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Meet the Guest
Mel Houser, M.D.
Dr. Mel Houser (she/her) is an autistic family physician with a clinical focus on providing primary care for neurodivergent patients across the lifespan. She is the Founder and Executive Director of All Brains Belong VT, a nonprofit 501(c)(3) organization in Montpelier, Vermont that uses universal design principles to provide healthcare, social connection opportunities, and neurodiversity-related education for kids and adults.
At age 37, Dr. Houser was diagnosed as autistic, ADHD, dyspraxic, dyslexic, and dyscalculic. She is also the parent of an autistic 5-year-old, who is her guru of so many keys to the universe.
Key Takeaways and Points of Discussion
- One in five people are neurodivergent
- The difference between neurodivergent vs neurodiverse vs. neuro-inclusive
- People can be diagnosed as neurodivergent as a child or even later in life.
- When there is a “default” system, this creates othering and is not inclusive.
- We need to give people a “menu of options.” Options foster autonomy, which ALL patients like.
- The “social model of disability” –https://www.thesocialcreatures.org/thecreaturetimes/the-social-model-of-disability
- We need a “universal design” for healthcare.
- The DSM has historical limitations for diagnosing neurodivergence.
- We need to do internal work to be more neuro-inclusive.
Main Questions Asked
- Before we get into neuroinclusivity, can you start off by explaining to our listeners what is neurodiversity?
- How does neurodiversity and health, especially sexual and reproductive health, intersect?
- Historically and currently providers use the DSM to classify and diagnose “mental disorders.” What are the limitations of using the DSM when it comes to discussing and diagnosing neurodivergence?
- When we think about our current healthcare system and how patients engage with the healthcare system, what works or doesn’t work for neurodivergent folks?
- What does a neuroinclusive healthcare system look like and how can clinicians make their practice neuroinclusive?
- (if not discussed in #4) We are all about communication on this podcast and during our phone call you mentioned neuro-inclusive interviewing. Can you share with our listeners what is neuro-inclusive interviewing and provide some examples?
- We have a growing number of listeners who do not identify as clinicians and neurodivergence is certainly a topic that is becoming more discussed on social media and in general, especially as it relates to adults who are being diagnosed as neurodivergent later in life. What would you like to share with these folks?
- Where can listeners go to learn more about the type of work you are doing and how to make their practice more neuroinclusive.
[00:00:00] Nicole: Hi everybody and welcome to the Woman Centered Health podcast. Today, we are speaking with Dr. Melissa Houser, a family practice doctor and Executive Director of All Brains Belong Vermont about neuro inclusive clinical practices. We also want to let our listeners know that we are undergoing some strategic changes so that we can improve our listener experience and streamline our processes.
We will no longer be offering our traditional show notes and we’ll instead include takeaways, resources and transcripts directly on our website. However, we would still love and appreciate your support. And you can find ways to support us on our website by going to www.womancenteredhealth.com and click the support us tab.
Also, if you missed our big news, nurses can now earn CE for listening to the Woman Centered Health podcast. Just check out myCEHQ.com, download the CEHQ app, or you can visit our website again, www.womancenteredhealth.com to learn more. And just a quick disclosure, I am recording with my tiny person
so you may hear a little extra noises today.
[00:01:02] Stephanie: Very sweet noises. So, hi Mel. Thank you so much for being a guest on our podcast today. We’re really excited to talk with you. So the first question we always ask our guests is if you can share a little bit of your background with our listeners.
[00:01:18] Dr. Houser: Absolutely. I’m so excited to be here.
So as Nicole said, I’m Mel Houser. I, use she/ they pronouns and I am a family doc with a particular area of concentration in providing primary care to neurodivergent kids, adults, and often, entire families. And most recently I founded a nonprofit 501C3 organization in Montpelier, Vermont, All Brains Belong Vermont.
And we are a healthcare organization that uses principles of universal design, which I’ll tell you all about to provide healthcare, social opportunities and neuro-diversity related education.
[00:02:00] Stephanie: Awesome. Can’t wait to learn more about that. And then the next question we always ask, our favorite question is what informs your perspective?
In other words, why do you do what you do and what is most valuable to you?
[00:02:13] Dr. Houser: So, you know, though, I was trained in conventional allopathic medicine. I have learned the most from being the parent of my five-year-old Luna. So Luna is multipli neurodivergent herself. And I have had to grow my brain to be a good mama to Luna.
And that has really made me a better person and a better doctor. And you know, when I have immersed myself through training and, you know, immersed in the literature on healthcare outcomes and barriers to access, like I recognized a major gap within my own knowledge, skills and even attitudes. So like now what’s most important to me is trying to shift the community conversation around neurodiversity so that Luna can grow up in a community and in a world where everyone understands their own brains.
