What to expect at the Thompson Autism Center during COVID-19

Changes due to COVID-19 can be stressful for everyone, but especially for children with autism spectrum disorder (ASD) and their families. Here are some tips from a CHOC psychologist on helping your child with autism understand and cope with COVID-19.

Some families may be worried about going to a healthcare facility or doctor’s office during the COVID-19 pandemic. But now, more than ever, it is important for children with ASD to stay on schedule with clinical appointments, to prevent or address physical and mental health problems.

The Thompson Autism Center at CHOC Children’s is taking extra steps to help patients continue to get the care they need safely and with minimized stress.

Safety precautions

The Thompson Autism Center has implemented the following precautions to ensure the safety and well-being of patients, families and staff and decrease the risk of spreading illness:

  • A week before, as well as the day before your appointment, you will receive a phone call from a Thompson Autism Center staff member who will ask a series of screening questions related to COVID-19 exposure. These questions may include, “Have you or anyone in your family been exposed to someone with COVID-19 in the past two weeks? Have you or anyone in your family, been sick with cough, fever, runny nose, shortness of breath or upper respiratory symptoms?
  • Please bring masks for you and your child and wear them for the duration of your time in the center.
  • We ask that only one parent or guardian accompany each patient to their appointment. A home health nurse may also attend if necessary.
  • All visitors, patients and staff are screened at the center’s front door every day, via temperature checks and questions about recent exposure and health status.
  • Additional cleaning and other protocols have been enacted to ensure safety.

To help patients cope with the changes at the center, videos are available for your child to watch when you arrive, covering topics such as how to wear a mask, how your temperature will be checked and what to expect during your visit.

We recommend that you practice wearing a mask with your child before your visit. Here are some tips from a CHOC psychologist on how to help children who are afraid of wearing masks. If you have concerns about your child and masks, please speak to their physician.

Telehealth for autism appointments

In order to minimize the number of patients and families in the Thompson Autism Center at any one time, telehealth appointments are now available for certain types of visits, such as medication checks, initial assessment appointments and other appointments as necessary. To make these appointments most beneficial for you and your child, we offer these recommendations:

  • We recommend that you use a camera-equipped desktop or laptop computer, tablet or touchpad device rather than a smartphone. This allows our providers to have a full view of your child and observe how they behave in their environment, which is a key part of autism therapy.
  • Sit in a room that can be limited to just you and your child, free from noises, distractions and other people coming in and out.
  • During the telehealth visit, we will likely spend part of the appointment without your child present, just as we do during your in-person appointment. It will be important to have a caregiver or activity available to occupy your child, allowing you to concentrate on the visit and be able to freely speak without worry of upsetting your child if you need to talk about topics that may be irritating or bothersome to them.

We appreciate your patience as we navigate the fluid environment created by COVID-19. As we implement changes, we assure you that we remain dedicated to our mission to provide your child medical, psychological and behavioral treatment as well as support for your family.

This article was updated on June 23, 2020.

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Answers to your most common telehealth questions

During these challenging times, CHOC Children’s is offering parents peace of mind when it comes to caring for their children’s health and well-being. All medical care for kids is essential, including well visits, immunizations and access to specialty care. That’s why we’ve kept our offices open with additional safety measures in place and why we are offering telehealth appointments when appropriate, giving you access to our experts from your home.

We understand that many parents and families are new to telehealth, so we’ve prepared this guide of frequently asked questions on telehealth, to give parents peace of mind and help them prepare for their child’s first telehealth appointment.

What is telehealth?

Telehealth appointments are virtual visits with a CHOC provider via a smartphone, tablet or computer. You and your child can take these appointments from home or anywhere with internet access that you feel comfortable. During the appointment, you will see and hear your usual physician or specialist and will be able to interact, ask questions and answer your provider’s questions.

Are all appointments eligible for telehealth?

