Assessing Feasibility of Providing Injury Prevention Counseling for Caregivers of Children with Autism in the Outpatient Setting

Caroline Chivily, MD, MPH
Katharina Goebel
Meghan Norred, CPNP
Timothy Moran, PhD
Maneesha Agarwal, MD
Kiesha Fraser Doh, MD
Claudia Morris, MD
Nathan Call, PhD
Sofia Chaudhary, MD

Unintentional injury is the leading cause of death for children and teens ages 0-19 years old. Children with Autism Spectrum Disorder (ASD) can exhibit high-risk behaviors, placing them at increased injury risk due to accessing improperly secured dangerous items, elopement, and drowning. The primary objective is to examine the feasibility of injury prevention counseling in a pediatric ASD outpatient clinic. The secondary objective is to evaluate caregiver injury prevention practice changes related to firearm safety, elopement, and water safety.

This was a prospective interventional study of caregivers of youth with ASD of varying severity presenting for new patient appointments to an outpatient pediatric ASD clinic in a large metropolitan area between July 2024 and January 2025. Advanced practice providers, specifically nurse practitioners, assessed caregiver injury risk awareness utilizing standardized questionnaires and provided verbal anticipatory guidance and written injury prevention resources. Caregivers were invited to participate in one-month follow-up phone surveys, which assessed the feasibility of injury prevention counseling and caregiver injury prevention practice changes. The primary analysis included feasibility measures such as caregiver attrition and intervention acceptability. Likert-scale responses were tabulated manually and dichotomized to strongly agree/agree (affirmative) vs. neutral/disagree/strongly disagree. Secondary analysis evaluated injury prevention practice changes related to elopement, water safety, and firearm safety via mixed-effects logistic regressions.

In total, 68% of approached caregivers completed a follow-up interview (n=21). Of these, 100% determined the clinic to be an appropriate setting to discuss elopement and water safety and 94% for firearm safety. Caregivers were most knowledgeable regarding elopement injury risk (76%). Enrollment in swimming lessons had the highest relative increase (153%) of all assessed water safety practice changes (pre: 19%, post: 48%). Among firearm owning families (n=6), there was a 24% relative increase in those “always” utilizing safe storage devices (pre: 67%, post: 83%) and a 66% relative increase in those storing firearms separately from ammunition (pre: 50%, post: 83%). There were significantly more self-reported preventive measures post-intervention compared to pre-intervention for both elopement (OR=2.22, 95% CI [1.45, 3.40], p=0.0002) and water safety (OR=1.60, 95% CI [1.18, 2.16], p=0.002).

The outpatient subspecialty clinic setting offers a unique opportunity for injury prevention counseling for children with ASD. Our study demonstrates that these subspecialty outpatient clinics are an appropriate place for these conversations and that caregivers respond to the injury prevention education with tangible practice changes.

1. Determine if outpatient clinics are an appropriate setting for injury prevention counseling for caregivers of children with ASD.
2. Illustrate perception of injury risk in caregivers of children with ASD.
3. Examine caregiver injury prevention strategies relating to elopement, water safety, and firearm safety.