#149 Neurodiversity Affirming OT for Adults with Samantha Valasek

The latest clinical practice guideline for occupational therapy for autistic people across the lifespan urges us to shift away from deficit models toward neurodiversity-affirming, strengths-based care.

But, what does this look like in practice?

We know from the research that there are barriers at every level to delivering the type of support we aspire to- from rigid service silos to inconsistent legislation. 

That’s why I’m so excited today to welcome to the podcast someone who is charting a new way forward: Samantha Valasek, OTD, OTR/L Director of OT Services, at Spectrum Psych in LA. 

Samantha delivers OT services alongside psychotherapy and psychiatry to clients with autism, ADHD, anxiety, & mood concerns.

I can’t wait to hear from Samantha about what assessment, treatment, and interprofessional collaboration looks like in her day to day practice. 

And most importantly: what it looks like—both as individual practitioners and as a collaborative team—to deliver care that supports our clients in ways that are truly meaningful to them.

See full course details here:
https://otpotential.com/continuing-education/course/neurodiversity-affirming-ot-for-adults 

See all OT CEU courses here:
https://otpotential.com/continuing-education

Check our our live webinar schedule here:
https://otpotential.com/continuing-education/live-webinars

Support the show by using the OTPOTENTIAL Medbridge Code:
https://otpotential.com/blog/promo-code-for-medbridge

Try 2 free OT Potential courses here:
https://otpotential.com/free-ot-ceus

Transcript

SPEAKER_01 0:00

The latest clinical practice guideline for occupational therapy for autistic people across a lifespan urges us to shift away from deficit models towards neurodiversity affirming strength-based care. But what does this look like in practice? We know from the research that there are barriers at every level to delivering the type of support we aspire to, from rigid service silos to inconsistent legislation. That's why I'm so excited today to welcome to the podcast someone who is charting a new way forward. Samantha Valisek, OTD OTRL, Director of OT Services at Spectrum Psych in LA. Samantha delivers neurodiversity affirming OT services alongside psychotherapy and psychiatry to clients with autism, ADHD, anxiety, and mood concerns. I can't wait to hear from Samantha what assessment, treatment, and interprofessional collaboration looks like in her day-to-day practice. And most importantly, what it looks like both as an individual practitioner and as a collaborative team to deliver care that supports our clients in ways that are truly meaningful to them. We have so much to cover today, so let's dive in. Welcome to the OT Potential Podcast. I'm your host, Sarah Lyon, OTRL, and I wanted to let you know that this podcast may qualify as continuing education for you. You are probably listening to this podcast on a free podcast platform. But to gain CEU credit, you will need to be a member of the OT Potential Club, our OT Continuing Education platform. You can go to OTPotential.com to learn more. Okay, here we go. As I mentioned at the top, joining us today is Dr. Samantha Valasec. Sam is a licensed occupational therapist who specializes in supporting neurodivergent adults with chronic conditions and mental health concerns, including ADHD, autism, anxiety, insomnia, diabetes, headaches, and migraines. She works for Spectrum Psych in LA. Many of her clients are artists, engineers, entrepreneurs, managers, students, busy parents who feel like a less draining, more enriching life is possible. She is able to provide tailored support for those possessing high intellectual and or creative ability, including gifted or twice exceptional adults who yearn to harness their strengths to create a life they love. Dr. Vallisek utilizes a holistic, goal-oriented approach that guides clients towards a more manageable daily life and greater satisfaction with their achievements. A client in her care will learn how to support their own body, brain, and mind through collaboratively developing an individualized self-management toolkit and incorporating a robust set of environmental and social supports. So without further ado, I will patch Sam into our live studio. Welcome to OT Potential.

SPEAKER_00 3:01

Sam, it's so great to have you. Hi Sarah, it's really exciting to be here. Thank you so much for having me on.

SPEAKER_01 3:09

I am so excited to talk to you for multiple reasons today. One, of course, I'm excited to talk about neurodiversity affirming care for adults. We've talked in several courses on the podcast just about this switch to what neurodiversity affirming care looks like, but we've never got to talk about it with an adult population. So I'm just really excited to hear about your practice and just what the day-to-day looks like. I'm also really excited because you get to work on this interdisciplinary team that seems like it gets to function in the way that we all aspire to, where there's close coordinations with uh your psychologist and psychiatrist. And the reality is most of us aren't on teams like that. Lots of times therapy is an asilo. We're not um in close communication. So this is really a model to me that shows that this works, that shows this is what we want to do. Um, and I just love seeing OT embedded in this mental health team. I think. I hope that's a way forward for us and we get to see more of it. Uh we'll talk more about all that today. Uh, but I really want to start with just your story and how did you become interested in neurodiversity affirming care for adults? And just what does that phrase mean to you?