Primary and specialty care physicians can safely and appropriately deliver care for many conditions via telehealth technology. Some types of visits require an in-person appointment. Your child’s provider will determine if a telehealth appointment is ideal for you.

Is CHOC’s telehealth technology safe and secure?

CHOC uses a special version of Zoom, a video conferencing software, with additional layers of security to ensure the protection of our patients and their personal health information. Our telehealth platform has always been and continues to be safe.

What happens once my telehealth appointment is scheduled?

Once approved for a telehealth appointment, you will receive an email with instructions, troubleshooting tips and a link to access your video appointment. Follow the instructions. First, you’ll see a virtual “waiting room” that will instruct you to wait for your child’s physician to admit you into the appointment. Do not exit this screen. Once admitted, you will be able to see and hear your child’s provider, and they will be able to see and hear you. Make sure your child is with you so the provider can properly assess them.

Watch this video on what to expect during your first telehealth appointment and get tips for a successful telehealth appointment.

Who needs to be present?

Please ensure the patient is present for every telehealth appointment so your provider can properly assess them.

Which doctor will we see during my child’s telehealth appointment?

You will see your regular primary care physician or specialist.

What will we talk about during a telehealth appointment?

You and your child can speak with your provider about anything you would bring up during an in-person appointment. Discuss symptoms, your care plan and any questions or concerns you may have. If needed, your physician can share lab results and X-rays with you as they would in person. Your physician may ask you to help by taking your child’s temperature or by showing them a child’s rash, for example.

How much does a telehealth visit cost?

Telehealth visits are billed the same way as in-person appointments. You may be billed your standard co-pay for a visit. Telehealth visits feature your primary care physician or specialist, so you can expect the same high-quality care you’d receive at any CHOC appointment.

Do I have to have a telehealth appointment?

While telehealth may seem awkward or uncomfortable, your physician may prefer to see you via a telehealth visit so that he or she can see you sooner than they would be able to in person. If you prefer an in-person appointment, ask your pediatrician’s office or the Patient Access Center (PAC) when you call for an appointment to see if your provider is OK with waiting until the first available in-person appointment.

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What to expect at your CHOC telehealth appointment

Telehealth appointments are virtual visits with a CHOC provider conducted through a smart phone, tablet or computer. Your child’s visit can take place at home or in any private location with internet access.

To schedule a visit with your CHOC pediatrician, call your primary care office. To see a CHOC specialist, call CHOC’s Patient Access Center at 888-770-2462. Your child’s provider will decide if a telehealth visit is ideal for you.

After your appointment is scheduled, you will receive an email from CHOC with instructions.

For the exam, please have information for your preferred laboratory and pharmacy available. It’s also helpful to have a thermometer, light source and scale on hand.

About 15 minutes before your appointment, you will receive a call from CHOC to ask if you need additional assistance for your appointment. To start your appointment, find the email from CHOC and follow the instructions.

For telehealth appointments, CHOC uses a special software with additional security layers. The video from your virtual visit is not saved or stored.

During the appointment, you will see and hear your physician or specialist. You will be able to interact with them, ask questions and answer your provider’s questions.

Don’t worry if the visit “feels” different at first. That’s OK and expected.

During a child’s virtual visit, parents might be asked to help with the exam. For example, you may need to take your child’s temperature or help show how well they can move their limbs. The provider will guide you through this process.

As your visit wraps up, the provider will explain next steps, including ordering any necessary laboratory tests or prescriptions.

Ger more information on telehealth

From hotline to surgery – How CHOC guided a family through an emergency during COVID-19

As the parent of a child with gastrointestinal issues, Kris wasn’t immediately concerned when her son Nolan complained of a stomachache while they were watching TV together. When his pain quickly got worse and Nolan started to vomit, Kris knew it was time to call CHOC.

“With COVID-19 going on, I didn’t know if the pediatrician’s office or emergency room was the best place to bring him. I didn’t want to take a spot in the waiting room from someone who needed it more than us,” Kris said.

