EPISODE 260

[OVERVIEW]

[0:00:00] MD: All right, so this week's gratitude entry is I am grateful for being teachable. I know I've said it before, but you never want to be the smartest person in the room. If you are, get out in a different room with mentors that will challenge you, will make you reassess what you think that you know, on so many fronts, not just professionally, but also personally.

One of the guests for today's episode is Dr. Rebekah Wada. She has mentored me, in so very, very many different ways. She's consistently demonstrated for me patience and the power of the pause, and she's just one of those women, that's the most active listeners that you're ever going to meet. So, you're in for a treat. One, I am grateful for Bekah, and two, IÕm grateful for embracing being teachable. So, I hope y'all enjoy this episode and the art of Implementation Science with Dr. Megan and Dr. Bekah. Enjoy.

[INTRODUCTION]

[0:01:18] 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 is right there with you. I run my own private practice, Heartwood Speech Therapy here in Columbia Town, South Carolina and I guest lecture nationwide on best practices for early intervention for the medically complex and fragile child. First BiteÕs mission is short and sweet, to bring light, hope, knowledge, and joy to the pediatric clinician, parent, or advocate.

[0:02:05] EF: By way of a nerdy conversation, so thereÕs plenty of laughter too.

[0:02:08] MD: In this podcast, we cover everything from AAC to breastfeeding.

[0:02:13] EF: Ethics on how to run a private practice.

[0:02:16] MD: Pediatric dysphagia to clinical supervision.

[0:02:20] EF: And all other topics in the world of pediatric speech pathology. Our goal is to bring evidence-based practice straight to you by interviewing subject matter experts.

[0:02:29] MD: To break down the communication barriers so that we can access the knowledge of their fields.

[0:02:35] EF: Or as a close friend says, ÒTo build the bridge.Ó 

[0:02:37] 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.

[0:02:50] EF: Every fourth episode, I join them. IÕm 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.

[0:03:09] MD: Sit back, relax, and watch out for all hearth's girls and enjoy this geeky gig brought to you by SpeechTherapyPD.com.

[DISCLOSURE]

[0:03:24] MD: Hey, this is Michelle Dawson, and I need to update my disclosure statements. My non-financial disclosures. I actively volunteer with Feeding Matters, the National Foundation of Swallowing Disorders NFOSD, and the 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, and a current Board of Trustees member with the Communication Disorders Foundation of Virginia. I am a current member of ASHA, ASHA SIG13, SCSHA, the Speech-Language-Hearing Association of Virginia, SHAV, a member of the National Black Speech Language Hearing Association in NBASLH, 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 the 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. I currently receive a salary from the University of South Carolina for my work as an 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.

[0:05:29] EF: 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.

[INTERVIEW]

[00:06:51] MD: All right everybody, we have a special treat to kind of get you hyped up for ASHA 2023 in Boston, and Lord Almighty, I am hoping that it's not as freaking cold as it was last time we were in Boston. So, if anybody else is also doing a dance to the universe for no snow, I am right there with you.

But in anticipation of Boston 2023, we have two amazing guests. One of them, I had the pleasure of working with for almost two years. The lovely Dr. Rebekah Wada, who is an implementation science guru, is also the fixer of all goals that should not be three or four goals inside of a goal but should be one goal because she perpetually helps me with that. I may or may not talk and run on sentences. And her partner in joyful crime. Dr. Megan Ð oh, I had practiced this. Dr. Megan Israelsen-Augenstein.

Bekah can vouch, multisyllabic words are hard for me on a good day. She knows that. Again, why teach swallowing. But y'all, they are presenting ASHA together this year on implementation science. And they're here to kind of give us a sneak peek and to share their passions, as it relates specifically to AAC, which is something that I know we all absolutely love between the three of us. So, ladies, thank you so much for coming on. Which one of you wants to start? Tell us who you are, where you teach, and how you landed there.

[0:07:01] RW: I can start. Since I've done this before, and it's been a couple years. So, I'm excited to be back. I am echoing the hope for no snow, because I was in Boston last time it was there, and it was cold. But it feels like most of the time, it was so cold, but it's still raining and not quite snow. So, it was just the wet and miserable cold. So, weÕll see how it goes. But IÕm excited.

So, as Michelle said, I'm Dr. Rebekah Wada. I currently am on faculty at Francis Marion University in South Carolina. And I have been working at Francis Marion now for three and almost three and a half years and it's been fun. I graduated with my Ph.D. from Utah State University, which is where Megan and I met. We both were master's students and doctoral students at Utah State University at the same time. We had the same mentors. While I was completing my doctoral program, I participated in a grant that they had to train professionals in multiple disciplines, in implementation science, with the goal being that the professionals coming out of this program will go on to be educators in their respective fields.

So, in our case, it was in speech pathology, but, that have this background and this specialized education in implementation science so they can one, become researchers that know about implementation science, to get better research, but then also teach students about implementation science so students are better at learning new information and applying it. It's kind of a twofold thing. That's how the implementation science stuff kind of just fell in my lap. It was like, ÒHey, there's this extra thing you could do, that I learned about and that this is great. I would love to learn more about this.Ó

It's become kind of this little side passion project of implementation science and figuring out how to better in the fields, use all of this good knowledge that we have, but how to actually start using it because we have so much knowledge that we're not effectively using, and that's kind of the goal here and what is my little passion. So, that's how I got to where I am.

[0:09:12] MD: Yes. Folks, I think our episode came out in January, two years ago, if memory serves. It was right at the start of the year because I think we kicked off the year with implementation science. And if you, too, have never heard of implementation science, because I know I hadn't until I met Bekah, don't fret. We will cover what it is. So, we got you. Okay. Megan, tell us your journey, love.

[0:09:37] MIA: Yes. So, I'm Dr. Megan Israelsen-Augenstein, the longest, hardest last name to pronounce. I like to joke that it's an articulation screener for any of the kids who I am serving, because it helps us know. Most of the phonemes that we would test for.

As Bekah said, I studied at Utah State University and we were part of the same grant. I'm studying implementation science. I am a faculty member at West Virginia University. I've been here for a year, which feels crazy. Yes, my research focuses on the development of interventions for kids with language disorders. Recently, I focused on kids with intellectual deficits, and my passion for implementation science started, like Bekah was saying, at Utah State in our studies, but it continues to grow as I learn more about what we need to do for kids with language impairments to help support them in school, and in their social interactions.

