Interview between Speaker 1 (Meg Ferrell) and Speaker 2 (Bryden Carlson-Giving)
Episode 90: The Cultural Model of Disability and Empowering Practice Frameworks
[Introductory note]
Hey, it’s Meg. If you love this podcast and you are a professional supporting Autistic people, this is your moment to check out the Learn Play Thrive education hub at learnplaythrive.com/trainings. We have three free masterclasses and a whole catalogue of neurodiversity-affirming, on-demand continuing education courses, including a brand-new course on trauma-informed practices for Autistic people. We also have an annual continuing education summit with an incredible panel of speakers. All of our courses are registered with AOTA and ASHA for CEU’s and many are registered with NASP for school psychologists and ASWB for social workers. Check it out and get your continuing education credit in a way that’s truly meaningful and aligned with your values; learnplaythrive.com/trainings.
[Introductory music]
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 our professional therapy practices. I’m Meg Ferrell, formerly Meg Proctor, from learnplaythrive.com broadcasting to you today from unceded Tsalagi territory.
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’ because this is the preference of most Autistic adults. Being Autistic is a part of their identity that they don’t need to be separated from. Join us in embracing the word ‘Autistic’ to help reduce the stigma.
Welcome to Episode 90 with Dr. Bryden Carlson-Giving. Bryden has been an enthusiastic member of the Learn Play Thrive community from the beginning and is now making waves in the field of occupational therapy by creating a truly empowering and affirming practice framework. In this conversation, we talk about the limitations of evidence-based practice as it exists now and what we can be doing instead. We examine the limitations of the social model of disability and explore what it looks like to use a cultural model of disability. If you’ve never heard this term before, don’t worry. Bryden explains it during the episode. And then, we really dive into examples of what it looks like to apply an affirming framework to our work and practices. While this conversation is more centered on occupational therapy practice than some of our episodes, we also talk about how all of this is relevant beyond the field of occupational therapy.
I’ll tell you about our guest. Dr. Bryden Carlson-Giving is a queer, neueodivergent, and disabled occupational therapy practitioner. With experience in pediatric outpatient and inpatient settings, he’s currently working in a school-based setting. He recently completed his post-professional doctoral program, in which he developed the first neurodiversity-affirming occupational therapy model, which is titled ‘The Empowering Neurodivergent Occupational Participation & Well-being’ (EMPOWER) Model. Y’all, the acronym is EMPOWER. I love a good acronym that really lands. So, it’s the EMPOWER model. You can find Bryden and his work online at neurodivergentnexus.com. This conversation is so exciting, and I can’t wait to share it with you.
Hi, Bryden. Welcome to the podcast.
Bryden:
Hi, Meg. I’m so honored. And thank you for having me.
Meg:
Yeah, you’ve been around Learn Play Thrive since the beginning. I remember seeing your name really early on and watching your story unfold as you move through your PhD program, and I’m excited to sit down and chat with you.
Bryden:
Yeah. I’ve been really enthusiastic and it has been really fun to kind of go back to like 2017, 2018 when I first discovered Learn Play Thrive with like your first course and just see how Learn Play Thrive has really adapted and evolved. It’s a really beautiful thing.
Meg:
I want to jump into your story, Bryden. Can you tell us about the work that you’re doing and what your path has been like to get here?
Bryden:
Yeah, absolutely. And before I dive into that, I just want to make clear, too, just about language and positionality. I know you do a great job of talking about how we use identity-first language when referring to Autistic people. And I’m going to be using the same language when describing disabled people, instead of person-first language. This is in support of the disability studies approach to viewing ableism and disability, and I always like to recommend to anyone though when in doubt, always ask the community or the individual what language they prefer. And I really most want to quickly talk about privilege. I am a white, cisgender, queer, disabled, allistic occupational therapist. I do want to acknowledge that I have used strategies that are not recognized as neurodiversity-affirming in the past and have been ableist, and will not recommend or use these services as I continue to learn and listen to disabled voices, and continue to dismantle my own internalized ableism.
Okay, so yeah, about me. I am a neurodivergent and disabled occupational therapy practitioner. And I currently work within the public-school setting. And I just recently completed my post-professional doctorate this past August through Boston University, which I love so much and would do it all over again. And my work focused on creating a toolkit to support OTP’s in challenging ableism within the profession, throughout the entire OT process with a component of the toolkit being the conception of the Empowering Neurodivergent Occupational Participation & Well-being (EMPOWER) model.
Meg:
What sort of changed your path, Bryden, as you started in I imagine in a more traditional model, like all of us did, and then at some point went, “Wait a second, this is not what I set out to do”?
