EPISODE 158

[00:00:00] MD: Hey everybody, thank you so much for tuning in to this episode of First Bite. Just a friendly reminder that if you'd like to earn credit for this episode, complete the accompanying audio course registered for ASHA CEUs on speechtherapypd.com. And you know, I love a good coupon! Don't forget to use the new coupon code ÒBite21Ó to get $20 off your registration fee. So, check out speechtherapypd.com, register for an annual subscription, and don't forget to use ÒBite21Ó for your $20 off.

So happy listening, happy growing, and from the bottom of our hearts with everybody behind First Bite, thank you so much for being part of this journey. Don't forget, check us out @firstbitepodcast on Instagram world and @firstbite on Facebook. Happy learning you all.

[INTRODUCTION]

[00:01:09] MD: Hi, folks, and welcome to First Bite: Fed, Fun and Functional. A speech therapy podcast sponsored by speechtherapypd.com. I am your host on this nerd venture, Michelle Dawson, MS, CCC-SLP, CLC. The All Things PFDs SLP. I am a colleague in the trenches of home health, early intervention right there with you. I run my own private practice, Heartwood Speech Therapy here in Columbia, South Carolina. I guest lecture nationwide on best practices for early intervention for the medically complex graduates. First BiteÕs mission is short and sweet, to bring the light, hope, knowledge, and joy to the pediatric clinician, parent or advocate by way of a nerdy conversation. So, there's plenty of laughter too.

In this podcast, we cover everything from AAC to breastfeeding, ethics on how to run a private practice, pediatric dysphagia to clinical supervision, and all other topics and the role of pediatric speech pathology. Our goal is to bring evidence-based practice straight to you by interviewing subject matter experts to break down the communication barriers so that we can access the knowledge of their fields, or as a close friend says, ÒTo build the bridge.Ó By bringing other professionals and experts in our field together, we hope to spark advocacy, joy and passion for continuing to grow and advance care for our little ones.

[00:02:39] EF: Every fourth episode, I join them. I'm Erin Forward, MSP, CCC-SLP the Yankee by way of Rochester New York transplant who actually inspired this journey. I bring a different perspective, that of a newest clinician with experience in early intervention, pediatric acute care and nonprofit pediatric outpatient settings.

[00:02:59] MD: So, sit back, relax and watch out for all her growth and enjoy this geeky gig brought to you by speechtherapypd.com.

[INTERVIEW]

[00:03:17] MD: Hello, everyone. So, today's lecture, one, comes with mommy parenting struggles. So, if you hear the tiny humans upstairs, hello. But also, today's lecture comes with a bit of a heads-up warning for your heart, because we are going to have the crucial conversation about ACEs. Now, I'm not talking about the nerdy girl SLP crushing her ACE award for earning like a boatload of CEUs. I am talking about Adverse Childhood Experiences, like trauma, and how that impacts a child's development across their life, and how the SLP on the team is directly involved in the healing process.

So, folks, you've been warned. The fact of the matter is we encounter aces every single day, not necessarily our own. But we do bring plenty of that baggage with us. But I'm talking about the ACEs that our patients are feeling, the ACEs that their caregivers are bringing with them, the ACEs that the other allied health team members are bringing too, and through all of that chaos, it's on each and every one of us to show up, bring joy, utilize evidence-based practices, and start that little one on their healing process. And that's our calling.

So, how and where do we start? Well, that's where today's guest Megan Branham, who holds a Master's in Social Work, is a graduate from the Annie E. Casey Foundation's Leadership for State Based Advocates, and currently serves as the VP of Strategy for North, a media company based out of South Carolina. She's here today to serve as a beacon of hope for all on this path. Megan, I am so glad that a lifetime ago, God led you into our lives at our sweet little church daycare. So, hi.

[00:05:11] MB: I know. Who would have thought, all those years ago, like, here's where we would be, right? It's a God thing for sure and I just love it when our paths crossed again recently. So, I am so excited to be here. Thank you.

[00:05:28] MD: So, a little bit of backstory. I basically embraced trauma as a theme this summer, which was like, maybe in retrospect, not the greatest theme to embrace when you're like coming off of like major work endeavors and emotionally exhausted, but it's a huge part of what we encounter every single day. So, this summer, my graduate student clinicians have worked through learning about trauma for our patients. Some of the coursework included this amazing book, The Body Keeps the Score, which I recommend every single person listening, read it. We had Dylan Hartley, OT RL with Advanced Institute for Development and Learning at Greenville. He guest lectured to talk about trauma and polyvagal theory. He was on the podcast a while back. And Megan came and talked about this with my students. And you remember in grad school when you have the lecture, and you're like, ÒWhy did they bring this person here?Ó And you like struggle through? I'm telling you that one, there wasn't a dry eye in the room, and there was also enough laughter that I did almost pee a little because post mom baby bladder.

And three, although I did trampoline jump last weekend, and I totally peed a little by like, three people came up to her. She had a line of people coming up to talk to her afterwards about this, about trauma, personal experiences, patient experiences, relative experiences, because yeah, this is what we do. So, I was like, we got to do this again, can you do this again? So, hi.

[00:07:03] MB: Hi. I just have to say your students are amazing and I think I even texted you after I was like, because I love, love, love, love working with students, right? Like have taught, and the field supervisor, like your students just were amazing and gave me so much hope for the future of the profession. Really feeling like South Carolina's children are going to be in great hands. So, it was an amazing experience. And I'm so thrilled to like, continue the conversation today. Because it's one of those, I don't know about you, but you start having these big conversations and then you have a thousand more questions after, and like processing after and just thinking and making the connections. So, it's really great to kind of be able to dive in a little bit deeper with you today, one on one.

