Episode 266: Beyond Observation: Comprehensive Evaluations in Pediatric Feeding Therapy

Hi and welcome to episode 266 of the Untethered Podcast. This is your host, Hallie, and you've just got me today. Today is going to be a quick episode because I want to talk about something that is. I don't know if I want to call it a pet peeve of mine, but it's something that we really need to discuss when it comes to functional evaluations and not skipping them in the feeding space, especially as part of a comprehensive overall evaluation, you know, especially calling out all SLPs and OTs on this one. All right, so let's jump in. 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 health care provider.

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I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, pot podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to.

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Okay, friends, so as I said, there's something I want to talk about today. And of course, you know, as you just heard, doors to feed, the peas are open. So that is one of the reasons why I want to talk about this because I do think that we should be having conversations around the type of assessment. You know, obviously we dive into treatment in the course, but I want to talk about something that I've seen, seen, come through in some assessments, right? I have a private practice. I have seen different reports come through that have been shared with me that say things like a, it's a comprehensive evaluation, but then you get to the oral motor section or the feeding section or whatever. Sensory, oral, motor, feeding section, right? And you're like, what's going on here? So they did an informal assessment. They did not watch the child eat. They did not palpate externally. They didn't look internally. There's like no screening even happening here. Like, I just taught everybody you know, if you guys are listening and you're joining live, last week we did that free five day screening that wrapped up and you know, if you're like, ah, I missed it. Well, if you join the feed, the Pete's course, by the way, you do get lifetime access to that, to last week's training as a bonus. And we will actually, if you do join the course, we will actually submit for five official CEU hours for Asha and Iota for you all. So whereas you have to basically just count them on your own if you don't join the course. And you know, that's fine too. But for those who want us to submit, it is a bonus that we do. If you're actually inside the 12 week course. Where was I? What was I saying? Oh, right. So, you know, it grinds my gears a little bit when I see these reports and it's like, this was a comprehensive evaluation. And you get to a section, it was like, no, this is not comprehensive because you didn't actually look at anything related to motor or sensory system or speech sometimes, right? It's like you go through and you're like, no, no, no. When you informally observe or you say you did not fully assess, okay, this is not comprehensive. This is not comprehensive. Maybe it's a comprehensive language evaluation. Can we call it that? Maybe it's a comprehensive speech. Speech evaluation. Can we call it that? Maybe it's a comprehensive speech and language evaluation. Let's call it that. Right? But if you're not including everything that we do as SLPs, I don't know, just my opinion, maybe we should be more specific about what we call the evaluation. Because this one in particular just said a comprehensive evaluation. And I was like, comprehensive evaluation. What does that mean? Okay, so I know I'm being like super nitpicky here, but I didn't love that it said it was a comprehensive eval because the parent then thinks they got all the things done. And then you get to some sections and you're like, like, where's the meat and potatoes? Oh, you didn't do that. You didn't even really do an informal screening, let alone. Okay, but, but, and here's, here's why I'm recording this episode, to then comment on it and say that it's not an issue when you didn't assess it and you don't actually know that it's not an issue. This is, this is what I take it. This is what I take issue with. This is where I'm like, oh, guys, come on, please. Like Just say this wasn't assessed or this wasn't formally assessed or this, you know, wasn't assessed to the degree that we can make a determination as to whether or not this is impacting function or function is impacted. Just make some kind of a statement that says, hey, I didn't actually assess this or look at this. So if you're curious about this, you might want further assessment or you might want to see someone else who specializes in this. Right. I mean, I just, just wanted to put that request out there. The other thing I think that we need to be considering is like, function, right? Like, what is function? What is this family coming to us for? Right. So we inherit kids from other practices all the time for a myriad of reasons. And it's always just very interesting to review their reports or their notes or whatever is coming our way because half the time I think that we're forgetting to listen to the patient and why they're there in the first place. I do want to make a comment about apraxia in a moment. I'm going to write that down so I don't forget, but hopefully I'll remember why I wrote this down. Yeah, I just. Let's just go there now. So one of the other things I want to mention is we cannot give a formal apraxia diagnosis, in my opinion, without ruling out other things first. Right. And so to see like a two year old come through with an apraxia of speech diagnosis when so few other things were assessed, that's concerning to me. And I'm not an apraxia expert. I did recently have a couple people on the podcast who, you know, had. We had great feedback from those episodes. Alana Bondar was one of them, for example. You can go listen to her episode and the episode after that. The point is, when we're diagnosing and we're calling it a comprehensive evaluation, just please be very specific to what you're assessing. Call the evaluation something that mirrors that and make sure that if you are assessing something that requires you to also do other types of assessment to rule things out before giving a diagnosis, we speak to that properly as well. Okay. That's kind of where I was going with that. Okay. And then the last thing I want.

