Direct Service Providers (DSP) Perspective

Interview with Dr. Eric Curcio

Dr. Curcio is a primary care physician and he specializes in internal medicine and pediatrics right here at UCLA health. He received his medical degree from New Jersey medical school, and he completed his residency at UCLA School of Medicine. We learned about Dr. Curcio’s perspective as a physician working on the needle anxiety program. Additionally, we discussed what we can learn from this program as we try to increase vaccine confidence in the disability community

Dr. Curcio Interview 6.21.21

Wed, 6/23 1:03PM • 29:39


patients, anxiety, people, vaccines, phobias, needle, procedure, child, support, hear, important, program, bit, distraction techniques, parents, disabilities, reassure, community, nervous, ucla



So we’ll go ahead and get started. Hello, Dr. Kersey. Oh, we’re really excited to welcome you in to interview for our program to discuss the needle anxiety program at UCLA and just learn a little bit more about needle anxiety and what you’ve learned about it specifically within the context of the neurodivergent community and the disability community as well during the covid 19 pandemic. So I’m My name is Laila and I’ll be interviewing you today along with LUCIA JUAREZ, Julie grassy and and Nicholas Shaw, who are also working on this program. And we’re specifically interested in learning about your perspective as a physician working on the needle anxiety program and what we can learn from this program as we try to increase vaccine confidence in the disability community. Before we get started, for anyone who’s watching this video, I would just like to introduce you. So Dr. Eric crucio, is a primary care physician and he specializes in internal medicine and pediatrics right here at UCLA health. He received his medical degree from New Jersey medical school, and he completed his residency at UCLA School of Medicine. So with that being said, Are you ready to get started? Dr. Chris, you? Absolutely. Thank you. All right. Wonderful. So first, we would just like to hear a little bit more about the needle anxiety program. Could you tell us a little bit more about the goals of the program in particular?



Yeah, absolutely. So this, you know, this was a project that we had kind of really a problem that we knew that we needed a better solution for for years now. And it probably was about two years in the making between when we first envisioned it. And it kind of serves as a multi pronged approach, really, we knew that basically, we could be doing a better job with procedures for everybody really, you know, there’s so much anxiety that doesn’t get talked about, and probably a common reason why people maybe skip out on those physicals or missing appointments, people who have, you know, serious, deep seated phobias, or needles. Now, there’s certain groups, particularly disadvantaged by this, I think what we saw that really prompted us to find this was a lot of clothes and myself, take care of patients with a variety of medical conditions, a lot of developmental delays for diversity. And those patients in particular, we’re really getting yourself out to collect medical treatments for these kids, adults, medication that they need to be monitored, every test that you’d look back, and you can see years have gone by, and none of these tests have been done. And when you look at the billets, who would always be you know, unable to get unable to get blood. Because you know, those those patients are, you know, particularly high risk or not being able to explain or understand the procedures. And it was really a problem that we had, what would have been done beforehand would be this sort of wait until they needed something major that required like Asia, so maybe they were going in for major dental work or something. And when they went in for that you can quickly do their blood vaccines and everything else. But that’s a district as you might wait years. For that sort of second tier of the program, you know, the first year was really just coming up with ways everybody to have our nurses trained better to training procedures, patient control and how they wanted to play on wanting to distraction, they wanted us things like that, we came up with the second of our program, which include things like the buzzy for children and other distraction techniques, there will be one of our colleges to be involved in kind of do the type of the whole things. And then the area that’s probably gotten the most attention, or which are the most challenging case, most of the reviews for vocational development really couldn’t understand. And that’s doing it as a base case of anxiety medicine that can be done right before the procedure and really have a calming effect. For everybody, for sure. We have had quite a bit of success, new Alto, I think kind of came up with the ideas behind it and identify the need and then I do a lot of work more on the implementation operation. So, you know, we did a fair amount of literature searching to see how other health systems had handled this. There’s a ton out there, you know, we kind of base our model with a few things we found from dental literature for doing sort of mid level procedures for patients with dental phobias or developmental issues. There are a couple of case studies of pediatric echocardiograms used for set, but we couldn’t really find much of anybody. We used it for this specific but it’s logical as they will translate. supports those protocols were able to find and then almost a year ago started doing our first Three August last year. Okay, so after about two years of figuring out all the processes getting anesthesia, ambulatory nursing and everyone else is, first and foremost, we needed to save safely, we needed to have emergency plans in place. But what we found and what we all spread in the literature is done right. And protocols followed it really is. We haven’t had any negative attraction. Yeah, that’s a little bit at the back.



Yeah, it seems like you’ve developed a really comprehensive program that caters to the needs of a lot of different types of patients. I’m curious, kind of, in your experience working with these patients, what are some of the underlying reasons that patients have provided surrounding their needle anxiety?



