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Making Your Practice Strengths-based Podcast

Making Your Practice Strengths-based Podcast
Kristie Patten, PhD, OT/L, FAOTA, Dennis Cleary, MS, OTD, OTR/L, FAOTA
November 8, 2022

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Editor's note: This text-based course is a transcript of the Making Your Practice Strengths-based Podcast, presented by Kristie Patten, PhD, OT/L, FAOTA, and Dennis Cleary, MS, OTD, OTR/L.

**Please use the handout to complete the exam.

Learning Outcomes

  • After this course, participants will be able to:
    • Differentiate between strengths-based and impairment-based practice.
    • Compare and contrast how systems (schools, reimbursement, etc.) are designed to hinder or help occupational therapy practitioners focus on impairments – and what to do about it.
    • Analyze one's own occupational therapy practice and how incremental changes can lead to a strength's-based approach.

Dennis: Well, thank you, everyone, for joining us. I am delighted to be joined today by Dr. Kristie Patton. Can you tell us about your background and how you ended up being a Vice Dean at NYU?

Kristie: Well, I always wanted "vice" in my title, Dennis.

Dennis: There you go. That is perfect

Kristie: Thanks for having me, Dennis. I got my bachelor's in OT back when you could still do that. I then got an advanced master's in OT and a PhD in educational psychology and started on the academic track after being in practice for years. I was at Temple University before coming to NYU. I received tenure on a Thursday and was asked to be a department chair on Friday, which is how things work.

Dennis: Sure.

Kristie: I was the OT Department Chair at NYU for seven years and then was asked by our new dean to be Vice Dean of Academic Affairs. In this role, I oversee Steinhardt's 8,000 students and 11 departments in culture, education, and human development. OT, PT, and speech all fall under human development. We are an education school with OT in it. I am finishing up my third year as Vice Dean.

Dennis: Nice. As a reformed academic, it is nice to have occupational therapists in higher positions within universities. It helps other people understand our language. What is it like being an occupational therapist in an administrative role?

Kristie: I 100% agree with you, Dennis. It is essential to have our voice and perspective. In professional schools, we are often dominated by a variety of professions. We need to understand professional issues, especially regarding clinical fieldwork and internships.

Dennis: During COVID, perhaps?

Kristie: Exactly. I might have a wealth of experience with that. I also feel I can bring a more holistic lens to the role. I do not want OTs not to lose their "OT-ness." I still maintain my academic appointment in my department and am a full professor. I teach electives and advise PhD students.

Dennis: Gotcha. Very nice. Could you talk a bit about why you decided to get a PhD in the first place?

Kristie: I was a geek that loved the idea of research to prove what we do works and why. I received my PhD in educational psychology from Temple University. Before going down this road, I was interested in how kids learn in schools. There was no PhD in OT or rehab sciences at the time, so educational psychology was an excellent fit. I had done my master's degree in temperament, and some temperament researchers were in that department.

Dennis: Gotcha. Well, that makes sense that you did your master's in temperament because you have such a pleasant temperament. I do not know if you know this, but you are an Eleanor Clarke Slagle lecturer.

Kristie: I heard! I gave a big lecture.

Dennis: How exciting is that? For those that do not know, the Slagle lecture is arguably, at least in the United States, the highest award that we give one of our practitioners. You presented that live last year at AOTA in San Antonio. Could you talk a bit about that process? How did you go about putting your Slagle lectureship together?

Kristie: It was such a gift. I was awarded it in the spring of 2021. In the fall of 2020, Wendy Hillebrand, the AOTA president, called me. 

Dennis: Things were going on during that time.

Kristie: Yes, I became vice dean during a global pandemic, so it was a gift. You have a year to write and think about ideas. I talked to several previous Slagle winners like Winnie Dunn, one of my nominators, Beth Pfeiffer, and Moya Kinnealey. They came up, and I workshopped some ideas. I also talked to Glen Gillen and others who gave me advice. The wonderful thing about the year was putting together the ideas I wanted to put forward and reflecting on our profession.

