EPISODE 241

[INTRODUCTION]

[00:00:00] MD: All right. We are continuing that gratitude journey. And this episode is about trauma-sensitive interprofessional care, right? I feel compelled to talk about being grateful for those that support us in our moments of trauma. 

Most people know my story. But if you don't, then I am a survivor of domestic abuse. And that is very difficult to talk about and to talk about openly and honestly. And I am grateful that during my darkest hours when I was trying to survive this, 13, 14, 15 years ago, I am grateful for the women who mentored me and pulled me through it so that I could get out to the other side. They know who they are. And I'm also grateful for my faith to get through that. Because, y'all, we can be #slpsoffaith and still be professionals because that's part of our identity and who we are. 

So thank you to everyone who supported me when I was in my trauma. And, y'all, if you were in it, get out. There is peace and joy in the journey. And, oh, my goodness, you're going to have some positive stories to tell. So I hope you enjoy this episode with Erin and Kim. 

[00:01:52] 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 PEDs SLP. 

I am a colleague in the trenches of home health and early intervention right there with you. I run my own private practice, Hartwood Speech Therapy, here in Col d' Town, South Carolina. And I guest lecture nationwide on best practices for early intervention for the medically complex child. First BiteÕs mission is short and sweet; to bring light, hope, knowledge, and joy to the pediatric clinician, parent, or advocate.

[00:02:40] EF: By way of a nerdy conversation, so there's plenty of laughter, too.

[00:02:44] MD: In this podcast, we cover everything from AAC to breastfeeding.

[00:02:48] EF: Ethics on how to run a private practice.

[00:02:51] MD: Pediatric dysphagia to clinical supervision.

[00:02:55] EF: And all other topics in the role of pediatric speech pathology. Our goal is to bring evidence-based practice straight to you by interviewing subject matter experts.

[00:03:04] MD: To break down the communication barriers, so that we can access the knowledge of their fields.

[00:03:09] EF: Or, as a close friend says, ÒTo build the bridge.Ó

[00:03:13] MD: 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.

[00:03:24] EF: Every fourth episode, I join. 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 new-ish clinician with experience in early intervention, pediatric acute care, and non-profit pediatric outpatient settings.

[00:03:44] MD: Sit back, relax, and watch out for all hearth growth and enjoy this geeky gig brought to you by speechtherapypd.com.

[EPISODE]

[00:04:00] EF: This episode is Ð long story short, I met Kim, because for those of you that have heard me talk about Karyn, if you follow the podcast, you know Karyn. She reached out to Kim and her husband, Bob, about Kim coming to do a course with advanced therapy solutions where Karyn works. And the stars aligned weirdly and perfectly that they were on the East Coast in the area to come teach a course that I was lucky enough to attend. 

And being the only SLP in the room, I'm pretty sure, I was able to take in so much new information that create a lot of light bulbs in my brain in regards to what we do as speech pathologists and a lot of you that listen to a lot of feeding therapy and how we can start to go outside of our box. As SLPs, we love boxes. 

And not only did I learn so much in Kim's course about autism and a lot of interesting, new concepts in regards to the way their brain works and how they perceive the world and how their bodies move. But also, I just found Kim to be a kind, warm, genuine human being that I could take a million courses from. 

I'm very grateful to Ð Karyn and I talk about you all the time. We're like we need to go visit Kim and Bob. But I'm grateful to have her on today to talk to us about trauma. And we talked a little bit about this before I'm so grateful that people are talking more about trauma because of all the things we know about what it does to our brain and our body. But there's so much information out there. And so, how do we find where to get the right information? And how to absorb this concept? And how to kind of build a philosophy of using trauma-informed care? 

And Kim is an award-winning occupational therapist. She's a multidisciplinary teacher. She's a speaker, a mentor, an author who has impacted people globally. She lectures across the world. And she's really passionate about complex behavior, neurobiology, sensory processing, movement, trauma-sensitive practice, attachment, and mental health. She collaborates with a lot of other professionals. So she's a great person to kind of speak different languages. Because we all, a lot of times, are talking about the same thing but we just say it differently. So translating that for us today. 

And she's been practicing for 39 years. So I'm excited to have her. I can't wait to chat with you more today. Thank you for coming on. 

[00:06:52] KB: Hmm. What does a human being say to an introduction like that? Really? And this is a podcast. So you can't see that I'm blushing, and humbled and honored. And Erin, it's a mutual admiration society here, in that you see things in others that resonate inside. And it felt that way for me when I met you as well. This feeling of connectedness and blessedness to know you. This is like having a cup of coffee at Starbucks, this particular experience. 

[00:07:30] EF: I got my coffee because we had to submit ASHA proposals this week. And I am a perfectionist procrastinator who finished everything last minute. So, I've needed some coffee. 

