Relationships as Catalysts for Growth

Examining the DIR® Model from a Lens of Diversity, Equity and Inclusion
Nucha Isarowong, PhD, LICSW, IMH-E®Barbara Stroud, PhD

The aim of this session is to highlight how a focus on diversity, equity, and inclusion directly impacts all of our relationships. Learning to identify and understand our biases and assumptions can lead to changes in how we establish and maintain safety and connection. The goal of this discussion will be to make use of the DIR® framework as a template to infuse DEI into service delivery and fundamentally are relationship-based work. Our hope is to ignite discussion around:When focusing on the self we must include the impact of structural racism as well as systemic inequity within all of our systems. How do we address issues of the self within the context of flawed systems? How do you actively seek to create space for others to be seen, heard, and known? The DIR® framework provides opportunities to integrate principles of diversity, equity and inclusion while expanding our capacity to create space to be seen, heard, and known.

As a result of this presentation, participants will be able to:

1. Recognize the connection between the concept of diversity and systems of oppression
2. Identify two ways that deepening self-awareness enhances one’s capacity to engage in intentional, accountable, and responsible healing relationships
3. Outline at least two ways the DIR® framework provides opportunities to integrate DEI principles into our current work with children, families, and communities and promote healing relationships

The Importance of Relationships in Building Homeplace to Protect Black Autistic Joy: A Virtual Fireside Chat
LaChan V. Hannon, PhD and Michael D. Hannon, PhD, LAC (NJ), NCC, BC-TMH

Researchers acknowledge how the experiences of Black autistic people and their families are virtually absent from educational research and research about autistic people. During this conversation, we offer insights and perspectives as parents of a Black autistic person, using hooks’ construct of homeplace and the critical need for trusting and affirming relationships, to understand the need for safety in school and community spaces. Drawing on tenets of self-study and co-autoethnographic methodologies, we provide recommendations on the ways service providers can help create homeplace to nurture and protect Black autistic joy through our singular and shared narratives.

As a result of this presentation, participants will be able to:

1. Assess how aligned their organizations’ and agencies’ norms and practices reflect homeplace for Black and other diverse autistic people;
2. Practice culturally responsive, relevant, and affirming engagement interventions to support the parents and caregivers of Black and other diverse autistic people;
3. Distinguish between the psychosocial aspects of autism for Black families in comparison to other diverse families.

In Conversation with Kieran Rose, The Autistic Advocate
Kieran Rose with Tyler Choate, MS, CCC-SLP

In this open and frank conversation with Kieran, we will explore being your authentic, Autistic-self in both public and private relationships.
As Kieran is well known for his writing, training and advocacy work, we will be asking him what it means to feel seen, heard, and known as an Autistic person in the advocacy space – especially as not all feedback is positive (as being in the public eye can bring as much negativity as it does positivity.)
And also, we’ll get personal by discussing what it means to be seen and heard in your own home as an Autistic parent to Autistic kids. With three Autistic kids aged 14, 15 and 11, this is bound to be an interesting part of the conversation!

We hope this conversation will support you to;

1. Understand more about yourself as agent of change (both for change within yourself and for the people the work and live with.)
2. Understand how providing space to be your authentic self can provide healing as well as the catalyst for deeper understanding of your Autistic identity.

Restoring Nurture
Pradeep Gidwani, MD, MPH

Nurture is “to care for and to encourage the growth and development of another” and is fundamental to the human experience. However, the ability of nurture can be disrupted. Participants will explore how nurture is fostered in the parent-child relationships, how nurture can be disrupted and restored. The impact of trauma, marginalization, and post-traumatic growth on nurture will be examined. Participants will learn a theoretical model of healing that they can apply to their clients.

As a result of this presentation, participants will be able to:

1. Identify three major disruptions of nurture.
2. Apply the three step process of building resilience
3. Name the three elements of healing relationships

Reflective Practice in the DIR® Model
Barbara Kalmanson, PhD

Tracking the ebb and flow of the influence of internal states on external reality is an essential tool in guiding practitioners’ interventions in all family focused fields. In every discipline, practitioners experience reactions or responses outside of their expectations. Using self-reflection helps us all to turn personal feelings into useful information and insight about the possible internal experiences of family members, and supports everyone’s capacity to sustain empathy, even in the most trying situations. A parallel process emerges to support the parent – child relationships as the parents experience feelings of being understood rather than brittle or criticized in their vulnerable moments. This presentation dives into the qualities of relationship characteristics that embody Jeree Pawl’s well known statement: “How you are is as important as what you do.” We will address the development of self awareness, curiosity, contemplation, emotional responses, and parallel process as building blocks of personal and professional development for DIR® practitioners across all disciplines. Practitioners do their best work when they are aware of their own reactions, tolerant of them, and able to use them to inform their intervention processes.

As a result of this presentation, participants will be able to:

1. Name four complex relationship networks they encounter regularly in their work.
2. Describe components of reflective capacity.
3. Define parental insightfulness.
4. Describe elements of how the parents’ inner life affects their perceptions of their child.

