Episode 108: Straight Talk with an SLP Leader and Special Needs Mom with Theresa Richard

Welcome to episode 108 of the Untethered Podcast. Today we have Teresa Richard joining us. Teresa is the founder and CEO of Mobile Dysphasia Diagnostics, a mobile fees company that has surfaced over a hundred sniffs and helped over 90 SLP start grow and scale their own mobile fees businesses through their fees biz Blueprint course. She's created the Swallow your Pride podcast with over 2.2 million downloads. She's a board certified specialist in swallowing and swallowing disorders and became an approved ASHA CEU provider. She started the Med SLP collective with over 5,000 members and began employing and contracting with over 60 SLPs and support staff. She provides career and business coaching for slps through her Inner Circle Leadership Group and was invited to present at the Charleston Swallowing Conference on blogs and podcasts and has been asked to be an invited keynote speaker for several state conventions this year. She's also been invited to contribute to two papers for the Dysphagia Journal this year on assessing and treating dysphagia during COVID She's been featured in Authority Magazine and Thrive Global and is excited to share the upcoming release of her new book for patients with Dysphasia that will be available in April 2021. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host Hallie Balkan. I'm a certified orofacial myologist, Feeding Specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Theresa, I am so excited to welcome you to the podcast. Thanks for joining me today.

Thank you so much for having me.

I know. I feel like we've talked about this for a while and so it's finally happening.

I know, I know, I know. And I think you were on my podcast like a year ago and I was like I'll come on here soon and wah wah, here we are nine years later.

So I tell everyone I blame you for creating for my yes, feed the peeds. That was totally like your bug in my ear that I was like nope, nope. Okay fine.

I'm like if you don't do it, Hallie. I'll find somebody to do it, so you better do it.

And it's been crazy. I mean, we've now launched it four times. I think we've had over 700 SLPs and OTS go through it in a year, all during a pandemic. So I'm excited about that. But why don't you share a little bit with us about your background? And I assume everybody listening knows who you are, but just in case they don't.

Yeah. So I guess I'm here today as a double edged sword. As both an SLP business owner, but also a mother of a little one with special needs who we've had our own hellish journey through. Probably, I don't know, 20 SLPs at this point for feeding, speech, AAC, you name it. But anyways, yeah, I started out, I did my CF in the schools. I totally hated it and ended up. Yep. And I ended up just going with my supervisor to check out a skilled nursing facility one night. She was also working there and she's like, I really think you would like it. And I ended up loving it. And I ended up staying at the same skilled nursing facility for six years. That really kind of just solidified my passion in old people, which is just what's. What's still funny because that is still very much my passion. I'm so passionate about the skilled nursing setting. But then I have this son with special needs, so it stinks when I go to talk to, you know, other SLPs and they just assume, oh, you're an SLP. You know all this stuff. And I'm like, no, no. But I don't, like, this is not my jam at all. Like, I'm coming to you as just a normal mom. Like, please forget that I know anything about slp, because I don't know anything about kids.

So.

But anyways, from there I ended up starting a mobile fees company, which I still own up in New York, and started the Swallow youw Pride podcast and started the Med SLP collective membership site for medical SLPs. Just wanting more information. And you know, part of that is we do have a little section on pediatrics and peds feeding, but obviously there was a much, much more, greater need for just some real solid foundational knowledge. So I'm so glad that Hallie filled that need for you guys.

Absolutely. And you know, you made such a great distinction earlier about the difference between working with adults and working with peds. But even within pediatrics, there's a huge difference with working with a Infant versus a toddler and a toddler versus a preschooler. There's just so much change that happens in these early years. And, you know, aside from the transition from salt, you know, from, you know, milk to solid introduction, just the anatomy and the physiology and just so much growth, and, you know, there's a lot of moving pieces at all times with these little ones. And so I actually specialized more so in the toddler population, the toddler and preschool population. And it wasn't until I had my own child with feeding struggles that I then really dove into the infant population. And so I think that that was such a great distinction that you made, that, you know, peds and adults are two different boats. But even within. And I'm sure that it's the same goes for adults based on diagnoses and what's going on in their medical charts. But even within pediatrics, it is a wide realm of differences on age and diagnosis and medical complexity. And so thank you for that distinction. I think it's really important to continue to highlight that, because I think we lose sight of that. And you also mentioned that you're a mom of a little one who has had his own journey. So can you share a little bit more about that with us?

