Latest / The STA Clinician Podcast / Ep.288 Neurodivergent Inclusion in Health Settings — The Reflective CPD Journal with Sarah Meharg & Rosi Sexton

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Ep.288 Neurodivergent Inclusion in Health Settings — The Reflective CPD Journal with Sarah Meharg & Rosi Sexton · The STA Clinician Podcast

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You're listening to the STA Clinician Podcast, connecting clinicians across healthcare.
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So 288 of the STA Clinician Podcast, formerly known as the Sports Therapy Association Podcast.
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My name is Matt Phillips, creator of runchatlive.com. And as always,
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this episode is being recorded live on the Sports Therapy Association YouTube
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channel and Facebook page at eight o'clock UK time on a Tuesday.
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So in this episode, entitled The Reflective CPT Journal, Neurodivergent Inclusion in Health Settings,
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I will be joined very shortly by my special guest, Sermy Haag,
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an occupational therapist at Moodlifter,
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and a neurodivergent accessibility and inclusion consultant,
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and also Rosie Sexton, an osteopath at Alton Health and Performance,
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as well as host of the Everyday Athlete podcast,
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and the first British woman to compete in the UFC.
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Sarah and Rosie are co-founders of the recently launched NeuroFlect UK,
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a neurodivergent-led social enterprise focused on improving how health education
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and workplace settings understand and respond to neurodivergent people.
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And they've recently published a reflective CPD journal. That's exactly what
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we're going to be talking about very, very shortly.
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I should also mention that Sarah and Rosie are two of the wonderful moderators
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in my Facebook group, Neurodivergent MSK Clinicians, which is an online supportive
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community for musculoskeletal clinicians who identify as neurodivergent with
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or without formal diagnosis.
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A link for that group will be in the show notes.
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Right then, if you have joined us live, then feel free to take advantage of
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the fact you can ask our guests' questions directly.
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I'm going to have a little look now in the comments. If you do leave a comment,
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then I can bring that up onto the screen so everyone can see your lovely face or logo.
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What have you got there? For example, talking of lovely, here we go.
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Jessica Janeman has joined us, or Janeman, is saying, good evening.
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Hey, thank you for joining us.
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And Sir Glenn Murphy has also joined us, saying hi all.
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Gary Benson, founder of the STA, is also in here, saying hi all.
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Hope all is well and dry in your world.
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Yeah, we had some of that as well. And people are still coming in.
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So yeah, if you have joined us live, then do feel free to ask questions and
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just reflect, leave some experience, whatever you, whatever you feel.
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Or just sit back and listen. And if you listen to the podcast and you've got
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some questions, then you can always leave them on YouTube after the show.
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And we do keep a track of that and we can answer any of your questions later on.
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Right, I've left them down long enough in the lobby. So let's get to it.
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Episode 288, The Reflective CBD Journal, Neurodivergent Inclusion in Health
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Settings with my special guests, Sarah Maharg, I said it properly, and Rosie Sexton.
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All good did you hear my first attempt at your surname i think i went sarah mehawk,
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and then the fact that you went back and was like do you know what this time
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i'm gonna nail it and you did it's fine i did tonight it's fine and i've called
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rosie rosie and not rosie so so far we're fine right so welcome thank you so
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much as always for giving up your time this evening
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just to let people know where are you in the world out of interest sarah you've
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already spoken so People can guess, but what was it? No, you've got this. Where are you?
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And it's the accent lies because I've lived in the Midlands as long as I've
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lived in Liverpool. So I've got this weird accent going on.
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But I am a Scouser, but I'm based just by Birmingham Airport in Solihull.
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There you go. Fantastic. What a lovely part of the world.
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And Rosie? I am also in Solihull, which is where I have my clinic.
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Fantastic. Right. So there you go. And I think we'll just jump straight into
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it, if that's okay with you.
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Maybe if we jump into, I mentioned the recent launch of Neuroflect UK,
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which can be found at neuroflect.co.uk.
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So Sarah, maybe you could tell us first of all what it is, why you launched
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it, and then after we can have Rosie joining in and saying how you and why you got involved.
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So we're a not-for-profit that has got, we've been registered as a CIC,
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so community interest company.
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And the whole purpose of it is around us improving accessibility for neurodivergent
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people in healthcare, education and work,
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because we just know through our clinical practices how many barriers people
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experience and the health inequalities and the work inequalities. Yeah.
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For about 20 years, there's been a little bit of a value in my head of,
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oh, I'd like to be involved in a CIC or a charity or a social enterprise.
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And over the years, what that looks like has changed in idea.
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Then when there was the pandemic and I had 2019 decided to go self-employed, very wise idea,
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I decided to head back into the NHS and was
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involved in a project looking
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why autistic young people
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were having more admissions into mental health hospitals and why they were in
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there for longer and from that piece of work I got involved in other pieces
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of work ended up doing some delivery on national autism train the trainer program for NHS England.
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And I was doing that all alongside my self-employed
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practice doing one-to-one work and I
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love my one-to-one practice but it felt
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like there are so many systemic changes
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that are you can
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make one person's life better but unless we look
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at that bigger system and culture and
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I met Rosie what year was the Birmingham Commonwealth Games that we were both
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at an event for it and it would just happen that we had.
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I went marching over to ask some very...
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Deep questions about fat phobia because I had lots of large clients that had
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had negative experiences.
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Of musculoskeletal professionals so I wanted to
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suss out Rosie and it just turned out we
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had a lot of shared values and and
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other things in common such as
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in Europe we got on extremely well very quickly so we
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we started small with applying
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we talked about wanting to put a
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training course together and I was
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like it's all very well having training but my experience
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of training delivery is that you
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give people information but whether that translates
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into practice is very hit
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and miss depending on how the training's
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rolled out how the reflection and that
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support for change happens which got
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us onto this idea of reflective journal we applied
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for a small grant for my professional body from royal college
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of ot just pilot the training and
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start pulling together some sort of cpt journal and
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a couple of years later we're in a position where we're
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ready to launched those and I was
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like actually now's a really good time to fit this under the umbrella of something
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that's bigger than me bigger than Rosie that we want this to be an organization
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that isn't about us as individuals but it's about our shared values and bringing
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in other people who share that so we launched in April and the.
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Journal has had lots of little bumps in the
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road but the paperback version is officially
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now available to buy and the hardback is
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we're just running through basically it was
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ready to publish and then we noticed
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a really minor error on the front cover and we've had to go through the process
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of publishing it all over again so we are in the midst of getting all those
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little the design's been sorted and we're just waiting on all the systems to
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catch up so that that's going to be available to buy.