And everyone understands that all human interaction, all behavior, all the things are a reflection of all of our unique neural wiring, plus the goodness of fit from their environment and with the people in their lives.
[00:03:30] Nicole: That’s amazing. And I always love the answer to that question and I am so freaking excited to talk about this.
So like we said today, we’re going to talk about neuro inclusive clinical practices. So let’s jump right in. But before we get into neuro inclusivity, can you start off by explaining to our listeners what is a neurodiversity?
[00:03:50] Dr. Houser: Oh, absolutely. And, and after, after I talk about neurodiversity, I’m also going to talk about what inclusion means.
So there’s a lot of people who like really want to be inclusive and know all about inclusion, but nobody knows what it means half the time. So we’re gonna talk about that. So neurodiversity refers to the diversity of human brains, you know, like bio diversity, like we all have different brains that all exist on a continuum.
There is an infinite variety in terms of the ways that we think learn and communicate, there is not one default or normal or healthy type of brain. There’s not one right way of thinking, learning, communicating. And so like the term diversity was coined by a sociologist named Judy Singer in the late nineties.
So she came up with this, this word to describe this phenomenon, moving away from the default medical model of like deficit -based thinking and more recognizing the reality, which is that just like we have variety and like our skin color , our gender, our hair color, like our brains have infinite variety as well. So when we use the term, neurodivergent that refers to having a brain that thinks, learns, communicates in ways that depart significantly from the so-called quote, “typical brain” which I don’t think is really a thing.
We’re really talking about the, the, like the neuro majority or like the societal standards of normal, which is like completely arbitrary and neurodivergence can be both genetic and neat, like the wonder of it. And you know, in the example of you know, brains that are autistic or ADHD and also acquired like in the case of traumatic brain injury, but either we’re not talking about like broken or infancy versions of normal brains, we are talking about like a broad spectrum that we all have our own set of strengths and our own set of challenges.
And that this all is just on a continuum. So when we talk about inclusion, inclusion means that people perceive that they belong. Perceived belonging. So the only person who gets to decide if they are included is the person. And so, because we all have different ways of thinking, learning and communicating, if something in the environment is offered in a way that does not work for one’s brain automatically, that person will not feel that they belong.
Because if they are offered a default and their brain does not work, according to the default, they recognize that they are being categorized as different. And any time somebody is made to feel different or othered in some way, they are not going to perceive that belong.
[00:07:02] Stephanie: I love that. I don’t think I’ve heard it kind of just that it’s, it’s simple sort of in its definition.
And I don’t think I’ve heard about it like that. Yeah. Yeah. I mean, it’s not, it sounds simple.
[00:07:13] Dr. Houser: Yeah. I mean, it sounds simple and it actually is that any time something is offered with one default way of doing it, even if you offer a variety of accommodations, you know, if you can’t do the default, you will always have another, anytime there is a default, there is an other
and you don’t have inclusion.
[00:07:33] Stephanie: Yeah and I th I think that we talk about that a lot on our show. And we just talked about that with Dr. Lewis, just kind of the, we like, if we’re quote unquote normal by societal standards, there is, there’s nothing really normal. And so we all have different things and like you said, different brains.
So, you know, making it inclusive for everybody makes it inclusive for our own selves as well.
[00:08:03] Dr. Houser: Totally. And if we’re thinking about this is, this is probably important for your listeners to be aware of, one in five people is thought to think, learn and communicate differently than the so-called quote, “typical brain”.
So this is 20% of the population, at least that is potentially excluded when you offer things according to one default way, that’s a lot of people. And so that’s why it’s so important to learn about this. I didn’t learn anything about this in medical. The healthcare system by and large functions in the medical model of disability, which is that people have limitations because of their deficits, things that are broken about them and that like, we have to fix them, but really disability is best conceptualized as the Social Model of Disability, which is how the, WHO
has defined disability for the past 20 years. And we’re still kind of catching up. The Social Model of Disability says that you may have impairments, you know, personal challenges or drawbacks, but the disability comes from the environment and the mismatch of the environment and the person’s needs. For example, if
you use a wheelchair and you approach a healthcare clinic that has a ramp. You are going to have less disability than if you approach a healthcare clinic that does not have a ramp. And so it’s helpful to think about it in these visible disabilities that way, but invisible disabilities are experiencing so much
barriers to access and therefore barriers to inclusion that we are not often trained in as healthcare providers and are having a huge impact on people’s lives in terms of their physical and mental health.
[00:09:58] Stephanie: Yeah, that was super awesome. I haven’t really heard about it like that. And we are behind here.