SPEAKER_00 4:33

Yeah, okay, yeah. Um, so let's start with defining neurodiversity affirming care just so everyone's on the same page. So, really, it's informed by the disability rights movement, the neurodiversity movement. These were sociological frameworks and you know, advocacy that really looked at differences in neurological development as forms of biodiversity rather than through this lens of deficit and disorder. And there's this real emphasis on inclusion of these differing perspectives that come from having like being wired differently, that these perspectives are valid, they we want to support them and not eradicate them. So it really comes from, you know, there's a bit of a social justice, you know, like we're coming in and we're like providing better care because we really care about people being respected and affirmed. And uh rather than being told like we we're trying to fix you, like that, you know, that I hear that from my clients sometimes that they're trying to fix themselves. It makes me so sad. And so I got into the went down this direction because I, you know, during the pandemic, I had that moment that a lot of people had of like, okay, I'm ready for some change. And I went, I was in a large, I was um clinical faculty at the University of Southern California. So I was providing treatment, and some of my clients were neurodivergent, autistic, ADHD, had mental health concerns. A lot of them, a lot of them had chronic conditions. I was uh practicing lifestyle redesign through their faculty practice. And I decided to chart my own course and do my own private practice. And really, I decided to niche down because I was seeing a huge variety of things at my, you know, where were my first job. Um, I was like, but as a solo practitioner, they really tell you like it's time to niche down. Um so I was like, okay, what am I gonna do? I know how to do all these different things. And I thought and I paused to think about who were the clients that I really loved working with, who I knew we were really connected, and who I thought, like, oh, they're gonna come find me. They're gonna go to do the work to find me when I go out and do my own thing. Um, and I noticed that they were all neurodivergent. And I was like, what does that mean about me? And so, of course, through this journey, I ended up getting my own ADHD diagnosis and doing a huge deep dive into the topic. And so I kind of haven't looked back since um because it so it was really a matter of like this is this is who I get along with, who like we just connect. And I feel really passionate about supporting people who, you know, maybe process the world differently to appreciate themselves and appreciate their the way that they engage in the world.

SPEAKER_01 7:43

Yeah, that's where I got started. Wow, what a stunning story. One an example of someone finding their passion, niching down. I think we hear that advice, but it's just nice to uh hear from someone who's actually done that, uh, to think and also to think about the self-discovery journey that you've been on, uh, getting your own diagnosis during that. I don't think I knew that part of your story. And then I think about looking around the country, and I feel like over the past couple of years, I've seen several practices pop up with uh that are OTs looking to serve neurodivergent um adults, adolescents. But when I look at you at Spectrum Psych, the model just stands out in my mind because you're so embedded in this team with a psychiatrist and a psychologist. I would think that works really well. But tell me about uh Spectrum Psych and about your work there. Yeah, just how'd you find it?

SPEAKER_00 8:53

Yeah, yeah. Um it it so uh Spectrum Psych is an outpatient interprofessional mental health clinic. Um, and we specialize in supporting clients across the lifespan who are neurodivergent, and uh we're located in Los Angeles. We provide telehealth services across California. And we don't, we, you know, in it, we we have OT, we have psychotherapy, we have psychiatry, we also have yoga therapy, we also have neuropsych assessment and neuropsych professionals. We offer support groups, we have social groups that we offer through our nonprofit side of our business. So um there's just uh parent coaching. So there's a lot of different services that are provided. And the way that I found Spectrum Psych is through our clinical director and our senior psychologist, or our clinical director, Deanna Dow and Jamie Barstein is our senior clinical psychologist. So when I was doing my solo practice, things were getting a little lonely at a certain point, and I was doing my networking, and I was just renting uh like an hour by hour therapy space to do my practice. And Deanna, the clinic director, was also renting in that space, and that space offered a networking event. And so we just met and we started chatting, and it was mainly mental health providers, but we were the mental health providers who were specializing in autism and ADHD. And we just talked about what we each did. And number one, I give so much credit to Deanna and Jamie, who just understood the value of occupational therapy right away. They were like, oh, what do you mean you can do all these things that I don't have the training for, but I know my clients need. And I could tell that they really cared about providing high-quality services. They really cared about being neurodivergent affirming. And so pretty much immediately we wanted to partner up. And because I was offering a service that the uh clinic didn't already provide, I could at first I just started contracting with them. Um, so I was a solo practitioner. I was contracting with them, but pretty soon a third of my caseload was all Spectrum Psych LA clients. And so we were working all together frequently, kind of pretty pretty quickly within a few months. And then about a year into that partnership, they were like, Sam, can we lure you into joining our practice? I know you have your own thing, but would you come on? And I I really liked the idea of extending what I could do by getting more administrative support and things like that. Um, and being on a team, being, you know, being even more integrated onto a team and being able to grow the the OT workforce in this area. So Deanna has been a big champion of allowing us to hire more OTs as soon as we hit demand, you know, and and demand grows, we're we're bringing people on. So we now have three full-time OTs, one part-time OT, and we're bringing on a postdoc um OT in the fall. So our OT practice has grown. And, you know, I provide all of my services via telehealth since I recently moved to Oregon and I'm licensed in both states. Yeah, so that's Spectrum Psych L. I would love to tell you more. Tell me what else I should say about Spectrum Psych Light.