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So that's kind of the very long-winded version of how it came to be.
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I'm sure that's the short version. I'm sure there's a lot more whines and problems
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and rollercoaster rides getting there.
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Yeah, I mean, I've followed you as you were getting the journey together and
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yeah, I think there was a lot of problems, wasn't there, and issues of getting those stuff out.
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But I'm really interested to hear what you said towards
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the beginning where you work with people who need help
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and you just realize you can only do so much because it's
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like the system closes so many
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doors and even if you're there with a person working one-to-one you're just
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seeing all the time this would be great if this wasn't the case and this wasn't
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the case so you felt is it in my mind and thinking that was it you thought I
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can do what I can do as a single individual occupational therapist here but
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I've got to try and do something to help change the system if I'm really going
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to help these people absolutely and I've come from an NHS and education background.
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I know how higher education works. I know how NHS works.
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And I know how many good people work within these big systems,
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but also how much inequality happens.
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And what I really loved about my role in the National Autism Programme was because
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the training was delivered over a month, it was a day a week.
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You'd have people very quiet in the
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first session and then the second session
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someone would go oh in the
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last week I just and then they they talk
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about a change that they'd seen the opportunity to make in
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their practice and it would always be I just and I was like hang on that's made
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a huge difference to the people that you're supporting that you've noticed a
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barrier or you've noticed an opportunity to really bring out people's strengths
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and to support engagement.
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And it was all those little I just moments that over the course of these two
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years delivering to hundreds and hundreds of people, I was like,
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you can see that butterfly effect of all the changes that can happen.
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So for me, it went from, I love my one-to-one work and I intend to carry it
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on because I'm really passionate about it but it really felt that some of the
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things that feel obvious to me with my lived experience of neurodivergence plus
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my 20-odd years of clinical experience.
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Aren't common sense they're not obvious but with people being curious with asking
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the right questions you can elicit so much change and hope that it felt like
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that was the direction to go in And I know, Rosie,
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you've got a very different background from me, but I think we definitely share
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some of those same viewpoints on how systems work or don't. Absolutely. Yeah.
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I mean, as I say, I come from the background of somebody who hasn't worked in the NHS and.
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I think I've come to realize that there are probably reasons why I've ended
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up going the route that I have. And that was probably for the best.
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I mean, again, to cut a very long story short, I think it was towards the end
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of 2021 that I had an autism diagnosis myself.
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And that came off the back of quite a severe period of burnout due to things, reasons.
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And sort of in the wake of that and trying to make sense of what this meant
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for me and what it meant for the way I should do things or set my life up in
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a way that was going to work.
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This was around the time when I met Sarah and actually,
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initially, I started having some coaching from Sarah around unpacking this and
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looking at what it meant and understanding a bit better.
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I think both putting the things that I found difficult, but also the things
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that I did well into context.
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She was fabulous, by the way.
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But along that process, some of the conversations that we ended up having were
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around some of the frustrations that I found working with patients who actually, in hindsight,
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were probably very neurodivergent themselves and who had been let down by healthcare systems.
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And again, starting to realise that there were some common themes to this.
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There were these patterns that kept turning up and these conversations that
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I kept having with people about the same kinds of challenges that people were
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struggling with repeatedly over and over and again I think it's a bit of a cliche
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in the neurodivergent community that.
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Somehow we can just smell each other you know we we've got that thing where
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people often end up finding you because they can sense that there is something
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about you that they can connect with.
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And I think that's one of the reasons
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that I perhaps end up seeing more neurodivergent clients in my practice.
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And because of that, I keep sort of running into these same issues that people are bringing to me.
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And exactly as Sarah said, I was getting
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that same feeling of I can help these people
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you know I I know that I can make a difference there and
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that's incredibly rewarding and incredibly valuable and
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I love doing that but at
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the same time I can only help the people who are there and there are so many
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more people out there and it's that sense of we need systems that understand
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some of these issues and some of these challenges better so that people are
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not ending up in those situations in the first place.
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And the more I thought about this and the more,
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We dug into this and we realized that actually we need to do something that
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is a bit more specific to how do we train people to get good at this stuff?
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Because actually it's really hard and it's not just a question of if everyone
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were a bit more aware of, you know, if we make people aware that neurodivergence
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is a thing, you know, the autism thing, ADHD.
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All of these various conditions, then they'll be more tolerant and helpful and
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everything all these problems will stop happening and actually that's really
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not the case because i think the challenges that come alongside.
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Neurodivergence they lead to some real problems in
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health care some real structural problems how we do health care and i think
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learning how to work well with people whose brains may not work in a way that
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healthcare professionals are used to or that is typical.
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I think learning how to do that and understanding how to do that,
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that is a whole specialty in its own right.
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There is a whole heap of skills behind that.
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And that's something that I don't think at the moment I'm seeing anyone really talking about.
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So there's lots of people talking about bits of this picture,
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but I'm not seeing it being addressed as a whole. And that's what we wanted to do.
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So it's a big ambition.
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And that's why we're not doing it on our own.
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There's four directors of the organization. We've got the pet project manager,
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who is someone who's organized because three of us are neurodivergent with a flavor of ADHD.
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So we have the one person who likes a spreadsheet to kind of keep on top of things.
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We've also got Remy, who is a professional expert by experience and just has
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phenomenal curiosity and has, I think,
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a really good balance between recognizing her own experience,
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but drawing in the thousands of
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experiences that she's worked alongside to then
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go into organizations and ask
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questions to elicit thinking because I think if you go in and tell people to
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do things people don't like being told what to do and they want to know the
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why so if you can just go in and be curious and ask the wine.
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She's phenomenal at that.
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So we've started with the four of us. We've roped in some.
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University of birmingham students to come on placement with
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us to do some of the pieces of work behind the scenes so
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we're small in number at the moment but we've
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got a really nice kind of balance of people and i think we're very we take what
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we call neuroaffirmative approach which i don't want to assume people understand
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but it's about not seeing these labels like awesome adhd,
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is inherently deficit focused.
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It's about recognizing that people are going to experience challenges with the
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environment. It's not built for them if most people operate in a different way from them.
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So it's not a superhero narrative of, oh, ADHD is brilliant because actually
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it isn't a lot of the time.
