298 - Perspectives of Clinicians and Clinical Staff Caring for Patients with Developmental and Behavioral Disorders in a Large Urban Hospital-based Pediatric Clinic

Youth with developmental and behavioral disorders (DBDs) can exhibit challenging behaviors in the healthcare setting. Clinicians and staff often do not feel competent in managing these behaviors, which can impact patient care.

Objective:

To better understand clinician and clinical staff perspectives and experiences working with patients with DBDs.

Design/Methods:

A 20-question survey was constructed to assess clinician and clinical staff experience working with youth with DBDs. Questions explored comfort caring for youth with DBDs, such as Autism, Sensory Processing Disorder and ADHD, methods for managing difficult behaviors in the office setting, perceived quality of care delivered, and concluded with four open-ended questions assessing individual approaches and patient stories. Survey participation was voluntary and anonymous. All clinicians, pediatric residents and clinical staff who care for patients in the general Pediatrics clinic were invited to participate by email and QR codes. REDCap was used for the survey hyperlink and data collection. Descriptive statistics and comparisons based on Chi-square and Fisher’s Exact Tests were conducted in R. The study was approved by the Drexel University IRB.

Results:

54 individuals completed the survey: 15 MDs, DOs and NPs, 32 pediatric residents, 7 staff (4 RN/medical assistant, 3 social workers). 25 respondents (46%) had prior experience or special interest working with youth with DBDs and this subset was significantly more likely to feel able to provide adequate resources to families of youth with behavior problems (p = 0.02). 30 respondents (70%) felt comfortable seeing patients with DBDs. Those who endorsed comfort were significantly more likely to 1) feel they provide high quality care and 2) provide adequate resources to families of youth with behavior problems (both p< 0.01). Perceived quality of care provided did not differ between the subset of MDs, DOs and NPs and the pediatric residents nor did provision of resources (p = 0.47, p = 0.11). The majority (96%) of respondents use toys, books, or other objects to help distract youth with challenging behaviors during visits and 74% believe these youth are less disruptive when a toy or other object is present to play with or explore.

Conclusion(s):

Clinicians and clinical staff in a large outpatient pediatric clinic with experience and/or perceived comfort were more likely to provide resources to youth with DBDs and consider their care high quality. Distraction item use is widespread. Future directions include additional staff training and obtaining sustained funding for sensory toy distribution and use.