Bryden:
It’s really beautiful that you asked that because actually, so with the program, you’ll work on your doctoral project for the entire two-year, two-year program. And actually about, like, halfway through the program, so about once I was done with one year, the program, my project was actually very different. I was going to try to create like this traffic light of evidence to help support OTP’s and selecting service, like different supports and techniques that were more not only just evidence-based, but were also incorporating lived experiences and such and trying to combine EBP with lived experience. But then I realized that, you know, much of our much of our research within OT and just healthcare in general often does not include the marginalized communities that we’re intending to serve. So, a lot of the research on about Autistic people, neurodivergent people about, like, what’s best practice doesn’t include the voices of Autistic and neurodivergent individuals. And like, so I actually had this big kind of like, like scare. I’m like, “Oh, my gosh, this project, it’s actually utilizing a broken system. What can I do instead?” And then, I completely shifted the project. You know what, no, I’m gonna make a toolkit that helps OTP’s and really navigating each stage of our OT process to be as affirming as possible. Yeah, that one year point, I was like, freaking out and reached out to my mentor. I’m like, “I can’t do this anymore because of this. It doesn’t feel right. Can I switch my project direction?” So yeah.
Meg:
That’s so interesting. We’ve critiqued evidence-based practice before based on what outcomes is it studying, right? Because people say ABA is an evidence-based practice. But the outcomes don’t center the person’s well-being, right. They center other outcomes that we would not actually consider positive outcomes, knowing what we know about masking. And this is a little bit of a different critique added on to the idea that evidence-based practice, as the evidence exists now, is the gold standard, right? So, what advice do you have to people who are living with the pressures of evidence-based practice period, with the limitations of our evidence base not reflecting the life experience of especially multiple-marginalized disabled?
Bryden:
Yes, right. Like, especially, especially with like intersectionality, and like, oh, my goodness, yes. I mean, I came out of — I graduated with my masters in 2018. And I came out of school, like, evidence-based practice is the highest quality standard, I need to be as EBP as possible. Like, if you’re, if I don’t use EBP, you know, I’m not providing the highest quality of care with my clients. And it’s just so interesting how that has evolved to actually, like, much of our research is ableist and it’s a dance that I’m still learning myself how to do that dance between how to utilize the research with lived experience and lived experiences.
And so, what I do actually is any research article that informs my practice, I ensure, like, I read through it that like an Autistic or neurodivergent shareholder is actually authentically present throughout the entire article. It’s not just like the researchers are like, hey, we asked them one question and then their participation was done. It’s like, no, they helped formulate the entire study or the entire article. And then, like another way to do it is, you know, for a lot of neurodivergent people, the health and well-being part is just positive mental health, positive self-esteem. And if I see resources online on like social media that are like different supports, then I’ll just look into the evidence for like that is completely done by with Autistic and neurodivergent people and what kind of way this mental health support versus this other mental health support, to see which of these supports that this community actually prefers more than the other. That’s typically what I do.
Meg:
We have quite a few podcast episodes at this point by Autistic or where I’m interviewing Autistic researchers. And we’ll link to those in the show notes so people can go back through because we have a number of different lenses that people have provided for us, similar to what you just gave for how to look at and critique research. It’s interesting, I get a surprising number of emails and social media messages for people asking me for research showing that we shouldn’t use hand-over-hand without consent. And that’s where I, that’s where I feel like we’ve really gotten off track because I’m like, it’s the code of ethics. Like, we don’t need research to show us that people have the right to bodily autonomy. Like, these things are assured by our internal moral compasses, I would hope, and then reaffirmed by our code of ethics. The burden isn’t on evidence to show those things. And you can show evidence about rates of sexual assault and, you know, forming routines and all of these other things, but sometimes saying, “Well, this is evidence-based practice,” is missing the mark if we’re starting with not harming.
Bryden:
Mm-hmm. Absolutely. Like, you and many of your other interviewees really have done a good job of talking about how like, yes, like, we want to provide the highest quality of care with our clients, with our students, those we support. It’s just, it’s a slippery slope with EBP because the vast majority of EBP’s were like not designed for or even appropriately standardized with non-white, disabled, or queer individuals. And it’s like, kind of what you’re saying, when a support or when a service is determined to be effective, who is the intervention actually effective for? Is it actually effective for supporting the neurodivergent person? Or is it effective for like the teacher or the family? Or like what society views as right, you know? And what are the outcomes? Who’s defining those outcomes? And I think with EBP, too, since it’s so entrenched with the medical model of disability, too, like it, I feel like in a way, there’s like an under the table assumption with EBP that it’s, when it’s viewed — its main lens when viewing disability, like EBP fixates on like reducing or eliminating disability and, you know, kind of given how EBP has these ableist tendencies, kind of calls on the question of the meaningfulness of EBP.