The Slagle lecture I gave was about critical disability studies and looking at disability with a justice lens. This incorporated some of the work I have done around strengths in autism, but it goes much deeper around this idea of society's bias against disability. It was a joy to spend that time looking back on our profession. It was also an opportunity to bring in "OT-based" materials, including my strong beliefs about inclusion, for example. This period of reading the literature was wonderful. I set up many practice sessions to prepare for this talk. Then, two and a half weeks before the Slagle lecture, I had emergency gallbladder surgery.

Dennis: Oh, I did not know that.

Kristie: I canceled all of my practices, and instead, I  practiced the talk four times to my mother, who came up and took care of me. I also got one practice with another group, but that was it.

Dennis: What did your mom think of the talk?

Kristie: She loved it and was there in San Antonio with 11 of my family members, which was terrific. My two sons, 27 and 25-year-old sons were there to support me as well. My one son came up afterward, and he said, "Mom, I think you're kind of a big deal." They will publish a journal article on the lecture. I am incredibly proud of that and want people to read and use it for their work to change the narrative and shift the paradigm in OT.

Dennis: Slagle lectures are lasting scholarly contributions to the profession. It is pretty cool!

Kristie: Yeah. It is humbling when you look at who has won before you. You want to do a good job.

Dennis: Your title was "Finding Our Strengths, Recognizing our Professional Bias, and Interrogating Systems." Do you want to discuss your introduction during the Slagle lecture and how that idea came to you?

Kristie: My intro was "Be curious, be wrong, be better." And I also told a story of being wrong a week before the lecture. You probably do not know this story. I was at a conference the week before doing work with disability advocates. I attend many conferences and meetings on this topic. One of the speakers, a disability activist, said, "When will I go to a conference where the default setting is a visual description?" I was getting ready to give this big lecture that I had turned in two months before, and I did not have visual descriptions in my talk for those that needed them. I told Frank Gaynor I was changing things a week before the Slagle. In the spirit of being wrong and being better, I practiced what I preached only a week before my talk. So for the podcast listeners, I still am a middle-aged white woman in a brown dress.

Dennis: What was it like to go back and read some of your previous writing and reevaluate what you were saying then? And how does that influence what you are saying now?

Kristie: Given my Slagle's tenor and scope, I realized how ableist I was in my writing. It was wonderful to look back at the threads of strength-based practice and shift this paradigm. It is crucial to recognize professional bias. I also had to deal with the fact that I did write in a very ableist way. I talked a lot about deficits and suffering kids. It showed me the evolution of where I have come from, which means that anyone can do it. A reexamined life is an excellent thing.

It also solidified a strength-based practice frame of reference. I wrote recently about resilience and autism from a strength-based model. It was also not rich in intersectionality, which I would now definitely include more authors and voices. For example, many autistic advocates are not of color. I also wanted to have historically underrepresented groups in my work as well.

Dennis: Sure. Could you define ableism?

Kristie: Ableism is a preference for non-disabled individuals. It is a preference for things that are more able-bodied. For example, an article in the New York Times came out last week that talked about doctors prefer non-disabled patients. That is a very ableist view. In my Slagle, I spoke about how 84% of healthcare workers prefer individuals without a disability. That is also a very ableist view, a preference for non-disabled ways of being. Since my talk, someone gave me the stat that of the past 61 best Oscar nominations in the last 30 years, 27 of them have been winners with non-disabled characters playing disabled actors. The entertainment industry prefers to work with non-disabled actors. Only three disabled actors were nominated in this category. The first was from 1946 when a World War II vet who lost both hands played a World War II vet who had lost both hands. Then in 1987, Marlee Matlin won, portraying someone who was deaf. Finally, Troy Kotsur, another deaf actor, won for Coda last year. 

Dennis: Absolutely, the numbers do not lie. In terms of disability studies, does this marry well with occupational therapy?

