Hope, Change and Progress: Hospital for Special Care’s Inpatient Autism Unit Impacts the Community

By Ariana Rawls Fine

With current statistics showing one in 36 children having autism spectrum disorder (ASD), the need for more in-depth, interdisciplinary services continues to rise, especially for those who have exhausted available community care and are in acute behavioral crisis. Serving Connecticut residents for over 80 years, Hospital for Special Care answered the call by opening its outpatient center in 2012 and then the inpatient unit in 2015 in New Britain. As the center, expertise and need grew, the hospital created an 18,000-square-foot, $13 million inpatient unit with 20 beds for children and adolescents with ASD in 2020 and a partial hospital program in 2021. The programs have been recognized nationally, ranked fourth of 90 programs in a 2021 study conducted by Stanford University’s Center for Clinical Excellence, said Lynn Ricci, Hospital of Special Care’s president and CEO.

The Autism Inpatient Unit is an interdisciplinary program for those experiencing severe and treatment-resistant behavioral symptoms or related to ASD, such as aggression, self-injury or psychiatric functioning declines. The hospital unit’s staff provide a step-down/step-up solution to support children with any level of care needs. The unit offers therapeutic recreation, occupational/speech and language therapies; applied behavior analysis (ABA); educational activities in a highly structured day; intensive parent training with practicing behavior management; collaborations with the child’s prescriber, outpatient services team and community providers; and more.

Getting There: 

The Road to Inpatient Care

“The first message we want families to hear is, ‘you are not alone.’ There are services and a way to help,” said Dr. Lauren Herlihy, Ph.D., the unit’s director of autism psychology and a clinical psychologist trained at University of Connecticut and Yale Child Study Center. Ricci has a child with autism and recalled a time she sat down with Dr. Sabooh Mubbashar, the Autism Inpatient Unit’s medical director. He mentioned that a lot of parents ask, “Why me, why my child?” He talked about moving from that place to, “Where do we go from here?” There is a journey of light after the diagnosis, and it isn’t all doom and gloom, Ricci added.

On average, the 20 inpatients spend 30-40 days in the program to get a start on medications, stabilizing harmful and unsafe behaviors, and more, stated Dr. Herlihy. “We also collaborate with providers who are going to receive our patients either in home or in our hospital program, which is a step-down, half-day program where patients sleep at home and attend their own schools but come to us for additional therapies in the afternoon.”

“Our goal for all of our kids is for them to go back to their homes, families, schools, and regular ABA or other therapies within the community after our program. Just with additional tools,” added Meghan Gallagher, a clinician and the unit’s practice manager for autism services. The Partial Hospitalization Program delivers supports for children to transition from an inpatient stay back into the community.

Working With Families

“This is a unique program. We are assessing not only what is happening with the child but also with the families and at home. We want to target the needs from the beginning of their stay,” said Joselyne Canchanya, LMSW, the autism inpatient unit’s discharge planner and one of two social workers there. “We give parents a minimum of 7-days notification about when their child is coming home. We have a final meeting with them where we go over the paperwork for discharge and the medications, and meeting with the clinical coordinator; we go over every single step. Even though the kids are stable in our unit, they will experience a transition even to go back to the car, to the home, to school.” She added that having bilingual staff is key for families who are scared to reach out because of language limitations.

Working With and in the Community

“As leaders in the community and the treatment of severe behavior problems and autism, we also have the ability to consult and train partners when it comes to accessibility,” Dr. Herlihy said. “Such as how a place like the Connecticut Science Center can make their programming more accessible to neurodiverse visitors. We’ve done training with first responders who are eager to understand how to manage and support patients in a way that is safe for everyone.”

The unit’s providers train others in school districts and in specialized therapeutic schools to help educators doing the hard daily work of educating students but who need more psychiatric or medication support, or support for parents on how to manage behavior outside of school hours.

Children with severe behavioral issues often end up in the emergency room (ER). The unit has an ER diversion program where the ER can consult with the outpatient department’s psychiatrist to divert the patient to the outpatient clinic for an emergency spot, to the partial hospital program or into the acute inpatient program.

Creating the Right People for the Job

“Our biggest limitation is really human resources,” said Ricci. The unit and clinicians encourage talent and workforce development with a comprehensive training program for APRNs. They partner with local APRN programs where the nurses spend months working with Dr. Hassan M. Minhas, chief of autism services, and Dr. Mubbashar to learn how to treat children with autism, explained Gallagher.

“It satisfies the APRNs’ child psychiatric setting requirement. Because we have a large number of APRNs coming through our program, we have been able to recruit those APRNs to become more independent in their practice and see patients on the outpatient basis, in the partial hospital program and in our inpatient program,” said Gallagher. “We see it as a win for APRNs who don’t stay with us too because now we have other providers who can continue to be community partners. We also have social workers, speech language pathologists, occupational therapists, physical therapists and psychologists training on our units.”

Community Financial Support Helps Families

With the hospital serving a population with 82% covered by Medicaid, it poses a challenging financial model, Ricci said. The hospital and the unit have philanthropy support and successful fundraising campaigns, but the funding is limited with providers seeing many parents in crisis as well. The connection and state partnership to preserve this resource is critical, Ricci said, but the community can help as the philanthropic funds are even more crucial to the program’s viability and success in the community. The Harper Autism Fund, established in 2015 by Senator Joseph Harper, fills gaps for equipment or services for parents that otherwise aren’t covered in a daily rate of Medicaid.

Recognition and Replication

The outcomes show the program is working. Eighty-nine percent are able to avoid or shorten emergency room visits and 70% remain home with outpatient management, according to the unit’s outcome data.

The Autism Inpatient Unit and its providers are recognized for the work they are doing. The outpatient program was named the nation’s first Patient-Centered Specialty Practice (PCSP) for Autism Spectrum Disorder as determined by the National Committee for Quality Assurance as well as becoming the first level-three PCSP in the country, said Ricci. The services have also become a featured HFSC Neuroscience Center of Excellence program.

The reach, expertise and experience of the program and its clinicians travels beyond Connecticut’s borders. Dr. Herlihy is the unit’s clinician representative in the National Autism and Disabilities Consortium, a workgroup collaborative to share best practices, knowledge and deidentified outcomes data. She was recently named as the education chair for National Autism and Intellectual Disability Psychiatric Care Collaborative. Ricci has sat on the state of Connecticut’s autism council for over 10 years to help inform policy and resource allocation.

It is the hope of the team that the Autism Inpatient Unit model and supporting programs will be replicated to help other healthcare providers in their own communities.

More information can be found hfsc.org.