There's a big passion and importance, I think, I put on this idea because we're so far behind and implementing and using the innovations and the interventions that have been developed for kids, and that are current evidence-based practices. It hurts my heart to see kids not getting the current evidence-based practice. So, I'm all about, let's talk about what this implementation science thing is, and get it out there and raise awareness for what it is, and how it can help us be better clinicians.

[0:11:20] MD: Yes. You triggered a thought. I'm older, but I grew up learning SALT, how to analyze language samples. And Dr. Geralyn Timler, who is on faculty at James Madison that I work with. She's the director of the SLP programs like the academic side. She was talking about SUGAR. The first time she said SUGAR, I mean, I thought food. She was like, ÒNo. It's another way to like analyze language samples.Ó I was like, well, that's just lovely that we went from Salt to Sugar, but it's a different methodology or approach. But it changes, folks. So, if you haven't taken courses on some of the newer stuff, that's one of the reasons why we do this, right? Yes.

Okay. All right. So, let's take it from the top. Can y'all just explain what implementation science is and why it's pertinent to our field of speech pathology?

[0:12:22] RW: Absolutely. So, there's like the technical thing of what it is, and then there's the way that it is commonly explained. technically, it's considered an entire scientific study. It's its own little niche area. But it's not specific to any one field. Implementation science is roughly the same, whether you're talking about health, whether you're talking about marketing, whether you're talking about business. It is like a multidisciplinary field, so to speak, and it can be applied to anything. But it's commonly described as if we think of what probably everybody has heard, is that we have a research-to-practice gap. We have research and we have how we practice and those two don't talk to each other.

So, information science is commonly explained as it is the bridge between research and practice. It's how we take what we have, and what we know, and actually use it effectively and efficiently. It's trying to link those two concepts together. And I like to think of implementation science as having two pieces to it. It has the research piece and the practice piece. So, we do have good research that thinks about how would I use this research and have the researchers think about, how can I make this easy to use. Then, we have the practice side, which is as a clinician, how do I use this? How do I take what I read and actually apply it? And implementation science tries to answer both those questions, the research side and the clinical side, by melding them together. So, it basically is a framework, a thought process, a set of directions on how to take something new and use it.

[0:14:11] MIA: Just to add to that, Bekah mentioned that it's not just in our field that this is occurring, and I think itÕs kind of a new thought in the field of speech-language pathology, and audiology, but it's something that we can learn from other fields, and how they are implementing their new innovations and practice, and I think we learn a lot from health and medical related fields to be able to look at what they're doing, and how they get from, here's this new drug or here's this new surgery procedure, and then implementing it and using it in hospitals and medical settings across the world.

I think that's the goal, right? There's a lot of thought on the medical side of, well, how do I make this better? How do I better cancer treatment so that there are better outcomes for patients? How do I make it so that nurses can use these things so that doctors are able to do it? And they do it for multiple different reasons, not just for patient outcomes, but even just like thinking about marketing and selling it to the medical providers. How do we convince them that this is something that they should adopt and that they should use?

[0:15:32] MD: Yes. Okay, so the thought process, what you triggered, there's a killer book, and it is called Every Deep-Drawn Breath by Dr. Wes Ely. ItÕs E-L-Y. I don't know how to say this word. And he is an ICU physician who came from the world of pulmonology, and he actually works at Vanderbilt, if memory serves correctly, because it worked throughout his career. But what he talks is the art of implementation science, embedded in how he took ventilated patients that would be heavy sedated, heavy sedation, completely incapacitated, and how he and his colleagues the other early buy-in stakeholders, which is a really good term, because he goes through like, there's early buy-in, and then there's those that aren't going to bring it to the rear, right.

But how he and his early buy-in stakeholders took away all of that sedation so that they're lightly sedated or just on pain medicine. And what they're proving is that it helps with long-term ICU delirium and dementia. But it's been amazing because, for those of us that work with medically fragile patients, a lot of them have had long-term heavy sedation from all of these procedures. And yes, I understand. He's talking about adults. But our peds patients go through this too. But his narrative style of the book, on the surface, you wouldn't realize the whole book is about implementation science.

But when you understand from what I've learned from Bekah, and from learning about permutation science, that's what it is. So, folks, if you want to see something in practice, I recommend that. Now, clinically, what this means to me is that I have permission not to get it right the first time, which, holy crap, I am a type A 100% plus SLP. I want it to be right the first time. But it doesn't have to be. So, if you too, are a perfectionist and firstborn child, let it go. Let it go. Because we can sit back and reassess how it's done. And Bekah was like, ÒIt doesn't have to be right the first time. We can review it.Ó And I hear you in my head. So, in our clinic, how this looks is  Ñ a question for everybody listening, a question for you lovely ladies. Have you ever heard of the ECERS model?

[0:18:03] RW: The name sounds familiar, as in like, I probably heard it at one point in my life. But I couldn't tell you anything about it.

[0:18:10] MD: Yes, yes. The ECERS model, all caps, E-C-E-R-S, is about how you use an early childhood preschool setup. And I only learned this because of Dr. Burns, but how you use the setup to facilitate and create language-rich learning environments. So, if we're not taught why an early childhood special education classroom is set up in a certain way, then we don't understand how to go in and implement language therapy in that environment because there was a method to why the room was set.

So, at JMU, we have two preschool classrooms that we have Ð we have two therapy rooms that we have flipped to look like preschool brooms, and we're having an in-service for all of our clinical educators to learn about what the ECERS model is from one of our early childhood special education faculty members in the College of Education because we have to know about it as CEs in order to then teach the students so that they have that knowledge base to go out and embed, and push in therapy in their practicums. But to me, that's implementation science. To me, it's, I need to know the research so that we can grow, so that we can teach the students and have Ð does that make sense?