SPEAKER_01 12:44

I well, this story is just blowing my mind. One that you, it sounds like you found this team just through like a personal, a random personal connection and finding someone with a shared passion. Um, of the few people that I know like you were, they're really embedded on a team, on this close interdisciplinary team. That's how it happened. It happened with just like meeting the physician or psychologist or psychiatrist and just uh connecting over that shared passion. And then also the story of like being a contractor first and then joining the team. Um, I also feel like I've heard that pattern before, too, to kind of dabble in it uh before committing because it's kind of a new model.

SPEAKER_00 13:36

And it's kind of a risk when people haven't heard of it. Yeah.

SPEAKER_01 13:39

I have a billion questions about Spectrum Psych. One thing I want to clarify for sure, though, is we're definitely talking neurodiversity affirming OTs for adults here, but it seems like you also see pediatric clients. I'm curious about the percentage of that caseload. And do you see pediatric clients over telehealth and what's that like? Can you tell me a little bit about the adult pediatric breakdown?

SPEAKER_00 14:02

Sure. Um, so you know what? I probably should know more about this. So we have one. Uh I can tell you about the OT side of the thing. Yes. Um, but we do have kind of a lot of both. I think we probably see more adults than pediatrics, just because there's already so many pediatric providers for this area, but the gap in care is really for neurodivergent adults. There's not a lot that's being provided, not a lot of people who have developed a specialty yet. But we do have full-time pediatric, one full-time pediatric OT, and we're hoping our postdoc will also be seeing some children. Um, we have some psychologists who specialize in this area, and our psychiatrists definitely treat across the lifespan. I particularly work with adults and older teens. Uh so but we have I think I think our population is more adults than children, but we still see a lot of kids and we do a lot of uh assessment and treatment across, you know, across that lifespan.

SPEAKER_01 15:06

And then tell me about your role on the team where you have the psychiatrist, psychologist. Like, do they start with one of those professionals first and then get to you? What's unique about your offering? How do you communicate with each other? What's your role on that team?

SPEAKER_00 15:27

Yeah, so clients can kind of start anywhere with us. We do have uh, you know, a fair number of clients who are seeing us, you know, like ad hoc, just one of us at a time. But we are always assessing to see like, would this person benefit from something else? Because sometimes we get referrals from psychotherapists outside of our practice or a psychiatrist outside of our practice. And we're not gonna say, like, you can't see that person anymore. We're gonna just collaborate with them as well if we can offer something that they don't offer. Um, so we have some people that we see on our own, but then we have a lot of shared clients. And very often they might come in initially for assessment. They're trying, they have this question of like, life is feeling hard for me right now, and I don't know why. Um, and they're trying to figure out like, is it ADHD? Is it autism? Is it something other, you know, something else that's going on? And once they receive an assessment, we do offer, well, you know, our assessors are really good about saying, you can come see ours, but we have other people we can refer to. We always give people options of where they might receive services. But a lot of people, once they have that assessment experience with us and they know that their assessor, you know, is going to be handing that report right to the person and having direct face-to-face contact with us, they they a lot of people do want to receive therapy, OT, and all of our other services with us. And so we'll share the case and we'll just get started. We always kind of meet the client where they're at. Oh, you know, the assessor or well, like our also our admin are really well versed in what each of us does. So they can kind of start this conversation of like, here's what psychotherapy offers, here's what OT offers, here's what your doctor said, you know, trying to help people figure out where to get started if they're trying to just dip their toes into one service at a time. So yeah, that the lot of entry points. We don't have like one standardized way. We're just trying to meet people where they're at, is what I would say, and provide them the service that they're looking for. When it comes to OT's role on the team, what I love about this practice is that I feel like we really get to work to the top of our license and do the heart of OT practice, which is really focusing on how does this person occupy their time? How can we help them engage in their daily activities and pursue meaningful goals and do that with more self-acceptance, more confidence, more ease. So while the psychologist gets to focus on maybe processing the client's past or understanding their current relationship dynamics, and that helps them figure out like, okay, this is what's coming up for me emotionally, what meaning can I make of it, what new meaning can I make of it? And the psychiatrist gets to focus on med management a lot of the time. The OTs get to focus on engagement in the present moment and that coordination of daily activities over time. So we look at everything that affects that because we're OTs, we look at a little bit of everything. So we look at sensory processing and how are sensations, you know, you know, too much or too little for this person, how can we incorporate soothing sensations or alerting sensations as needed? We're looking at executive functioning, helping a person develop the systems and supports for organization, time management, memory, decision making. We can help them look at the lifestyle factors that might be affecting their chronic conditions and how do I form new habits and routines so that I'm experiencing less pain or less side effects or whatever it might be. Um, and then a lot of it comes down to energy management. So we're doing a lot of work on helping people figure out like what are what are all the inputs that are causing me to feel so drained all the time? And how do I fill my cup? How do I reduce how much energy things things cost me over time and pace myself? And then because we're in mental health, we end up having a lot of scope overlap with our psychologists. And on our team, that is not an issue. We don't see that scope overlap where no one's competing with one another, like, oh, you shouldn't do that, you shouldn't do that. We're all like, thank you for reinforcing this thing. Like they really need to hear that from multiple people. And we really feel like we're not providing duplicative services, we're reinforcing things that need to be reinforced in different ways because we have such different ways of approaching the same topics. So, you know, the psychologist and I might also we're all going over self-regulation techniques or assertiveness and self-advocacy. Like, what is our identity and our values? And how does that come up in our occupational engagement? What are the best, what is the best fit for me long term in terms of like a career or a family? All of these things have a lot of overlap with psychology, but like I said, like we're gonna come at it with our lens. And so we don't really like we're just like, yeah, uh, you know, we we we oh yeah, we had a similar conversation, but we kind of went this way versus that way. I'm so glad that you were able to reinforce this. They really need that this week is a common thing that we hear between each other. I feel like we're getting the best of both worlds where um we're not competing and we're just helping each everyone do the best work that they can by staying in communication.