[00:07:43] KB: Right on. Here we go. 

[00:07:44] EF: Mm-hmm. Well, I know I talked a lot about me meeting you and your background. But tell us a little bit Ð Michelle and I always like to start with your story. How you got to studying all of these things that you did and what your passions are?

[00:07:59] KB: Whoo. That's such a big question. 

[00:08:02] EF: Cliffnotes. 

[00:08:05] KB: A big question of actual faith really. I wanted to be an occupational therapist since I was nine. And who does that, right? Who knows at nine years old that they want to be something as obscure as an OT? I had a lot of exposure to individuals with unique needs very early on in my life and had the opportunity to meet an OT. And I thought what she did to make things possible for children was magical. And that was it. It was this sense of knowing that that is where I wanted to go. 

When I was in university, I had a professor. I went to university in the province of Manitoba in Canada. And my professor was versed in sensory integration. And that was cutting-edge, new thinking in that era. And she had a granddaughter with a learning disability. 

And in my first year of OT school, she said, "Kim, will you come and treat my granddaughter?" And I was humbled and stunned at this offering. And really what it was for me was an introduction and a mentorship to what sensory integrative therapy might look like. 

Upon my graduation, I had the opportunity to study at The Ayers Clinic before the passing of Dr. Ayers. And Dr. Ayers, in some conversation while I was sitting on the mat in The Ayers Clinic, she looked at me and said, "Kim, you need to go study movement about the body." And I thought, "That's a really interesting thing to say. Anything you tell me to do, I'm going to do." Right? It's that feeling of, "Okay. I'll do that." 

And I never questioned why. Why she said that to me? What she was intending or thinking? I just took that as a sign of this is what needs to happen next for me. I said to her, "What does that mean? And where should I do that?" And she said, "I think that neurodevelopmental treatment. The Bobath is what you need to find out as your next step in your learning." Promptly, that occurred. 

Even in my Ð it was my second year out, I went on my very first NDT course and fell in love with the work of movement and the body and started to see right there, 25 years old, the integration of sensation and movement and how the body holistically is not a separate. It's impossible to create any separation between the systems of integration in function. Whatever that function is. 

And this started the journey of, "Well, the next stone will appear as you are ready to be curious and continue to learn." And so, my journey of learning has taken me on a wild ride of many, many different masters in a wide variety of dimensions that I would never have been able to mentally create as an intention. It's the ability to say yes and continuously pulling it back into Òhow does this fit together as we look at people in the complexity of who they are?Ó That's the Kohl's notes version of the journey. 

[00:12:17] EF: And I love Ð while we're recording this, it's OT Month or OT Appreciation Month. 

[00:12:22] KB: Yeah. Yeah. 

[00:12:23] EF: It'll come out afterwards. But I think occupational therapists have given me, as a speech pathologist, permission to connect more things and to go outside of where might feel comfortable or where we feel like we reside because it is so connected. And at the end of the day, we are a human working with another human.

And so, I'm very grateful for the mentorship that I received from OTs because they have to look at all that because they're looking at activities of daily living throughout the lifespan. So they have no choice to sit there and say, "Well, I'm just focusing on articulation. Or I'm just focusing on their receptive language or something like that." So how do we look at that bigger picture and realize that we do play a role and that's important? 

And it's me and saying, "Yes. Sure, I'll take this course. Sure, this course might fit in with feeding or Ð" and communication, what I always tell speech pathologists is communication is a part of everything that someone does whether they realize it or not. So in the same way, we have this breadth of influence in regards to what we're working on and we have to understand those bigger concepts as well. 

[00:13:48] KB: I have an additional little tiny secret. It's not such a secret. But my sister is a speech path. 

[00:13:53] EF: Oh, yeah. I forgot about that. Mm-hmm. 

[00:13:56] KB: And so, the conversations at Sunday dinner, we're often very integrated. And so, I feel like I have an honorary speech path sitting on my shoulder who has brought me to that relevant awareness of the integratedness of our professions. 

[00:14:16] EF: Right.

[00:14:17] KB: I'm very early on in the path of serving children with diverse needs. 

[00:14:23] EF: Right. And now that we're seeing varied diagnoses that we've never seen before and we're seeing children that are impacted by things, our world is different than it was years ago. There's influence of just the speed of the world that none of our brains are really adequate to navigate even if we're neurotypical, which I'm not neurotypical. But Ð 

[00:14:48] KB: I was going to say, what does that mean, Erin? 

[00:14:51] EF: What does that even mean? Our brains are all diverse. And one thing, though, that we do all have a role in is recognizing trauma and using a trauma-sensitive practice. And so, I'm happy to be able to pick your brain today about your experience with trauma-sensitive practice. What you view it as and how we, as speech pathologists, can start to implement that in how we work with children? 