[0:19:30] MIA: Yes, and I think you bring up multiple points here, not just that, ÒHey, here's the science and that we need to know that in order to be able to implement it.Ó But we need to not only know the science from our field, but from other fields as well, because the special education team, at your university, is really the ones that have looked at this ECERS model and setting up preschool, and that's what they're teaching their students to do when they go out and become preschool teachers, and I think thatÕs a piece of this too that is the beauty of implementation science, because we are able to start to grab things from other people and learn things, so that we can be more effective in implementing what we know, and what we do in a natural setting for any of our clients.

[0:20:22] MD: Yes. Go ahead, Bekah.

[0:20:25] RW: I'm going to just touch on something we talked about, you mentioned earlier, is the idea that it's okay not to get it right the first time, and that is one thing that as I learned more about implementation science, really honed in, that you have to go into using implementation science with the idea that this is a long-term process, and there is a fantastic visual in our talk, you'll get to see the visual. But the idea that generally speaking, from when you first learn about whatever new thing is you want to do, to when you have integrated it into your daily practice, that's a two to four-year process.

[0:21:06] MD: I hate that. I hate that in my bones.

[0:21:10] RW: Every new thing, and when you learn something new, and you're like, ÒI'm going to do thatÓ, you have to give yourself two to four years before you are consistently using it. Then, the thing I learned in our first class when we were talking about it, that just blows my mind, is when are you most likely to stop using something, is after one year. When we look at the data, out of all the things that have happened, if they've stuck with it through to the second year, they are way more likely to see success with it. So, you didn't get the return that you wanted after that first year.

Most of the time, and there's a percentage, and I don't remember what it is, but it's a high percentage. If after that first year, you didn't hit the goal that you were hoping to get, most people switch. They pick something new, because this didn't work, I didn't get the return, I'm going to try something new. But those that stuck with it for another year, generally, after that second year, they got the return they were looking for. So, there's this thought process that you really have to sit with something for longer, longer than you think, and longer than a lot of us feel comfortable with. Because we're like, we're in a very fast-paced career. You're seeing people, and depending on your work setting, you may not see them for more than a couple of weeks if you're in like a hospital or a rehab. You're like, ÒCan I really waste a year on trying this new thing out?Ó

When really, a lot of times you got to give it at least two years. Try it for two years. That's really Ð and that's not to say you're not making improvements and slightly changing things. If it's clearly not working, you abandon it. But if it is somewhat working, but not to the level you are hoping it would, you got to give it more time. I am known in the department here as the person saying, ÒIt's okay. It's not good yet. We got that up for a win.Ó And I'm the one telling people two to four years, like faculty meetings, I'm like, two to four years. We have to keep working on this. Give it one more year. Let's bring it back next year. Because many times, people, in all fields, abandon things too early. And if they had stuck with it for a little bit longer, you would have seen success. 

[0:23:11] MD: Yes.

[0:23:13] MIA: If my memory serves correct, when we were learning about this, Bekah, we really looked at like education and what they did for like reading curriculums. And that often, when we're trying to increase reading outcomes on different assessments that they use regularly in schools, those curriculums that they use, or that they adopt, that would change every year because they weren't getting that yield. That really hit home to me especially with reading, like how important that is for kids. If we can really adopt something and stick with it for a little bit longer, that it will be more effective.

One of the things I also really love about implementation science, is they have this idea of an improvement cycle, and that this isn't something that you just like, start and keep doing it for two to four years, and it will be fine. But there's this improvement cycle that you do throughout the whole time that you're using the new innovation, or new therapy, or intervention, to help you be able to improve what you're doing, figure out what kinds of things are roadblocks, or making it difficult for you to implement, or things that come up with your clients that you see are roadblocks, and being able to plan a new way to do it, or just slight changes to be able to help you be better and improve.

I love that. That cycle that they talk about, itÕs a plan, do, study, act. That you plan what you're going to do, then you do it, and then you study it, and then you act by making a new plan, and figuring out what you want to do next. That's something that I think is really important, not just saying, ÒHey, I'm going to keep going with this for two to four years. But I'm going to keep studying what I'm doing, and making an improvement plan to help me continue to use this.

[0:25:18] MD: The piece about jumping so quickly hits home to a PFD heart. Because what we find is that when we have like an infant, and we're looking at like, do they have a food allergy or a dairy allergy or intolerance if they're breastfeeding, mom starts limiting things from her diet if we change the formula. But what we find is that you're supposed to give the body a set period of time to adjust to the new formula, before everything is fully eliminated. Unfortunately, some pediatricians are not familiar with the guidelines set forth by the allergist. So, they may say, try this for two weeks and let me know how it works.

However, it can take up to 30 to 45 days for everything that was in that child's body to be fully released, right? Because they have an emerging gut microbiome, and you have to change or allow time for that to change over, essentially. But we'll see parents that say, ÒHey, this didn't work.Ó In the span of six weeks, they've gone through three to four formulas and you don't have a clear understanding of, okay, which one was accurate? Which one wasnÕt accurate? Or mom eliminated too many foods from our diet that we don't know which one helps the child feel better. Right?

So, folks, if you're a feeding therapist, implementation science has merit for what we do as well. This is not just a language thing. All right. I can't Ð I got to stress that, not just for language. It's for like, all aspects of what we do professionally.

[0:26:55] RW: It's for everything. I tell people, I'll use examples of implementation science. I'm like, ÒWhat is something new you've tried to do it? New Year's resolution. How long did you stick with it? What prevented you from doing it?Ó That is a piece of implementation science. It's everywhere. It's everywhere. But it's just kind of shifting it to see how we apply it as speech pathologists, but it's implementation science. Once you know about it, and you know about some of these different theories and these different frameworks, you realize that it's kind of embedded in your life already, and you start realizing the things you do that you're like, ÒOh, I didn't know.Ó But that was actually, I'm in a way doing this thing in implementation science.

[0:27:38] MD: Yes, I'm excited. Y'all didn't see me wiggling my chair. Okay. So then, let's go through, can you talk this through the implementation science framework, because I know Megan alluded to it with the plan, do, study, act and Ð I have that written down here with a circular arrow, because I remember RebekahÕs model of, she had the circular arrows in all Ðand visual. I love the visual.

[0:28:04] RW: You've seen the visual before. So, I'm going to preface this and Megan will go into more detail about the specific framework that our talk is going to focus on. But I'm going to preface this with an introduction that at this point, there are probably close to 100 different identified published about frameworks. Because everybody has their own personal view on this is the best way.

