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stanford neurodiversity summit day 2 part 2 continued

Unknown Speaker 1:45:40

So our study design is a randomized control trial. So individuals are randomized, either have a coach or not have a coach for the 20 weeks, and then they are re randomized to either maintain a coach or either get a coach or continue to not have a coach, we really wanted to make sure those who'd had a coach during the didactic training didn't suddenly feel abandoned, because the relationships that you make over 20 weeks, they, they would still want to contact those, those coaches. And so we wanted to make sure that that was feasible and possible. And so as we were rolling our first cohort out, COVID hit. And so we had to pivot and create this as a fully remote intervention. And so that happened, and we have actually just wrapped up our first cohort of 20 weeks. So we had 23, autistic young adults who completed the program, all of whom now have internships or paid employment, which is extremely exciting. And we are recruiting for a second cohort now. And because this is a fully remote program, anybody within California is welcome to to seek this program and see if it might be a good fit for them. It actually has worked very well remotely, which is something that I'm happy to talk about, at the end, if people have questions about, certainly everybody I think is thinking about the creative ways to make sure that we can still access and that individuals have access to things that are helpful during the pandemic. And this has certainly seemed to be very effective remotely, which was exciting. So I'm going to talk a little bit about the program itself and the content of the program. So this program is based on the peers model. And so this is a model that was developed at UCLA, and has really been disseminated worldwide and is really based on evidence in terms of how to effectively teach social skills. And so the idea is that it is teaching the skills that socially successful people do, not what we think might be helpful. So if you think about some of the advice, I certainly have you gotten advice over the years about how to navigate a social situation, that really didn't make sense because it was from somebody of a different age or a different, you know, kind of a different environment that didn't really understand the nuances of the social situation I was in. And so the idea is that this is really designed to think about the social situations themselves, not what you know, maybe an adult thinks a child might want to do. And then often appears is parent or caregiver assisted so that the coach is somebody who has a lot of contact with the individual. Again, as I was saying, Our program is really intended to have that coach be appear so that we are again, removing a burden from the family, but also allowing an ecologically valid peer relationship to support the development and engagement and skills.

Unknown Speaker 1:48:49

Oops, sorry, my mouse has taken a break. There we go. Okay. And there's there's a lot of evidence for the efficacy of peers in supporting social skills development. So we feel like that's a good place to start in terms of thinking about the kind of employment related social skills we feel are going to be helpful. So and thinking about the curriculum that we've developed for the peers to careers program, it's really designed to help support individuals think about and choose what type of career might be a good fit for them thinking about their own strengths and weaknesses and what they want. And what's feasible, what's reasonable in LA, there's obviously, you know, some some big industries that are very exciting but hard to break into. And so kind of thinking about realistic ways to engage in the television or film industry, the music industry or other industries that some of you might have wonderful aptitude for, but they're hard industries to break into. So how to support that, how to create an effective resume, how to how to find what jobs are out there and apply for them successfully. interviewing skills that really support who you are authentically Making sure that you're kind of providing context, if that's helpful for the interviewer to kind of understand you better and see your strengths, working on conversational skills that relate to employment settings. So thinking about the break room or the lunch room, obviously, right now, not too many people have break room or lunch room experiences, because most people are still remote, but thinking about ways that, you know, engagement with colleagues, managers, etc, can be supported so that individuals feel successful. And navigating electronic communication effectively disclosing the diagnosis of autism spectrum disorder, if that's something that the individual chooses to do, and how to advocate successfully for accommodation needs. That's something I'll get to examples about both of those, because I think those are important things to be thinking about. And also organizational skills. So again, thinking about some of the young adults can experience things like time management, or kind of effective recognition of prioritizing can can be challenges for for many people, and also for individuals on the autism spectrum. And so building some skills around that can really help individuals feel more comfortable and be more successful within the workplace. So I want to talk just briefly about this idea of disclosing diagnoses. And, you know, the idea, it's something I get asked a lot in my clinical work from, from parents and from autistic adults is what what to do in terms of disclosing a diagnosis when seeking employment is that something that's going to help or something that's going to kind of hinder the employment process, I would say that the data on that is, we don't have robust data either way. And I think it's a very personal decision. But I do think that it can be helpful to think about if if you do decide to disclose a diagnosis, that can be a very empowering thing to do. But making sure that you're doing it in a way that feels empowering, and that also really transmits the information that you want to transmit to the individual you're disclosing to can be helpful. And so in the piers, for careers curriculum, we talk about choosing the right time and the right person and the right place for this, right. So making sure that you're kind of effectively targeting who needs to know, and when it's appropriate to talk to them about it.

Unknown Speaker 1:52:31

Being able to kind of reflect on things like you know, I may not make eye contact when you're talking to me, and that may feel like I'm not listening. But actually, I'm really listening quite intensely, I just don't make eye contact very often, or that's, that's something that kind of gets in the way of me listening. So I want to make sure I can listen to you well, and so you just so that you're aware, eye contact is not something to expect. So acknowledging that, you know, you may experience me a little bit differently than some other people. And let me contextualize why that is. Um, and then I also think that really recognizing that, that, you know, neurodiversity comes with an enormous amount of strength, and that there are many things that individuals on the autism spectrum can do very, very well in terms of being incredibly successful long term employees. And so really making sure that you're advocating for what you're bringing to the table in terms of the employment skills that you have the interpersonal skills that you may have, or ways of, you know, kind of navigating the environment of that specific job, that are really important for that job. And that really show that you are actually an incredible candidate for that position. And I think that's something that can be really important to make sure that you as that we're helping individual autistic adults, build that sense of self advocacy and strength, that they're bringing incredible strengths to the table. And employers need to be aware of those strengths. And then I think making sure that you're, you know, kind of able to answer questions, but also that you're clear that, you know, your diagnosis is not something that, like, you're you're just one person, and this is your experience, and these are the needs that you have. And that's kind of how you want to be discussing that. And then I think, you know, similarly to thinking about accommodation needs, there are reasonable accommodations that are very appropriate for individuals within the workplace. And I think one of the things that can happen is that if you are not aware that that's the case, you may not be asking for very reasonable supports that would allow you to very effectively demonstrate wonderful skills and be an incredible asset to employment opportunities. And so one of our goals is to really make sure that we are supporting young adults in feeling comfortable and recognizing their right to have the the accommodations that they need. And so again, this kind of walks through the steps that we think about in terms of How to support young adults in feeling really comfortable requesting reasonable accommodations and knowing the language that reasonable accommodations are actually a legally supported thing that you can that you can obtain. And so thinking people with ideas that might be helpful in terms of the accommodations that you think would support you in the workplace, but also being open to what others might might think might be helpful if you're struggling with something, and you're not quite sure what might be a good support for it, or a good accommodation. And so again, this is really intended to help the individual feel comfortable self advocating for what they need in the workplace, which is expected to support effective job maintenance, it's something that clinically, I often see individuals who can obtain employment, but struggle to maintain it because they are, there are certain needs that are not being met within the employment environment that if they were met, they actually probably could be very successful long term employees. And we want to change those initial statistics in a positive direction, this is a way to support that.

