Interview between Speaker 1 (Meg) and Speaker 2 (Dr. Matt Braun)
Welcome to the Two Sides of the Spectrum Podcast. A place where we explore research, amplify autistic voices, and change the way we think about autism in life, and in occupational therapy practice. I’m Meg Proctor from learnplaythrive.com.
Meg: Before we get started, a quick note on language. On this podcast, you’ll hear me and many of my guests use identity-affirming language. That means we say, ‘autistic person,’ rather than, ‘person with autism’. What we’re hearing from the majority of autistic adults is that autism is a part of their identity that they don’t need to be separated from. Autism is not a disease, it’s a different way of thinking and learning. Join me in embracing the word ‘autistic’ to help reduce the stigma.
Welcome to Episode 14 with Dr. Matt Braun. If you haven't listened to Episode 4 on strengths-based interventions, and Episode 12 on strengths-based goals and evaluations, go back and listen to those episodes first, because this episode is a follow up to those where Matt answers lingering questions that listeners have about how to write strengths-based evaluations and goals, and how to use a strengths-based approach in our work. The research article that inspired Episode 12 was 'A Pilot Study on Professional Documentation: Do We Write From a Strengths Perspective?'. That was actually Matt's doctoral thesis. He has so much insight into strengths-based approaches, and is really walking the walk in his work. So, I'll tell you a little bit about him.
Dr. Matt Braun is a speech-language pathologist who owns a private practice in the Kansas City area. Matt has worked in a variety of settings including the public schools, a children's hospital, a university-based research and diagnostic center, and now he runs his own private practice that provides speech, occupational and physical therapy services to children and families affected by a variety of developmental disabilities. In addition to being a therapist, his youngest son has diagnoses of auditory processing disorder, learning disability and apraxia of speech, as a result of a medical condition. Matt's experiences as a parent have greatly influenced his practice and his interest in mastering the art of strengths-based services. In this episode, we talk about how to apply the ideas that have come up so far on this podcast in schools, in clinics, and in early intervention. Matt has tons of new insight to add to the conversation, and we get really nitty gritty about how to actually do this and what it can look like in your work. Here's the interview.
Hi, Matt! Welcome to the podcast.
Matt: Thanks for having me. I'm really excited to be here.
Meg: I am really excited to have you here, because we have so many questions for you. I have a few questions of my own and then I want to get to listener questions. So, by now listeners have heard Episode 4 and Episode 12 of the podcast where we talked about strengths-based interventions and strengths-based goals and evaluations. And I think we're mostly on board with strength-based approaches to therapy, and we also have some idea what it might look like. But I want to flesh out some of the ideas that have previously come up on the podcast. I know one of your personal areas is strengths-based interventions in the natural context. Can you talk to me about why the natural context matters, and give some examples of what it can look like?
Matt: Sure. I think the most important thing to sort of think about when it comes to that 'natural context' is the authenticity of the experience. You know, one of the things that when we talk about supports in various environments is, "How do we make this relatable?" and, "How can we make this valuable and more meaningful?".
We can sit at a desk, and we can talk about concepts, and we can talk about vocabulary, and we can talk about anything, really. And I think we can memorize that, and we can teach kids to memorize that, but I think when it comes to kids with unique learning styles, we really have to be cognizant of making sure that the information we're providing is relatable. So I say, "How do we make the learning information relatable to their lived experience?", and no better way to do that than to do that within the natural occurring activities of their daily life.
So, you know, one of the strategies I know we use a lot is pre-teaching, for example. So, I will have a teacher send information that's coming up this week, right? And we can sort of breeze through and see, okay, these are the concepts. And then how is this child experiencing those concepts throughout their life over the weekend, so that when Monday, Tuesday, Wednesday comes in, and they're introduced to these concepts, all of a sudden this isn't new information. They're like, "Oh, hey, that was like I did this weekend! It was, you know, such and such and such."
And I think when we as therapists operate in natural environments, the parents, and caregivers, and teachers get to see what that looks like on a day-to-day basis, it's easier for them to extend those activities beyond the therapy sessions.
Meg: I love your example of pre-teaching because that really speaks to therapists who are working not in the natural context and going, "What do I do?", and they really have that opportunity to prepare their clients for things that are going to be coming up in their actual daily lives and routines. And I think this is harder than it sounds for a lot of therapists because it really asks them to get outside of their comfort zone. Coming into a house with my bag of exciting toys or working in a sensory gym with all the cool stuff, I know I can have this successful engaging session that maybe doesn't really matter in that child's life, but it feels good to me.
And so you're really challenging folks to put their own experience and their own sense of success in that hour of intervention aside, and do something that might matter more in the child's daily life.
Matt: Yeah, I think the easiest way to have a plan go awry is to have a plan. And when we walk into a therapy session with a plan and, "I'm going to get this, and this, and this," I think so many people will attest to the fact that that never happens, or doesn't happen, you know. In our practice, part of the reason I went out on my own as a private practitioner is, I wanted to have more autonomy and more ability to do these things that are happening in the natural context.