Meg:
It does. And for those of us who are anchored to evidence-based practice, this isn’t permission to go all in on pseudoscience, right? We have other things to guide us. And I think it’s lovely being an occupational therapist. I know a lot of our listeners come from other fields, and they have their own anchors, but occupation guides us, right. Meaningful and authentic participation in daily life. But, like you just sort of brought to light, if we’re not careful — well, and even when we are — we’re often overlaying ableism onto that. So, you know, we’re critiquing evidence-based practice. And that’s not just a blanket permission to segue into pseudoscience, right? If evidence-based practice is our only anchor, it really shouldn’t be. We have other things that guide us. What do you recommend, if we’re starting to critique evidence-based practice, what can we sort of put in its place?
Bryden:
Yeah, there’s been kind of, there’s been two alternative approaches to EBP. They’re called ‘community defined evidence practice’ and ‘lived experience informed practice’. So, community defined evidence practices, CDEP, it actually originated with the National Latinx Network, aiming to kind of close the gap between culturally and community relevant practices and published research. And CDEP is defined as a set of practices that have yielded a positive consensus with the community over time, or successful application of practices developed with significant community input. And what I really love about this kind of framework is that it emphasizes that communities are the experts on what is meaningful and important to them.
Lived experience informed practice was first proposed by Sonny Jane Wise, a remarkable queer and disabled advocate. And the whole premise behind this is that lived experience is the foundation. Like we talked about how EBP, yes, there’s that third, there’s the third part where it’s clients’ unique circumstances and values. But okay, how often do we actually consider that part of EBP in our practice? But also, lived experience is not like a, like the first requirement when it comes to kind of figuring out what you want to use. And I really love how lived experience informed practice really emphasizes that. Lived experience is the foundation. Like, utilizing research evidence to inform practice is sometimes optional, especially if that research does not validate the experience. And I really love those two frameworks a lot.
Meg:
Thank you so much for sharing those, we’ll link to some resources around that in the show notes as well. I want to talk about how we view disability for a minute. So, we often critique the medical model of disability on the podcast, and we talked about the social model of disability. I’ve heard you talk about the cultural model of disability. Can you explain what that means and why you like this model?
Bryden:
Absolutely. Even just for a quick little review, like, you know, with the medical model, medical model naturally creates ableism. There’s like this binary of non-disabled, healthy, or like disabled, sick binary, and there’s no requirement for society to change. And I even would argue that there’s no place in the world for the medical model to even be considered because the disabled experience is not even considered. So, yeah, this social model. So, like a big part of my project was trying to figure out a really holistic and authentic view of disability. And so, I was actually originally going to use the social model. But then, I was reading a lot of the literature, you know, so like, the social model really emphasizes that there’s a difference between impairment and disability, coined by — officially coined by Mike Oliver. And his traditional social model defines disability as barriers within society, like kind of like a political focus, and disability as a result of social oppression. And typically, to sit from his definition, disability is not related to the individual’s impairment. The social model has, I appreciate everything that the social media has done for disability rights. And I think it’s also healthy to you know, have conversations about maybe ways that we can either improve upon the social model and maybe other models, too, as we have more research and lived experiences.
But a lot of people have criticized the social model often focuses too much on how our capitalist society is the cause of disability. The social model has a heavy focus on separating someone’s impairment versus disability. And so, disability activists, even including myself as a disabled person, like you could remove all of the environmental societal barriers, you could even in a dream world remove ableism. But, like, our impairments, may still — like, my impairments still can have such negative impacts on my life that my impairments in and of themselves are disabling to me. And, yeah, even some scholars have even talked about how, like, non-Western scholars, have advocated that the social model of disability kind of neglects culture and how various cultures even define disability. Because ideas of disability vary over region, social class, and culture. And even actually, a lot of the research kind of criticizing the social model, the traditional model, have been from those with chronic illness and mental health disabilities, too. I know there’s some work being done about having a reformed social model that kind of helps to re-emphasize that kind of holistic view of disability. But yeah, I think disability is far too complex than, like, society being a barrier and is causing disability and someone’s impairment. I don’t think it really captures the complexity and the richness of the disabled experience.