Unknown Speaker 1:56:12

So just kind of wrapping up the peers for careers program that we're that we're in the process of not recruiting for the second cohort of there's an evidence based framework that we're working from, we're not teaching job skills, we're teaching the skills around kind of the social aspects of employment to support individuals feeling comfortable, going out to obtain and maintain employment. And we're really hoping to empower young adults to feel comfortable self advocating, by kind of working with them on effective strategies for navigating the workplace related experiences that may come up including conflict, including, you know, needs for accommodations, etc. all 23 of our participants in our first cohort have found employment or internship opportunities, we're extremely excited about that, since obviously, in the middle of a global pandemic, the economy has not been kind and so employment is difficult to find, and having everybody find some type of opportunity has been really, really exciting. And we are enrolling for our upcoming cohort. Again, you can live anywhere in California, I will have information at the end, should that be something that you're interested in. Um, so just kind of wrapping up Generally, the current statistics that we have our heart, it's hard to see such low employment rates for autistic adults. But I do think that things are changing. And I think one of the exciting things and why we're all here is to help turn that tide really dramatically. And I think that that's happening. So my goal in my hope is that in five years, this talk won't start with those same statistics, and that we're going to have much more exciting statistics to talk about once we're able to shift the workplace to be more open and accepting and flexible for neurodiverse employees, but also making sure that neurodiverse employees have some skills and supports to effectively navigate the employment environment. So we really want to make sure that self advocacy is an enormous component of supporting individuals who are seeking employment, and also that we're building neuro diverse awareness within the workplace. So when I acknowledge some of our collaborators, this is the contact information about the piers for cruise program if you guys are interested, and I will stop there.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 1:58:50

We have a lot of interesting questions. So the first question is asking about how the appears program is actually teaching social skills to autistic adults. autistic masking is a huge problem in our community, and results in mental health problems. You think? So? programs like peers program, actually helping adults or they simply forcing them to mask being autistic, to continue to suffer through an able is workplace?

Unknown Speaker 1:59:30

I think that's the heart of the question. Thank you for that question. I think that's an excellent question. And really important. The goal is not all the goal is simply to provide skills that individuals can decide when and how to use to be effective in the environments that they want to be in. That is super complex within the context of the masking that is happening. Very continuously, often for autistic adults, and we know how painful that masking can be in terms of mental health outcomes. So I, I would really, really hope that the takeaway is not that we are asking individuals to not be who they are, but simply that we are providing options for additional skills that might help them contextualize for others who they are, and how they're able to, you know, provide and be a part of the spaces that they want to be a part of. And there's going to be, unfortunately, sometimes a little bit more of a burden on the individual to provide that context. And that's not fair. But that that is kind of how it, it's working right now. But the goal is not that you're hiding who you are at all, it's simply that you are creating space for yourself where you want to be.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 2:00:55

Oh, there are a couple of questions about gender. So they would like to clarify. Seems like what you're you're showing has defined male and female. What about trans non binary gender non conforming autistic people? Where do they go?

Unknown Speaker 2:01:19

So I'm not sure that I totally understand the question. It sounds like there. Are you asking about that for the for a specific component of the program? Is the individual asking about that for a specific component of the program? Or just a generally Where do non binary autistic adults fit?

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 2:01:39

I think, the questions there are a couple of questions that are saying that, from the slides that you're showing, adults are gender divided.

Unknown Speaker 2:01:50

Oh, so I want to be super clear about that the only gender divided component at all is the group intervention. So nothing else is gender divided at all. And there's no gender, focus, unless that's something that's of relevance to the individual. The group that we initially started was a women's only intervention group intentionally to be able to access the experience of women on the autism spectrum. In the future, we are very open to groups that are that span different intersectionalities of gender presentation. And that that's something that we we have several programs at UCLA that work with gender diversity that we are partnering with, to kind of make sure that we are providing spaces that are helpful to individuals who are gender diverse, but that is the only a gender program that that exists at all. Everything else is everybody is welcome. And it's it's not intended to be gender specific at all. Sorry for that confusion.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 2:02:56

So the next question. I think it's basically asking about the communication support that hears for periods is, is providing this attendees asking, Are you expecting the burden of communication to fall on the autistic person only?

Unknown Speaker 2:03:21

That's an amazing question. So no, absolutely not. And some other work that I'm not presenting today, we are starting to really work on how do we create an environment within the workplace where communication is a burden that first of all, hopefully does feel like a burden, but is a an expectation that is shared by every single person within an employment settings such that there is no kind of differential burden on the neurodiverse individual, and that there's very clear concrete plans for communication that everybody is aware of, and that everybody complies by so that everybody is on the same page, and everybody feels responsible for communication being effective.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 2:04:06

So there's the last question. There are many more, but we'll leave them to me at the end. unemployment and underemployment are major issues among educated artistic professionals, because they struggle with workplace social interactions, and workplace politics. How are you settling people for success? setting people just success and career progression? how to navigate evaluations, self efficacy, promotion, conflict resolution, and management team.

Unknown Speaker 2:04:43

totally amazing questions. So this is the first step. What what I'm talking about now the peers for careers is the first step. The goal would be and I actually suspect that some of the speakers later maybe talking a little bit more about ongoing support within an employment setting. But the goal would be that we are shifting the dynamics of the workplace to support neurodiverse individuals throughout their lifetime of employment, including making sure that conflicts and performance reviews etc. are done in a way that that worked for neurodiverse individuals, and frankly, that worked for everybody. And that there are supports over time. So So what I would say is that that is something that we will want to to research more over time and build supports around more over time. This is kind of the first step but that's absolutely the question. You need to get in the door and get employed. But then the goal is that you have a long and illustrious career and how can we support that over time? Carolyn, thank you all so much.

Unknown Speaker 2:05:54

Okay, so thank you so much for that, Dr. Grants. And I'm excited to present our next speakers who are my colleagues, Christy Mehta and Dr. Janet Miller, who work on the neurodiversity project. And they'll be presenting today on the neuro diverse employee support and training program, the nest program, and looking forward to hearing from both of them.