That’s and that’s so true. Like it’s the way that we’re structured, our society is structured or buildings are structured. It’s it’s systemic.
[00:10:15] Dr. Houser: Right. And if I can add to that, that so many physical and mental health problems experienced by neurodivergent people actually come from living in a world that’s not designed for us.
[00:10:28] Stephanie: Yes. That makes a lot of sense. And as also sad.
[00:10:32] Dr. Houser: Yeah. Yeah. One of the things that I, if I could insert that. This I would probably it’s important. I think for me to have said that after concentrating my focus clinically, I actually learned that I am Multipli neurodivergent. I am autistic ADHD, dyslexic, dyspraxic and dyscalculia that’s often these things co-occur.
And I was formally diagnosed by professionals with all of these things at the age of 37. I had no idea. I grew up thinking I was entirely neuro-typical and anxious, like really anxious all the time. And things were really hard that I didn’t quite understand why they were hard. And, and that is an increasingly common
experience of adults only first discovering their brains in adulthood and then having the opportunity to rewrite the narrative of their lives, that they’re not broken neuro-typical people. They are neurodivergent people with invisible disabilities whose needs are not being met by the environment.
[00:11:38] Stephanie: Can I ask how that, you know, coming to these realizations and getting these diagnosis, how did that change things for you personally?
[00:11:47] Dr. Houser: It was a profound relief and profoundly empowering. I was able to zoom out and recognize how much of my internal resources were spent masking and complying with the default of a neurotypical society, including in the culture of the health care system, in which there is very clearly a default way of being a human.
[00:12:29] Stephanie: Thanks for sharing that. Because Nicole and I both talked about this recently, we have known a lot of people who sort of discovered later in their life that they are on the spectrum or, or have ADHD, you know, different neurodivergence and, and just kind of recognizing that as an adult, because their kids are getting diagnosed.
[00:12:53] Dr. Houser: Right. And a lot of us as children. Or literally taught, but there is one right way to be a person. And we receive feedback implicitly and explicitly over the course of the decades of our lives. And then when we realize that we have a ton in common with our children, that is how we are discovering our own brains.
What happens is that currently in 2022, the healthcare system is still using the DSM-V, the diagnostic distal manual to classify and diagnose autism, for example, as a disorder and really what we are not taught as healthcare professionals are that those behavioral descriptions of what someone manifests externally are actually stress behaviors.
So the people who are more likely to get an autism diagnosis earlier in life, are those who are more profoundly dysregulated and have more stereotypical stress behaviors. Some brains, some autistic brains devise compensatory mechanisms to exist in the world. And we call that masking or camouflaging, which for many people is involuntary and automatic.
It’s subconscious and not under control. Those are the people who actually have the. highest suicide risk. Autistic people in general have four to nine times increased risk of suicide as compared to non autistic adults. But that suicide risk is higher in those with low,support. Those who are experiencing the pressure of being forced to comply with neuro-typical defaults and not be their true selves showing up in the world.
We know that we’re in other marginalized groups, let’s say for example the trans community increased risk of suicide that comes from not being your true self and being othered and marginalized and the toxic impact of that stress, especially when we think about the intersectionality of all of the ways in which people are marginalized and othered, that risk, that trauma you know multiplies exponentially.
And in fact, it’s also important for your listeners to know that actually autistic people are more likely to be gender diverse. And there’s also research that gender diverse people are actually more likely to be neurodivergent. So that’s also important to know when we think about the multiple impacts of marginalization, when there’s multiple parts of your identity that are marginalized.
[00:15:43] Nicole: Throwing in a little intersectional feminism. We’re all about that.
[00:15:48] Dr. Houser: Yeah. And, and not just feminism, you know, because we’re, we’re really talking about when there are arbitrary, you know, like when we think about how, how arbitrary gender designations are when little kids are taught, you know, you only got two choices and then you grow up and like, you’re not one of those choices, or you’re not the one you’re told you are.
And you’re not told that there’s like lots of options. There’s in fact, infinite options on the menu that feels bad to people and brains are like that too.
[00:16:20] Nicole: So speaking of the DSM, which you brought up to classify and diagnose, quote unquote, mental disorders, are there any other limitations you’d like to discuss abusing the DSM when it comes to discussing and diagnosing neurodivergence?
[00:16:34] Dr. Houser: Oh yes. Thank you for that question. So I am trained extensively in the use of the DSM. However, there was something really important omitted from my training. I was never taught the history of how the autism narrative was developed in the early to mid 1900s, which is important because how autism is described in 2022.
