Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan

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Speaker B: Welcome to day two. Uh, Kavita Murthy is an occupational therapist and research scholar dedicated to advancing neurodiversity affirming practices in education and in the community. Her work centers on strength based, interest driven approaches that support neurodivergent youth and adults with clinical and research experience spanning India, the UK and the United States. She is committed to championing authentic neurodivergent voices through community based participatory research. Today she will discuss occupational therapy practice guidelines for autistic people across the lifespan.

Speaker A: Dr. Murti, thank you so much for that generous, uh, and kind introduction. I truly appreciate it. I'm, um, going to quickly start sharing my slides at this point. Um, today I'm going to talk about a little bit more about the occupational therapy practice guidelines for autistic individuals. I'm going to keep it very clinical focused so that we have a lot of interdisciplinary, uh, audience members here who are interested in the clinical side of things, but also provide some evidence to support our practice. Before I begin, I want to um, share my thanks to a couple of people because it takes a village to build this body of work which spanned over multiple years. And sweat, uh, and tears of a lot of people. So firstly to Dr. Christy Patton. Dr. Christy Patton is my mentor. She's also a leader in the space who sort of advocated for the practice guidelines in the first place and spearheaded this whole project. Um, Dr. Patton is a visionary in the OT field as well and she's pushing to create more neurodiversity affirming occupational therapy practices. The other authors who helped us with these, uh, guidelines and um, all their names are listed here, um, and other members from the American Occupational Therapy association who reviewed, um, this work, supported this work, helped organize and mobilize the crowds for this work. So we are very excited and want to thank them as well. Um, finally, the American Occupational Therapy association that felt that it is very important to commission these practice guidelines first of all and then to of make sure that it is neurodiversity affirming and it does what it says it does. Finally, a fiscal disclosure. The practice guidelines were commissioned, edited and funded solely by AOTA without external fiscal support or industry involvement. All authors disclosed conflicts of interest with none reported. Okay, uh, so before I begin, I also want to give a little bit of disclaimers about the language that we use because we believe that language Sort of either empowers a community or marginalizes and stigmatizes a community. We wanted to share very, um, clearly that we've used identity first language in this practice guidelines. What it means is that identity first language includes terminologies that view autism as an identity, not as a disorder. It's now increasingly favored by autistic communities and self advocates and increasingly adopted by healthcare professionals and researchers. But at the same time, we respect and recognize that person first language is a choice. We will use that language which is preferred by the person while specifically addressing them in research or practice. Okay, so moving on, this is the agenda for the next 25 minutes. Hopefully I will be starting off by setting up the stage with, um, giving, uh, a little bit of review or recap or overview of what OT is, um, and then talk about how we came to develop these practice guidelines, what were the gaps that we saw in our, uh, interventions and our intervention research space to build that evidence, um, up. And then I'm going to describe the practice guidelines in some depth, like talk about why we did it, how we did it, and then move on to provide some, um, outcomes or the goals that we, um, just to show that we hit the goals in ways that we decided or we wanted to. Then I'll talk a little bit about the strengths and limitations of this work and then moving on to talk about what we did after, which was sort of noted in the limitations of this work. So future recommendations, what are we doing right now? And, um, because this is such an interdisciplinary audience, I also wanted to take some time to talk about how we can collaborate, how we can, or what OT can do in this interdisciplinary space. Okay, so let's start with a quick review of what OT is. Uh, so the American OT association describes occupational therapy as a healthcare profession that's built on research and evidence to support individuals, communities to access environments, participate in daily activities, using occupations in the rehabilitation process. Sometimes we build skills, sometimes we help rebuild skills that, uh, were lost due to a traumatic incident or something. But our scope is very broad, especially in the autism space. Um, we are a community that has ot, that is occupational therapists and OT assistants who work with us in close partnership and collaboration. And together we form the OT community. We use the knowledge about a person's physical, emotional, psychological and environmental aspects to develop our interventions and supports. So we look at occupations. Our heart and soul is occupation. And we use a lot of information about the person's occupations, their environments, to build our interventions and support them. Just like every other healthcare profession, we have unique Domains and processes. So what are these? Domain is the scope of a profession and how it is distinct to other professions in the same field. It is how we also present to other stakeholders, regulators, policy people, financial reimburses and clients. It is areas where we make clinical decisions about. And this is very important because I'm going to sort of like tie it in with the practice guidelines because we maintained our distinct domain in that space and when we develop that piece of evidence and then processes are uh, actions we take as OT practitioners. So this is basically to answer the question, what does an OTP do that is distinct from a, uh, speech therapist or a physical therapist? So let's look at our domains quickly. I feel like our domains are centered around meaningful occupations. And it is a variety of different types of occupations. It is a variety of different