So, the way to think about a framework is it's kind of the outline. It's the structure of how you would go up throughout this process of finding something new, figuring out if it's good, and using it effectively. They all have that same premise, of find a new thing, learn about it, do it, make improvements. But everybody has their own slight way of the order that things should go in, what questions you should ask yourself. So, there are frameworks out there. We're focusing on one that we like, for a variety of reasons. But there are at least identifiable, the number is 87. There's more than that by now.

So, keep in mind that if this doesn't really resonate with you, as I think I could do that, there's going to be another one out there that will be like, this fits how my brain thinks. There's a framework out there that's going to fit how your brain likes to organize things, and that's really all it is. It's an organizational structure to help you take all these big pieces that you have to do and put them into a nice order with steps when you start and stop things, to just help make this process easier to work through.

And then we have one specific type of framework that our talk is going to focus on that goes into more detail. But I like to preface it with that this is not the only one, and it is not the best one because the best ones going to vary depending on your situation and who you are, and who the people you work with are. So, there's a framework out there for everybody. But we like this one.

[0:29:58] MD: Wait. What is your talk? Tell us the title of your talk.

[0:30:02] RW: It is called Applying Implementation Science to AAC Assessment and Intervention, A Tutorial. It is going to be on Saturday, November 18th, at 2:30.

[0:30:14] MD: Y'all, you can find them in the ASHA App. I may or may not be starting this in the ASHA App.

[0:30:20] RW: Yes. ItÕs in the app. You can search either of our names, it will pop up. So, the talk that we will have will be going into detail about what is this one specific framework, and then showing how you apply it to an AAC with assessment in mind, and with treatment in mind, because the framework we're talking about is very teams based. And how do you get a bunch of people to work together for a common goal, which fits really nicely with AAC, which is very usually team-based. You have a lot of people that need to work together. So, it fits really nicely as an example of how it works. But the framework is for anything. You could use it for anything. The AAC that we'll be going over, it's just kind of the example that fits nicely with it. 

But I'll let Megan kind of go over this framework that weÕll talk about, which is it's one of the more complicated frameworks, I think, just because it has a lot of different components. But because of that, I find it to be useful, because it kind of covers everything. Some other frameworks only take out like a piece of a chunk of it. So, you use whatever you need at the time.

[0:31:31] MIA: Yes. So, what we are focusing on, we're looking at this framework, knowing that there's different cycles and different stages and things that we need to be paying attention to, to help us be able to know what's going on. The first piece of this framework is looking at usable innovations. We have to be able to first find and identify an innovation that we would like to use. And for us, it's something that needs to be, and not just for us, but in the literature in order to identify this thing, we need to identify it as something that we can teach. It has to be teachable. There has to be a basis and theory behind it, that supports what's going on, that our client or the people that we're working with not just our clients, but the clinicians have to be able to learn this skill or this innovation, and they have to be able to do, not just skill-wise, but in the facility that they're in, or with the client, or with the different resources that they have available to them. Then, we have to be able to assess how it's going, and what is being used.

There are just different stages in the implementation of those innovations that we identify that we really have to pay attention to. The first is exploration. This is where we identify the needs in our different facilities. And for our talk specifically, it's looking at AAC for kiddos. Identifying a need for that child to be able to communicate and needing that kind of support, and then you find that innovation, the different Ð there are lots of different ones out there that you can use. Then, you start to explore and assess which innovation is going to be most useful for my client.

[0:33:26] MD: Sorry, when you say innovation, you mean like language? Like the program of AAC device. Is that like an example for those of us that Ð

[0:33:34] MIA: Yes. So, it could be the device, it could be the strategy that you're using to teach your client how to use the AAC device. It could be Ð again, this is why it's so multifaceted, right? It could be that you want some sort of Ðthat a child has a specific device but doesn't have the physical capability to use and manipulate that device, so then you're working with a different professional to identify what could help a child be able to use that device. If somebody invented something, or, can we invent something that would help this child be able to access this device and use it?

[0:34:15] RW: Yes. So, innovation is a very broad term that basically is a fill-in-the-blank for insert new thing here. If you're working on kids with language, it could be what strategy am I using? Or the specific language program that I want to use? If it's feeding, it could be the specific method you're using, a new food you want to try, a new tool you want to try. The innovation is just Òthe new thingÓ and it's the broad term that the length that the field uses because it is so multifaceted. So, anytime you hear us say innovation, it's just fill in whatever new thing you're thinking about. That's the innovation is the new thing that you're trying to do. You're considering, I might use this, if you're deciding between two different assessments. The innovation is the assessment. So, it's just whatever is the new thing. That's the innovation.

[0:35:06] MD: Sorry. For me, the new thing is CoughDrop AAC. It's this new language program that I've seen on the land of Instagram, and let's be honest, if it pops up on Instagram, it doesn't make it science-worthy, right? But talk-to-me technologies now have that app on their devices that you can trial. There must be some accuracy and legitimacy to it because otherwise, they wouldn't have it as one of their language tools. So, when you say innovate, like in something new, I'm like, ÒOh, I need to learn more about this.Ó Okay, I got excited. Sorry.

[0:35:39] RW: In this case, at this stage, if you're thinking out in context, you'd be like, all right, what is the need? Do I need a new system, a new app? Does this app fit with my client needs? Do I have the potential to use this? Who needs to be involved in using this app? If itÕs not on their device, letÕs say they're not using one that's on a talk-to-me technologies device, who do I need to talk to get it on the device they have, or are we going to have to switch devices? So, it's just the innovation is yes, you just insert whatever thing you're thinking about there.

[0:36:12] MIA: And I love that Coughdrop came up as an example, because it's one I'm familiar using. It's cool. ItÕs a cool.

[0:36:20] MD: Really? Okay, good.

[0:36:22] RW: Now, I'm going to do that, because I've never heard of it, and I teach the AAC class, so I'm going to have to know.