Is pretty similar to how this was described. And if your listeners are interested in that narrative, I have a free talk on the All Brains Belong website that maybe you can link in your resources where I talk about the stigmatized narrative of autism and where it came from and how this actually worsens patients’ health.
And what our role is as healthcare providers in learning about that narrative and taking responsibility for knowing our role in perpetuating the stigmatized narrative of autism. But that was something I was not trained in. And when I learned about it, I was like, oh, “How do people not know this!?”
[00:17:46] Stephanie: We say that all the time, about everything that history, you know, there’s, we lose all this historical context in our training, nursing medicine, which would be really beneficial to have that.
[00:18:01] Dr. Houser: Totally. I mean, healthcare providers are in general critical thinkers. And when the information is missing healthcare professionals lose the autonomy to use critical thinking skills to decide bogus, not bogus much like if I read a paper and the statistical methods weren’t solid or something.
[00:18:24] Stephanie: Yeah. That’s a good point. So I want to ask you about the intersection of neuro-diversity and health, and then. with sexual and reproductive health. Can you talk about that?
[00:18:36] Dr. Houser: Totally. I mean, it’s, it’s everything it’s like, we’re talking about, we’re talking about your brain, we are talking about your nervous system.
It, this, this affects every aspect of your life. So in the context of health care, I would think about like four major buckets for healthcare providers to be aware of. So bucket number one, How someone is accessing health care. Number two, we have to learn about sensory processing because we all take an information from our senses and process it and impacts every aspect of our life in healthcare, in the world, in relationships, in all the things.
Number three, I think that for your audience, there are some specific issues that come up in the context of pregnancy and childbirth, that, that, or something we don’t get training in that that are huge barriers and huge stresses for the neurodivergent community. And then number four as I said before, the intersectionality of neurodivergence with gender diversity in sexual orientation diversity, we need to be aware of all of the subtle, yet profound ways in which people are othered by the healthcare system, and this is a major source of stress and in that perceived invalidation by the patients.
[00:20:10] Nicole: So let’s get into that. When we think about our current healthcare system and how patients engage with the healthcare system, what works or doesn’t work for neurodivergent folks?
[00:20:22] Dr. Houser: Sure. I mean, this is, this is huge. This is a whole, this is like a whole talk in and of itself. But the literature shows that neurodivergent people experience more healthcare problems. And in fact, even in a primary care environments. Even when people have established primary care, almost 80% of neurodivergent people experience, difficulty accessing care. It’s not about finding a provider it’s about actually accessing it. So this includes issues of the environment, whether that be, you know, the bright lights in the fluorescent lights in the exam room, or how chaotic visually and all the poorly chaotic a waiting room is perceived. Inadequacy of the provider, both in knowledge and attitudes about meeting their needs.
When we are trained in a deficit-based framework, this impacts how we interact with people, how we see people, the language we use, how we think about them has impact on our interpersonal interactions with our patients. And this is also going to impact communication since we all have different ways of communicating when it is expected for a patient to communicate in a default way. In the context of the 15 minute visits Though there is variety in how people communicate in terms of what’s going on in their body, how they experience pain, their processing speed, the length of verbal content that people can process, how they best organize information and the, and the systemic barriers to giving people flexibility in that.
So the 15 minute visit. The default about neing able to get access to care. You got to pick up the phone and make a phone call. You need to fill out the 20 page packet to become a new patient. There’s all of these systemic defaults that even though as healthcare providers, I think most healthcare providers by and large are patient-centered people that want their patients to be comfortable. It’s just that the system really constraints and individual provider’s ability to like zoom out and say, whoa, the way I was trained in that default really doesn’t work for all brains. So in bucket number two, sensory processing. So we all take in information through our senses. There’s the five senses that we learned about in school, but there’s also proprioception or the feedback that you get from your muscles and your ligaments and your bones.
So proprioception. Interoception which is the internal body signal perceptions, the stimular processing and neuroception. Neuroception is threat detection. So there’s like four other senses that most healthcare providers don’t have training in that have profound impact on people’s entire lives. And so when we think about sensory processing aspects, you know, not just in healthcare, but in relationships when we think about, you know, like issues of having healthy relationships, healthy sexual relationships and the sensory processing aspects that play into that. And these are things that like providers, aren’t often well-versed in to have these conversations with our patients and to normalize that like, yeah, this thing that you’re experiencing, that no one ever brings up, it’s a thing experienced by lots of people and think about all the things in which we try to normalize with our patients as it is, but there’s like a whole other, this infinite bucket of things that are not said. And if you don’t name the thing, people feel shame. Pregnancy and childbirth is a total other thing. And you, you, you covered this in another episode, right?