Probably when you ask most people who have that the needle anxiety most can’t give you a good reason why they have it. There’s just a subset of people out there that have these phobias, they might have had a bad experience, they you know, there’s a subset of people about what we hear of somebody who every time they get their blood drawn has a fairly high chance of passing now. It’s beyond their control. It’s not an anxiety issue. It’s just a visceral response their bodies have where all their heart rate and blood pressure. But like many phobias, so people really know why they have, it’s not usually a bad experience from memory, but probably something maybe dating back to childhood maybe years that they can’t even remember. So the phobia side, probably about half of the patients that we see are more in that group as you’ve been putting off, putting off drugs because of that. And then the other half is really more than the the neurodevelopmental disabilities, these are patients that can’t understand necessarily what’s happening, or maybe have already VHD or other hyperactivity kind of conditions, particularly a lot of different things. And then that group, it really is just trying to make your hands as pleasant as possible as productive experience for them. Because once they learn that this place is associated with pain, or this place is that scary place where people come in and hold me down aggressively or something like that. It’s really hard to undo that kind of damage. And now they’re going to have this you’re probably walking into every medical office, because they all kind of look the same young, potentially for the rest of your life. So we want to do what we can not pretty more phobias, inadvertently from negative experiences, if we do hear that a lot of parents that the last time you had blood drawn, we had such a setback in their anxiety levels spiked so much, because yeah, they went, where were they had a bunch of people grab them and hold them down? And wait, no, that’s great.



Yeah, thank you. And I’m curious to hear for you, the other providers or for anyone listening? What is kind of something important to know regarding working with families or patients with disabilities regarding needle phobia, while still promoting vaccinations and inoculations?



Yeah, I mean, for starters, I’d say the most important thing is nobody likes surprises. As much as in development, well, the patient in mind, the more we can explain up front, maybe you walk through the scenario, talk through how it’s going to go. I think, you know, a lot of times parents do the opposite sometimes, or caregivers will do the opposite, where oh, I don’t want to upset so we’ll just get on them last night. Nobody likes that, right? It just breeds this just make that phobia that much worse. You know, there are books about this pamphlet, there are online resources out there that you can use to really talk through how this is going to talk about if it’s a play that we’re going to do. We’re gonna feel a little spritz of fluid in your nose, maybe try that at home with a nasal spray over the counter just to kind of really build that confidence of knowing what to expect. So I think we found that the cases go fast, when when patients know sort of what’s coming. They’ve talked about it before they’ve walked through it as much as they can. So that honesty is definitely an important step. We also want our families to know that this is not a cure, all right. But if there’s somebody who’s so extremely anxious, this one one dose of anxiety analysis, that we tend to repeat doses, because that gets more into the safety side of things. So it’s not going to work for everybody. But we figure if this work for you know, half two thirds of cases, that will still have to figure out that other case, probably working with those right now.



Wonderful, thank you very much. And just to kind of elaborate from that question, can you tell A little bit more about how you communicate with patients directly surrounding their needles anxiety or getting shots in particular.



Yeah, absolutely. So, you know, this might be a lengthy process, it might just be at the time of the visit, if it was sort of an unexpected thing. But you know, a lot of times people will either directly voice concerns or caregiver or family might, but a lot of times it’s more in the subtleties of you say blood and you see the kind of recoil or say, Oh, can we do it another day or something like that? Get this going on? And then just try to have an honest conversation. You know, I see maybe a little bit nervous about about the vaccines you have a bad experience before? Did you have your, because like you felt the need, or maybe it’s just about vaccines in general, or about medications or something else, you kind of need to know, if it is about measles, I think it really is referring to a lot of patients, families know that this is something that we’re just rushed off or eyes and say, Oh, really critical. But no, this is something that we identify the problem with common kinds of scenarios, we built this program around it. And I think a lot of times, knowing that are nurses trained in this, this is taking you off, you passed out once paid, we’re gonna have, we’re gonna have you lie down, we’re going to watch for a while afterwards, just those kinds of things alone that we’re going to, we’re going to take it to her, I think, again, if it’s something that’s going to be more of a planned thing, where we’re going to bring them back now for that we’ll talk about, you know, why we do this, how it works, what to expect. It’s a funny feeling, getting this, we should create into those what we’re hearing, burn is quite the right word, but it’s an odd sensation, I think. So making sure patients go to expect that. And, you know, encouraging them to, you know, whatever is going to help calm them down the most might be something like a buzzer, or distraction technique, or kid this may be accepted on the videos, whatever else helps them calm down. Maybe there’s a buddy who really liked us. And with headphones on and distraction that way. Maybe that’d be what kind of gets.



It’s kind of like anything else. I come up with a plan that everyone comfortable with.



I see and has this sort of communication or this sort of approach changed when you’re talking in context of the COVID-19 vaccine or just in the pandemic times in general. Yeah, I mean, COVID certainly heightens everything a fair bit more, when you look at the rate of young people who are passed out after vaccines is not almost certainly related to the actual vaccine itself. It’s more related to both knees and everything, the rates much higher for this, I think it just speaks to that extra level of anxiety. But everyone really has about COVID. You know, there’s a lot of information on where money news is often not that accurate. political issues and other things, it’s really just left people are undecided extra nervous. They’ve heard that somebody they know how to really bad reaction to the second dose, and now they’re extra nervous about it. But you know, we look what’s happening here now that we finally sit down and allowed reopenings No, that’s pretty much thrown out. So people at the same time know it’s important. So it creates this kind of dissonance, I think where they know they need to do it. But they’re also extremely nervous about getting it is a good opportunity. I think he just talked about all these different features of comfort, reassurance. Even more for that I hate to have no fear of needles being are the reason why somebody chooses not to get a COVID back. If there’s things that we could easily do that would probably make a pretty, pretty benign. What we often hear from patients, you know, there’s sort of mental image of them, you know, walk themselves through this in their mind of how horrible it might be, when they actually do the procedure, especially with respect to filming now, they said maybe, you know, whatever else is going to help them. The end result oftentimes is Oh, it wasn’t that bad. And it turns out the vast majority of patients, ie your patients as well as very diverse developments, patient, the best journey don’t ever get to that theory but don’t end up needing the anxiety medication, really just behavioral approaches can take care of most. But COVID has definitely shifted the spotlight I think on all the founding teams



and kind of um he’s you know, many interactions I’m sure you had. Do you have any particular anecdotes or particular Patient interactions through this program that you would be comfortable sharing with us and with the neurodivergent community.