activities. It is a variety of different tasks that make up these occupations. We look at occupational roles, uh, that people do. We look at occupational context that people have, which, uh, which includes their personal, their social, their cultural and physical environments. We also look at performance. I know performance sounds like a little bit of um, ableist terminology. But when we look at performance, we look at patterns like habits, rituals. We also look at social skills and motor skills. Many times we work to enhance these skills, but at other times we try to find out ways that we can change the environment where an individual can perform at the level at which they are. And then we also look at client factors which includes body functions, structures, values. These are social, uh, factors which includes values, traditions, beliefs and spirituality. Because we have this distinct focus, our evaluation, our interventions and our outcomes focus on occupations. And when I say that we have lots and lots of assessments that look at different activities that people do and we break them out. We do something called activity analysis and break them into components and then come back and see how a person can function or perform these activities. Again, it cannot be emphasized enough. We try to modify environments. We try to make environments more naturalistic. We try to make environments more inclusive. And we work a lot in that space. Then we use clinical reasoning. One thing that stands out in our distinct clinical reasoning is how we use ourselves in the process. I want to give an example here. An OT would work, um, with an autistic child in school to co regulate their emotions when, uh, they're in that space. Then the idea being that the child can self regulate and uh, regulate themselves at a later time. But we start off with this CO regulation. We start off by bringing ourselves in the processes. With that quick review, I want to now move on to the topic of the day, which is the practice guidelines. Um, I know this diagram looks a bit of a nucleus, uh, but it was supposed to uh, look at how we develop these practice guidelines and what uh, informed us to develop this practice guidelines. So we started off by mapping interventions and evidence that existed in the field of not just ot but in the broader um, allied healthcare field to see what kinds of interventions exist for um, autistic individuals. And once that was sort of mapped, we decided to go in and see where the gaps are. And we found a lot of gaps, some of which I'll um, discuss in this talk today. Once we saw the gaps, we also then decided to rank these evidence to see what evidence and what interventions have highest um, strengths and then what interventions need more to add to their strengths. And the wonderful part of all these processes is that all our research was developed with autistic researchers, with autistic community members and with autistic partners. So everything came from the community to inform the practitioners in many uh, uh, spaces at many times. We learned from our community partners in immensely and I want to stress that um, at this point and then we developed the practice guidelines because when we developed these uh, systematic review briefs, we wanted to make sure that our practitioners, our OT community, um, understands how to use this evidence, how to use it to inform our practice. Because they are busy, they don't have time to go in to dive deeply into the evidence. We wanted to give them some recommendations to become more um, neurodiversity affirming more strengths based as ah practitioners. And once we finished that, we got a lot of call from our uh, clinical OT community who told us to be more specific, include more evidence, provide more strategies of how they can be more neurodiversity affirming. Dr. Patton and I just m. Our book chapter is coming out next month. We wrote an entire chapter on how to use some strategies, um, to be more strength based and neurodiversity affirming. And we'll discuss that um, as part of this presentation as well. Well, okay, so when we conducted, when we mapped out interventions that existed in um, the field of ot, the thing that we noticed and uh, something that our autistic community partners pointed out was that when practices are only holistic, practices are only neurodiversity affirming. If we presume the competence of an autistic individual, no matter their support needs, no matter their communication preferences, they can be non speaking, but we still presume competence. One of our community um partners told us this eye opening Insightful, um, dialogue about how non speaking does not mean they uh, are non thinking. It is really important to go in and presume competence as practitioners, then to build authentic partnerships with them. This does not restrict itself in the space of research. We also need to build partnerships with families that we work with, with autistic adults that we work with in clinical spaces. And it is also to educate the next generation of OT practitioners by building these partnerships with our community members and then to develop supportive context where, um, an autistic individual can use their strengths, can use their interests, and gain that opportunity to participate in occupations that are meaningful for them. But what we noted when we mapped the evidence was that when authentically autistic individuals, interests and strengths are brought into the conversation, there is organic improvement in participation and engagement in the rehab process. I want to pause here and talk about national, uh, Science foundation study that Dr. Patton, uh, developed in the public schools in New York City area. Uh, the whole point of this was to use, authentically use interests of middle school students. And our students, uh, artistic students pointed out that they were very interested in engineering. So the whole grant evolved around developing interest driven engineering clubs. And the way we developed it was that we were focused on teaching engineering skills. We partnered with engineers, we partnered with museum specialists, we partnered with educators and psychologists to make a curriculum that is not just accessible, but that is meaningful for our middle school students. And they developed a lot of skills as engineers. And then they went in at the end of the program, uh, or the club year, they would go