Maggie McKay (Host): Welcome to Wellness Waves, a podcast from Bergen New Bridge Medical Center. I'm your host, Maggie McKay. Today, we're going to find out about a supportive environment for neurodivergent individuals in healthcare and why it's important with Darian Eletto, Chief Clinical Officer for Behavioral Health Services, and Julia Orlando, Vice President of Integrative Services. Welcome, Darian and Julia. It's so good to have you here.

Julia Orlando, CRC, ED.M, MA: Thank you.

Darian Eletto, M.Ed., LPC: Thank you for having us.

Host: Let's start with you, Julia. Your emergency department recently became a certified autism center. What does that mean?

Julia Orlando, CRC, ED.M, MA: Through what's called the IBCCES, which is a credentialing board, we had training for both our clinical staff, which includes our doctors, our nurses, our social workers, and all of our clinical staff that works in our emergency department as well as our nonclinical staff. So, the clinical staff had three hours of training, which I took myself, and so did Darian. It was not an easy test. Really had to make sure that our staff were well-versed to manage even the most challenging patient that might be nonverbal, that might need specialized care. Through this three-hour clinical certification, we've got our clinical team ready. Our nonclinical team, those would be people that were in registration, our EVS workers, they also had a one-hour certificate program. So, having these certifications means that our staff are better equipped within the ED setting to create a welcoming environment, a better understanding of the needs and be able to have it be a more effective process, not just for the staff that are interacting, but also for the patient, and especially too their family members who might be coming in with them as well.

Host: How do you earn that certification?

Julia Orlando, CRC, ED.M, MA: For the certification, each staff member, and we had to have 80% who took the class and passed the test to be able to qualify as a certified autism center. In addition to that, we also had an expert who flew to our hospital in Paramus, New Jersey, who spent the day with us saying, "These are modifications that we're going to recommend that you make, make sure-- and there were things that, you know, we may not have even been aware of, that these experts came out and really helped us identify the space, identify the things we needed to bring in to the space. It was so eye-opening to be able to have this consultant who came. And so, we're building in those recommendations, not only into our current ED, but into our new behavioral health ED, which will be opening up this fall.

Host: Darian, what motivated Bergen New Bridge Medical Center to pursue this certification?

Darian Eletto, M.Ed., LPC: We recognize in New Jersey, we have some of the highest populations in the country with diagnosed individuals. One in 29 children in New Jersey are diagnosed with autism spectrum disorder. We also like to see things like the ER. I always say our ER speaks to us. What is coming through the doors of our ER is telling us what the needs of our community is. So, we did notice a vast increase in the number of neurodivergent individuals coming through our doors seeking help. So as a response to this, we decided to go for our certification as an autism center within our ER walls.

Host: Julia, how can healthcare providers create sensory-friendly environments to accommodate neurodivergent patients?

Julia Orlando, CRC, ED.M, MA: That's such a great question and it's a question that we've taken very seriously, but not only listening to consultants that have come and given us advice, but also to families and patients who have been in within our ED. And Darian and I have also done some local tours of some programs that specialize in service delivery to neurodivergent individuals. So, I think the most important thing that I've learned in this journey is that many of the family members coming into healthcare have a very low expectation that a hospital is going to meet the needs of their family member. And that was really eye-opening for me, because it let me know that there are some very simple, some very basic things that we can do within a hospital setting that will be helpful.

So for example, having dimmer lighting, having sound machines so that it's quieter, right? You know, in an ED, it's a very chaotic, it's a very loud environment. So within our hospital space, we're designing a treatment room that we're calling our calming room that's going to have softer lights. Noise machines, we're going to have simulation toys. We're going to have iPhones and iPads. Because a lot of times in a crisis, even though those family members have a very good understanding of what they need for the individual, if you're in the middle of a crisis, you may not everything you need. So, Darian and I have worked to do the research and talk with experts and family members to say what are the things we could have here.

So for example, one of the things we're going to have in our ED is an adult changing table. And that was something that we didn't even realize was something that was necessary. So that if you're bringing in your adult child, if you don't have those facilities, now having that families understand that we did our research, we did our homework, we understand, we've listened to the needs of families, the very specific needs that a person might need. Also, maybe having softer gowns, because the whole tactile stimulation. We're going to have TVs in the rooms. We'll have nice images, calming images. So, really listening to making our ED experience feel less like a traditional ED, but more that helps to reduce the stimuli.

Also, our treatment rooms are a little bit larger, so they'll allow for family members to be able to be in the room with the patient. We also have meeting rooms where we can meet with the family that are pleasing and comfortable to be able to really listen. Because that was the biggest takeaway, I think, for me, is when you are treating a neurodivergent individual within your ED, very, very often, they are accompanied by family members, who can help you understand how to have this be a better experience for that individual. So, being able to accommodate the family within the treatment room within a separate room, I think, will really help us to better provide service and care. And through the training the staff have had, they know better how to work with someone who is nonverbal, how to listen to what is the family is telling you is the better course of treatment for their loved one.