Kristie: It should marry well with occupational therapy, but it has not. Disability studies are taking a critical look at interventions and therapeutic practices from a disability-lived experience to define how we should be doing things. It is questioning the dominant paradigm of OT within the medical model. If you look at our school practices and ACOTE standards, they are still very medically based. Some critiques are that we are integrating disability studies and disability justice work in OT but have not figured out how to integrate it into our practices, research, and education. We know what it is, and we like it, but we are not using it.

Dennis: Next, I am going to ask you about some of your biases in terms of occupational therapy practice, but first, I want to tell you about a blind spot I had in front of 600 people on a webinar.

Kristie: You know that "blind spot" is an ableist phrase.

Dennis: Oh my gosh, you are right. Thank you for calling me out on it. Now, I cannot think of what another phrase could be.

Kristie: How about an unforeseen consequence?

Dennis: It will be ironic when I tell you what this "unforeseen consequence" was. I created an assessment that is on data visualization. We have an NIH grant to make this assessment even prettier and better. I have always worked within a Project Search framework, a group I work with through Cincinnati Children's Hospital. During COVID, we made it telehealth-enabled, as providing services for individuals with disabilities in home-based settings was tough. As you can imagine, schools and employment opportunities were minimal at this time.

The first webinar I did was for 5 to 600 people, with many from vocational rehabilitation (VR) and state VR agencies. I am showing this data visualization and talking about how proud I am of this tool. Someone from the audience asked, "What are the accessibility features of this data visualization for someone that has low vision or is blind?" I had never thought about it, and that is embarrassing for an occupational therapist to say that.

We are now a couple of years in and are still working on trying to make the data visualization, which changes regularly, accessible for someone with visual deficits. This was the bias that I brought. What are some other biases that occupational therapists have?

Kristie: There are many educational biases, which I will talk about in a minute. But first, I will frame this conversation about bias more broadly. We are biased toward helping others overcome disability versus helping society overcome ableism. Fixing this would enormously help those that we serve. We have these narratives of "let me help you," "let me fix you," or "let me help you overcome your disability." Instead, how about we help overcome ableism, stigmas, and societal and environmental barriers? We are a profession that can do this.

If we turned our eye to the environment, for example, and focused on encapsulating the individual and the interaction within this context, we would see better results. We talk about high and low-functioning individuals when we should talk about high and low-functioning environments. Individuals are not high or low functioning. Environments, education, people, the paradigms used in those environments, and society make us high or low functioning on any given day. There may be environments where I am very high functioning and environments where I am not. This is because of the environment, not because anything changed within me. For example, if you have someone with sensory sensitivities that enters a noisy environment, they may become low functioning. Did they or the environment change?

Our biases are about overcoming a residing disability within an individual. We assess the individual to change or remediate weaknesses. We do this with a population that then disadvantages them from that bias. I had this great talk with two of my students during a disability, justice, and inclusion class. Many students at NYU with disabilities took that class. The two students were sitting right next to each other. One was gifted or twice-exceptional, and the other had a disability. They talked about their IEP meetings. If you were gifted and twice-exceptional, it was all about what you could do and your strengths, but if you were a special ed student, it was all about what you could not do. This example typifies bias. We must catch ourselves and do things differently.

In education, we teach universal design for learning, and we know that there are multiple means of engagement and representation. However, when do you see on a syllabus that students can turn in assignments in various ways? Or, can they show what they know in multiple ways? Do we say to a class at the very beginning, "Get up and move when you need to?" Sometimes, we expect them to sit in their chairs for three hours. We do not do that, yet we teach them to do things differently with clients. If we start teaching and modeling that in our educational settings, we will see practice begin to change. 

Dennis: I was teaching about employment in a class on autism, and there were several autistic people in the class. I asked, "What's a stereotype we have about people with autism?" In hindsight, this is a horrible question as well as a horrible way to start class. One of the guys raised his hand and said, "We're friendly and smile a lot." It was great for him to step up with some positive traits for the entire class and me to hear. It helped me to reimagine what stereotypes we bring with us.

