Department of Family Medicine

(From left to right) Dr. Melissa Houser, Isaac Bernstein, and Matthew Bernstein.

At the age of 37, University of Vermont Larner College of Medicine alum and family medicine physician Melissa Houser, M.D.'12, was diagnosed for the first time with autism and attention-deficit/hyperactivity disorder (ADHD). This transformative experience inspired her to create a new model of healthcare delivery. In December 2021, using her decade of experience treating patients of all ages and her personal experience as a neurodivergent individual, Houser officially opened All Brains Belong VT (ABB)—a nonprofit neuroinclusive primary care and community center offering patient-centered healthcare and inclusively-designed community events.

"There are so many 'defaults' in our society, including within the healthcare system," says Houser, who is a clinical assistant professor of family medicine at UVM. She cites just a few 'default' situations in the healthcare system that can create difficulty for neurodivergent patients: calling to book appointments, completing long packets of paperwork prior to accessing care, and creating and remembering patient portal passwords. "Any time there is a default expectation, anyone who doesn’t fit into that mold feels 'othered,'" she says, adding, "When we cause people to feel 'othered,' we don’t have true inclusion and there are so many who feel excluded from current healthcare system."

The foundation of ABB’s approach to healthcare is an understanding and respect for each patient’s individualized holistic physical, emotional, sensory, communication, and executive functioning needs.

To meet patients in ways they feel most comfortable, Houser focuses on the subtle details of her patients’ needs and how they impact access to and engagement with healthcare. "Many people don’t realize how something so simple as the lights in an exam room or the sounds of a waiting room literally keep people away from care," explains Houser.

ABB offers a variety of environments in which patients can meet with providers and modes in which communication can occur. For instance, patients can schedule appointments online, request indoor, outdoor, or telehealth visits, communicate by HIPAA-secure texting and email, and select specific environmental settings in which they feel most comfortable.

Recently, in the face of the ongoing COVID-19 pandemic and the necessity of vaccination and booster shots to protect against severe illness and death, Houser’s expertise has become invaluable for neurodivergent individuals and their family members.

On December 18, 2021, in partnership with the Vermont Department of Health, Vermont Family Network, Waterbury EMS, and a group of volunteers, ABB hosted its first sensory-friendly COVID-19 community vaccination clinic at its offices in Montpelier, Vt. The clinic was a blessing for neurodiverse children and adults whose discomfort had kept them from getting vaccinated, some after multiple attempts, at other locations.

Larner Class of 2023 medical student Elizabeth Barker, who is currently working with Houser during her family medicine clinical clerkship rotation, was there to lend a hand. "I watched parents try not to get emotional as they watched their child finally getting vaccinated without suffering trauma," said Barker, adding, "I spoke with a mother who told me how hard doctor visits were while trying to regulate her neurodivergent child in a typical clinical environment." 

In the weeks leading up to the clinic, patients or their caregivers registered for the clinic, filling out custom-designed registration forms that let them choose to receive their vaccine indoors, outdoors, or in their own car, and specify the lighting, music, toys, and other preferences that would help them feel most comfortable. Families selected whether they’d like topical numbing gel applied before receiving the shot, or if they’d benefit from the use of sensory tools or watching videos about their monotropic interest during the encounter—all factors which can make an enormous difference between a traumatic or successful visit to the doctor for neurodivergent patients. 

"Nothing we’re doing is magic," says Houser. "All we’re doing is asking people what makes them comfortable and doing it. When you give people freedom and choice, they feel safe."

On the day of the clinic, Matthew Bernstein of Montpelier brought his 5-year-old son, Isaac, to receive his vaccination. "The staff's patience and care for Isaac’s processing time was the most calming thing for his nervous system in a potentially scary experience," said Bernstein. "We're already scared about COVID, and this allowed for a feeling of security and safety during a COVID-related experience."

"Thinking about healthcare through the lens of personal bodily autonomy, we have to take a full look at the system, the environment, the nervous systems of the providers – all of this has an impact on the patient’s experience," says Hannah Bloom, a pediatric occupational therapist and president of ABB’s board of directors. "In the traditional healthcare system, there are times when medical events are delivered without intentional acknowledgement for a child's bodily autonomy. What Dr. Houser created with this vaccine clinic was the ability for family systems and individual nervous systems to be the directors of their own health experience."

The experience has made an impact on Barker and how she plans to approach interactions with her future patients. "It’s really amazing to see a physician identify a need in her community and do something about it," she says. "Watching what Dr. Houser has accomplished has inspired me to step up for my future patients like she does, providing health care to a community that our current system is failing to reach."

The next sensory-informed COVID-19 community vaccination clinic is being held Saturday, January 15 from 12:30 – 3:30 pm at ABB in Montpelier, Vt. To register for the clinic, patients and their caregivers can register at www.allbrainsbelong.org/protectkids.