We have a number of therapists who work for us and we always start with, "Okay, we have three rules. Number one is, try anything you want to do. Number two is, have a reason for doing it. And number three is, be open to adjusting, changing, listening to feedback when that doesn't go right." Because we've all had that. Like, it doesn't go the way we think it's going to go, or it's not working. And sort of that working on the fly is one of my favorite parts about working in that natural context, because I go in without a plan and I'm going to follow him around. That doesn't mean he just gets to do whatever he wants to do. It's, 'I'm gonna place myself, situate myself in his world, and meet him where he's at'. And I think that starting point is integral to what we're doing.
And, you know, the point you make about this being hard. It absolutely is. I mean, I've been sort of studying this area, this field for — I mean, it's been close to 10 years that I've been trying to make this happen and I, you know, I've been listening to your podcast and I'm still learning new things, you know? And it's like, I don't ever expect to reach that infinity goal of, "Okay, there it is! I'm a strengths-based provider," but that's something I'm always working towards.
Meg: I love that. I love to hear you acknowledge that it's hard, and it's a work in progress, and it's something that we all need to be ongoing learners about. And I also hope that practice owners and managers are taking note of your rules, because they weren't 'Focus on goals for 90% of the session and make sure that you make progress towards those goals'. They weren't that at all. They were more about engaging in the process in a way that respects children and families.
Matt: To that point, I remember sitting in a session. There was a class at one point, and we were having a discussion about what is helping, quote-unquote 'helping'. And one of the therapists who was an early intervention therapist said — she's like, "You know, I went to this child's home, and I sat the entire session in this child's closet with her mom. And she was going through all these beautiful dresses that the child had, and we were talking about the child's clothing, and dress, and in that moment, the support that that family needed was that mom just needed somebody to talk to. And while we did really no exact or direct therapy for the child, we were supporting that family. And we were able to incorporate maybe some of those things that we would work on in that element." But that's how you build rapport. And that's how you really become, you know, a fixture in that family's home.
And to that point, the thing that we share with our sort of young therapists, or a new therapist, or even therapists who are new to in-home therapy is, it is an absolute privilege for us to be able to go into a family's home, which, by the way, is their most vulnerable space. This is the space where they should be feeling comfortable and safe, you know, letting their guard down. If we walk in and play expert and say, "Okay, you need to do this, and this, and this, and this," in their home, then that creates this riff that is going to make the therapeutic relationship challenging. And so we have to manage that relationship with the utmost respect, that that is a privilege we have.
Meg: That's such a nice reframe to put that first, and there's a lot of newer therapists who have this performance anxiety about, "I need to show that I know something," — I've been there — "I need to come in and do therapy," that comes from this place of anxiety and uncertainty. And I hope that sounds like permission to let go of that and to start with relationship building which we're all good at, and not start from proving ourselves as experts which doesn't really serve anybody except our own anxiety.
Matt: [Chuckles] Right.
Meg: I would be pretty put off if somebody came into my house like that. So, I want to dive into some of the interventions that we've been talking about that resonate with the strengths-based approach, and one thing that's really stuck is not withholding a child's interest, and sort of dangling them as the carrot, "You do what I say, and then you can engage in your interest," but rather incorporating them into our sessions. Can you give some examples of what that looks like in your work?
Matt: Yeah, I always start our interaction with, "Tell me what your child's good at. What does he like to do, and how does he spend his time? If he was left to his own devices, what would that look like?" And that's where I start. And then, sort of like I mentioned earlier, I'm just going to bring myself into his world, and from there, follow the lead.
And sometimes that looks like tapping a stick, sometimes that looks like some visual stimulation of sorts. I'm going to get into his world and try and figure out what's this about, and how can I use this interest as a way to teach and promote the skills that we're looking to build based on what the parents are interested in doing, or if the child is at an age where they can communicate those things? Okay, so what are your goals, and how can we do that within what's already there rather than trying to create this new thing?
One of the ways that we do that is I have a colleague of mine who — it tends to make this all sound so simple right — he's like, "Try easier. Like, just go in, sit down with the child and he'll tell you. You will see very quickly what it is he's interested in, and then you follow that lead."
Meg: It is so much easier when we start with what the child can do and what the next emerging step is, rather than starting with our big and lofty goal for the child and how can we make them meet it. I've been thinking about strengths-based approaches a lot this week. I have a non-autistic three and a half year old who hates daily routines. He hates self-care routines. My husband and I are both OT's. [Laughs]
And he's really into this book series called 'The Nocturnals'. And I don't dangle it. I don't say, "Sit on the potty and brush your teeth, and then we'll read The Nocturnals." I say, "Let's read The Nocturnals while you're on the potty, and then I'm going to brush your teeth and see if they turn into wombat teeth," which there's wombats, and pangolins, and these types of characters. And so we'll roleplay within the characters of the book, and it's not a battle.
And if I dangle it, if I say, "In order to access this thing you love, you have to do these things I want you to do," it is a nightmare. So, I was thinking, we do this with our own kids! We use strengths-based approaches, and we can grant the same kindness and respect to our clients. Just because they think and learn differently doesn't mean we have to strong-arm compliance.
Matt: You know, Kristie Patten touched a lot on that, I thought, and that was really good, because — the same colleague I'm talking about, it's Dr Keenan Stump. He's kind of my partner in business, if you will. He always asked the question; he's like, "Are we holding the children and families we work with to a higher standard than our own children or their sort of age-matched neurotypical peers?"