into this museum in New York City to present their work as engineers. And we would pin them with an engineer, uh, ribbon and give them certificates. So this was a way that we tried to change meaningful occupation for that age to include it or make it more strength based. But we also noted that the majority of interventions that existed out there that were ot, um, within the domain of OT looked at modifying behaviors. And these uh, interventions also use trends. So just contrary to our program, if we would have used engineering just as a token, just as a reward when it came to building social skills, when it came to building behaviors that would make an autistic child look and be more non autistic, then that is not a, uh, way to use trends based practice. That is a tokenistic way to use trends based practice. We could understand that only because we had an autistic researcher on our team who pointed out these subtle nuances that we were not aware at that point. We also learned that strengths based practices have a positive impact on mental health. They are intrinsically supportive, they are intrinsically healing in their own ways and they improve engagement and interest driven activities. Going back to our interest driven clubs, many of our students pointed out that they wanted to grow up and become engineers. And we love that. And then when we develop inclusive and accessible environments, autistic individuals can have opportunities to more and more to participate in these spaces and showcase their talents and skills. So once we saw that a lot of gap existed in the space where our intervention research was not where we were at, we decided to go in and develop our practice guidelines so we can inform our clinicians and our practice community a little bit more about how to be more neurodiversity affirming. I'm going to talk a little bit more about, and this looks uh, a little bit scary but uh, I'm going to talk a little bit more about how we develop these practice guidelines. But the reasons for developing this practice guidelines were fivefold. We saw that there's an urgent need to develop supports and services that respect autistic individuals differences and abilities. We saw that current interventions still focused on remediating and normalizing these differences and they viewed them as deficits. So differences in communication viewed as communication deficit because they were not in alignment to what a non autistic individual would use as a communication choice. Uh, we also noted that systematic ableism was the cause or the underpinning challenge that creates professionals to be more ableistic in the way they practice. This mainly uh, impacts marginalized populations, but also racial and ethnic minorities to a greater extent. We wanted to develop equitable services for these communities. We felt that a practice guideline could not be developed if we do not include this historically marginalized racial and ethnic groups in our research and our practice. And also uh, understanding how social systems can support autistic individual. And finally we wanted to create these practice guidelines to provide a structure, language and recommendations to create inclusive practice for OT practitioners. But I feel like a lot of this applies to um, many um, interdisciplinary professionals as well. One thing that we are very proud about our practice guideline was that it was informed at every step along the way by autistic researchers, by autistic community members, by stakeholders. Um, we started developing this practice guideline by listening to our community. And we had a couple of listening sessions where community members, it was open to everyone, people could come in, share their questions, share the areas or share what they wanted to see OTs do more or less of. Once we had that, we developed um, a few topics in which we would go in and look at the evidence and the scene, the state of evidence, and then try to rank that evidence based on their strengths. Once we did that, we went in and then um, started reviewing the evidence. But we included autistic researchers in that uh, process as well. Then we wrote the practice guideline. We added a lot of case studies so that our OT practitioners could learn a lot of practical strategies. And uh, every step along the way, as you can see, we had an autistic researcher, an autistic co author. And then the external review process, not only did we send it to the American OT Association's external reviewing agency, we also sent it to our community members. And we got lots and lots of feedback that we incorporated for our final dissemination. So the goals of our practice guideline, then this came from the community. So we had our reasons, but the community added to that and enhanced the reasons for developing this practice guideline. One of the most important things that the community told us was to share their needs and their priorities to practitioners. So a guideline that comes from the community, informed by the community and that can be shared to practitioners. So working with them rather than uh, developing goals and developing interventions for them, so trying to bring them in the conversation then to present a decision making system called Abigraphs. I feel like this is a very unique, uh, system that we uh, came up with, of course, with our community partners. Because these uh, decision making systems were more visual, were more accessible and we um, sort of disseminated them widely so that not just OT practitioners can benefit out of it, but also the community at large can understand what kind of interventions, you know, will be used with them. What does OT look like so that they understand how they can be partners and support us in the process then to share clinical outcomes, strengths and limitations of this practice guideline with future recommendations. And this is where our autistic, um partners told us that there are limitations in the research itself and sort of build more research that is more participatory, that is more inclusive so that they can be um, authentic partners in the process with us. So some systematic review topics that came out of these listening sessions where, um, self determination and positive mental health for people on the autism spectrum. I feel like this was the top rated priority by the autistic community. We wanted to go in and see the state of intervention research for these