To say, this is probably going to.

Be a super short episode because this is really just a hallie like going like, why don't other people teach this? Like we teach it inside. Feed the peas. Like I teach you how to do a comprehensive feeding eval. And we call it a comprehensive feeding evaluation because that is what it is. Right. But we are making sure to cross our t's and dot or dot all of our I's here. And here's the thing. The other thing, if you're going to send a 17 page report and you're going to call it comprehensive, it should be pretty comprehensive at that point. Now anyways, that's neither here nor there. I get this from like so many different practices all the time, which is why this is kind of just popping into my brain. The other thing is, I think that our recommendations need to be specific to a child and not always just copy and pasted. It's very obvious. Copy and paste things to others, to other individuals evaluations and their reports. Especially, especially when you forget to change the name or the pronouns. Hint, hint. You might want to put something in your little process where you remember to do that. But if we're going to give recommendations, like, I saw something recently and I was like, one of my therapists actually that inherited the child pointed this out to me and I was like, oh yeah, that's interesting. And I'm going to change it so it's not obvious who this was in case this person listens to my podcast. But let's say you want the child to stop, you know, grazing all day and eating food all day and avoiding meal time. We're not going to then in turn turn around and make like suggestions for them to make requests in whatever modality they're using to make requests. We're not going to say like, we're not going to have them request food as the main example, like all day long. Like, yes, obviously communication around food is important, but if we're trying to cut something out to the child, just like, let's say the child eats one food all day, right? Or two foods all day. That's all they want. They're grazing on it. They're not eating meals. And we like need to expand that diet. We're not going to turn around and go, oh, hey, maybe you should work on having the child ask for like, you know, veggie sticks all day. Like, hey, like encourage them to use a sign for veggie sticks or use a sign for, you know, that particular snack or whatever. Right. I think there needs to be more care given to the reports or make them a little shorter so that you're not accidentally leaving things in from prior reports that don't need to be there. That's just me. I don't know about you, but I also. We can go here too. The length of reports I think is important. I personally don't want to read a report. Every single doctor that I've talked to that we refer to does not want to read a long report. And so if you can get the meat and the potatoes into like a summary to share with other professionals and, or learn how to make your reports a little shorter, it's just my, you know, suggestion, so take it or leave it. I do think that it would be, one, better understood by the parents reading it versus all the other stuff we put in reports. And two, I think that it would also be helpful for other therapists and especially the doctors, like receiving that report to understand, you know, the meat and potatoes. Right. Maybe we just need to add a summary because I know there's some people who are like super long report writers and that's never going to change. And I'm not judging you. That's totally okay. Maybe that's also why I started to really like the feeding world because I felt like my reports were like so much shorter than my reports when I was in the speech and language space prior to being, you know, really solely just age pediatric feeding therapist. But anyways, all right, that's it. This one's a super short one. You know, I do think that understanding what needs to go into a report, understanding how to actually assess and how to dive into proper assessment. Right? And not just writing things off and saying like, oh, I did an oral mech exam and the child's fine. Nine times out of ten when I get those, the child is not fine. And that person completely, completely, completely missed a very obvious, to me issue. And so that is, that is what we're talking about inside. You know, feed the peas. We teach you how to assess, we teach you how, we give you sample reports, we teach you how to make treatment plans and basically turn that information into, you know, take that, go back to the family, talk about what's important to the family and what we see as, you know, needing to be addressed through our therapy. And then together we come together and decide on what the treatment plan is going to be and how best to proceed forward. Because it is very responsive based and it is very family oriented. They're very. A very central part of the feeding team. Right. So we need to make sure that we are addressing what's important to the parents as well. Which is, you know, I could go off on a tangent about that because these days I still see a lot of therapy that is not patient centric, it's not family centric, it's not responsive. You know, it's basically what the therapist thinks needs to be there, and the therapist does what the therapist thinks they need to do. And when you're doing to somebody instead of with somebody, your therapy is never