[0:36:28] MIA: So, clinically, I've worked in early intervention, and I've used that app often with families and I went through this framework to kind of figure out if it was something I wanted to use, and I found a problem, or a need of being able to help kids who weren't yet verbal, but could use picture exchange, or could use different things to request items from their parents. And parents would say things like, ÒWell, we do this at home, but they go spend a lot of time with their grandparents.Ó Or, ÒThey have a babysitter, or a nanny, or they're at daycare, certain parts of the day, and they're unable to do this there. I'm not sure how to make that happen.Ó

So, we were looking at Ñ for an innovation or something new, that we could use with families to help them be able to their child communicate in a bunch of different areas, and we came across CoughDrop as an option, and it became something that we thought would be useful, because the family could have an account, and could sign on, on any device that they wanted. So, it could be grandma's iPad. It could be Mom's phone. It could be a computer that they had access to so that they just had multiple devices that the kid could use at any time. It is cool, and it was something that, for that problem or that need, this was an innovation that allowed us to be able to make it so that multiple people could use it, as well, as if I wasn't the only clinician that there could be other clinicians that we're working with and using the device. It was something that, it was an innovation that we were interested in trying, and we went through this whole exploration process before we started using it, clinically.

[0:38:24] MD: Nice, thank you. Now I want to meet the CoughDrop people and have them on for a podcast episode. Okay. I got us all excited and squirreled this in a very large way. But okay, back to implementation science.

[0:38:41] MIA: So yes, I think it was just a good example of here's this new thing, and this is what we want to figure out about it. Then, after you figure it out, you've got to prepare yourself to use it. In the literature, they call this the installation phase. This is the phase where you're preparing for using innovation. This is where when your losses are bringing in somebody to teach you about the new thing that they want you to do. This is part of the installation phase. It's the training that is involved in using something new. It's the resources and figuring out what resources you need and pulling them together, and it's also looking at what are the procedures that we have in place, and what do we need to change to make it so that this can be effective? Yes, Bekah, did you want to add anything? Sorry.

[0:39:38] MD: Wait, so in my head, the exploration phase, the innovation was changing two therapy rooms to look like preschool classrooms, to look like the ECERS model. And then, the installation phase would be we've identified this special education professor to come in and to do the training. Is that a good analogy?

[0:39:59] RW: Actually, if you changing the rooms to meet the ECERS model, is actually the installation stage where you're Ð so exploration is when you went, is there a better way for us to use these rooms? Do we need to train our students in something different? And as part of the exploration, you went and said, ÒWhat should we do with these rooms?Ó And you identify the ECERS model could work. And you probably did some looking into, is this an effective use of our rooms. Is this good? So, that's the exploration stage.

Then, in the installation, you go through the process of, okay, we need to change these rooms. Who is going to help us do this process? Do we need training? Who's going to train us? Do we need to buy materials? How much is that going to cost? Do we have that budget? Do we need to ask for money? Now, you're in the Ð installation is also still, ÒAll right, let's do the training. Do we have a plan of how we are going to move forward after training?Ó

So, after installation, we are still planning. We have not even done the thing yet. We are still thinking about doing the thing. I tell people like, in my head, 90% of implementation science is thinking about what you're going to do, or thinking about what you've done. The doing it part is a very small piece, because we're spending an extensive amount of time planning and an extensive amount of time analyzing. There's four stages that we're going to work our way through, three of them involve thinking about whether what we're going to do or what we did. Doing it is only one small piece. So, there's a lot of planning involved. 

Exploration would be, do I need to do something different with these rooms? Do I need a different AAC device? Is there a need? And you pick, okay, here's my options, and you go through and you pick, this is the one I think is going to work. That's exploration. And then installation is now that I've picked what the one that I think is going to work, how could I do this? What do I need to do to set this up for when I actually start using it.

[0:41:52] MD: Okay. So, then what comes after installation? Where's my brain now?

[0:41:56] MIA: Then we get into just the initial implementation, we do it. You use it, and you make adjustments if you need to, and I think that in the framework of AAC, that's important. There's going to be something that happens, and we're using it and something happens, and now we need to make a little bit of an adjustment. I think the most important piece of this is taking and analyzing data throughout this whole using-it phase. And Bekah was talking about the other three phases, or stages are all about thinking about what we are doing or what we did. That data, I think is really important to be able to help us continue to make improvements on how we're implementing things.

Another thing, I think, is really important is when you start using something new or doing something new, you always feel pretty incompetent doing that thing. I remember five years ago, I wanted to start exercising more, but I hated running. It's just not a thing that I was going to ever do. So, I decided I was going to start road biking. That involves like clipping your feet into your pedals.

[0:43:11] MD: I would die. I would literally break all the bones in my body. Okay, continue. Please tell me you did not wipe out.

[0:43:18] MIA: I have a couple of times. But just because I couldn't figure out how to like, unclip my foot quickly enough. But it was one of those things that I felt really incompetent at, not just because I couldn't put my feet in. But also, it was a new type of exercise that I wasn't used to. I remember, when I was first starting to do that, that I was about ready to just like throw it away, and not even try. But this is in the middle of us studying and starting to figure out this implementation science idea and I knew that I had to stick with it for a little bit longer, because it takes two to four years.

One piece of this too is when you start using a new innovation, is you've got to build your confidence and your competence, and that's going to be something that is also really important. And I think we said earlier, you're not going to get it right the first time, and that's okay. This stage is for you to be able to try something new, work on it, take data, make adjustments, and help yourself feel more competent at it. You're going to wipe out a couple of times, right? You're not going to unclip your foot fast enough. But when you do that, you actually give yourself more opportunities to improve and identify what you may need to make it so you can be successful as you continue to try and use the new thing.

[0:44:42] MD: Have yÕall ever seen Captain Marvel the movie? Okay, do you remember like this Ð I cry every time I see the scene. I'm like, ÒHell yes, you got this.Ó But like, where she gets up from the dust. I'm getting goosebumps. She wipes the dirt off and she's a little girl that got wiped out when she was derby racing, or like when she was playing softball, or when she was climbing the rope. Every time she does that, I'm like, ÒYes, we fall down, but we get back up.Ó And the boys, because I am raising future feminists are always like, ÒYes, woman powerÓ, because it's not girl power. Let's be honest. It's woman power.

But that's what I envision when you bite the dust and you pop back on, like, with a good plan. We're going to eat it, y'all. There's no way it's going to happen. But Captain Marvel, like, brush it off and then go on about your day. I should have been her for Halloween. Okay. Now, I'm sad. Okay, got it. Two to four years. God, I'm so impatient. So, are you still road biking then?

