EPISODE 276

[INTRODUCTION]

[0:00:14] 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, early intervention right there with you. I run my own private practice, Heartwood Speech Therapy here in Cola Town, South Carolina. And I guest lecture nationwide on best practices for early intervention for the medically complex children. First BiteÕs mission is short and sweet, to bring light, hope, knowledge, and joy to the pediatric clinician, parent, or advocate.

[0:01:01] EF: By way of a nerdy conversation, so there's plenty of laughter, too.

[0:01:05] MD: In this podcast, we cover everything from AAC to breastfeeding.

[0:01:10] EF: Ethics on how to run a private practice.

[0:01:12] MD: Pediatric dysphagia to clinical supervision.

[0:01:15] 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.

[0:01:25] MD: To break down the communication barriers, so that we can access the knowledge of their fields.

[0:01:30] EF: Or, as a close friend says, ÒTo build the bridge.Ó

[0:01:34] 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.

[0:01:45] EF: Every fourth episode, I join them. I'm Erin Forward, MSP, CCC-SLP, the Yankee by way of Rochester New York transplant who actually inspired this journey. I bring a different perspective; that of a new-ish clinician with experience in early intervention, pediatric acute care, and non-profit pediatric outpatient settings.

[0:02:06] MD: Sit back, relax, and watch out for all hearthÕs growth and enjoy this geeky gig brought to you by speechtherapypd.com.

[DISCLOSURE]

[0:02:20] MD: Hey, this is Michelle Dawson, 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. 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.

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. I currently receive a salary from the University of South Carolina in 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.

[0:04:06] EF: Hi, this is Erin Forward, and these are my disclosure statements. I receive a salary from Cincinnati Children's Hospital Medical Center. I receive royalties from SpeechTherapyPD for my work with First Bite Podcast and other presentations. I also receive payment for sales from the First Bite boutique, which I have with Michelle Dawson.

For non-financial disclosures, I am a member of ASHA and a member of Special Interest Group 13. I also am a volunteer for Feeding Matters. I am a contributor for the book, Chasing the Swallow with Michelle Dawson, which I receive no financial gain. I also am a member of the South Carolina Coalition Committee with ICLDIF full-time.

[0:04:46] 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]

[0:04:55] EF: Hello, everyone. Welcome to a new episode of First Bite. Today, it's me, Erin, in case you forgot what my voice sounds like. I have the lovely Casey Rovinski with me out of Tampa, Florida, who we are actually both from Rochester, New York, and have moved very far from Rochester, New York. I met Casey because Taylor Anderson, who is one of my very close friends, who if you have listened to the mentorship pediatric feeding episode, that was with me and Taylor, she connected us and we had a conversation, I think, it was months ago.

I just remember Casey's very warm energy and she's one of those people that I think you feel like you've known her for a very long time when you first meet her. Both from what Taylor has expressed to me and from what Casey has a really wonderful social media page, I will tag it for you guys to go follow, but it just makes you feel good. I love what she's doing with her private practice and how she's empowering caregivers and how she's empowering the clinicians that work for her to really do therapy that feels like what we should be doing and relationship is at the center and connection is at the center. I think that's something that we can never hear too much about and something that really should ground us in our practice. I'm really excited to have her. I'm really excited to talk today about how she's gotten to where she has and just really the core values of her practice. Thanks for coming, Casey.

[0:06:35] CR: Oh, thank you. Thank you for that introduction.

[0:06:39] EF: I like to start with tell us a little bit about yourself. Tell us your story, like how you got into speech therapy, how you got to Tampa, and then tell us a little bit about your private practice.

[0:06:50] CR: Yeah, of course. Well, thank you so much for telling all those nice things about me. I love that you can feel my warmth through the screen. I love that.

[0:06:58] EF: Well, and anytime Taylor talks so wonderfully about someone, like Taylor says what she means. She really, really speaks highly of you, which means a lot to me, too.

[0:07:08] CR: Taylor is the warmest human as well. I'm flattered and honored. Yeah, I got into speech therapy just because it was a class that Ð an intro class that I took at school, SUNY Geneseo. Then I just stumbled upon it and went with it. I initially wanted to work with adults. I was more actually interested in the medical side of things. Then my summer, I had a summer job at a program called BOCES in Rochester. I was working with autistic kiddos.

My best friend at the time was a PCBA and a teacher in a classroom, and I was the speech therapist. In Rochester, before getting your master's, you can just Ð it's not as SLPA, it's a speech therapist. Are you familiar, Erin?

[0:07:57] EF: Mm-hmm. Yup.

[0:07:59] CR: I did that before I got my master's and I absolutely loved it. I was like, wow. I just loved connecting with the kiddos. I was doing things completely wrong, to be honest. I have no idea what I'm doing.

[0:08:12] EF: We all were.

[0:08:15] CR: Yeah, just being able to connect with the children felt so good to me. That's when I knew, okay, I definitely loved this population. I want to work with kiddos. Then from there, my first job out of grad school was in early intervention in Rochester, New York. I worked at Cappell. Are you familiar with that program?

[0:08:37] EF: That sounds familiar. Mm-hmm.

[0:08:41] CR: It was with birth to three-year-olds in their homes. I absolutely love that. I had a great mentor, a great supervisor, that was my CF. I loved working with families. I loved working with parents one-on-one. Then I moved to Florida because it was too cold and ended up staying in Florida, worked for a private practice that was very sterile, very white walls, in and out. I was seeing 12 to 16 kids a day and just completely overwhelmed. Luckily, I had really good experiences from the past. I knew this does not feel right. I had something to compare it to.

Then from there, I opened my own practice called Speak Outside the Box. We currently have five SLPs and SLPA and OT and we just started with an OTA. We're growing and it's been really exciting. I'm absolutely obsessed with my team and my practice. Yeah, that's where we are.