Kristie: We have done such an excellent job of training society. I had such a good conversation a few nights ago with a young man that is autistic. We talked about different subjects, like history. I am a history fan myself. Often, the person that supports the autistic person will say, "Thanks for being a saint and talking to them," instead of, "I'm so glad you took the time to talk to them." As a society, we have created a lot of deprivation around social engagement that is not part of a social skills group or not something with a purpose. We can talk about things that interest us mutually.

Dennis: Absolutely. Are there other ways that you might suggest we look at our own professional bias that we bring to our practice instead of fumbling around as I have done?

Kristie: We need to have people that we serve come and teach us. If you work in acute care and want to see what your biases are, talk to people who have graduated from acute care. If you are a rehab therapist and want to see your biases, engage your former patients and clients in honest conversation. What did I do wrong? What could I do better or do differently? This is how I view it. Healthcare professionals are disproportionately gatekeepers to identity, and we should not be.

Dennis: What do you mean by that?

Kristie: If I treat you as a patient that needs to be "fixed," that becomes part of your identity. If I treat you as someone that is collaborating with me and know what you need, that is empowering. Let's find what they need in a way that is not about us fixing but about reducing environmental barriers. We want to recognize that they are amazing the way they are. We need to ask the questions, "What are your goals?" and "What do you want to do better?" This is not ignoring the challenges but referencing disability awareness, acceptance, and pride. It does not help if you start intervention as the only one that can fix them.

Dennis: I do a lot of consulting in the schools to encourage occupational therapists to re-screen students as they age to see their different needs. As kids get older and start talking back a little, the OT often graduates them or is less interested in working with them. This may be my personal bias.

Kristie: Maybe we should not be doing what we are doing.

Dennis: What?

Kristie: It goes back to talking to self-advocates. We have a new program called the PATH Program that was funded by the NYC Department of Education (DOE). It is a collaboration between the DOE, my colleague in applied psych, and myself. We are running a program for kids diagnosed as emotionally disturbed (ED), similar to autism. It includes many post-trauma interventions. We had a self-advocate that was diagnosed as ED and written off. He came back and trained the therapist. He then instructed the teachers and occupational therapists. He said, "You thought taking me out of class was good, but it was not. I would come back into class, and everyone wanted to know where I got stickers or why I got things they didn't. It was hell."

When you start to talk to people who have had a lived experience, you will discover that our service delivery models are messed up. As a result, you can hopefully be more creative from a systems perspective. This does not mean that everyone feels this way. However, if you start talking to advocates and recipients of your services, no matter what area you are working in, your practices will improve. This is not just about how you did as a therapist but how they feel about how their disability is viewed. Are there issues with stigma? What goes on during their day? You taught them how to use a wheelchair, but do they have access to transportation? I tell my students that it is easy to be a bad therapist.

Dennis: Yes.

Kristie: And it is tough to be a good one. If you are a good one, you start to consider these things.

Dennis: I hang out with many Canadian OTs because my group is growing in Canada. I think they are a bit more holistic and interested in systems thinking, probably because of the nature of their system compared to ours. Their line is, "Why am I working on something with a younger child that will benefit them when they are 18, 19, 20, 21, or 22 years old? Is this significant to them?

You have had a lot of experience with autistic adults that has changed your practice. How did you get connected with them in the first place, and how do we invite some of those service recipients back to critique us a bit?

Kristie: First and foremost, you put it in your budget and pay people who come back. This is not free labor for disability activists to come to teach us better. I always give that caveat because I have many people calling me and saying, "Hey, we'd love to be able to bring a group of autistic advocates and learn from them." I always ask what their budget is and typically hear silence. They are providing a service and teaching, so build in compensation. There are so many support groups out there. I think if you go with a willingness to understand your biases and learn, many advocates are available to give lectures, consult, et cetera. This resource pool is growing as all these kids grow up and become activists.