SPEAKER_01 21:05

I love this because it just sounds like you're getting to do like bread and butter OT, but at the top of your license and on the kind of team we all wish we were on in all kinds of settings we wish we were on this kind of team. I have to ask one logistical question. I just want to see this in my mind's eye. Is there like a spectrum psych location where offices are co-located and people might be rubbing shoulders? I know you're remote, but is there like a main office or is are all the therapists remote?

SPEAKER_00 21:36

No, so me being remote is a new thing, and I feel very lucky that you know the company worked with me to keep me on while I made this transition for other factors in my life. But there is one location, it's in um Los Angeles. There's a clinic, we have a bunch of different offices, and what's great is we were able to customize our offices. So one of the rooms has like a futon that can fall down into a bed. So if we need to do like making a bed, it has a cabinet in it with some like laundry that we can stroll around the room and be like, okay, let's practice picking up. Or we it has a kitchen. So I I've done sessions where we're doing everything you can do kind of in a small kitchen without a full, you know, stove. And so our office and we have a PES room, you know, board games, crafts, tons of craft materials, um, all of those things. So, and we make sure that all of the rooms have a table, like has the couch, you know, has that couch arrangement that you would expect from like a talk therapy setup, as well as a table with chairs, so that whatever kind of conversation you're having or activity you're engaged in, you have the facilities for what you need to do with clients.

SPEAKER_01 22:58

I love this setting. I wish I would I've already said this, but I'm just going to say again, I just wish we had more models like this across the United States. Um, I just see how it works. I want to keep asking about uh your workplace, but I am instead going to drill down into your individual sessions. Sure. Um and let's just start at the beginning with like your eval. What's typical uh in one of your evals? I know you see all kinds of clients, but is there a general framework to your evals?

SPEAKER_00 23:33

Yeah, so I would say our eval work starts even before we meet the client for the eval. If we're lucky, we get to read the client's Neurosec report before they get started. So we have all this information. We don't have to ask them a bunch of questions or redo testing or things like that. And we also offer a free 15 to 20 minute phone consult because we're private pay. We always make sure that it feels like a good fit before someone's financially committing to, you know, therapy with us. So I also I'm already taking notes during that first call to be like, okay, I don't want people to have to repeat themselves. And, you know, our intake paperwork also primes our client for the evaluation because we know for a lot of our clients that maybe like surprises are gonna be hard, or ideating in the moment about certain things might be hard to do in like an organized linear way all the time, which is great. It's like I get the free association. I well, I want the free association, I just also want to get the information we need. So our paperwork is really structured, it has a lot of prompts, it has options so that people feel like they can answer the questions, but it doesn't take too much from them. Um, and it asks a little bit about most things we're gonna cover in an email, but with the key phrase of feel free to be as brief or as detailed as you like. So that way, if someone really wants to, you know, provide that detail in writing ahead of time, they can. But if they're like, I just want to put a one or two words here or check a box, then I know to ask more about it during the session. And one of the key things in our intake paperwork is also like what is most important for you to address. So we can really start even before we meet the person, getting a sense of their priorities. And I learn a lot from about someone just reading how they responded to our intake paperwork. And then for our evaluations, um our OT evals are 90 minutes. Um, so that gives us plenty of time for someone who might need more processing time, more time to build rapport, someone who might want to take notes during the eval so they remember things for later. And I always sprinkle in a little bit of education as we're going along or start, you know, seeding this idea of self-compassion right from the beginning. And so that time just makes it feel like we're not rushed. We get to be authentic with our clients and really connect with them. And then, you know, of course, we're gonna do a very thorough occupational profile, finding about their daily habits and routines, you know, figuring out what does life look like, where do you live, all of the things that people know how to do for an occupational profile. But with this real emphasis on what has worked for you before versus what hasn't. What are you interested in? What really motivates you? Like what would you do with the free hour? And what are like what are your strengths? What are the things that you're coming in with that like is going to be a resource while we work together? Um, so really trying to start with strengths-based from the beginning while identifying those challenges, validating that it is so painful to like have gone through life because um for a lot of clients they're coming in with late diagnosis. So it's so hard to like go through life and have challenges and not understand them. And so, you know, the eval might be the first time where they're there's hearing some words that I'm using and they're like, ah, I always had that experience, but I never had the words for it, you know. So that, or, or like, oh, I was always so hard on myself for this. So, you know, when we're going through the eval, I'm always emphasizing self-compassion, the concept of interdependence versus independence, and how like it's all it's about support systems, not doing everything on your own. And like that just right challenge with experimentation, this idea that like you're gonna we're gonna try things together. I have lots of ideas of what could work for a person and what has worked for many people, but you're really the expert on yourself. And so I'm gonna offer you experiments, and you get to choose which experiments to run and which ones you think will work for you. Um, and we're not gonna like there can be a perceived pressure on on like a particular strategy needing to work. I really try and take that pressure off from the beginning. And so basically, we're gonna agree on goals in the eval via the Canadian occupational performance measure. And then, you know, if they don't have a neuropsych, we might also do the brown executive function and attention scales, which is more of a self-report, but gives us information about executive functioning. And then when it's appropriate, the adult adolescent sensory profile. Um, so those are things that we might do in the first follow-up if we don't have time during the eval. And then always wrap up with like what to expect during the next session, like what topic are we gonna do. So I always try to make sure that people don't feel like, like I said, surprised by any step in the along the process.