[0:09:39] EF: That's how, and I'm always curious, especially when someone starts a private practice. I feel like, in having students that I trusted patients with after they were my students, I can get to that point. But I do feel like, hiring can be challenging, especially when you start your own private practice. Like, okay, how do I meet someone and know that they're going to both represent me, but more so, treat the patients and the clients that I have in a way that I want to be treated?

I love when you talk a lot about these core values of your practice and how did you, especially starting out and opening your private practice really Ð because it seems like, you have a really wonderful team that very much aligns with those values, but what would you say to somebody or, for example, your practice when looking to find people that align with you?

[0:10:42] CR: Yeah, that's a really good question. I feel like, there's a story behind it that, can I share my personal story in doing that?

[0:10:50] EF: Absolutely.

[0:10:51] CR: When I first started my practice, it was just me and I was going from home to home. Then my referrals started coming quickly and I didn't want people to be put on a wait list. I had a friend who I worked with at a past job and I just asked, ÒHey, do you want to see clients for me?Ó From there, the intention was like, this therapist is just seeing clients for me. It wasn't like, I'm a leader, I'm mentoring this team and we're going to have the same values, we're going to have the same approach, we're going to have the same style. It was more so, I was almost like dimming myself because it was too scary to be a leader. That was definitely a process for me. I would say, a year or two process and it's still a process now.

At the time, I just didn't feel Ð it's almost the imposter syndrome, which we all have, but I didn't feel like, who was I to have a company and have SLPs working in the way that I felt was right. That was a process. I had to get my own mentor, my own therapist who I worked a lot on finding my truth and finding my center. Then from that point, I was able to just cultivate a team and some fell off and then new ones came forward, but it was the intention from the beginning when speaking with someone that like, hey, this is a team. We all have this similar approach. Like, does that feel good for you?

Then typically, with a new hire, I always give them a week, or two to just observe, to be part of our meetings. Then I just ask like, ÒHow does this feel?Ó If it feels good, then we move forward for both ends. If it doesn't, we don't. That's how I've been doing it. Another thing is we do weekly meetings with all of us come together weekly. It's probably 50% talking about work and the 50% talking about how do we build connection within ourselves? How do we work on all these things that we want to work with our kids, but also embody them in our own personal life? I feel, that's also just been huge in a sisterhood almost.

[0:12:59] EF: I love that too because I think it is really hard to go from grad school, where the focus so much is on what information are we getting? Do I know all these diagnoses? Do I know all these deficits that I could be treating? Because unfortunately, I think it's unfortunate, our field is a deficit-based field. We have the big nine. We're focused on, what can I fix? There's a shift, but I compare it to the OT field as well, where it's more of a participation model. It's just a different framework that we have. To go from that to then start to, like you said, trust yourself and trust what feels good, because there's so much that we do that can't always be explained. You have to feel it.

Yes, there's neurobiology to a lot of this if we want to get into it. There is science that some people struggle with, and this is one of my Ð I won't go into my whole irritation with it when we're talking about research studies, but it's like, is there a research study for it? I'm like, well, there's neurobiology. There's science. But to allow us to just feel good in the moment and get in tune with who you are as a clinician because there's going to likely be people that need more structure, that need something that's a little bit different and that's okay. Our job is very emotional. I used to think it was a really bad, negative thing to feel those emotions.

I mean, also I think being from New York, it's a very like, you don't show your emotions at work. You don't talk about certain things. Then to go from being like, no, feeling emotions with a family, with a client, with a co-worker is a part of our job and should be a part of our job because knowing the fact that if you allow yourself to feel an emotion for 60 seconds, it can leave your brain. If you don't, it can live there for, I think six years, is that what it is?

[0:14:55] CR: I don't know, but yeah, 100%.

[0:14:58] EF: Just to understand that and to create the fact that you're cultivating this sisterhood to, especially in a field, and I love our field very much. In a field that can be very competitive, because of this weird idea that women have of the scarcity mindset when there's so much room for everyone. I think there is so much to that really trusting your gut because there's a lot of things that can't always be explained, and that's okay. How do you feel about this environment? How do you feel about this vision? How do you feel about these people? I think is wonderful.

[0:15:34] CR: Yeah.

[0:15:35] EF: In regard to that, because you and I have talked a lot about really honing in on the core of what we do and the fact that most of us, like you were saying before we recorded, most of us are heart-centered, even though we can be very type A and very focused on accomplishing and meeting goals. A lot of it comes from a place of like, ÒI want this caregiver to feel accomplished. I want to make sure I'm doing everything for my clients that I can.Ó I feel like, it is a really hard balance and therapy of making sure that you are focusing on goals and feeling their success, but also shifting the mindset to what success may look like. I think you do a good job from my experience with you of speaking to that and speaking to the value of that connection and centering and relationship piece.

I'd love to hear even just a little bit about how you got there. Because I think that we all have a journey of getting to the point where we trust ourselves, where it's not, ÒOh, my gosh. My client didn't meet this goal in a certain period of time, but I know that this therapy was valuable and I know that there's something to this.Ó That takes building confidence and that takes building trust in yourself. I'd love to hear your perspective on that. It's a big question. Go where you want to go. You can go any which way.

[0:17:01] CR: Yeah. I have so many different things in mind. I think you hit the nail in the head, where we have to have trust in ourselves and this innate knowing and it has to be really Ð we have to be grounded in that truth in order to make a parent feel safe in a new situation, where maybe there's no data. Maybe there's no note-taking. Maybe there's no goals being stated every month, right? That might be really different for a parent that has had a child, maybe an ABA therapy for the last three years, or has just been in a different type of clinic that was not relationship-based and was a little bit more data-driven.

In my experience, we are in a really wealthy part of South Tampa. We have most of our parents pay out of pocket. We have a lot of parents use scholarship, but we're working with families who are, they're wealthy, I don't want to say privileged, but they have a lot. They have a lot and they have a lot of resources and they know a lot. It's intimidating sometimes to be in front of doctors and lawyers and accountants and all of the things and being like, ÒNo, I swear this works. Can't you see it? But I don't have any data, because I'm not taking data daily.Ó

Just like you said, we have to be grounded and confident. For me, it really just comes right back to self. An activity that I did really early on in fairness, I forget if I talked to you about this during our first call, when we first met.