Communication of Inner State for the Autistic Population
Rachel Dorsey, MS, CCC-SLP

Speech-language pathologists and occupational therapists commonly address difficulties in identifying and communicating feelings, sensations, and emotions in autistic clients they serve. However, this process is easier said than done, as clinicians frequently utilize either surface-level or too complex, failing to meet autistic clients where they are in their expression of inner state. In this presentation, Rachel Dorsey, MS, CCC-SLP will walk learners through how to meet autistic clients where they currently are and then build upon it in regard to their clients’ communication of feelings, sensations, and emotions. A general process will be described and demonstrated through clinical examples from Rachel’s work with autistic clients and lived experience as an autistic person.

Developing Attunement: FAN as a Tool for Collaborative DIR® Work with Families
Rebecca Berg, MS, OTR/L, IMH-E®; Socorro Cornejo, SLP; Kristin McNally, MSR, OTR/L, IMHM-C®

FAN (Facilitating Attuned Interactions), is a model created by Linda Gilkerson, PhD to provide non-mental health practitioners a conceptual framework and practice tool that supports self-awareness, reflection, attunement, and collaboration with families. FAN operationalizes the use of self, providing a framework for the practitioner to be aware of their own emotional state moment-to-moment while simultaneously supporting them to be present and attuned to the caregiver’s emotional state. This process uses the collaborative relationship between practitioner and the family during the DIRFloortime® session as the pathway to nurture their sense of confidence and competence in their relationship with the child.

In this session, clinicians Kristin McNally, Socorro Cornejo, and Rebecca Berg introduce the FAN and share their experience and reflections integrating this model into their DIR® work with families.

As a result of this presentation, participants will be able to:

1. Describe how the use of FAN as reflective tool can support the DIR® practitioners to be attuned and responsive to the affective experience of the caregiver regardless of their professional discipline
2. Describe how the use of FAN as an attunement tool can operationalize a collaborative partnership with caregivers, co-creating interventions that are respectful and inclusive of the family’s values and culture.
3. Describe the use of FAN as a self-awareness tool that can support practitioners’ intentional use of self through self-reflection, self- compassion, and mindful self-regulation practices.

Elle’s Journey: Inviting Connection, Communication, and Self-Agency through Radical Collaboration
Cortney Grove, MA, CCC-SLP, I/ECMH-C®; Jeannie Gutierrez, PhD; Barbara Kalmanson, PhD

Clinical professionals spend significant time studying and practicing in specific areas of development, but in DIR® we recognize how vital it is for professionals to understand the unique role that other disciplines play in a child’s developmental progress. Increased collaboration and intervention planning across domains allow for functional and lasting therapeutic progress. Additionally, true collaboration flourishes when the family system is centered in the intervention process.

“Radical Collaboration,” as our team calls it, requires significant commitment and time to ensure team members are able to communicate regularly, co-construct intervention plans, reflect jointly, and consider in nuanced ways how each clinician’s expertise may be employed at specific points in a client’s developmental timeline. It allows clinicians to hold families as an integrated but adaptable team, able to respond effectively to changes in family priorities, dynamics, and needs as factors shift over time. When used with respect, humility, and conscious intention, transdisciplinary work affords ongoing opportunities for reflection, support, and shared problem-solving to maximize progress. This also becomes a protective mechanism for clinicians who willingly delve into challenging clinical cases on a daily basis. Having partners with whom to consider the work, especially when scaffolded by the framework of DIR® and ongoing reflective supervision, becomes the catalyst for growth of the child, family, and clinical team members alike.

We will present a family that we think exemplifies the reflective practice we employ and how the process unfolded over time to illustrate radical collaboration in action. We began our journey with Elle and her family when she was almost 4 years old, over two years ago. Within our practice mental health was the initial service, while Elle was on a waiting list for occupational therapy. The parents arrived in a state of deep worry and concern for their daughter. They had recognized very early in Elle’s development that she evidenced significant challenges with engagement, communication, and reactivity to expected sensory experiences, which led to great emotional dysregulation and difficulty sustaining sleep. Given these intense early concerns they began intensive speech and language therapy when Elle was a toddler. However, after a year and a half of therapy services progress was not occurring. That meant that when parents reached out to our team, they were feeling a great sense of urgency. How we as a therapeutic team received this family, especially how we engaged and connected with parents and of course with Elle was of great importance to beginning the journey of helping support Elle’s developmental growth and progression. Could we create space to hold the parents’ real concerns, could we give hope for growth, could we hold the family as we ourselves learned about Elle to begin working toward the parents’ desired goals? Could we build a team that included all the needed professionals and maintain a sense of purpose and progression?

This case provides a powerful example of how reflective practice and collaboration are central tenets of therapeutic work in DIR®.

As a result of this presentation, participants will be able to:

1. Describe the ways in which a collaborative treatment model provides a protective mechanism for both families and clinicians throughout the clinical process.
2. Explain the importance of communication and collaboration among and between therapeutic team members.
3. Discuss the importance of partnering with the family, of holding and creating space for hope and also for the emotional ups and downs that occur while hoped for developmental goals are met or are slow to unfold.
4. Describe the process of anticipating, recognizing, and accepting change as the child and family grow and progress and the therapeutic team is needed less.