[00:07:56] MD: Awesome, well, stick around because at the end, I'm going to sweet talk you into talking to my friend, Yumi, and do a webinar for us. What you don't know I'm pulling you into Megan.

[00:08:09] MB: Obviously, all part of your master plan. I know.

[00:08:13] MD: But I promise I'll buy you a cold pint at Steel Hands when we're done to make up for it.

[00:08:18] MB: I fold. I am there.

[00:08:21] MD: Also, disclaimer, I highly recommend going to Steel Hands in KC South Carolina. Okay, moving on. We have to embed a little bit of humor. Otherwise, we wonÕt get through this now.

So, ACEs and ACE is not a thing your ASHA CEUs. Can you talk to me about what is an ACE for our children?

[00:08:44] MB: Absolutely. So, I have to say I have a background in social work and I came to social work because I love people. I wanted to work with people. I am really particular, had an interest in doing community work. So, really engaging, meeting people where they're at, in their communities. And 15 years ago, plus, when I was in graduate school, we sort of talked around this issue, right? We knew what trauma was, and we knew sort of how it showed up. But it honestly wasn't until I really got into my career. And in the last, 5, 10 or so years, that there's been this sort of collective conversation around ACEs. And it's elevated in a lot of different ways.

So, I wasn't just having these conversations, like among social work colleagues or other colleagues that were working with children and families, it was kind of becoming more of a bigger dialogue. So, I think for a lot of people, I always say when you hear about ACEs, you are probably going to realize like, ÒOh, okay, so that's what that's called.Ó I knew what it was, but I didn't know that that was the name for it. So, the short story is, ACEs really came out of some research that was happening in the early Ô90s, about chronic health issues. And there were some researchers that were looking at why there were these mental or behavioral issues later in life, and what they were tracing it back to, were adverse childhood experiences, things that were happening to people in their youth.

So, things like living in a home where substance misuse was prevalent, or experiencing trauma. So, experiencing a physical, emotional, sexual abuse, it was things like living with a parent who had maybe an undiagnosed mental health issue. And all of these things started to connect, right? So, we're seeing a lot of things sort of play out and later in life, with chronic health issues, mental health issues, and again, we're connecting it back to the dots of, wow, what was happening was in these early, really, formative years, trauma was literally changing someone's physiology. It was literally changing their body and how their mind worked. And all of this was happening without awareness, like it was happening, but it was having such an impact on people later in life.

So, that's kind of the origin story of it. I would say, if you're interested in really digging in, on the research, if you're like me, and probably Michelle, ÒGive me the research, give me the data.Ó

[00:11:30] MD: Tell me the why.

[00:11:32] MB: Tell me all the things. Dr. Robert Anda, and Vincent Felitti, were the two investigators on the preliminary, the very beginning ACEs study, and it was, again, early Ô90s, a controlled group out of California, limited participants, but there's fantastic information if you want to dig into more of like how it all started with the study. So, that's kind of the jumping off point, I think, for the ACEs conversation.

[00:11:57] MD: When I was in grad school, I was going through the trauma of a very violent first marriage. And so, I distinctly remember shutting down when they were talking about it in school, because I just Ð it was like a switch and I couldn't hear it. I'll be honest, sitting and listening to your talk, every time we talk about trauma, it hits my triggers. But like, I have to have that conversation and I have to push through because domestic abuse happens and I'm no longer a victim. I'm an advocate, which is very powerful, very humbling to say. But Dylan, when he was lecturing, he was talking about how it alters the DNA in our bodies and it triggered a memory too, when they presented it in grad school, there was a research study, and forgive me, I cannot remember the name of the author of the research study. But what they did was they looked at three generations of families after World War Two, and it was one, and I'm going to butcher this word, but you all know I work on swallowing, not on the talking aspect of things.

So, multisyllabic words are hard. Hasidic Judaism, where itÕs very orthodox. So, what they did was they looked at the three generations out for the Hasidic Jewish families that survived the concentration camp and stayed in Germany. For those that made it to England prior as the war was going on, and those that made it to Canada. So, the original family members, and then three generations out. And the closer you were to the epicenter, the more mental health issues, the more like you were talking about physical illness, and even down to learning disabilities that were increased prevalence three generations later. ThereÕs a part of our DNA, it's the tails of the Ð oh my gosh, oh, somebody somewhere screaming the name of that word. It's the very tip, the very end of the chromosomes. They're deteriorating, because of the trauma that we carry. And we are carrying that trauma, and embedding that at a molecular cellular level into the next generation, and then you have an ACE. Yes, okay.

[00:14:23] MB: That is exactly it. And I think for a lot of us in the social fields, we don't always get a really deep dive into the biology of it, like we sort of Ð and kind of depending on the type of work that you do, you come into working with clients, with maybe not that Ð at least for me, personally. I don't know that I really understood the biology component of it, but everything that you're describing is exactly what the research is showing, that like generational trauma is real. It is literally embedded in our cells and our DNA, trauma rewires the brain. And so, like you said, stuff that triggers us from our own personal trauma can happen at any time, in our body, and we have no control over it, right? Our body is doing what it does naturally, which is protecting itself. 

So, our body's going to go into that fight, flight or freeze mode of like, ÒOh my gosh, warning, warning, what am I supposed to do? Am I supposed to flee? Am I supposed to fight? What am I supposed to do?Ó And so, I think that having that understanding of it is your body doing what it does, there is no shame there, and I am big, I'm a big BrenŽ Brown fan. I love her. I want her to be my best friend. And I hope that she's listening to this podcast, I'm putting it out there, BrenŽ be my friend. I would love to have coffee with you, but let's destigmatize that. And let's like recognize that like it is the body doing what it does naturally and reframing and reshifting from like, what is wrong with you, to what's happened to you. 