[0:45:47] MIA: Yes. But I moved to West Virginia, and they don't have Ð from Utah, right? And in Utah, the roads are very wide and you got lots of space to road bike. We don't have the same kind of space out here. The roads are much smaller. 

[0:46:05] MD: And very dirty, in a lot of places.

[0:46:08] MIA: Yes, and up and down. Yes, itÕs a lot. So yes, I am, but not as regularly as I was before.

[0:46:16] MD: Yes, but that's a very large variable that is out of your control. From a data perspective, that's going to throw it a little.

[0:46:25] MIA: Also, that's part of the implementation, right? Is that there's going to be these other factors that come up that you don't really foresee? If something ÐI adopted road biking, and I knew exactly how to do it, and I had built up my system to make it happen every single day out in Utah. Lots of miles and feel fit. Then, I moved to West Virginia and there's a factor that now I have to start planning again and looking at, ÒOh, now my use of this innovation or this thing has changed. Why? And what are the roadblocks? What's making it so I donÕtÓ Ð

[0:47:01] MD: Literally.

[0:47:03] MIA: Yes, exactly. Literally, what are the roadblocks that are making it so I don't use this as often or as effectively?

[0:47:09] MD: Bekah, you were going to say something and we got squirreled on the roadblocks.

[0:47:13] RW: IÕm basically emphasizing the fact like you said, you just can't plan for some things, right? The first two phases, exploration and installation are all about planning. But when we get to actually doing it, there's always something we couldn't plan for, that you then have to change and ingest in the moment. Hopefully, not as much as if we Ð because we're going in with a solid plan. But that means that there's still going to be issues. There are still going to be things come up that you have to adapt for.

[0:47:36] MD: Whenever we're brainstorming or putting the plan together, my go-to is what canÕt I see, in all things, right? So, I can see what I can see. But what canÕt I see? What don't I know? There's always the trial by fire. You're just going to learn it in the process. But to me, that's when you seek the council of elders. When I'm trying, if we tie this back into AAC, right? Say I've got my initial implementation of a targeted language program with a certain access method. How are they actually reaching for and touching? But it's going abysmal. Then my council of elders, I'm going to track down an OT. That's my go-to. Who is this child's OT? And sometimes they have multiple OTs. Because if you're working with a child that's school age, they can have a school-based occupational therapist, they can have a home health occupational therapist.

But if they're successful in home and struggling in school accessing the device, then I want to talk to the school-based OT as well as do they have a ParaPro. Because ParaPros are like the CNAs of the world, right? They know the things. And the doctors, the teachers, they might not always know because they might not be there for those intimate moments, but your ParaPros and your CNAs, they know what's up. So, make them your friends and seek their advice. Because they can tell you, well, after lunch, we're really tired, and we struggle with sitting upright. So, in my mind, I start thinking clinically. Okay, so if we're fatiguing, then they're going to lose their core, they're going to shift. What do we need to do? Do we need a second access point then? Or do we need some postural support in our chairs, in our seats, in our wheelchairs? Where does that fit into the model? If that's not the initial implement? Is that the fourth one? Is that where we review and then go back? Did I get ahead of myself? What is that one called? See, Bekah has trained me well. Do you hear? I have listened to you, woman.

[0:49:44] RW: Very proud.

[0:49:45] MD: Yes. I got my gold stars.

[0:49:50] MIA: I think, I said this earlier. It's the plan, do, study, act. So, we hit the next stage of okay, we did initial implementation and we tried this. We're making adjustments, we're figuring it out. We're finding all these different things that maybe are different that we need help with, because we found all the roadblocks, and we go and find the people to help us make the adjustments and have those conversations. Then, we hit the stage of full implementation, where now we have some Ð we have lots of ideas, not just ideas, but we've tried them out. We have problem solved, and now we're trying to implement this in as much of its full extent as possible, so that we can start looking at whether or not we met fidelity for this intervention. Whether or not we've met our goals. What do we want to do to continue to improve what still needs to happen? And how do we help ourselves make this sustainable, that it's not just something that we did one time, and fixed for a week, and now we don't need to worry about this anymore for a kid, but that we sustain this, not just for this individual, but for other clients that we have in the future. 

[0:51:04] RW: And this stage is all about Ð this is when it's become that daily habit. So, at this point, we don't have to think hard about it. We know what we're doing. We are competent. We are confident. And at this point, itÕs something you can do without thinking about it. When you're going along, and let's say it's at AAC and you're like, ÒAll right, he can use this device. Yes, we're still learning things. We're still working towards our goal. But I'm not fighting every day with like, how do I use this device?Ó Is there a better option out there? At this point, we've hit our stride and we're still working on things and doing things, but we've hit our stride, and we're feeling pretty good about it, and we feel like it's going to be able to sustain itself for the future. But there's always still a little bit of planning involved, where we're like, ÒOkay, next year, he's going from elementary school to middle school. We need to plan for that.Ó Because hopefully, the transition will be good.

But what if it's not? What can I do now to prepare for the future? So, you're always thinking ahead. Or maybe it's, they have a great OT, and we're making lots of progress with it. That OT is going on maternity leave, going to be gone for a while, and maybe will not come back, because she's thinking that, ÒMaybe I'll just stay home with the kids.Ó Now, we have to plan for this new OT that we don't even know who it is yet. But we can at least prepare.

So, it's knowing that we've got our stride. We're doing good. But what could be coming up that we can prepare for. And when things do come up that we haven't prepared for, you're able to go back into your adjustment mode, and go back into your problem-solving to figure out how do we keep this going? Because the whole point is that we want this to be sustainable. This is a long-term lifelong change that you're doing, as long as it's working. So, how do we get to that point where it's now easy, and it's self-sustaining? It's going to keep itself moving forward. If you're thinking about that classroom, we changed our classrooms, we're using it, students are doing good with it, patients are doing great. But what happens when a clinical educator leaves? Do we have a plan in place to train the new one? Do we have a plan in place that what if funding changes? And now this room has to get allocated to something else. It's that plan ahead to keep it sustainable in the future.