SPEAKER_01 28:57

That is such a satisfying eval to hear about um so many, again, bread and butter OT things. I love your emphasis on interdependence. That's not something I hear people say explicitly, but I can I definitely hear that thread throughout therapist practices. I'm not familiar with the Brown executive function and attention scales. I have an assessment database on our site. I'll go ahead and add those. I love self-reports like that that give you um a little snapshot. So it may not be up on the website right away, but I'll get that um as a resource for people. I want to drill in a little bit uh into one thing you said about people coming with a late diagnosis. I was just wondering that about your practice overall. Um how I'm just curious, like what percentage are your uh clients who have that late diagnosis just kind of off the top of your head? And how does that change your approach like with that late diagnosis? Are there certain considerations that you're making often or educating on? Yeah, tell me a little bit more about that specific slice of your clientele.

SPEAKER_00 30:13

Yeah, so I would say that perhaps like for me personally on my caseload, I probably have like at least 80% of my clients are late diagnosed adults, um, or maybe like older teens, but like really like adults, you know, some people getting diagnosis into their like 50s. Um and so I think the biggest thing about late diagnosis is that it really is this moment for a person that is could dramatically impact their self-perception in all sorts of different ways. So some people it's this moment of clarity and like self-acceptance. For some people, it's a moment of grief, of like, well, all for all this like lost time that they feel, like they could have known this about themselves and that how that could have changed their lives. And for some people, it's like particularly because of the stigma, it is like a hard moment of like, you know, because they haven't heard very neurodivergent affirming language in their life. So they're like, oh, what is this thing? I don't want this. So, you know, that and having that as an adult versus as a you know, growing up as a child knowing this is super different. It leads to a lot more confusion and shame, I would say, because people are coming in and they've had so much criticism, they've had so much cognitive dissonance over like this is particular, because I I work with a lot of gifted individuals as well. So there's this like the concept of potential that um it just uh so heavy. So I think you know, we're always looking at like how, you know, how do we support this person who's who's having this unique moment of a new diagnosis, form a healthy identity around it and develop a relationship with it that works for them, you know, and this is where some people really like that concept of like neurodiversity and autism or ADHD as neurotypes. And some people actually feel very validated by the disability language, and they're like, no, I have a disability, and that like just like it is like things are different for me, like I engaging in the world and the way that it's built is is harder. So and I'm just like, whatever framing helps you move forward in a way that feels authentic and helps you be whole. Like I I have no stake in the game as to what perspective you take, as long as it one is one that is appearing to help you. Um but yeah, with late diagnosis, it's a lot of helping people rebuild trust with themselves because for some reason or another, they they either don't trust themselves because of you know the difficulty trusting future self or being told that their intuitions were wrong for some reason, or distrust with the medical field overall, you know, due to previous misdiagnosis or inappropriate recommendations that were made because we didn't have this piece of information.

SPEAKER_01 33:39

I'm just definitely hearing this theme of how you're following what's important to the patient, meeting them, where they're at. I loved hearing about your evals, thinking about your treatment sessions. Um, of course, you're responding to what's important to the individual. Uh, but overall, are there like common inner treatment interventions that you tend to do? Like what does that part of your practice just tend to look like?

