Simulation training to manage challenging behaviours in children with autism.

Simulation-based education for staff in managing aggressive and high-risk behaviours of children with autism spectrum disorder (ASD) in the hospital setting. Staff training programs designed to teach best practice principles in the management of clinical aggression in paediatric acute care settings is warranted however evidence on training effects in general hospital settings is scant. There are a number of reviews of aggression management training programs in the psychiatric and mental health settings however the results cannot be generalised to the acute setting or further extrapolated to the paediatric setting due to the different types of care provided in each facility and prior training of staff. In addition, aggression management training programs designed for nursing staff working with children with neurodisabilities are rarely described in the literature. Simulation training may be an effective educational tool to practice de-escalation skills in a high fidelity situation. The benefit of simulation-based education for communication skills has been shown to improve patient safety in a number of studies. There is a paucity of literature in the use of simulation-based education to teach de-escalation communication techniques to staff working with children and young people, particularly those with ASD, in the acute care setting. The training intervention will consist of two components. 1. A web-based learning package, developed using ArticulateTM software, about management of challenging behaviours in children and young people with autism (with and without intellectual disability (ID) ) in the hospital setting as pre-reading. The learning package was developed by an advanced practice nurses who specialises in neurodevelopmental disabilities and has extensive education and training experience. The content was reviewed by three health care clinicians who are autism experts with revisions made prior to commencement of the study. The online learning package has been designed to increase learner’s knowledge about autism. It provides tips on how to communicate with children with autism, especially when they are scared, frustrated or angry. It is estimated that it will take learners about 30 minutes to complete. The package consists of one module and includes short case studies with questions and answers to apply knowledge learnt within the training module. A weblink to the online package is sent to participants via email. Study participants complete the online learning package individually during work hours but prior to the simulation training. Participants will be reminded via email each week for three weeks to complete the package and the surveys during the study period. Nurse educators for the wards participating in the study will also follow up with study participants, reminding them to complete the training during the study period. 2. This will be followed by a 1.5 hour simulation-based group education session to manage challenging behaviours in an adolescent with autism including two separate simulation exercises each followed by a facilitated reflective debrief which explores what the participants did well, what were the challenges and what they will do differently next time. The training will be conducted in the hospital Simulation Centre, conducted by the Simulation Faculty and Code Grey Coordinator with an actor playing the role of the patient. The simulation exercises will be recorded using SportstecTM software. The Simulation Faculty staff are all highly trained and experienced in delivering simulation training. The Code Grey Coordinator is the hospital lead for aggression management and is highly experienced in aggression management procedures and training. The simulation-based training will be delivered twice to enable participants to attend a training session that is scheduled at a time most suitable to them.