[0:18:27] EF: I think you may have. But yeah. Go ahead. Yeah.

[0:18:32] CR: My mentor that I was working with, she's like, ÒYou're so good with connecting with children. Can you tell me why? Can you write down what you do in order to connect with children?Ó I made a list. To name a few, it was like, movement, regulating their nervous system, putting little expectation on them, playing off their interests, being in flow within play and interaction. Then she's like, okay, so taking however many qualities, those four. Take those four qualities and give them to yourself and put that same framework on yourself every day and see what happens. It was such a paradigm shift for me.

An interaction with parents, right? Give myself flow, give myself space, regulate myself. That helped me create relationships with parents that felt safe and confident to them. If we're not feeling that in ourselves, they're not feeling it, then they're not going to trust us. That's a huge. It's a constant journey and it's always evolving. We're human, so we're going to get in our heads and there's going to be that one parent that really intimidates us, or that almost is our trigger because we're able to see ourselves in the mirror of their face of looking at us like, ÒDo you really know what you're talking about? Are you really being affective with my child? Why aren't they talking at Ð They're not doing anything. They're just playing.Ó

There's that one parent that you really have to go back into your own practice and reestablish that trust within yourself so that you can actually continue to make the difference. Sometimes the parent isn't always going to meet you and that's okay, and having no attachment to that. Because that's also another really hard part is knowing like, you can't help everyone and all you can do is your best.

[0:20:21] EF: Yeah, Michelle always calls it the seed planter. She's like, sometimes you're just planting the seeds. Sometimes you don't always get to see them grow and develop, but somebody has to start that conversation, and sometimes the caregiver is not ready. Sometimes they may need to hear it from other people, or it may not be the right time, but making sure that you're being authentic to yourself. I will say, coming from not working for myself, it can be a little bit more challenging when you have insurance over you, or when you have a bigger organization that's monitoring how you're doing things, but I think there's ways to find that grounded in your values and advocate, too. I mean, I've advocated at times to be like, ÒI'm not the right fit for the family.Ó I know we need to find someone for them. I need to also advocate for myself and my regulation, how I feel because I've left sessions where I'm just crying because it doesn't feel good to me, but I know that this is what the caregiver wants, and I know that I am doing everything that I can.

I do love, too, the going back to yourself, which I always say, when I'm teaching any course, or I'm talking about trauma and informed care, I'm talking about neurodiversity affirming care, you have to learn to be emotionally intelligent and you have to start to understand yourself, or this is going to be so hard. Because like you said, when you're faced with clients, or caregivers that maybe there's a disconnect, or maybe you have to meet them somewhere, you're going to have to understand why that affects you and the way that it affects you. Why maybe you're getting a different reaction from that client, or that caregiver. Just like our clients, I may have had a hard day and I may not have as much left in my cup to be able to regulate myself for this family that maybe I'm feeling more anxiety, or when you're an empath, you just feel those emotions.

If I can better understand how to support myself, too, then you can co-regulate the child, then you can co-regulate the caregiver. It's going to be hard. I've learned things about myself that I'm like, ÒOof, I thought I worked through that. Or, oh, this is bringing up something that happened.Ó I remember I took Ð I think it was talking with Kim Barthel, who I will praise her forever. SheÕs a phenomenal OT. We were talking about kids with big feelings. I was like, ÒI love kids with big feelings. It's like, I love them so much.Ó She's like, ÒI think when you work with kids with big feelings, you're healing a part of yourself.Ó Because I was a kid with big feelings, that felt like I couldn't have them. It wasn't my parents' fault. I was very, you need to be okay for everyone. When my parents divorced, I was like, you need to make sure everyone's okay, and I put that on myself.

I have to acknowledge that sometimes those kids are going to have big feelings and that's going to be hard for me. When I see a kid that has signs of OCD, that's going to trigger things in me, because I have OCD. It's being aware of that, being okay with having that reaction, and then figuring out how to support yourself through it. I love how you talk about giving to the child and then giving to yourself.

[0:23:36] CR: Something that I just thought of when you were talking, that's a wound, right? The wound of feeling like you have to take care of everyone. Then, what was the other one? Feeling Ð

[0:23:45] EF: Any of my kids, because I have OCD. The ruminating, all of that. If I see a kid that has signs of OCD, I feel their anxiety and it rises that in me.

[0:23:56] CR: Then the other one is that you said was big feelings.

[0:24:00] EF: Oh, big feelings. Yeah. My feelings are too big.

[0:24:01] CR: Feeling like you have to Ð yeah, you have to dim yourself, or shrink yourself, which is such a common one that mostly, we as women have. What I always find is interesting that I always connect to is how our field is predominantly women and how women, our throat chakras, our ability to voice our needs is what a lot of us have a hard time with, whether we know it or not. It's what we're working on with kids. I always think that's so phenomenal.

[0:24:32] EF: Mm-hmm. I remember I wrote Ð I vividly remember this. I don't know why, but when I wrote my letter for grad school, I wrote about how when I was younger, I had such a hard time saying when I was upset with someone, I just never wanted to tell anyone I was upset with them. When my parents split up, obviously, you're going to have feelings of what happened. My mom would sit with me for an hour, maybe more, while I was crying, trying to tell her how I felt about something, but she would sit with me. It may not be the same as what some of our clients are experiencing, but feeling the opportunity to give a child that freedom to communicate how they feel was what my mom did for me. I really connected with that, because that's so interesting is, I think, really, really hard, because you feel like, you're supposed to be that caregiver support system as a woman.

Community is so important. That's something I also really wanted to talk to you about because I think from my conversation with Taylor, I really value the community that you're building within both the clinicians that you work with, but also with caregivers. Like, starting a book club and having Ð I know that you will have webinars for caregivers to listen to. I would love for you to talk both about that and what sparked doing that as well with Ð as well as treating clients because I think it is a wonderful thing for people to hear about.

