After some time in the ER, she “realized that there’s a big problem with knowing how to manage these kids. There’s a lot of anxiety. Parents are coming in very anxious. The staff wants to get in and out as soon as possible, so I just realized that there needs to be something better,” she said.

She started the program with $500, mainly for sensory toys and objects that are soothing for kids with autism. She held several education sessions for the ED staff to teach them how the REACH program works.

“It’s not so much about the toys,” she said. “It’s about the awareness and communication.”

Montalvo and her kids – her 7-year-old daughter has autism, too – were at the receiving end of that education.

“It’s not that if you go to the emergency room in other hospitals they’re not aware of autism. It’s just that they say, ‘OK. I understand.’ But this was different. Everyone was more involved. They weren’t afraid of approaching the child. They reached out more. They were more animated. There was no line they were afraid of crossing,” she said.

Nemours is now conducting studies to evaluate the effectiveness of the program and potentially expand it to other areas of the hospital.

© 2016 The Orlando Sentinel
Distributed by Tribune Content Agency, LLC

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