I know that you guys talked about that in the shoe tying incident, so I have an example of it. I was working with a parent the other day whose child is very young, and we were talking about communication skills. I said, "You know, it's really interesting. It's like we have to ask ourselves, especially in this realm of communication, are we holding him to a higher standard than we would other kids his age?" And she's like, "Well, I never really thought about that."And I said, "You know," I said, "the quintessential example is shoe tying." I looked down and I was like, "I'm not wearing tie shoes, you're not wearing tie shoes. Why does he have to wear tie shoes?" Like, what? She was like, oh my God. Mind blown. [Laughs]
Meg: Yeah, that makes me think about I've had several guests who are autistic talk about how they know so many non-autistic people with terrible social skills who aren't getting social skills training. I've noticed this in my personal emails with podcast guests. I write this business-y, short email to an autistic person and I get back like, "Hello, Meg. How is your week going? I hope that the change in the season isn't impacting you, I hope that you have fun plans for Halloween despite COVID," and I'm like, "You know what? My social skills are terrible and yours are lovely."
Part of that might be differences in them having high levels of empathy, and part of it might be that constant insane high standard that we're setting, which is a nice segue to talking about social skills. So, Damian Milton in Episode 2 and Kristie Patten in Episode 4 both talked about moving away from this discrete social skills training model which we don't make anybody else do but we torture our autistic kids with, towards a leisure participation interest-based engagement model. For instance, having interest-based groups where social opportunities arise naturally, rather than discrete social skills training. What does that look like in your work?
Matt: So, that's like a — this is like a hot button pet peeve for me. So, hearing your guests talk about those things, I'm like, "Yes, yes. People, get this." I can't tell you the number of phone calls I get where it's like, "You guys have any social skills groups?" I'm like, "Well, no, but here's what I can do."
And what we like to do, you know — my biggest challenge with if I hold a centralized social skills group, we're bringing kids in from geographic point A, B, C, and D. We're working on skills, but we don't know about interests, right? They may or may not have shared interests, and then they go back to their singular worlds, and they don't have any other interaction with these kids that they're supposed to be developing social skills with, and that makes no sense to me.
What I will tell the parents is, "Let's do an interest-based thing in where we see what your kid, you know, see what's your child really interested in, and then find either a group in your area, a club at school that has that interest, that's based on that interest, or build that interest yourself." I sort of put that back on the parents where it's like, "Hey, you know, talk with your friends about whose kids have this similar interest."
Sometimes those interests are a little bit different than what you might see in neurotypical peers, right, and that's okay. There are those clubs. Those clubs exist, and there are other people with those interests and if we can't do it in person, now with this evolution of Zoom, we can have online social groups and ways to interact. And we had a club, we called it the Y Club, and it was a boys social group. It really was more of a leisure activity, and we met at our office, and we sort of hand-picked those boys knowing that they had these shared interests of Nerf guns, Minecraft, Wii sports, and we built it from there.
One week, the project was we were going to design Nerf targets and have Nerf target wars. We had a project where we built a roller coaster on Minecraft. We had six kids and three iPads, so we paired up, and we had to take turns. So, all those sort of communication skills and interaction strategies were naturally built in, but because the shared interests were there, like you said, those opportunities for interaction were natural.
I think the outcomes of that were much greater than when we've had groups in the past where it's like, "Okay, let's work on greeting! Turn to your partner, say hi!" So, yeah. And the finale of that was we went to a semi-pro baseball game out here. The best part was that going to the baseball game was not the activity. The activity was the tailgate, you know, that's what dudes do, right? Or some dudes, at least. And these kids, these boys, were all interested in doing that. So, you know, we kind of assigned roles. Somebody was in charge of cooking, somebody in charge of games, someone is in charge of some of those other activities that were part of the tailgate. We had a blast doing it, and it was very natural. And guess what, we didn't have any quote-unquote 'typically developing peers' in the group, because these children all served as their own peers.
Meg: That ties in so nicely to your focus on natural contexts, and gives us a nice example of how therapists who want to do groups, and who can do groups, can do that. And what folks can do who can't do groups because, at least in the U.S., OT can't usually bill for groups, which is really unfortunate. But being able to help their parents connect them to interest-based groups is a great strengths-based natural context participation opportunity.
Matt: What I'm finding more and more of is if you approach the schools where the kids attend, they're generally willing to put — they just need a sponsor, right? They're generally willing to put that club together, or put that organization together. And then we get to sort of avoid that billing conundrum that you talked about. That was kind of one of the things we ran into but we found ways around it and made it work.
Meg: Yeah, the schools are a great place for that to happen. I had a middle school Lego building club after school for autistic kids and I got a grant for it. It was so much fun. This is before I had the language to talk about leisure engagement instead of social skills, but it just felt good, and the kids loved it. I want to segue into some listener questions because I did get a few, and I'm going to start with one that's come up over and over from so many listeners.
So, when working with families in early intervention or in the clinic, often we've come to this place of saying, "Yes, we want to do strengths-based, non-coercive, child-affirming interventions, but the families might be in a different place." And there's a lot of paths that can get families to where they are. Jen Schonger talked a lot about that in her episode on the parent perspective of all of the pressure that's put on the parent early on to do the interventions prescribed, but a lot of therapists are trying to navigate — what do we do when the parent wants something different from the strengths-based intervention model that we are hoping to provide? Do you have any suggestions for that situation?