going to be as successful as when you're doing it with the patient or the person or the family unit that is sitting in front of you. So conversation for another day. But, you know, I really got to lean into learning how to get those families on, on the same page and on board with what you want to do, especially if what you're doing directly ties into the reason that they're there. We need, it's our job to make them understand that. Right. So I know this was kind of like a tangent. Tangent. Is that a word? Here I go, making up words again. Episode today. But it's because I saw something come through. And it's my continued hope that as we bring more SLPs and OTs through feed the Peas, we can help share what we, you know, experienced and what we feel works really well and really best supports our patients and their families and the other professionals that are working together on patient cases. So hopefully this, this is helpful. The doors to Feed the Peeds are open, as you've heard and as you will hear probably again in a second. But go to www.feedthepedes.com and join us because we only have doors open for five short days and our certification will be rolling out later this summer. So this is the last cohort that you'll be able to enroll in prior to the certification rolling out. So if that's something that you may want to enroll in as well, you know, down the line, I don't have all the answers for that right now. I don't know details on that, like final details are still being ironed out. So if you email us and ask us about the certification a lot, we might have some answers. But a lot of it might still be, I don't know yet because we are currently meeting and figuring these things out, ironing that stuff out. You know, we're still like four months, five months out at the time of the recording this, but several months out from actually opening doors to that. Just wanted to let you know though, this will be the last Feed the Pete's course before, before that is rolled out. So if that's something you want to consider, because you will have to have taken Feed the peds to be a part of this next or first, I should say this first cohort of, you know, those going through pediatric feeding certification with us. You know, if that's important to you. And you've been, like, waiting to take feed the peds. Now is the time. Jump in. But we offer the course again in the future. That is our plan. Yes, Only one more time this year, later this year. But, you know, I don't want to cause any confusion there, but if you are hoping to take it so that you can enroll in the certification at the end of the summer, this will be the last chance. The last chance you can do that if you have not already taken feed the Peds. All right. Hope that makes sense. Let me know if I confused you. Supporteedthepedes.com we'll see you guys inside the course if you're joining us. Otherwise, just get out there. And please, please pay attention to what you're putting in your reports. Pay attention to what you're calling reports. Pay attention to how you're diagnosing and making sure that you're ruling all the things out that you need to rule out in order to make a proper diagnosis. And. Yeah, and I think, you know, just. Just to kind of put some context around it. I used apraxia as an example because we actually received an eval this week where the child had a diagnosis of apraxia from a speech pathologist practice and they did not do a formal feeding or oral motor evaluation. It was informal with very little information included. My therapist went and saw this child, and the child does not appear to have apraxia. The child was imitating everything with ease, communicating very well with the therapist to the extent they were able to, but did not appear. Did not appear proxic. And upon further evaluation, this child has some, like, oral motor things going on, but also able to do some. Engage in some early imitation. And this kid is like two. Okay. So that's kind of why I was picking on apraxia. This was not meant to be an apraxia, you know, topic kind of conversation, but I wanted to put some context around that. All right, I'm gonna zip it. I said this would be short. I hope that some of these topics are just either helpful to hear or good reminders. But, yeah, SLPs and OTS. Join us. Can't wait to see you inside the course. This is Hallie signing off, and I am done with all my tangents for this week, so can't promise there won't be more on social media. But that's what's fun, right? We get to have little tangents and stuff. Come ask. Come into the Q and A box. Join, you know, join me. Ask all the questions you have, I'm happy to answer them. We will be doing a live Q and A also, I should say this Wednesday should plug that 7pm Eastern. And we always do a little bit of Q and A around tots, like tethered oral tissue stuff for those who join. But I do it to answer questions about the Feed the Pete's Course. And sometimes I also give away one last full scholarship. I don't know if I'm doing that yet or not, but if we have like over 100 people turn up, then maybe I'll give away a free scholarship. We'll see how many of you register, right? Another one last free full scholarship to the Feed the Pete's Course. All right, I'll see you guys there.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halliebalkin.com or pop over to Allybulcan on Instagram to get all the latest updates.