[0:53:09] MD: So, we had Dr. Sue McAllister from Australia come out to teach us about competency-based education because in Australia, they've completely done away with their minimal hours requirements and transition to competency-based education. So, Dr. Carol Dudding, who's the director of the online MS SLP program, she was my professor a lifetime ago. And she's also the current VP of ethics for ASHA. She booked Sue to come out and talk to us about competency-based ed, and we also got to have like, one one-on-one time with Sue. Some of the greatest feedback that she Ð and she met with all of us individually.

For me was, ÒYou are quick to go to the solution.Ó My brain goes, ÒOkay, well, how can I come up with the solution?Ó She's like, ÒBut you need to hold a little bit more space.Ó She's like, ÒHold space for the potential for other solutions.Ó That's profound, like truly. ItÕs eye-opening for me as a human, but also in a leadership role, right? Because for so long as SLPs especially when you're a silo clinician, you have to be able to identify and just act. You just have to be able to do it, right?

Megan, you worked in early intervention, you're normally solo and you get really good at being a solo siloed clinician out of necessity. But being able to hold the space for potential other solutions that come up for very, like you said variables, and not having to do a react. I like being proactive. So, folks, I say this long, windy, discombobulated sentence that when you're planning this, and you're prepping for variables as they come, make sure that you're also holding space for other people's inputs as potential solutions. We don't have to do it all. Somebody out there needed to hear that and maybe I need to tell it to myself again.

[0:55:08] RW: I love that. And that's one of the things, we're not going to get to that component of this framework. But the part of the framework is finding the people that will support you. The people that are going to be your immediate support, that you're going to work with day to day. So, like in the AAC example, right? This is you as the clinician, this is their OT, their PT, their teacher, and their parents. The people that you are like, we were the people in the trenches. You got to find those people, and then talks about how you find them, and what are qualities to look for. 

But then the other group is you need to have basically your case manager people, for the implementations, who is the person organizing all the people involved? And the couple people that are your basis of broader administration, who are your people to support you at that level. So, I love implementation science, because it really emphasizes that you shouldn't do it alone. It's going to be hard to do it alone, and you really shouldn't, and it's building in that thought process of identify the people who can support you. Doing that from the beginning, from the get-go, so that way, you are able to be more successful, because you've identified your support system, whoever that person is. It gives you guidelines on these are people that could be good support systems that are a little more designated. But that support system could be anybody. But it really makes you find your support system and make sure you've identified them, so that way you have that. Because you're more likely to succeed if you have a support system.

[0:56:30] MIA: I like to think about this, too, is, we all work every day to try and make it so that our clients have meaningful change in their lives. We use innovations, new things, all the time. And we can set up something that's evidence-based that we're using consistently with our clients and helping them be able to make that change that rarely do you stay in the same place for your whole life, and can set up something in a system, and make it so that it's sustainable and useful in making changes. And that if you left Ð this is the question, I think, that it's important that we're asking. If I were to leave today, would the use of this innovation be sustainable? If you can answer that question as yes, then you've looked at all the different Ð you've set up the support system, and looked at all the different variables and things that you would need to in this implementation science to make it so that you have successfully implemented and created something that can last after you're gone. 

If your answer is no, then this is where you can start to ask different questions like, ÒWell, what would I need to do to make that possible?Ó I think sometimes there's a lot of Ð we're so very proud of what we're doing and we feel very Ð we've gotten to the point where we feel confident and competent, and all that. That's a good feeling when you leave. Sometimes, for me, it's like, I want people to know that I'm good at what I'm doing and I want them to want me or need me. I think that's Ð it's a feeling that we want to have. But when I think about it, as if I were to leave today, can this continue? If the answer is no, then I need to do some other things to help make it so other people are aware of what's going on. They're competent and confident in what they're doing, so that my clients, whose life I'm trying to change their life every day, that their daily life can continue to be changed, and have that positive effect.

[0:58:46] MD: That's a big question with a lot of emotions behind it. Or maybe a big statement. But yes, it's like when I tell my students when they're writing their SOAP notes, God forbid you die. But if you were to keel over, can the next clinician come in and read your eval plan of care? So, short, concise, take on your kiddo and keep on moving forward. That's a lofty thought too. Also, nobody really wants to think about that thought process, but also implementation science for SOAP notes. That should be a whole subset of research. I'm not doing it.

[0:59:25] MIA: That's the whole point, right? We're getting there so that when we adopt something, it's not just a one-person change, because that's not sustainable. It's not something that's going to be effective. It's a whole system. We want the system to be able to support, adopt, and use this new thing.

[0:59:41] MD: Okay. So, IÕm going to piggyback on the AAC Palooza. Bekah and I, and Dr. [inaudible 0:59:46] set up the AAC Palooza back at FMU. Three years ago. I think it was Ð

[0:59:52] RW: Yes. We had our third one this year.

[0:59:54] MD: Yes. And I loved that it's still going and you added in speakers. So, this year, we rolled it out at JMU, and I took an inspiration from Bekah, and we added in two speakers here for free CEUs for community-based clinicians and folks loved it. So, we had it, and then it got built upon, and then replicated elsewhere. But to me, that's powerful to the testimony of like, we have really good stakeholders. We had really good Ð you had a term for it, the people that you go to, those people.

[1:00:30] MIA: Yes, there's different people, but they're basically we call them Ð the term in this framework is implementation drivers, because they're the people that are driving the boat. And they are the people that are in that leadership role. So, that's, not everybody needs to know everything. Everybody has their own specialty and there's somebody that's going to help guide this boat, and keep everybody moving, so that everyone's working towards a goal and working together, because there's so many pieces in the pile. As Megan said, it's a system change, not a person change. So, we need somebody that will organize the system.

I like the term implantation driver, because it kind of emphasizes what their role is here, is to the bus. Keep it moving. Keep us moving towards our goal. We might have to take a bit stop. We might have to go in to get oil changed. But we're still moving towards the goal. We're still driving our way there.