Okay, so yeah, cultural model. I really love how the cultural model, devised by David Mitchell and Sharon Snyder from the University of Chicago, I really love how the cultural disability really prioritizes the lived experience of disabled individuals across contexts. They kind of attempt to merge sociocultural, physical, political, even psychological dimensions. They actually attempt to eliminate that disability and impairment are always separate. Like, they’re never, they’re never linked, and they emphasize how the cultural model highlights that disability must be considered in a given culture; and ultimately, how the disabled individual illustrates the lived experience and function within that culture. I think the cultural model really helps to allow the disabled individual to really define disability on their own terms. I feel like, too, like something I’ve been even navigating within myself, even with like the social model, like right now with neurodiversity, I think there’s like a pressure sometimes that you can’t ever be frustrated with your neurodivergence, you have to always accept it. If you don’t, you have internalized ableism. Like, I feel like there’s that pressure. And what I love about the cultural model is that it really allows, really allows the person to really dive deep into that and really explain that disability identity is more complex than accepting your disability and feeling empowered by it.
Like I’ve said, like, I have depression and post-traumatic stress disorder. Would I ever want to ever wish I wasn’t an ADHDer? No, I really, I really enjoy it. I really love being in ADHDer. Do I ever wish that sometimes I didn’t have depression and PTSD? Quite often, yes. And I think for some individuals, like them hearing me like, you know, I’m not super embracing of my depression or my PTSD yet, or there’s days where I wish I didn’t have it can be kind of like, “Wait, you have internalized ableism, you need to be accepting of all your neurodivergencies, and, you know, you’ll be a better advocate that way.” And so, I really love the how the cultural model frames disability kind of allows, that allows that really, that rich, beautiful complexity of disability identity. Sorry, I know that was a lot. But yes.
Meg:
No, thank you. Thank you for sharing all that nuance and your personal experience. Why is it called the cultural model?
Bryden:
Yeah, so the cultural model really is about how, like, because in many other, especially in non-Western cultures, how the social model defines disability often would actually not resonate within those cultures. There’s been a lot of research, exploring non-Western cultures and their views of disability. And quite often, how the original social model defines disability, would it really fully resonate with those disabled individuals? Because in some cultures, environmental barriers are not as much of a barrier, it’s more of the impairment. And it’s really about centering someone’s lived experience, especially within the context of their culture, time. And that might vary between disabled individuals. And that’s also okay.
Meg:
That makes a lot of sense. I want to start zooming in on how all of this can impact our practice. It feels really good to think about our frameworks that are happening, often invisibly, to us. And then there’s always this question of like, what does this mean for my work? I know in most fields, we have practice frameworks that are supposed to guide our work. I will tell you, I wasn’t particularly inspired by the practice frameworks I was taught in occupational therapy as a graduate student. I know that in fields like psychology, they’re much more robust and have a much more clear impact on the work people do. Can we talk about why we need practice frameworks? And what’s the harm if we just kind of ignore them?
Bryden:
Absolutely, yes. So, I was actually the kind of the same boat like you’ve been. I’m sure most OT students were when they’re in the programs, like why did we learn all these practice frameworks, they’re so dull, or there’s no direct application. And I will admit, I was one of those students. But upon graduating and especially within my doctoral level work, I really learned to appreciate practice frameworks. So, I think like with practice frameworks, they really provide, whether you consciously are aware of it or not, they really provide the lenses on which you view your clients, you view yourself, and you view the world. And, you know, and they change over time, like even with OT, they initially started with kind of more of an occupation-centered practice, but then switched gears to like within the 1980s of this more medical model kind of focus to kind of like legitimize our profession to the medical community. In frameworks for like what OT educators teach, they grasp on how we would view disability.
And I feel like if we ignore frameworks and how they influence our practice, it’s very challenging, I think, to provide high quality care with those that we support. Now, you know, even the neurodiversity model, or just the application of neurodiversity is a framework in and of itself as well. I think the tricky part is, is it’s kind of similar to evidence. I mean, who is defining the frameworks, and like, what we should be focusing on is the outcomes that we should address. And I think that can be, it’s really exemplified with our, like our AOTA’s, our own framework, like there’s no discussion on ableism. And even for me like the descriptions, the examples that they provide within our framework for occupations, like they don’t really, I think, authentically illustrate neurodivergent occupational participation. Have you read AOTA’s — its 2022, it’s like their position paper. And this is what they call it in quotes, ‘Autism Spectrum Disorders Across the Lifespan and OT’, have you read that?
Meg:
I’ve read the AOTA’s Autism Spectrum Disorder book. But despite the title, that was written by Dr. Kristie Patten with a number of Autistic co-authors. I don’t think I’ve read the position paper.
