Rethinking Our Approach to Fostering Language and Social Development, Matt Braun

2/24/2017

Rethinking our Approach in Introduction Schools and the Community: Taking a Strengths Based • Who am I? Approach to Fostering Language and Social Development • Who are you?

• What are we doing here today? Matt Braun, PhD, L/CCC-SLP Speech Language Pathologist Owner- Speech & Language Solutions, LLC

Getting Started Our Goal

To reiterate some of the common themes we’ve heard through the Evaluate the evidence. conference: Evaluate our practice. From the folks at Notre Dame (ACE)- Welcome, Serve, Celebrate

Create a culture of Inclusivity in our schools and communities (define How can we make changes? communities) What’s our plan to make those changes? This is a Journey….It takes time….but what are we doing to promote inclusivity in my school and community See Handout

Overview Traditional approaches

• Review Traditional Models of Practice Medical model and Subsequently, More Traditional Models of Practice • Introduce Strengths Bases Practices • Focusses on what is wrong, broken, or needs “fixing” • Review theory and evidence for Strengths Based Practices • In general physical health, something (a system, organ, bone, muscle, etc.) is • How to apply strengths based practices in the classroom broken, hurt, weakened, etc. • Questions/Comments/Discussion • Moving in to more social sciences we’ve tried and tried to apply this same model • Speaking in this way suggests that the problem lies within the person and implies that something is wrong or broken inferring there is something to fix (Saleebey, 2009)

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Traditional vs. Strengths Based The Evolution of Family Centered Approaches to Care Care and Strengths Based Practices • Traditional deficit based approaches aim to fix what is broken or support a disability.

• Professionals tend to over estimate the negative effects of disability conditions Various Healthy People National (1990, 200, Organizations 2010, 2020) Adopt the idea rd Family of Family • Systems are set up to foster deficit based approaches (e.g. DSM-V, ICD-10, 3 Centered Care Centered Care Party payers) Movement, Focus on 1979 Deficits, Fix a • Strengths based approaches aim to build on what already exists or enhance Problem current abilities (or strengths) Traditional Not One Agreed Upon Definition Medical Model of Family Centered Care

A General Consensus on Family Theory, Evidence, and Application Centered Care of Strengths Based Practices • Respect for all team members (including families as team members) • A focus on family strengths and resources • The Strengths Perspective (Saleebey, 2009) • Cultural competence • Positive Psychology (Seligman & Csikszentmihalyi, 2000) • A balanced and trusting relationship between providers and families • Neuro-diversity (Muzikar, 2016) • Active partnering between families and team members • Empowerment • Positive Deviance (Lindberg & Clancy, 2010) • Services be differentiated, solutions focussed individualized, goal oriented, and community focused

(American Occupational Therapy Association, 2010; American Speech-Language Hearing Association, 2008; Braun, Dunn & Tomchek, 2017; Christon & Meyers, 2015; Committee on Hospital Care & Institute for Patient and Family-Centered Care, 2003, 2012; National Center for Family Centered Care, 1989; Zajicek-Farber, Lotrecchiano, Long, & Farber, 2015)

Strengths Based Approaches are Finding Bright Spots more…. A framework • Be Solutions Focused rather than Problem Focused A philosophy A way of thinking “Even in failure, there is success” A way of approaching our work

than an actual practice….. Chip and Dan Heath Switch: How to Change Things When Change is Hard Our practice becomes strengths based when we put the skills, abilities and existing resources of the people and families we serve at the center of our care- Rather than focusing on the disability or disability condition

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Narrow Framing & Applying Strengths Based The Spotlight effect Practices • We often operate with just the information in front of us…..There’s • Focus on positive usually a much bigger picture • Focus on strengths

• Let’s ask questions, become better informed and widen the spotlight…. • Shifting the starting point from what is wrong to where we are, what exists, and how to build on it. • In doing so, we’ll find the bright spots… • What is wrong is still good information, but in many instances, goes Chip and Dan Heath without stating. Decisive: How to Make Better Choices in Life and Work