I have always worked with autistic clients and students throughout my whole career. I connected to many advocates through a project at Temple University, where we were given a grant to train behavioral health providers. Through sheer luck and good fortune, we decided to shift away from what they wanted us to do. After we went to a behavioral health session that looked like dog training, we thought, "How are we going to talk about sensory if this is what they are doing?" We stepped back and got a group of autistic adults, many of who typed independently to communicate, to help us. Many were classically autistic and had all the behaviors that we, as OTs, would want to change, and they were brilliant. It made me change everything I knew about autism, to be quite honest. I understood at that moment how much we had gotten wrong. After that, people knew I was receptive to talking with autistic adults, and many came as many were not talking to the autistic community at the time.

I came to NYU in the fall of 2007. I started to get calls from self-advocates saying, "Kristie, what are you doing at NYU?" I thought, What is going on?" I thought it was a good career move. They said, "Don't you know about the Ransom Notes campaign?" I did not know what that was, so they schooled me. There was a psychiatrist who headed up a prominent institution at NYU, who had gotten some free marketing and decided that a good idea would be to have a public awareness campaign about mental health issues in adolescence and youth. The campaign used something akin to ransom notes like you were kidnapped. It went something like this. "Warning, I have your son. He will never have a job and never have friends. Signed autism." And, "Warning, I have your daughter. She will make herself throw up and then die. Signed, anorexia." I am paraphrasing, but that was the gist of the campaign. I got involved in advocating on behalf of and with the self-advocates. We talked to the psychiatrist and said what a horrible idea it was. We asked if he spoke to autistic advocates. He said that he had not but had talked to their families, but I did not speak to them. He then said that people kept hacking his system and taking down these ads. I replied, "Ransom notes meet passionate interests." Ari Nieman and other self-advocates pushed the needle to take that campaign down. This was my first semester here at NYU, and it laid the groundwork for the Autistic Self-Advocacy Network and all the incredible work they have done.

When I saw professional bias, aligning myself with that community was necessary. I do not have research teams, write, or present without autistic collaborators. I do not say, "Hey, let me tell you about the lived experience of autism," or "Let me tell you about the sensory issues in autism." That is not mine to do. I think we should be paying autistic experts to do that.

Dennis: Gotcha. It is on all of us to figure out how to include and ally with the people we are supporting and who are also supporting us. It is a two-way street. Can you talk about how you became involved with the ASD Nest program?

Kristie: Sure. When I came to NYU, I met Dorothy Siegel, who founded the ASD Nest program. At that time, it was a small, comprehensive inclusion program for autistic students. They are educated alongside their non-autistic peers. It is not a typical inclusion class where you have kids with different disabilities. There is excellent training with everyone involved in the ASD Nest, from the principal to all the therapists, teachers, et cetera. It is a collaborative team-taught model. Each room has a special ed teacher and a gen ed teacher.

When I started here, I want to say there were maybe five schools. We are now in 70 schools educating over 1700 students that are autistic alongside about 6,000 other peers, K through 12. The program embodies some of these strength-based practices. We are very much about looking at their interests. We have autistic consultants, and I have a full-time autistic independent learning consultant on my team. We have always centered on the voice of the autistic expert to guide what we are doing, and now we do so in a more profound intersectional way that is working. These kids do well. Again, it is not about changing them, but rather it is about understanding them and giving them the academic, sensory, behavioral, and social support they need.

This changes school culture. When a school becomes a Nest school, the entire school changes practices. We went from begging a school to have this inclusion model to schools now begging the DOE to be a Nest school. And we are doing the same thing in PATH. Our goal with PATH is to do the same for marginalized kids who are often diagnosed as emotionally disturbed. We have changed that name in New York to give these kids a different experience and "path" than their current one.

Dennis: I do not know much about the PATH program. There are three or four individuals with autism in a classroom with peers who may have another disability or may not have an identified disability. Is that correct?

Kristie: It is usually 4 to 6 autistic students, with 8 in kindergarten going up to 20 non-autistic, non-disabled peers. There is so much support for the teachers and coaches. We have a coach in each school, and we train everyone. The OTs have, I think, six professional development days where all the OTs from the Nest schools come together. So if we are doing something on executive functioning, everyone learns about it. This is the same with our social development intervention. One of my PhD students, Dora Amueri, created an "independence" curriculum for middle school, and it changed practice. The independence curriculum includes self-determination and self-advocacy as a part of it. It is an excellent way to spread good practices.