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There's a lot of things that are really hard work, but
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also we're not coming in with the assumption that
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people are broken that they need fixing during it's
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about recognizing that as humans we have
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diversity and variety and we think and
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experience the world in so many different ways and we need to recognize beyond
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what happens on our own perspective and have systems in place that are flexible
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enough to reduce any health and work inequalities that people may experience.
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And actually I think something that I see a lot at the moment is that health
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in particular is, if anything, it's going the other way.
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I think we're sort of moving towards there being more rigid systems and more
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sort of rules and flow charts and guidelines.
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And I think that very often the person gets lost in all of that.
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And particularly when you've got somebody who in whatever way is an outlier,
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whether that's physically, whether it's mentally, emotionally,
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that person is an outlier from normal.
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Our whole medical system is set up to deal with typical, variations of typical.
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Even when we're looking at an unusual condition, what we look at is how that
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unusual condition typically develops because that's how we do research.
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So when you've got somebody who is not presenting in a way that is typical.
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And that might be because their brain is processing the internal signals that
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they're getting from their body differently.
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They're describing it differently. They're communicating it differently.
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Their body language, their facial expressions look different.
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Those people are often the people who end up being dismissed or being not believed or being.
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Health professionals will very often find those, the quote unquote difficult
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patients, you know, the patients who are non-compliant or who are hard work.
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And I mean, sometimes, again, some patients are harder work than others.
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I think as health professionals, you know, we will acknowledge that often through no fault of their own.
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Often through the nature of the problems that they're coming in with.
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But I think the problem is when we don't understand where those differences
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are coming from and what's going on,
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I think it's very easy to end up projecting those onto the patient and making
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a value judgment and say, oh, they're being lazy or they're unreliable or they're flaky,
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they're not compliant, And whatever adjectives we want to use to describe it,
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rather than looking and saying, what is it about what we're doing that is inaccessible,
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that is not working for this person?
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And what can we change that's going to make that work better?
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And as I say, that's not a straightforward question at all.
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I mean, there are some times, and again, this is something that I've been thinking
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about a lot over the last few years.
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And I very often come up against situations where
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I'm scratching my head and going what do we do with this one because
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just because you've recognized that there's a challenge there that
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doesn't immediately mean there is an easy way to solve it but it's a starting
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point for we can start to think around what to do about that and I think it's
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that's where where we're trying to get to is where we're having those conversations
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about what the problems are you what the challenges are,
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who is it that is being excluded when we set up these systems,
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who is that system marginalising?
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And I think that's something that.
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People are absolutely not thinking about enough at the moment,
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particularly with all of the transformation that's happening,
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with the move to using digital tools, AI tools, all of those things, they have their place.
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But if we don't set it up with the full diversity of humanity,
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of human minds in mind when we're setting that up, it means that some people
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are inevitably going to end up being marginalized by the system.
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And it's not necessarily that anyone within that system has bad intentions or
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doesn't want the best for those patients.
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It's very hard to go beyond what the system allows you to do.
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So much in there hold on i'm just gonna i'm just putting some fire out of my
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head because there's so much there you've got me thinking about i want to kind
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of unpack it a little bit for the listeners,
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and it's great i'll go backwards probably i think i'll go backwards for what
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you've just said rosie and then go back to something that sarah said which really
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i think it's important for listeners to understand rosie i love the fact that
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you kind of point out that traditionally in health care.
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Regardless of whether it's looking at diversity of minds there's this idea of
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the norm isn't there and we run into problems with runners going,
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oh yeah, you're supposed to have a neutral, you must be an overpronator,
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an over supinator, or your shoulders are supposed to be level.
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And the whole of healthcare is based on norms and typicals, which often don't
24:06
make sense because just because the majority of the people maybe do have this
24:10
going on, it doesn't mean that everyone who doesn't have that particular same leg...
24:15
It's tricky finding an example because most people are not symmetrical,
24:19
but healthcare's got an issue with it on an MSK level.
24:25
Absolutely, yes. The step to moving, I find that's really, once a clinician
24:29
can understand that and they're no longer looking for everybody with level shoulders
24:33
and looking like, you know, the kind of like person on the anatomical model,
24:36
then it's not such a big step to realize, okay, we know there's variety and
24:40
diversity in bodies and bone shapes and that.
24:43
All we're saying is there's diversity as well in minds and the way to process stuff.
24:47
And I think that's quite a nice step for people to take on board that once you
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celebrate biodiversity, the newer diversity is just a part of that,
24:55
just part of writing life.
24:56
So it can make all therapists a better therapist to kind of cross the board.
25:00
I have some more thoughts around this actually because I'm reading a really
25:04
interesting book at the moment.
25:07
I remember, I forget exactly what the title is, The End of Average.
25:12
I think it's the end of average. I think I've got that right.
25:14
I will confirm in the notes.
25:17
But it talks about actually where this idea that there are these sort of categories
25:24
of what ideal looks like that are defined by the average person.
25:31
And there was a he's
25:34
actually an astronomer in the 19th century
25:38
of the 18th century 18th to
25:41
19th century called catelet q-u-e-t-e-l-e-t and
25:48
he was the person who came up with or
25:51
promoted this idea that you could
25:54
know everything you needed to know about the
25:57
ideal human by measuring the average human
26:01
and basically whoever conformed to the the average
26:04
the best would be the closest to
26:07
that ideal and then actually that idea
26:11
was then sort of taken a step further by
26:15
by Galton I think it was and then that led to some eugenics and some general
26:21
nastiness along those lines But that was from the idea that you could rank people
26:28
according to specific traits and specific characteristics.
26:33
So this whole idea of the norm being the thing to aim for or being something
26:40
that we're interested in.
26:46
In human history terms, it's a relatively recent idea, but it's something that is everywhere.
26:51
And the more you look, the more you see it, where this idea that,
26:57
I mean, certainly, again, back when I trained, I think we've moved on from then.
27:02
But I think, again, there's this focus on symmetry and basically balancing people
27:09
up and making sure that they conform to these...
27:15
Basically, symmetries and these ideals that we were looking for.
27:22
And that if somebody was out of balance or was wonky in whatever way,
27:29
we'd try and put them back to being straight again.
27:31
And then that would fix whatever pain they came in with.
27:34
And actually, I mean, it's a really strange idea when you start to think about it for too long.
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Like you say, it's exactly the same thing with footwear and orthotics.
27:43
And I was on a course recently where they were talking a lot about this,
27:46
this idea that, you know, we went through this whole period where everyone was
27:49
being diagnosed as having flat feet.