Yeah, absolutely. I from last recap, one have a 14 year old with a rare genetic condition that was part of it has a developmental disability component to it. But had had to go before with vaccines, whatever, we had actually talked about maybe getting too much history. But we ended up bringing him in with that there for support with distraction techniques, but you know, the iPhone out and favorite videos playing on Tick tock, if I remember, right, and, you know, dealt with those distraction techniques or numbing medicine, he had a completely pleasant experience, barely even notice that he had gotten the vaccine by the time was done, and left her you know, with a smile on his face, not having that negative association. And that’s gonna make our lives much easier next time, he needs a boost for vaccine. But I think, for the family to kind of see that, you know, with these interventions, having supported president holding down a restraining, or those kind of things, that we were able to do it safely, that we were able to get it done and not in any sort of stressful or more anxiety ways. But I think we all if you ask the other doctors, I think we’ve all got examples of these. If you think or one of our politics was the passion project, we did a lot of training with the nurses, the medical assistants, in our office, office across.



Ya know, it seems really important to build an environment in which you’re not provoking further anxiety, but helping to ease the patient while also providing them with with quality care and getting them all the procedures and all their occupations that they need. And so when it comes to context of younger or for neurodiverse patients in particular, how do you as a physician weigh the benefits and the risks of the COVID-19 vaccine for those patients that may have needle anxiety?



Yeah, I mean, well, we know the benefits are potentially huge, right? We know that, you know, patients with autism patient with developmental delays, we’re seeing worse outcomes with COVID. pretty consistently, they were getting diagnosed later, they were getting tested later. And we wonder why that is. I mean, it could be it might even be anxiety that’s kind of playing in on patients, or parents or or caregiver who’s now even more afraid to bring them in, because now they’re gonna get this nasal swab that we know is comfortable, oh my god, they’re gonna go into the hospital, we know how disruptive that can be to their routine, because disruptive to anybody, and especially somebody who maybe can completely understand what’s happening or something like that. It’s weird. But, you know, what’s the end result is that, you know, we’re hiring to death batteries, ventilator use in patients with those types of disabilities. So, you know, the benefits, and the risks of not getting it early, or the risk of not getting the vaccine and for COVID risk road are huge. So I think it’s a hurdle that needs to be overcome and taken seriously to build that support. But, I mean, it’s so important, I think that, you know, patients not put off, you know, important medical procedures out of fear of something that we’ve done, right, probably shouldn’t be all that fear provoking, at least most people.



Thank you very much. And we’ve discussed kind of the context of younger patients and neurodiverse patients, but I’m sure you work with patients across a kind of all age groups. And so how does your approach to discussing middle anxiety and more broadly, their care as well, along with the ramifications of any sort of procedure vary depending on the age of the patient?



Right. I mean, there’s, you know, obviously, everything you do has to be developmentally appropriate for whoever you’re talking to. I think, you know, it highlights the need for family centered approach a lot of times for bc it’s a very different discussion group talking about their newborn. who, you know, we’re a couple of months old means x y&z Oh, that’s reassuring Mom, it’s going to be maybe letting mom nurse right after the procedure to calm down maybe letting her hold the child on her lap rather than you know, being on this table or something more intimidating or mom feel more removed from the situation. And then the discussion is going to be different with a school aged kid where maybe we can encourage them to tell the child ahead of time because now the child knows is asking that question you never want to ride on the building. It’s just there. And maybe if the if we know this as a child as a major issue with vaccines Trying to get prep them ahead of time use those that are out there. If it is a an older patient with a neurodevelopmental disability or something like that it really is meeting them where at the level they’re at with the understanding, they have giving them a chance to answer any questions that they have, and get those concerns addressed. And still being there to support the families, because oftentimes, they’re equally as nervous about the whole situation. But we see needle anxiety through the entire age spectrum, we have plenty of patients, they’re young 70s 80s, who also still hate needles, doesn’t go anywhere. For most people, if you’re one of those people that are affected by a disease probably be there, you know, maybe you have to deal with your whole life.



Right? Yeah, thank you very much. And you mentioned, particularly for children, kind of incorporating their parents into that procedure, or just building an environment in which they’re more comfortable. I’m curious if you have any other advice specifically for a parent or a caregiver, to assist their children that have needle anxiety, either at home or at the clinic?