[00:15:21] KB: Very, very happy to share that learning with you. It really began with a kid who, often, kids are our greatest teachers. I lived in Winnipeg for much of my early career. And Winnipeg is cold in the winter. And I had a private practice. And there was a center in Winnipeg who delivered services to children and youth who were homeless and living on the street. 

It was an initiative to create crisis response in our city. And they had never had an OT in the program. And the director came to me and said, "You know, you do this stuff with kids with autism, with kids with sensory differences." And this is how she described it, "Their state of being eases. And even though our kids are identified as having adversity in their environment, they look similar," she said.

And I remember being very afraid because I thought, "Oh, this is way outside my wheelhouse." And Helga convinced me to step into this role. This one particular child had been born to a mom that was crystal-meth-addicted. And she overdosed when he was three months of age. And his three caregivers were an eight-year-old, an 11-year-old, and a 13-year-old. And they lived homeless in Winnipeg, on the street, for eight years unknown to the system. It's hard to imagine that that is even possible in our First World environment. But it happened. And so, this young man survived in significant adverse conditions in his early development. 

At the age of eight, he was caught on the CCTV camera at a 7-Eleven stealing a chocolate bar. And he was brought into care and care in the system of the program that I was working in. He had three meals a day in a bed and caregivers. And he was in a classroom for the first time. 

And I'll never forget the teacher said to me, "Take this kid into your magic lab." Like no pressure there. You know, that's the sensory gym. "And do something with him," she says. "I need him out of my classroom. He is a feral animal who is destroying my environment." And then she said he is undiagnosed ADHD and needs to be on Ritalin. 

I remember at that time feeling overwhelmed, of course, and thinking, "Well, I have something to prove here. My role on this team from a sensory integrative lens for this new population to me." 

And one of the things that I was eager to do was to try this out. I took this guy into the magic lab. That's what it was called. And we had a six-foot climbing wall in there, in this facility, with a big foam pit on the bottom of this wall. And I went to the Dr. Ayers School of the Child Guides Treatment. That when we create the best environment, the child will know what they need to self-organize and heal. My orientation in that era was to look at the environment and track the behavior to see if there were any shifts in state organization. 

This guy, he would climb and crash. And climb and crash. And when he would fall into the foam pit, he would fall face first without even putting out his hands to stop himself from falling. And I remember my wide eyes watching him thinking, "Wow. You are so intense." 

I also thought at the time, "Hmm, you must be so intense because you grew up in such intensity." Having that thought that this was in fact an adaptive response. His way of being. 

20 minutes into this session, he is dripping wet with perspiration and lying on the mat with his hands behind his head. And he looks present, and contemplative, and organized. And I'm so proud of myself as if I have done anything at all believing that this session was highly successful. And he left my session and went back upstairs to the room where he lived and tried to hang himself. 

Now he didn't succeed. And he was able to communicate that in that room, after all that experience of crashing, that he actually had memories. That in that state of all that how I would explain it, embodiment, he was able to connect to himself and to his experience. And what he found in there was a legacy of danger and trauma. That he wasn't ready, able to manage. And it flooded his system. This was a switch that absolutely lit up my brain, both with fear at the time, but also, a whole new lens of wondering about how trauma can look the same as other diagnoses. That what we see can come from different places. 

If I were to go back and do that session again, which I've replayed it in my mind a million times, I would have had more relationship. Instead of observing, I might have climbed the climbing wall with him. I might have narrated, "Hmm, I just saw you take a breath. I love how your arms hold you up when you climb. I wonder what it would be like if you protected yourself with your hands." I would have, given what I know now, added psychotherapeutic meaning-making to the experience to start to resource him with connection to his body rather than smash into the body. And I might have spent five minutes there instead of 20 minutes. 

It was a profound awareness of the power, the power of sensory for me in connection. And that would have been the best language that I could have put to it at the time. And only now do I realize that was the beginning of understanding the impact of early developmental trauma. 

And remember, I said he also had prenatal exposure. That's also a neurodiverse complex brain in there and how that interfaces with the environment. That's the beginning of how I started to think about this topic that we are talking about. 

[00:24:17] EF: I remember I heard you telling that story because Dylan played it for me. Him and I started our own little book club because I had asked him all these questions. And he kind of took me under his wing and was like, "We're going to start talking about this." 

And we had a patient who had a lot of Ð she would run around the clinic and she would grab people's glasses and grab them and then laugh. And at first, you see that reaction, you're like, "She knows she's being bad." And then you learn she's trying to connect. And this is a way that she knows how to connect. 

