NAUGATUCK, Conn. (WTNH) — Jenn Harding is a single mom to her son, Derek, a non-verbal 11-year-old with autism, epilepsy and Tourette syndrome.

A frightening episode last January in Naugatuck spurred this mother to act.

“Naugatuck police had an incident with a young man who was autistic who fled on foot from his residence,” Chief C. Colin McAllister of the Naugatuck Police Department said.

“When that happened, I said we need to get this done,” Harding said.

So, Harding created an Autism Alert Form that was supported by McAllister. It contains vital information that gets inputted into a station’s system.

“Their names, their date of birth, height, weight, hair color, identifying features,” Harding said.

It also provides information about atypical behaviors and calming methods. The form is being implemented in Naugatuck by Detective Sgt. Alexia McMasters.

“This program was a no-brainer for us to get involved in,” she said. “The more information we have as officers, the better off the situation will be.”

“I knew it was needed, I had no idea what I was creating,” Harding said.

The info sheet provides knowledge that helps officers diffuse a potentially volatile situation.

The voluntary program kicked off in the spring with a visit to the police station for a group of children on the spectrum.

“The idea is to acclimate them to the officers that might be out in the community so they’re not going to be traumatized if they do have an interaction,” McAllister said.

Harding has long been active in the autism community.

The upcoming Walk With Derek on Oct. 2 raises money for support groups and provides much-needed resources.

“The Special Olympics will be there, the Miracle League, the ARC of Litchfield,” she said.

The alert form has now been adopted by 30 towns, as well as the Connecticut State Police.

Harding is grateful that the Naugatuck Police Department responded so quickly and that this conversation is growing.

“Every day I get a ‘thank-you’ from the family,” Harding said. “If we can help one child, that’s amazing.”

You can call your local police department to inquire about the form. Click here for an online version.