um, areas. We divided them into three. We looked at self determination, self advocacy and then positive mental health, um, interventions, then participation in daily activities, because that is the scope of ot. Our distinct uh, value lies in building occupations and um building pathways for people to participate in these occupations. A few things that stood out to us was when autistic individuals pointed out that sleep is a very important occupation and we were not looking at that. So we um, looked at it more closely and then um evidence around health management so they can be partners and they can be advocates for their own health um and other health related um needs and wants. Then finally person, student or family centered planning approaches. This is very important because it helps people in planning transitions. It helps in developing goals for schools, IEPs. It also helps in developing employment opportunities. Autistic individuals wanted to see the state of evidence in that space and then how we can improve our intervention process in these areas. So I'm going to present the clinical uh decision points. I'm very excited about this because the way we developed this again was very visual, very accessible. Um, I will not be going in into every um part of every um area only because we don't have that much time to go in. I can talk ages about it but I want to point out a few areas where the strength of evidence was high. But our community partners did not want want those evidences to take the main stage. Whereas in other areas the strength of evidence was moderate but they wanted to see more of that. Let's look at self determination and self advocacy. Uh, I'm sorry, I think these look smaller on um, my other screen. Uh, I'm m really sorry. I've sent slides so you can go in and zoom it. I couldn't stretch it beyond this level because it was very pixelated. Um, so looking at uh self determination and self um efficacy, autistic individuals um, pointed to us that they wanted to see more of interest based group interventions. Instead of social clubs or social um social skill group interventions. They wanted to um, look at more interventions that included them in the process in program development, program dissemination, um when it is related to developing self advocacy skills. Contrarily when we looked at mental health uh, the highest strength of evidence was in the area of cognitive behavior therapy. But um, our autistic partners and researchers pointed to us that CBT is okay as long as we include self advocacy, social skill development, mentorship programs so that we make it more um, authentic and make it more occupation centered rather than behavior modification center. That was very helpful to us because we only included those studies in our systematic reviews. Only included those studies in our practice guideline development that looked at CBD but in conjunction with occupations. That was a very interesting change that we brought in. Again we looked at feeding, we looked at Education play again was looked at in different environments and this is where the environment took over. We looked at play in clinics for early intervention, we looked at play in the community, we looked at play in schools and then encouraging symbolic and spontaneous play as well. And then we looked at sleep again. Sleep is a very interesting space because the evidence uh, around sleep, um, interventions were focused and targeted on changing behaviors. But our autistic community partners pointed out to us uh, that we needed more and more studies that put in positive habits, created environments that are conducive for sleep and sleep management. So we went in and looked at and included only those studies that did so. And then we had work and again work was very interesting and this was for autistic adults. And we looked at individual tailored job coaching. And I remember listening to uh, the self advocate uh panel yesterday and we saw how much importance and power and potential um, peer mentoring has, like from an autistic mentor to an autistic mentee. And that was the kind of uh, interventions that our community partners um, advised us to include in this space a little bit of discussion, ah, around the strength of evidence. We spoke about cognitive behavior therapy and we also spoke about other interventions, interventions that authentically included autistic individuals in interest based occupations. And um, we noted that as the strength of evidence was moderate for these interventions that developed self advocacy, self determination or mental health, we need to think of ways to build research to use those practices more. Again, when it comes to higher evidence, sometimes higher strength of evidence does not mean that those are authentic. Those are um, supportive neurodiversity affirming or supportive to autistic individuals. We need to use those interventions with care. It is important to set goals with the autistic individual in question and try to find out goals that are meaningful for them. Then we also urgently need more research and processes that are participatory in nature. The strengths of this practice guideline, Um, I feel like this is one of the first practice guideline that was developed in partnership with the community rather than from practitioners to the community. It was informed from community to practitioner. So we um, flipped that cycle and then focusing on including and prioritizing evidence from interventions that supported the community versus remediating individual behaviors or normalizing behaviors. Then we developed a practice guideline that could be used as a starting point for neurodiversity affirming and trauma informed care. But our strengths were also tempered by some limitations in developing these guidelines. We could not get a lot of participation from non speakers and non speaking communities or communities with complex and higher support needs. We wanted to bring them more in to understand their health priorities, their needs from OTs and we couldn't do that with this practice guideline. And I feel like that's a miss for us. But we are trying to build that and then limited research to understand various communication preferences. And this was something that was again pointed to us by the autism community which we're working hard to build pathways and channels to developing then limited research from diverse communities and cultures to