27:52
And, you know, your feet are deformed, basically, is what we were telling people.
27:56
And obviously, this isn't true. You know, people have different sizes,
28:01
shapes, orientations, and different body parts.
28:05
You know, lots of people have very common variations.
28:08
And actually there's a remarkably large amount of difference when you look at
28:13
people's bodies, you know, and how those bodies move and work.
28:17
And actually all of that is normal. It's within the range that,
28:21
you know, you regard as normal.
28:25
But what we're interested in is why is this particular person in front of me?
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Why is that person getting pain? And that may or may not have to do with any of that.
28:35
And so I think, as I said, there's a real parallel there between this idea with
28:41
human minds and human bodies and, well, why are we looking for normal anyway?
28:48
But what we've seen is we've got a whole society that has set up catered to
28:51
normal, you know, whether that's clothes we wear, you know, you go into a shop,
28:56
if you've got slightly unusual proportions, you're going to find it really difficult
29:00
to find clothes that fit.
29:01
If your brain works in a slightly unorthodox way
29:05
you're going to have a really hard time with education because the
29:09
school system is not set up to deal with the way your brain works and over the
29:13
recent years and I think things have got worse rather than better in many regards
29:17
because systems have been moving
29:20
towards having more structure more rigid systems more expectations of.
29:29
What normal is. And in order to, if you want permission to not fit in that box
29:36
that you've been assigned to, then you have to have some kind of diagnosis.
29:41
So these adjustments for those systems are being gatekept.
29:46
And that's, I mean, that's also one of the reasons why we're seeing increased
29:50
rates of diagnoses, right?
29:51
Because we've got more and more people who are not into those increasingly narrow
29:55
boxes that they're being allocated to.
29:57
And as a result, those people are
29:59
then experiencing problems and some of
30:03
those people are then eventually realizing that
30:06
actually in order to find a workaround they
30:09
need to have a diagnosis they need to have somebody sign a piece of paper saying
30:12
actually you've got permission to not fit in that box and this is a dreadful
30:18
way to do all of this actually but again finding a place to start is the challenge
30:25
and I I think Sarah always looks at me when I go on these.
30:30
Right, what are we going to do?
30:35
I try to be the catalyst to go, okay, let's turn this to some action.
30:41
Now we've just got to fix it. So, yeah, I think this is one of the reasons we
30:47
work really well together.
30:49
Sarah's relentlessly practical when it comes to doing it. She'll let me go off
30:54
on my mad rant and then bring back to it. It's not a mad rant.
31:00
It's the recognising what's there.
31:03
And being able to sit in that discomfort without normalising it is a really tricky thing to do.
31:13
Just as you were talking, I was thinking of if you use the most commonly used
31:19
autism assessment tool, the AAA,
31:22
there are 3,000 different ways you can be diagnosed as autistic if you look
31:26
at all the stats for the combinations.
31:30
Therefore, within what they think is quite a narrow diagnostic criteria of ADHD.
31:36
I was going to say, that's very on-brand.
31:40
The same is true for ADHD for dyspraxia if you look through the amount all the things that we,
31:49
pathologized because either it's different or we don't understand it or because
31:52
people are struggling there's a huge amount of variation there and the moment
32:01
we start measuring it against a supposed norm,
32:04
we're creating that conversation of what's wrong with you.
32:08
And I can't remember who said the quote, but it's that, you know,
32:13
no one recovers from remedial weakness. We've got to focus in on where the actions
32:20
are, where the strengths are, which.
32:22
Neatly can kind of make me segue a little bit into the
32:26
cpd journal is when me
32:29
and rosie sat down to go what does this need to include there
32:32
were so many ideas around the
32:35
questions that we we had pages at
32:38
some point i should publish all these questions that
32:41
we have that are brilliant questions to elicit these thinking and
32:45
we were like actually people need to be thinking
32:48
about this on a day-to-day basis because that's where
32:51
the opportunity me with my practical pragmatic head-on is
32:55
not everyone has the
32:58
capacity energy resource power to overhaul
33:02
a system I mean if I if I had that I'd
33:06
have done it by now but what we can do is look
33:08
at day-to-day routine and our
33:11
work and where those opportunities are so we've
33:15
stopped it's why we kind of came about with
33:17
the structure of a planner because I
33:20
was like right people can use this as a do list they
33:23
can put their clinic things in it but around that we've got some questions we
33:27
can get people to think about what their intentions are we can get people to
33:31
create space for themselves to pause to reflect because we're in such regardless
33:38
of whether you're in the NHS or private clinic.
33:41
You know, we're constantly on this treadmill of being productive, seeing the next person.
33:47
So just to be able to take a moment to pause and to catch yourself and see where
33:52
those opportunities are is really kind of important. So me with my practical
33:57
head, I was like, right, we need that.
33:59
And then when we were talking about some of these innate barriers, this.
34:08
And people's attitudes to neurodivergence are as diverse as neurodivergence itself.
34:15
Kerry Murphy created this zones of neuroaffirmative practice,
34:20
which had come out of a doctor during COVID.
34:27
I've made a note of his name because I think it's it. I don't want to get it wrong. Oh, was it Dr. A?
34:36
There was a doctor during COVID that had looked at some visuals around people's
34:43
kind of responsiveness to the pandemic, but it was at the same time as Black Lives Matter.
34:48
And he was going, actually, the model for being anti-racist is here.
34:54
And so he'd created, oh, desperately trying to remember.
34:59
I'm going to scroll, I wrote it down, so I'm just going to scroll because I
35:02
think it's often people that come up with these things, particularly if they're
35:07
not white, get overlooked. It was Dr.
35:10
Abraham. So in 2020, he did what he called a visual mental model of...
35:18
Becoming anti-racist and he had these zones of
35:21
fear learning and growth and then Kerry
35:25
looked at that and she's an
35:28
amazing early years educator and
35:32
she kind of recognized okay there's professionals that are
35:35
in their comfort zone there's professionals that
35:38
are curious they may be going oh maybe I can
35:41
do something differently but feel uncertain
35:44
maybe scared maybe anxious maybe stressed by
35:47
that idea and then there's this learning zone
35:51
where we're kind of actually really
35:55
scrutinizing our own practice because I
35:58
hold my hands up what my practice looks like
36:01
now I'm embarrassed about some other things that
36:04
I did 10 years ago but I also treat that kindly and
36:06
compassionately with I could only do with
36:10
what what I knew you know I
36:13
was working with the information I had at the time but I've grown
36:16
and I've learned and I've adapted and I want.