Yeah. Yeah. So my son was born with an extremely rare chromosomal abnormality. At the time he was born, I believe there was seven documented cases. Now there's actually 19, which is still kind of wild, but we honestly had the most amazing neonatologist ever in that. She just said, you know, we don't know what the future holds. You know, it could be grim, it could be wonderful. And he could, you know, be a thriving member of the community. So I think just having that outlook from the outset was wonderful. He was in the NICU for 15 days. We did not have an SLP. The only thing keeping him there was that he was on a feeding tube. So I would go into morning rounds every morning, and I'm like, so what's the plan for discharging my son? And they're like, well, he has to learn to eat. And I'm like, okay, so what's the plan for teaching him to eat? And they're like, well, he'll figure it out. And I'm like, I find that very hard to believe. So we played this round and round game. We ended up. I finally convinced them to just let me pull the. Pull the feeding tube and take him home and get therapy at home. It was horrible. We were not able to find SLPs that knew how to work with him. Not only that, but just, well, I don't specialize with babies, I don't specialize in infants. I only specialize with toddlers. And I get that. I really truly do it because I'm so passionate about only I'm very focused in adults and geriatrics basically and fees really, that's my jam. But I understand that. But there just is such a need for so many more people to get into this area. So again, I'm going to keep plugging your course, Hallie. But again, it's one of those things that if you have a passion for working with this pop, please go seek out the training to get it because there's so many parents that are desperate for your help. I mean he just turned, he turned five two months ago. I'd say in his five year life he's had, I would say one feeding therapist that really knew what her stuff that really knew what she was doing. And that's sad, you know, it's really sad. And I don't, you know, I don't blame people for trying, you know, and, and we would have at one point, I think he was having 23 therapy sessions a week between PTO speech. I mean, it's just crazy. You know, there's just, he has a lot of needs and you know, I'm trying to just be the best mom I can to get him all of those services. But at the same token, I want the best bang for my buck and I don't want them to be wasting our time and I don't want them to be wasting their time either. So I mean, we've had some SLPs come in, they're like, well, I don't really know what to do with him. Like, we could try this. You know, I've heard about this and I get that to a point. Like I get a little bit of experimentation but like you got to know what you're doing. So I've definitely fired more SLPs than I care to talk about publicly. But it's really just because, not that they were bad people, they just didn't know what they were doing and I didn't want them to waste our time, to be honest. So that's really one of the drivers for me starting the medical SLP collective too, is that I just, I want SLPs to really know their stuff. Like I want you to be so competent in what you're doing because I really believe that competency leads to confidence as well. And I want you to be confident. I want you to show up at My house and say, yes, like, I know what we can do. Yes, he has weakness here. I'm going to start using words that I don't even understand. But, like, you know, yes, we need to work on these areas, and I want you to be confident that you can help my child. Like, I think that's why we all became therapists, right? Like, we want to help people. You know, we didn't just think, oh, maybe I'll show up and maybe I'll maybe, you know, do something that helps them. No, like, you got there to help people. So I don't know that that was your question, Hallie, but that's the ramp that I took. So.

No, and I think that's really. I think it's still another important distinction because, you know, in my private practice, I will never send a therapist that is not competent and that is not confident that they can help this family. So, you know, I have contractors who work for me, and we will say to them, hey, we have a kiddo. Here are the needs. This is where they're located. Do you want the case? And they know to say yes or no based on, you know, obviously, we all need to stretch ourselves a little bit. Like you said, we need to, you know, so if it feels uncomfortable, that's thing. But if we have the competency to take on the case, you know, the confidence may come. And that's where, you know, I never want to send a therapist into anybody's home that I do not believe. Like, I don't want to throw anybody into the fire, right? I don't want to send them. And that's something I pride myself on, is truly matching our patients with the therapist that can actually help them, that actually has the skill set. And that's, you know, and I love that you're saying competence and confidence, because I've talked about this throughout the. For feed the peas, that we are creating competent, confident therapists. It's not enough to just take a course. You need to be able to become a critical thinker. You need to be able to see that patient, that little patient sitting in front of you who maybe you've never heard of the diagnosis before, but you still need to know how to assess that patient and how to, you know, make sense of that information to then create an individualized treatment plan, both taking into account what the family desires and what you feel is appropriate based on your assessment. And so, you know, there's a lot that we could talk about this all day, but, you know, I've. I've recorded a podcast on my three Cs. You know, I'm like, competence and community leads to confidence. And you know, I also feel like that community aspect, like what you've created with the Meta SLP collective and what we've created over here with our Feed the Peds alumni group is so key as well. We need to have those other professionals in this space working day in, day out to go and bounce ideas off of so that and additional education so we can continue to grow our skill set. It's not enough to just take a course and think that we have all the knowledge in the world. No, we need to take it, we need to apply it and need to start thinking critically. You know, and that's one of the biggest things that I think we really pride ourselves on is we're creating critical thinkers because we see a lot of our students and enter on day one, the SLPs and OTs and they look like, a lot of them look like deer in the headlights. They're like, what have I gotten myself into? I really want to do this. But. And then, you know, we see them about halfway through the program, their thinking changes, they start, you know, we use case studies and they're real kids and you know, we'll use case studies to really drive home this is how you might apply it. Now let's get on our weekly call and discuss, discuss the cases and let's talk through what's coming up for you and what you know, and, and they really drive those calls. And I think again, it's that, that component that's missing. We don't have these graduate programs. I think there are six graduate programs that I'm aware of that have a pediatric feeding course about like a whole, you know, leg of courses.

Right?