support occupational diversity. A lot of our participants were um, from similar or had similar occupational um challenges or issues. But we wanted to look and go in more to understand about different cultural um choices and occupational choices and differences in different um cultures and communities. And this could be the next um area where we can develop our research. After the practice guideline. We got a lot of feedback from our um practitioners from our OT community to uh, write either book chapters or create more research pathways so they can understand how to be more neurodiversity affirming. Dr. Patton and I wrote a book chapter that's coming out next week, sorry next month. And we are very excited about it. Uh, that book chapter talks about um, helping practitioners to be more stressful. And we've developed this framework called the KCB ETS framework. And I'm going to talk about it in the next slide. And we wanted to um, showcase how practitioners can move away from presumably from deficit based approaches to adopting and embracing approaches that presume competence, that recognize the power of yet just because someone doesn't have a skill does not mean that they're deficit but they have not learned that skill yet. And taking and flipping that um, uh, in a way which is more strength based, recognizing and criticizing internal ableism and biases by understanding the power of professional socialization. A lot of times new graduates are socialized into adopting certain ways of practice. And how do we change that? How do we build in reflexivity as a practitioner then shifting labels like high functioning or low functioning individuals to the environment? A person is not high or low functioning, but an environment sure is. So how do we focus on environment? And how do we emphasize that people need not change, but environments should? So for any person who wants to participate in an environment, the environment should be just right. So we provide some strategies for that in our um, in our chapter too. So let's look at the KC Vets framework and the KC stands for knowledge Production. And these are a set of questions that we develop so that practitioners can go in and ask these questions again. These questions are more for us that has come from the autistic community to change us as practitioners. I'm not going to go through everything because they are very self explanatory, but I wanted to look at one or two in every slide. How do I view and try to understand my clients lived experience? Do I use lived experiences to impact my decision making as a clinician? And E stands for values and ethics. So when we think of that, what do I think of disability? How do I want to approach topics of disability and inclusion? So having questions around that, reflecting on that is really essential for us as practitioners. And then theories and models, these are very specific to ot, but I feel like everyone can take away something from questions 3, 4 and 5. What do I think about strengths based practices and why? What do I not know about it? And what challenges do I foresee about adopting strengths based theories and models? And then S stands for clinical skills. Again, this looks vastly different for every healthcare professional, but some of them are uh, very interdisciplinary in nature. What have I learned about neurodivergence, strengths based practice and neurodiversity affirming practice? How do I co produce my knowledge with my clients and with the community at large and then to move on to become a neurodiversity affirming practitioner? And I feel like when neurodiversity affirming practitioners practice, I feel like they have a very good understanding of their biases. And it's not that we shouldn't have biases, it is about us understanding our biases and working on it and trying to learn more about it with curiosity and um, with an open mind. So do I think every person, no matter their age, sexual preferences, gender, geography, fiscal status, disabilities, statistics, status, should have a pathway to attain the goals that are meaningful for them? So questions like this, that keep, uh, that we need to keep at the top of our mind and then looking at deficits as opportunities. How do I look at failure for myself and my clients? Do I feel that they are regular part of the learning processes? Or do I view them as a, uh, component of skill deficit? Do I see the failures are fixed or failures can be worked upon and changed? And then emphasizing potential, Do I believe that all neurodivergent individuals have the capacity for growth, even if that looks different for each person? And then how do I improvise? Do I believe failure promotes deeper learning? And then questions around that? And then finally embracing the power of yet do how do I model a growth mindset for myself, my clients, demonstrating that learning and development are lifelong Processes. And with that I want to, because we are such an interdisciplinary audience, I want to showcase some areas of potential for us. I know I'm at time, but I'm going to quickly run through this. Um, we can empower clients to understand and advocate for their medical, dental and other healthcare needs. We can work with them, be partners with them so that they can engage in these occupations more authentically. Supporting uh, intervention development with other professionals to highlight autistic people's abilities, interests, goals, preferences and healthcare needs. We have worked with schools, we can partner with medical communities like clinics and other spaces as well. Increasing awareness of the diversity of communication strategies used by the community to support healthcare professionals. Then developing high functioning environments. I think this is a must. If there's any takeaway, I feel like this one is how to make environments more high functioning so autistic community can participate and use their strengths more authentically. Then develop trauma informed and culturally sensitive intervention process disease. I want to leave you all with a key takeaway from Dr. Patton. If she would have been here, she would have mentioned this that no one builds their lives on remediated weaknesses. No one. And I feel like this should be applicable for every person in the world to use their strengths and have opportunities to engage in interest driven activities. Thank you all for listening and um, I'm excited to discuss more.