SPEAKER_00 34:14

Yeah. So I think the the common things that people are, you know, when when people are coming to OT, they're coming because they're having a moment where things are hard very often. And so it's very often there's neurodivergent burnout or autistic burnout where people are, you know, this is not a formal diagnosis, but it's a a pattern that has this grassroots consensus kind of around it, where um there are papers that have come out around trying to define it so we can study it. Um, but basically this pattern of persistent exhaustion, increased sensory sensitivities, and decreased functional capacity, particularly executive functioning, that are all happening at the same time. And people are kind of hitting this wall, and for some they're on a medical leave, or they've had to stop school, or they, you know, they just all they had kids, and all of a sudden, like something happened that like just they hit their limit of like how much they could cope without this piece of information. And now we're helping them to figure out, you know, all of those pieces of like what is contributing to the exhaustion, um, which demands are feeling like too much, and how do we adjust them? You know, how do we be OTs and do that activity analysis with them and help them, you know, adjust lifestyle patterns, that sort of thing. And so, you know, I think the common bread and butter things are like we are doing a lot, like I said, energy management. We might be counting helping them figure out how to support sleep, how to support like basic like eating, you know, physical activity. Um, I do a lot of sort of metacognitive work around understanding how your brain works and how is that impacting your engagement in these activities? So very often people are noticing that they're having difficulty with uncertainty tolerance, or they're having difficulty with decision making. And so then we're really able to label it and come up with different ways to like, okay, how do we get comfortable with doing a thing while uncertain? Or how do we let's just use some tools. Like there are templates and tools for decision making that we can use to analyze our options. And then for you know, executive functioning things, there's basic things like visual schedules, you know, creating an anchor, some anchor activities in the day, and you know, then those sensory pieces, you know, sunglasses, weight a blanket, um, heavy work, those sorts of things. And the last big thing that I'll say about this, because there's like, you know, it's just like a long list of things that you know we might incorporate into a session, is you know, I do offer people can bring in their partners or a family member who they think would they're like, I can't tell my family member or my partner this information in the same way, or it won't be received in the same way as if you have this conversation. So we'll have a conversation with all of the parties there and just you know be able to talk about like this is what this person's experiencing. Here are the words for it, this is kind of where it comes from, the best of our neuroscience understanding, and here's how you can support this. So that's another piece. Not everybody wants, you know, friends or family in their sessions, but we I do offer it because I, you know, our social environment is a big part of our environment.

SPEAKER_01 37:49

I love hearing about all those areas you address. They all feel familiar, but I love hearing how they like materialize in your setting. Uh, one of the logistical things I'm thinking about is just your documentation and kind of like billing codes. I know you're private pay, but do you do super bills for people?

SPEAKER_00 38:11

Yes. So we're private pay, but we provide super bills. Um, so you know, we use the OT codes and then 97535, which is that self-care and home management code, 97537, which is a community and work reintegration code, and then five seven uh nine seven five three zero. I hope I said those all correctly, um, which is the therapeutic activity code. Those are the three most common codes that we're gonna use. And then we also California has something called regional centers that provides people with developmental disabilities, uh, financial support to be able to be integrated into their communities and live as independently as possible. So if Medi-Cal, which is you know California's Medicaid, denies OT services, Regional Center can actually be the payer of last resort for occupational therapy. And we can provide non-clinical services as community integration support specialists when appropriate. So we we were very clear with clients, like if we're doing something in that role, that means like if you have something that turns up that like kind of moves past, like, okay, this is to, you know, participate in school, like it goes into the more medical realm, like, okay, that we're gonna, you're gonna have to go seek, like, I can't do that within this service. So little complications, but how we try to make the services as available as possible to as many people as possible.

SPEAKER_01 39:45

One other logistical question I have about your work is is your whole team on a shared EMR? I know that sometimes that's a struggle in mental health practices to find one that works for both OTs, and psychiatrists, and psychologists. And is that how you communicate with each other? Is through this EMR? Yeah, what does the logistics of that workflow look like?

SPEAKER_00 40:08

Yeah, so we do have a shared EMR. We're all on simple practice. I would say I do look at my colleagues' notes, but most of the collaboration actually happens outside of the EMR. Um, and I make simple practice work for me by like we I've built a lot of custom templates to make it work for OT. And so the OT team meets weekly so we can consult with one another on our cases. And then every other week we have case collaboration meetings for all of our shared cases. So um all the different practitioners can come in and communicate with one another face to face. And but I would say like a lot of our collaboration is just happening with us calling and direct messaging each other with just updates about like, here's this thing, you know, uh that happened this session, could you follow up on it? Or the psychiatrist, you know, might say, like, oh, could you let me know if they're actually taking the medication? Things like that. So, or you will have things where we tell the client, like, oh, that would be really good to go over in this other session with this other provider who can address this the best. And we kind of give our our colleagues a heads up that, like, hey, this is a thing that we were hoping that you might be able to talk about. So yeah, we I would say a lot of the communication is is this more spontaneous, you know, access to each other. Um, but we do have a lot of structured opportunities to meet as well.