And he, I remember one day, got her very regulated and she just flipped a switch and grabbed at him. And I was confused because it felt like it happened so quickly. And we taught we listened to your video and he was like, "Sometimes when you get a child to that place, those memories come back." And I thought that was so interesting. 

Also, what I loved Ð feeding was one of my first loves because I loved how it integrates so many body systems and you have to dive deeper. And the more I've learned about sensory and trauma, sensory is neuro. And trauma impacts your neurology as well. And so, you have to dive so deep in that area as well and just keep pulling back these layers. 

The tricky part is that you can't stay in your box fully or Ð because like you said, it is so connected. And so, there's always more to learn from it. But it wasn't until I started to collaborate with the more body-brained co-work colleagues that I work with to see. And Karyn and I talk so much about embodied cognition when we're working on language and that development. 

But if you're going to embody Ð if you're working on language and communication and you want to embody that a memory and a child has trauma, than if you're starting to embody an experience that brings them back to something that is more triggering for something they've been through, you have to recognize that as well because that can impact your sessions. 

[00:26:23] KB: Hmm. You said something very important there that I want to add in a thought to. It's this idea that many of us have, that regulation is calm. Regulation is actually connection to what is that I'm experiencing. And we have mixed this up, that when a child is regulated Ð which to me is a physiological state. That when they are regulated, that everything is going to be of ease. 

When you are regulated, you're actually more connected and available to what is there. And I am having the experience right now of supporting families and soldiers in the Ukraine. Sometimes I find myself having conversations on this screen with people living in makeshift bomb shelters. 

And so, they're actively living in conditions of danger and they have regulation at the same time. That this is not a condition of I am relaxed. It's a condition of connection and presence. 

And so, in that bomb shelter, some moments, there's fear. Some moments, there's laughter. It's the oddest experience to be present in something that is so surreal and see people making music, playing chess, laughing, reading books, and weeping at the same time. 

And it's this moment-by-moment fluidity of arousal that allows me to meet the demands of the environment that I'm in. And that is what regulation is. And it invites us to meet it back, that when a child grabs at your glasses or at our hair, the curiosity of a trauma-sensitive lens invites us into understanding what the communication is. 

And that feeling of being manipulated or that this is consciously intentional actually invites most of us into the "let's get this behavior to stop". And if we can pause there in curiosity, then there's opportunity for connecting to the emotion that sits underneath the behavior that is the communication. 

And so, if I think about communication, and emotionality, and physiology of regulation, they are one stream. Hence, it's not about managing behavior. It's about appreciating its intent. It's about connecting to it and allowing the child to feel felt in what it is they are communicating to us. 

[00:29:55] EF: Sometimes I think the word behavior has gotten a bad rap. But when we realize that, you say, like be a behavior detective. How are we interpreting what's happening? And I will say to other speech pathologists as well, like communication can also be regulating. Because if you can tell us what your body is feeling. But you also have to understand what your body is feeling before you can communicate it. 

The cool thing about what I think we do as speech therapists that we don't always recognize is that I wish we were called communication therapists instead of speech-language pathologists. Because behavior can be that communication. When you look at how communication develops, it starts as unintentional behavior. When a baby cries, or displays their hands out, or does something, and our job is to help develop that and respond and build that connection and attachment. 

But just as Ð and I love when Karyn Purvis, I vividly remember from the TBRI course, where she talked about even taking older children when they were appearing very dysregulated and bringing them back to that position of being in the womb. How do we help them bring them back sometimes so that we can help them feel felt, like you said? 

And I love speech therapists. But I do think we get very Ð that connotation, that regulated is calm. And we want them to sit in the chair and work on the task. But that's not building those same connections. Like you talk about neurons. What do you say? Neurons that wire together, fire together? 

[00:31:33] KB: Hmm. It's fire together, wire together. 

[00:31:35] EF: Fire together, wire together. 

[00:31:36] KB: Yes.

[00:31:37] EF: So how do we work through that? But knowing all of this, hearing your story, would make me feel overwhelmed as a speech therapist. Like, "Okay, what can I do? How can I engage in trauma-sensitive practice without maybe having all of this neurobiology and understanding of the psychology behind all of that?" 

[00:32:02] KB: Well, there's two parts to your question, I think. One is there are some basic principles that make anyone. It doesn't matter what your Ð any human Ñ trauma-sensitive. And so, those basic principles are the guiding, underlying ways, of their beliefs and values that help us to be with people in a way that really embodies compassion. 

And so, those principles, I'll tell you what they are in just a second, they are kind of like something that you can hold in your being. And you can do them in the grocery store, or the gas station, or when you're walking your dog in the park. They're not fancy. 

And then the second part is what we share. And you just mentioned it. What we share in all of our work, whether you're a speech pathologist, whether you're an OT, whether you're a PT, whether you're a physician, whether you're a nurse, whether you're a dentist, is relationship. And the relationship is the powerhouse of preparing the brain to learn anything. 