And exactly what you just described, it's these experience that have either happened to us directly, or oh, my gosh, happened to our parents or grandparents and we're still dealing with the residual effects of it. So, there's a lot to unpack there. And again, I think it's one of those, like, you go into this, and you start to peel back the layers, and you start to realize how much he says, impact everything. I often talk about it and I think I mentioned this to your students, also often talk about it and think about it in terms of an iceberg. Because visually, you can think about what an iceberg looks like. You have the big block of ice outside of the water. But what you don't see is what's underneath the surface. And that's often, what trauma looks like is what we see, which is the behavioral issues, or some of the chronic health issues, or some of the other kind of residual, like I said, effects of trauma that have reshaped us. But what we don't see is all of that under the water, the generational trauma, the experiences itself. A lot of times we see what face value and having an awareness and have an understanding that there's so much more to the picture, really helps us to be better clinicians and better approach our clients with that trauma informed lens.

[00:17:29] MD: So, one of the things that I've had a hard sell for families is getting them to understand that what they've endured actually qualifies as trauma. Because folks don't want to think that they have been through trauma or that their child has been through trauma, especially my NICU babies when they're like Ð and again, I don't work in the NICU, but like the babies that I received that have successfully navigated out of the NICU. You know what I mean? I'm like, but that was trauma. You go from, and Dylan explained it excellent yesterday. So, it's fresh in my mind, you go from a safe, safe space in the womb, to all of a sudden, you're ripped out of there and attached and being poked and prodded. And then God help you if you start having a bleed, or what if your mom had substance abuse problems, and now you're going through detox, but yet you're a preemie and I've had patients that had full term healthy pregnancies, and then all of a sudden, they get stuck in the birth canal. And then they have trauma of that experience.

Let's not neglect the absolute trauma that is the delivery process, the trauma that is embedded and you can speak into the adoption process and all of our foster warriors out there, not worrying in the sense, but advocate warriors. All of those can be types of trauma.

[00:19:05] MB: Yeah, I think that is a great starting point, because the original ACEs study was so limited, and there was only so much that we knew from that initial study, because, again, this is not something we've really Ð itÕs been researched for a long time, believe it or not. I mean, trauma has existed, since the beginning of time, but it's not something that we've really studied for very long. And so, I think that some of the things that that initial study showed and that subsequent studies have shown is that ACEs are common, they're very prevalent. Out of those 10 first, sort of classic, what we describe as like the classic ACEs, your emotional abuse, domestic violence, some type of mental health, parents being separated or incarcerated. So, you have those like sort of 10 original.

And then from that, we see the list growing, and I think we talked a little bit about this class of like, we know that trauma doesn't stop there that kids who experience homelessness, or maybe there's like food insecurity in the homes or maybe there's a lot going on with the parents, and there's unresolved trauma from them, and then how does that show up in their parenting? So, I think, again, we start to realize that this is just kind of the beginning of the work of realizing what trauma really looks like, and that while it is universal, in the sense that trauma is pretty common, and we all have experienced some type of trauma in our lives, it is also very unique, meaning that it's going to look different for everyone. So, it's going to present itself differently and it's going to have to be addressed differently, and in a way that works for that person.

So, I think that is one thing that does make it a little bit more challenging, because it's so nice when you have a standard practice for like, if this, then then, and here's how you respond. Trauma is tricky. So, it's going to require a little bit of finesse and a little bit of agility in order to really address it, depending on the person and their experiences. So, that's just something I think to be aware of, in this field, in this work, itÕs just as we kind of move through learning more about it. 

[00:21:33] MD: I feel like chemistry and maybe math, but not theoretical math, but like math, math are the only things that truly follow the if this, then that philosophy. Because if you screw up in chemistry, something explodes. So clearly, if this, then don't do that, or maybe you needed an explosion, but like otherwise, not necessarily.

[00:21:57] MB: It's one of those like, if only everything was that easy. If only it was like oh, okay. It's like parenting, right? You're like, ÒWe're going to try this today and we're just going to see what happens. It's an experiment 24/7.Ó

[00:22:12] MD: This morning, the 0 dark 30 this morning, we're sitting around and I'm like, ÒGo brush your teeth.Ó And they're like, ÒWell, I did.Ó I'm like, ÒClearly you do not because they're still slimy.Ó If you don't do this, then this will happen. Kids are gross. I love my children, like rawr. 

Okay. So, trauma, when we go in, and we do our assessments, and I'm going to speak to home health for a second because this is my first love. So, when I go into a home, this is very intimate, right, and our pediatricians, our physicians, our specialists, they don't get those moments with our patients. They get the patients when they're in their office. And typically, our families present different when you haven't an office visit, versus when you're in their space. From the second you exit your vehicle, the subway, the second they can see you, somebody somewhere is assessing you. So, tip number one, engage your therapeutic presence at that moment, right? Take your baggage, and as best you can, put it to the side.

I tell Erin, I visualize myself in a hamster bubble. So, like, I can go in and engage but I'm not letting that trauma into my space.

[00:23:40] MB: Oh, I like that.

[00:23:42] MD: Yes, like the bubble is a circle. Sometimes you get stuck at the bubble, and you're sitting in circles and all directions. But like, that's a whole nother conversation. But when you're in there, feel the room. Take a peek at what's really going on. When I'm doing a PFD eval, I ask the family to show me what their foods are, not just talk to me. Don't tell me, show me. Because when you open a cabinet, and it's kind of bare, Old Mother Hubbard style, that's when I'm like, ÒOkay, so we may need to make a phone call here and get this support over here.Ó But thatÕs Ð I don't know.