Traditional Practice Models Strengths Based Practice Models Focus/Emphasis A person’s vulnerabilities, deficit and/or A person’s strengths, capacities, abilities Strengths Based Practices…. problem situation; must identify a cause and surrounding resources; forward to work towards an outcome focussed

• Do not end in identifying strengths and positive Attitude/Perspective Families require expert help to solve All families have resources; Problem attributes problems; Providers and systems are the situations create opportunities for primary source of growth and change. families to uncover those resources and realize potential. Growth and change • Providers must go beyond simply reframing problems comes from the individual and families and finding strengths. Provider and Family Roles One directional relationship; Two directional relationship; Both families Professionals hold the expertise and and providers bring expertise to the table • Identify resources that support the use and application knowledge to solve problems of identified strengths when challenges arise Environment/Context Emphasizes a diagnosis or problem Emphasizes each families’ individual condition as starting point of service strengths, unique situation and culture as starting point of service

See Tables Handout (Bransford, 2011; Early and GlenMaye, 2000; Saleebey, 2009; Weick, Rapp, Sullivan, & Kisthardt, 1989)

What people with autism are Applying this Idea saying Temple Grandin Examples of individuals who have used strengths and interests to build unique opportunities for work. John Elder Robison • Emma: Master Shredder Michael John Carley https://open.abc.net.au/explore/103775 Daniel Tammet • Embrace the Shake- Phil Hansen Stephen Shore What Parents are Saying: https://www.ted.com/talks/phil_hansen_embrace_the_shake Jesse Sperstein Ron Suskind • Gregory Blackstock- https://www.brainpickings.org/2011/12/02/blackstocks- collections/ Zosia Zaks Roy Richard Grinker • Rising Tide Car Wash- http://risingtidecarwash.com/

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Harnessing strengths and interests Harnessing strengths and interests

“Consider the preferences of the individual with ASD as “Consider a person’s sensory preferences as an essential being equally important to the use of an evidence-based prerequisite to all learning situations, but especially during intervention. Provide individuals the opportunity to activities that include social interaction. By taking steps to choose their peers, activities, and environments as the minimize sensory-based challenges, families, educators, and foundation for successful focused intervention service providers may provide more comfortable contexts for approaches.” social interaction.”

(Stump, Dunn & Tomchek, 2017) (Stump, Dunn & Tomchek, 2017)

Harnessing strengths and interests Harnessing strengths and interests

“Obtain feedback from individuals with ASD about social intervention “Increase the value of conclusions from traditional quantitative research by practices. Such information would prove useful to the educational, incorporating more “real world” evaluation. For example, Pragmatic research, and service provider communities and direct practices related to Clinical Trials (PCTs) allow researchers to measure the effectiveness of a explicit social skills training, naturalistic and guided intervention therapy practice during normal, daily routines (MacPherson, 2004). Such approaches, and family and self-initiated supports. Perhaps a more hybrid methodology may provide the most efficient path to finding truly comprehensive review of existing qualitative research about social effective approaches for teaching something as dynamic as strategies for interventions is a first step toward increasing attention to individuals’ social socializing. As the world of social interaction continues to rapidly evolve experiences.” (e.g., technology-based communication, social media, etc.), there will be a corresponding, ongoing demand for new and effective approaches to social intervention.”

(Stump, Dunn & Tomchek, 2017) (Stump, Dunn & Tomchek, 2017)

Strategies Harnessing strengths and interests

• Consider where STRENGTHS and INTERESTS intersect http://projectkeepitreal.com/stephen-shore

• Connecting children to content by INTERESTS

• Connecting children to others through SHARED INTERESTS

• Using INTERESTS, STRENGTHS, and ABILITIES to build skills in deficit areas

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Strategies Two Pronged Peer Buddy Approach

• CHILD LED learning in concert with adult led learning 1. Peer buddy in social- a coach/mentor • Tapping all areas of learning (MULTISENSORY approach to learning) 2. Peer buddy in academics and organization- • Teaching and re-teaching a wing man of sorts.