Let's back up for a second and talk about trauma-sensitive principles. And let me tell you why I call it trauma-sensitive instead of trauma-informed. For at least 20 years, I called it trauma-informed. If that was the first chapter. And then during the pandemic, everything changed here in this studio where I'm talking to you from, in the vast collective experience of fear. 

I will never forget as long as I live the three years of standing here in this spot, sometimes talking to eight countries in one day of shared collective suffering. And as a holder of suffering, sometimes it was the Canadian military. Sometimes it was the physicians in the emergency room in Jakarta. Sometimes it was people working in the homeless shelters in India. It was mind-boggling to hold all of that knowing as one human in my consciousness to recognize the shared experience that we were having. 

And now I recognized that we were embodying the understanding of trauma as a collective whole. And so, instead of having trauma-informed, which lives in your head as a concept, a series of ideas, this was now something we were living. 

And so, the word trauma-sensitive implies a knowing of these ideas at a deeper level that we bring into our lives because we felt it too. And that's where that language became a conscious shift. Because I knew that when I was having these conversations with people like you, that the feeling was felt. And that wasn't just some learning that they were taking in as information. 

Trauma-sensitive living, the very first principle, is to be curious. That this takes a pause to slow down because each and every one of us is designed to judge. We have, in the design of our brain, a tagging system. I call it a valence of good, bad, right, wrong, safe, unsafe. This is happening every millisecond of your life. And we can't help it. 

We are designed to discern. And we're not responsible for our first thought. We are, however, responsible for our second thought. And if I can catch my judgment and pause, then I open this lens of curiosity, which makes space for a bigger decision of potential action or not. Of how I'm going to connect with this person in front of me. 

And so, this understanding of curiosity is that you cannot be judgmental and curious at the same time. That they are actually different neural networks, different parts of the brain. And they feel different in the body. And this takes practice to pause because each and every one of us brings our own backpack of our developmental trauma history into the present moment. And so, we get triggered and activated unconsciously all the time. And we tend to meet people from that space rather than a mindful curious space, which allows us to make room for a wondering about what it is they're telling us. It's communication. That's the first principle. 

The second principle is to create a culture of comfort and safety. And this is environmental. It's the task and it's the relationships. In a therapy room, how we set up our room? What kind of tasks we offer? And how we co-regulate through relationship? These are the variables that either enrich felt safety or diminish it. 

Keeping in mind by knowing the child that's in front of us, we attempt with the best of our capacity, we won't always get it right, to find the sweet spot where the child experiences empowerment, competence, and connection to themselves. That's the second principle. 

The third principle is to try not to re-traumatize people. And this is also not easy to do because we won't always know what has happened in that situation for that person. 

The fourth principle is that it's strengths-based. That we work with kids from their strength rather than their deficits. And for many of us, that is not easy to do. 

The fifth principle is to watch language. Interesting, isn't it? To watch the language that we use when we are describing or talking about the children and their families. That through our own language, we are Illuminating our beliefs, values, and understandings. We have insight to ourselves only through our language.

And the last principle is that relationship is a healing force. That it isn't this toolbox of stuff that we do. That what really shifts the state of the brain into readiness is oxytocin, and dopamine, and serotonin combined together as a felt sense that someone sees me, soothes me, and supports me in my experience. 

Those are the principles. And in those principles, if I remember and tap into that relationship part, this is where speech paths excel. And this is more than just being fun. This is attunement, which is all communication. Pro-social communication, communication in infancy. I learned all of this from you, from your profession. And so, we really do meet in there in this understanding of trauma-sensitive practice. 

[00:41:11] EF: Isn't it so interesting too that oxytocin is very important in breastfeeding?

[00:41:17] KB: Yes. 

[00:41:18] EF: And that so much of it starts from that relationship in Ð if the mother chooses where they come. But from our history, when that's how you build that connection. And when I started learning more about trauma-sensitive practice, it was the most relieving feeling because it just aligned with my core values. But I couldn't define it at first of what just felt right in working with a child and a family. And to be able to have these principles to really check back on and say, "Okay. Is this aligning with what I'm doing here?" 

And that part about not re-traumatizing a family or a child. I mean, I have moments I can think about where a child walks into your room at the hospital, and just that setting can be re-traumatizing. And, yes, there's healing involved in making that setting feel safe. But then maybe they go to another doctor's office and then there's another. 

There are so many things that are sometimes unavoidable, especially with the medically complex children that we work with. But then to me, it feels so much more important as someone that works with them consistently to really create that space where you can connect and you can build that relationship. And that is that groundwork of anything we ask a child to do developmentally. But sometimes I think we get too anxious to meet goals that we don't spend as much time building that framework and that groundwork of relationship. 