[00:24:19] MB: I know exactly. I mean, I think first of all, just love the image of the bubble. It's kind of like protecting yourself and I always talk to student and again, colleagues too, about and this could be a whole other episode about self-care and like, how are we paying attention to our bodies and ourselves and realize, like, ÒOh, I'm triggered now. Oh, that's how this is showing up for me and I need to be able to just likeÓ Ð I always feel like hit the pause on it, not like push it aside. But let's hit the pause on it so I can stay present in this moment. Deal with what's in front of me, and then revisit this later. That takes practice. That is an ongoing struggle and constantly learning about how to take care of yourself. So, I feel like that is definitely one but I love that visual. So, now I'm forevermore going to think about it that way. 

[00:25:13] MD: Michelle running around in a hamster bubble. 

[00:25:16] MB: Hamster bubble. Sometimes itÕs hamster on a hamster wheel in the bubble. All the things. But I think that's great. I think about like when you step into the person's environment, and I have done work as guardian ad litem, and so like, you are seeing people at their worst, their absolute worst. Something has led to the removal of their child from their care. And as a parent, that just guts me. So, I think about stepping into these situations of people's home environments, and knowing and the awareness that, again, the research tells us three and five South Carolinians report an ACE, and this is all data. I do have to make a plug for the Children's Trust of South Carolina, they do phenomenal work. They have some fantastic data, some fantastic programs, but they were doing research showing like this is three and five South Carolinians that are reporting.

Like you said earlier, Michelle, some people are not addressing, that are realizing they have trauma, they're not disclosing it. So at least, this is what we know to be true of people that are telling us they've had these experiences. So, you are stepping into a home with let's say, itÕs mom, dad, grandma, and two kids. Three of them have had some type of an ACE, at least one, right? So right off the bat, you sort of know what the playing field is. And then I think from that, figuring out where to start, and I love that you are looking at not just kind of like, like we said, not just what's in front of you with that iceberg. But like, what is the cabinet look like? Are you able to provide? Are there areas where in which you're struggling? Because it's all connected. You can't just be like, ÒOh, you have food insecurity. But yet you are fulfilled in every other aspect. ÒNo, no, that's going to seep into it.Ó

So, I think a lot of times too, checking yourself at the door, like you said, sort of checking any preconceived notions that you have about what that family is or is not, and really just being open to listening and observing and not just kind of coming in and like, ÒOkay, we're going to do this, this this, this, this. Check a list, move on.Ó You really do have to approach it more from like curiosity and wanting to learn and understand so that you can really best serve, best serve a family in that setting.

[00:27:57] MD: And what you said implicit biases, that's what triggered my head when you said Ð yes, because we have implicit biases that we may not even be aware of. When you look at our profession, our profession speech pathologist. I can't speak to what social workers, what the overall demographics look like, but I mean, we're 97% female, and 91% white women. I probably have my percentages slightly skewed there. But I mean, it's basically a middle-aged white female dominated profession. I don't know what I don't know. But God help me, I think I'm teachable. I try to be. And if IÕm not, he sure has a way of making me teachable.

[00:28:46] MB: You will learn it, one way or another.

[00:28:49] MD: One way or another. ItÕs what my dad always said. ItÕs the care learning style. DonÕt get your head on the electric fence, and I wonder where Bear gets it from. But we have we have those. And I mean, an evaluation day or reevaluate day or a transfer and continuity of care day, that's your opportunity to get a whole another fresh set of eyes on on a case. And I see trauma with my feeding kiddos and how they react when the food is presented to them. Do they go into a startle reflex, like fight or flight? Moro reflex, do they throw their arms out to their side and pull their hands up? Or their hands clenched? Those are other red flags. What about when they turn their head and purse their lips? I mean, folks, one horrifying fact that I remember from undergrad was when they were talking about infants and children and toddlers when you're going to change their diapers. If they get very still on the table, that's a sign of tiny ears, rub serious, but [inaudible 00:29:51]. And you have to be aware of that being a red flag. I think I work a floor away from my children having this conversation. Working mom props. 

But yeah, those are red flags that need to be talked about. And honestly, how many of us in the home health world have been there, when a parent has to change a child's diaper right in front of you, and they don't even think anything about it. I mean, you should be critically assessing all of these. And if you're doing a session with one caregiver, and another caregiver enters the room, and the child's behavior, demeanor changes, and those, you have to be aware of what's happening.

[00:30:40] MB: I know, I think that's it. It really is. I feel like when I have these conversations with students, or like early practitioners, their eyes start to get really big, and it starts to feel a little overwhelming, because it's like, you don't want to miss anything. And I always try to reassure, like, ÒLook, you're human, you're not going to pick up on everything. But the point is, is that you are conditioning yourself to look at it again, from that lens.Ó We talk about being trauma informed and that really means like responding in a way, or working with someone in a way that you know that they've experienced trauma. So, we don't want to re traumatize, we don't want to assume but just because you did this, then this means this. But you really want to start practicing a way of interaction that you can be aware and or if something just doesn't quite, just like, I don't know what it is, but it just doesn't quite feel right, that I have a trusted colleague that I can go to and be like, ÒYou know what, this didn't feel like Ð I don't know, I wasn't sure about this.Ó And have that safe space to have those conversations.

Because to your point earlier, we have a field and again, social works very similar, predominantly women, predominantly white women. If we're working with a population that is predominantly black or Latino and we are not aware of the cultural pieces as well of like, ÒOh, I could totally misread the situation.Ó But it was part of their culture or part of their family practice. And so, if I am not sort of like clued into that a little bit, then it may have a totally different outcome.

So, I think that part of that is that sort of constant learning, assessing, having a safe place to sort of debrief and say, ÒWas I totally off on that?Ó Or ÒDo you think I should have handled that differently?Ó And again, I think that's one thing that all this ACEs work and trauma work has taught us is that, again, it's still new, we're still learning and we're still exploring how we deal with it, frankly.