Bryden:
Oh, my goodness. So, like, I think this position paper, because it really uses our framework to try to help guide how OT’s support Autistic individuals. You know, our framework, was it informed by any disabled neurodivergent or Autistic otherwise individuals? And I think that kind of error really illustrates pretty loudly within that position paper. I mean, throughout this paper — it was 2022 as well, like it wasn’t just like 10 years ago. I mean, it’s pretty new. This position paper provides a lot of ableist examples of how OT supports occupations like tolerating sensory aspects of like grooming activities, expanding play interests, just a lot of these like neurotypical occupations, ableist goals were present throughout these this entire position paper. I think for me, too, the case study, one of their case studies for an Autistic adult, they literally have the Autistic adult within this case study mentioned, in quotes, “I would like to experience intimacy like neurotypicals do,” end quote.
Like, that actually happened. And there was no, there was no conversation about how maybe the OT could help, you know, validate how Autistic individuals, how they experience intimacy very differently than neurotypicals do. There is no, like, no mention of trying to coach and provide support with kind of navigating some of the internalized ableism experienced by the Autistic adult. Nope, there was no conversation about that. It was just, here’s some ways that you can support this Autistic adult to experience intimacy more like neurotypicals. And that really shocked me and throughout the entire position paper, like I said, this is authored by AOTA using our framework as a guide. There is no mention of neurodiversity, no challenging the medical model, no mention of Autistic OT’s or shareholders advising or informing the article. And I feel like it’s a really, it’s a good example of what happens when we create and apply frameworks about a marginalized community without them.
Meg:
That’s a very compelling point. I think for those of us who are searching for our self-compassion, especially OT’s of like, “Why was I doing this?” Our practice framework did lead us to the practices that we were using or that we have been using, I have the OTPF — the Occupational Therapy Practice Framework — in front of me, because I was recently looking through it, too. We’re an AOTA approved provider. So, we use that framework to get all of our courses approved for AOTA CEU’s. There’s a lot of, in the performance skills, ‘Person sends messages about mental health challenges of an appropriate length’. And that’s effective performance. Ineffective performance is ‘Person sends prolonged messages containing extraneous details’. Lots of comments in the ineffective performance in different specific skills: Using a loud voice, using slang, asking an unrelated question, not nodding, or using words to acknowledge someone talking to you. This is like a meeting at a social security office. I mean, it’s racist. It’s ableist. There’s so much wrong with it. And you’re right, that is impacting our work.
I want to talk about the practice framework that you created. Just have one more thing to say about the OTPF conversation and I wasn’t planning to add this, but when you were talking about that position paper, I got really excited because we have a talk in the 2025 Summit by Autistic social worker Jen Harr on Autistic dating, love, queerness, and asexuality. And I just got Jen’s learning objectives yesterday. And they’re things like ‘Differentiate the way neurotypical and Autistic adults learn about, experience, and understand sexuality’. And she’s asking, specifically asking therapists to critique their ideas about how Autistic people should experience sex, dating, and sexuality. So, I’m really excited about that. Couldn’t be more different from what you just described.
Bryden:
Yeah. I mean, it’s actually really, it’s such perfect timing that you mentioned how you delved into the practice framework and really noticing, especially in the performance skills, because I actually had within my notes to talk about some of those, but to alleviate some time actually deleted them. Because like one of the ineffective ones was like ‘Staying on topic in a conversation’. And as an ADHD, or we have a lot of, like, info dumps or momentary contributions, where we kind of maybe share something that maybe feel like a tangent, but actually, it just inspired a memory, or it’s, it actually is very relatable, just kind of give us some time to explain it. And it just, yeah, fully agree.
Meg:
It needs an overhaul for sure. I’m curious folks from other fields, if their practice frameworks have something similar, okay. So, I love the emergent nature of your pitch in your work that you thought you’re going in this direction, then you were like, “Oh,” and then you kind of started going over here. And you were like, “Oh!”, and it unfolded, as you saw the biggest needs that you could identify. And you wound up creating this model called the EMPOWER model. So, I’m going to quote you from your website, you say, quote, “The original conceptions of occupation were not developed with neurodivergent and disabled individuals, requiring a paradigm shift for how we support neurodivergent occupational participation. There are no current frameworks of occupation prioritizing authentic neurodivergent wellbeing, resulting in the first neurodiversity-focused occupational therapy model.” So, I want to ask you all about this, I’ll give a quick caveat for folks who might not be familiar with OT that when we say occupation, we’re not specifically talking about work. But yeah, their participation in meaningful daily activities that they need or want to do. So, even for folks who aren’t in occupational therapy, we’re all supporting occupation. So, in response to this limitation of our practice frameworks that you found, you developed the EMPOWER model. What is the EMPOWER model? What does it entail? How does it work?