Unknown Speaker 2:06:41

Okay, can you hear me hopefully. Okay, today, we're going to be talking about the nest program, which stands for Oh, start my video. Okay. All right, hopefully, I'm being heard and seen. So as I started to say, we're going to be talking about the neuro diverse employee support and training program, also called the nest program. And that program is actually part of the larger Stanford neuro diversity at work program. So I'm going to talk a little bit about that program first in case some people are listening who haven't heard about it. So there's basically two main components to that program. And the first is really focused on the employer for training and educating them about working with neuro diverse employees, all the way from the recruitment, the hiring process, and during the employment process itself. And also in assisting them and creating a supportive and neuro diverse, friendly work, work environment. And it's from that group of employers that we we've created or the neuro diversity of Work Program has created the job bank. The second component of that program is the candidate registry. And that's where the nest program comes in. And the registry is designed to provide employees support throughout the entire process from job seeking and resume writing and hiring process as well as preparing them for success in their jobs, and giving them access to the job bank where they can find jobs and then putting them into one of two nest programs. Briefly, the overall goals of the neuro diversity of work program are to match neuro diverse candidates with suitable jobs in the job bank. And really, we're hoping not just to find jobs for them, but to match them with jobs that really emphasize their skill set, and are also in line with their interest and their employment goals. And then we support them. Throughout the process, we really want these jobs to last and that means that the needs, they need to fit both the needs of the employer as well as the employee. Some of the objectives include cultivating a strength based model of neuro diversity, empowering employers with the skills and the knowledge needed to work with neuro diverse individuals, and creating really inappropriate inappropriate work environment. also increasing job readiness for the employee or the intern and helping them to build on their strengths and some of the challenges that they may face some of the challenges they have and support both the employer and the employee throughout that entire employment cycle. So one of the ways that we're doing this is through what we call the support circle. model and that's where we're helping both employees and employers create a support system that really can help the employee succeed in the workplace, and even in their personal life as well. So we'll be coaching them on how to connect with support in both their personal life and at work. The personal support circle includes things like, you know, family, friends, possibly a therapist, even groups or organizations that can serve to support that individual in the workplace ultimately. And then at work, we have another group of support circles, both in the job itself, manager, a co worker, or HR representative, and possibly even a job coach or other job related support. And so you'll notice that the nest coach is not directly working with members of either support circle, but rather, they're helping the employee to develop the supports, and the you utilize them in the most effective and helpful way possible.

Unknown Speaker 2:11:11

So a bit about the structure of the program. So first, the individual would go into the candidate registry, and then from there, they would go into one of two nest programs either the five week internship Nast program or the 12 week employment program. And that would happen, they would enter either of those programs once they were actually starting the job or the internship. The model really starts with this strength based model that I mentioned earlier, that's part of the neuro diversity work program. And we're really trying to cultivate the unique strengths of the individual, helping them to overcome any employment challenges increase their skills, and work experience and other qualifications. The structure is basically that we have a weekly meeting with the individual, the NES coach and the individual once they've started, and then it would go for either the five or the 12 weeks that I mentioned earlier. Now I'm going to turn things over for a brief part of the talk to Christie to talk more about the process of developing the program and some of the principles and values that underlie it.

Unknown Speaker 2:12:37

Okay, thank you, Janet. So it's helpful to understand the program is to understand a little bit about how we develop the program. So we started by talking with people with the aim to understand their individual experiences with employment. And we spoke to people who are on the autism spectrum, we spoke to caregivers and parents, we spoke to experts in the field and those with clinical experience. And from our discussions, it was clear that each person who is seeking employee employment and does neuro diverse, is it is an individual with individual experiences, and strengths and challenges. However, we did find some common pain points. And we learned about challenges in the new job in new jobs. So some of the things that were often mentioned to us, related to challenges were that neuro diverse individuals often mentioned difficulties with approaching co workers. We heard that they struggled with asking questions worrying, either that they were asking too many questions or didn't know who to ask for help from. Many Express struggling with overwhelm during a new job change frequently contributed to that overwhelm. And they often talk about a lot of change that happened in the early stages of a job, maybe changing goals, maybe meeting locations, changing priorities changing, and that could create anxiety and stress. Knowing protocols and norms and mastering those basic work protocols added to the cognitive load that many neuro diverse employees talked with us about and felt they had to contend with during early employment. and managing sensory sensitivities such as lighting, noise, temperatures, those kinds of types of things was for many employees, something that they were, that was a challenge in early employment. And one challenge came up multiple times in different ways for employees, and that was understanding the hidden curriculum which is the unspoken norms that are often communicated through body language gestures, facial expressions or other unspoken means in the workplace. And some examples of this include one employee who remembered trying to follow the conversation and staff meetings, and just feeling a sense of confusion. And we heard from employees who were told more than once that co workers didn't feel comfortable because of their level of interest. And because they asked a lot of questions. And from the neurodiverse employees perspective, they didn't realize how their interest and behavior was being interpreted by others in the workplace. And we've heard from neurodiverse employees that conversations at work can sometimes feel like they're flying blind, to the point where some neurodiverse employees suspected colleagues were having meetings without them, when in fact, they were later realized that they were just not following some of the subtext of the meeting those gestures and these unspoken communications and norms. So that was a key area of challenge that seemed to come up and was a, what you would think of as a pain point for many of the people that we talked to a theme that emerged. So clearly, the although there are many challenges during early employment for neurodiverse individuals at the same time, they bring enormous strength to the job. And we asked them about some of the strengths that they felt like they were really bringing to the work environment. And some of the ones that we heard about were an ability to follow directions, a sense of humor, analytic processing, concrete thinking, visual processing, thinking and pictures, a consistency to work, attention to detail, hard working attitude, a diligence, responsibility, a commitment, and incredible integrity and work ethic, and a credibility. And of course, the strengths as with challenges are incredibly individual. And these were just some that were shared with us.