Yeah, I mean, it’s, you know, family is important part, probably, regardless of age to for a lot of people have a support person, there can be huge. at any level. Again, I think it’s just time to think about, what could we do that would put, you know, this patient that they’re most comfortable, and maybe it’s going to be bringing a support object, or if we have a favorite toy, or if we have something that we can bring in a younger kid that we can have with us for support. On occasion, we’ve had people bring their emotional support animals, if that’s like, that kind of helps. Great, you know, whatever it’s gonna be. And it does have to be customized by the points because everyone’s going to have different distraction. That is that they were people want to meditate, some people have a really tough time doing that. And now more and more we go more with music or something else, there’s no kind of one size fits all approach, I would say.



Right, and I’m just gonna move a little bit more broader and just hear from kind of your experience working with patients. What are some kind of comments, questions or factors about needle anxiety, that, in your opinion, are the most important when it comes to raising awareness, either about the issue that needle anxiety itself, or just to the fact that there are resources for people who have needle anxiety amongst the community? If you have any thoughts or opinions on that?



Yeah, I mean, it’s, it’s tough, because one of the hallmarks of phobias, I think, in general is not wanting to talk about it, right, we tend to avoid things we’re afraid of. So a lot of times people really voice voice screamed, patients, just occurred around like anything else, just to be open and honest, you know, with, with your medical team, with the doctors, nurses taking care of you compared to they want to do what’s best for you, and they want to do it in a way that’s gonna make you most comfortable. And on the other side, I think providers, you might know, somebody didn’t know, oh, this is the third time you’re back, you spoken, get that blood work done. You know, and taking that step back to try to dig into why you might be surprised to find us. We’re just, we need help on the search for scientific transportation or get support or something like that. Or maybe it will uncover that bad experience that happened before or if you’re have one of these deep in phobias are that bad experience that happens as a kid or whatever it might be? Just people really kind of keep communication open both ways. Be aware that it’s a combination, to be aware that it’s a common cause why people are getting multiple health care. And then just



and then just based off of your experiences, what are some of the kind of biggest myths or stigmas surrounding the intersection between vaccine hesitancy and neurodiversity that should be broken?



Yeah, I mean, probably not so much related to the needle side of things. But we all know, there was a lot of air and fear put in by studies that were, you know, later discredited, specifically around the MMR vaccine and autism, and that kind of got broadened out to many other vaccines and things like that. And despite, you know, countless studies and excellent research, looking at huge groups, populations, this proving that, you know, beyond the shadow of a doubt, and you know, that study having its own, you know, ethical concerns and being recalled and retracted you that are still out there. And then the last thing any parent wants to do is do something that could possibly hurt their child or even the slightest stress. And I think because there’s misinformation on the web, Now for the people who can’t get any media on your site. And then you don’t see so much of polio and things like that, because Luckily, they’ve done their job and really low, it puts these tough positions where they see a lot of negatives. And the positives are quite as obvious. I think, you know, again, it’s having that dialogue it’s trying to get to the root of a person CERN’s was a good article they read was it’s being their friend told them is there some better direction, we could point them to give them some good information that is out there and give them you know, the things that reassure us as physicians that what we’re doing is, and I think a lot of times, you know, as parents read into that more, that can help reassure them, it’s scary. I mean, you know, nobody, when it comes, especially to taking care of family members, children, I think we’re even more more nervous. Anything that could cause harm, but every parent you’re at the end of the day wants to do what’s best for your child may have just put a navigate to the information that’s out there. And I think we should remember that and just try to move that dialogue further. That’s going to have the best outcomes given people. We think about vaccines to you, they are hesitant to maybe come up with a plan or take them one by one and look at the research data out there. And when most people see the real data there, it is pretty reassuring to hear the medical community is as confident as they are.



Right. And I just have one more kind of broader a specific question for you. I was curious to see if you had any advice for providers or other health care professionals who may not have a formal needle anxiety program on how to approach or communicate with patients who have disabilities and who have some sort of needle phobia?



Yeah, it’s tough. I think the lesson is that you don’t really need a very informal type program to do probably 80% of the work. They’re they’re quick skills that we already have. Time is one of the biggest things. And I think that’s something that all physicians with your you have, you should arrange your appointment times that are often dictated by the health system. And you know, when you’re rushing these things, first to go that taking that extra minute or two to really get to the root of a problem. But at the same time, we know, that’s what a lot of health disparities and for groups that, you know, are diverse disabilities. So you’re being thoughtful that you know, this needs to be addressed and maybe revisit periodically to check in is important, maybe scheduling those patients are a little bit of extra time, maybe doing that prep work ahead of time during email or something like that. A lot of the words pretty dumb for him be huge. But I think all of us are trying to provide the most equitable care that we can. And this is part of that duty, really.



Thank you very much. That’s really great advice. And hopefully, we’ll be able to, or the this type of program or this type of approach will be able to be implemented across the nation and be able to help people who have needle phobias. And then, yeah, and then just last thing, I was wondering if there is anything that I haven’t asked you or that we haven’t discussed today that you think would be important to share with the neurodiverse community? Um,



yeah, I mean, I think we touched on kind of a lot of the highlights. But again, I think the most important thing is just communication, right? You know, and this is, could be generalized to many, many things beyond this, but patients are often hesitant to have these conversations with doctors, probably fear of judgment or a negative experience that they had with another health care provider before but, you know, to get the best you can, the most important thing by far is to just have that open communication with your physician to be able to talk about the awkward things about the things that are inherently, you know, anxiety provoking, as tough as it is, knowing that, you know, nobody’s making any judgments everybody is working towards this goal is probably the most will help you get the most out of healthcare and in any setting, really.