[0:26:08] CR: Yeah. First it started with, I saw that parents weren't really getting the support that they needed. Of course, it's like, there are mirrors, right? We can tap into things because we needed it for ourselves. Not that I was like, ÒOh, my gosh. All these people need so much help.Ó But it's like, ÒOh, my gosh. I feel you. I feel you in this.Ó You have no support. Your child has 30 hours of ABA therapy. They have two hours of speech. They have OT. They have all these things. What are you doing? Where are you getting your cup filled?

That's a huge thing that I don't have the answer to, how we can create a solution for that. But I do know that establishing community, bringing space, and just bringing helping, yeah, being there for the parents that we work with. Creating a connection with them that says like, ÒYes, I'm your SLP, but I'm also your friend and I'm also here for you. We can hug. You can cry on my shoulder.Ó Being okay with being in those really mucky conversations and those really sensitive, vulnerable topics, I think, it's so important, because sometimes we're really the only woman that these primarily moms I'm working with have.

Once I started to really tiptoe into that and then feel the effect of it and just see the opening, like feeling the opening in these parents, that's when I saw the acceptance of themselves and also their child, right? That's when I saw more neurodiverse affirming parents, with not their awareness, but just with their ease and their acceptance. Then from that point, it's creating community for them outside of me and our therapist, but for other moms to come together and to be in a similar frequency and awareness and intentionality with their children.

It's just been really neat. I want to be friends, best friends with all the parents I work with. This is a great way for me to be really professional about it. Yeah, so we have book clubs. I have a connection clinic that I was hosting every week and it got just a little bit too hard for me. Now it's once a month, where I just invite all of the moms and dads, primarily parents with autistic kids, which is 95% of the population of my clinic.

Then we just meet and we chat for an hour. People say what has worked, what hasn't, what challenges, and just everyone just chimes in. I personally learn. I'm hosting the meeting, but I'm learning because it's from a place of friend. I feel like, I learn more in that context than I have been as a speech pathologist, if that makes sense.

[MESSAGE]

[0:28:59] ANNOUNCER: Want graduate-level semester credits for your speechtherapypd.com courses? They are available now in collaboration with the University of Pacific. As you know, most of our 750-plus video and audio courses are evidence-based and all are super practical. Subscribe now.

[INTERVIEW CONTINUED]

[0:29:21] EF: I've had a lot of conversations recently about the value of community and how people that live the longest tend to be the people that are most connected, which is again, neurobiology, it makes sense. But thinking about yourself as a clinician as in your relationship with a family and a client, as building that community as well. Because again, I used to be told all the time that I get too attached, or I need to desensitize a little bit more. Which granted, when you're working inpatient in the hospital, it's difficult. You have to protect your heart a little bit.

When I started to be like, ÒNo, that's not a bad thing, it shows families that I care. It makes them feel seen.Ó Because I used to think it was a negative thing to tell Ð Not a negative thing. I used to think it was unprofessional to tell a child that you love them that you work with. I do not feel that way at all anymore. I tell them that I love them because I do and they should hear it. When a caregiver hears that you love their child and sees that you love their child, I think it starts to reduce a fear that society is going to accept their child more because we know that that is a fear of caregivers. Most of the time, if a caregiver is ever trying to change their child, it is not because they want to change their child. It's because they worry about how the world is going to treat their child. The more we can help build that feeling, okay, here's a community where your child is accepted. Let's build a bigger community where your child is accepted. There's other families that accept your child and you accept their child, I think, is a very beautiful concept to think about, too.

The greater aspect of we're not just doing a book club, we're not just having these meetings, we're creating community and we're building this space and we're creating community within the clinicians because it's hard when you don't have someone to go to that really gets what you're doing and why you're doing it and you have a hard session. To have somebody that you can just call, or sit with, whatever you need to, because we also need to co-regulate. When I'm frustrated, or when I had a bad day, I call someone, or I want to be around someone. That is valid and that's okay. That's how we were made as humans.

As much as America tries to make independence seem the most important thing, it's not. I think there's a lot of ways that people listening to this can think about just the concept of how do I build community for my families and clients and for myself? Because I think it can feel lonely if you don't feel someone is also understanding you as a clinician because we put a lot on ourselves as well.

[0:32:17] CR: Yeah, I agree. I love the first idea of feeling vulnerability and openness is something that's going to hold us back, or make us seem unprofessional, or make us look not as good as a therapist because we're open and loving. That's like, we need to debunk that, because truly, if we can act as love, move as love, play as love, be as love, that energy is literally healing for ourselves. The session, if we're just open and love is regulating for our bodies and these parents are feeling it and it just Ð it's like this little ripple. They leave and whether or not they got anything out of it, if they feel our love, I believe that's crazy, that's potent energy in combination with what we do.

We literally, our job is, it's just really a cool job to be in because yes, we have all this knowledge and all of the research and all the science, and then pair that with just being connected and open and love is I feel like, those are the perfect combination. A lot of us are holding back. We're holding back for multiple reasons. I mean, there could be barriers. There could be something misaligned in our jobs. There's always things and factors. But if we could open up just a little bit more and yeah, say I love you to the kid, or be less expectant about something, It's just this release in our body. I feel like, that's what we need as a women, as a society, as a world. It's impactful.

[0:33:53] EF: I like what you said, too, about how much you learn from families because I always say, I learn so much from my patients and my families, and it informs the way that I do things and it may not be something that is written in a research article, but it's something that helps me to better understand the next child and to better open up my eyes. The fact that I'm able to see the world through kids' eyes in a way I never would have seen it before, I think is Ð I feel so lucky to have that experience and for the children and families I work with to be open to allow us into their world because the world will be boring otherwise, honestly.