[00:24:27] Nicole: Well, we haven’t yet, but for our listeners, we actually talked to Dr. Lewis and they will be coming on to talk about her research regarding birthing people with autism or who identify as autistic. So that that’s a future episode. So if you love this discussion, be sure to stick around because. Yeah, that is going to be another really awesome episode.
[00:24:52] Stephanie: So let’s talk then about what a neuro inclusive healthcare system might look like. Especially, I know you have started this in your non-profit, so you can definitely talk about that. And then, you know, how can the clinicians listening right now make their practice more neuro inclusive?
[00:25:11] Dr. Houser: Absolutely. As I mentioned before, inclusion is perceived belonging. And since we don’t have a default type of brain, anytime we have a default workflow within our systems, we are not going to meet everybody’s needs.
And so first step is accessibility. So that is you have your default and then you provide the accommodations for people to have some options to access the default. That is a first step, but that is not inclusion. Inclusion is when people feel that they belong. And as I said before, anytime you have a default, everyone else is othered and they’re not going to experience they belong.
So in healthcare, we have to zoom out and say, where are all the places that there are defaults and we have to get rid of them. So we have to offer multiple different ways of doing the thing. And then give people freedom and choice to choose what works for their brain. So this is called universal design, and some folks may have heard of universal design for learning that’s in the education system. There’s universal design for architecture, there’s universal design and like all the things, but universal design for healthcare is what we do at my organization, which is that everyone, they do not need to disclose a disability. Everyone is offered a menu of ways to interact with us. They have a menu for choices of how they schedule appointments, how they communicate during, in between appointments, they get to pick their furniture and their lighting and their sensory and executive functioning support. There are no defaults. So we give people this customizable menu and they get to pick what works for them. It’s supporting their agency on autonomy, and it is sending a clear message that there is not one default way to be a patient because there’s not one default way to be a person. So what clinicians can do to make their practice more neuro inclusive is first off accessing training about this. Cause again, this is not something that most clinicians have training in and my advice would be to access training from those with lived experience, because often there is a gap, much like other areas of cultural competency. The gold standard is to receive training from those with lived experience, as opposed to folks who may have a gap between their formal education and the realities of lived experience.
And for example, when I consult to professionals and organizations to enhance the neuro inclusivity of their organizations, one thing that we start with as we walk through the workflow of the people that they’re interacting with the whole workflow, each stage, is there a default, and if there’s a default, there’s an other.
So it’s first step is eliminating defaults. And so even if we think about being neuro inclusive for your staff, you think about, you know, at every stage of the hiring process, the way you define a job description, the way an interview works you know, all these stages are, is there a default? And if there is, you’re not neuro-inclusive. You’ve got to give choices and flexibility. And so patients, when we think about each stage, you know, how do they become a patient? What’s the intake process like? What’s the actual appointment like? What is it like between appointments thinking through, you know, is there one thing. Is there one way to fill out a new patient application and, and remembering that, you know, though I’ve never seen the case where if a patient asks for a work around meaning we’re asked for an accommodation, I’ve never seen a healthcare practicing “no”, but anytime you put the onus on the person with the disability to come up with their own accommodation, That’s not inclusive.
[00:29:21] Nicole: So Dr. Hauser, can you talk about, I know you did this on our phone call. Can you talk about the ways in which your practice that you implement these things, or what does that look like at your practice?
[00:29:32] Dr. Houser: So, in my practice, we have a customizable menu of all of the different ways of interacting. So when it comes to scheduling an appointment, you certainly can call, but you can, we have secure text messaging, secure emailing without a patient portal, because guess what? There’s a lot of brains that struggle to remember the portal or have the two factor authentication to log in like, ah, the worst. You can self-schedule online. When you get to the appointment, you have chosen ahead of time what your furniture is, what your lighting is, the sensory and executive functioning support that are available to you during the appointment. After the appointment, what, you know, here’s a whole range of things we can do to support you, to make your next appointment, to connect with your referrals, to you know, th dif different ways of taking home, the information based on how you learn.
It’s not like the default written after visit summary. If you have told us that you have the kind of brain that learns by pictures, learns by videos. That’s how you get information. And it’s not, it’s not a default of, you know, here’s the paper. It’s okay. If you, if paper is what you chose fine, but there are other options being emailed to you, links to videos, links to, you know, being texted to you.
So all kinds of supports that way within the visit. There are people who process information by writing or process visually. So there’s a really easy way for some folks to be able to share their information ahead of time. I remember as a student being explicitly taught, you know, there’s the patient with list like, what does that mean? That’s somebody who organizes information visually. That’s all that means. Why is there like stigma and judgment? Like, so, I mean, there’s the hidden curriculum of medical training and all the judgment that goes on when really that’s somebody who figured out their brain and figured out what works for them.