Unknown Speaker 2:17:01

When we were asking people about their strengths. And as with anyone, many of the neuro diverse individuals connected overcoming challenges to strengths that they had developed. And one of the example of that was developing observational skills. And to cope with challenges. A number of neuro diverse individuals described developing observational skills as one of their strengths. And again, another example of this is one individual described bouncing around in her career. And while she felt forced to change jobs, she also found that because she had switched jobs, so often, she learned to observe other people. And what she learned early on in during early stages of employment was to imitate other people until she formed similar work habits. And she recognized that each work culture had its own unwritten written rules, and she would be able to follow the unwritten rules once she had learned them. But another thing that she observed and learned over time and multiple experiences, was that having somebody there in the work environment who was supportive was really key. And an example would be a supportive manager who maybe could give some tips on some of the social interaction in the work environment, such as that you might be expected to bring a gift to a holiday party, which would make a big difference in her feeling comfortable and able to fit in. Which leads us to sort of what are some of those important experiences for new employees to have, that might really impact their getting comfortable in a job reduce sense of overwhelm and, and support them in early employment. And feeling heard, was a key, a key thing that came up repeatedly in in situations where employees felt heard, it seems to make a big difference, especially early on, and people overall and their relationships where people were key. So mentorship was often important as an early experience. Having someone to joke around with being able to have a little fun at work made a big difference. Having some time to have a more gradual orientation. So learning things a little bit one at a time, rather than being feeling overwhelmed with everything that often occurs during new employment. Having work that match their ability and interest, so doing interesting things, being able to explore something new that was interesting. And relationships with co workers and supervisors were really key. So feeling supported by the team, having one on one meetings with supervisors and teammates, and support for someone who actually asked about their strengths and weaknesses or something. Other things that people identified as experiences that would make a difference in their employment, especially in early employment. So from the interviews and discussions that we had, as well as from experts in the field, and from those with clinical experience, we identified four key content areas for skill development for new employees. And these included managing sensory differences. integrating into the work environment socially, which includes understanding the hidden curriculum, work performance and organizational tasks. So often, managing schedules setting and setting priorities could be extremely stressful or overwhelming, and emotion regulation. So multiple people discuss how overwhelming new employment can be. And several talked about how during early employment, to manage the feelings of overwhelm, they had to cut back on or eliminate other things in their lives until they had adjusted. And so while offering support and skill, develop development in the four core areas is important. Through the our connection with people, we realized that the success of the intervention was not simply what we were teaching and the skills that we were teaching, but also how we interacted with the employees and the underlying values and strategies that we brought to the process.

Unknown Speaker 2:21:27

So we started by considering the core content, how the core content is delivered, and adopted the universal design for learning model, which draws from a variety of research, including the fields of neuroscience, the learning sciences, and cognitive psychology, to form the design of interventions to be open and applicable to all learners. So in the program, the core content is incorporated into discussions, the activities we practice together during sessions and the action steps identified at the end of each session. So for example, at the end of each session, the coach will review the past week. And as a, and as they talk about it with the employee, they'll explore gaps between what the employee knows or is able to do and what they need to do and where their goals are. And what what the coach and the employee are looking to do in that process is to really identify just right challenges, sort of those things that will help them to grow in their ability to manage new employment or their skill with with new employment, but aren't overwhelming and discouraging. And that's one of the principles of universal design is sort of finding things that are just right, a chat just right, challenges that are not completely overwhelming and discouraging. Another key value and what strategies are built around is the idea of self advocacy. So the model engages the employee in developing and strengthening the ability to articulate their needs, and to make informed discussion decisions, which includes making decisions about the support, they feel like they need to meet those needs. If the skills would include and built within the model will include asking for support in a timely manner. So when you need it, before things get sort of spiraling into a crisis, and then being able to ask for support in different emotional states. So sometimes we're good at asking for support one more very calm, or when, when we're not having too much trouble. But when we start getting frustrated, or we start feeling despondent about something, it can be harder, so making sure that they can ask for the support they need, even when they're already starting to struggle.

Unknown Speaker 2:24:05

And the other thing is Janet had mentioned is that, when she talked about the support circle model, is the idea of engaging with supports in the system. So we part of the model, and part of the values and the strategies that we're working on, is building an ecosystem of support. So while it's important for the employee to understand and communicate their own needs and built in Independence with self advocacy, it's equally important to develop and strengthen supportive relationships, at work and in their personal life, that are going to help them achieve their work goals, and all employees, anything, anybody whether you're neurodiverse or neurodivergent, or neurotypical knows that you rely on your colleagues to do your job and to progress in your career and for many years diverse employees. In particular, they benefit from support in the work environment. Because they may have, some of them may have challenges in particular areas where input and support from, from people in the around them can be really beneficial such as reading social cues or identifying priorities. And then another key valuers and strategy built into the core curriculum is the idea of problem solving and strategies around problem solving. and problem solving in and adjusting are really key to self advocacy, to maintaining self regulation, not getting overly frustrated or stuck and to achieving goals. And so for those reasons, problem solving strategies are woven throughout the program. And it's through the problem solving that the coach and employee sort of strengthen the decisions that the employee is able to made, make their ability to kind of evaluate what they need, and their adjustment as because as the work environment changes, because that's really a reality in work environments is that there's sort of constant change. And so there's constant need for adjustment. And then, as mentioned, by Janet earlier, the program has grown out of a strength based approach. So the curriculum is not designed to simply address challenges. But as a central tenet, to build on strengths with the aim of increasing both, you know, their short term adjustment and happiness within the job as well as longer term life satisfaction, and hopefully, career satisfaction as well as they're able to move, continuing their career and, and move within within their career. So now that I've provided a sense of where the program came from, I'm just going to briefly talk about the four content areas a little bit more. And then Janet's gonna talk about the structure of the program, which includes a meeting structure and a weekly action plans, and then planning for beyond the nest program as it is a time limited program. So as a reminder, the four content areas are integrating socially and the hidden curriculum, work performance and organizational tasks, sensory differences in emotion regulation. And so integrating socially and the hidden curriculum is this module. This curriculum is primarily designed to help employees understand the nuances of communication and learn skills to ask for what they need. Its focuses on how to build and strengthen relationships, how to make choices about when to adapt to the social environments. So at times, they may want to choose to act and adapt socially, and then when to assess and to assess when to self advocate for others to understand their unique communication and social interaction style. And it's really about making the focus of this is really about making choices around when they want to adapt versus when to self advocate for others to kind of understand how they're communicating. And then in terms of work performance, and organizational skills, this can be a really key area for skill development, particularly early in a job. And often, employees have expressed difficulties with managing time or so there would be a focus on setting up routines, routines, or a time block setting, potentially using visual schedules or tools, such as apps, calendars or timers to provide structure or and, in addition, managing emotion during times of change at work.

Unknown Speaker 2:29:00

And every person's sensory experience is different. Managing sensory differences can make a really significant impact on feelings of overwhelm, and the ability to focus and concentrate. And a few examples of some of the environmental changes employees might might make include things like wearing headphones to blackout noise, covering flickering fluorescent lighting, or changing desk locations to reduce distractions. And this module is really focused on understanding their own individual sensory differences. And what kind of either accommodations can be made in the environment or what are some strategies they could use that might help them to manage those sensory differences or sensory sensitivities that they may have. And then the final the final module is on emotion regulation. And this is really understanding their individual experience of emotion and stress and enhancing their ability to articulate their needs and choose strategies that will work for them. And with that, I'm going to turn it over to Janet.