[00:32:48] MD: Yeah. Generations living in a home together. I grew up with my grandma raised me, she was in our home, my parents are there, but they split when I was young, blah, blah, blah, trauma. My other grandparents lived right next door. But to me, it was normal to have that many older people around, that many people to physically be in a house. And I have a boatload of siblings to boot. So, I mean, there's a lot of people. Christmas is really, really loud, everybody yells just to be heard. But my husband and Goose go hide because they're the introverts. And like, you find them in a corner somewhere gaming or reading or playing a board game. And they're like, ÒMom, it's just two people, leave.Ó Christian is like, ÒYeah, Mom, it's two people.Ó And I'm like Ð

[00:33:38] MB: Yes. Oh, my God.

[00:33:40] MD: But that's normal, right? But for somebody outside looking in, I could easily misconstrue, well, how many people are in a bed? I mean, how many people? But I mean, that's implicit biases.

[00:33:54] MB: Yes. So much that and I think too, part of it, and we talked a little bit about this when I came to your class. But I think a lot of times, and again, this is a shift in practice. A lot of times, it is really easy to focus on the risk factors like, what is wrong? What are you not doing right? I think that our field, or any field that's interacting with children and families is a shift to what's often referred to as the protective factors. So basically, what's working right, and there's really five protective factors. And I'll just run through them really quick, because there's a lot that we could go into on this, but it's looking at parental resilience. So, how resilient? What is the bounce back factor for parents that are struggling with everything that's going on in their life? Is there an understanding of child development? Do they understand like a six-month-old is not going to be like walking and talking and moving around? It is totally normal for your three-year-old to basically look like they're having an exorcism on the floor. Like all of these things are an understanding of child development.

So, if we have an understanding, we can respond appropriately and carry them out the one-armed football carry out, that we've all had to do many a times. So, itÕs that, itÕs knowing that they have concrete support that there are, like you said earlier, there's connection to a food pantry to fill that empty cabinet, that they have social support. Again, like you said, there were extended family around. They were there to watch kids when somebody wasn't able to. And that too, there's like this, also the social emotional competency of children. So, children are building from very early on their emotional intelligence. They are understanding identity. They are feeling loved and protected, and secure in themselves.

And so those five protective factors, and I'm sure in the show notes too, Michelle, we can put a link for folks that are interested in learning more, but it's really looking at those protective factors to say, ÒWow, you are just like knocking it out of the park. You have got some really solid social supports. You've got people that have your back. Where you might need some help are some concrete supports. You might need food stamps, or you might need connection to childcare, some childcare vouchers.Ó So, I think Ð

[00:36:29] MD: Power bills.

[00:36:31] MB: Yes. Oh my gosh, transportation bills.

[00:36:33] MD: Yes. Okay. Power bills, did you know most power companies can set up a monthly payment, like on an average so that it's predictable, as opposed to fluctuating, and wait, transportation here in South Carolina, we have something called logisticare, if that's the name of it. And if you are a recipient of Medicaid, they will reimburse you if you call in advance for your mileage to and from all medical health appointments, and I believe school services as well. I have to double check that second piece. But if you don't have transportation, they will provide transportation for you, which is for free, for free. So, you have to know those resources. Sorry, I got excited.

[00:37:17] MB: No. You are absolutely Ð that's it. I mean, and that's the kind of stuff we see, in practice. I mean, that's real. And I think knowing that there are organizations out there who we can connect with to be like, ÒOkay, like you said, you need help with your power bills, you need help with transportation, fill in the blank.Ó You need help with whatever, knowing that there are community organizations or other initiatives to help. I do think and I want to make a point here, because the advocate in me just cannot miss the opportunity, that one of the frustrating things I think a lot of times about this work is that the practice and the policy don't always match up. And so, we were talking about this right before Ð

[00:37:58] MD: Yes, say it again.

[00:38:00] MB: Is that we work literally decades on changing public policy to match what we know to be true in practice. And so, there is a need in this field to be loud, be vocal about that, about the reality of what families are dealing with, so that we can change. Change the policy, which often in turn leads to funding for services and programs. So, I think, and I always try to instill that in the students that I work with, and support that for my colleagues of like, we have got to let state or federal lawmakers know, this is what's happening to their constituents. They don't have this or this is where they are meeting roadblocks and we can fix that. We can fix that with policy and we can support practice in that way.

So, I just always say is, where there are opportunities to engage in advocacy, whatever that looks like for you. Please do that. Because we so desperately need more of that, where it's only going to make serving our families. It's only going to make it better and we're only going to end up really helping more people as a result, but we have to be vocal about it, have to. Soapbox, but I had to Ð I could not miss the opportunity to say that.

[00:39:21] MD: No, I'm going to piggyback on that soapbox. Okay, so alright. I have said this, this is Episode 158. So, I have probably said this at least 300 times, but we are members of a national association that has registered lobbyists at the national level. They do not have a lobbyist registered in each one of the 50 states. Only your state registered lobbyists is able to advocate at a state level. There are laws protecting this. So, ASHA can guide a policy for your state. It is you, the practitioner in the state, recognizing the problem, and then it's one thing to fuss about a problem. And my daddy, this is the G rated version. It's another thing to turn around, what are you doing with that next breath? So, what you're supposed to do is, write it down, send an email to your state association lobbyists, VP of governmental affairs or president. They're the people that work together to advocate on behalf of your patients, and your colleagues in your state. They want to hear from you.