36:19
To keep changing so part of being
36:22
in that learning zone is to kind of have the
36:25
confidence to go oh actually maybe
36:29
I didn't get it right for that client or maybe the way I thought that would
36:35
land or help has actually been harmful and as a like health professional we
36:41
don't want to cause harm so we often kind of have a blinkers on and try and
36:45
avoid it and then from that learning.
36:48
We can then take those actions and grow and be allies and proactive and feel
36:54
much more enabled to tackle these mammoth systems.
36:59
So that's kind of how we ended up structuring the CPD journal was thinking through
37:05
from this huge mammoth list of reflected questions that we felt would help elicit.
37:13
Well, why am I finding this person in front of me challenging?
37:17
Or why am i feeling really fatigued at
37:20
the end of the day kind of taking our daily experience
37:23
of being clinicians or even the bits that
37:26
we love doing and then go through this process of
37:29
going where do i fit on those on these zones it
37:32
just helps us kind of see our own development and
37:35
feel like we're growing and it's that there's hope
37:39
there that the things that we do matter i'd like
37:42
to i'd like to try and break down what the book like
37:45
is tricky because we're on a podcast obviously in yeah but let's
37:49
imagine that thank you for everything you said by the way
37:51
i mean we've painted a really good picture i think of how why this
37:54
book is needed and and also just
37:57
to reiterate the point that when people understand that
38:01
you can help at the
38:04
end of the day it's not just neurodivergent people it's everybody but when you understand how
38:07
important the environment is and and you understand the concept
38:10
of mismatch and stuff and and how it's not
38:12
always a pathology it's not like that person's broken actually you
38:15
can make their life a whole lot better and you can get a result with this person
38:18
if you change the environment which is your clinic and the way you talk and
38:22
communicate and look and write things down or record things or not then it gives
38:26
the therapist a lot more power so that's kind of set us up for why this book
38:30
can be so powerful I just want to check the book is designed essentially and correct me if I'm wrong.
38:37
In mind of a clinician who does not necessarily identify as neurodivergent,
38:42
but they do like the idea of being more neuroaffirmative and realizing I'm missing the trick here.
38:48
So that's the kind of main, because I've seen it, and I reckon it could be equally
38:52
as interesting and useful for somebody who is neurodivergent,
38:54
just have a little look through.
38:55
But then we love reflecting anyway, probably too much and overanalyzing.
38:58
But it's for the neurotypical people out there, the newer majority.
39:03
The senator making money bit of it was like if only
39:06
i had made pieces of stationary eggs at the adhd as
39:09
we'd have been rolling yes exactly yeah yeah
39:12
give them a i want you to reflect okay sum me
39:15
up so so yeah so let's paint you through so imagine somebody's listened
39:18
to this they thought this sounds really good i understand that i
39:21
can make a difference i understand that depending on
39:23
the statistics it could be 20 of the population don't fit into the newer
39:26
majority and they're part of my patients so the chances is
39:29
one in five people coming through there could be a chance that i'm going to help them better than
39:32
i am at the moment so they've got the book talk us through
39:34
how the book is kind of laid out they've got it it's beautiful they
39:38
haven't got a copy we've just got the misprint on the front so their copy's
39:40
not worth as much but it's still good what are
39:43
they going to find they're going to open up the cover and and how's it laid
39:46
out what take us a journey through the book if you could so we've
39:49
got a little bit of an acknowledgement just recognizing all the
39:52
people that have helped us and a
39:55
bit about me and rosie and then it's the
39:58
first couple of pages are about how to use it
40:01
because we don't want to assume that people are going to feel
40:04
comfortable with it but also because we
40:07
recognize people will use planners and reflections in different ways we wanted
40:12
to make sure that there's enough structure there for people to feel comfortable
40:17
to be able to dive right in and use it but with also flexibility for you to
40:23
go, oh, I need to work it in this way.
40:25
We've then got a couple of pages of terms and language.
40:33
Some of that language might be things around electrophymia.
40:41
So someone who expresses, communicates experiences, emotions differently,
40:48
or maybe doesn't experience them at all.
40:50
So we've got some terms so that if someone isn't familiar, there might be some
40:54
concepts in there that are new to them, or if they're going,
40:57
oh, I think there's a word for this, you can flick through and see it.
41:01
The language side of it I've got
41:04
a kind of relationship with where I hope it becomes out of date because language
41:11
changes all the time because our thoughts are influenced by language and language
41:15
influences our thoughts so some of the language in this is at the time of writing,
41:23
neuroaffirmative it might be in a few years five years time
41:26
future Sarah and Rosie know better we've
41:29
done more work or there's some different ideas around this
41:32
and the language has changed again there's a great website called um stimpunks
41:37
that has a really lovely glossary of lots of different types of neurodivergent
41:42
language that is far more detailed than a few pages but we pulled out kind of
41:48
the key things that we thought.
41:51
And also, just to jump in quickly, sorry to interrupt, but just having seen
41:56
it myself, I think it's a really important point that this book has been written
42:00
by people with lived experience.
42:02
So it is neuroaffirmative because there's a danger, isn't there?
42:05
And this is not to kind of criticize people who aren't neurodivergent,
42:10
who have produced books and things like this on the topic.
42:12
But when you've got someone who's got lived experience, it means that it's going
42:15
to be laid out in such a way and language is going to be used,
42:17
which is neuroaffirmative because you've lived it.
42:19
So this book is quite healthy in that respect as well i
42:23
think in a sense yes but in
42:26
another sense i think there is always a danger that as a neurodivergent person
42:33
when you produce something you assume that it applies equally to other neurodivergent
42:37
people and of course that we know that's not true we know that neurodivergent
42:42
people can be as different from each other as they are,
42:44
you know, as a neurotypical person is from a neurodivergent person.
42:47
And in terms of what's going to work for a majority or what's going to work,
42:53
you have to look at that from lots of different angles.
42:56
So I would always say, be careful just because somebody is neurodivergent.
43:00
You can't assume that everything they're saying or writing about is therefore,
43:07
you know, the gospel truth when it comes to neurodivergent people,
43:11
I think. I will also understand.
43:13
I'll also add to that that I've worked with,
43:17
I've known a lot of neurodivergent people that aren't neuroaffirmative and a
43:21
lot of that's down to how professionals have pitched what being autistic,
43:28
what being dyslexic, what being ADHD,
43:31
what being dyslexic means.