Host: That's got to be so reassuring to the families and so comforting to know that you took the time and trouble and effort and expense to make these rooms, and just the program in general. It is so brilliant. Just the lighting, like you said, that alone-- and the softer gowns-- I mean, that is so many little things that really add up to a much better experience, I'm sure.

Darian, what are some common misconceptions about neurodivergence that healthcare providers should be aware of? And just for people who don't know, can you just tell us what neurodivergence entails?

Darian Eletto, M.Ed., LPC: So, neurodivergence means that someone has a different form of communication, a different way of processing information and communicating information than someone who might be neurotypical. This is something that generally people are born with, and we typically see that within the first eight years of life. Individuals do get diagnosed typically by 24 months. We see that someone does get diagnosed with an autism spectrum disorder diagnosis.

 things that I see happening within the healthcare systems and with healthcare providers is that healthcare providers neglect to see that even though someone might have a neurodivergent diagnosis. We also see that they neglect that there might be a mental health diagnosis. So, you can be neurodivergent and have depression and anxiety, or maybe you might have bipolar disorder. So, we often see that these things might get misdiagnosed, underdiagnosed, and that plays a role in the care of the patient because, yes, they might be neurodivergent, we also need to treat what other underlying mental health disorder could be going on. So, that's a very common misconception that I've seen as a clinician.

And also, there's a very common misconception that I think is very stigmatizing that these patients can be violent, these individuals can be violent. We don't typically see violence. And when we do see violence, it is not violent act against a person. It is generally how it might be a way of communication, it might be a frustration. Again, it's a communication disorder. So, we see that they're not able to communicate how you or I might communicate. It's a different form. So, I think that that's a very common misconception, a very stigmatizing misconception at that. So, we really have to learn, and that was part of why we got certified and why we did the training so that our staff can understand how to communicate with this individual who might not communicate like you or I would.

Host: Julia, how can interdisciplinary teams work together to provide cohesive care for neurodivergent individuals?

Julia Orlando, CRC, ED.M, MA: I love that question. And it was one of the most challenging part of this-- really, this initiative-- for me in my role as vice president for integration. One of the things I realized through this journey was that in an ED, which is very busy, we're trying to see a lot of different patients and also recognizing the needs of the family. The needs of a family of a neurodivergent patient, especially who's having a crisis.

In particular, what Darian talked about, maybe having a mental health crisis. They need time. They need time to talk about what's been going on, what's unique about their family member that's going to be challenging for a doctor or a nurse in this very busy environment. So, the design that Darian and I have come up with is the idea of taking two social workers that work with Darian who have some either experience or affinity for this work and to get them advanced training.

So, really how I look at this is that when we have someone come into our ED, we're going to need to have special expertise, but also someone to kind of-- I describe it like a quarterback who's going come in, who's had advanced training-- to kind of be the liaison between the medical and the family members and really help this to be a better experience.

And I think within that you allow that multidisciplinary team to all do the piece that belongs to them, but also give that special amount of time and attention and specialized service to that family through the social work team who have this advanced training, even more training than your doctors, your nurses, right? So that they can actually be the care coordination for this experience. And so, in that way, having this multidisciplinary approach, but also having almost like a commander who's at the center of it who's helping pull all the pieces together, then everybody can really bring their expertise and work together. And then, my plan would be after you know, the next day or within the next week, to bring that team back together to be able to talk about how did this go? What could we done differently? What is it that we need that we don't have. Is there something we could be doing differently?

So, I think, the constant conversation and communication around this multidisciplinary team, but also giving them the gift of having people who can navigate this for them allows everybody to really bring their best self and doesn't interrupt the flow of a very busy ED, which we expect, especially in this new behavioral health ED to-be. You know, again, this is innovative. This is a new thing for us. We're very excited move in this direction. I think it's going to help bring everybody together to be to the piece that everybody has to do with this patient

Host: Darian, what community-based resources can complement healthcare services for neurodivergent individuals.

Darian Eletto, M.Ed., LPC: Like we always say with raising any child or any individual, it takes a village. So, there's a lot of support services that can help neurodivergent individuals work through life, work through some of the challenges of communication and learn social skills. So, things like applied behavioral analysis, so ABA therapy. It's a great support for neurodivergent individuals. There's also things like occupational therapy, which is very supportive, helping with skill-setting, with focusing on things in the world and doing day-to-day tasks, as well as speech therapy. Speech therapy is very helpful because it, again, helps those communication skills, socialization skills, as well as teach them how to interact with the world around them.

Host: Thank you both so much for being here. This service sounds like it's much needed and like you have got every base covered, so good job.

Julia Orlando, CRC, ED.M, MA: Thank you for having us.

Darian Eletto, M.Ed., LPC: Thank you so much.

Host: Again, that's Darian Eletto and Julia Orlando. To find out more, please visit newbridgehealth.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wellness Waves from Bergen New Bridge Medical Center.