Matt: That is challenging, and for me to transition to that point was really — you know, it takes a lot of reflection to do that because you're sort of facing this conundrum of, "How do I respect the parent perspective, but also respect my philosophy and sort of what I feel is really the right thing to do by the child?" Jen's information, I thought, was so telling. I think it's so important that we as therapists grant that permission to the families to say, "Okay, hang on. I'm gonna step on the breaks." Not like it's our permission to give. But help them feel that they have that permission to do that, because I think a lot of these quote-unquote 'expert models' — the parents are coming to you as the expert, but your approach isn't that 'I'm the expert', the approach is — for me at least — is 'You're the expert in your child. Tell me what I can do to support you'.
I think Scott and Evan talked quite a bit about our role is not as much the expert as it is the coach. The difference in those models is the level playing field. There's this disconnect between 'I'm above you and telling you what to do' versus 'I'm with you and helping you arrive at your goals'. So, that being said, I look at those opportunities to be teachable moments, and I know that can sound sort of arrogant like, "Oh, I need to teach." It's not that, but it's an opportunity to reframe how families think. And I think, you know, what Jen was saying is that diagnostic process is so doom and gloom. That's why I got out of it. I did that for 10 years.
And I came — in my course of study I was like, "Wow, I really need to reshape this," and when I started doing parent interviews and I started the questions with rather than, "What are you here for? What can we do? What's wrong with your child?" it's, "Tell me about your child. What's he do best?" And I cannot tell you the number of parents that stuttered on that question, because they're so hell bent on telling me what's wrong, because they're here to find out what's wrong. And that's not to put any negativity on the parents, that's how we've trained parents to think. That's how we've trained people to think. And so starting that quest, starting that interview with that question, "Tell me. Tell me what's good about your child. Tell me what he's good at, tell me what his strengths are, tell me how he spends his time," you build so much collateral with that family that talking about the deficits and the challenges comes very naturally.
Meg: So, we can use our process to reshape the parents' model of intervention. Acknowledging the power dynamic. It shouldn't be there, but it is, and saying, "If I suggest something that doesn't feel right to you, doesn't make sense, doesn't fit into your life, you have every right to hit the brakes, to ask questions, or to ask for something different." And we hope that plays out in our relationship with the parent and could carry over if they have that nagging feeling that Jen described of being told to do things with other providers that really didn't sit well.
And then we use our leveling statements to bring the parent up to our level and bring ourselves down to their level, making lots of affirming statements about what they're doing, and how it's so clear that they care, and how many great ideas that they have, and asking them questions to get information; and then starting with encouraging the parent to share the child's strengths, and what they're good at. You're saying we can shift the paradigm through our therapeutic process rather than from directly confronting, which I think is what feels so uncomfortable to the therapist asking these questions. That we're not saying, "Actually, you're wrong. You shouldn't be doing that because this, and this, and that. We're modeling a different way."
Matt: Yeah, it's so — we're so programmed not to challenge authority, right? And so if you have this expert coming in, we're programmed not to challenge that. So, if we situate ourselves as a coach, and as a team, as an equal level team member, and welcome the challenges, then it's going to go much better. We use the term 'Therapy is invitational'. And so, if the parent isn't ready to shift that paradigm yet to really focusing on things that we see more valuable like the strengths and the abilities, we can get there, and we don't have to go in guns ablazing first session. But we have to meet that parent where they are.
My absolute favorite part of my job is meeting parents where they are. And when I do have those parents who are so frustrated, or sad, or because of the challenges they see their child facing, and then we can help them realize and really see the silver lining in some of this, the potential that's there. Watching that transition is hands down my favorite part of my job.
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Meg: That's so lovely, and I'm excited that you use the language 'invitational'. In Episode 13, Elizabeth Sherman talked about using invitational language in trauma-sensitive yoga, rather than giving directions; inviting clients to participate. That's really helpful for us to generalize that to our work with parents, that we can use that invitational language rather than giving directive instructions to invite the parents to try something if it feels good to them.
Meg: So, Katie, who works in the schools had a similar question. She sees parents at IEP meetings who want their middle or high schoolers to master letter formation in print or in cursive, and she's really excited and eager for lower grade OT's to shift their model so that parents are exposed to this new perspective on strengths-based rather than deficit-based models before they get to the upper grades, but it hasn't happened yet. And, again, we heard Jen Schonger on Episode 10 talk about that intense pressure that parents learn to remediate deficits. It's hard sitting in the IEP meeting and trying to navigate that. So, do you have any tips for OT's in IEP meetings with parents who might be pushing for deficit-based goals?
Matt: Yeah, the — you know, some of the feedback I get on this is, "Well, this is really easy for you because you don't sit in the IEP meetings," and you're right. I don't. And that's partially why I left the schools. It is challenging, and I think I'm going to go back to that point, making it invitational. We have to reframe the questions. If we reframe the approach, we can take any really deficit-based approach and reframe it from a disability to an ability.
Scott and Evan talked a lot about using ability-focused language versus disability-focused language, and I think just in that we can start to move that needle a little bit. Rather than talking about what the child can't do, just talking about what the child can do. I know one of the sort of criticisms of using, you know, writing strengths-based evaluations and writing strength-based, you know, writing from a strengths perspective is, "Well, so we just ignore the challenge and the deficits?" Absolutely not. It's important that we acknowledge those things.