I just think it's something we shouldn't take lightly. I think it's something that we have to sit there and I'm going to work to understand you first. I want to first understand where you are and it's so multifaceted. Why is there this idea that we have to have everything figured out within the first couple sessions? I will say to families, ÒI'm observing and learning about your child and will continue to learn about your child,Ó because it would be unkind of me, to them, to assume I know about them after just meeting them. It's a constant build-up relationship and that takes work every single time.

[0:35:20] CR: Yeah. I think there's this Ð the foundation of building connection is a child feeling that you're feeling them. A child sensing that you're tuning to them. A child being like, ÒOh, she knows what I'm saying.Ó Not the child's like, ÒOh, she's helping me talk. She's helping me communicate. She's helping me eat. She's helping me swallow.Ó It's like, ÒNo, she feels me. She's here.Ó I had a parent just today tell me, I did a AAC training with Taylor at a school with ABA therapists and we were saying how we can use the device to just simply comment. It doesn't need to be a mand because for ABA therapy we have a lot of them just manding, or trusting and we're just like, we're going to focus on just commenting on what she's looking at.

The mom said, ÒYes, my child prefers to just hear what she wants and what she likes and what she's looking at and what she sees over being prompted to say what she wants.Ó It's just like, ÒDuh,Ó right. They just want to be felt and heard, which is a skill. That is the most important piece to be taught.

[0:36:29] EF: Well, and communication is a part of almost everything that we do to some extent. Because everyone's always like, OT scope of practice is so big. Yes, they can work on a lot of things are involved with activities of daily living. But in every activity of daily living with another person, you're communicating. We know factually that 80% of the message that we're getting across is not with the mouth words that we're using. But yet, I think in therapy sometimes, those other things get lost and we don't cling to them in the way that we should. I do find because I'm sure you hear all the time like, ÒOh, my child's not using their device as much at home. They don't use it as much at home. I'm trying to work on it.Ó

We don't always use as many mouth words with the people that we love the most when we're home after work all day because they understand us without having to do that. There's beauty in that as well. I mean, I can communicate with my best friend from across the hallway just with the way my eyebrows move and she's like, ÒI know what ErinÕs thinking.Ó That's just as valuable as if I pulled her aside later and said, what was happening? Sometimes more valuable, because it's within the moment of what's going on, and how many times we're missing out on the moment, like you said, that feeling because we're so focused on advancing in some area?

The more we can sit, and floor time talks about lingering at lower levels is the term they use in regard to the social, emotional developmental capacities, like how quickly Ð and I do it too sometimes. I'll feel like we're getting somewhere, we're getting in a flow and then I'm really quick to see if I can bring in a new problem-solving. It's like, let's let ourselves and families sit in those moments for longer, because if someone asked me to do something that was challenging every time I felt comfortable with something else, I would be pissed off. That would be frustrating.

[0:38:39] CR: Yeah. Let's let more time to be here. Let's just flow here. Absolutely. I find myself the same. I'm just like, wait. It's almost like, we're conditioned to have to take that next step up just in life, and so we do that in therapy, too, and it's being super aware of that piece because I completely agree. It's almost like, they lead us up. Even though we think we're leading, they're leading us up and we're following. I mean, of course, but we always want to push just a little bit too much. That's a balance. That's for each kiddo. I completely agree. That's a hard discernment. I always say, less is more, especially when I'm with a parent. If I ever push them like, ÒDon't do this. I'm doing this. Don't do this.Ó

[0:39:32] EF: Mm-hmm. But I love to call out my mistake. I'm like, I pushed them a little too far. I'm going to acknowledge that and I'm going to sit with that and I even give myself grace when I'm having a bad day because I'm like, ÒYou know what? We're still going to be here together and I may not feel my best, but they deserve to know that I'm still with you even if something else is going on, or I'm not able to give you everything. We're still going to be here together and this is what happens with people we're connecting with.Ó I struggle and I would love your thoughts on, I've always said and I've had to learn. A lot of this, I think, comes very naturally to me and I feel like, I might be wrong, but I feel like, that feeling and trusting your gut takes work, but it comes more naturally to some people than others.

Some of these things are whether you want to call them soft skills, or what you want to label them, a lot of our newer grads and clinicians that are starting out in this journey that were taught things are more black and white. It's a difficult shift. I struggle and don't quite have the answer to some of the advice in regard to how to start to give yourself grace and focus more on the relationship, as opposed to honing in on these very specific skills. In building your leadership, do you have any advice, or words of wisdom on how do you work with clinicians that are maybe building this aspect of themselves? How do you support them and how do you support even caregivers as well because we coach caregivers all the time? Again, I'm asking you a lot of loaded questions, so Ð

[0:41:16] CR: No. Yeah, I love this question. I think having a framework that can be tangible and direct is really important. I love the floor time, the developmental levels. I'm more well-versed in the play project, which is some modification of floor time.

[0:41:37] EF: Floor time acknowledges play pro Ð yeah, they're very similar.

[0:41:41] CR: Yeah. I with most of my clients, I teach them the levels of development, one through six. I use that as a reference point when we're in play, and I'm just shouting out the levels. I mean, like, this is a two. If I have a mom being like, ÒWhat's this? What's this?Ó I'm like, ÒThis is a two. We're working on circles here.Ó I think having concrete language is really important, where I really just want to be like, ÒHey, settle into this. Be here.Ó But that doesn't work for everyone. Also, with my new clinicians, they're trained in this the best that we can. It's a process that I feel like, I love that framework. The play project has lots of good language and I'm sure some of it is directly from floor time, but a lot of good language strategies that I just feel you can just pull them out of your toolbox and it helps parents to lock in. Does that make sense?