SPEAKER_01 41:38

I wasn't expecting to ask you this, um, and I won't hold you to your answers, but it's really top of mind for me right now. We're writing our comment layer to Medicare, and we're talking about the OT billing codes. And to me, there's a couple things that OTs do on a regular basis, and we don't have the best reimbursement pathways for. Like I know they get shoved into the codes, as you mentioned, but one, a lot of other healthcare providers have like a health coaching code, which I think would be nice for that time spent on like um working on your goals. That's one of them. Another one would be right now, it's a caregiver coordination goal. I would love it to be just like a family coordination. Uh, I feel like the caregiver doesn't resonate with everyone, but family's such a huge impact. I would love to see that. And a lot of other professionals have uh interdisciplinary um uh collaboration uh code where they get paid for that time. As I'm hearing about those practices, those are the codes that I would add for you off the top of your head. Do you agree with that?

SPEAKER_00 42:44

Yeah, I think that like I think you're right about the language of like caregiver is not appropriate. Like yes, it's a lot of a lot of the times it is they're not providing like direct care, but they are providing significant support in some ways. So I do think that that like, yeah, family, a family education or family training code would be amazing. And you mentioned, yeah, interpro yeah, of course, having some interdisciplinary care code would be great. There are these sort of health behavior codes, but then you in order to build those codes, you have to do a health behavior of special evaluation. Yeah, but I do an OT evaluation, so I can't use those other codes. So that's that feels like such a uh missed opportunity there. I mean, a lot of the times when we're addressing things like lifestyle factors, I put it under self care because it's the best fit. But yeah, it it you're right. It's like we could we could use more codes that cover more of the things. I mean, the other direction to go would be like a psychotherapy visit has one code and it's just one. We trust psychotherapists to do their work. We could just have one OT code and we just trust that OTs are doing their work also.

SPEAKER_01 44:08

Yes. Yeah. It's hard to like break the session down by these codes for sure.

SPEAKER_00 44:13

Yeah. I mean, that is like a lot of like labor we're putting on OTs. I feel like that other other professions are not asked to have to do.

SPEAKER_01 44:22

Yeah. Something I wanted to be sure to include in this conversation was I wanted to find a research article where we got to hear a little bit from neurodivergent adults. So I was able to find this research article called How Can We Make Therapy Better for Autistic Adults? Autistic Adults Ratings of Helpfulness of Adaptations to Therapy. This was published in 2025. It was talking more about psychotherapy, but we're going to talk about it broadly here. I want to tell, uh just give like a brief overview of this and then kind of get your response to the article. We both read it beforehand. So in this paper, 130 autistic adults in Australia and New Zealand were surveyed in this online survey. There were 55 items that had like a Likert scale on them. And they just wanted to see how helpful autistic adults actually find these clinician-recommended therapy adaptations. And what stood out in the results was one, there was no adaptation to therapy that every autistic adult loved. Like there was a lot of diversity in the responses. There's no single right answer. But the four most highly rated adaptations were a neurodiversity affirming approach, which we're talking about today, having the therapist uh have a high knowledge of autism, which makes sense, online booking options, that makes sense to me too, and individual one-on-one therapy sessions. The four lowest rated were having shorter sessions, less than 50 minutes, uh just being on the phone for phone therapy, group therapy was not as highly rated, and involving a family or partner in sessions was also on the lower-rated side. The author said our findings highlight the importance at an overall level of incorporating neurodiversity affirming adaptations into practice, as well as underscoring the need to understand the individual client with no universally endorsed adaptations. Um, I really enjoyed reading this article. For anyone listening to this course, I'll put it in the show notes. I recommend everyone just read it. I thought it was a helpful read. I'm curious to get your reaction uh to this article.

SPEAKER_00 46:48

Yeah, yeah. I I mean, I just thought it was like number one, I always love particularly qualitative research that is getting voices from the community that we're trying to work with. And a lot of my learning, I try to look for autistic and ADHD voices. Um, so that always makes me happy. But it also just validated a lot of the things that we're doing in our practice. I do feel like having the specialty and working pretty much all day with neurodivergent adults and having a lot of knowledge about this really helps. Like I have clients who are like, I'm coming to you because I have a therapist who doesn't have this background, and I would, I need someone with this background. And sometimes I'm doing a little bit of educating their provider on like, hey, you're addressing this pattern in this way, but actually there might be this different lens on it. Or uh recently I have a client who is incorporating more fidgets and cognitive um engagement during the therapy practice to stay within their window of tolerance while they talk about trauma. So, but they they could they had didn't have access to that with their therapist before. So I think just having that knowledge helps you to like support the person the way that they need to be supported. And of course, yeah, that neurodivergent affirming approach makes sense that that would be uh, you know, uh helpful. But I yeah, and I think, yeah, my my other thought is of course, the variety of responses. Um, like I think that's the thing that I heard from like day one in OT school was like when you've met one person, one autistic person, you've met one autistic person, like the variety of like thought and opinion and way of being in the world is just very high. And this is why I really stick with client-centered and like what language do you prefer? You know, like all of those things is because it like there is no one size fits all for like good mental health care or any healthcare really as we head into the last seven minutes of this uh time.

SPEAKER_01 49:09

I want to drill in on that like being highly informed, your path to finding expertise in this for someone else who is interested in this area. Is there anything you would recommend them to pursue learning about? It just feels like there's such a gap in services out there, and we need more OTs trained in this area, and we need more OTs to be able to find jobs in this area. Like there's only so many spectrum sites. How do we build this workforce? Um, how can we get more SAMS out there?