[00:43:08] KB: You nailed it. I have an inspiring little thought connected to what you've just said. And that's that, in our amygdala, which is the structure in our brain designed to contribute to the creation of our emotional experiences. One-third of that structure is designed to track non-verbal communication, facial expressions, body language, intonation of human voice. We also could say that that's true of the vagal nerve. 

But the amygdala itself has receptor sites in this location that detects nonverbals of oxytocin. And what we know is that cues of safety can override experiences that we perceive as threat. And this is so critical, especially in the hospital. Where if I'm having a potentially terrifying experience, if there is simultaneous kindness, compassion, care, feelings of love, this gets wired together. And that that can reorganize history and also prevent future logging into memory the intensity of the things that many hospital experiences can't avoid. 

Just think about some of the invasive procedures that our kids have to endure. And when that is met with these experiences that I am with you, it minimizes the activation of the adrenaline through the oxytocin pathway. And so, this means to me it's never about what you do but how you do it. 

[00:45:16] EF: OTs have taught me what subtle things can make such a difference, like a handheld, or getting on a child's level, or really Ð and I didn't recognize I did it as much as I do until a mom pointed it out. Anytime I recognize Ð if I'm in a session, a child is going for something that maybe is unsafe or I was communicating something, I will always, always, always tell them, "I hear you." I recognize Ð always acknowledge any form of communication that they're giving me. 

Especially from a trauma-sensitive perspective, I think as speech pathologists, we really have to honor Ð this does not mean a child gets everything that they want. Boundaries are important. Learning safety is very important. But showing a child you hear their communication is really important for their body autonomy, for understanding that their communication has power. And for creating a space where they can advocate for themselves. Because we know that the children that we work with that have medical complexities, or have cognitive difficulties, or any child that needs our support is at a higher risk for other trauma as well because that's just, unfortunately, things that happen. 

And so, the more we can show them that their communication, their behaviors, their words have power, the more they recognize that in themselves and feel like they have more control, which is really important as well in order to be trauma-sensitive.

[00:46:55] KB: There's one other really important thing I want to add here about language. Language is impossible to separate out from psychological wellness. 

[00:47:08] EF: I would love for everyone to just take a moment and hear that again.

[00:47:15] KB: Yeah. 

[00:47:16] EF: Language is impossible to separate from psychological wellness. Because every experience has language attached to it. And all psychotherapeutic intent is meaning-making. And meaning-making comes from language. 

You said when a child can communicate what they feel, that is regulating. I want every OT to hear that. That in the capacity to connect, identify and express, that there is a shift neurobiologically in chemistry of stress. That what's shareable is bearable to the human psyche. 

We are so wired for belonging and connection. And when we can communicate what we experience, even some of the most horrific things in human suffering, this changes our landscape of our chemistry. And language is at the heart of that. 

I think that as communication specialists, you don't just focus on the art of communicating. But you are enhancing what I call meaning-making, which is the sense that I have of identity and me. This is me. In those words that I have that help me understand myself. 

And how beautiful is it? It's beautiful but also something that we have to hold gracefully and carefully. And acknowledging that the words and the language that we use can have such an impact about how someone views themselves. And to your point about using various strengths, looking at their strengths, from a caregiver child perspective as well, there are a lot of things that they may not see yet in their child because no one's defined it and no one's explained it. 

And so, I've told my students and clinicians that I talk with that our first job when we work with a family and a child is to help them feel understood. To help a caregiver understand their child and to be able to Ð I will spend a lot of my session labeling and describing what I'm seeing in a child and how I feel that they're using these strengths that they have to experience the world so that a caregiver can then hear that as well and recognize these things that maybe they didn't realize were strengths. Or maybe they never heard someone say it that way. So that we can figure out who this child is authentically. Because I think it's really cool that we get to be a part of a child figuring out who they are. 

And my brother Ð and I've had a lot of conversations with my family recently because my brother was diagnosed with ADHD when he was younger. And my family always just got Ð this is Reese. We're all different. We all have our own strengths and how we experience the world. But recently, we've had a lot more conversations about does Reese feel he's autistic? And more so because language can help you feel understood. Thus, because he needs a label. But more, when I receive my OCD diagnosis, I was like, "Oh, this makes sense." And I see my strengths. And I see things like that. 

But it's beautiful. And he doesn't Ð we don't have a Ð we have great conversations with him when it's about things he loves. And this week, we realize that he has been making videos and has a YouTube channel about music all across these bands of over the last 100 years. Animated this beautiful video. Narrated a 30-minute long video about connecting all these bands that sang Gloria. And I was just like this is because my family was able to foster his strengths and allow him to figure out who he is. And we'd have to recognize that because that's what's going to make someone happy and connected. 