Course. And what's even more upsetting is that within those, some of the individuals who are teaching these courses are basically not teaching EVP all the time. They're also not, they have very strong positions one way or another on. Instead of teaching you about both sides of the discussion, it's very one sided. And so I just think we need to do better as a profession. We need to be supplying this information. I mean, pediatric feeding is a huge part of our scope of practice. Why is nobody teaching this in grad school? That's the part that just drives me up a wall.

Yeah, I mean, I think, you know, and to go off of your EVP point, I think, you know, I talk about one of the best feeding therapists that we did ever have. And you know, she came, she came in Very, you know, she was almost intimidating when she came in. You know, she took her job very seriously. And she just said, you know, I do not have experience with this particular condition, but I've done a lot of research, I've done a lot of reading and I do feel confident that I can help you guys. And I believe that her approach of being honest, but also she showed me that she was willing to work at it. It wasn't like, oh, we're going to just wing it and see what we can do. She was like, hey, I read these papers. I know that this is some of the evidence we have. However, from my clinical experience, I also know that this might be a good thing or this might be a good tool to use, or this might be a good product to recommend. She was extremely well rounded in where she was getting her knowledge from evidence, from clinical experience. And then just, she constantly wanted feedback from me too. And I, I think probably that was why she was my most favorite was because she, it was very even on all sides of the evidence based triad. And I just really, really appreciated that she wanted that sort of feedback from me as well.

Yeah, well, and I think that's huge. I mean, it's hard to get vulnerable and to even say, hey, I'm. I mean, but you've said he was one of, was it eight children or nine? Seven. Okay, so one of seven children when he was born that had that diagnosis. So the chance of finding a pediatric feeding therapist in your area, that's experience with this, like, probably slim to none. Right. So, you know, the fact that she didn't just walk all up in there going like, I've got this, like, I've seen this before. Well, no, you haven't seen this before. Like you don't know what you're dealing with until you really educate yourself. And that's where. That's how we gain competence. And, you know, we need to be keeping up with the literature. We need to be keeping up with our course work. We need to be keeping up with our colleagues in the field and having those communities that allow us to have these actual conversations around information that can be beneficial to us as, you know, for our growth, but also for our patients. And so, but I also love that you highlighted that part of that EVP triangle includes the feedback from the family. It includes the experience of the therapist in addition to knowing the research or related research that's going to help you in this on this case. And that is getting forgotten might be the word. You know, I joke the EVP police Are ebp police are back and they forgot there's five levels of evidence based practice that includes case studies, that everything starts the case study and then evolves from there. And if we lose sight of that, we lose sight of some really good research that's available to us. And we often hear, oh, there's no research in this space. Yeah, maybe there is research. Maybe you're just looking in the wrong place. And maybe we need, we do need more. However, you know, there is research in a lot of these spaces. So it's a really great conversation. And you know, the other thing I'll say too is we don't want to just rely on clinical experience because if we get stuck in our ways, which some people do, and we've been in the field for 30 or 40 years and we're not open to reading new research, taking new courses, or retaking courses we took 10 years ago that have probably been updated, that's also a problem because we can't just fall back on just clinical experience.

I will say we did have an SLP that came in. She came for one visit and you'll hear why she came in. And she's like, why? I had heard something that this type of condition might come with, with a submucosal cleft. And I was like, yes, he does have one. And she's like, okay, well, we need to have that repaired first. And I was like, okay, well, but we already saw genetics and she doesn't want to repair it until he's about 5 or 6 because it's not impacting anything right now. And she's like, well, I don't really understand how that's possible. I was like, okay, well, I'm just going by what the doctor said and we've never had any trouble with it, so I'm going to trust the doctor. And she's like, okay, well, we need a modified barium swallow study. And I was like, all right, I'm going to pump your brakes here a minute because I am board certified in swallowing. My child's never had an issue with swallowing. He's never had pneumonia, doesn't cough or choke when he eats. He just has so much weakness in his mouth that it's difficult for him to chew. It takes forever. I said, these are the types of exercises we need. I'm not concerned about swallowing. And we just could not get on. We could not see common ground with that. And she's like, well, that's what I'm going to need before I would even know where to start. With him. And I was like, okay, well, that's not happening. So I guess this is going to go nowhere.

Yeah. What is that going to tell you? When his swallow comes back normal?

Yeah. Yeah. But honestly, the thing is, and this is what I was telling the one SLP that I loved, is that it may have shown that he was aspirating, and I would not put it past him. If it did come back that my child was a functional aspirator, then it is what it is. He's never had pneumonia. I think we've had one sick visit to the peas in his entire life. So that's his functional baseline. So are we going to fix it? I mean, to me, as a mom, we got a lot more fish to fry than something that's not causing us problems. So I do stand very strong in those EBP values of getting the parent input, because that was not something that was important to me to try to fix. That wasn't really broken at the time.