Any good therapist can read a report, and read what the child does, and figure out what he does not do. We can still state what the child does not do. We just have to keep that free of bias and interpretation. You know, using connotative language that implies 'problem, deficit requires fixing'. We can use language to say, rather than, "The child did not do X," we use that positive language meaning, "What did he do." And I think the same is true in our goals, and where I've had success in goal writing is to keep it broad and keep it general.
I know that there are school people who are going to hear that and are going to just bristle. And, you know what, I get it, because it's not easy to do that. If you keep it broad and keep it general, the child will communicate. I, as a speech pathologist, I'm going to sort of speak from the communication aspect. If you keep it broad, the child will communicate successfully in X amount of tries. Okay. What you have to decide, then, is what is successful. And that's going to look different based on the context, and based on the person rating.
So, we talked about one of the ways that we set up a data collection sheet to say, "Okay, plus minus, was it successful or not?" and then record the anecdotal data. What did he do that made it successful, and who's judging it's successful, and why was it successful. Then we sit down as a team and we talk about those things.
I know people are gonna hear that and be like, "We don't have the time to." Well, you have to make it. Like, that's the thing, is we can set this up so that we have five different people looking at these communication interactions and deciding what does success — we can put some rubric too, what does success look like.
I think one of the biggest challenges — and I think Kristie Patten touched on this too — is some of the gender differences in communication. Dudes in high school will walk up and greet you by dropping a shoulder, "Hey, what's up, man," and drop a shoulder into you. And, you know, if we're teaching social skills, that is not appropriate. But guess what? For 13, 14, 15 year olds, that's totally appropriate. So, you might be marking that a minus, that it was not an effective greeting, when in the context it's totally appropriate. That's not appropriate to do to the teacher, but to your peers, it is. And so you can't write that goal and generalize it without some leeway on the subjectivity of it.
Meg: So for that therapist sitting in that meeting, their reframe is sort of what can they do, what do they need to be able to do, and what are the supports that they need to do it, not, "How can we remediate this deficit and put the whole burden on the child to learn some skill that they've been working on for a long time."
I have been surprised in my work by how easy it is to inspire OT's to shift what they're doing. It's like we hear it once and we go, "Actually, that's not what I've been doing. And that's what I want to be doing, because it feels right, and it resonates with what we believe at our core, even if it's against what we've been trained and taught to do." And I believe that parents are likely to have a similar experience of, "That feels really good. That feels really affirming of my child. I didn't know my goal was for him to be able to communicate given whatever supports he needs. I thought it was for him to write perfect letters in cursive, but now that I'm hearing you, I actually think my goal is for him to do whatever it takes to be able to self-advocate or give safety information."
Matt: Yeah. And, you know, you bring up that point, I think, that's very important of 'with X supports'. I left that part out when I was talking, because that was something that really struck me. When listening to you talk with Scott and Evan, too, was "What is independence?" And it's 'independence with X amount of supports'. And I think that really, in the goal writing, that's where those strategies and supports are almost more where the spotlight is. It's, here's the goal, but here's what we need in order to be successful in attaining that goal.
Meg: So, Mary and Kristen both want to hear examples of strengths-based goals. Mary works in the schools and she says, "The information on strengths-based evaluations helped me start to shift my focus for evaluations and assessment reports to a strengths-based approach. What would be helpful to me is to be provided with examples of strengths-based IEP goals." So, she has a number of autistic students in first through third grades who have difficulty with handwriting, they write fast, their sizing and formation are off, and some have difficulty staying at their centers.
She wants to know what strengths-based IEP goals would look like, because concrete examples would help her think in a new way about drafting IEP goals. So, I love this. She's saying, "I want to do this, I don't know how, inspire me." And Kristen is basically saying the same thing. She has preschoolers, and they have goals for pre-writing, play, self-care in the schools, but she's not exactly sure what a strengths-based goal looks like. What examples do you have for Mary and Kristen, and everyone else listening?
Matt: So, that's the magic question. And, you know, Meg, you sent me a couple of these to kind of look at beforehand, and I've been thinking about this all week. Like, how can I, how can I come up with this? And my biggest challenge is I don't write. I don't write IEP goals, I write treatment plans, and I'm not bound by the rules of IEP's. And so, I don't have an exact answer for this, but I will do some digging with some friends of mine and I will get some examples and provide you, Meg, for the show notes.
But I will go back to when I'm writing goals, these are the — sort of the core components of it is, stay broad and general, what supports do we need to make that happen, and what does it look like. To me, if you can put some kind of rubric in there is, 'what does this look like', that's going to — like, when I talk from a communication standpoint, or were you talking from a sit-at-a-table-and-work-goal, right. What does that look like?
So, talk about what we want to be doing, and then where are we at now. What's the child doing now, and what do we want that to look like, and what's a reasonable expectation. And always keep in mind that point, is this a higher standard than other kids in his class? Are we forcing him to sit at the table longer than his peers? Especially given some of those sensory things that we know this child might have that are preventing him from, or, you know, making it more challenging for him to sit.