Thank you very much, Dr. crucio. That was the final question that we have for you. But otherwise, we really appreciate you taking the time out to come talk to us and to our community as well about middle phobias and the program at UCLA and hopefully, more and more people will be able to take advantage of the program.



be great. Thanks so much. Let me know if there’s anything else I can help with. Wonderful, thank you. Bye now.

Interview with Nurse Kendal Wilkie

Kendal Wilkie is a registered nurse at the UCLA medicine pediatrics comprehensive care in Santa Monica, and she is also a clinical nurse working on the needle anxiety program. We learned about her perspective as a registered nurse working on the needle anxiety program. We discussed what we can learn from the program as we try to increase vaccine confidence in the in opportunity for COVID-19 in the community with disabilities.

Dr. Wilkie Interview

Wed, 7/7 9:59AM • 24:59


patients, vaccine, clinics, anxiety, vaccination, program, sedation, rn, people, important, vaccinated, patient population, doctor, needle phobia, needle, family, parents, understand, nice, caregivers



So I cannot thank you again for making time to speak with me. I’ll introduce myself again, my name is mocha. And I’m being joined by Julie lucea. And Michelle and I would love to introduce you and provide you with an opportunity to give us a little background about your, your career and yourself. So I’m joined by Kendall Wilkie. She is a registered nurse at the UCLA medicine pediatrics comprehensive care in Santa Monica. And Kendall is also a she’s a clinical nurse working on the needle anxiety program. Can you please be able to introduce yourself as well?



I’m sure of course. My name is Kendall. I’ve been a nurse here at UCLA for the past 15 years. I’ve been at that UTC clinic where we’re doing the needle program for the past two and a half years now. And yeah, it’s it’s just lots of lots of interesting opportunities. The clinic definitely we see everybody from newborns to the elderly. It’s it’s a fun place to work, lots of challenges.



Great, thank you so much for your time, Kendall. And we want to provide you with a brief summary of why we’re doing this interview. So we are interviewing you to discuss the noodle anxiety program at UCLA to learn about the program at what you have learned about the new anxiety in the neurodivergent. And in the disability community with disabilities. During the covid 19 pandemic. We are specifically interested in your perspective as a registered nurse working on the needle anxiety program, and what we can learn from the program as we try to increase vaccine confidence in the in opportunity for COVID-19 in the community with disabilities. So my first question was, will you be able to briefly tell us tell us about your role in the needle anxiety program?



Absolutely. Um, Dr. Kuo approached us last year regarding doing the program, there was a lot of things to put in place, kind of from a nursing perspective, we had to be signed off from ambulatory, we have to have certain emergency equipment in place, we have to have certain training for the staff. So once that was in place, we went go live on in August with the with the program. So it’s a it was a little bit of structure set up before we went live. But definitely Dr. Koh has been has been the advocate for this program for a while now. So it’s really nice that it’s actually come to pass.



And can you tell us a little bit about how has this program helped the neurodivergent community during the covid 19 pandemic, and the vaccination efforts with relation to COVID-19.



So definitely, I mean, not just with the COVID Panda, but we haven’t seen too many of our patient population requiring the anxiety program for COVID vaccines yet, we’ve only had one person, but definitely for general lab work for vaccines. It’s you know, the there’s a certain patient population that it’s it’s very hard to get to get those kinds of orders performed. And some patients need monitoring for drug levels, things like that, that classically they haven’t been able to. So it’s been a really, really good opportunity. The families have reacted very well to it. And we’ve had, we’ve had some successes, we’ve had some failures to some patients, we were not able to administer the medication. But we’ve learned from everything we’ve evolved our program, we’ve evolved, how we how we approach it with families and things. So we’re constantly learning and improving the process. But definitely I think for particularly with the COVID vaccine, it’s going to be absolutely amazing to reach out to, to our patient population to be able to vaccinate.



Great. And overall Can you tell us how many patients have participate in the participated in the needle phobia program to the state?



I can so I put together some information, I can send it to everybody in an email as well. I apologize for not getting back to you before. And we have done actually 14 patients today we have about another five more over the next month or so. But 14 to date of which we have successfully given vaccines and done lab work on eight of the patients. So it’s pretty to the 50% success rate. We are still working, as I say there are there areas to improve upon all the time we’re learning and evolving. But it’s been very successful for a number of patients. Great.



And you describe some of the reasons why patients have stated they have needle anxiety.