Yeah, absolutely. And that's one of the biggest things I tell therapists, too, especially early on. If you can't get the family or that support unit on board, your therapy's for nothing. They're going to see you for a very small period of time. 30 minutes, 60 minutes, whatever it is, once, twice a week. What about the rest of the time? If they're not implementing what you're giving them? If they're not. If you don't have that family on board, you're wasting your time. You're not helping that patient. For me, it's more important to, yes, we have to go in and build rapport with the patient, but we also need to build rapport with whoever the caregivers are and find out what. What is most important to them. And again, like I said before, obviously we're not going to do anything that puts the patient in danger. But, you know, if you build rapport with family, then you can have those conversations with the family also to discuss what you feel might be safe and, you know, what's realistic, depending on what their desires are for the patient.

Yeah, I think. You know, one thing I really super respected about her, too, was that she worked in the same office as my son's dietitian. And we were trying to do some funky things with this diet. We couldn't get him to gain weight. He'd never even been on the growth curve till last year. But she just asked me, where do you guys grocery shop most of the time? And I'm like, well, Trader Joe's is literally I could walk there from our house, that's where we usually go. And she was like, okay. And her, the dietitian came up with a list of foods that the dietitian loved that she also loved that I could just easily get, that we could try, that she could try in her therapy, but that I would also carry over at home because it wasn't some fancy food that I had to order, it was some food that I could grab easily off the shelf when I'm doing my grocery shopping and also know that it's meeting his dietary needs. So I think, you know, from that standpoint, I mean we still use a lot of those foods and that was probably two years ago. So I think that was just a really great example of really interdisciplinary collaboration on one kiddo and making life just so much friggin easier for me.

Yeah. And then that's a great, you know, making life easier.

Yeah, yeah.

You have these kiddos who have complex medical needs. Life is not super easy for the family. I mean you guys, like you said, you were running him all over to umpteen appointments or having therapies in your home. And your life is constant therapy because when therapy, you know, when the therapist is not there, you're trying to implement and it's, you know, we've heard from a lot of our families it's hard to have that downtime and just let the child be a child and not, you know, constantly think about what do we need to be doing next? And so we do, you know, we do recommend these types of strategies where what can you do to make what you're recommending easier to the family? Like keep them out of overwhelm, let them know like we are their partner in this and our goal is not to give them more work. Like yes, obviously we're going to give you a plan and we're going to help you carry it out. But again, such a great like real world example of how we can make life just a little bit easier, you know.

Yeah, yeah. And on that note, if I can add something to, you know, a lot, a lot of your listeners are going to, you know, create their private practices or work for a private practice. And I want to just reiterate how. Please don't make the barrier to entry that much harder than it needs to be. And I'm going through that right now with, with a private practice agency. There's a specific therapist that I want to work with, does wonderful work. I know she's going to help my son. It's a 70 page intake form. And not only that, but there are questions on there that have absolutely nothing to do with why she is seeing him. And it's an online form and required fields, so I have to fill in something. So it's taken me, I've sat down to try to fill out the form about five times now, but it's so emotionally draining on me to have to look at these questions that I know my son can't do that. Have absolutely nothing to do with why I want her to see him in the first place. And I can't just write like. Like, na. Like, that's not an option. Like, I have to write in a blurb or something. So to me, then. Then, you know, the therapist is like, you know, are you going to fill out the paperwork? Like, do you just not want to get started? Like, no, I want to get started. I just can't get past the paperwork misery to even work with you. So at this point, it's like, as a mom that has, you know, just think. I mean, she's one of seven therapists that we're working with right now. Like, if I have to do that for every therapist that my son works with, like, he probably wouldn't get therapy because I don't have the emotional energy or the time to do that. So, you know, I completely understand. It's important to have intake information. Don't get me wrong, not what I'm saying at all. Always happy to fill out, you know, a good summary, but I think overlook the importance of making the barrier to entry simple. But then also have a conversation. Like, a lot of this stuff I said, we're like, I'd love to talk to you more about this because it's not easy for me to delineate in a little form online. I think it's just important to really make sure that there's time in there to discuss this information. The intake form, do it over the phone or make sure you set aside time during the eval. Don't just come at me with four standardized tests that my kid can't do and say he failed. Because we went through that a few weeks ago, too, and I was like, cool, we've gotten nowhere. Like, I could have told you he couldn't pass any of these tests. Like, so just. Just a little frustration, you know, because then the flip side is, oh, well, I can't get patients. Like, I'm having trouble. You know, I do these evals. I'm having trouble with these patients, you know, now wanting to come on and continue therapy. Don't make it a nightmare for the parents.

Yeah, absolutely. How long do you think it would actually take you minute wise to like complete that intake?

It would well over an hour. I mean. Yeah, yeah.