Dennis: Is it a public health model where everyone benefits?

Kristie: Yes. It is tier one, so it is for everyone. This is the same with PATH.

Dennis: Gotcha. Do you see improvements in both autistic and typical kids?

Kristie: Yes. These are good classrooms because they are well-taught by two teachers and somewhat smaller. You cannot count out that as a variable, but the practices that benefit students with disabilities help students without disabilities. It embodies the universal design aspect.

Dennis: My daughter is in college and has some attention issues. She uses a skills coach, which puts a positive spin on things.

Kristie: We hire coaches as well, and language matters.

Dennis: Absolutely, it does. Do we need to diagnose the system more than we need to diagnose the folks we are supporting?

Kristie: I think we need to kind of call out the system. For example, if I say to you, "Dennis, I am going to work one on one with you for a half hour once a week in the school, and you're going to have such a better school experience." Conversely, if I say, "Dennis, I'm going to work with your teachers and everyone that sees you during the week. I will still work with you, but I will work with everyone else so they know what we are doing. You're going to have an even better experience." I can then go to the principal and say I have a plan for every class. And if we do this movement or activity for every kid, we will see a cumulative effect. It would be best if you were armed with research showing what works and how the system can be improved.

I am lucky to be in a position where I can influence systems now. You must figure out who is at the table and whose voice people follow. We are lucky in the DOE in New York City because the head of all therapy services (OT, PT, speech, and social work) is an OT. From a systems perspective, it is amazing to have that connection. We talked about this earlier. OTs can influence and change systems as they get into higher positions. You can also change things if you are an OT working in the school by yourself. If you have a good idea, you can educate people around you about that idea. You do not need to do it in isolation.

Dennis: Yeah. The least effective intervention is working with someone one-on-one, as we only influence 15 minutes of their week. It is more effective if a student is exposed to an intervention 35 hours a week by various clinicians.

Kristie: Exactly. If I do a sensory-based intervention with you in my room, great. However, if I teach you how to do a sensory scan and advocate for your sensory needs in whatever environment you are in, that is way more powerful.

Dennis: Absolutely. Giving control to someone to figure out what they need and do not need is incredibly valuable.

Kristie: It develops agency. It gets you away from the therapist "fixing" the person. Instead, it is giving the person tools they need to go out into this world, given the systems in place.

Dennis: You mentioned social skills on another podcast. Apparently, you see other podcasters.

Kristie: I would never cheat on you, Dennis, but I have to be on another podcast.

Dennis: Whenever I have a student or someone interested in running a social skills group, I direct him to this podcast. Could you talk about occupational therapists running social skills groups and what you think about that?

Kristie: How did you learn to be social? Did you learn to be social in a social skill group? No. You learned to be social by doing things that interested you. And if you do not like reading books, you do not join a book club. We must focus on meaningful occupations. Social skills groups are where you are teaching me how to be social, versus interspace groups, where socialization naturally emerges. My PhD student, Dr. Yu-Lin Chen, has done some incredible work with our maker clubs showing how being in a mutual space talking about your interests, like the presidents or 3D models of presidents, can be very social. Should I take someone from that type of experience and put them in a social skills group? Again, that is a remedial fix-it model. This does not mean you cannot work on "social skills," although I do not like that term, nor do many autistic advocates. They say, "Don't teach me eye contact because you'll get creepy eye contact." They say, "Instead, teach me when I need eye contact contextually, which is not a lot of times." Eye contact may only be recommended when you enter a group, a restaurant, or a party. If there is a group of people, you should probably make eye contact with one or two people, but prolonged eye contact is unnecessary. It is a group entry skill. They should learn how to enter a group, but remember, they should not be forced to join groups discussing topics that are not of interest. For instance, I am not going to enter a gaming group.

Dennis: Not even Donkey Kong?

Kristie: My preference is Atari ping pong. Are you kidding me?

Dennis: I had Pong.