One of the greatest things I learned from an autistic friend of mine is, she said, "We have to consider the context and the environment, the environmental factors, every time." It's not just about what's the goal, but it's what's the goal, what's the environment, what are the strategies, and how are we setting up the environment for that goal to be successful?
Meg: I think your advice about keeping it broad is really helpful, because when we're writing goals we often haven't had the chance to learn from our clients about what they need. And so I see therapist write goals like with no more than two prompts, and, you know, no more than one demonstration, kind of limiting the supports. As opposed to, I write goals that say things like, "Given visual instructions and structure as needed, or with sensory supports and XYZ," kind of broad categories of supports that our goal is not to fade out.
Our goal is to give them supports, and help them be successful in the activity given the supports they need, and generalize to lots of different contexts with those supports intact if they need them. But we don't know exactly what those are before we've worked with the kids. So, broadly stating that we're gonna give these categories of supports as needed to help the child do XYZ.
Matt: And I think it's sort of an unwritten rule that the goal is independence and participation, right? And if we have to state that then state it, because there are people out there who don't recognize that as the, you know — but if we state participation and independence, then whatever we have to do to get there. You know, it's kind of like, that's the goal. Then we can identify those strategies; what does this strategy look like, what does success look like, what is a plus in our datasheet, what does that look like.
Meg: I appreciate that perspective because I often see therapists who have trouble making the distinction between support and prompts. Because our goal is never for the kid to need us to say, "Okay, start! Here's the next step. Okay, it's finished," and we get caught in like being fun, and engaging, and using lots of language, and being really animated with our instructions. We become part of the activity.
And our kids learn the routine of looking to us for the next instruction. In my opinion that's unskilled prompting, because we are making ourselves a social partner by giving instructions, rather than teaching in a way that allows independence with the instructions. And social engagement can happen. I can play with a kid by engaging in the play together, but I don't want to play with the kid by talking them through everything they need to do. So, independence from adult prompting and interdependence in social relationships.
Matt: Yeah, that's a really good point. I like the way you stated that. The way I sort of describe that to parents in terms of supports and strategies, I call it a dial and a dance. I'm like, it's a dance because we're following their lead, and we're supporting them, and doing our part. But it's a dial because we're reading the child, and we're dialing up the supports as necessary, and dialing it back to promote skill acquisition, or acquisition of new skills.
So, it's a constant. It's not a switch where we turn it on and off, it's a dial, and we're going to — because in that same context, on that same skill, he may need this amount of support this minute, and the next minute he may need less. It's when we're in tune with the child, and their skills, and their abilities, and their strengths, and what they're doing, we're more able to turn that dial as we go.
Meg: A dial and dance, I really like that language. I think that's a really helpful shift and a catchy way to remember it. I wanna call myself out on language, too, because Jen Schonger, we've talked about her a lot. She was very impactful. She talked about the difference between independence and autonomy.
Meg: And I didn't really linger there as much as I wish I had. So, I'm just saying it here that I keep using the word 'independence', and the question has been raised if we should talk about doing something autonomously rather than independently. And I want to have a full episode on that.
Meg: You know, I'm still learning, too, so I just wanted to throw that in there. I have just a couple more questions for you. I've got one more IEP question, and then I'm going to go back to your wheelhouse of early intervention. So, Dierdre, who works in the schools, wants to reduce her paperwork. She says, "This was amazing and my head is spinning, because I have to put it out there that I hate paperwork and I try to put as little effort as possible into it, because I want to give my time and energy to kids. I would love, love, love if you could help those of us working in the schools to be able to do this quickly."
So, she doesn't really get any time to write her evaluations, and this is a really big paradigm shift that she wants to make. She knows she needs to make it, but she needs some help with how to do that without taking a ton of time.
Matt: So, this is, I think, one of the most challenging parts of this. When I worked on my dissertation, I did writing from a strengths perspective. And the reason I did that is because if you can write from a strengths perspective, it sort of demonstrates your ability to take the strengths perspective and sort of apply it in one domain, which is writing. Some of the conversations I've had with some of the therapists who have really tried to make this, when they were first making that transition I would get this call and like, "Matt. I'm trying to write this report and it's taken me five times as long because of the way you wrote. You're telling me how I need to write—".
Look, it's not simple. The best way that I know how to simplify it is this: number one, what did the child do. Number two is, what did the child not do. And that's different than 'what are the what are the child's challenges', right, because I know Scott talked about writing descriptively and I'm gonna sort of build on that, and I'd say write objectively. The child did this, the child did not do this; the child did this, the child did not do this. Any therapist should be able to look at that report and say, "Okay, here's sort of the checklist of what the child did. Here's what the child didn't do. Here's my interpretation in terms of, okay, diagnostically here's where we're fitting. And here's my plan."
That sounds very simplistic, because we want to write so much, we want to blah, you know, but I think you just have to document that starting point. To me that's the easiest way to do it. You're going to sort of put your recommendations based on where that disconnect — not the disconnect, but the discrepancies between what the child's doing, what the child's not doing.
Meg: Yeah, so I actually wrote this way in my last job in a clinic and I'd say it wasn't time consuming, and it was actually a lot simpler than very clinical OT evaluations that I would read from other providers that used a lot of standardized tests, and a lot of interpretation, and a lot of just clinical stuff that it really wasn't so simple to write about what I observed, and what a parent reported that the child could do, and what supports they needed to do the next thing, and what their emerging skills were.