I mean that's, that's absurd. I mean, I own a private practice. We are private pay. We have an electronic intake. The goal is that it takes you like five minutes to complete everything from going through hipaa, you know, policies and procedures and filling out all the medical HIP history along with. And we try to make everything as like clickable and checkbox a couple areas for you to like elaborate, you know, throughout. But then we also use that, that's part of, you know, our assessment. So like you said, we want to take that, we print it off or we copy and paste over to Word and then print that off so that we can elaborate on that during the initial assessment. That is so important. I will also say not all of our children have formal evaluations done their assessment and we price things accordingly. We price based on whether we think it's going to be an hour because we kind of know that the child coming in can't sit for more than an hour and, or these assessments are just not going to give us anything. So we want to do more of an informal assessment approach and we want to talk with the family, want to play with the child, we want to gather information that's going to be more beneficial to whatever the therapeutic goals are for the family when they enter. But yeah, I think that's a really great point because as a parent, like I had, you know, my one kiddo went through PT and we were going because of her, you know, torticollis that was secondary to her tongue tie that was released. And it was the same kind of thing where, you know, I was very appreciative of certain things and very frustrated by others where they had paper forms still. And I was like, paper forms, like get with the program here. Like this day and age. I don't want to print something off, fill it out, scan it back to you, like send me a link that I can click through and just complete, you know, and their forms weren't super long by any means, but, you know, I think we really need to be considering like this day and age, like where we're at with technology. If you don't respect your patient's time, don't expect them to repay, you know, to respect yours.

Yeah, yeah. I actually asked if they had a paper packet because I wanted to just write a big X through the stuff that had absolutely nothing to do with Him. So, you know, I don't know if they're using it.

Can you do, like, space? Enter space.

Enter space. I tried, like, everything possible, and it was like, you know, must. Yeah, it was ridiculous. But yeah.

Yeah. Well, yeah. Maybe they'll listen to this podcast.

Yeah, maybe.

Maybe. So if you're willing to share, will you talk to us a bit? You know, I know that you've. You've kind of been through a roller coaster just trying to get him pediatric feeding services in general, but are you willing to share what happened when the pandemic hit?

Yeah, so we. I feel like, you know, it's been, you know, how old was he at the time? 4 When the pandemic hit? And I feel like we had finally just made some amazing headway. Just. We had had such a great team of therapists. We had a great feeding therapist. We had a great speech therapist. We had a great ot. We had a great pt. He was going to preschool a few days a week, Had a wonderful special ed teacher. We just had my dream team for him. And then the pandemic hit, and I guess I should back up a little bit. I had found out about this physical therapy intensive program for my son that was down in Orlando, Florida. And we were on the wait list, I think, for over a year. So he finally was able to get in there last February. So we just decided, you know, we're gonna. I. And I had literally just had a baby, too. So I was like, we're gonna pack up the whole family. We're gonna, you know, I'm not really working. I'm still kind of on maternity leave. We're gonna pack up the baby. My parents went down. We stayed in a house for a month down in Orlando. He was in therapy for. He was in PT for five hours a day, every day for a month. So it was extremely intensive. We came out of that. That ended March 2nd. We drove back to New York. March 5th, March 6th, the lockdowns went into effect. So we went from this amazing PT experience where he had made incredible progress to all of a sudden, no therapy whatsoever. So if, you know, depending on what state you're in, if you're in New York, they shut everything down. They stop, you know, close, closed the schools. They stopped all in person services. They were trying to do, quote, unquote, you know, teletherapy. Our PT that we had had for him was just amazing. She was absolutely wonderful, and, you know, she was trying to do stuff over the computer. But it's impossible for some professions, you know, like she's trying to have me do things and she's like, do you feel this muscle firing? I'm like, I have no friggin clue.

What I'm looking for.

Like, I have no idea, you know. So it was pretty awful. So kind of that whole month that we had no school, no therapy, no nothing, I was trying to carry over anything I could from the intensive while also trying to run my company and care for a newborn on top of that. So it was pretty hellish. But yeah, yeah, yeah. But we had seen some behaviors from him that we had never seen before, and it was awful. And I think the hard part is he's so much smarter, he's much more intelligent than I think people when they first meet him, think that he is. So after about a month of these just absolutely horrific behaviors, my husband was like, why don't we just. Let's call the therapy clinic back down in Florida and see if they're still doing therapy. So I called them and they were just starting to open back up again. She's like, we feel confident with all of our, you know, precautions and everything. And she's like, we just can't, you know, figure out a way forward with these kids via teletherapy. We feel like they have to be seen in person. And, you know, it was such a moral and ethical dilemma for me because as an slp, I was watching this whole pandemic unfold. I was seeing my colleagues, I was seeing people that work for the collective just watch the bodies line up, quote unquote, you know, in these hospitals, hospitals, and just, you know, some of them even had Covid. And I know that they were living this most hellish, horrific experience at work. I was living this hellish, horrific experience at home with my child just flying off the rails because he was not stimulated, not getting any of the therapy that he needed. So we ended up packing up the whole family and going back down to Florida where he was able to get therapy, I think. I don't know that we. It's honestly such a blur. Maybe like a few days a week, if I can even remember. I don't remember. So we did that, I think for about two months. And my husband was like, I feel like we, you know, might need to move down here. And I was like, oh my God, no. Like, no, we can't move down here, mind you. We had literally just moved into a brand new house in New York too.

With the perfect therapy team, of course.