[1:01:26] MD: Carol teases me. She goes, ÒRemember, both hands on the steering wheel for the bicycle. You can't build it while youÕre steering it. You can't change the tire while you're steering it. You steer and then you pull in the people to do that component.Ó And I was like, ÒThis is a mighty powerful analogy.Ó But it makes me chuckle. We have the bicycle pizza cutter. Bekah knows. Every Friday night, pizza movie night at our house like clockwork, but it's a Ð it has two both wheels, our pizza cutters. So, you just have to Ð it cuts down on the amount of time you have to do the back and forth. This is a brilliant design. And it's shiny, so it's like fake brass, but it's machine washable. So, like it hits all of the lovely components. Whoever designed this, clearly also had a wife that has ADHD.

Okay, we have joyfully gone over. So, tell us your closing thoughts, and then I have found your room. So, I can give that information. But tell us your closing thoughts first while I pull that back up from ASHA.

[1:02:28] RW: My closing thought, anytime I talk about implementation science is always the same. It's always you are, if we think of the whole process and the whole stages, you are the exploration. You have learned what implementation science is and you're deciding is this going to work for me. Which one is going to work? You're in the exploration stage. And out of the four stages we talked about to get from exploration, to when you're using implementation science things in your daily life, when it's become a sustainable feature that you use, that's two to four years. So, you have just started the timer on your four-year process. All of those type-A personalities are like, I got to be perfect right now. You got to be perfect, eventually.

You only just started the process, so you're going to explore it, decide if it's right for you, decide what you like and don't like, and make modifications, and allow yourself those two to four years before you feel like I am using this in my daily life. And you got to give yourself time. So, I always end with, you have just started a four-year process. So, allow yourself those four years to feel competent and confident and like you've got a handle on it. Because that's what should be expected. You started the process and it's okay that you don't feel like you know the answer or even any question at the moment. That's okay. Because you're just exploring it and that's where you should be.

[1:03:54] MIA: Yes. It's hard to piggyback off that. But I think, just because it's true, that youÕre just starting. But I think we're talking about ASHA, we're thinking about it, and we're all thinking about all the different toxin and different innovations, new things we're going to learn about at ASHA. I guess my challenge is, is you're in the exploration stage, pick one. Find one thing and start your cycle. Your two to four-year cycle and take your data and start looking at Ð two years from now, how did it go? What's going on? Did you follow this implementation thing or not? Did you throw it away by the wayside after a month after you crash the first time? Start your cycle. Pick one thing and start it and see what kind of changes it can bring you as a clinician and as a researcher for those of us that are going to learn new research things.

[1:04:51] MD: Amazing. Okay. Thank you both. Okay. They are in your ASHA app because ASHA has an app for that for convention programming. 1984 is their number. See, whoever is born in Õ84, getting ready to come up on the 40 here, because I turned 40 this year, so it should have been 1983. If it had been 83, I would have gotten a good chuckle. But it's 1984. Applying Implementation Science to AAC Assessment and Intervention, A Tutorial. It's a one-hour seminar on Saturday, November 18th at 2:30 in the Westin Grand Ballroom, C/D. It's on the concourse. You got a really good space by the way, that's a good setup.

Behind the scenes I may or may not have volunteered for two consecutive days for two hours each day to look at spreadsheets. That was for the birds. Y'all, when you go there, please be sure to thank the topic chairs. Tthank all the volunteers. There's hundreds of volunteers behind the scenes. Also, Gina [inaudible 1:05:55] and Ð oh, my goodness, I'm going to be remised if I don't remember her name as well.

Well, Gina is one of the gurus that's behind the scenes. And y'all this year's ASHA convention chairs are Dr. Kelly Farquharson from Florida State University, who is a speech sound disorder, dyslexia guru, and Dr. Jennifer Simpson from Purdue University, and she's an audiologist. They are affectionately known as the sparkles. And the sparkles put in hundreds, if not thousands of hours of work to pull this off as volunteers. So, be sure to, I don't know, buy them a whiskey, send them a coffee, something when you see him. But Bekah, and Megan, thank you so very much for coming on.

Wait, quick question. If somebody right now love the episode, and they have love money, and they want to donate it somewhere, where do you want them to donate it? Go.

[1:06:47] RW: Oh, I don't know. I don't know donations. I would say that, and full disclosure, I am on the SCSHA board, South Carolina Speech Language Hearing Association. So, I would recommend that they donate to their state organization that most likely has a scholarship for students to help support students get education in this field. So, don't donate to South Carolina unless you want to and you're from South Carolina. But find maybe your state organization, or even if you have a local national chapter that takes donations, so that our students can be supported, because they need all the help they can get. Speaking from someone who is a student not that long ago.

[1:07:23] MIA: I have a soft spot in my heart for kids with Down syndrome. So, my place to donate is always the National Down Syndrome Adoption Network. That's where I would encourage donations.

[1:07:37] MD: Beautiful. Folks, I get to please consider donating to the ASHA Foundation. They fund scholarships for students as well as scholarships for researchers. And then my second one is Ðwell, third, technically, Sharonda Coleman Memorial Scholarship from South Carolina. It goes to a member, graduate student, or undergraduate student who is a member of the BIPOC community. And it's an honor of Sharonda Coleman, who was slain as part of the Mother Emanuel shootings that were a hate crime in Charleston. So, SCSHA does their part to turn wrong into right. So, I'd recommend that one and I sit on the Board of Trustees for the Virginia Communication Disorder Foundation, so I would recommend donating there. If you're in Virginia, in the Commonwealth, we can help fund some scholarships for students. These are very lofty choices to pick from. But that's it.

All right, everybody, we will see you at ASHA. Don't forget to pop by the SpeechTherapyPD.com booth, which I don't remember the number, but you'll find us. It's big and we have dice and we roll for fun things. So, I will see you at ASHA.

[OUTRO]

[1:08:43] MD: Thank you for joining us for today's course. To complete the course, you must log into your account and complete the quiz and the survey. If you have indicated that you are part of the ASHA registry, and entered both your ASHA number, and a complete mailing address in your account profile prior to course completion, we will submit earned CEUs to ASHA. Please allow one to two months from the completion date for your CEUs to reflect on your ASHA transcript. Please note that if this information is missing, we cannot submit to ASHA on your behalf. Thanks again for joining us. We hope to see you next time.

[END OF INTERVIEW]

[1:09:22] 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]

[1:10:16] 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 Dawson, the All Things Peds 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 260		Transcript

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