Unknown Speaker 2:30:10

Thank you, Christy. So in talking about the basic structure of the curriculum using these four content areas, we're basically using two different models. One is the five week model, as we've taught, as I've mentioned, and the other is a 12 week model. And the basic structure of these are very similar, the main differences being the length of the program and the breadth of the material covered. So in the employment program, we cover all four of these core content areas, although you probably can't see the detail in those different squares. But if you could you notice that it varies how many weeks we might focus on one particular topic. And that's because we really want to tie the program to the employees needs and what skills and challenges they have. So we may cover one, you know, emotion regulation for two or three weeks, and maybe sensory interests for just one depending on what the employee needs. In the internship program. Since we only have five weeks, what we're doing is selecting one main priority target area, and covering that area throughout the five weeks of the program. I want to mention that in reality, these four content areas really overlap and often in or impact one another. So, for example, if somebody has difficulty with time management and setting priorities, which is maybe more focused on in the organizational section, that can of course, exacerbate their stress and which we will talk about in emotion regulation. And it also may lead to tension with colleagues and difficulties in interpersonal interactions. So even though there may be this one primary area that we're focusing on, for example, in the five week program, when you start to address something like organizational tasks, that can have a ripple effect, and you know, lower one's stress, and which in turn may improve interpersonal interactions, and so on. So even though the 12 week program is more comprehensive, the five week one can still provide some significant support for the individual. So in setting the stage during the first meeting, it's it's an important meeting, because it really defines the expectations about how the nest coach and the neurodiverse employee will interact. So starting in that first meeting, we're focused on focusing on as we've mentioned, identifying the individual strengths, but also looking at their challenges and deciding what areas to focus on. And we're also emphasizing the principles of self advocacy and self determination as Christie went into more detail

Unknown Speaker 2:33:11


Unknown Speaker 2:33:14

As I think she also mentioned, several of the employees that we spoke with, really highlighted the importance of having had somebody to talk to about their their challenges in the past and how that really made a significant difference. So in the first session, the employee and the NES coach will be identifying either the primary target area for the intern or you know, the priority of these areas for the longer 12 week program. And we're doing this because we want to work on strategies that are really relevant and most important to that employee. It also really helps them to begin to articulate their needs and practice self advocacy right from the beginning, as they're making choices about how to address their own unique challenges and strengths. Okay, I'm noticing we're almost out of time. So I'm going to quickly go through just the basic weekly meeting structure, it's more or less broken into three parts. The first being problem solving, evaluating strategies that might have been used in the previous week and adjusting the strategies for the coming week. Accordingly, we will have a short shorter cycle educational content, which may be videos that we've prepared or written content that the employee may either look at prior to the session or during the session with the coach. And then finally, we'll be engaging in a guided discussion, possibly behavioral rehearsal feedback session and identifying various ways they can use their support circle to the best effect. So we're also developing a weekly action plan, encompassing all of these principles that Christie went into great detail about. And we're coming up with an action plan for that week, as well as at the end of the program, an action plan for moving forward. And that's because we're not just sort of offering them the support and then just disappearing. But we really want to help equip them to move forward, have a plan where they're really utilizing their support circle circles, as best they can, perhaps even increasing them and continue to use the skills of self advocacy and problem solving that they've been learning and practicing during the next program. So I think I'll stop there. And thank you both. Thank you for listening.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 2:35:54

So we'll leave the questions to the q&a session for this particular presentation. We have about 15 minutes of break at the moment. We'll come back at 245 Quinn, do you want to try uploading your slides? Sure, let me do that. Looks good Quinn. Okay, thank you.

Unknown Speaker 2:51:08

Hi everyone, welcome back. And I'm very happy to introduce another one of my colleagues, Dr. Quinlan, and she will be speaking today about wellness while working remotely. Thank you so much for speaking with us today.

Unknown Speaker 2:51:28

Thank you Janie. I'm really honored to be part of this summit and joining such a wonderful selection of speakers.

Unknown Speaker 2:51:46

That look okay, Jane. Alright, looks great. Thank you. So again, I'm Colin one. I'm a psychiatrist here at Stanford.

Unknown Speaker 2:51:58

And today, I want to briefly cover how autistic adults have been affected by COVID-19. Many of those who were able to continue working had to quickly pivot to remote work. And there are pros and cons of working remotely and some strategies, we can try to make it better. And also now more than ever, we need to take care of ourselves to mitigate burnout and zoom fatigue. So even before the pandemic started, autistic individuals were more likely to struggle with mental health issues such as anxiety and depression compared to non ASD controls. So in this study, using information from Kaiser Permanente of Northern California, which is a large healthcare organization, Lisa Cronin looked at diagnoses of over 15,000 adults without autism, and about 1500 adults with autism. And ASD adults had significantly increased rates of depression, anxiety, bipolar disorder, obsessive compulsive disorder, schizophrenia and suicide attempts. You can see in highlighted that anxiety disorder and depression were over 25% in the adults with ASD compared to the controls. And additionally, The study also looked at medical diagnoses, and noted that things like epilepsy, gastrointestinal disorders, immune disorders, sleep and cardiovascular disorders were also more prevalent in the autistic population. And so with COVID-19, this has led to changes in structure and routines, lapses in services and therapies. It's also made it harder for people to access their usual social supports. And so these challenges may have disproportionately affected autistic individuals who had these underlying health needs. So Spark, which is part of the Simons foundation sent out a survey to over 3000 autistic people in the United States. And results were collected between March 30 and April 10. There were 636 respondents of who 50 of whom 59% were female. And to give you a sense of the timeline of COVID-19 impact in the United States since I know we have some international attendees, it was declared a national emergency on March 13. And then a week later, states such as California, Illinois, New Jersey and New York issued a state wide stay at home order. And so this survey was collected just a couple of weeks after the stay at home orders. Overall, most people reported experiencing disruption to their social life, their employment, and home life. 97% reported that the changes related to the pandemic negatively affected their social life, with 68% saying they're coping minimally to moderately well. Prior to COVID-19, over 80% of the respondents reported being self employed or employed at least part time, after COVID-19 89% reported being negatively affected by the changes to their employment. Almost every respondent reported negative impacts to their mental health with greater depression, anxiety, and 50% reported feeling good to excellent. So again, this survey was collected about a month after up to a month after it was declared a national emergency in the United States. And not to make light of the issue. But during this time, many people were still just figuring out where to buy toilet paper. So what did these people think were some of the positive things within that first month, some reported that they felt happier to have fewer social interactions. Other said that they were communicating with families and friends more than before through video. Almost two thirds of the respondents reported receiving services or therapies remotely through telehealth and being able to check in with providers via email or phone. Some figured out things to do so some coped by limiting exposures to the news related to COVID-19. And others found that journaling, gardening and crafting were helpful.