[00:31:37] Nicole: So I’m curious then Dr. Houser, and I think that our listeners would be as well. How, or what mechanism do you use to assess what someone’s needs are as far as the lighting or the chairs?
[00:31:49] Dr. Houser: You ask them. Literally it is that simple. All patients are given these choices and they pick what works for them. They are also asked what is stressful to them about healthcare experiences so that we don’t do it. And we ask them what comforts them and we do it. It is literally that simple. And so if they have checked off that they prefer a dimly lit waiting room. We have the lights dimmed when they arrive. And if they have said they want a chair that rocks. We have it in the room, literally. It is that simple
[00:32:37] Nicole: Who collects that information?
[00:32:40] Dr. Houser: We do. So so it’s myself and a nurse practitioner colleague, and we have a variety of ways and people in which people can fill this out, they can do it online. They can do it by text message. They can do it in person either verbally or filling out paper. There’s no default. And we find is that it doesn’t add extra time. And you have patients who are feeling like, I mean, we have people who thank us for asking such nuanced questions.
[00:33:15] Nicole: So then from like a physical space design structural, but when you ask these questions about dim lights, different chairs, what then does the physical space look like for your waiting room? Like, you know, if you have multiple people waiting and they all have different needs, do you then have multiple waiting rooms?
[00:33:34] Dr. Houser: We generally don’t have multiple people waiting, like to exceed the space. So, so I’ll give you an example. So my organization sponsored a COVID vaccination clinic for the community. This was open to people beyond our patients. So when we, we basically offered the same menu to all the people and there’s a lot of conflicting access needs. You can’t have the person who wants a dim lighting waiting in the same space as the person who wants bright lighting. And so we have to take that on to coordinate the logistics of making sure that people’s needs are being met. And they fact are not able to have appointments at the same time. And that’s the trade-off. So your appointment could be at this time. But then it can’t be dim. So it’s it’s, it’s really working with people and because we ask them, for example, when they were choosing their slots, we gave them choices. And these were the choices for dim time. And these are the choices for bright time. And like, it’s a trade-off, but overall humans want autonomy. So just giving them any kind of autonomy over the things that matter to them. It’s free. It’s thoroughly free.
[00:34:43] Nicole: And what recommendations would you have for maybe people who are in like a multi-practice or a bigger setting?
[00:34:51] Dr. Houser: So for that, it would be about, I think creating containers. Like there’s going to be things you can control and things you can’t control, but if there’s going to be periods of the day that you can kind of bucket off about, you know, when w when are certain things available and when are certain other things available.
It’s also, you know, a lot of this. In the communal waiting areas. And you can offer a choice on the menu, like skip the waiting room. That’s a choice on our menu. So we arranged this so that you arrive for your appointment and we’ve kind of set up the schedules that you’re gonna come from outside, we’re going to text you when we’re ready. That’s a choice. So you get a text us when you’re ready, you come right into the room. And so lots of people choose that choice. So that’s a way of like, not you know, just, you’re not changing the waiting room at all. You’re just skipping it because it’s terrible for a lot of brains.
And so once they’re in the, once they’re in an individual exam room, you have a lot more control, you know, can you figure out alternative lighting, different temperature modifications, you know? So if there’s people who are really, really sensitive to cold rooms. Like what can you do to make that person more comfortable? Can you have heated blankets waiting? Can you have, how about you don’t default put people in gowns before you meet them. You know, like there’s all kinds of things. And in fact, when, in addition to our menu, we have open-ended spaces on, on, on some of our intake forms about like the things that are stressful. And I can’t tell you how often people specifically, spontaneously volunteer how stressful it is. The default of like being asked to be put in a gown and have that be the default expectation. When we really know that there are more times than not, that’s not really what, what is needed by that patient for their interaction. Cause we didn’t even ask them what they were there for to begin with. We just had the default and put them in the gown where they can feel exposed and vulnerable and loss of autonomu.
[00:36:39] Stephanie: Yeah, I like, I love that. I, luckily my mom is a very outspoken person, but she would always, the gown was like a big trigger for me as a kid. And she finally said, you don’t need to put that on. just don’t. And I finally like, oh, just because the nurse or the medical assistant told me to put this on doesn’t mean I have to, and most of the time the physician would come in they wouldn’t even need me to be in a gown. It was just like you said, the default.
