Episode 249: Like A Dance Between Art and Science with Marissa Douglas M.S. CCC-SLP

Hi and welcome to episode 249 of the Untethered Podcast. Today we have Marissa Douglas joining us. Marissa received her Master's in Speech Language Pathology from Missouri State University in Springfield, Missouri. She moved to Florida while finishing her degree and has been here ever since. In school, she did not learn anything about feeding in the pediatric population, but she's always enjoyed working in pediatrics. So when she graduated, she really wanted to learn feeding in PD in the pediatric setting. Now she owns her own private practice and specializes in working with pediatric feeding disorders. She works with a variety of conditions such as tongue ties, orofacial myofunctional disorders, oral motor deficits, selective eating, tube weaning, sensory aversions, difficulty latching and transitioning from the bottle or to new foods.

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 provide.

Welcome to the Untethered Podcast. I am your host, Holly Balkan.

I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner 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, airway, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener as we jump into today's episode. Remember to listen with correct oral rest.

Posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Marissa, welcome to the podcast.

Hello. Thank you. I'm excited to be here.

I'm excited to have you. You are? I know we were chatting beforehand, but you're like one of our OGs from like year one of Feed the Pete's Cool Course Fall 2020. And I know we're going to talk a bit about that today, but I would. I'd love to just start off with, you know, and obviously you can share your background and where you were before the course, even from as far as feeding therapy, feeding therapist goes. But why, like what. What led you to take the course?

Yeah, so it was 2020, which was just a fabulous year for everyone. I'm sure everyone recalls many things from that year. Working out, not working out, but feed the peds. Really awesome things that I think I found myself in, you know, doing during COVID that I probably wouldn't have had time for otherwise. So, you know, I was working two jobs. I was working. Working outpatient and I was working for early steps, so going into the homes, and I was just seeing a lot of the same things with all of my clients. And I was really interested in feeding. I had been working as one of the main feeding therapists there, but I was just kind of seeing all of these, like, similar things like lisps and picky eating and open mouths and low tone. And I was just like, what? I'm missing something here. Like, what is going on? What is the connection? Why is everyone, you know, presenting like this? And so, yeah, during COVID things changed a lot for work, which is kind of why took on another job. And I just had a lot more time. So I was doing a lot more research just on the Internet, like digging and digging and digging. And I came across your course, feed the Peds, and I was like, wow, that sounds like, you know, a really well rounded course. You know, I'd taken things. I had had great training from my job, from my co workers, but I didn't really have anything that I felt like took it, you know, from A to B all the way around. You know, in grad school, we learned about dysphagia and we learned about adults. And I think we had a one day, like one. One day in our class, in our dysphagia class, we covered pediatrics. One day, that was all I had. I got, oh, my gosh.

I was like, no peds feeding. Zero peds feeding. That was only adult dysplasia and that was it. Yeah, yeah.

And I know that, you know, tends to still be the case some places, depending on where you go to school. And, you know, it's unfortunate, but at the same time, our scope is so broad. I understand how it can be difficult to, you know, get every single, you know, piece in there, but, yeah, so I was kind of like, okay, I think I have the time to do this right now. It seems like a big commitment, but. And, you know, maybe financially and just like time commitment, but, you know, I was like, I have the time. I'm going to go for it, I'm going to do it. And I'm so glad that I did because it was kind of that missing piece for me. And it put a lot of things in perspective and helped me connect the dots between, you know, things that I already knew or already suspected I knew and just really helped me understand and see the Big picture. Um, so, you know, it kind of gave me the confidence that I needed to really go out on my own and confirmed a lot of things when it came to just understanding the why behind a lot of things.

So I love that. Obviously, I love that. But, you know, it's so funny. I tell people I'm like, the origin story of, like, the whole feeds and heats course. I actually was like, I'm going to create a MYO course. I know there's a, you know, my courses out there, but I'm going to create one simply because I was like, I took a mile course. I felt like I left that course with at least an idea of where to jump off, but everybody else I knew was telling me, like, I took a mile course and I left more confused when I entered. And so I was like, oh, I got. I got to change this for people. Like, I gotta figure out how to make this process a little simpler so people actually feel like they know where to begin and have a place to go to help them continue. And. And then one of my really good friends in the field was like, also a slp, you know, met SLP and business owner. She was like, yeah, Hallie, we really need a pediatric feeding course. And I was like, I know. And she was like, you should do that. And I was like, ah, that feels like a lot.