So for some of our patients, they just had bad experiences with coming to the doctor’s office, they’ve had, you know, maybe a vasovagal episode after they’ve had labs or vaccines in the past. And when they were children. They had bad experiences. So it stays with a lot of patients for a lifetime for some of their special needs patients or our autistic population as well. There is that resistance. So it’s a change in their routine. It’s a new place, going to the doctor doesn’t always have a positive positive thought behind it. So I think that’s some of the barriers to why Patients have this anxiety even just generally walking into the doctor’s let alone getting vaccines and lab work. And how can you describe the results of the program and some of the successes? Absolutely. So what we found the best successes with is obviously reaching out to either the patient or the patient’s family before they come in to do a really good rundown of what our program offers exactly what to expect when they get here, particularly for some of our special needs patients, we want to minimize the amount of time during the waiting room, we want to minimize the amount of time they’re in the clinic. So we don’t want to bring him back to a room and not be ready to go. So it’s having that conversation a week or two before with the family to make sure they understand this is what we’re going to do. This is the medication, this is how we administered that we’re going to monitor you closely, we’re going to monitor you afterwards as well to make sure you’re back to your baseline so that no one walks in that they’re not prepared that I’m going to be here maybe for 30 minutes to an hour. That not to know what to expect, because some of our patients, even though we go through it, with just getting near them to get the nasal spray, which is how we give the medicine can be very challenging. So one thing we have learned is to speak to the families beforehand, and you know, at home, try using a sideline spray just so that they used to that concept of having something sprayed in their nose, we’ve we’ve learned that through through trial and error. So it’s it’s a it’s a process. Yes,



I think so one of the what I’m hearing is one of the important strategy is to help prepare the families and the caregivers before they come to the clinic.



Absolutely, absolutely. That’s been Paramount so that they know what to expect so that they can and we also want to encourage them, you know, bring things that make the patient feel more comfortable iPads, earphones, anything that can make them have a more positive experience. Absolutely. And we also want to work with them on you know, keeping the patient to a routine as much as possible, we don’t want them to have to come in, when is the lunch time when it’s you know, time that they would normally be doing something else. So there’s a lot of different factors to consider when we’re scheduling as well.



And what are some metrics I do use for this program to measure the success.



So we’ve been keeping count of basically the amount of medication, we can get between five to 10 milligrams of sedation. So we’ve been monitoring how much we’ve given and what our success rate was, whether with the sedation, they were able to have the procedure done, whether they were able to have vaccines and lab work, just lab work. So we looked at every every side of it, whether we’re able to even administer medications to carry out orders. So we’re monitoring and measuring all of those.



And what is important to know regarding working with families and patients with disabilities, and needle phobia while still promoting vaccination.



So it’s it’s important that everyone’s on on this, you know that we were all working towards the same goal. We want to help, you know, promote vaccines in patients and obviously get the families just understanding the process and definitely that we want to our goal is to help to make that happen, really. And that’s what we strive to do. We do prepare the families that it’s not always successful. We don’t want to be saying that, oh, they’ll come in and witness sedation, we’ll get everything done. It will be everything will be good. That’s that’s ideal. But it doesn’t always happens. We always want people to have at the back of their mind that if it doesn’t work, it’s okay. It doesn’t work for everybody. But definitely it’s been such a booster to make sure that we can reach out to this patient population and assist them to receive vaccines. It’s so important.



And what are some strategies that do utilize to meet the patients and the caregivers in the middle? So in the middle in terms of in middle of hesitancy for vaccination, you know, anxiety, but also providing the importance of vaccination? That’s it. I



mean, definitely, they genuinely have a meeting with the doctor who’s placed the order, who’s obviously spoke to them regarding vaccines, and we’re just, you know, working alongside the doctor to just to work with the families well to promote what the best thing for their patient, you know, to make sure that they understand everything regarding vaccination, potential side effects, everything like that, but also, you know, risks and benefits, we want to explain and make everything clear. And,



according to you, why is it important to discuss needle anxiety with your patients, especially for our COVID-19 vaccination or other vaccination efforts?



So we want to basically with regard to needle anxiety, we want to understand you know, what kind of what it How is their anxiety presenting is it that they you know, they’ve had a negative experience, that’s what they’re associated with, do they have vasovagal episodes, everything like that, because we want to, you know, make sure that they understand the important they want the vaccine that they understand how important it is and just how we can help them to meet in the middle I explained to them, the process will have you laid down we’ll have a nice quiet room. We made it very clear that when the patient gets to the clinic, there’ll be no vaccine equipment, no lab equipment in the room so that way they can relax in a room. In a comfortable environment before they’re introduced to any of that, that’s very important to us. And



can you provide us with an example or an anecdote of working with a patient with disability and or their family caregiver who has needle phobia?



So we’ve had a few actually. And we had one that does spring to mind he, his mum was wanting him to be vaccinated, but they’d had a negative experience when he was child, he’d received a vaccine and spiked a very high fever afterwards. So she was understandably anxious regarding the vaccines we spend a lot of time talking through before she came in about the vaccine. And then when he came in, we let him you know, we work with the parents, once they get in the room, we say how things should we proceed. And they said, Can we have like five or 10 minutes just for him to climatized. So we did that. We came in when the parents were ready, and it’s it’s taking the time, you know, it’s not something you can rush, it’s not we walk in, right, here’s the sedation, we want to get time to kind of bond with the patient and the family, we want to them to explain as much as we can, what we’re going to be doing and work with them. Because if we just go rushing into trying to date, they’re going to be fighting us, they’re going to be uncomfortable, they’re going to be agitated and upset. So it’s, it’s taking the time to really work with them and the family put them in.



Yeah, and I want to expand on that. Can you provide us with some of the strategies that you use to communicate with these patients and families during this process.



