Designing emergency departments to support autistic children

Beginning with a universal design approach

Universal design is an approach that makes buildings, products or environments accessible to as many people as possible – regardless of age, disability, background or any other factors. In health infrastructure, universal design means creating spaces that are functional for everyone and that address physical, sensory and cognitive needs.

Our design guidelines explain how to accommodate people with autism within healthcare facilities. Solutions include installing clear wayfinding, and avoiding highly complex or stimulating patterns on surfaces. There are also design methods to reduce sensory triggers of lights, sounds, colours, and smells

Accommodating sensory issues

We spoke to Professor David Krieser, Director of Paediatric Emergency Medicine at Western Health, about the issues autistic children may face, and how he has seen design make a difference.

He says autistic children often find comfort in routines and surroundings that are familiar. They may not like highly stimulating environments. Emergency departments (ED) are generally not familiar to them, are rapidly changing and certainly not routine for anyone.

‘Trying to provide quieter spaces with capacity for images that are familiar to the child is useful. Auditory and visual separation from the action of the ED is important as this may mean autistic children can respond to the people they are most familiar with - for example parents, carers or case workers - without the confronting distraction of others. The use of doors rather than curtains may improve the auditory separation.'

‘Sensory equipment such as weighted blankets, toys and tactile sand can also be acquired. Of course, medical care and staff safety must be assured, but selected patients and the staff caring for them will be safer in such a space than in a conventional ED cubicle.’

Professor David Krieser says videos and soothing sounds can also be helpful.

‘Ceiling projectors linked to an iPad can provide visual and auditory distraction tailored to the child. Artworks can be used to trigger interaction. For example, wallpaper in the Sunshine Children’s emergency department has a variety of pictures contained within it. I have used this to ask children with autism questions, “Can you find the flower?” “Do you like flowers?” “How about the snails?” “Where are they?”’

The Victorian autism plan states that about one in every 100 Victorians report being autistic. However, many autistic people live without a diagnosis, and the true rate of occurrence may be higher. Autistic people have differences in their characteristics, needs and their experience of disability.

In 2017, the Australian Institute of Health and Welfare reported that autism is most commonly identified in children and young people. As such, people with autism were more likely to be younger, with 83 per cent aged under 25.

The ABS 2018 Survey of Disability, Ageing and Carers found:

• there were 205,200 Australians with autism, a 25.1 per cent increase from the 164,000 with the condition in 2015
• males were 3.5 times more likely than females to have the condition, with prevalence rates of 1.3 per cent and 0.4 percent respectively.

Our Universal Design Policy states that we are committed to:

• providing equitable access to health sector infrastructure for Victorian people of all abilities
• exceeding minimum standards to ensure universal design provisions be included and applied to planning schemes and delivery of health infrastructure
• developing the capabilities of our workforce through best practice guidance and leadership
• promoting a culture of inclusion by integrating universal design principles into compliance commitments and requirements
• delivering innovative solutions to anticipate the needs of all end-users through design and implementation of development initiatives.

The Victorian Government is investing $102.4 million to deliver specially designed children’s emergency areas at:

• Northern Hospital in Epping
• Frankston Hospital
• Casey Hospital in Berwick
• Maroondah Hospital
• University Hospital Geelong.

The new emergency departments will meet increasing demand for paediatric emergency care. This will translate to better, more personalised treatment for kids, their families and carers at a time they need it most.

Learn about our investment in making emergency departments safer, calmer places for kids.