It took as much time as writing a slightly skilled journal entry, about an hour of your life, that it really wasn't so complicated, but it does take practice because we've made things so complicated to sort of fit into this medical model. Now we're saying, "Break me out of this medical model, and let me just be descriptive, and write a nice strengths-based evaluation that like you said is objective and descriptive, and includes the challenges as well as the strengths."
Matt: So, yeah, I have a sort of a rubric that was part of the part of the manuscript in the — we put together, and I'll share that with you with the show notes. It's just this sort of algorithm of how to keep yourself in check in terms of, you know, as you're writing. And then there's some examples in there of what does strength-based writing look like, and what does strength-based writing not look like.
Really, the biggest difference is in our interpretation, and the bias, and assumption with which we come to the table. Are we using words that carry this negative connotation. You know, Jen talked about those reports. Those diagnostic reports, and how ugly they are, and that was actually, you know, in my dissertation study I looked at autism diagnostic reports and the language we're using. In order to develop this coding system to sort of look at the bias we put in our language, I tapped parents, OT's, PT's, speech therapists, doctors, and got feedback from this multidisciplinary team of people to sort of say, to describe what does this language mean to them.
So, then we developed that coding system to sort of look. And it was overwhelmingly negative, the language in those reports. Because of this need we have to document what's wrong. There's a way to document challenges and deficits, if you will, without assigning this negative connotation to it. She talked a lot about behavior, and behavior having this stigma; and even the term behavior having the stigma to it. It's like, just talk about what the child did or didn't do, you know? A good therapist is gonna be able to look at that report, read between the lines and say, "Okay, well this is what this child is doing."
I know that that was once called stereotypic behavior, but today we're gonna call it, you know — he flapped his hand several times, you know? It doesn't carry this negative connotation of stereotype, right.
Meg: Absolutely. So, this is doing so many things, it's making our evaluations easier to write, not harder; it's moving away from jargon which is hard for families to understand, and also stigmatizing and sort of medicalizing their children's learning style. So, Neetu — I feel like you really hit on this — but Neetu wanted help writing her evaluations from early intervention, and you really did just walk us through what the different categories of your evaluations were. I feel like I have a clear picture of that. You've mentioned several things that I'm going to link to in the show notes. She is dying to see a de-identified evaluation of yours that maybe we could link to. What do you think?
Matt: Yeah, I could. I'm sure I could find something. If not, we can put something together. But the part that I sort of missed when I was talking earlier is, don't forget the parent report, which is sort of, to me, the main event. It's, what do the parents report — and then in that you're reporting what the child does, what the child doesn't do. And then, what are your child's, you know, what are your wishes for your child. We're talking early intervention, but for me, another piece of this for the older children is the extent to which we can include them in the process. And that's something I think that is sorely lacking in a lot of our diagnostic reports.
Now I've been out of that realm for a while so it may have changed a little bit, I haven't read a diagnostic report in a long time. It may be changing. But I think that's an important piece. Then your summary is sort of this culmination of, "Okay, here's where we are. This is where we're starting. The child can do X, Y and Z. And here's the goal for the parents. So, here's our, here's our sort of recommendations of where we start and where we want to go."
Meg: That's so interesting because the IEP process does this — I don't know if they do it well but they always do it — parents vision, parents goals, parents stated strengths. I, in my experience, those are often disconnected from the actual goals that we're writing, but they are stated, and that might get lost or not done in early intervention and clinics. So, how can we start there and make that not a token reference, but actually a meaningful part of our process?
And I really appreciate you bringing that back into self-determination and including children in the planning process, too, because Evan Dean in the strengths-based goals and evaluations process talked about that a little bit. I think that really resonated with folks because that's something that we're also missing sometimes, is how can we incorporate our clients themselves in the process.
Matt: Well, I think a lot of people think that just because a child's in kindergarten or first grade, we can't incorporate their, you know, them, or their ideas into the report, or into the goals and I'll argue that point. The way I like to think about it, and this is the way I sort of explain it to parents as I'm working with them is, third grade is this sort of pivotal time. The second to third grade gap when you jump in education is one of those crucial — it's like all of a sudden the work gets really hard, and we go from multi-sensory learning, like in kindergarten, first and second grade, to sit at your desk and didactic learning.
I think we're starting to see that paradigm shift a little bit, which is great but historically that's been the case. I think that's also the case for when we're talking about supports and strategies in the classroom, particularly with kids with learning needs, is that up until that point, we're sort of — we're doing the strategies, we're doing the supports. And at third grade, fourth grade, fifth grade, we're starting to teach kids how to advocate for themselves. So, "I'm going to give you this set of strategies. You try them out. You tell me what works for you." And now we really start getting their input on it, and then we're building our plan around them.
Some children at that young age of third grade aren't able to articulate what's easy, but I think giving them that opportunity to at least start to understand that and include them, recognizing them as part of — that their input matters, is really important. If you start laying that foundation in third grade, by seventh, eighth grade those kids are going to be more involved in that process, and more able to articulate. So, how do we include the ideas of the younger kids? And really, it goes back to this idea of incorporating strengths and interests. I would say, let's put this list together of what are this child's interests, and our strategy list, our support lists, better be incorporating those interests.