So like I say, the wait time before they come in, we talk to the family on the phone, when the patient comes in some patients have communication devices, somebody had through the iPad, we can communicate with him via that way. Or the parents will use a sign language or something like that. So sometimes it’s the patients during the communicating for us. But we always address the patient, whether they have the understanding or not, we always want to talk to them, include them in everything we’re doing would tell them what we’re doing. And we work with the parents to you know, how can we make sure he understands that I’m going to be touching his arm, how can we understand and going to be approaching him to give him a spray, just and you know, even join, because we want vital signs beforehand. So we want to make sure the patient is comfortable that we’re going to be touching their arm, we’re going to be touching your finger. It’s constant explanation and working very much with the family for a lot of patients just to make sure they’re comfortable. Sometimes, the parents will put on the pulse ox probes, the parents will help us put the blood pressure cuff on the parents are really involved. And that’s that’s what we want is like a team approach that way the parents were involved. And that’s I think, when we have the most success.



And does this strategy differ based on the age of the patient? Or is it very similar?



It’s very similar. First of normalcy is tailored to the younger patients, we approach it a little differently, but each patient is individual and we just tailor it to how the patient is on the day. And I’m



and as a as a clinical nurse, what are some strategies that do you use to work with these patients and family, family members with needle phobia in specifically in terms of supporting them with stress management, with some of with reducing some of their anxieties, to getting buy in to get vaccinated? So can you talk about your communication, and some of the conversations that you have with these patients and caregivers regarding that?



Definitely. I mean, we want people to be empowered with knowledge before they come in, we don’t want them to say, and we never want them to feel that we’re pushing something on them. It’s their right always to refuse at any time if they don’t want anything, but we want to make sure that they have the full information, the full education, you know, we have information leaflets we can give to patients when we vaccinate. And like I said to you beforehand, the phone call that we have with the family or the patient beforehand where we can go through that what are your concerns? What questions do you have? How can I assist you in answering Let me tell you more about the vaccine that the child is having. Let me tell you more about what the left drawer involves. Just really i think that’s that’s the biggest part of it, it’s empowering them and making sure that they’re part of the decision making process that they’re really involved in have a good understanding that they’re not feeling well, I shouldn’t have this done, but I don’t really feel comfortable, we’re making sure that they really are involved and and really have that support to to understand what’s going on and to to really be be comfortable with that to really be you know, involved in the in the decision making process and really be educated to I think that’s a big part of it.



And in addition to the needle phobia, are there any other reasons why in addition to needle phobia or having a previously bad experience with vaccination, are there any other reasons why our patients or family caregivers are hesitant to get vaccination?



I think sometimes, you know, the media plays a big part in it definitely you know that, oh, the the MMR vaccine is bad or you know, the COVID vaccine isn’t real, but there’s a lot of media influence for people Definitely, that’s where we ask you to do you have any questions or concerns? Can we help answer any of these things? We haven’t had too many with the COVID vaccine. But you know, the media is negative about one thing positive, bad another. So I think that’s where a lot of the, a lot of the hesitation and misunderstanding does come from. So we want to alleviate those fears, we want to answer to the best of our capabilities. And, and like I said, we want them to make an informed choice. We want them don’t ever want someone to feel that we should have you must have this vaccine. It’s always their choice, but we want to empower them to understand to the best of our knowledge to really make a good informed decision.



And what are some resources that you provide to these families and patients who have needle phobia or, or even have vaccine hesitancy.



So like I said, we give different patients when we give vaccines, we have fact sheets for every single vaccination explains all about the vaccine, what side effects to look for. And also, the schedule of vaccines, because some of them are two series three series, we want them to know beforehand, that if you’re going to get that HPV, there’ll be a follow up shot in six months. If you get this vaccine, there’ll be another shot so that they don’t think it’s one and done. And that’s it. We want them to understand if their series of accidents. But definitely give them the fact sheets, let them have time to read them to don’t just hand them this, oh, let’s do the vaccine. It’s making sure that they read everything. Do you have any questions, any concerns? So yes, we have fact sheets for the COVID vaccine, we have information sheets for all the vaccines that we give.



And are these factories or information sheet more tailored to the age group of the patients or the disability of the patients? There,



it’s a general form for everybody. They haven’t been adapted for different patient populations. Um, so generally, it would be for the family or caregivers of patients, really, that they’re tailored towards. But we obviously want to make sure we’re talking to our patients that Do you understand what I’m giving you today? Do you have any questions about it? Absolutely.



And we want to hear your recommendations and suggestions for other healthcare providers who work with people with disabilities and their family, caregivers, but who do not have access to needle anxiety program at UCLA, and we want to hear your suggestions and recommendations for these health, primary primary health, health care workers.



So I think one of the biggest things I’ve learned is, is allowing lots of time, I think time is the most precious resource. It’s something we don’t always have in the clinic environment. But it’s it’s taking that time to really sit down with people and to, to not try and rush them. When you try and rush patients, they pick up on that. And they it makes them uncomfortable and understandably so. So when you are working with patients who do have need low anxiety, you want to relax them as much as possible, you want a nice, quiet environment, like I said, you it’s important, you don’t have your introduction sitting there, you don’t have your lab work sitting there, you want that sort of stuff away from the area, you want them to really relax beforehand, you want to kind of establish as much of a relationship as you can with the patient and their family. But just taking lots of time and knowing that this patient, it may take me 30 minutes to give a vaccine because we have had some patients who’ve come in for sedation who ultimately didn’t take the sedation, but we managed to do the vaccinations because we had them sit and relax. We took the time and we were successful in administering vaccines. It’s it’s not always possible, that would be the dream. But it’s it’s very much it’s very dependent on lots of time, lots of time and lots of patients, I would say.