Bryden:
Yeah, and I will say, like, this model creation, I wasn’t like aiming to really create something like this. When I ended up switching gears in my project, I just was — actually, I think, I was just literally talking with my husband, we were like watching the Real Housewives or something. And I was always just like, “You know, Zach, you know what? I’ve been reading about a lot of neurodiversity-led, and like disability activist literature across all disciplines. There’s really these common themes that I’ve been finding. We don’t have an OT model to help guide really practitioners in providing neurodiversity-affirming services and supports. Do you think I should try to like just give it a shot?” And he was like, “Absolutely, you should.” And that ended up leading to the EMPOWER model, the Empowering Neurodivergent, Occupational Participation & Well-being model. It was initially conceptualized by me, but I do want to say that I’ve had some feedback from disabled OT’s and academics around the world to kind of like shift some wording and consider some things have been so, so helpful.
The model was inspired by common themes found within disability advocate and neurodiversity-affirming literature. So, like the four foundations, I’ll make sure to send a link with like a visual of it. But like in the center of the EMPOWER model, or like the, on the outside are like the foundations, like the four kind of underlying things that we want to be considering when we’re applying the process, sectioned in the middle. So, for the four foundations of forming the model, the first one is trauma-informed care, I was reading a lot about how neurodivergent individuals are even more likely to be exposed to traumatic events, much of which is due to experiencing ableism every day. So, we should always be considering trauma-informed care. The second foundation is disability justice, which is a coined term by Sins Invalid, a collective started by disabled women, queer women of color, and it kind of aims to secure the rights of disabled individuals by authenticating that the disability experience is incredibly complex, intersectional, and they just do such a wonderful job. The third foundation is strengths-based practice, which I think if you have had even someone listening to this podcast, because you do such a great job, Meg, of like illustrating strengths-based practices that I’m sure folks are well aware of strength-based practices. And then, the fourth foundation is anti-racism. So, you cannot be neurodiversity-affirming and like not be anti-racist. Racial justice is an essential component of disability justice and affirming care, and we need to center intersectionality within our health equity conversations.
And this passage that I’m going to quote is from, I look up to them so much, from Dr. Khalilah Johnson and Dr. Ryan Lavalley. They said, “Occupational science and occupational therapy must recognize how occupations themselves manifest racism, and how occupations contribute to promoting and reproducing injustice.” I thought that was amazing. Because I think we always think of like all occupations are, they’re good occupations, and they, you know, they’re all positive. It’s like, actually, no. Many of the occupations that we participate in can actually be harmful to others. And I don’t think we’ll ever think about that. So, those are the four foundations to help inform the process. So, like the cycle, like the steps of how to actually be neurodiversity-affirming. It’s kind of like, like a really, really tweet, modified version of the practice framework. So, like, the first step is critical reflexivity. Critical reflexivity is like the capacity to see one’s perspective and assumptions, and how — and understand how like one’s perceptions, assumptions, and identity are socially constructed through critical reflection. Like, we don’t, within our framework, we don’t have any requirement to really reflect on our racism, our ableism, I mean, really our discriminating conceptions of thought. And I fully believe that OT’s are required to reflect on all of these things and be aware of like where they’re at, you know, within their kind of anti-ableist, anti-racist journey.
And then, the second part is inclusive evaluations. A big part of this is really, like you’re centering the disabled individual as the primary source of information. And so, using assessment tools that maximize lived experiences, and addressing environmental barriers, you’re writing empowering goals, and you’re utilizing strengths-based documentation and goal writing. Step three is affirming supports and service delivery. I’m not really a fan of using occupational therapy treatment as much anymore because for me, like the syntax of ‘treatment’ implies that neurodivergent ways of being need to be intervened upon. And there’s like this under the table implication that like neurotypicality is the ideal benchmark of functioning. And so, I just love like, yeah, services and supports, because it feels like we’re providing services with individual not like to, like more collaborative sounding. Step four in the process is neurodivergent occupational participation and outcomes.
So, a lot of this is about like, what are the health and well-being priorities identified by disabled individuals. And really, really unpacking our current views of occupation and really shifting our mindset on how occupations, what they actually look for neurodivergent individuals. Like, a really quick example is like I think for with our framework, or just I think with how we view healthy leisure activities. I’m sure some, a lot of OT’s or a lot of individuals are like, “Some days, I play video games for like, six to seven, eight hours on the weekend.” And some, you know, and I think a lot of people would be like, [gasp], because, you know, for ADHDers, we like to hyper focus we get, we dive into the world, we just get — we are like, in a very beautiful way, are like consumed by the video game universe, really, like a really common occupation by ADHDers. I think a lot of people are like, “That’s unhealthy. That’s not like, that’s just not a healthy occupation, because you only should be playing a couple hours,” and that. And then, step five is advocacy. And I like to think of this process as like a never-ending cycle. It’s like a continuous process of self-reflection. So, yeah, that’s the EMPOWER model.
