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An Emergency Mental Health Screening Tool for Youths with Autism

Identifying crises before they become emergencies.

By Michael Eisenstein • Image by Benjavisa/Getty Images

Nobody likes visiting the ER, but for children and adolescents with autism spectrum disorder, the experience can be a punishing ordeal. 

Luke Kalb, an assistant professor in Mental Health and at the Kennedy Krieger Institute, saw this firsthand while working at a psychiatric hospital. Long wait times, the use of restraints and providers’ lack of knowledge of ASD can exacerbate an already challenging situation. “The ER experience can be traumatizing for them, especially when they are experiencing acute mental health symptoms such as self-injury,” says Kalb, PhD ’17, MHS ’08. 

The ER remains the gateway through which most individuals with ASD seek immediate psychiatric attention or access to inpatient psychiatric care during a crisis. Because psychiatric beds are rarely available and ERs are not equipped to offer psychiatric care, many families return home without resources or treatment. “Families end up getting stuck in this loop,” bouncing between home and the ER, says Kalb.

He and his colleagues hope to spare families this experience with the Mental Health Crisis Assessment Scale, a tool they’ve developed to determine whether a child or family is actively in crisis or at risk for it. 

The MCAS is a 28-item parent-report questionnaire designed to assess crisis from two angles. The first section determines whether a young person with ASD is at risk of hurting themselves or others; the second gauges parents’ or caregivers’ ability to manage the child’s dangerous behavior. The ultimate goal would be for service agencies to provide interventions to families and young people at risk for crisis—before it becomes an emergency. 

Although it’s still used only for research purposes, Kalb is optimistic that the MCAS may soon help adolescents with ASD avoid a costly, emotionally taxing—and ultimately ineffective—trip to the ER. “I’d like to see us developing new models of care,” says Kalb, “ways to improve life for both the child and the family at home.”