I don't know.

I don't know about that. And she was like, well, if you don't do it, then I'll just like, I'll go tell someone else to do it. I was like, okay, now she kind of like, hit.

She know.

You know, it's like she knew how to kind of get me to be like. So I was like, let me think on it overnight. Let me. Let me. Let me sleep on this. So the next day I came back and I was like, all right, I will do this if I can get a team of people to basically help me do this. Because I think for me, even I was like, I want to create a comprehensive course. And I realized that's lacking. There isn't, like, a course that kind of, like you said, pulls it all together. I was like, but also, we need to go over, like, typical development, and we also need to touch on some things that may be a little taboo, like tongue ties and MYO and the Birth the three Crowd and, like, how that's actually more feeding than true myo, right? And sensory. Sensory, oral, motor feeding. So I was like, all right, I can definitely jump in with, like, the topics that I'm treating that I'm assessing and treating every day, but I have not worked in a nicu. I haven't worked in hospital settings, you know, outside of NICUs with peas. I have with adults. I'm like, I've worked in the schools, I've gone into homes. Like, I was more home based at that point. And truly before I even had my own child, you know, just over eight years ago, I was working more with the toddlers. I wasn't even working with infants. I'm like, that's a whole nother ball game. And then, you know, add the medical complexity components on top of it all. And I was like, I've had very few medically complex cases, like my med complex cases typically come to me because they suspect there's tether oral tissues at play. And they've been to a number of other providers and it's kind of like the last straw. They're like, we need to prep for this release to see if that helps because there's just so many other things going on too. But we think this may be part of the puzzle. So I kind of just was like, all right, all right. And this was all summer of like 2019. So I was like, all right, I'm going to do this, but you have to, like, tell me who you use for marketing. Like, who, who writes your copy and who like writes your emails and who write me does your sales pages and your Facebook ads and all the things. So I was, these are not things I have time to learn. Like, I'm running a private practice. I'm treating full time. And I was also now trying to start online business. And she was like, deal, you create the course. Like, I'll tell you who I use. And like, obviously, like, I paid them all. It's not like she gave me anything for free, but it's like going into a business like that and kind of knowing like, okay, these people get my market was also really helpful. And yeah, I was like, all right. So from that point, I think around like fall of 2019, we started to launch everything. And then, you know, what happened, happened. Like, you know, pandemic. Enter pandemic. I literally launched the first course March 16, 2020, as the world shut down. I was also like, didn't know yet, but I was about to go through a miscarriage and it was like kind of a surprise pregnancy for us too. So I was like, all kinds of like all over the place. Like, do I start this business while there's this whole pandemic happening? Is that like insensitive people Are like, not sure if they have a job anymore. Like, you know, it was very interesting, but I'm so glad that I was like, you know what? I have invested a lot of time and money into this. I have a team that I also want to be able to pay. It's not just about me. And just because there's this pandemic, which we had no idea how long that was going to last at the time. I'm like, there's still babies and toddlers and preschoolers who are not feeding. Like, time does not hit pause for these children. So my whole goal was like, let's create more feeding therapists so we can get these kids off caseloads. And I was like, full on. Let's go. Like, let's. Let's just. Let's go and let's do it. And I still remember, like, we. Some people participated, like, in the free training I do beforehand, and they were like, this has just been so nice to be able to, like, get on zoom and connect. Before we all were all zoom fatigued and connect with people, right? Like, we're all stuck in our houses. And for so many people, like, this was the beginning of their zoom journey. I was like, my team's already been doing some zoom IO prior to the pandemic, so it was, like, not completely new for all of us. But, man, like, we had dance parties. Me, my kids, and I was like, join us at, like, noon on Friday. We're gonna just put on some music and dance. Like, everyone was just freaking out, right? Everyone was like, high stress. We had no idea what was happening next week, let alone, like, tomorrow. So, you know, we kind of. It just. I just kind of embraced it. I was like, let's embrace what's going on here. And the interesting too thing too, was like, I always planned for it to be an online course. I never planned for it to be in person because I felt like it would be more accessible to people if we could keep it online. Even though I know some people prefer, like, in person. But so I'm like, it kind of all worked out in that sense. So I think you were in our, like, third cohort by then. We had already, like, kind of finessed some things. We already had, like, a change in some team members that were even teaching just because of the pandemic and family stuff and workability and hours and everything. But yeah, so long story. Long story not short. I love just. I love to hear that. It kind of was sort of that thing that pulled all together for you because that was My big vision, it was like, if we can kind of simplify what feels like a very scary thing for people, and I can almost take my 10 years and thousands of dollars in courses that I've done, plus all these other people who have, you know, also had similar experiences and we're all treating in these different arenas, maybe we can pull something together that would be like really comprehensive and like really beneficial. Because even if you end up going more, you know, specialize within who you work with in peed feeding, I feel like it's still, you still need to know the information. It's like basic information across the board. So anywho.