Unknown Speaker 2:56:51

People recommended physical activity and maintaining some sort of a schedule also helped. My think it would be interesting to see how people respond to the same survey at different time points now that we are seven months into it. And then very suddenly, many of us were pushed into the world of remote work. telecommuting is not a new concept. And the mid 1990s companies such as IBM and at&t started allowing employees to telecommute, then in the early 2000s, innovations in technology made telecommuting more feasible. So we had wireless internet, so we're not just tied to a desk, we could go to a cafe, the internet was faster. And then there were new video conferencing applications that allowed us to stay connected with our colleagues. A survey in 2018, done in Europe by IW G, which is the international Working Group, they're an office space provider to people who work remotely found that 70% of professionals work remotely at least one day a week, and over 50% at least half the week. So over time, the number of people working remotely at least part time has increased. And so there I mean, and the reasons things have increased are because there are advantages and so remote work. Notably, people notice they spend less time traveling and this allowed for more time to exercise. more time to schedule medical appointments, people found a better way to balance work and home life. remote workers reported increased autonomy, having fewer office distractions, which then improved productivity. Managers then had to kind of shift the way they were measuring success of their employees, instead of measuring it by attendance and hours worked, but more towards performance and outcomes. So these pros that are noted here are reported by people who chose to telecommute. But for many of us, in March, we were propelled into a world of telecommuting, maybe without the proper training, or the office setup that we needed. And so there are some disadvantages that people recognize. And this wasn't just working remotely from a different office or a cafe. This was working from home where we may not have the right environment are there other people around that might not make it the best place to work? Different distractions and working from home blurred the lines Between home life and work life. So for example, if your computer is in the living room, it's hard not to think about work when you're relaxing in front of the TV, or if your computer is in the bedroom, because that's the only private space that you have. It's hard to disassociate work time from bedtime. So working remotely led to an always on culture where employees could be contacted at any time by their managers. It was up to the employee whether or not they responded, but that option was there. And while video conferencing facilitated the transition to remote work, being in front of the camera for meeting after meeting everyday causes fatigue and burnout. So you've probably heard of the term zoom fatigue over time. Not being in the same workspace also added barriers to interactions with co workers, that may have happened more naturally in the workplace. Collaboration can still occur in telecommuting, but there are extra steps that you have to go through. So instead of just walking to someone's desk and saying hello, you would have to send them a message, send them an email, and then try to figure out a time to talk if it wasn't the right time when you sent them the email. So it may not be as naturally as when you just see them in the same office space.

Unknown Speaker 3:01:34

And that's just communication with your team. There are also benefits from collaborating with non team colleagues as well. And so those interactions with non team members that may have occurred, just passing each other in the hallway, in the lunchroom now have to be more deliberate, we have to reach out to someone schedule a meeting. So now that we have to work remotely, how can we make it better? And I will be upfront to say I am not an expert at this. My first day of telecommuting was on March 12. Like many I quickly had to make adjustments that I thought were going to be temporary. And then as things as time passed, I had to shift my mindset to prepare for working remotely long term. And so one of the first things that I recognized and also this author Sarah cook talks about is setting yourself up for success by considering your workspace. So are you in the best possible area available to you in the home? Do you have what you need from the office to do your job at home? Can you request your employer to provide equipment to make sure that your work is easier, such as having an external monitor or getting an office chair? Will they provide a headset so that you can block out background noise and that your co workers can hear you better when you're on meetings. And with all of the considerations for your work setup is also be mind full of your health and safety in terms of ergonomics is your chair at the right height is your desk at the right height. Are there any pressure points caused by the table chair, the keyboard, the mouse? over time these repetitive actions are what causes injuries and so noticing things earlier, we can prevent a lot of headaches in the future. So then on to time management, which is not an easy thing to do. Unless we have clear goals and a degree of self discipline, it's really hard to manage our time and deliver regular meetings with the team can help us prioritize what are the tasks that we need to focus on. But there are a lot of distractions, even if we have a goal in mind. So with remote work, the volume of emails likely increase, you're getting emails from everybody that normally would just stop by and ask you something. And unless we can prioritize effectively, we can spend the whole day responding to emails or returning phone calls. So in her book, Sarah cook recommends classifying tasks based on urgency and importance. And this is just one strategy. We're all different. And so this might not work for everyone and it depends on what your role at work is as well. So The reason she endorsed this strategy is that she says, As humans, we tend to overestimate how much time we have to achieve task, we can make long to do lists so that we don't forget things. But at the end of the day, we might not achieve very many. And that can be discouraging when you have a long list, and maybe you only did one or two things. So it might be more effective to focus our efforts on the critical test. So we would classify tests into the A, B, C, and D based on the urgency and importance. then within each category, we can prioritize even further the different tasks. So she recommends focusing on the urgent important first, then the important but not urgent, then not important, but urgent. And then D we might not get to. And using this strategy of classifying tasks, it could also help us identify what tests can we delegate to other people so that we can focus on what we need to do based on our role in our strengths.

Unknown Speaker 3:06:17

And another aspect of Time management is creating a routine. And that also includes scheduling breaks and setting limits for ourselves. Because the lines between work and home are blurred physically, we need to set up limits and boundaries of when it's appropriate to do work and versus focus on ourselves and our family. And limits are different from everyone. So, for example, for me, I choose not to turn on my computer until after I eat breakfast. That way, I can now enjoy my meal without thinking about what I have to do that day. And with the demands on our time and attention, we have all tried to multitask at some point, thinking that it will make us more productive. And there are a lot of studies, you know, that show that multitasking isn't effective. So we've heard it time and time again, that it's not good, and it actually decreases efficiency. But it's hard to avoid doing it anyways. It's probably okay to have a phone call with your parents while doing laundry. But we may miss important details on a work call when we're drafting an email at the same time. Something I found to help me resist that urge of multitasking is to pause notifications when I'm doing something important. This could be notifications for my email, my phone, just so I could focus on the task at hand. And this has helped me avoid that urge to send a quick reply when they get the email so that I don't have to take the time to switch tasks. And then it's also important to communicate, communicating with your manager communicating with your team, but also communicating with people you go to for support. So families and friends there is working remotely can be very isolating. And so seeking support from these people can be helpful. And it can also be helpful for others to get a sense of things that you're also dealing with. While working in the same office space, you may be able to see if someone is having a difficult week or a difficult day. But working remotely it's not as easy to see when someone is struggling. And so we would need to speak up if we're we're having trouble or if we need to extend a deadline or need someone to help with a specific task.