I mean, heavens to Betsy. I was on the phone yesterday driving home with Kelly Caldwell, who's the [inaudible 00:40:44] of VP of Governmental Affairs, and we were identifying a loophole where clinical fellow years are not allowed to access certain things and bill in a certain setting. And it's a direct violation of the Federal Ð she found that it was a direct violation of like a Federal Medicare policy and blah, blah, blah, because like, she's amazing. And then I was on the phone with Hilary Cooper, who's the new President Elect of Louisiana, and she was talking about an issue that they're facing in their state. And I was like, ÒWell, hey, did you consider this?Ó And she was like, ÒOh, my God, we can do that.Ó She was like, we can enact this policy change. But I'm driving home. Yes, maybe I shouldn't be talking on the phone when I'm driving. 

But it's asking the question, seeking the counsel, and then turning around, and you may not need to be the person who carries it forward. Yeah, they may task you with it. They may say, ÒHey, you identified the problem, come tell us more and help us fix it.Ó But they don't know that the problem exists in the first place. Because often, your state association leadership may not work in your geographic area or physical setting. So, if you don't carry it over, we don't know how to fix it.

[00:41:57] MB: Exactly. And I just want to underscore because I think a lot of times, people are like, ÒOh, this is maybe just an isolated incident.Ó I guarantee you, I would bet you money, like take it to the bank. It is not. And if you think, ÒOh, maybe this is just me. Maybe this is just what I'm dealing with with this particular instance.Ó Absolutely not. And so, what happens, and what you said perfectly described is it's the collective voice of all of these people being like, ÒYeah, yeah, this is not working. And we don't know what to do about it. But we can take it to the people that do and we can find that.Ó Oh, my gosh, there is a loophole, and oh, my gosh, there is a solution for this. But the people that can fix it, again, don't always have the awareness that it's a problem in the first place.

So, I think just having the conversation and being like, I'm just putting this out there. Like I said, I don't know what to do with it. But it seems like this should be fixable. So, I think that there Ð I love that you made that plug, because I think a lot of times people are just like, it's so easy, right? It's so easy to be like, it's not my problem, or I don't know what to do about it. So, I'm just not going to do anything, but just be like, just have a conversation and be open and honest of, I am really struggling, or man, I am seeing so many families really struggling with this and there's got to be a better way.

[00:43:17] MD: Exactly. Okay, so full circle this, we now have a better understanding of ACE awards. Oh my gosh, Megan, squirrel, I really have this huge project idea that I want to create. Okay, we're going to go ahead embedded here, somebody messaged me afterwards.

[00:43:36] MB: Manifest it. WeÕre going to manifest it.

[00:43:36] MD: WeÕre going to put it in the universe. I've called a friend, I've pitched it to a couple people. Here in South Carolina, this is what I dream of happening. I want an adaptive communication board that has latex free paint on it at every single handicap accessible playground across the state. I don't know how to make that happen. But I want to make it happen and I have a notion on how to fund it. I think if we do training, if we create a training program, and then train volunteers, and how to reach out to local police and law enforcement, on how to engage with adults with special needs that are having a breakdown, and how to communicate with them using their communication device. Instead of the departments paying for the training, they instead put in a communication board at an adaptive playground.

[00:44:35] MB: The wheels are turning.

[00:44:38] MD: Right. All the wheels. So, folks, here's my idea, please replicate, please take it please do, let's do that. But I think that would be phenomenal. And I have a lady coming on and like a couple weeks. Her name is Brianna Emmanuel. I'm hoping I'm saying this correct and she created a communication board. She's a school-based clinician and she had one built for an adaptive playground. And because I've had this idea, like in my head for like from ever to quote, Theodore, BearÕs real name, Theodore. From ever mom, from ever, but do hours right thank you doctor. But that would be, I think manifesting. Okay, so just full circle lists for how we do about it.

[00:45:23] MB: Okay.

[00:45:25] MD: That's a really big squirrel folks, I apologize. Okay. But here's the thing, we recognize the adverse childhood experience. We recognize the trauma in our families and we recognize big picture now the steps involved in creating a state advocacy for change, whether that be getting a communication board in place, because we need one or another notion for state advocacy for change. What about our patients that have celiac disease, and gluten free foods are not yet covered by stamp benefit? How atrocious is that when you have food scares Ðinsecurities. That's the word. Thank you, food insecurities. However, the financial aid doesn't cover what your child needs. So, what community resources? Where do we go for help?

[00:46:22] MB: I think one thing I'll say about South Carolina is we're small but we're mighty.

[00:46:26] MD: Tiny but mighty.

[00:46:28] MB: Tiny but mighty. So, at least in South Carolina, and I know, you probably have listeners from all over the country, all over the world.

[00:46:38] MD: Also, hello to everybody from Australia, Italy, Japan, Germany, England, in New Zealand, who bought Chasing the Swallow. Thank you, guys. I totally cried.

[00:46:50] MB: We will take the show on the road. We will come to you as a selfless act.

[00:46:57] MD: Yes. Oh, my God, I love that. Yes, Megan and I, Erin too, weÕre coming your way.

[00:47:05] MB: Yes. It really depends on Ð I mean, I can talk specifically about South Carolina. But these organizations are everywhere. And I think it's finding organizations, I mentioned Children's Trust earlier just that are doing the research, doing the policy work and doing the programming and helping to serve families. I think about other organizations like family connection of South Carolina that are really working with families who have children who have some type of either disability or other chronic health issues that they're they're working on. There are some really great nonprofits and our state that are serving families, meeting them where they're at. And then two, there's some really good sort of like great hybrid policy, or state and nonprofit organizations like first steps that are working to serve children in preschool and early Ed.

So, there's a lot that's happening. Again, oftentimes, I think we probably feel like theyÕre Ð weÕre all sort of operating in silos, or we're operating just within our space. But really, we're going to be more effective if were interconnected. That's just how humans live. That is literally human nature. We are social creatures. We have to be connected. And our organizations, our collective like work has to all be connected. I have worked for several years with groups that are serving kinship caregivers. And so these are people that kind of like you, describe Michelle, your personal experience of being raised by extended family or having Ð or spending periods of time living with grandma, grandpa, aunts, uncles, somebody that would take you in and take care of you and do it without support because there isn't Ð a lot of times, policy and practice that bolsters those family settings.