Nolan_with_Kris
Nolan with his mom Kris

Luckily, Kris had noticed on social media that CHOC had implemented a COVID-19 hotline (1-844-GET-CHOC) staffed by a team of registered nurses. She called the hotline for advice on where to safely seek care for her son during the pandemic.

“As the parent of an immunocompromised child, I knew CHOC could help,” Kris says. “A nurse took our call, and within a few minutes we were on a Zoom video call with a doctor. She gave us very clear parameters of what to watch for and when to call back. Nolan’s symptoms got worse, and when we called back, we were immediately patched through to a video call with a pediatrician.”

Dr. Lori Openshaw, a CHOC Children’s pediatrician, spoke with Kris and Nolan via video chat. After taking a medical history, Dr. Openshaw was able to walk Kris through doing an abdominal examination on Nolan, while the physician closely observed via video. With Kris’ help, Dr. Openshaw better understood the location and intensity of Nolan’s pain, and what might be causing his symptoms.

“Dr. Openshaw told me exactly what to do. She told me where to push on his stomach and where not to push. She paid attention to Nolan’s facial expressions during the exam,” Kris says.

Dr. Openshaw highly suspected that Nolan may have appendicitis and needed an urgent surgical evaluation. She directed Nolan and his mom to get to the Julia and George Argyros Emergency Department at CHOC Children’s Hospital quickly.

“By the time we got to CHOC, they were ready for us,” Kris says. “Dr. Openshaw had called the emergency department and told them we were coming. She gave us instructions to wait in the car at valet, and a staff member would come to the car and ask for our name. It was clear that everyone from valet to security was following protocol implemented to keep people as safe as possible during this pandemic.”

Nolan’s room in the emergency department was ready and waiting for him. He and his mom noted how everyone in the emergency department, and the medical unit to which he was admitted overnight, was calm and collected, which in turn helped them feel calm during a stressful health emergency.

Although Nolan has been a patient at CHOC many times before, he and Kris noticed that a few things were different about this trip to CHOC. To protect the health of patients, families, doctors, nurses and staff during the pandemic, CHOC had implemented a variety of safety measures. Kris and Nolan noticed that everyone underwent a health screening before entering the hospital, people wore masks (and more protective equipment when necessary), social distancing measures were in place with people staying 6 feet apart whenever possible, and additional cleaning measures were carried out on top of CHOC’s already stringent cleaning practices.

“Seeing people go above and beyond to keep patients safe, healthy and comfortable during this time is what makes CHOC so different and so special,” Kris says.

Testing confirmed Nolan did indeed have appendicitis, and his surgery was scheduled for the next morning with  Dr. Mustafa Kabeer, a pediatric general and thoracic surgeon. Surgery was a success.

Nolan_aftersurgery
Nolan was in good spirits while recovering from surgery.

Nolan appreciated that staff made him feel as comfortable as possible during his stay.

“CHOC sees you as a person, not just a patient,” Nolan says. “Everyone explained to me what would happen and what medicine I would get. They made it easy for me to understand what was going on, which made the process feel smooth.”

Having a hospitalized child during a pandemic isn’t something Kris envisioned, but she knew Nolan was in good hands.

“It gave me peace of mind that there was consistency in protocols from each area of the hospital that we interacted with,” Kris says. “Everything was well thought out, and it was clear that everyone had bought into the changes being implemented throughout the hospital.”

Kris noticed that staff were reminding each other of changes in protocol, which further reassured her that the hospital was a safe place.

“Hearing nurses and other staff remind each other of things – whether that be a change in protocol, or where an item had been moved to – reassured me that the decisions CHOC had made to keep people safe were being upheld throughout the hospital.”

Nolan shares in his mom’s appreciation for CHOC.

“You never want to be sick, but if you’re going to be sick, you want to be sick at CHOC,” he says.