Kristie: I am old school. I will not feel like talking to anybody who is engaged in a conversation about video games as that level of conversation is at a much higher rate level than my knowledge. If I am autistic, would I want to participate in a discussion about current movies or books if I do not care about them? The bar is already set high for me, similar to the video game conversation. Do I practice video games to enter the conversation or take my little social skills elsewhere? 

Dennis: Which is why I think colleges are such a great opportunity. I will share another story about my college freshman. She could join hundreds of different clubs that span many interests. The more we support and encourage folks with various disabilities, especially with autism, to be in post-secondary environments, the more they may connect with other people that are as interested in similar things. Some people love trains, and there is a place near my house where many tracks cross. People of varying ages go there to watch and discuss trains. My great-grandfather worked on the Baltimore and Ohio Railroad Company (B&O) railroad, so I have a little interest. 

Kristie: So was mine, Dennis! My ancestor worked for the Pennsylvania Railroad.

Dennis: Contrived Things do not work very well. The more we can tap into someone's interests, the better.

Kristie: This does not mean you have to have those interests and be good at them. When they come to your OT room, you may need to help them find those interests. How do you connect with families and start very early in valuing those interests?

Let's take the example of a four-year-old that is not disabled nor autistic but is interested in Dora the Explorer or another popular tv character. What do caregivers do? They flood that kid with Dora paraphernalia like sheets, clothing, et cetera. However, if you are autistic, there is a behavioral plan for you not to watch and talk about Dora. Something has gone wrong there. Because there are different depths and breadths of this interest, we counter it as interfering and bad. We know from our research that it is not. Interests can be calming, purposeful, and valuable for the child to learn concepts, relationships, and the "social code." Please use these interests instead of calling them restricted and repetitive and pathologize them.

Dennis: You talked a little bit about maker spaces. I was reading one of your articles that I thought was incredibly interesting. Could you talk more about these?

Kristie: I have three doctoral students on this team. One graduated, but I have three that are currently on this project. It is funded by the National Science Foundation and the Economic Development Corporation (EDC), our partner. We started in the middle schools and Nest classrooms. We also did afterschool maker clubs with autistic and non-autistic students and whoever was interested in them. My one student measured social reciprocity and showed some sound evidence to support the double empathy problem that Damian Milton discusses. He is an autistic researcher and talks about how it is a mismatch in communication. If autistic to autistic individuals are communicating, you do not see any autistic social deficits, and we found that as well. Autistic to non-autistic communication is problematic. There is reciprocity, interaction, engagement, eye contact, et cetera around interests.

I have a student that has an article coming out in AJOT. The issue is on the engineering design process in maker clubs and how that maps executive functions like problem-solving, frustration, and cognitive flexibility. How can we do this in an interspace group?

We just received a supplemental award for a project where we will train NYU autistic students that are STEAM majors, STEM plus art. These STEAM majors will mentor our high school students in transitioning from high school to college. We are excited about that. We are working with the Wassermann Career Center here at NYU, and they will be training our mentors before they go out and mentor next semester. They will have to find their strengths and skills as a mentor to build their resume.

Dennis: Nice. There was also some evidence that when you have people with and without autism in maker groups, the people without autism are more uncomfortable. This is not a social issue; rather, they may not be as successful at some activities. I thought that was pretty interesting.

Kristie: Right. And autistic students can help out. They can be in a position to help and coach service recipients. We have a bunch of OTs trained in that now as well. OTs are going to be part of the people that are delivering these clubs to public schools.

Dennis: Nice. Is that in New York specifically?

Kristie: Yes, but all of our materials are available to anyone. We have a curriculum, and we will have a website where they are available for free.

Dennis: Nice. Free is always a good thing. Any other advice that you might have on systems change and looking at the world a little differently? You said we could do a little bit in our corner of the world. Are there things we can do together?