Speaker B: Wow. Uh, Dr. Murthy, thank you so much for discussing ot practice guidelines for autistic people across the lifespan, including how inclusive your process has been to write the guidelines. I'm feeling that those guidelines may be helpful not only to OT practitioners but also to a much larger professional audience. Uh, I have a number of questions that have come up. Sure. Um, one has to do with the whole process of coming up with the uh, guidelines, the inclusive part. Um, so what strategies uh, uh, can we use to develop partnerships with people with higher support needs? Uh, uh, who can help inform research?

Speaker A: Absolutely. That's a great um, question. And I feel like the community, we didn't have the opportunity to do that for this guideline, but we heard a lot from um, the community that we work with and they said that we need to be more open to uh, embracing and using a variety of different communication strategies. It starts there. I feel like communication, when it is supposed to be only fixated on spoken communication is very ableist in nature. Our community partners told us to be more open to bring in and embrace diverse communication styles and then also for people with higher support needs, working with their partners, using rapid response, uh, to communication, finding out ways where we can um, partner with them. And this could be sometimes completely in their uh, homes or in their environments versus getting them on zoom and having conversations with them. And I think we should be open to do that. We should be open to uh, bring ourselves in their environments to understand their m. Their challenges. And I feel like those are so real and um, sometimes really compounded. And that was one of the key advice that we got to be more open and be more, um. I feel like, curious about a variety of ways that we can collaborate with them.

