Neurodivergence & Accessibility in Primary Care

Hello, my name is Natalie Paul. I'm a family nurse practitioner. I'm the owner and founder of Lavender Spectrum Health.

Today, we're gonna be talking about neurodivergence and accessibility in healthcare. And I'm gonna tell you some of my most important highlights and clinical pearls from my nearly 10 years of experience as a nurse practitioner, so you can learn more about your own healthcare needs and we can help you meet them. So this is a population level issue.

It's not just a niche issue. Between two and 5% of the population is neurodivergent using our most recent estimates. And so it's really wild if you think about it that so many people are not getting their healthcare needs met and no one is asking except for us, well, how can we meet your needs? And how can we design healthcare to give you the care you need in a way that feels comfortable and safe? Accessibility is a critical and central piece of how we design every aspect of our care and our clinic and our workflows.

Our website is accessible for many different kinds of issues including with screen readers and other kinds of accessibility devices. And we think a lot about the patient experience and what that means. So for example, many neurodivergent people hate phone calls.

We have a HIPAA compliant text service. So you can text us to start with the clinic. Patients can schedule themselves for appointments on the portal once they're established patients.

Patients can request refills on the portal. And these are just some of our basic accommodations. For our in-person services, we use warm lights rather than overhead fluorescent lights as those lights are overstimulating, may cause headaches, may trigger migraines.

We have fidget toys in every exam room. So people who may be nervous about getting healthcare can feel calm and centered. We center accessibility in our exam table and our chairs.

All of our exam tables support at a minimum of 500 pounds. And we have an extended table that supports 800 pounds. We have four different sizes of blood pressure cuffs.

We have 11 different options for vaginal specula including four plastic and six metal size options. We never want anybody to be unable to receive care with us. We also are a mask required facility and use acute illness screening protocols.

So people who are immune suppressed or have chronic illness can feel safe getting care with us. And this is just an introduction to our accessibility features and how accessibility is at the core of what we do. We also offer telehealth visits for people who may have difficulty getting to the clinic or may live far away.

And we look forward to sharing our accessibility features with you when you get care with us at Lavender Spectrum Health. 

Carevix for IUD Insertions

My name is Natalie. I'm a nurse practitioner and founder of Lavender Spectrum Health, a private practice in Vancouver, Washington. I've for a long time been thinking about how can we make IUD insertions more humane and sustainable. 

The current technology that's the standard of care is this, the tenaculum. It is used by the clinician to grasp the cervix here and pierce the cervix to hold it and stabilize it. This is very painful and I have stopped doing these procedures and I said I would not do them until we have better technology. 

I just got my CareVix cervical stabilizer device that uses suction instead of piercing the cervix. These are single-use devices so I'm just going to demonstrate how you use it. You first pull back the plunger, lock it, then we place our device here. 

I'm just going to use it against my arm and we engage the device and you can see here this is just like not going anywhere and it also like doesn't hurt or anything and then when you have inserted your IUD you just push down to disengage it. I think that we as a society have a lot of reflecting to do on why no one has thought to challenge the tenaculum until now.

What is Trauma-Informed Care?

The next pillar at Lavender Spectrum Health is Trauma-informed care. What this means is that we assume everyone has experienced some amount of trauma and some amount of hardship in their life, whether it is "Big T" trauma like assault or war or or "Little T" trauma like chronic invalidation and marginalization that goes on over long periods of time. 

This shows up in a lot of different ways for us. We always ask before we touch you in any way. We explain everything we're going to do step by step.  We ask you if you have questions. Whenever we're making treatment suggestions,  we lay them out for you and give you the options to choose between them as long as they are safe. We do our pelvic exams with a lot of care and intention.  

We often will talk someone through what we're going to do, show them equipment, ask them if there are modifications. For our pelvic exams in particular we can prescribe anxiety medication as long as it is medically appropriate. We can offer topical numbing medicines. We can have support people. Additionally we do not use stirrups in our exams. 

Believe it or not, it is not necessary to restrain someone when they are getting a pelvic exam. It is really important for you to feel safe with your clinician. 

We think about your experience from aspect, from when you are contacting to the clinic, to when you're scheduling, to when you're receiving care at Lavender Spectrum Health. 

What is Neurodivergence?

At Lavender Spectrum Health, we care for neurodivergence.

You may wonder “What is neurodivergence?” Neurodivergence includes seven main conditions or symptom clusters, and these include autism, ADHD, OCD, tourette’s syndrome, executive function conditions, intellectual disability, auditory processing disorders, and co-ocuring or overlap conditions.

These are the conditions that are most commonly accepted in the umbrella of neurodivergence or neurodiversity, but there are controversies. Many people include psychiatric conditions such as post-traumatic stress disorder, bipolar, schizophrenia, personality disorders, and more. Neurodiversity is an umbrella term where everyone is welcome. This is in many ways similar to the LGBTQ+ umbrella where everyone is welcome.

This is a way to identify yourself as having a way of thinking and processing information and relating to others that is different from other people.

Natalie Testifies in Support of HB 1430 in the WA Senate!

WA HB 1430 is a bill in the Washington senate to grant ARNPs and PAs pay parity in Washington for primary care and mental health.