No, definitely, I agree. And I'm so glad that you didn't press pause when you, you know, considered it and you went through with it because there were people like me out there that were like, well, now I've got more time, so why not learn while I can't really do as much work? Because nobody wants teletherapy for some reason, because they don't know what that. And they're, you know, they don't understand how it works. So putting my time, you know, still to my career by doing something else and learning was really beneficial for me. And you know, I love that you took all these different people and brought them together to teach one course because I, to me, that was a really cool experience to get this person's perspective and this person's perspective and different settings and different ages because we covered it all and no one person can be a specialist in everything. And I think, you know, that's something I learned from you, from the course and just from like some of your business trainings as well as you just can't do everything and you have to, you know, find a team and find people you trust and, you know, disperse. Whether it's with, you know, something business related or a referral network for your patients. That's something that, you know, I taken with me and I feel like I've been able to apply it in all aspects of my life. Even, you know, so did you watch?

Like, I know, and it's so bizarre to people, but I'm like, no, you don't get it. This is how my brain works. Like, I'm like, hi, yeah, there's a free business training at the end of the feed the beads course. And people are like, what? And I'm like, well, it makes sense because a lot of people also come to me for business training. So in Hallie's world, like, why not just include it in there for free? As a bonus at the end. And so did you actually watch that business training?

I did. And, you know, it was funny. I always said that I would never start my own business. That's just not what I was looking to do. I'm a therapist. That's what I want to be. I don't want to be a business owner. And, you know, I think just as things change throughout the pandemic and after that, and then listening to your business training and all of the great, you know, resources and information that you provided, and then I was also working for early steps where I was contracted, and I was doing everything on my own, essentially. I kind of was like, wait, I think I can do this. Maybe I do want to do this. Like, this is an option for me. It just never really felt like an option before, and then suddenly it felt, like, real. Like I really could do it. So, yeah, I took Feed the Peeds in September of 2020. So we ended, like, December that year, I think. And then In February of 2021, I started my private practice and seeing patients on my own going into the homes. And it was slow, I would say, as a private practice, not taking insurance, it was a slow start. But eventually, just through, you know, networking and finding your team of people that you trust, that you want to refer to and get what you get, things just, like, took off. And it's been. Yeah, since 2021. And now I have taken on another therapist who's starting working with me. She's a cf, which I'm really excited about because I see a lot of myself in her and just how she wants to learn this feeding side of things. And it's hard to get a position in feeding as a cf because everybody wants you to have experience, and obviously, as a cf, you only have so much experience. So I love, you know, teaching and sharing my knowledge. So I'm really excited to have her on board and share with her everything that I've learned and hopefully nudge her to take Feed the peds.

I love it. I love it. And I also just have to say, the fact that you got peds feedingtherapy.com as a URL and it wasn't already taken. Like, when I saw your website, I was like, I've seen it before. And I was like, that's genius. I just have to say, like, amazing. Completely amazing.

I was shocked that it wasn't a thing. I was like, let's just try this. And expecting it to be rejected. And it was like, okay. And I was like, well, that was easy.

Okay.

Yeah.

You're like, that's. I mean, that's such a great URL, so, like, congratulations on that. So in your practice now, like, are you like super specialized and that you primarily work only with certain types of patients, do you still, like, take articulation cases or only if it's like myo related or like, where, where are you at? Share with everybody?