[0:42:41] EF: Yeah, because I think just like we talked, you have to meet caregivers where they're at. I've worked with other clinicians, too, where they're like, ÒBut I need them to be over here.Ó My response is, we are the professional that they're coming to see to support them and their child. We have to understand, okay, if they are here and I'm here, where can we meet together for me to support you? Yes, there's times, like we talked about, where you just may not be the right fit. They may not be ready. But I can't expect a caregiver to start where I am, because they don't have the training that I have. The amount of times I'll say to a caregiver, ÒYou deserve to be mom, or you deserve to be dad. My job is to support you to feel like you can support your child in that role. My job is not to turn you into a therapist. My job is to hopefully work myself out of a job, but still to allow it to be in the authentic way that you are engaging.Ó That, I think, is really important as well because the course I'm developing, too, every section has a self-assessment because I want to know how you're processing this information because it's a lot of information and what is resonating with you? What is resonating with your practice that you're building?

You and I, from a yoga perspective, every time I go to yoga, I'm like, this reminds me so much of your practice as a clinician. If you view your practice as a clinician like your practice in yoga and how you're building your space, you're building your energy, it's not always linear. If I was able to do a move a certain way in one session, am I going to expect that my body is going to do the same thing the next session? No, because so many things have happened. But I love the idea of you're building your practice. Yes, you're going to have to adjust for the clients you work with, but you do show up as yourself. Whether you want to or not, you are showing up as who you are as a human, and the kids and the families we work with can tell when we're not being authentic. The children especially will call you out on it. They know. You have to know who you are and know what you're bringing with your practice, if that makes any sense.

[0:44:58] CR: Yeah, absolutely. I 100% agree with that. I feel like, that's essentially what we're trying to instill with our kids. It's like, we want them to be their most unique, authentic self, so that they can open, relax, communicate. We have to show up as that. I mean, embodiment is huge. I feel like, everything that we're working on with our kids, we're working on with ourselves. We touched on that.

[0:45:28] EF: Yeah. ItÕs like, we talk about embodied cognition with the children we work with, but we're also trying to embody all that we know about our practice. It's very similar. Do you have, because I'm a storyteller, do you have any examples of either a family that maybe you started out not fully on the same page and it turned into this connection and relationship, or family that you just are really proud of the relationship that that caregiver-child Ð I don't want to put you on the spot because I didn't tell you I was going to ask you for a story, but I feel like, we talk about all this and then sometimes people are like, okay, but give me an example.

[0:46:06] CR: Give me a real-life example.

[0:46:08] EF: Give me something that happened.

[0:46:09] CR: Yeah. I have two things. I'll share a story of one of my beloved clients. I love all of my clients, so much my babies. As a story on being your own and being comfortable in your skin and just fully confident, I always tell my therapist, I think it's really important for us to be uncomfortable, to feel like we don't know what we're doing in front of them, like within play, for example. Because connecting with autistic kids in play can sometimes be very, very challenging, even if you're good at it, right?

I'm always like, ÒJust be weird. I know it feels so uncomfortable, but if you can be weird and uncomfortable and do it wrong in front of a parent, that parent's going to feel like they can do that too in front of their kids.Ó This is what's holding parents back. It's this resiliency of feeling unsuccessful because I can't even imagine being a parent and not knowing how to connect and not feeling that love back and forth.

It's like, yes, we want to model these amazing things, but I think it's so important to fail over and over again in front of them, which is so hard for us. It's still hard. I mean, we've been doing Ð both, I'm sure, you know what I'm talking about. It's hard. It never gets easier. But it's like, we have to continue doing that because that's what makes a difference and that's how parents show up. That in my experience, if I fail in front of a parent, those are the parents that are like, ÒOkay, fine. I'll do this really weird thing. I'll go under the blanket and wait here till the kid finds me.Ó Even though for 10 minutes, they're just playing with the light switch. That's really uncomfortable, but they've seen me do it, so they're like, it's fine.

[0:47:52] EF: Imagine how you feel Ð I know those sessions where I'm like, ÒOh. I could have done this, or I should have done this, or I didn't connect in that way,Ó and how I feel and then imagine that happening over and over and over and over again with a caregiver. Then on top of it, they're having to explain to people, or I have a rule in my sessions that caregivers are not allowed to say sorry, especially sorry for their kid, because it breaks my heart every time. I'm like, ÒI'm here with your kid. We're here together. You do not need to apologize for them. You do not need to feel you have to be sorry for however they show up to my session because they're showing up.Ó

For some caregivers, it's really hard. But I think that's such a good point, too, of being vulnerable, being open, allowing them to also see children learn by doing something, it not working and then trying it again. If caregivers can watch you do something, it not working and trying it again, it also helps them problem-solve that when something happens. I think that's wonderful.

[0:49:00] CR: Yeah. I think that a lot of times, if a parent isn't exposed to, ÒOh, I can mess up play.Ó Because no one's taught how to play. As adults, we don't really play. A lot of parents haven't been more play with as children. They don't know how to play. They think there's a certain way to do it and you're not. If they know like, ÒOkay, I can mess this up and it's fine,Ó then they won't get into the pattern of, ÒIf this play isnÕt working, I'm going to give directions.Ó It becomes question and answers, and then that becomes either disconnect or a connection that is just not meaningful and substantial and can't go anywhere. It becomes a learned preference.

I don't know if you see this. It's like, the kid actually starts to enjoy it, but it's not real connection. It's just a learned, sort of, almost a stim sometimes. Almost like a comfort zone. Anyway, yeah. But I will share a story about a child. I started working with this little guy. He's still in my case now, but I started working with him when he was two. He was at a speech clinic for a year.

When I met him, I instantly knew, I really believe this child has autism and mom didn't know. The signs were very clear to me. For about two or three months, I had to tiptoe with this parent, because she was already really emotional. That was a process for me. This was about six years ago, so this is always a hard conversation to have. A hard experience to be in. After a few months, I said, I recommended a developmental eval. She got the diagnosis. But it was a journey, and reteaching her, or just shifting her perception of where her child should be. Becoming more accepting of his pace and his differences and all of that.