• Peer buddy system for support, friends, and learning.

Lots of Talking….. But who’s Walking? Temple Grandin • Effective Professional Development

• What’s Your Plan? “I’m certainly not saying we shouldn’t work on deficits. But the focus on deficits is so intense and so • How will you measure and adjust? automatic that people lose sight of the strengths…If even the experts can’t stop thinking about what’s wrong, how can anyone expect the families who are dealing with autism to think any differently?” See Handout

• “…When it comes to a child with a disability, doctors and educators, Are we Helping, Fixing or Serving? and parents too, can easily spend too much time on what the child cannot do, meanwhile not noticing “Helping, fixing, and serving represent three different ways what he can do. We can be so busy of seeing life. When you help, you see life as weak. When you dealing with what is absent that we fix, you see life as broken. When you serve, you see life as ignore what is right before our eyes. whole. Fixing and helping may be the work of the ego, and It’s often difficult to understand that what we need to make visible is service the work of the soul.” not darkness but light...” - Rachel Naomi Remen Roy Richard Grinker Unstrange Minds p.280

STRENGTHS BASED APPROACHES IN MY PRACTICE

Rate Each Statement according My plan to increase the visibility of this strategy with all the people/ families/ to our 1 – 5 rating scale My current rating units I serve 1=10% or less 2=25% 3=50% 4=75% 5=90% or more

1. I recognize that regardless of life situation, EVERY person/family/ unit is capable and has resources to support their own development

2. I can write down at least 5 strengths of every person/ family/ unit I serve

3. I am confident that no matter what a person/family/ unit indicates as their interests and priorities, I can find ways to support them within those areas

4. I know every person/family/ unit’s daily life routines and have a record of how they spend their time

5. After I complete an evaluation, I can write down at least 5 strengths of every person/family/ unit I serve

6. My goals explicitly address the person’s participation in THEIR everyday life

7. All my plans harness strengths of the person/family/ unit, with no attention to the “weaknesses”

8. I spend intervention time supporting people/families/ units to identify their strengths

9. I identify the ‘uber’ strengths* of the person/family/ unit to support them to recognize their unique identity and potential contributions of ‘uber’ strengths

(Dunn, W., 2016) Rethinking our Approach in Schools and the Community: Taking a Strengths Based Approach to Fostering Language and Social Development- Presentation at the FIRE Inclusive Education Conference, Kansas City, MO, February 24, 2017

OUR GOAL Evaluate the Evidence and What is NEW Evaluate my Practice

What Changes Can I make? How Can I make these Changes?

Rethinking our Approach in Schools and the Community: Taking a Strengths Based Approach to Fostering Language and Social Development- Presentation at the FIRE Inclusive Education Conference, Kansas City, MO, February 24, 2017

Presentation Bibliography

American Occupational Therapy Association. (2010). AOTA Practice Advisory on Occupational Therapy in Early Intervention. Retrieved from http://www.aota.org/Practitioners-Section/Children-and-Youth/Browse/EI/Practice- Advisory-OT-EI.aspx?FT=.pdf

American Psyciatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

American Speech-Language Hearing Association. (2008). Roles and responsibilities of speech-language pathologists in early intervention: technical report [Technical Report]. Retrieved from http://www.asha.org/policy/TR2008- 00290.htm

Bransford, C. L. (2011). Reconciling Paternalism and Empowerment in Clinical Practice: An Intersubjective Perspective. Social Work, 56(1), 33-41.

Braun, M, Dunn, W. & Tomchek, S. (2017a). A Pilot Study on Professional Documentation: Do We Write from a Strengths Perspective? American Journal of Speech-Language Pathology. In Press.