Kristie: As an OT community, we can be leaders in centering the voice of disability experts in our practice. This would change systems if we committed to that and had stakeholder groups involved in our research and the education of future OTs. I put up a commitment slide during my Slagel and gave some examples of what they could commit to, which will be in the AJOT article. By committing to at least one of those things, you begin to change your system and find more people like you. You can also find groups on Facebook that are talking about this. Disability activists have been waiting for healthcare professionals to get this for a long time. The train has already left the station. We will either be left behind or have authentic partnerships with disabled activists, their families, and other stakeholder groups to fundamentally overcome ableism in our professions and society.

Dennis: If you do not have a budget, what are some recommendations for resources like podcasts or books?

Kristie: There is a wonderful disability activist community on Twitter, Instagram, and Facebook. Follow people that are out there that are doing this work. When you follow these advocates, you will start seeing a very different narrative than how you were trained and what you have experienced. I say follow people on social media only because it is free and an excellent way to see how people view the subject from different lenses. 

Dennis: You encouraged me to do that about five or six years ago. To be allied with the disability community, we must understand their concerns.

Kristie: Yeah. There is a great piece I watched on media representation by Dan Habeeb that I had my students watch. He is the father of Samuel Habeeb, who did a lot with "Including Samuel" and has done several movies since then. He interviews disability activists, including the clip of Cody Lee on America's Got Talent. He is the autistic blind singer that I think ended up winning, so it is well known. The disability activists break down that clip. You may think, "Wow, he is a good singer;" however, the disability activists point out how the media representation of that was ableist, which many of us may never think. This is what you should be listening to and watching.

Dennis: Well, Vice Dean Dr. Kristie Patton, thanks for joining us today. It has been a pleasure to have this conversation with you.

Kristie: It was my pleasure, Dennis. Thank you so much.


Available in the handout.


Patten, K., & Cleary, D. (2022). Making your practice strengths-based podcast. OccupationalTherapy.com, Article 5552. Available at www.occupationaltherapy.com

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kristie patten

Kristie Patten, PhD, OT/L, FAOTA

Kristie Patten, PhD, OT/L, FAOTA, is Vice Dean of Academic Affairs at NYU Steinhardt and Professor in the Department of Occupational Therapy. Dr. Patten’s research focuses on utilizing a strength-based paradigm, in partnership with stakeholders, to understand the impact of our biases and practices on quality of life and well-being with a focus on interventions in inclusive settings. Dr. Patten has received over $20 million dollars in external funding for her research and programs.

Dr. Patten is the Principal Investigator of the NYU Steinhardt's ASD Nest Program, an inclusive program for children and adolescents with autism in the New York City Department of Education, the largest inclusion program in the country, grounded in strength-based practices. She is Co-PI of an NSF grant entitled, “Developing Abilities and Knowledge for Careers in Design and Engineering for Students on the Autism Spectrum by Scaling Up Making Experiences” which is an expansion of an earlier NSF grant entitled "IDEAS: Inventing, Designing and Engineering on the Autism Spectrum".

These projects leverage strengths and interests of 5th through 12th grade students on the spectrum to develop social competence and potential career pathways. Dr. Patten has published and presented nationally and internationally on topics related to examining the efficacy of public school inclusion models and viewing autism from a strength-based or abilities-based model. She was awarded the 2022 Eleanor Clarke Slagle Lectureship by the American Occupational Therapy Association, the highest academic award in the profession, for her work entitled "Finding our Strengths: Recognizing our Professional Bias and Interrogating Systems".


dennis cleary

Dennis Cleary, MS, OTD, OTR/L, FAOTA

Dr. Dennis Cleary has over 25 years of experience as an occupational therapist.  Dennis’ clinical practice has been primarily with children and adults with intellectual disabilities to encourage their full participation in all aspects of life at home, work, and in the community. He has had faculty positions at The Ohio State University and Indiana University. As a researcher, he has been on teams that have received over seven million dollars in grants from state and federal agencies, including a National Institutes of Health multisite trial of the Vocational Fit Assessment, an age-appropriate transition assessment, which he co-created. He has numerous publications and national and international presentations. Dennis is passionate about increasing the role of Occupational Therapy in transition-age service with the goal of improving outcomes and quality of life for all. 


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