If this child has this interest of trains, then guess how we're teaching math, and guess how we're teaching science? I think that's the way that we can incorporate these kids into the IEP process. I think even at an unconscious level when kids that young can start to see that, oh, hey, we're respecting your interests, I think it's even unconscious, but it's, you know — they're starting to recognize that they're being respected as well.
Meg: Thank you for that. We need to be putting that into the forefront of our minds, and I love that perspective that the kids will notice if we're listening to them, and respecting them, and seeing their strengths, and seeing their interests, versus teaching the lesson of, you need to change, there's something wrong with you, you need to do everything differently. Because that doesn't lead to a positive relationship with yourself, and it doesn't lead to skill acquisition, as opposed to what you're describing. It does, it teaches kids to advocate for themselves, to ask for what they need, and to set themselves up for self-esteem, and connection, and continued growth and learning.
Matt: One point I want to make is, I've been — I touched on this earlier. I've been studying this sort of area field for 10 years, okay. And it's taken me a long time to get to where I'm at today. I acknowledge that for you and me to sit here and talk about this, it's fairly simple. And it almost seems, I think, as if we're making this sound simple.
In the field, in the practice, in the trenches, this is not simple. It can be. But I recognize that we're oftentimes going up against a system that is not meant to work like this. So, I just think it's important for us to acknowledge that we've had the opportunity to sort of see these things in action. But there's a lot of things that sort of went into getting there, and I don't want to discourage people, but I also want to acknowledge that hey, if you hit a wall, you got to keep going because we acknowledge it's not simple.
Meg: It's almost like therapists need to do their own therapy process with themselves, right. Like, what are my strengths, what are my barriers, even in my personality or in the context, and what are the emerging opportunities, and what changes can I make. Not making this huge lofty goal that's going to leave them frustrated and feeling like a failure. That I'm going to use a pure strengths-based approach tomorrow, but then I'm going to notice those areas of opportunities and figure out what barriers I can break down, and work my way there. I always end with this one question, Matt — of everything we've talked about today, if there was one thing you'd like to see OT's and speech therapists start doing or do differently, what would that one thing be?
Matt: So, I've thought about this and I was like, how can I make this clear. So, I'm going to say it — shut up and listen. I say that emphatically, and I say it unapologetically. Because we just have this — and I am just as guilty as anybody else — we just have this need to help. Sometimes the biggest form, the best form of helping, is shutting up and listening.
I say it that way because I want you to remember it, right. I want you to remember, "Oh, yeah, we, like — stop." I can't tell you the number of times, I have to say, "Okay, Matt stop, listen to what's going on, and survey the room, and watch because you learn so much." The greatest service I did for myself without knowing that I was doing this, the impact this would have is reading the stories of those who've gone before me, and the adult autistics who share their stories in popular press, I've got this sort of list that I recommend everybody read.
It's Ron Suskind's 'Life Animated' and Barry Prizant's 'Uniquely Human' are the first two, and I read those when I was going through my doctoral work. It completely shifted my thinking and the way that I operate as a therapist. And then the other ones are 'The Journal of Best Practices' by David Finch, who is an adult autistic. It's just an incredible story he shares. 'Unstrange Minds' by Roy Richard Grinker, and then 'Be Different' by John Elder Robison. Some of these guys are parents, one of these guys is a therapist, and the others are adult autistics, and even in those five books the different perspectives you get, it just shapes the way that you think about your practice. I cannot tell you how impactful that is for me. And the next on my list is Ido's book.
Meg: I will link to your list in the show notes as well. Every Wednesday, after an episode has come out, I put out some of my favorite quotes from the episode in big font on Instagram and Facebook, so you're gonna see 'Shut up and listen' with your
name next to it. [Laughs]
Matt: [Laughs] Great. Which anybody who knows me is going to be like, "Oh, well maybe he should listen to his own advice."
Meg: [Laughs] Sometimes we do things for our clients that we don't do for our friends and families.
Matt: That's right, that's right.
Meg: Thank you so much, Matt. Tell me what you're working on now, and where we can find you online.
Matt: Well, it's been an honor to be here, and I really appreciate you having me. So, my private practice website is kcspeech.com, where I'm pretty busy with that right now. But I, too, am also rolling out — I've started recording a podcast of my own called 'From Every Side of the Table' which our message is similar to yours. It's really trying to get perspectives from every side of the table, and the title sort of came from — I have, you know, my own son has a fair amount of needs, and I've worked in hospitals, I've worked in schools, I've worked in private practice, I am a parent myself. So, outside of the neurodiverse chair, I've sat in every chair around the table, and that's really shaped me into the therapist I am, and I want to share that experience with others. So, we're looking for that to come out early next year.
Meg: Awesome, ‘Two Sides of the Spectrum’ meets ‘Every Side of the Table’.
Meg: How fun. Thank you so much for your time today, and we will be looking out for your podcast, and for all the wonderful things you are doing online
Matt: Right. Thanks for having me.
Thanks for listening to the Two Sides of the Spectrum podcast. Visit learnplaythrive.com/podcast for show notes, a transcript of the episode, and more. And if you learned something today, please share the episode with a friend or post it on your social media pages. Join me next time, where we will keep diving deep into autism.