Braun, M., Dunn, W., & Tomchek, S. (2017b). Strengths Based Practices: Barriers to Implementation and Action Steps for Moving Forward. Manuscript in preparation.

Christon, L. M., & Myers, B. J. (2015). Family-centered care practices in a multidisciplinary sample of pediatric professionals providing autism spectrum disorder services in the United States. Research in Autism Spectrum Disorders, 20, 47- 57.

Committee on Hospital Care, & Institute for Patient and Family-Centered Care. (2003). Family-centered care and the pediatrician's role. Pediatrics, 112(3), 691-697.

Committee on Hospital Care, & Institute for Patient and Family-Centered Care. (2012). Patient- and Family-Centered Care and the Pediatrician's Role. Pediatrics. doi: 10.1542/peds.2011-3084

Dunn, W. (2016). Focus on Strengths: Imagine the Possibilities. Presentation

Early, T. J., & GlenMaye, L. F. (2000). Valuing Families: Social Work Practice with Families from a Strengths Perspective. Social Work, 45(2), 118.

Grandin, T., & Panek, R. (2013). The autistic brain: Thinking across the spectrum. Houghton Mifflin Harcourt.

Grinker, R. R. (2008). Unstrange minds: Remapping the world of autism. Basic Books.

Heath, C., & Heath, D. (2013). Decisive: How to make better choices in life and work. New York: Random House.

Heath, C., & Heath, D. (2010). Switch: How to change when change is hard. New York: Broadway Books.

Lindberg, C., & Clancy, T. R. (2010). Positive Deviance: An Elegant Solution to a Complex Problem. Journal of Nursing Administration, 40(4), 150-153 110.1097/NNA.1090b1013e3181d1040e1039.

Muzikar, D. (2016). Neurodiversity: A person, a perspective, a movement? Retrieved from: http://the-art-of- autism.com/neurodiverse-a-person-a-perspective-a-movement/.

National Center for Family Centered Care. (1989). Family-centered care for children with special health care needs. Retrieved from http://www.neserve.org/maconsortium/pdf/Medical%20Home/Family_Centered_Care.pdf

Saleebey, D. (2009). The strengths perspective in social work practice (5th ed.). Boston, MA: Allyn and Bacon.

Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive Psychology: an introduction. American Psychologist, 55, 5-14.

Stump, K., Dunn, W., & Tomchek, S. (2016) Social interaction and autism: Autobiographical listerature as evidence. Mansucript in Preparation.

Weick, A., Rapp, C., Sullivan, W. P., & Kisthardt, W. (1989). A Strengths Perspective for Social Work Practice. Social Work, 34(4), 350.

Zajicek-Farber, M. L., Lotrecchiano, G. R., Long, T. M., & Farber, J. M. (2015). Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities. Maternal and Child Health Journal, 19(8), 1744-1755. doi: 10.1007/s10995-015-1688-z

Additional Reads (Not all inclusive, but some of the best reads in my opinion)

Armstrong, T. (2011). The power of neurodiversity: Unleashing the advantages of your differently wired brain. Da Capo Press.

Carley, M. J. (2008). Asperger’s from the Inside Out. New York: Perigree.

Carley, M. J. (2016). Unemployed on the Autism Spectrum: How to Cope Productively with the Effects of Unemployment and Jobhunt with Confidence. Jessica Kingsley Publishers.

Dunn, W. (2007). Living sensationally: Understanding your senses. Jessica Kingsley Publishers.

Gaus, V. L. (2011). Living well on the spectrum: How to use your strengths to meet the challenges of Asperger syndrome/high-functioning autism. Guilford Press.

Grandin, T., & Panek, R. (2013). The autistic brain: Thinking across the spectrum. Houghton Mifflin Harcourt.

Grinker, R. R. (2008). Unstrange minds: Remapping the world of autism. Basic Books.

Prizant, B. M., & Fields-Meyer, T. (2015). Uniquely human: A different way of seeing autism. Simon and Schuster.