43:34
So that gets internalized. So we can't always assume that we are neuroaffirmative.
43:41
I certainly still catch myself thinking about,
43:47
maybe older. It took me a long time to get my ADHD.
43:52
I knew I was dyspraxic, but it took a long time for me to get my ADHD diagnosis
43:57
because I had some internalized ableism about that.
44:00
And I was working as an ADHD assessor at the time.
44:03
And it was only when I heard my story coming in countless times and me being
44:10
very compassionate going, of course, your ADHD,
44:14
look at these experiences, is look at how much work you're putting in.
44:18
And I thought, why am I not giving myself that same compassion to acknowledge
44:22
some of those difficulties that I've experienced?
44:26
So it was a really hard process to actually become neuroaffirmative for myself.
44:32
So I think it's always, like Rose said, it's hard to... So what we've tried to do with this is...
44:43
Do you know what? Even if you don't want to be neuroaffirmative,
44:46
a clinician needs a planner.
44:48
We need somewhere to bung a to-do list. We need somewhere to put down what we're doing when.
44:56
But also, for some of us, we may need somewhere to record our CPD because we
45:04
have various kinds, depending on our different professional bodies,
45:09
different things we need to capture.
45:10
So we can use the
45:13
intention some of the mini practices to try that are
45:16
kind of scattered around the weekly planner and the
45:20
prompts at the end of the week to capture those cpd
45:24
reflections even if they're not specifically related to
45:27
neurodivergence it's to do with our practice it's
45:30
just we've then got this extra page behind the planner
45:34
each week to go more in depth and to
45:37
look at it from but you're affirmative focus can
45:42
we have some examples again because we can't see the books so what would be examples
45:46
of things that might go on the planner or things you might record or practice
45:49
it's got this week's intention and you've got one thing i want to be more intentional
45:55
with this week is another lovely gap gap's right so you could put anything at
45:59
all in there you could put something in for yourself you could put in actually my intention this week.
46:06
Is to not assume I'm being understood in the way that I'm communicating because
46:14
one of the things that happens across different types of communication is it
46:20
breaks down when one person's message is received in a different way.
46:25
So you could just say I'm going to be intentional about not making assumptions
46:28
about how my communication's landing.
46:30
And there's many practices to
46:34
try like ask the client what
46:36
works for them and I would say to me
46:39
I've got a love-hate relationship with that question because we did lots of
46:43
surveys and this replicates research results where people were actually saying
46:50
either I don't know what reasonable adjustments I need I don't know what will
46:54
help I need some guidance on it or I feel I don't feel I can ask anyway.
46:58
But actually, it's a really good starting point to ask someone. So be curious about it.
47:04
Notice one thing I can alter in my environment to make the sensory experience
47:08
more comfortable for a client.
47:10
I quite often cross out the word client and put me because I think I so often
47:15
sit in discomfort and get used to that.
47:19
But actually, what can I
47:22
do to prompt myself to turn off the bright light that's
47:25
staring at me when I'm on a video call afterwards that
47:28
will make my processing so much better
47:31
if I have a reminder to make my
47:34
sensory environment more comfortable and then at the end of the week we've got
47:39
a question of a moment that felt affirming or meaningful so it's just taking
47:45
that moment to celebrate that success to notice where those little moments are,
47:51
and there's a few other prompts in there.
47:54
I think there's just different ones that will kind of, I think different people
48:00
will find different questions and maybe on different weeks.
48:04
Elicit it and then we've got I think
48:08
it's I think it's basically 52 weeks of
48:10
planner and then on each day we've got a
48:13
planner and then the following day we've got the zones of affirmative practice
48:19
so we ask you to kind of write down one experience that you've had so what's
48:24
happened where did it take place what was involved what was your role so that
48:30
could be something like Like,
48:33
I was really frustrated when that patient was a no-show again or they hadn't
48:38
done their homework again.
48:40
You then kind of look through the different zones and the questions of those
48:46
little tick boxes to say, oh, this feels like where I'm at. So you can kind
48:50
of see which zone you're in.
48:52
Then there's that reflective space to go kind of during and afterwards that
48:57
event of your current knowledge, values, environment, influence how you respond.
49:01
And so we turn it in with some rather it being about, oh, this disengaged patient,
49:06
it's actually about what's my values that are at play here?
49:09
What's my response in this?
49:12
Sounds like just such a, regardless of the subject matter, which is,
49:15
I mean, is paramount anyway, but just sounds like if you can persuade people
49:19
to just to reflect and take a moment in the week, especially health professionals
49:23
where you're entrusted with someone else's health,
49:25
just sounds like a really healthy thing to do anyway.
49:27
Just a pause and reflect. It is. And I think it's just really,
49:31
I think for me, all of us say, oh, we should do CPD.
49:37
Actually, when I was working within organization, I do loads of CPD in my kind
49:43
of self-employed work because I'm passionate about it and I can make it flow where I want.
49:47
And when I was working, it was really hard to create that space.
49:52
There was so much pressure.
49:55
So I think finding really simplistic, quick ways of being able to pause, to not be reactive.
50:04
To justify that that couple of minutes to jot down a couple of ideas,
50:09
you know, for some people, they might want to write reams and reams and go,
50:12
oh, there isn't enough writing space. And it's like, well, that's great.
50:15
You can add some more writing, like get a bit of paper, stick it in there.
50:21
But we've given enough space that it only needs to be a couple of bullet points
50:27
or a paragraph, just something that you can do over a coffee in those kind of,
50:35
five, 10 minutes where there's just a little bit of breathing space.
50:40
As that's saying, isn't it? I
50:42
know, Sarah, about being embarrassed by what you were doing 10 years ago.
50:46
And I know I am as well. I think back to what I was doing 10 years ago.
50:50
And I think I heard somebody say, if you're not embarrassed by what you were
50:55
doing 10 years ago, you've just wasted 10 years.
50:57
And I think there's a lot of truth in that. And I mean, buy our CPD journals
51:03
so that you don't waste the next 10 years.
51:07
That's very forceful of you there, Rosie. That was wonderful.
51:10
There's a clip there for the worst.
51:13
But I also wanted to say, there's a lot of practitioners who will say,
51:18
oh, I don't really work with neurodivergent people.
51:20
It's like, first of all, that's not true. You definitely do.