Now he is seven. It was a process for all the things. It was a process for AAC. It was a process for play-based therapy. It was a process for everything that was not sitting at a table and doing work. We did a really structured play program, where I filmed almost once a week, I think, I saw him three times a week for 60 minutes. But one time a week, I would film mom the entire session. I would just film her around the house playing. Then we met virtually and I would have her watch the videos and I would say like, ÒHey, this is really good. This wasn't, like can you tell?Ó Did that coaching model with her.

It was really uncomfortable. She didn't like it. She didn't want to show up to the meetings, but she did. Now, we're at a place where this kiddo is the most social kiddo, the best player. The mom comes to every community outing. She's the most neurodivergent affirming. I just had a conversation with her today about adding a support in the classroom that I thought he Ð that I was hesitant to even talk with about. It involved writing and talking about like, maybe we want to incorporate typing, instead of writing. She just instantly was like, ÒI trust you. This is great. Whatever you think.Ó

He's just a success story. Also, in addition to this, he started talking last year and he's seven now, and he has used AAC, but now he is verbally communicating 90% of the time. Is so excited to, and itÕs just like, beings with delight. The challenging cases I feel like, are the ones with the most rewards, of course.

[0:52:48] EF: Yeah. I always say, I'm like, I want Ð because I tend to be the person at work that if there's a kid that's had significant trauma, or there's a kid that is maybe a little more challenging autistic child, they tend to be like, ÒErin, can you see them?Ó I always say like, ÒI want to work for it.Ó It's okay if I have to work for it. I don't take any offense to it. I don't feel bad about it. I understand the fact that you may have to earn that trust, and you should have to earn that trust, both with a family and a child. I will say, I took the last floor time course I took, which I have one more, was the parent coaching course. They have you film the caregiver and they have you film yourself coaching the caregiver.

It is hard and very uncomfortable and very hard to get a caregiver. I mean, it's hard enough when I first started doing, excuse me, the floor time courses and had to fill myself doing therapy and watch myself and see how I was reacting. Because you're like, ÒOoh, I've talked too much. Or, ooh, I should have said this.Ó But it is so eye-opening and it really helps you see the art of what we do, too, because it helps you see the little things that you do and the impact they can have.

I remember, and Karen and I always tell the story about the patient we worked with, who hadn't autism diagnosis when I started seeing him, I'm pretty sure. I think that was when he was four, three or four. I saw him for a couple years and we shared him. He also had apraxia, so he was just a language processor, also had apraxia, so it was very interesting in regards to his scripts and navigating what he was communicating. But he would really stick to whatever his passion was. They usually lasted for a couple of months. It would be Mario or it would be cars and we'd really, really dig deep into the interest.

My favorite, favorite day and I'm repeating the story for people who do listen to the podcast, because they've heard it. But he would start to come into sessions with an idea. It was very interesting, because he would have ABA all day and then he would see us in the afternoon and he would carry that idea with him until he came to see us. He blessed him, because we had built trust, and because it was sometimes difficult to navigate what he was expressing because it was very disfluent at times. He would work with us for 45 minutes.

Sometimes I'd see him with Karen. Sometimes we'd see him separately, to really get to his idea. There would be frustrations that we would regulate and it was all of trust. One day he came, literally picked a lined piece of paper up from his house at the beginning of the day, brought it to ABA, brought it to my session. I saw him first that day. He had this piece of paper and he kept saying, he's like, ÒCircle around, stop. Circle around, stop.Ó I had to cut a circle in a piece of paper. I cut it out first. I did that wrong. Then I cut a hole in it and we eventually got this circle of paper around his head.

I'm not good with craft, so I pulled in another therapist who's much better at them. He got two pieces of papers. He's like, ÒTape feet. Tape feet.Ó We had a lot of frustration, because it wasn't big enough, or it was too small, but he stuck with me and it took us 45 minutes, what we got the circle of paper around his head, we got one piece of paper on both feet, because he didn't want them on separate feet. Then he starts hopping around and starts making a clicking noise. It took me a second and I was like, ÒOh, he's the Pixar lamp. He wanted to be the Pixar lamp.Ó He put his nose, he go, ÒBoop, light on. Boop, light off.Ó

Thankfully, Karen saw him afterwards and it ended up Ð if you people have been to my lectures, I have this picture where they wrapped him up in paper, wrapped a huge thing, put a flashlight in between his head and he'd go, start to be like, ÒIt's dark in here, let's go there.Ó I literally cared, and then after he left, just cried, because it was the Ð and I every time I talk about him, I still cry. It's so beautiful when a child trusts you that much with their idea and then trusts you to help them work through it, because if we had not built that trust, that would have ended within five minutes, because it was frustrating on both ends. But he believed in his idea. He had the idea from the beginning of the day and he trusted that I was going to listen to him and figure it out. That little boy, I will never forget him. He changed my life. Truly changed my life, because he just made me realize the value of that relationship and of building his world.

Our children have these ideas, but it's hard sometimes, whether they're Ð praxis is difficult, which a lot of the kids we work with, praxis is really hard, or communication. They deserve to dress up in how they want to dress up, and have these ideas and build these ideas with the accommodations and support. I'd rather accommodate and support a child so they can have bigger ideas than force them to do it on their own and limit the world that they experience.

[0:58:11] CR: Yeah, I love that so much. That's such a cool story. It's an amazing feeling to witness a child in their own artfulness and then being able to express it and then be able to share it with you and then be like, ÒWow, we're in this together.Ó It was from the beginning, right? Okay, she's here with me now. Now, I have to problem-solve how I'm going to figure it out, and now I'm sharing it and now we're in it together.

Sometimes if you don't get there until for a whole Ð that takes a whole month, or two, but you did that all in one session. That's so rewarding and I always tell Ð like, one of the things I always tell parents and my therapist and it's like, how do we find the balance? But I'm always just like, go into the distraction. It doesn't matter. Just go into every distraction because it could be an idea. It could be a new expression that the child wasn't able to share with anyone until now.

[0:59:08] EF: Yeah. It's so fun. Not always. Yes, every kid has their moment and it can be challenging at times. But when you really get in the moment and those moments happen, it is so much joy and it's, yeah, it's big emotions. If we sit in that shallow part of it, we're missing out on a lot of it. I think that's just something to think about.