Robison, J. E. (2011). Be different: Adventures of a free-range Aspergian. Doubleday Canada.

Robison, J. E. (2008). Look me in the eye: My life with Asperger's. Random House.

Saperstein, J. A. (2010). Atypical: Life with Asperger's in 20 1/3 chapters. Penguin.

Shore, S. M. (2003). Beyond the wall: Personal experiences with autism and Asperger syndrome. AAPC Publishing.

Silberman, S. (2015). Neurotribes: The legacy of autism and the future of neurodiversity. Penguin.

Suskind, R. (2016). Life, animated: A story of sidekicks, heroes, and autism. Disney Electronic Content.

Tammet, D. (2007). Born on a blue day: Inside the extraordinary mind of an autistic savant. Simon and Schuster.

Zaks, Z. (2006). Life and love: Positive strategies for autistic adults. AAPC Publishing.

Other Web Resources https://open.abc.net.au/explore/103775 https://www.ted.com/talks/phil_hansen_embrace_the_shake http://risingtidecarwash.com/ http://projectkeepitreal.com/stephen-shore

Comparison of Major Underlying Assumptions of Deficit Based and Strengths Based Models

Traditional Practice Models Strengths Based Practice Models Focus/Emphasis A person’s vulnerabilities, deficit A person’s strengths, capacities, and/or problem situation; must abilities and surrounding identify a cause to work towards resources; forward focussed an outcome

Attitude/Perspective Families require expert help to All families have resources; solve problems; Providers and Problem situations create systems are the primary source of opportunities for families to growth and change. uncover those resources and realize potential. Growth and change comes from the individual and families

Provider and Family Roles One directional relationship; Two directional relationship; Both Professionals hold the expertise families and providers bring and knowledge to solve problems expertise to the table

Environment/Context Emphasizes a diagnosis or Emphasizes each families’ problem condition as starting point individual strengths, unique of service situation and culture as starting point of service

(Bransford, 2011; Early and GlenMaye, 2000; Saleebey, 2009; Weick, Rapp, Sullivan, & Kisthardt, 1989)

From: (Braun, Dunn & Tomcheck, 2017b)

Case Example: Consider the family of a child with an autism spectrum disorder.

In Deficit Based Models In Strengths Based Models

The provider enters the provider-family The provider enters the provider-family relationship with preconceived ideas of what relationship with an understanding of autism the family needs. spectrum disorders and the impact this can have on families.

The provider begins by gathering information The provider begins by having the family tell about parental concerns, the child’s their story, inquiring about child and family challenges and what the child does well. strengths and the families’ hopes and desires for their child.

The provider may or may not complete formal The provider may use formal or informal testing to compare the child to other same assessments to gather information about the age peers. Based on this comparison to the child’s abilities and strengths. Based on general or typically developing child, the assessments and family input, the provider- provider develops a treatment plan. family team generates goals and targets that help the family work toward desired outcomes.

Treatment programs may include toys or Therapeutic programs will include a variety of activities specifically designed to promote activities aimed at creating meaningful development and are chosen by the provider. experiences for the child and family. Treatment activities may take place in a clinic Treatment materials will include existing setting, a therapy room at school, in the resources to which the family already has child’s home or in classrooms. access (e.g. toys in the home, the child’s favorite cup or plate). Treatment activities will take place in settings that are natural to the child and family.

The provider takes the lead on therapeutic The family takes the lead in therapeutic activities and gathers data throughout during activities and the provider is more of a coach, treatment activities. a guide or resource to the family. Data is used to track progress toward goals Together, the family and the provider monitor based on “normal” development. progress toward desired outcomes.

Once the child has met all of his goals, he is Once the family decides they are comfortable either discharged from therapy or the provider and have the necessary skills to continue to develops new goals based on the next level promote the child’s development, the provider normal development. phases out of the therapeutic relationship.

(Braun, Dunn & Tomcheck, 2017b).