[00:51:51] KB: Hmm. Very powerful. 

[00:51:55] EF: If we're talking to majority speech therapists, what would you say to them in regards to trying to better understand some more of those sensory body-based impacts of trauma and how we can be better informed to recognize that in the children that we work with? 

[00:52:18] KB: When you understand, I think, that all experiences are sensory processing. I remember someone saying to me historically, sensory processing doesn't exist. Because neurobiology is my eat, sleep and breathe, I thought, "How can it be possible, if you have a brain, you're processing sensations?" 

To have this belief that sensory processing isn't contributing to the way that I experience the world, it doesn't make sense to me. When I am experiencing adversity, sexual abuse, physical abuse, neglect, domestic violence, chaos, maternal depression, situations where my family is struggling to do the best they can with what they have and are preoccupied with their own suffering, there is going to be less meaning-making. 

I smiled when you talked about how you make sense out of a child's communication for a caregiver. And I wanted to say to you, that's attachment. That what you are doing in that, from a psychotherapeutic perspective, is providing the caregiver with a skill that we call mentalizing. 

And mentalizing is a highly empathic skill that allows me to have insight into what is happening for me simultaneously being curious about what's happening for you. And this is the dance of attachment where I am processing this dual information of, "What's going on here in me?" And putting my mind in your mind at the same time. 

And this is what caregivers do instinctively, thanks to oxytocin, with their babies. And that this is a process that deepens the circuitry within the baby's developing brain to regulate. This co-regulation through meaning-making creates this neural network of inhibition of states of arousal that are outside of my window of tolerance. All of this is done through the body. 

Let's walk through that for a second. A baby cries and we stand over the baby. And the they're in their crib and we go, "Oh." Our voice has porosity and it mimics state, "Oh." 

I imagine that porosity as a dialing-down starts up high in intonation and it moves down. And that cue alone has impact, a ripple effect on the neurochemistry in the sensory systems of audition of shifting how I experience sound in meaning in my body of safety. That's one example. 

[00:55:50] EF: Can I ask you a really quick question with that? 

[00:55:53] KB: Yes. 

[00:55:55] EF: When you think about that, that happens early. We're using that tone with the children that we work with or with babies with their caregiver. I think about that, that we stretch out sometimes when we're working with children that have trouble regulating and coming back. So we start higher and then bring them down. But maybe they didn't get those connections as much when they were younger. So we're having to, again, bring them back to the womb of starting higher. Interesting.

[00:56:25] KB: You're replicating typical development really. 

[00:56:28] EF: Okay. Sorry. I just had a Ð 

[00:56:29] KB: No. That's a great aha. You're remembering Ð this is what Mrs. Beaubath taught me, is to watch over, and over, and over, and over, and over again typical development. And attachment is an embodied example of typical development. 

Voice is one. And we do it instinctively without really knowing what's really happening in this brain in response to this sensory cue. Then we go to pick up the baby. And in our mentalization of empathy for the state of my baby, my motor system is already set for tenderness. 

The way that my muscles, and my body, and my muscle tone is primed is what we call affective touch. And so, I go and I reach for the baby but it's Ð you can imagine it in your mind. There is a tenderness in it. And the baby feels that through their skin, into the depths of their tissue as that warm hug of safety in the quality of the touch. That is connected to my state of emotion in my body communicating through my hands into the body of the baby. 

And through that repeated experience, the baby learns touches. Comforting. It is connecting. And it makes me feel comfortable in my own body because my state changed when you did that. The touch system comes in there. 

Now I want you to simultaneously imagine what happens when this doesn't work. When a caregiver is anxious. When a caregiver is angry. When a caregiver is preoccupied. That that state of embodiment of intent is different in the touch that is generated by the adult. And that's the baby's experience. Their whole registration system is different around what that touch is communicating to them. 

Then what do we do? We bring the baby close to our body and they feel our heart rate through their entire being. It's like a rhythm that resonates through their whole Ð through their bones. And that's vestibular. Any kind of bone conduction, especially in a small infant, is like waves of vestibular input that has an instantaneous entrainment at the brainstem. And then we rock the baby. And it's rhythmical. 

And not only are we soothing the baby. But we're soothing ourselves at the same time because their cry usually irritates us as well. There's this dance of co-regulation that is all sensory. That can be different if my state of being is different. If I'm agitated. If I'm Ð and imagine how this plays out in feeding, right? Imagine how this plays out in feeding. 

The sensory systems are the places where safety gets coded. And the sensory systems are the places where danger gets coded. It's hard to say Ð it's hard to separate that out from communication. Because communication that is through non-verbal body is all sensory. And then words are scaffolded on top of that. 