Yes, we had moved like into our dream house. We had our dream therapy Team, but it's your dream therapy team. But what good is it if they can't help you? You know, so as we just kept getting word, you know, they kept saying, we're going to extend the lockdowns. We're going to extend them. Like, you know, in person. Therapy isn't going to resume for a few more months. And I just kept thinking, like, my child made so much progress, and he's five years old. Like, I can't wait a few more months. I can't be at the mercy of this game, really. And, you know, these people were making these decisions based on, you know, everyone says follow the science, but these decisions were not based on the science. You know, it's. It's. You think of, you know, you think of the nursing homes, you think of the hospitals, you think of outpatient clinics and SLPs and other therapists are in full PPE seeing their patients. You know, we came down to Florida, and that was exactly it. These therapists were in full ppe. I mean, we weren't allowed in there. We had to do temperature checks. We had to fill out very rigorous questionnaires every single day. But we did what we had to do to make it work for my son. And nobody in the entire therapy clinic got sick. None of the therapists were. I think it was. And I know people are going to be judgmental of this, but it was. We did what we knew was best for our family. And I can't imagine where our family or where my son would be today had we not made that decision or for him, because I know they just literally started in person therapy back up a few weeks ago with the therapist that we would have had in New York. So my son would have been an entire year without therapy. And I honestly don't know that me and my husband would still be together. I think after that month of the horrible behaviors, you know, it was just like, what are we going to do? You know, the whole family was falling apart. So I think you just do what you have to do for your family at the time. So that's what we did.

Yeah, well. And look, you're going to be judged one or the other, right? Whether you did it or whether you did it. Like, you're damned if you do, you're damned if you don't. So I always say, you got to do what's best for you, what's best for your family. And only you know that nobody knows what's best for Teresa or your son or your, you know, marriage or your family situation. So you know, I'm happy to hear that he was able to get the therapy he needed. And, you know, there's. I think everybody's living their own different realities during this. This pandemic. And I think the most important thing we can all do is just, you know, take a chill pill and remember that our reality is not somebody else's reality. And we just can't compare. We can't compare from one household to the next. You know, some households are dealing with teens who are in deep depression in school, and there's people who have medical complexities that absolutely need access to medical care that they've not been able to get. And, you know, and then there's moms who are homeschooling, who are at their wit's end, and. And they have all this anxiety. And, I mean, every single situation is real. And I think we all need to just step off of judging each other and recognize that we are all doing the best with what we have in front of us right now. And so I love that you shared that, and you're getting very real, because you do. When we share things like this, we put ourselves out there to the world, and we know everybody judges one way or the other. But I think we all need to realize that we're a year in. And while some places are just reopening, you know, now we're. Now we're off into spring break, and people are traveling all over the place. So what's going to happen in, you know, a week or two when everybody comes back from spring break? Are we going to shut down again when somebody gets, like, a case of COVID in the schools? I mean, it's. We're living in this unknown right now. We don't, you know, so the best we can do is just what's best for our families. So thank you for, you know, being vulnerable enough to share that. And I'm glad he was able to get, you know, at least some services during this past year, even if it looked different than what you had anticipated.

So, yeah, yeah, I think, you know, me and my husband were just actually talking last night about it. I mean, you know, my son started school in here in August, and it's been, you know, he's almost done with this school year. There's only, you know, two months left. And it's just crazy to think, you know, there's been no cases at his school the whole time. But these kids just desperately. You know, he goes to a school for kids with severe special needs. Like, I can't imagine what These kids or what these families would do without the support that we get from the teachers and the therapists at school. So, yeah, you know, I understand it's very controversial, but it's. It's what we had to do that was best for our family. So I'm not ever going to. I don't really care what you have to say about that, actually. So.

And I mean, I also think it depends where you live, right? I mean, where live is highly dictating people's perceptions of the situation. And we're not downplaying Covid. We're not downplaying that there have been deaths. We're not downplaying that this disease or that, you know, medicine is important. Nobody's downplaying that. But if you live in the state of Maryland, it's been shut down. Our schools just started rolling out and, like, opening back up a couple weeks ago. And it was a phased entry to the point where I don't think the high schoolers are all back yet. I think they're coming soon. And I'm like, for what? Our schools end in two months, and we're going into spring break right now. I mean, I get it. Like, get them back to schools if.

That'S where they want to be.

But not even all the spots are filled. Families bring their kids home in fear of sending them to in person schooling. So it's also a mentality of, you know, you are who you're surrounded by. You are what you listen to. And so I think we need to keep in mind that there are ways for people to live their lives differently based on the information that they have and they feel safe with.

And that's totally. Yeah. Where we are. I think there was only like a few thousand cases total. I mean, the county that we're in just had such minimal impact. And, you know, I don't know the. I don't know the reasons why it just. There was not widespread here, which was great. You know, we went down to Miami for a friend's birthday, and you understand why they have billions. I'm probably misquoting, but you understand why they have so many cases because people are acting so reckless there. Yeah. I mean, we drove in there, and my husband's like, okay, I don't think we're gonna be hanging out. Okay. Yeah. I mean, you make responsible decisions, but, yeah, it was very fascinating, you know, being in a county that did not have a lot of cases. And I'm obviously grateful for that, and I'm grateful for the way that they handled everything. At my son's school. And they still are.