Speaker B: So really to be more inclusive. To be inclusive, yes.

Speaker A: And also to listen. I feel like most of our community partners said that this was the first time they actually felt heard. And those communities, uh, those community listening sessions where uh, we did not have a time for that, we went in and kept it open so that people can come in and communicate at any times. They could drop in, they could join whenever they wanted. So I feel like keeping that open avenues to uh, listen to people is very important.

Speaker B: So, um, the next question. What has been the impact of writing this practice guidelines? Uh, specifically, for example, how do you think this has changed AOTA as an organization?

Speaker A: I love that question. I, um, feel like AOTA initially at the start of this practice guideline, and this was three years ago, uh, they told us that uh, we might not be able to bring in the community in this process. We might not have autistic researchers who would be billing and who would want to work with us. Uh, from that to having listening sessions, uh, from the community members has now become a mandated process, uh, in every, uh, for every guidelines, I feel like. And they want to be more open to bringing in community partners from different neurodiverse. Neurodiverse. Neurodiverse communities in the process to uh, work with them and to build. So I feel like initially there was a lot of hesitation in how can we do this? Because it seemed daunting for them. But I feel like a lot of work was done by Dr. Patton who went in and sort of like changed their ways. She also gave a wonderful, um, uh, uh, uh, like an ot, um, professional talk and addressed this and called it as professional bias. She called it out openly and I feel like the American OT association learned from that and listened to her. We are still a long ways to go. I would say that too. But we are, Are getting there, hopefully getting there as quickly as we should be.

Speaker B: Wow. Thank you. So very specific question, but I think it talks about sort of the. Maybe the gap between the guidelines and what actually happens on a regular basis. So um, uh, uh, we struggle in Santa Rosa to access OT therapy for our patients in need of strength based therapy. How do we find OTs with this training and approach?

Speaker A: I love that question too. I feel like a lot of OTs, uh, even now are still with this uh, idea of adopting the medical model. We are not saying anything wrong about the M medical model. Our community said that we need the medical model when there's a medical challenge or an issue. But when it comes to ot, I feel like the awareness is not catching as quickly as uh, it should be. This practice guidelines are available to everyone for free. I can share it with you as well and you can share it with them. And I feel like one thing that our community told us is that if an OT does not know about strengths based practices, we need to take it on and advocate for them. And I know that it is not the responsibility for an autistic individual to let an OT know how to perform. But I feel like at many times we have community members who have advocated and achieved that. And I can share these practice guidelines. They are available for people as people read it. I feel like there is a mindset shift and I can also share other um documents and other um research articles that Dr. Patton and I have co created which very specifically focus on strengths based practices and how we as practitioners need to change versus changing the communities at large.

Speaker B: Thank you for that. And just in Pediatrics we see this comes up all the time where we want us to be and where we currently are, that there's often gaps and you have to do training. But it's also about uh, culture change.

Speaker A: Absolutely. And I feel like the book chapter that's coming out next month has more uh, like you know, clearer strategies, clearer what to do on a day to day basis, uh, for OTs to be more strengths based in your diversity affirming.

Speaker B: So the next question has to do with collaboration. Sure. So uh, and it's about schools and there may be two questions here but, but um, so how to advocate in school settings to work towards these types of OT goals. And so one person writes, currently OT in our district are okay with functional level, but aiding in the toolbox seems detrimental to a growth mindset and the power of yet I'm not quite sure what that means but I think the key thing is how do you collaborate uh, with sports this school.

Speaker A: Absolutely. And I feel like many schools and many school based and I have a lot of um, professional colleagues who are in school settings and the schools still adopt and uh, specify the domain of OT in the space of either handwriting development or participation in the classroom and have those strict like rigid rules for ots and that's the specific domain that you have to work with. But I, I feel like a lot of advocacy starts within the classroom just by talking to the teachers, just by talking to the child. And I always say that start with the child, then talk to the teacher. And then when we can channelize that in the way that this is the challenge and this is a solution we need to instead of looking at functional because a lot of ah, the community partners that I work with also talk about function in a very ableistic way. Because autistic people think that unless they are functional to new non autistic levels they have deficits and they don't want that because function can be flipped over its head to where a person is at and how we can create changes in our environments. So some of the strategies that we've used in our schools in New York City and these are also public schools, uh, where to change the environment in such a way where we have a calming spot and the class and this can be just developed with the teacher and then using some of the sessions instead of taking the student out for one on one sessions to pushing the students in the classroom and working with the teacher in that setting where they can be part of the classroom and they can participate and function in the classroom. I feel like some teachers are even more sort of open for collaboration in ways where they are okay with replacing desks with therapy balls. We've done that. These are like small strategies. It seems like small changes but they make the world of difference for the child. And then once we see the progress difference, once we see that a child is interested and is learning and is at their best sort of like potential for learning. I feel the school is ready to make a change. It takes a lot of advocacy and I truly appreciate that question because it is not um, sometimes funded and sometimes in our um, in our story as well. We started with minute baby fundings from where we can get in from different state level organizations, fundings from private institutions to then building up that National Science foundation grant. And I want to be very clear here. That um Grant funded my PhD. I'm super grateful but we had to write the grant about seven times before it got funded. So there's a lot of rejection. But I feel like if we keep keep at does help create a change.