Nolan only had to stay at CHOC one night after surgery for observation and went home the next day. Dr. Openshaw, although not Nolan’s primary pediatrician, called several times to check up on him after surgery.

“Dr. Openshaw’s care and follow-up made us feel comfortable and assured,” Kris says.

Today, Nolan is back at home, getting reacclimated to distance learning while his school is closed – he’s also learning how to cook and do laundry before he heads off to college in the fall.

Kris is happy to have this health scare behind them, but grateful she knew who to call when her son was sick.

“CHOC has always known what is best for my child. No matter what is going on around us – even a pandemic – doing what’s best for my child will always be CHOC’s priority,” Kris says. “I knew the only place I would trust information from during this time was CHOC. The fact that they had set up a COVID-19 hotline for parents was just another sign that they are always three steps ahead in every situation.”

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Telemedicine

child with computerWHAT IS TELEMEDICINE?
“Telemedicine encompasses a broad range of different applications,” says Dr. Knight, CHOC’s Pediatric Transport and Telemedicine expert. In a nutshell, telemedicine, also sometimes called telehealth, is the delivery of health care services using telecommunications or electronic technology. Telemedicine can involve video and audio equipment to assess a patient remotely, patient portals, remote monitoring of vital signs, the use of smartphones and tablets and remote medical education efforts. Telehealth also can include giving consumers medical and health information via the Internet or wireless devices, including access to online discussion or peer support groups.

CHOC AND TELEMEDICINE
CHOC has become a leader in telemedicine nationwide. “The way we utilize telemedicine at CHOC is to help assess and triage patients in settings outside of our own walls. Most hospitals do not have telemedicine capabilities that would allow a pediatric specialist to provide assessment and triage remotely,” explained Dr. Knight. “Our experts can assess patients in emergency departments at other hospitals with a mobile telemedicine unit called the RP-Xpress that the CHOC transport team takes with them into the field. The RP-Xpress works through Wi-Fi or a cellular signal and allows a specialist back at CHOC to evaluate the patient using both video and audio. That assessment happens sooner than if we had waited until the patient arrived at CHOC and it may determine if the patient needs intervention right away.”

FAST FACTS

  • Estimated number of Americans who benefited from telemedicine services in 2013, according to the American Telemedicine Association: 10 million
  • Annual number of patients transported to CHOC in each of the past three years: 4,000 – 4,200
  • Percent increase over the past five years in the number of patients transported to CHOC Annually: 30 %

View the full feature on Telemedicine

Dr. Gurpreet Ahuja
Dr. Jason M. Knight
CHOC Pediatric
Transport and
Telemedicine expert 

PHYSICIAN FOCUS: Dr. Jason M. Knight

Dr. Knight is the Medical Director of the CHOC Emergency Transport Services Program and an Assistant Clinical Professor at UC Irvine. He completed his residency training, including a year as chief resident, at Harbor-UCLA Medical Center. He completed a three-year fellowship program in pediatric critical care medicine at Harbor-UCLA Medical Center and CHOC Children’s. Under Dr. Knight’s leadership, the CHOC Transport team has become one of the busiest pediatric transport teams in the nation, able to pick up patients from 130 different hospitals throughout California. The transport team also arranges long distance and out-of-state transports via both rotor and fixed-wing aircraft.

Dr. Knight’s philosophy of care: “I believe all children deserve to receive world-class care at a children’s hospital. For many children that care begins with CHOC’s Emergency Transport Services Team. Our team is truly an extension of CHOC and the Pediatric Intensive Care Unit, and I take great pride in our team’s ability to assess, resuscitate and stabilize patients before they arrive at CHOC.”

EDUCATION:
Eastern Virginia Medical School, Norfolk, Virginia

BOARD CERTIFICATIONS:
Pediatric Critical Care

More about Dr. Knight | CHOC Children’s Transport Services

This article was featured in the Orange County Register on April 21, 2014, and was written by Amy Bentley.