Yeah, so, yeah, absolutely. Well, thank you for sharing that.

Yeah, of course.

So is there anything else, like, anything that you could say to like a top tip or two to a therapist that maybe wants to get into pediatric feeding but either is fearful of it or has maybe taken the courses but still has no idea how to assess and treat? I mean, I have, you know, earfuls to share with them and this is often what I. I market to and preach to. But any tips as like a mama, you know, you're a mom, SLP of a kiddo who's got these, these needs, anything you would share with them, any tips?

You know, I think, I think as I actually just finished up like a, like a leadership mini course that's going to be launching today, actually. But you know, what's. I think one of the main points that I always say is action breeds clarity. And I think you can, you can sit and just play this analysis paralysis of what should I do? Do I know enough? Should I work for myself? Should I go work for somebody? What should I do? And I think, put the wheels in motion. Go start talking to people. Go apply to some private practices. Go apply to different hospitals. I hear so many people talk themselves out of things before they're even presented the opportunity. It's like, well, I don't know if I want to work at this hospital. Well, did you apply? Do you know if they even want you? You know. Oh, well, I was presented, you know, with this job offer. I don't know if what I want to do. Well, did you ask what the salary is? Like, did you ask what the PTO is? You know, I think people just get. We. I don't know what it is about SLPs. This is a very obvious overgeneralization, but we just get into this overthinking and overanalyzing. And I feel like if we just stopped the madness and actually helped the people that we could help, your life would be so much better. And I know for me, like, once I got out of my own stupid way and I just realized that I'm really frigging smart in my one area and I'm very strong and I know that I can help a lot of people in this specific area. I started my own business and I made six figures right away. I mean, I made a lot of money. I helped a ton of patients. I'm still friends with a lot of families that I worked with at the time, you know, so I think that's my one piece of advice is to just get out of your own head and realize you have the skills to help a lot of people. And there's so many people that need your help. I think, you know, I've gotten, I don't want to say off of Facebook, but I don't spend nearly 1% of the time on there that I used to because it can be very toxic and competitive and it's like, are you kidding me? Like, there are people out there, there are parents out there, there are family members out there that are desperate for the services that you have. And even if you're not totally competent in it, if you're one course away from being super competent, go take that course. Like if you're hesitant, you know, I don't know if I have the time to take this 12 hour course or I don't know if I have a few hundred bucks. Like if that is the barrier to entry for you to helping so many other people. Like there are so many families out there that would really, really appreciate you. You know, and I think we obviously could talk forever and ever about this too. But you know, making what you're worth to charging what you're worth, I mean, I can't tell you the amount of therapists that, that I've worked with that are private paid. I have no idea how much I even pay them. Like, I, to tell you the truth, they could be charging me $1,000 a session for all I friggin know. Like, I'm kidding, I'm joking. But they're just very, very good at what they, they do. And I know that they, they charge their worth and they, they feel very fulfilled. Like I tell, you know, I tell some of the girls that I mentor too, and I say girls because they are only girls. So I'm not being sexist. But if, if you're not fulfilled in what you're doing and if you don't feel like you're being paid enough, you're not going to keep doing it. Like, if you're not making enough money to feed your family, to live the lifestyle that you, you want, you're going to be looking for other things and you're not going to come back next week when I need you. So I want the therapists that are changing my son's life to feel fulfilled. I want them to charge what they're worth. I want them to be able to live the life that they want to because they're doing good work in the world. And I know you feel the same way I do. And I Don't think that was your question, but that's again, the rant that I chose, so.