51:24
Some of them know that they're neurodivergent and are telling you.
51:27
And some of them probably don't know that they're neurodivergent.
51:31
But what's more, and it's Not just that sort of 20% or whatever the figure is
51:34
that I was talking about earlier.
51:37
Actually, neurodivergent affirmative practice applies to everybody because we
51:42
all have individual traits that may be less typical.
51:47
We all have, again, when you break it down and you're not looking at diagnoses,
51:52
but you're looking at traits and you're looking at characteristics and sort
51:55
of the different ways that people's brains work.
51:58
Actually, there's something there that you can apply to almost every patient.
52:03
When you look at what is this patient struggling with and why are they struggling with it?
52:08
What is it about this task?
52:12
How is their brain processing that?
52:14
And why is that creating challenges?
52:18
And when you start breaking things down and thinking about them like that,
52:21
Actually, this applies to all of your patients, not just the ones who come with a pre-printed label.
52:29
So I would argue that actually, yes, we're talking about neurodivergent affirmative
52:36
practice, but if you get good at neurodivergent affirmative practice,
52:41
you will be a better practitioner, full stop.
52:44
Yeah i think that's a really important message yeah definitely which is why
52:48
this book is i mean obviously we're all biased and i love the work you guys
52:53
do but it's it's it's not expensive.
52:57
Compared to what probably what you're charging your client but you
53:00
can make such a massive difference and and will
53:03
persuade you to take a pause during
53:06
the week because it's lovely well not for everybody but for a lot of people you've got
53:09
that structured nice blank clean play pages with nothing on
53:11
there and you've got your favorite pen next to it just find that 10
53:14
minutes once a week to put something in there and then it would come a bit
53:17
like keeping a journal for your exercise or you know it's something
53:20
you can create a habit and i think yeah i think
53:23
it's a fantastic initiative to help on so many different
53:26
levels where do people get hold of the book so very
53:30
soon it'll be available all over the place like any
53:34
retailer you can think of we have got
53:37
a link to sell it directly from
53:40
our distributor that's on our website or
53:43
if you could so that's neuroreflect.co.uk if
53:47
you on the main screen you will see a picture of the reflective cpd journal
53:52
click on that and then the first couple of sentences there is a link to being
53:57
able to buy the paperback straight away and that's really exciting there's also
54:03
on our social media which is neuroreflect uk okay,
54:07
we've got a link tree which has links to the website, to the book.
54:16
To my random hyper focus a few weeks ago of
54:19
making random t-shirts so so all
54:23
the merch is there and i
54:26
do we we don't we've kept
54:29
it very intentionally affordable that
54:33
there's only a very small profit margin for us
54:36
but any profit that we do get
54:40
goes because we're a cic it goes
54:42
back into helping the community that the money
54:46
from it is funding us doing more work
54:50
and kind of looking at
54:53
how we deliver training how we deliver self-advocacy workshops
54:57
and all sorts of exciting bits of resources that we've
55:00
thought about i think that's really important because yeah
55:03
people need to know that the money isn't going it's going back into the system
55:07
and helping into a good system not into the normal system yeah and even the
55:11
t-shirts as well what if you make out of those although there's no price you
55:15
could pay which would pay for the time and energy you put into creating these
55:18
talk about bespoke i mean you've been reinvented bespoke.
55:25
Anyway it's good to know the money's going to what we started off talking about
55:29
the beginning to making a difference little things can get depressing thinking
55:32
the system and capitalism and all that there's just no way we're ever going
55:35
to get out of this hole but it's things like you guys are doing and the book.
55:39
And also I wanted to say like, you've got some courses and things coming up as well.
55:43
Yes. So we will very shortly have some dates for our pilot course.
55:49
We're just in the process of putting all our ideas together.
55:53
Actually, it's how we narrow it down.
55:56
How do we get this into something that is going to be deliverable?
56:00
Because there's so much content.
56:05
Before we even get into the evidence base and the contents of mine and Rosie's mind,
56:09
we've got about three hours of
56:12
lift experience videos that we've got read it down from our experts by experience
56:17
talking about their barriers and experiences so there's so much there but we're
56:22
meeting tomorrow to kind of get those dates in who's the course aimed at the course is aimed at.
56:32
Anyone who's working in physical
56:35
health settings so that could be a massage
56:38
therapist your physiotherapist your osteopathic roti we
56:42
want to expand it out wider than that but
56:44
just we're kind of because we're aiming for
56:47
one day of training we want to make sure that
56:50
it's a good networking opportunity and it's
56:53
a good opportunity to focus in on some of the bespoke challenges
56:56
of working within those particular
56:59
settings and then we've got like you say we've got
57:02
lots and lots of content that we're then going to roll out more widely
57:05
to certain groups hopefully so
57:09
any level of healthcare professional yeah and
57:13
is there any kind of
57:16
attribute think this who would it really suit this course
57:19
do they need to have a certain passion or interest or no
57:23
what we found is often the people
57:26
that come to our things are either the neurodivergent clinician
57:29
or the person that has got an interest or passion but
57:33
and you guys are really welcome we
57:36
love having you it makes it really engaging but the
57:39
way we've pitched it is if you're sitting there going I don't know what Sarah's
57:46
going on about at all here actually that I I don't know I just feel stuck they're
57:53
the people who if you're sitting there in your practice going, I don't know what to do.
57:58
I've maybe done some autism awareness, but what can I do differently?
58:02
And you might be feeling quite powerless. They're the people that I particularly really enjoy.
58:12
Supporting and working alongside because that's often where there's such big
58:16
opportunities for shifts.
58:19
I see. Excellent. So I would say if you're there sitting there,
58:23
wondering what to do with that one weird patient that you've got that just doesn't
58:27
seem to respond to anything you do with them. This is the course for you.
58:33
That's very good. Say that again, because I missed that. I was looking at Jessica's comment.
58:37
If you're an MSK health professional and you're there and you're wondering what
58:43
you should do with that, you know, you've got that weird patient who you just
58:48
can't figure out what to do with them. Nothing seems to work.
58:51
This is the course to come on. Excellent. Yeah, definitely.
58:56
I think once people, hopefully they listen to this and listen to what you guys
58:59
have been saying and they realize how it can't make a difference to all of your
59:04
clients, then people will hopefully generate an interest. But yeah, absolutely.
59:09
We'll look forward to tracking that. And if people are interested,
59:12
then there's a newsletter, isn't there, on your website, which they can sign
59:14
up for, and that'll keep them up to date with when these course dates are launched.