[0:59:41] CR: Yeah. It's like, I grew up dancing. You have choreography and you have improv. I feel like, improv is where we need to be with these kids, instead of, we always want to choreograph. We always want to say, ÒOkay, now this is next, and then this.Ó Sometimes it's appropriate. But most of the time, it's we need more improvs. We just need to get the flow.

[1:00:04] EF: Yeah. I think you might have to, at the beginning, similar to, I love what you talked about finding a way to make the play a little bit more structured for that mom to just help her. It's like, she may need it because I talk about feeding in a way, it's a dance. I love the idea of maybe it needs to be a little more choreographed for the caregiver at the beginning, so they can find their own improv. That's how they learn. I like that a lot.

Do you have anything that we missed, that you want people to take from this, that you want people to know? I mean, I know we went in a lot of different directions, which I love. Honestly, I was feeling very dysregulated before this podcast and I've been very anxious and my I no longer feel like an elephant sitting on my chest, so thank you for that. This is very helpful, but yeah, if there's anything that we missed that you would just want people to take away from this?

[1:01:02] CR: I feel like, we touched on so much. I feel like, our field. If you're working with this population and closely with parents and have Ð you're grounded in relationship, I just feel it's such a portal for us ourselves, and the depth that we can go and our own evolution and I believe it's like Ð I think it's really powerful if we can just have gratitude. I mean, our job, is it's amazing. It's so hard. It's so hard and it's so energetically draining and fulfilling at once. If we can just ebb and flow and find the balance and find the gratitude and open this love, it's the best job. It really is if you can be in it. Be present.

[1:01:50] EF: Yeah, I agree. It's nice when you find people that get it, too. I mean, I will say, like we talked about, it's a hardship sometimes to make. But when you start to pull on those strengths that you have. Yeah, we're using all the information that we have while we're doing all this, but this is the groundwork that we can build all those skills off of for sure.

[1:02:16] CR: I also just feel like, in our field, it's almost like, there's a hesitancy to go Ð I mean, our practices speak outside the box. There's a hesitancy to go outside the norm. There's a hesitancy to say, I love you. There's a hesitancy to take a job that you're not really sure about. I just feel like, I wish as a field, as a career, we're a little bit more, I guess, courageous and adventurous. Just take the leap. If something doesn't feel right, do something different. Because there's so much of us who are locked into these jobs and we're working overtime and we're just in this rabbit race. What is that called? A hamster wheel. Don't think it has to be like that. The only reason is, is because we're just in our own lane and we don't Ð we're not open and present to what possibilities are. So many kids need so much support. We can do it. You can open your own business. You can find a business that's amazing to work for. You can. You can do those things.

[1:03:18] EF: Yeah. I like that. Being open and creating your own support system, too. If you're not in an environment where you feel safe and you feel comfortable, it's going to be really hard for you to do that for somebody else.

[1:03:34] CR: Yes. That comfort system is wanting you wherever else. Wherever it is, it's there.

[1:03:43] EF: Well, Casey, I'm very grateful to have you on and talk to you and pick your brain, because it definitely filled my cup today, which I apparently needed, because as I calmed down, I was like, oh. I was feeling a little more anxious. But I also like to ask. We like to, two things at the end. Where can people find you? Where can they follow you? Then Michelle likes to ask if you have a little, as her grandma will call it, love money. I didn't prep you for this either, so if you don't, we can always put it on there. But if anyone has a little love money and there's any organization that you really love and would love for people to donate to, you can put that on there.

[1:04:23] CR: I can put it on there, or tell you?

[1:04:25] EF: You can tell them, yes. Yes, you can tell them, or I can put it on the show notes. Again, I think this is my fault because I didn't prep you, so you can think about that if you want to.

[1:04:34] CR: ThatÕs okay. I'll think about that one. IÕll think about that one. Yeah, my practice is Speak Outside the Box, and our website is speakoutsidethebox.com. My Instagram is my name, @CaseyRovinski. I post as much as I can and I love posting. So, you can find me on there, but I just don't post a lot.

[1:04:54] EF: It's a lot of work. It's a lot of work.

[1:04:57] CR: Instagram is so hard.

[1:04:57] EF: Oh, my gosh.

[1:04:57] CR: If I can just have that as a full-time job, it would be so fun. I'd love to. But then, I don't know if you feel like it, but it's like, you go for a week of posting on Instagram and you need three weeks off, youÕre like, ÒOh, my God. Where is my life?Ó

[1:05:14] EF: Well, because I feel every Ð I want it to be authentic and nuanced. I'm always like, okay. I put enough of myself out there this week. Maybe I need a break.

[1:05:24] CR: Yeah, it's a second job. 

[1:05:27] EF: Yup. Well, thank you so much. I really appreciate you.

[1:05:30] CR: Yeah. Thank you so much, Erin.

[1:05:31] EF: I'm sure well I'm sure we'll have other things to talk about soon. Every time somebody comes on, I'm like, listen, Michelle and I have lots of people come on more than once.

[1:05:39] CR: Well, I would love for you to come visit Taylor and do a training, or just a speaking gig for Ð

[1:05:46] EF: I would love that. Honestly, it would just give me an excuse to come see her. I would definitely do it.

[1:05:52] CR: Okay. Just tell us when. Tell us when. You're welcome.

[1:05:56] EF: Perfect. Perfect. Okay. All right, y'all, we will see you all soon. Thanks for tuning in. Yeah.

[END OF INTERVIEW]

[1:06:04] ANNOUNCER: 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.

[OUTRO]

[1:06:45] MD: Feeding Matters guides system-wide changes by uniting caregivers, professionals and community partners under the Pediatric Feeding Disorder Alliance. 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.

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, a 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.

[1:07:37] 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 PFDs SLP.

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

[END]
FBP 276		Transcript

	©Ê2024 First Bite	1