Speaker B: So I do think that funding is um, you know, is a factor. One person writes um, understanding this about changing Practitioner orientation. What would fund these different practices and changes going forward. So you know, you've actually brought that up already. Uh, so definitely challenges for us, uh, as practitioners.

Speaker A: I just want to add a little bit more about funding. I feel like Dr. Patton is currently now working to get private funding from private organizations. Trying to move away a little bit from the uh, federal grant systems only because she is very invested in developing a peer to peer mentorship program where autistic, uh, mentors who are in college, uh, would mentor autistic students in high school, middle school. So for that specific kind of program, be where pushback. And we were rejected a couple of times for funding. But then now we are looking at private funding. So I feel like there's a lot of avenues when we think about it, from private, from angel investors trying to go down that road at this point rather than going to the more prominent uh, scopes of funding.

Speaker B: Wow, thank you. Um, so this may be the last question. Maybe there's one more. Uh, uh, but I think one. You know, personally I was really stunned when you showed the slides about self reflection and self. So really I think you're changing the culture of what it means to be an ot. And so it's always slightly more challenging when an OT has been in practice for quite a while as opposed to their being newly trained. And I'm just wondering what your approach is for education for culture change.

Speaker A: Absolutely. No, that's a fantastic question. And I feel like that's a more Christy Patton question than me because she's such, um, she's such a wonderful leader. I feel like um, her motto is that when we keep talking about these um, these things, these reflections and these um, opportunities and try to create that mindset at very much at the top level, it is, it is the way to chip into creating an actual change. So she always says this, that, that it is okay to be wrong, it is okay to uh, unlearn and it is also okay to be non judgmental. So be curious, be wrong and be non judgmental. I think the first thing is to be open minded to say that, okay, I have to relearn. And I remember that both me and her at different times have gone back to the people that, the autistic people that we've worked with and apologize to them, them because yeah, we were socialized that way, but then to make these small efforts. So every class that Dr. Patton teaches on strengths based practice for OT practitioners, she co teaches it with an autistic individual. So she is sort of the expert in OT And I feel the autistic person is the expert in the autism space and to always respect and understand that and to bring them along in the process. And in our new book chapter, we sort of, uh, provided some guidelines for the educational body of OT to make changes in the curriculum, um, syllabus itself, to sort of look at neurodiversity as part of biodiversity rather than teaching it as a disability or a deficit. Uh, and you know, then presenting students with that ideology and then trying to change that ideology. But we are still a long ways to go. These are things that are working, some of them working a little bit more quickly, quicker than the others. But then I feel like working continuously on it and chipping it away. Every single chance we get works is helpful for us.

Speaker B: Wow, thank you so much. Um, I guess being inclusive and being humble are sort of mantra for all of us.

Speaker A: Uh,

Speaker B: and just that it looks like people are looking forward to the book, the chapter that uh, you've written.

Speaker A: I'm happy to share the link. The, the coolest part of this book is that it is edited by a neurodivergent OT clinician, um, who works in schools. We have lots of strategies there for schools. We have lots of, um, approaches that we could do to be more neurodiversity affirming. In this book we have chapters written by non speaking autistic and other neurodivergent community members. We have indigenous, uh, um, community partners writing book chapters and talking about how we should be more culturally humble and sensitive. So this book is like really exciting. I'm going to share the link after the presentation with you all and also where we could buy it from.

Speaker B: Okay, thank you so much.

Speaker A: You've been listening to a podcast by University of California Television. For more information about this program or uc, visit us online at UCTV tv.