It'S all good. You know what a simple question leads to. You did answer the question and then you. Which I love. Okay, we're good. No, but I think that's also. You know, I've had some podcasts where I've talked about money and making money in a helping profession was one of those podcasts. And I'm like, it's not discussed enough. People say, oh, you didn't get into the SLP profession to make money. You got into the SLP profession to help people. I'm sorry. Everything is a business. So you know what, like you said, you have to make enough to one, feed your family, pay your bills, but also, you need to live your life. And I'm not saying that you should be overcharging your patients so you can go buy a Lamborghini. I'm saying you should be making enough that you're not living paycheck to paycheck every month. And like you said that you're excited that you feel like you're getting paid your worth, because that's been very important to me. I pay my contractors at the top end. I'm one of the highest paying in my area. And I know that because. Because I was a contractor. I went through all this. I know what people were paying, and I've also kept up to speed with that. And guess what? As a contractor getting paid the high end of what contractors get paid in my area, I was excited to work for somebody else. I was excited to go and do my job because I felt like I was valued. And then being the business owner, I was like, I want to have that. I want to instill that same feeling in my team. I want them to recognize that I value them. So my team gets paid for the time they spend eval and double that for writing a report, which is unheard of in a lot of private practices. Most people don't pay anything for writing a report or they underpay a very tiny, you know, chunk of money for an eval, a full eval, regardless of the amount of time spent in eval or writing the report. And yes, there's, you know, from a business standpoint, yes, I have, like, you get paid for 1 hour report writing or 2 hour report writing based on how much time you actually spent and how many evals, you know, a formal eval or whatever. Different areas were assessed. But it's. People always say, oh, okay, like, like they've never Heard of that before, you know, so I always say look at what your business as a business owner can do where you are still making money as a business owner and getting paid your worth as you know, the person running the practice. But what, what, what other things can you do to also demonstrate to your team that you value them, that you know, you want them to feel good about the work they do and that they should be commanding a certain fee for their services because you can't just go replace them with any random person. You need to find another highly skilled person to take their place. So, you know, if they decide to just up and leave you one day, which happens. But yes, no, I think that's a very under discussed topic, one that I've been like trying to shed more light on because, you know, look, the reality is there are some private practices that take insurance and they can only offer you so much because in order to keep their lights on that it is what it is. But then there's other practices where they might have some wiggle room. Maybe they get a really great insurance reimbursement or maybe they have higher private pay fees and they have some wiggle space for those who ask and for those who are doing a awesome job and the families really love you. You know, I'd be, you know, I've had therapists come to me and I've said, you know what, let me look at, let me just look at the financials and get back to you. And in that space I have been able to give raises to certain therapists who really work their butts off and they really go, you know, they go above and beyond for their families. I want to, I want to compensate them well. But I think that also, you know, begs the question of why therapists who are just getting started in private practice often feel like they don't have enough experience as a private practice owner and that for some reason should dictate their fee. Because I've had this conversation with coaching clients of mine where I said the number of years that you've owned a private practice are completely irrelevant. How much experience, how specialized are you in the type of therapy you're delivering? You've been in the field for 15 years. You need to charge like you've been in the field doing this for 15 years. So there's, you know, there's that component also to think of. But yeah, this, this gets me fired. Fired up because I just, I hate to say burnt out because that's what happens. You get.

And what I see too, like, you know, I help people start mobile fees businesses. And I've just seen so many businesses fold up. And I asked, you know, how much are you charging? And they'll tell me. And I'm like, well, there's your answer right there. You're never going to run a profitable, sustainable business charging that. You know, and, and a lot of us just, we, we aren't business owners. Me and you are, but SLPs in general are not. You know, we, me and you have, have spent exorbitant amount of money for business guidance and business coaching, but SLPs haven't and they don't understand that there are so many other things, charges that go into running a business, that if this is just your fee and you think that this is what you're going to take home, you're out of your mind. You know, there's taxes, there's overhead, there's. If you're running a fees company, there's equipment charges, there is daily, you know, disposable charges. There's tons of other charges that, that people don't consider. So, yeah, I mean, when people say things like, oh, they're charging too much, that just shows how unknowledgeable you are about the topic because there's many, many other things that go into it. Yeah, so like you said, we're not taking our fees and buying Lamborghinis, so.

Exactly. It's like cost of doing business. And arguably, for those who don't really understand how business is often run, a lot of of us put money back into the business. A lot of us are putting money back into our teams. A lot of us are putting, you know, there's a lot of behind. And I tell people all the time these days because they say, how do you do it all? And I'm like, I don't. I have a team that makes me look really good. You know, there's a team that helps me with the podcast, There's a team that helps me with the online business. I've got a team helping me with my local private practice. I mean, no single person is Superwoman or Superman. They, they can't. You can't do all of this by yourself. I mean, you'll die trying. Like, you will literally drive yourself into the ground. There aren't enough hours or enough energy in the day. And I don't advise on that at all. You know, I always advise on build a team as fast as you can, because you will, you will thank me later. Well, this has been awesome. I know we can always chat for hours and hours.

Are there any.

Any last tidbits you want to share that we didn't talk about?

I don't think so. I think I gave you all my rants that I wanted, so. Fabulous.

So where can they find you if they're interested in, like, learning more about your new. Your leadership course you just mentioned, or be collective. Do you. We'll put it in the show notes.

Okay.

Crap.

I'm the.

I'm the.

I. I'm a horrible business owner. I don't even know the links to where you can find this stuff, you guys. Holy cow. Anyways, swallow your pride podcast is swallow your pied podcast dot com. I will get you the links to the. We're not actually open for enrollment with the collective right now. We'll be opening that, I believe, may 21st. That'll be metslp collective.com you can get on the waitlist there. But we do have some other. Some other things I got going on that I would love to share with you. And yeah, we'll get those in the show notes, so thank you, Halle.

Absolutely. And if they're on, like, the waitlist for the Med SLP Collective or. Or the podcast, will they get information about your other courses or.

Yes, yes, yes.

So med slp.com or swallow your pride.

Medslp collective.com or swallow your pride podcast.com. yes.

Medslp collective.com or swallow YOUR pride podcast.com.

Right. You got it.

Yep. Awesome. Okay. All right, well, we'll put that in the show notes for you guys. Thanks so much, T. Thank you so much.

Okay, bye.

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