[00:37:11] Dr. Houser: The default. Yeah. And when I first opened All Brains Belong and didn’t have any staff at all, it was just me doing all the things and. When I was processing my own referrals, there were so many defaults like, well, well we need this progress note. I was like, there’s nothing in the progress note you need, you need to know why I’m referring the patient was like, no, well. It’s like, conflicting access needs of like the, the reception staff thinks they’re going to get yelled at or criticized in some ways. So they like do the default to check the box. That none of this actually impacts in first patient care. And it just leads to like tension and no one being able to communicate their access needs.
[00:37:55] Nicole: So of course, on this podcast, we’re all about communication. And I have a couple of questions related to communication. One being on our phone call, you had mentioned neuro inclusive interviewing. Can you share with our listeners about that?
[00:38:10] Dr. Houser: So in my medical education, I was trained that there is one right way to interview a patient. And in fact, I was like graded on this and got feedback and there were rubrics and all the things, but turns out. There are some brains who cannot respond to open-ended questions because their brains are generating so many possible answers. If they get overloaded and shut down, or the language you use didn’t really match their experience because of their interoseption differences or because all just the way they process language or use language.
And I think we’ve all had the experience of asking a question that we can see doesn’t land with the patient or the patient’s like, I don’t know, or they look confused. I mean, anyway, so the claritive language that is rather than asking questions, turning your questions into statements is a way that some brains can process language much easier.
There’s also the element of kind of figuring out if you’ve got the, if you’ve got a patient who benefits from short conversational terms, as opposed to the long conversational terms that if I’m not working at it with my impulse control, like I tend to monologue that’s that is a valid form of communication and conflicting access needs. There may be, you know, I might be a monologue communicator but I can’t process monologue. So somebody like going on, you know, the clinicians going on or whatever, like I can’t take it all in. So like, oh, okay. So pause. So as a, as a clinician, recognizing that, trying to keep questions short for some people, once you kind of figure out what their communication patterns are, like one question at a time, and again, a question that’s not a question.
So what that might, what that might look like practically is as opposed to,” What does it feel like?” “I wonder what it feels like,” that actually makes a difference. It’s a different part of the brain. It’s a different communication skill. When we think about the way in which language is developed, those what questions are, are pretty complicated. They come in later.
[00:40:14] Nicole: Also just curious, what are some other communication tips for clinicians to have a more neuro-inclusive environment? And if you can give some examples, like you just did of what you say.
[00:40:26] Dr. Houser: Yeah. And often it is what format you are asking the question in. So I, because I asked upfront how people, here’s the menu of ways that you can give me information. If people have checked off that they are more comfortable communicating in writing this, these are the people that I am sending formats to communicate ahead of time that I have in front of me. I haven’t read them in advance. It doesn’t take up extra time. I’m reading it during the visit, but they have been able to organize their information and communicate it in a way that is more satisfying to them, then they would be able to generate in real time with spoken speech. So that’s again, not an accommodation. It’s not like, well, the default is that I’m going to ask you questions and you’re going to answer them spoken speech. It is on menu presented to all the people. And you know, though I would say the majority of my patients, kidsm and adults are, neurodivergent, not everyone, theneuro-typical people like given freedom and choice.
[00:41:29] Stephanie: So let’s go back a little bit. You talked at the beginning of the episode about, like we talked about like folks who are diagnosed as being neurodivergent later in life. So we have a lot, we have a growing number of listeners who do not identify as clinicians and neurodivergence is certainly a topic that has been discussed more and more on social media.
So, especially as it relates to adults who are being diagnosed, as neurodivergent later in life, what would you like to share with these folks?
[00:42:02] Dr. Houser: I would say that neural lurking, as I like to call it is, a complex process that is going to bring up potentially a lot of complex emotions. You know, like I said, that I felt profoundly relieved when I received my diagnosis. I also, it also brought up like a whole lot of resentment and anger and regret of like what could have been and like all of the internalized ableism and shame that has come on, because I didn’t know. And I had this narrative of being broken and defective, like, like I didn’t have to be in like all the things that were hard about medical training and like existing in certain environments.
Like anyway, just, just normalizing that. The thing I would say is that someone spoke to say like, well, how do I do it? How do I neuro lurk? Well, it’s really about connecting with neurodivergent folks. It’s really about, you know, whether that be synchronously or asynchronously, reading books, blogs, vlogs, YouTube channels, there’s all kinds of social, you know, all the things on social media.
I remember when I was neuro lurking, you know, it was this like profoundly, strange experience to find perfect strangers communicating my innermost thoughts on infographics on Instagram. Like, “What!? How’d they know!?” There’s like a whole bunch of people who see the world pretty similarly. Anyway. And so that can be like a profoundly empowering process.