Unknown Speaker 3:09:16

And part of being able to sustain all of this is to make sure we're taking care of ourselves. So self care is very important to preventing burnout and help us sustain wellness during this challenging time. And so as I mentioned earlier, part of the effective remote work is having the right workspace setup and ergonomics is something that is often ignored until it causes bigger health and safety concerns. So you want to make sure that your workspace is comfortable and to address any minor aches and pains become before they become worse with repetitive injury. And as we're all used to scheduling meetings, we also need to make a conscious effort to schedule breaks for ourselves. Try not to skip meals, we may even need to schedule those meals in between things to try to get up and stretch, meetings are often scheduled back to back and try to plan for time to transition between meetings by asking if the meeting can end 10 minutes before the hour. That way you can get up, you can use the bathroom, you can grab a snack, you can browned yourself for the next meeting. So we just have to be more intentional about scheduling things to make sure that we have time for ourselves. Having your camera on is really helpful in connecting with other people in the meeting. But it's also very exhausting to be on camera all the time. So depending on the meeting, it would be nice to ask if we could turn off the camera so that you're not on video. So that you're not expected to sit still in front of the camera. That way, you can stretch you can fidget but still pay attention to the material. Of course, your regular exercise and physical activity is really important. So a way that I've found to fit in a little bit of physical activity is if there is a meeting or a phone call that I can take away from my desk, I try to take it while I'm going for a short walk that way, I still engaged in the meeting. But I'm also getting some exercise and also, you know, taking some time for myself in terms of self care, especially if the meeting is not something that I'm actively sharing or participating in but being more of a passive listener because it's informational. And then it's also helpful to recognize the signs of stress so that we know when we need to make changes to our routines, or when we need to ask for some support. And Michael field has shared some of these signs earlier. So I thought that was really awesome. And then I can just review it. So it's important to recognize where the stress comes from, as well. So we know stress comes from work. Things like pressure of meeting deadlines, adjusting to changes at work, maybe even feeling bored, because we're not challenged enough at work, or just navigating the politics in the workplace. There's and then there's also stress outside of work, especially during this time. So financial worries, illness or death in the family relationship issues, moving homes, caring for others, or just living in a place where the conditions are not great. So in these tables, there's, it stresses the difference between kind of positive stress and negative stress. So you stress is the positive kind of stress that helps us focus our energy and motivates us. For example, it's the excitement that we feel when we're close to completing a major task. It's a kind of stress that we can cope with. On the other hand, distress is something that we feel we can't cope with. And so in these two tables are signs of physical signs of stress, as well as emotional signs. So you may notice things like changes in breathing, indigestion, aches and pains, headaches, feeling sweaty and clammy. And emotional signs could include feeling anxious, feeling tense, depressed, low self esteem, under confident.

Unknown Speaker 3:14:16

And then there are also signs of stress, behaviorally. And so with us stress or pressure, we can be more focused on our work and more decisive. Our thinking is clear. We have an awareness of what's going on. On the other hand, when we're in distress, we have trouble focusing, concentrating. We can't make decisions. It's harder to make plans. We don't think as clearly. And so when we notice signs of distress, it's time to reflect upon our self care. And then thinking about you know, is this time For me to make a change in my routine? Or is this time for me to reach out for help from a medical or mental health provider? So pay attention to your body and ask yourself, am I eating more? am I eating less? Am I losing or gaining weight? How many cups of coffee? Have I been drinking? Have I've been drinking more coffee than usual? For people who smoke as a way to relieve stress, am I smoking more? And what about sighing? You know, some people notice that when they're tired, or they're under stress, they seem to be saying more, and that's more of a subtle sign. And stress can also affect our immune system. So are you getting sick more often? How is your sleep? How is your thinking? Are you forgetful? Are you showing up late to things? Are you not meeting deadlines? Are you showing up late to meetings? When you're at work? Are you always just watching the clock? So when we notice the signs in ourselves, this time to ask, okay, what should I do to adjust my routine so that I could schedule more time for self care? Or should I seek professional help? So in summary, COVID-19 has negatively affected our lives in multiple ways school, social life, work home life. And many of us because of the pandemic had to shift over to remote work, which has pros and cons. But there are strategies to make it more effective. And most importantly, for my talk, I hope you take away what are the signs of stress so that you can practice self care and to also communicate when you're having a hard time to seek support. Communicating is effective both for the remote work but also for your mental health. All right, so I'll keep that summary slide on. But I can take questions.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 3:17:25

Thank you, Quinn. Um, let's move on to the q&a session. I think maybe the questions will trickle in. Okay. Sounds good. If we can all turn on our camera. Miko? JANET, Christy. Carolyn. You're currently in this already on? Okay. So I'm going to just go back to Michael first.

So there was a question about if you are admittedly focused fully on the employers perspective. Why do you have psychiatry, psychology staff? That sounds like a liability issue, not authentic support? Yeah, so

Unknown Speaker 3:18:34

I think part of it, what we've done is really how do you actually grow the knowledge base of the really the environment? What I mean by that is really, you know, everyone in the organization. I think it's just I think we're all now knowing that mental health is an issue more broadly. And I think a lot of us are building capacity. So it's all about building capacity with co workers and managers. So I think we use psychiatry, psychologists know teas as a way of actually making sure we have, we're building a capacity for everyone, not just ourselves.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 3:19:12

Excellent. Carolyn, this is amazing work that you're supporting young adults going into their career. As a person with ASD, I've been in the workforce 10 years and was diagnosed later. Is there any programs that you or your group will do for someone who has been in the workforce and need the training at a later point in their career? Please unmute.

Unknown Speaker 3:19:50

I'm so sorry. Um, that's such a great question. So I think that's something that we're definitely wanting to pursue in the future is providing access to the skills And kind of the way we're thinking about things to people, regardless of where they are in their career. Also, what I was mentioning towards the end of my talk in terms of supporting workplaces in being more flexible and adaptive to neurodiverse employees is another area that we would want to go into. So what I would say is currently, maybe Stay tuned. There are peers, programs for young adults. And so if if that's something if those specific skills are something that you're interested in, that's something that you could pursue. But I would also say stay tuned, because you're absolutely right. That's really important. And we and we will be getting to it.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 3:20:42

Going on to maybe I'll ask general Christy a few questions because they didn't get to any questions earlier? Is there a program to help the person figure out the strings are and what career they want to pursue? Please, unmute?