So, I just have to brag and say there is a great network of organizations across the state that are working and serving kinship caregivers. And a lot of this is back to the protective factors, a lot of itÕs, you know, helping to meet concrete support. Getting them money so that they can pay for school expenses, or all the things that come with raising a kid without cashing out your retirement, right? Because you are now unexpectedly raising children that you didn't plan for but are willingly and ready to do. So, just things like that, where we're trying to figure out how to support families and simultaneously address their trauma, address all of the generational trauma that comes with it.

So, there are a lot of organizations that are sharing best practices sharing resources. Again, with the goal in mind, the end result in mind of making sure families and children get the help that they need. So, I would say, wherever you practice, get to know your local community organizations. There are always going to be some version of parent advocacy organizations. There's always going to be some type of child advocacy organizations, early Ed, you name it. I mean, you can go down the list. It's just finding who they are for you locally, and building those relationships and making those connections because nobody is able to do everything, we're just not. We're never going to do it, we need to stop trying.

But the key is always knowing who to go to for whatever the issue is that has kind of come up. So, I know my boundaries, I know my limits, I'm not going to be able to fix it. But I know who can. So, that's always my charge to folks, is just figure out what your network looks like. Build your support network as a professional and who can you pick up the phone. I can't tell you how many times just happened yesterday. Picked up the phone to call someone and ask about a case that someone else asked me about of like, I need therapeutic intervention and I don't know who in this area does it. But I know, you know. So, can you tell me who I can refer to? So, it's that type of practice that makes us better clinicians, better practitioners, and again, better serves our families.

[00:51:24] MD: Okay, so I have so many happy thoughts that I have to pull my references. Also, the kids are jumping upstairs and they're not supposed to be. And so, the ceiling fan is shaking. So, you all, you're welcome for the background battle. We're apparently jamming out upstairs. So, one, we are mandatory reporters right out the gate. So, if you see it, and you say nothing, that's a problem. And yes, when you're a mandatory reporter, they will ask for your content information, they will keep it private, okay? Because that's protected by law. So, there is a piece in here in our code of ethics, where we are supposed to make referrals. It is our responsibility to make referrals and I will find it, but go back and there we go, rule that fix. I will eventually find this position statement in ethics. Here it is, ÒRule of Ethics, Principle of Ethics 4, Rule of Ethics, A. Individual shall work collaboratively when appropriate with members of one's own profession and or members of other professions.Ó Where is the one that says referrals? Okay, whatever, it's in there.

But here's the thing, you were allowed to, in your plan of care, make a request for a referral for the family, their caregivers, the child to receive counseling. We can make the referral request. Can you make a referral as a speech language pathologist yourself? No. We're not the licensed physician. But we can request that the referral be made. So, that's a huge piece, because Ð

[00:53:09] MB: It is. And I think that's the part of like, realizing you as the advocate. And I think, I love that. I love that there's the guiding principles of your ethics of your profession that say, lay out, clearly, here's your roles and responsibilities. So, within those parameters, what am I required to do and where's my boundaries? What am I supposed to be doing? But yeah, making sure that you are an advocate and requesting that. So, I think that's, that's perfect. That's exactly, and that is what, that's really what it takes right to getting to the point where we're helping people deal with their trauma, is being that spokesperson for people. They may not be able to advocate for themselves, or they may feel like they're not being heard. And so, giving them the space and the place to do that. I mean, again, life changing.

[00:54:03] MD: Now, there's one other piece that we have to work in about patient client abandonment and that ties in a couple different ways. One, making a referral to social services does not mean that social services are going to show up for every single case and remove the child from the home. That's a huge misunderstanding, right?

[00:54:25] MB: Absolutely.

[00:54:27] MD: Yes, Some circumstances, absolutely, they will. But other times they're going to come in and this is your world, not mine. But don't social workers come in to help the family in that moment of crisis instead of just removing the child? Isn't that like your first target? 

[00:54:42] MB: Absolutely. And I think that Ð I love that you said that, because I think there are a lot of misunderstandings or misconceptions maybe about what happens exactly when DSS or some other child welfare entity is involved, is like they may assess and determine that the risk is not there, the need is not there. Now, we can debate that about, well, I think there is, but maybe they don't think there is the need, has risen to that level requiring the child to leave the home, maybe they need some in-home services, right? So, having that understanding, at least generally, of the process of like, just because you make the call doesn't automatically mean that this is going to happen. It is truly a process and it can take a while. It's not going to resolve itself overnight. So, being aware that that's what's going on, once you initiate that contact is important, is really important to understand that.

[00:55:40] MD: So, as a practitioner, it is within our scope of practice that we do not have to provide services in a situation where we are fearful for our own wellbeing. So personally, I have discharged families and transferred and made reports when I felt sexually harassed by a caregiver in the home, especially when I was pre children and 10 years younger. And then I had one case, now I'm so mad because I put up with it for so long, because I was so afraid. I would go do therapy, and like the father was just completely inappropriate. I was afraid. But I mean, young, naive, you learn, you grow. This is why I'm telling you now, right?

I've had situations where I've gone and done a therapy session and there was illicit narcotics in the home and I've had to contact DSS and police, and then I've had to discharge and not return for safety. I did that. But I made the referral that the child Ð to the pediatrician, contacted, relayed what happened, what occurred and said, ÒI recommend for clinician safety that the child also received services in a private practice out of the home.Ó And you can do that. I know that we're already over on time, but like, I just had to get those Ð so when you are encountering ACEs that place you in jeopardy, and it's the child, the patient's ACEs as well, make sure that you're putting those supports in place for the child and make those referrals. But also make sure that you're putting supports in places for you so that you can stay in your safe hamster bubble. 