Meg:
Thank you so much. And so, it’s so very different than anything I was exposed to when I was becoming an occupational therapist. And I will say it’s kind of stressful — it’s quite stressful — not to have a framework guiding you as you start to practice. And I think that’s why — I mean, Learn Play Thrive started tiny. You saw it. I was just like, anybody want to talk about this together? Like, is this helpful to anybody? And people were, people are really, really struggling knowing what to do in their work. So, it’s lovely that you’ve created a resource that’s concrete and practical, ties into systems of power and oppression in a way that I think speaks to our deeper values of what we want to be doing in the world, the people who show up here. Is this framework really specifically just for OTs, or is there any use or application outside of occupational therapy practice?
Bryden:
I absolutely believe that the EMPOWER model can be used by other professionals. I mean, yeah, the entire model focuses on occupational therapy, but I mean, it’s a therapeutic process. So, I feel like other, especially other healthcare disciplines, speech therapists, physical therapists, social workers, like, you know, they all do their own version of evaluations, they do their own version of providing services and supports, and targeting some form of an outcome. And so, I feel like it can easily be tweaked. I also think because a lot of it is talking about these four foundations that are really common across interdisciplinary, disability-led publications and resources that I think that helps to kind of make it really easily adaptable. And I will say, too, within my doctoral project, there’s a like 25, I think, actually, I think it’s like a 25-page appendix with a massive table for each of the foundations and each of the steps of the process, how you actually can implement tomorrow aspects of like that foundation and process. So, I try to really, really make it super duper concrete.
Meg:
Oh, what an incredible resource. All right, let’s talk about what this looks like in action, Bryden. Can you share a case study or two that show what it might look like to actually use the EMPOWER model in practice?
Bryden:
Yeah, so I’m gonna use the name Sora. Sora is one of my favorite video games. So, let’s just say like Sora, Sora is a seven-year-old Autistic child and the OTP is going to be evaluating them. So, like an example of the OTP implementing the first step, critical reflexivity, is the OTP wants to reflect on their current views of neurodiversity and ableism. And so, like, I even have this within my table, and I’ll provide links for this as well. But there are some really great options out there. So, like the Bridges Learning System, I think they were on one of your podcasts. It’s amazing.
Meg:
They were, yeah.
Bryden:
Yes. Oh, my gosh, yeah. So, amazing. They actually have a free, like, tool. It’s the Assessment of Individual Ableism tool. And then, another individual, I think it was a part of her PhD project, but she created and validated a neurodiversity attitude scale to kind of help gauge where you’re at with like neurodiversity, ableist kind of attitudes. For step two, for inclusive evals, you know, the OTP, like, would examine which affirming assessment tools are most likely to garner information regarding Sora’s participation in daily life, and really kind of, for me, assessment tools, a lot of them are just really centering lived experiences. And they also in some way talk about the environment and how the environment might be a barrier. So, maybe the OTP selects a child’s Sensory Profile to — bless Winnie Dunn — to learn more about Sora’s sensory processing patterns. And then, to look at participation in daily activities. I really love the Perceived Efficacy of Goal Setting System, the PEGS. It is remarkable. It’s created by a Canadian therapist, of course. They do amazing work. And what I really love about the PEGS is that it would help Sora with really identifying from their perspective, like these a bunch of different functional activities and how they feel that they’re doing within those activities. And it really encourages conversation about like, “Sora, like what do you want to work on?” And like really creating goals with the individual.
And a lot of people will say, like, “Oh, but what if you know the individual, they can’t share what their goals are, if they’re really young, and they don’t have access to robust communication,” all that stuff. Well, I like to tell people, if really, the individual can’t share what their goals are, I always like to say, really center, like, your team, make your best clinical judgement on really what the goal should be really focusing on how the individual can lead like a self-determined life basically. That’s the foundation, like, how are we lead — how are we doing that with our goals? And then, for steps three, affirming service delivery. And for step four, neurodivergent outcomes. The OT would select programming strategies that target occupations prioritized by Sora. And for Sora’s example, they are positive self-identity, friendships, and self-efficacy skills. I have an appendix within my project that I collected a lot of, I reviewed a lot of like reviews done by Autistic and neurodivergent individuals about what they find their health and well-being priorities are. So, there’s like a table, actually even divvied up by our practice framework. And, you know, surprise, surprise, the only like medical model-esque health and well-being priority, or just the medical part is like pain. And that’s because our current assessments of pain don’t consider how neurodivergent and Autistic people view pain, so it’s actually about changing them.