59:18
And the book available at the moment on the website. So again,
59:22
the website is your place, newreflect.co.uk.
59:24
But eventually it will be available in the normal kind of places you get these books.
59:28
And also, how are you for time? Are you okay, 9.05? Are we still okay for five
59:31
more minutes? I'm okay, yeah.
59:33
Cats are well-fed and watered, nothing going on. I mean, she's looking at me with eyes.
59:37
Okay, I'll go. I don't want to she can make an hour she's not getting at least
59:41
an hour can't believe the cats even get a credit in the book amazing,
59:44
but it's also just mentioned again we've got the pleasure or anyone going to
59:48
therapy show in November 25th and 2026 are going to have the pleasure of meeting
59:54
you as well if they go along to our presentations or you're going to be out there are you both,
59:58
yes indeed definitely yeah I hope so,
1:00:03
good just wanted to get that a clip of you just suddenly yes and yes So if you're
1:00:07
going to the therapy show, it's not quite up on the website yet.
1:00:09
We're going to have a wonderful panel discussion with Sarah Mihag and Rosie
1:00:13
Sexton and James Dua Haggart about neurodivergence and neurodiversity and MSK practice.
1:00:19
I mean, that's going to be a nice question and answer, a 40-minute session in
1:00:23
one of the open theatres. So another reason, yeah, another reason to go along to the therapy show.
1:00:27
And also, just before I wrap it up, the STA Midlands Conference in Ludlow being
1:00:33
organised in particular by the wonderful Mike Grice on June the 20th in 2026.
1:00:38
Rosie, you're going to be talking at that, aren't you?
1:00:40
I am, yes. Yes, I will be.
1:00:44
So I'm going to be talking about rehab in combat sports athletes.
1:00:50
Fantastic, which is obviously your thing. We've glossed over the fact in this
1:00:53
hour that you were the first British woman to fight in the UFC.
1:00:56
We even said what UFC stands for, presuming everyone knows that,
1:00:59
but there's a whole unknown. Just go to Wikipedia. There you go.
1:01:01
That's a reliable place to go.
1:01:03
Also go to MSK Mag this month because you'll see a wonderful piece by Rosie
1:01:07
as well about combat sports. Really good article, by the way.
1:01:10
So well written really really and yeah you entertain so
1:01:13
many different aspects of it so i would encourage that i'm not sure if it's
1:01:16
going to come out as a free version some of the articles come out as free but
1:01:19
it's definitely another reason to sign up for that if you're an msk professional
1:01:22
and some brilliant articles in that and then sarah oh there we go sarah and
1:01:27
company oh there you were what have you coming up sarah what have you got coming up i i i,
1:01:32
going to be at the Neurohub Autistic Mental Health Conference.
1:01:41
It's a hybrid conference. There's a day in Brighton and there's some online stuff.
1:01:46
I'm doing the online bit, which I want to say is Friday the 14th of August.
1:01:54
My talk's going to be much more around self-advocacy as a neurodivergent person
1:02:01
in that particular talk rather than thinking about it with my professional head on.
1:02:06
It's going to be much more around. I'll make sure I'll link to where people
1:02:09
can see details about that. We'll go into the show notes.
1:02:12
And great. Okay. So there we go. We've reached, thank you for going over the time, 908.
1:02:18
If people want to follow New Afflict, we've already said website's probably
1:02:21
the best place at the moment, but you've also got a page that people can join on Facebook.
1:02:25
People can follow you there, which is gradually growing. so that's a nice
1:02:28
place to also see updates and anywhere else
1:02:31
they should get in touch with you or both personally linkedin instagram
1:02:35
my self-employed practice is
1:02:38
mood lifter and i'm mood lifter
1:02:41
pt on social media because when
1:02:45
i first set that up i didn't really know what i'd
1:02:48
do occupational therapy wise but i was using my personal training
1:02:51
qualifications so that's moodlifterpt
1:02:54
and i've got a website moodlifter.co.uk
1:02:58
which is horribly out of date because everything's been focused on your reflect
1:03:03
but it it's still got some info still a good looking website don't worry about
1:03:07
that it's got some great photos on it and then also we've got alton health and
1:03:10
performance in solihull as well which you can find across social media yes so
1:03:15
we're on facebook and Instagram.
1:03:18
I think I'm also on LinkedIn, but I don't go there very often.
1:03:22
And I have a personal account as well as the clinic account.
1:03:26
You can find our website, altonhealth.co.uk.
1:03:31
Marvellous. And just to squeeze in there for you and Mike, the wonderful Mike
1:03:35
James, as I mentioned in the intro, we've also got the Everyday Athlete podcast,
1:03:40
which is you and Mike, what a great pair that was,
1:03:44
talking, chatting during the cut, as it were, and you're on episode about seven
1:03:48
now, is it, I think, something like that? Seven, eight?
1:03:50
I think, is it eight? I think we just put out eight.
1:03:54
Eight is the most recent, which is about, I mean, I haven't listened to the
1:03:57
whole lot i tapped into it and looked at it but i think i remember that was
1:04:00
about what it what is how to find a good therapist i think was one of the part
1:04:04
of the conversations that's right yes
1:04:07
what to look for in a good therapist and also we did a bit on training in the
1:04:11
heat and things to look out for it was very topical last week not very topical
1:04:15
now yes yeah damn it for it.
1:04:20
Next next week how to train in the rain yeah but
1:04:24
um yeah definitely recommend that really nice you to a wonderful pair
1:04:26
up on that podcast so for any msk practice practitioner
1:04:30
then check out that on all the normal podcast apps
1:04:34
right that's it i must let you go people go thank you if
1:04:37
you joined us live i really appreciate it if you are listening to the podcast and
1:04:40
you fancy joining one of our shows live to ask
1:04:43
questions to our guests or just to share experiences then we love that
1:04:46
i mean hopefully you'll get something out of it all you need to do is go along to the sports
1:04:48
therapy association youtube channel or facebook page normally on
1:04:51
a tuesday at eight o'clock we'll be back at that time next week
1:04:54
with another show to see what
1:04:57
that show's about and just follow us on social media uk underscore sta but until
1:05:02
then just thank you once again to my guests sarah and rosie sexton thank you
1:05:05
very much and thank you everyone who joined us live we will hopefully see you
1:05:10
on another tuesday in the not too distant future until then look after yourselves
1:05:14
and remember more importantly.