The next one I would make is that self identification is totally valid. There are some people who feel that they need a professional diagnosis for a variety of reasons, and that’s a very personal decision, but it All Brains Belong we totally support self identification and depending on where you live, there may be certain barriers to accessing professional evaluation and diagnosis. And depending on where you live, there may not be neuro-diversity affirming professionals. You might have professionals who are still operating in an outdated paradigm. And so we’re really talking about your identity. And since I don’t believe that autism and ADHD are disorders, I believe that that often there is profound disability associated, but again, that’s the Social Model of Disability that the amount of gaps between what I want to do and what I can do is influenced by the environment. And so when I have autonomy over my environment, I have way less disability, but we’re really talking about indentity here. And so you don’t need a professional to tell you about your identity and that’s where like all the other aspects of identity. This is by the time you, if you are someone who is seeking professional diagnosis, my advice would be to get yourself to a place where it’s like checking the box afterwards. It’s not because you’re not sure. And you get sure. Only you can be sure because it’s your identity.
[00:44:49] Stephanie: Can you tell our listeners specifically where they might go. When they, if they want to neuro lurk as you called it, I had not heard that term before.
[00:45:00] Dr. Houser: Totally. And in fact I’ll share some resources with you that you can pass along to your listeners.
[00:45:06] Nicole: Yeah, that would be great.
[00:45:08] Stephanie: Perfect.
[00:45:09] Dr. Houser: If you go to the All Brains Belong website, allbrainsbelong.org, there are free lectures on our education page. We also do you know, customized trainings, but there’s lots of resources available for free. In addition, we offer free community programs that are open to everyone professionals.
And non-professionals regardless of where you live, because most of our community programs are virtual. And in fact, one program to bring to your attention Brain Club. It is a virtual lecture discussion series. We cover all kinds of topics of everyday brain life, things like sensory processing, co-regulation, workplace accommodations, school-related issue, like all shame and internalized ableism, neuro lurking, lik all kinds of topics. And if you can’t make it live, they’re all recorded and they’re available for free.
[00:46:07] Nicole: Yeah, that’s awesome. And I, I have a kind of off the cuff question. I feel like, I mean, you have given so much amazing information, threw out a bunch of terms. It may be that our listeners are like, holy buckets. You know, this is a lot, but this is amazing. So if you could say to our clinicians who are thinking like, you know, I want to embrace this, this is a journey I want to do. You know, what is like the one thing that maybe they could start to do today to make their practice more neuro inclusive. What could they do today? Maybe within themselves?
[00:46:42] Dr. Houser: I would say that the lens in which we are seeing the world and framing our experiences is the thing. So if we can shift our lens and be willing to unlearn a lot of what we learned in our training, and that was reinforced in the culture of our practice and relearn this new narrative, which is that we all have different brains that learn, think, and communicate differently. And if we want to be inclusive, of people who learn, think, and communicate differently than we do or differently than the mythical default, we were trained in.
We have to zoom out and say, okay, where’s the defaults. Replace them with flexible multimodal strategies for engagement.
[00:47:35] Nicole: So I know we’re getting low on time and I don’t know how to make this a question, but I remember Dr. Houser in our conversation, you had even mentioned the flexibility you offer in where you do exams.
[00:47:48] Dr. Houser: We also give people choice of settings for their appointments, not just office versus telehealth, but we have lots of patients who are most comfortable having appointments outdoors. There are so many people with healthcare related anxiety and healthcare trauma, that outdoors is what’s most accessible for people. And I see, I see people outside all the time.
[00:48:11] Stephanie: That sounds kind of lovely. So, Mel, I would personally like to thank you so much for your time and commitment to advancing sexual and reproductive health through communication. Do you have any last thoughts that you would like to add before we end?
[00:48:24] Dr. Houser: Well, I just want to thank you for your interest and engagement in this topic and for your listeners taking the time to learn about this, because I think this is the missing piece of the social justice conversations. If we’re not talking about neurodiversity and we’re not talking about visible and invisible disability, we are missing a huge chunk of the population that does not currently feel included within the healthcare system and outside of the healthcare system. And so I think that together, if we can do this work and zoom out and unlearn a lot of the defaults that we were taught, just like we had to unlearn a lot of defaults in all of the other aspects of cultural competency. If we can improve our neuro cultural competency, I think this is going to help all of us.
[00:49:19] Nicole: Yes. And thank you so much. And we appreciate that. Well, we found Dr. Houser via Twitter, going down a rabbit hole to a article, and then we were super creepers and found her email online. So we really, we were lurking. And so we really appreciate that you responded to our random email because this, this is amazing. And we can’t wait to share all this information with our listeners. So thank you.
[00:49:46] Dr. Houser: Awesome. Thanks for having me.
[00:49:48] Stephanie: Thank you so much.