So, affirming strategies are that the OT utilizes resources by Autism Level Up in OT’s for Neurodiversity, collaborating with Sora to identify tools that are most meaningful to them. And so, for the final step, advocacy, the OT provides this data to Sora’s teacher and their family, along with OT’s for Neurodiversity’s resource, the neurodivergent versus neurotypical communication styles. And also, the fidgets or tools by Autism Level Up resources to help advocate and educate everyone on differences in social communication and how unrestricted access to these tools can really empower Sora with their co-regulation skills. I know it’s a very, very brief case study. I look forward to like actually sharing more at length, more complex case studies. I do want to kind of share some examples of like directly applying one of the foundational concepts, that I’m going to choose disability justice. These two examples are from Yell et al’s 2022 article. It’s amazing. So, like, two examples of applying disability justice principles are, like, it actually goes back down to like our drive for independence. So, like, I think it’s a very Western ideal that like striving for independence should be the absolute goal. And I feel, you know, dependency is an essential aspect of humanity. It’s valid, it’s beautiful for an individual to not need to learn how to be independent in activities and really benefit from support from a caregiver. And for a lot of disabled individuals, having that assistance actually leads to far greater meaningful participation and performance than like aiming to achieve for independence.
But the second example, is acknowledging crip time. This was a whole brand new, beautiful concept to me. So, crip is a reclaimed slur by disabled individuals and kind of like queer for queer individuals. It talks about how disabled individuals benefit from extra time and effort, secondary to the plethora of barriers that exist within an ableist world. And what I love about crip time it’s that it’s a concept that recognizes and embraces that disabled individuals benefit from more flexibility, time, and accommodations, and really, like, signifies liberation, like it talks about, like, it really helps the disabled individual reclaim and celebrate how time is experienced differently by disabled individuals. And, like with Sora, it’s really kind of educating the team like, you know, Sora requires more processing time, Sora requires, you know, maybe Sora can, you know, really like providing that accommodation that Sora is going to complete a test at school, Sora gets to help pick the environment that feels the best for them, that helps them to, you know, feel more successful in completing tasks. And making that okay, like, it’s not like an accommodation that we’re going to try to extinguish or remove as they get older. It’s like really valuing accommodations. It’s like we all use accommodations; it’s just some are more socially acceptable than others. But yes, thanks for listening.
Meg:
Thank you. Yeah, is there anything from the conversation that you want to bring us back to or anything that we missed that you’d like to add?
Bryden:
Yeah. Disability identity, I feel, is super, super complex. And I think we need to go beyond. I think, right now, a lot of practitioners are doing a good job, if they’re interested in neurodiversity-affirming practices, they’re doing a good job of like not forcing eye contact, using identity-first language. And I really challenge us to recognize that most of the frameworks that we use within our profession do not authentically support neurodivergent people. And our ableist predispositions and a dominant medical model really kind of obscures our OT lenses, kind of making it hard for us to see how actually like we perpetuate systems that harm the communities that we intend to serve. And so, we have to be okay with being vulnerable and being wrong, having these tough conversations, and we need to commit to do better. And I totally, absolutely believe that we can. There’s no other health profession that’s as exquisite and holistic as OT. And I think when we provide disability justice-focused OT, we really provide care that is not focused on like neurotypical expectations, but really support neurodivergent well-being, like authentic flourishing in life. And I think there’s nothing more beautiful than that. Oh, and for the listeners, yeah, I will be, I’ll be publishing a neurodiversity-affirming OT book with fabulous co-authors. That will be published in March of 2026. And the book will be called ‘Neurodiversity-affirming Occupational Therapy Practice: An Anti-ableist Approach’.
Meg:
So exciting. This is going to be a very robust set of show notes for this episode. And we put those that learnplaythrive.com/podcast because you’ve mentioned so many different resources, you’re really a wealth of knowledge and resources in a wonderful way. For folks who don’t make it there, tell us where can we find you and your work online.
Bryden:
Yes, I have a website. It’s www.neurodivergentnexus.com. And I have also an Instagram. I’m also a wedding photographer, so it kind of mixes photography with some of my neurodiversity like more activist stuff, but my Instagram is @BrydenCarlson_Giving. And also, too, Meg, I know I’ve mentioned a lot of resources and to kind of help you I have compiled any article that I’ve mentioned or resource, I have like a preliminary list of those for you that will send to you.
Meg:
Thanks, Bryden. And thanks for all your work. We need you in our field, and thank you for your time today.
Bryden:
Again, super honored to be part of your podcast, and really proud of where Learn Play Thrive has gone since like 2017, 2018, when I discovered it. So, super amazed by you. Thank you.
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