Unknown Speaker 3:21:08

That's a great question. I think it's not necessarily a question I can answer. Well, we definitely do some work on exploring strengths at the beginning of our work with employees together. But that's not that's not kind of where our focus has been. So I don't know that I'm the best person to really answer in terms of how do you explore your own career strengths? Or those sort of things? I know there are programs out there that do that. But I don't know that I would be the best person to answer that question. I don't know if you have anything to add to that. Janet? Are you muted? You're muted? Sorry, I was double muted. Yeah, our

Unknown Speaker 3:21:57

program is really starting with people once they already have their job or their internship. But we do work with the employee or the intern to help

Unknown Speaker 3:22:08

figure out what their strengths are through various means. So through just asking them about their interests and their experience in the past, you can also look at like a list, or list online of different strengths or attributes. And you can have somebody look at those and sort of choose the ones that apply to them. But I think in terms of really working out longer term career goals, that's not the role of the program. But there, I know, there's a lot of books out there about that, or going to see a guidance, you know, somebody who specializes in helping people discover their career goals would be more appropriate.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 3:22:46

So I'm just going to add that they had six, I'm going to give a talk on strength based assessments. So that may help answer partially your question. And there are also some apps out there, like one of them is called identity for that particular app, actually use some very similar concepts that this strength based model of neuro diversity that our group has been developing the last couple of years. And basically, some of the strains are based on the theory of multiple intelligences that Howard Gardner at Harvard, initially talked about about 25 years ago. And we basically adopt that and also adopt positive psychology, positive psychiatry, and also the seven vectors of development to collectively try to have a package that can get people to understand how to assess strings. So the the app identifier actually also use the the multiple intelligences theory in there, and you can explore that as well. So, Tuesday at six, if you're wanting me to tell me tell me more. So the next question is, you described a woman being able to mimic social skills and said that this was a strain for her. Do you consider that autistic masking this exhausting and can lead to poor mental health outcomes for autistic adults? How is the mental well being of autistic adults taken into account in this program?

Unknown Speaker 3:24:53

Yeah, so I can, I think that was the example I gave about observational skills is probably what they're reading Referring to and just just to clarify the example, because that came from multiple people who were sharing some of the skills they developed in early employment, and they were talking less about mimicking social skills and more about being able to observe work protocols and norms. And so I had one person Give me an example of some very extensive paperwork that was part of their work performance, and how they were able to observe really the intricacies of that in great detail based on their sort of experience of having had really, actually very varied careers. And that they sort of became the expert on that paperwork. And then another was somebody who

Unknown Speaker 3:25:44


Unknown Speaker 3:25:46

some of the office social interactions and was observant about, you know, kind of when they were occurring, this was somebody who also knew that she struggled with understanding some of what the norms were around those and would ask somebody else that but So just to clarify that, if I gave the impression that we were suggesting that she that people mimic, sort of unmask their social experience that wasn't wasn't what that had been intended to demonstrate. But in terms of how, how we address emotion regulation, and mental health, there's sort of two different pieces to the program. One is that we do have the emotion regulation, sort of module and piece to it. And so there are some strategies that we use that we work with people, a lot of, it's understanding their own emotional needs, their own experiences, their own, you know, kind of where the stressors come from, and talking about strategies within that, that maybe have been effective for them in the past or are effective for them. Now, we also look to really connect people with positive psychology strategies. So if they and related to their interests, and what is really resonant for them. So for example, somebody who already has a might meditation practice, or had one in the past and wants to re start that we might really work on how do you reconnect with that? Or how do you incorporate that into your life now in a way, that would be really helpful. So it's really coaching around particular strategies and understanding and assessing when they need to really be using them. But we're also not therapists, and this isn't therapy. So that's an important distinction to make. And so that's kind of where the support circle model comes in. And we would encourage people to, if they're needing therapy, to really connect with a therapist, and to make use with that and make sure that they had that support in their system. And we might be coaching them around how to how to get a therapist if they don't have one, or how to make sure that they have that support, if that's something they need in terms of their mental health.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 3:28:04

Um, thank you, Christy, for the audience out there. If you're submitting your questions right now, please indicate in the beginning, what that question is addressed to all who that question is addressed to. So we can direct the question to the right person. So Nick, the next question is for Dr. Newman. many college students came home to California from out of state due to COVID and can continue with their preferred is online across state lines. Do you have any suggestions on how we can get a temporary change to the loss during COVID. So therapists can continue to support their clients remotely across state lines. I understand psychiatrists are permitted during COVID to work remotely across state lines, but not therapists.

Unknown Speaker 3:29:05

This is definitely an area of challenges. We also work with many college students who had to return home without, you know, clear indicators of how long they would be home before returning. And so it's hard for me to speak about how therapists can provide care. But for psychiatry, it isn't universal. So it depends state on state, which state is accepting like a waiver for their medical license for a provider to practice during this COVID emergency. And the that also has changed in terms of when states have decided that the emergency is over and then that providers no longer able to do the telehealth care. So, I mean, I think it's a big need for us to be able to continue seeing our patients because continuity is so important. what some of our providers here have done, at least at the university level is help students find other providers to kind of bridge that gap. And so we have people here helping students navigate their insurance system to see if there are other providers who can do therapy as well. And I wonder we do have a few psychologists on board here, if they have any additional thoughts into being able to provide care across state lines during this time.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 3:30:38

Jamie or Jenny?

Unknown Speaker 3:30:42

It's very similar, actually, to what Dr. Irwin was saying about. It depends on the state. And each state has different requirements for being able to potentially get a temporary waiver to be able to be licensed in that state. I myself have gotten a couple of them actually, to be able to provide some sort of some continuity of care for different clients, but making very clear to the client that it is only within this state of emergency that's dependent on the local government, in terms of how long that state of emergency

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 3:31:20

is declared, I guess. This question is for Michael. I'm a manager at about company. How do I comfortably introduce training about neuro diversity in my teams? I know I have to work with human resources, and other legal teams, what resources or ideas can I bring to them?

Unknown Speaker 3:31:49

Yeah, I mean, that's a good question. I actually have a believe in a lot of training and continuous training for managers, and co workers. And that's what the research actually comes back with. So we've used tools such as we partnered with Google, Microsoft, JP Morgan Chase around a product called optimized, so optimizer, some product, we've kind of used them for providing training, just broad autism, neuro diversity training, but also more persona based training, meaning in roles meaning HR, they might be a manager, we've also use a couple of tools, as well for performance management. So we felt fine. That's one of the biggest pain points for where things kind of break down. We use a an Israeli tool for performance management. So we we find that very helpful as part of our program. And probably the other part we were also kind of deploying is some of the Mental Health Training, which is first aid, mental health training, which you can get some time, you can get that usually from providers. We're also embedding that hopefully through some of our products we use, optimized and live sharper as well.

Lawrence Fung MD PhD | Stanford | Assistant Professor of psychiatry and behavioral sciences | child and adolescent 3:33:10

Thank you. This question is for Carolyn. I'm not autistic. I do have a lot of neuro traits that were problematic when I was young, and now very healthy, very useful. I work best in my own systems. I have two bachelor's degrees and two master's degrees, have worked in a nonprofit in planning, fundraising, and so forth. my close friend is autistic with sensory triggers. She's a respected global contract attorney. Why then do programs like this? such as yours? How do you encourage participants not to internalize buyers and limit their goals? That's an amazing question. Yeah, um,

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