And we’re coming to the end of the interview, and I have a few questions. One is, I understand that you haven’t had a lot of COVID-19 vaccination, patients who are in your clinic, but do you see a difference in the patient population who are getting COVID-19 vaccine or other types of vaccines? Um, so



definitely, I think for our special needs population, we haven’t seen too many yet for the COVID vaccine. But again, like you say, I think there’s not a lot of people aren’t aware of the service that we offer with a needle anxiety program. And I think it would be really nice if it was kind of rolled out to more clinics to it would really be helpful to have that resource or multiple places because right now we have people travel from Redondo from Santa Clarita, it would be nice to have clinics a little more local to them too. I definitely think it’s maybe not. It’s not as well known about yet, I think definitely. But it’s something that we’re we’re building on obviously patients come in to see a doctor quo, it’s something that they’re discussing it their, their, their, their appointments. So it’s definitely something we can improve on.



Great. And then one last question. We want to ask you and we want to be we want to ask you, is there anything that I haven’t asked you, but you think it’s really important for for us for the audience to know and share with the new diversion community about kneeling It and vaccination efforts



just kind of just putting the word out there that there are resources for patients who, who do have special needs or do have severe phobias that we can work with you to try and achieve getting people vaccinated if that is their wish, and it’s just get, I just wish more people knew we were able to reach out to more people definitely that’s, that’s our goal. And it’s really lovely when people come in, and they were able to give them their vaccines and do their lab work. Because it’s, you know, it can be very emotional for the parents to that the patient hasn’t had their loved one in years, they haven’t had their vaccines and now they’re catching up, it’s, it’s really lovely to feel that you’re making that difference. So it’s, it’s just you know, and letting people know that we we take the time, we want to work with them, we want to work with the whole family to get this, this down, we’re happy to talk to you to work with you to work with your schedule to try and accommodate you. So definitely it’s a it’s a real team effort.



And how do you how do people get access to the Nina anxiety program, since you mentioned that people come from various different parts of the state or parts of LA County.



So a lot of our doctors that come here, because we do urgent care in the evening. So a lot of the doctors that cover urgent care, go back to their practices in those locations, and then they reach out to me and so I have a patient, I think would be ideal for the need, like so it’s kind of a bit of word of mouth right now. So it would be nice to have something, you know, other than just word of mouth to put the word out there that this program does exist, but it is, you know, at first, we just had a few patients Now, every couple of weeks, I’ll get messages about more patients. So it’s when doctors come they learned about our program, and they spread it to their colleagues.



And if you have to think about a perfect world, or a world where there’s no restriction or constraints with money or time, what do you envision for this program and the future of this program?



So I think definitely, with more demand on this program, it would be nice to have more resources it does it is dependent on an RN, because an RN has to monitor the patient the whole time. So in a, you know, ideal world unlimited budget, you know, we would if we had an RN dedicated to doing this we could do so we could do a lot of patients a day, you know, if say we did an hour and a half each patient, we could see a number of patients every day to to be able to help in obviously in an ideal world and take that time to do everything we needed to. So it is yeah, that’s that would be my only consideration for different clinics as well. Is that it? Is it is time consuming for it’s an RN, that’s their sole role. So definitely it’s not all clinics have an RN full time. So that is one of the problems, one of the stumbling blocks, I’d



say. And based on that what you just mentioned, and what I’m hearing is that the time and resources resources, such as money, or Rn, are important for setting up a similar program in different clinics.



Absolutely, absolutely. And having the rooming space available. Because you know, a lot of clinics, we have 10 dedicated rooms, we also have our doctors doing primary care, we have infusion patients coming in, we have vaccine patients coming in. So it’s, you know, it’s nice if we could have a dedicated space to do this, then that would be you know, that room wouldn’t get used for anything else it would be that would be obviously in the ideal world. But that is something to definitely consider you need a dedicated space, dedicated staff, definitely, lots of time, it’s a very time, you know, it’s worth, you need to spend time with this patient population to be successful. So that’s very important to consider.



Great. And is there any training that you are providing as an RN as a as a team member in the new anxiety program to other clinics or other community members, other conditions?



Not at this time, no, ambulatory nursing, they come to do the do the assessment service and they signed us off which is their their protocol. But I would be happy to work with anybody who wants some advice and some, some just some assistance definitely with establishing the program because when we started it was it was kind of unknown. We didn’t there’s nowhere else that did it. So we’ve we’ve learned and we’ve like I said we’ve had some successes and some failures, but we’ve we’ve learned from both. So it’s definitely you know, I’m happy to be a resource for anybody to help establish more of these clinics will be fantastic.



Great, thank you so much candle. Is there anything else you’d like to add to your to the conversation we have had so far or you think that there is a question that I did not answer, but it’s really important for the audience to know. No, I think you covered a broad range of questions. No, I appreciated that. Great. Thank you so much for your time. If my team members have any questions, I want to open the room for them to ask. Otherwise, we will stop the recording