[01:00:29] EF: And imagine the things Ð because it can be separated, we have to also acknowledge and understand what non-verbal communication we are giving a child without even recognizing. And I have talked on the podcast about a lot of OT models of the intentional relationship model and therapeutic use of self. Because that's not something that we learn about in grad school. 

I'm sure there are some programs that talk about it. But I did not learn about myself as a human and what impact I have in a session. I think a lot about, unfortunately, a lot of the autistic kids that we work with there used to be a strong push for in order to increase language to withhold certain things or to force them to say something in a certain way. 

And while we may think we're encouraging language, we are communicating that their communication is not valid. Because they're communicating with us, they're just not using it a specific way. And that can be traumatizing. And that can teach that I'm not safe because I'm not recognizing their communication. And then you've lost that relationship. 

But all of this is still happening even if we're only looking at the words. So if we want to have more of an impact, we have to. And I preach to speech pathologists that we have a role in sensory. Because it's just how people experience the world. I think our field just has to do a better job of the education component of that because we don't receive as much information on that in our work. 

[01:02:12] KB: You said that with such grace. And it is something I want the whole audience of listeners to really take in. And in many ways, what I really want to sort of leave us with here is that there's very little in reality that I can actually control. And it all begins with us. And in this trauma-sensitive work, it all comes back to it starts with me. And at the bottom of that statement is the skill of self-compassion. 

You know, you can't beat yourself into evolving. You can only get there through kindness to yourself. The very same things that we need to give in a trauma-sensitive lens to others has to begin here in our own body, in our own being. And the more that I can soften into my own self and be with my own self, the greater my capacity to do that and resonate that out with others. And to me, that is the home of the work of being trauma-sensitive, is coming back to me. 

[01:03:40] EF: I will say also, it feels right like when you feel connected really with the children that you work with. It feels how it Ð like this is how it's supposed to feel. And then when you're not, you really feel it because you're like, "Wait. This is not how it's supposed to feel." But we have to give ourselves permission to show ourselves grace. But it does take a lot of internal work. Because when you start to recognize trauma in other people, you start to also recognize it in yourself. And that is not to be taken lightly at all because that's a journey in and of itself. 

[01:04:26] KB: Erin, I want to express to you a great deal of gratitude for this conversation. And I am always humbled that through the sharing of ideas, and thoughts, and words that there is some kind of impact, a ripple of impact into people's being when we come from that place of authentic passion and connection. And I really feel like we got there together today. Thank you so much for this experience with you. 

[01:05:04] EF: Thank you. I'm very grateful for meeting you and continuing to learn from you and being able to, like you said, have conversations with people that are very like-minded. Because it just fills my cup. And I'll probably have to listen back to this a couple times just to process everything and feel it. Because sometimes certain words and certain conversations, you're like, "Okay. I really just need to feel this in my body." I'm very grateful that you took the time to come on today. Because I know you are very busy. And it means a lot to be able to have our audience hear from you also.

[OUTRO] 

[01:06:12] 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. 

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 Dawson, The All Things PEDÕs 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. And as always, remember, feed your mind, feed your soul, be kind, and feed those babies. 

[01:07:23] MD: Hey. This is Michelle Dawson here. And I need to update my disclosure statements. My non-financial disclosures, I actively volunteer with Feeding Matters, National Foundation of Swallowing Disorders, NFOSD, Dysphagia Outreach Project, DOP. I am a former treasurer with the Council of State Association Presidents, CSAP. A past president of the South Carolina Speech-Language and Hearing Association, SCSHA. A current board of trustees member with the Communication Disorders Foundation of Virginia. And I am a current member of ASHA, ASHA SIG 13 SCSHA. The Speech-Language-Hearing Association of Virginia, SHAV. A member of the National Black Speech-Language-Hearing Association, NBSLA. And Dysphagia Research Society, DRS. 

Additionally, I volunteer with ASHA as the topic chair for the Pediatric Feeding Disorder Planning Committee for the ASHA 2023 Convention in Boston. And I hope you make it out there. 

My financial disclosures include receiving compensation for First Bite podcast from speechtherapypd.com as well as from additional webinars and for webinars associated with understanding dysphagia, which is also a podcast with speechtherapypd.com. 

And I currently receive a salary from the University of South Carolina and my work as adjunct professor and student services coordinator. And I receive royalties from the sale of my book, Chasing the Swallow: Truth, Science, and Hope for Pediatric Feeding and Swallowing Disorders. As well as compensation for the CEUs associated with it from speechtherapypd.com. 

Those are my current disclosure statements. Thanks, guys. 

The views and opinions expressed in today's podcast do not reflect the organizations associated with the speakers and are their views and opinions solely. 

[END]
FBP 241		Transcript

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