Yeah, I'm taking mostly, you know, like picky eating, aversions, tube weaning, you know, those infants latching and which is a huge part that Feed the peds helped me with because I felt like when I was working outpatient, we didn't get a lot of infants and outpatient because they were in the NICU and then they were probably seen at home or, you know, however that worked for them. They never made it to outpatient when they still needed help. And but when I started with early steps, I started seeing a lot more of those infants and Feed the peds helped me feel much more confident in my ability to, you know, assess and treat them. So now I'm still seeing, you know, those kids around that age for feeding difficulties and then I'm seeing myo kids as well. So when it comes to articulation, I don't really truly treat just articulation. I'm trying to address the whole picture. So if a family comes to me and they're only looking for help with articulation, first, I'm going to share with them my assessment and my findings and everything that I see that may be related to the articulation and I'm going to explain the treatment plan. And if they're on board with that, then fabulous, then they understand that, okay, we're not really going to necessarily be treating articulation right now, but it will come with time. And if that's not something that they're looking for, then, you know, I just try and explain, you know, my why and support them and what their journey is and find another therapist that can best help them with their needs. So I'm still seeing, you know, a pretty broad range when it comes to ages. And I do get a lot of people with, you know, younger, like toddlers 2 and 3 with tongue ties, and they're kind of like, well, what do we do? You know, somebody says they need therapy, somebody says they need a tongue tie release, you know, what's the right plan of action? So kind of helping those kids get where they need to be. So maybe they are ready for a tongue tie release, or maybe they're not, but they're breathing Better and they're sleeping better. I work a lot with just like strengthening my, the lips and the jaw and the tongue to achieve better nasal breathing and get better, you know, orofacial growth and development. That's a big part of what I do. And I see a lot of clients just for consultations that are like, okay, you know, this doctor told me that I need to see you, and I don't really know why. So here we are. And, you know, and then I can kind of explain that to him and them and give them the education that they need to maybe explore other referrals or, you know, find the treatment plan that works for everyone. I think the biggest thing when it comes to oral ties is everyone's journey is so different. And you can say this is how it should go, but it's probably not ever going to go that way. And, you know, even if the textbooks says it should be that way for maybe that family, it shouldn't because of whatever other stressors or environmental factors or, you know, family factors are going on. Maybe a surgery just isn't what they need right now or, you know, so it's been, it's been really cool, you know, navigating that journey with everyone, though, just because it is so different. And I think that's something I love about pediatrics and feeding is it's never the same.

Never, never. It never goes as planned. Exactly. Yeah. I feel like that's like one of the big things we try to instill as well, especially like, even starting, like, with assessment, because we noticed early on that a lot of, like, students, you know, or like therapists who, whether they were experienced or brand new or sometimes, like, I really struggle to, like, get through the entire. Because we give you guys, like an assessment, assessment, you know, template, and we teach you how to do it and everything. And everyone's like, I don't get through the whole assessment. Usually in a feeding, like, assessment, we're like, you're not supposed to like, yes, in a perfect world, it would be great, right, to like, check all the boxes and have all the information and like, look, you might get to a point in your career where you feel like you're doing all that because it's so second nature to you that you're able to even just kind of do things in your head and move around. But I'm like, if you're spending an entire hour staring at a piece of paper, you're never going to connect with the patient, you're never going to connect with the family, the caregivers. You're going to have a hard time getting them to trust you and actually give you helpful information. So it's like if you only ask five questions, but you get a whole history and you understand why they're there, and you understand maybe where to start in therapy. Like, that is your goal. Right? And so I love, like, what you said, too, because I think there's just so much to be said about that. Like, I always say, there's, like, a dance between art and science. Right. It's sort of like a, you know, you kind of have to massage the relationship and build that trust and rapport with the patient and the family, while also trying to get some baseline data. And, you know, you don't want it to be completely just like a conversation unrelated to why they're there. But we also don't want to feel like we have to check all the boxes all the time. And that is, I will tell you, one of, like, the consistently, like, I think, hardest things for a lot of therapists to grasp. And so I'm excited that you have a CF that's going to. That's working. She working with you already or going to be working. Okay. So. Because I just. I feel like having a mentor who understands, like, what it is to kind of learn how to navigate these waters, these uncharted waters, if you will. Like, you can take every course under the sun, but if you don't actually start.