Get to Know YBC

KATHLEEN JOHNSON, DNP, ARNP, FNP-BC, C-PMHS, C-PMHNP, "Dr. Kat"

Yellow Brick Clinic: Integrative ADHD, Autism & Developmental-Behavioral Pediatric Health (YBC) is a novel, community-based clinical practice that was created to offer increased access to care for people with autism and other developmental-behavioral pediatric challenges in Washington State.  Our mission is to “Change Stumbling Blocks into Building Blocks” for people with developmental-behavioral challenges.  Our model of care intertwines specialty-trained Advanced Registered Nurse Practitioners (ARNPs) and Telehealth to increase accessibility and offers evaluations with diagnosis, multiple therapies, including genetic testing and both pharmacologic and complementary and alternative medicine (CAM) options.

The spirit of YBC was inspired in part by my young adult child with autism who told me, “Are you kidding? I hated going to clinics as a kid, I still do…the smells, the lights, all the people!”  In the beginning, YBC patients were seen in a scent-free, low-lighting, wood-floored, home-like clinic space with fun toys.  My daughter thought that people with autism might like the unique clinic environment and only seeing “one face” providing their care.  Knowing my affinity for The Wizard of Oz, and the clinic’s proximity to “the Emerald City” (Seattle, WA), my daughter suggested the name “Yellow Brick Clinic.”  With her lived experience and input, and an idea for a model of care that might increase access for care and decrease disparity, the “shingle” was hung -- literally!

YBC offers fairly short wait times, and most everyone referred or who self-refers is “screened in”, as we believe each person’s concerns are usually valid and should be at least addressed and referred when appropriate. As the clinic practice has grown, we continue to offer patients a personalized, holistic approach to care and participate in virtual IEP meetings and community-based team meetings for complex patients. Virtual YBC Team members able to understand the challenges of parenting and special needs help patients/parents with registration and scheduling.  The YBC scheduling team not only manages the schedules, but also provides assistance and reassurance to incoming patients and their families.  With the pandemic, this model of registration has been invaluable, and the YBC Team works well together, with each person’s input contributing directly to the workflow method. We have a culture of innovation - each individual’s perspective is valued, and team members are explicitly encouraged to bring forward their ideas and have them vetted for implementation.  As a Center of Excellence for Autism, we also participate in ECHO Autism: Washington State for continuing education and professional networking.

Telehealth was implemented early on for follow-up visits to allow patients an option to reduce both travel and patient/caregiver stressors. With the COVID-19 pandemic, Telehealth quickly became the only mode for care at YBC and we adapted from using in-person developmental testing to online options and Telehealth delivery methods. Behavioral Health screening forms were also digitalized and are attached with every visit to assess for ongoing focus, worry, sadness or mood concerns. This novel model of care has now become so comfortable for all that it is here to stay! We are able to provide care from the borders of Canada to the borders of our neighboring states, and we love and learn so much about patients by making Telehealth “house calls.”

The need for autism, ADHD, and other developmental health evaluation is not just for children, so this then extended to colleged-aged youth who were questioning autism or ADHD for themselves.  Many of these youth come with years of psychiatric history and failed medication trials, but may benefit from simplified care plans in the context of newly-diagnosed autism or pediatric developmental understanding. Caring for older youth patients with autism teaches us more about caring for younger children and vice versa!  We have found older youth with neurodiversity often responds well when given the same medical treatments as their "10-year old selves"; rather than utilizing heavier psychiatric medication. Much of the time we opt for treating sleep, focus, or worry challenges first, making recommendations for collaborative care ideas for primary or specialty care team to continue in community health settings.

A funny thing happened on our own Yellow Brick Road, and as we cared for people with neurodiversity, it was observed that many of these patients had overlapping symptoms of connective tissue disorders, and were very "stretchy". Our patients had complaints of similar symptoms such as fatigue, panic attacks, large outbursts or tantrums, dizziness with standing, bedwetting history, pain in their joints or limbs, etc. This led the YBC providers to participate in Ehlers-Danlos Syndrome/Hypermobility Syndrome Disorders (EDS/HSD) ECHO learning collaboratives to gain additional training and understanding. As a result, YBC now has been recognized as  an Ehlers-Danlos Society Center/Networks of Excellence (2023-24) and offers an integrative model of care that includes caring for children and youth with connective tissue disorders and the frequently co-occurring neurodiversity.

The YBC Team is so happy to be able to work with such wonderful, interesting, and diverse individuals and families!
Thank you to all who have contributed to making this community developmental-behavioral pediatric practice idea such a fantastic reality!

Warmly, Dr. Kat, ARNP