[00:57:29] MB: Exactly. It all comes back full circle.

[00:57:33] MD: Perfect. hamster ball. I love you so much. Dang, that's fun. Okay. All right. So, do you want to come back? We got to do this again.

[00:57:51] MB: WeÕll do it again. We'll do a road show. We'll do a live recording from Steel Hands. We'll do all of it, whatever is required, whatever is required. But yeah, I would love to and I would love to just hear from your listeners to like, what resonates with them, like what they're curious about, as we continue this conversation because we're all learning. We're all just learning. NobodyÕs doing it perfect. Nobody's doing it right. We're all figuring it out.

[00:58:17] MD: How do they reach you, Megan?

[00:58:19] MB: All the ways. You can find me on social. I am forever on Instagram. So, moxiemegssc. I am a text girl, listen, you can text me, this is my phone number. I will give out my phone number because I believe in this so much. So, (803) 727-5769. Text me and I always say this to everybody, every presentation I do like. Listen, I know what it feels like to not feel like you have a safe space to ask a question. Or like I don't know what to do. I am forever willing to be a sounding board to people. And as we're all trying to figure this out, because so many people did it for me, right? Especially early on in my career, and I have colleagues now where I just text in the middle of the night and I'm like, ÒI don't know what to do about this.Ó So, please reach out to me. I'd love to hear from people, seriously, as we continue to move this work forward, because we're all doing it for the people that we love and serve. So, we're in it together and thank you for this opportunity, again, Michelle. I think every Friday morning should start with coffee, and a podcast with you.

[00:59:27] MD: Honestly, this whole summer, I've done that every Friday morning. And then on Sundays during nap time, and the catch is Goose, he has not napped in years. Bear still needs a nap. But whether or not he wants or does is that, whatever. So, if you text me on Friday mornings and I don't respond, it's because here I am.

[00:59:50] MB: Right. Awesome.

[00:59:51] MD: Thank you. Thank you. Thank you. Okay, so everybody who is listening, we love it when you follow us on Instagram @firstbitepodcast, check out the new book. I guess it's not as new. It's been out for two months. It's also on Instagram, Chasing the Swallow. And we have our First Bite Facebook page. We are always extra appreciative when you leave us a review for First Bite on the Apple Podcast as well as tell me what you loved about Chasing the Swallow on Amazon. And don't forget that Chasing the Swallow has recently been approved for 13 and a half hours of continuing education for SLPs through speechtherapypd.com which brought this lovely podcast to you today. So, Megan Ð

[DISCLOSURE]

[01:00:43] MD: Hey, so it's Michelle Dawson here and I need to lay out by disclosure statements. So, if you ever wondered how bad my ADD, ADHD and lack of sleep, Monday through Monday, actually as well, here you go. These are my non-financial disclosure statements.

I volunteer with Feeding Matters. I'm a former Treasurer with the Council of State Association Presidents and the past president with the South Carolina Speech Language Hearing Association. I am a current member of both ASHA and SCSHA, and for this year for 2021 I volunteered for the Pediatric Feeding Disorder Planning Committee for the ASHA 2021 Convention.

My financial disclosures, okay, all right, so I receive compensation for First Bite presentations as well as talking teletherapy and understanding dysphagia from speechtherapypd.com. I also receive royalties from speechtherapypd.com for ongoing webinars that I have on their website, as well as compensation from PESI Incorporate for a lecture course and webinar that I have on their website as well. I am coordinator for clinical education and clinical assistant professor for the Masters of Speech Language Pathology Program at Francis Marion University in Florence, South Carolina, for which I received an annual salary. I also received royalties from the sale of my book, Chasing the Swallow: Truth, Science and Hope for Pediatric Feeding and Swallowing Disorders that I self-published and is available on Amazon. And I do receive royalties from the accompanying 13 and a half hours CEU for the book from speechtherapypd.com.

So yeah, I stay pretty busy, but those are my financial and non-financial disclosures. If you ever have any questions, please feel free to reach out. Thank you all. Bye.

[01:02:51] MB: This is Megan Branham. These are my financial and non-financial disclosures for today's podcast. I do receive financial compensation from North and Family Connection of South Carolina and additionally, receives financial compensation for today's presentation. For my non-financial disclosures, I currently serve as a volunteer Chair of the Sisters of Charity Foundation of South Carolina's Kinship Care Advisory Council.

[END OF INTERVIEW]

[01:03:19] MD: Feeding matters, guide system wide changes by uniting caregivers, professionals and community partners under the Pediatric Feeding Disorder Alliance. So, what is this Alliance? The Alliance is an open access collaborative community focused on achieving strategic goals within three focus areas, education, advocacy and research. So, who is the Alliance? It's you. The Alliance is open to any person passionate about improving care for children with a pediatric feeding disorder.

To date, 187 professionals, caregivers and partners have joined the Alliance. You can join today by visiting the Feeding Matters website at www.feedingmatters.org. Click on PFD Alliance tab and sign up today. Change is possible when we work together.

[OUTRO]

[01:04:11] MD: That's a wrap folks. Once again, thank you for listening to First Bite: Fed, Fun and Functional. I'm your humble, but yet sassy host, Michelle Dawsom, the All Things PFDs SLP.

This podcast is part of a course offered for continuing education through speechtherapypd.com. Please check out the website if you'd like to learn more about CEU opportunities for this episode, as well as the ones that are archived. As always, remember, feed your mind, feed your soul, be kind and feed those babies.

[END]


FBP 158		Transcript



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