SPEAKER_00 49:42

Well, um, that's so kind of you. Um, so I mean, uh one thing to, you know, we have our postdoc that we're offering, and I think having more people who have this information who are willing to share this information is really important. Um, so that way newer clinicians or clinicians who are ready to pivot their niche um have access to it and can, you know, know that it's possible. When it comes to the way that I got prepared for this role, I mean, I do think the chronic conditions background was really helpful because um neuro the neurodivergent population is more at risk for a wide range of chronic conditions. I also fully read the textbook, the multi-context approach, um, to for cognition or for functional cognition. Um, and so having that background um and like doing a lot of uh investigating in and also listening to a lot of ADHD and autistic voices on like what works for them when it comes to addressing executive functioning, you know, people like Megan Anna Neff, um, who is a clinician and has lived experience, I think that has been really helpful. And then, you know, I think also develop, you know, making sure you're up to date on sensory interventions and you know, then like I you you kind of like I think hmm, the thing about working, like if you say you specialize in neurodivergence, you don't specialize in one thing, you work with people and people have all sorts of concerns. Um, so it might be mental health, but it's gonna be in so many different areas. Uh, this is a great fit for people who want to be a jack of all trades or a master generalist who like learning about a lot of different things and want to do something different in each session. So, yeah, I think it it is, you know, starting with the basics of executive functioning and sensory processing and self-regulation, and then, you know, building that from there.

SPEAKER_01 51:51

Did you do further training and like acceptance there and commitment therapy? I'm also interested in self-compassion. And I also feel like I heard the co-op approach under your, which is like a problem-solving approach. Do are any of those undergirding your practice?

SPEAKER_00 52:08

Yeah. So, like I said, um, I I you I think about things through the lens of the multi-context approach a lot. I probably use it in a more uh eclectic way. Um, I I feel like every clinician in my office, when you ask them, like what how do what how do you provide therapy? We're like, oh, eclectic. Um so I weave that in as a um a way of addressing functional cognition um and like reducing supports over time, that sort of thing. You know, so we do do the weekly calendar planning activity as one of our functional cognitive assessments sometimes. Um particularly if someone doesn't already have a neuropsych that can give us some insight. Yeah, so yeah, acceptance and commitment therapy, um uh, you know, dialectical behavioral therapy, kind of just trying to pull in a lot of like the mindfulness and somatic work, um, because straight CBT doesn't always work. We really want to focus on antecedents. We want to focus on like setting people up for success rather than hitting the same wall over again and then trying to like be like, okay, I just have to think about this differently. It's like, no, like how do we actually prepare and like set up for a better life? So I would say that the, you know, having that the background in third wave mental health approaches and and and uh cognitive approaches that are based in functional cognition, not like executive functions in these neat little boxes necessarily, but how do they come together to for interaction in everyday life?

SPEAKER_01 53:51

This has all been so helpful. I could have lingered on every uh kind of area we talked about and asked a billion follow-up questions, but I'm so uh just like I want to use it just say proud of the work you're doing. I love the model at Spectrum Psych. I wish there were more Sam's, I wish there were more Spectrum Psyches um around the country, around the globe. We've talked about so many important things today. What's the final thought you want to leave us on?

SPEAKER_00 54:23

You know what? Uh I think that I'll end with this like we're all just walking each other home, which is a Ramdas quote. But it I really like it because it really speaks to the humility and vulnerability that is demanded of the practitioner. Um, we're all just walking each other home. A lot of clients will kind of try and compare themselves to me or the people in their lives. And I think really breaking down hierarchy, breaking down the divisions between ourselves and just being real with one another. Like, I actually think the therapy, we, you know, the one thing I didn't mention through all this is like the therapeutic relationship, like being interested in what your clients are interested in, being proud of their strengths, that goes along, and then you know, having that deep expertise is helpful, but you know, really connecting with them and and showing them that like you we're just doing, we're doing this together. Um, I'm not doing this to you, and you're not doing it alone. That's that's the big thing that I think I get from working as a mental health OT with the neurodivergent population.

SPEAKER_01 55:37

Well, Sam, what a powerful end to just an awesome conversation. Thank you so much for sharing today for the work that you do. Um, I know I'm going to be chewing just on that end line that uh we're all just walking each other home. Thank you for sharing that and for all that you shared today. Uh, thank you for this conversation.

SPEAKER_00 55:59

Yeah, thank you so much for having me. This was so much fun. Um, yeah, it was a blast.

SPEAKER_01 56:08

Thank you for joining us on the OT Potential podcast. To earn one hour of AOTA approved continuing education for your time today, you will need to sign in or sign up at OTPotential.com. Once you're in the OT Potential Club, you will find a five-question post-course quiz connected to this episode. When you pass the quiz with a score of 75% or higher, you will be able to download a PDF certificate that certifies your completion of this course. Okay, I want to thank you for joining us today, and we'll see you next time.