Screening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference

It's about the child sitting in front of you. Because every time we become a little more thoughtful, a little more curious, a little more willing to slow down and ask one more question, there's a child who benefits from that. And it gives me chills to talk about this. That's a family who gets answers sooner too, right? There's a parent who finally hears, "Hey, I think I know what's going on with your kiddo." And if you've ever been that parent or you've sat across from one, you know how much that moment matters. I can't tell you how many parents have cried in my office because I connect the dots in ways that they never dreamed possible. Welcome to the Untethered Podcast. I am your host, Hallie Bulkin. 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 face. 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. Hello friends, and welcome back to the Untethered Podcast. We are going to dive into a topic today that I'm really excited to chat with you about, and that really has a lot to do with screening versus assessment versus treatment and myo and why that distinction actually really matters. Let me ask you a question. Have you ever finished an evaluation and had this feeling in the back of your mind? I know there's something else going on here. I just can't quite put my finger on it, right? A child who's mouth breathing throughout the entire evaluation. Maybe it's a kid who can't seem to organize a chew even though you've worked on oral motor skills for months. Maybe it's a child whose speech, feeding, posture, and sleep all seem somehow connected, but no one has ever put the pieces of the puzzle together, right? If you've ever had that feeling, this, my friends, this episode is for you. Because I think one of the biggest reasons clinicians get stuck is that we accidentally blur 3 completely different clinical processes, right? Screening, assessment, and treatment. And we arguably use those words interchangeably all the time, and they're not interchangeable, especially not screening and assessment, which I see used interchangeably the most. And when we confuse them, families get mixed messages, referrals happen later than they should, clinicians work harder than we need to, right? And sometimes we end up treating the wrong thing, in complete honesty. So I want to untangle all that today because, you know, not because I love definitions per se, I want to untangle it because I think becoming crystal clear on these distinctions will make you a better clinician almost immediately. So let's start with screening. Okay, so here is the definition that I want you to remember when it comes to screening. Okay, a screening is simply a process of deciding whether someone needs a more comprehensive evaluation. That's it. You're not diagnosing, you're not creating a treatment plan, you're answering one simple question: do I have enough concern to know that this patient deserves a closer look, right? That's the job. If you think about a hearing screening, a vision screening, developmental screenings, right, nobody expects anyone to diagnose a problem with those, right? Their job is just to identify people who need further evaluation. That's it. Myofunctional screening is exactly the same. And now here's where I think clinicians get tripped up, okay? Sometimes people think screening means doing a mini assessment. And listen, I have pretty comprehensive screening forms, but they're comprehensive because they just have the 40 to 50, depending on which screening form you're using, most common symptoms we might see. You're not necessarily— you're not necessarily supposed to go through every single one of them. It's just as you scan, you're like, are there a couple things going on here that I'm concerned about? Okay, yes, I have enough information, enough of a reason to recommend an evaluation. That's it. That is it. A screening should be fast, a matter of minutes, 2 to 3, but I'll give you up to 5, especially if you're new and still figuring this out. Okay, you're gathering just enough information to know whether you should keep exploring further and not enough information to explain the picture, really the entire picture, right? Just enough of a reason to know, hey, I want to screen and why. So what does that actually look like? Let's say you're already completing a feeding evaluation, right? A child walks into the room. Before they even sit down. You've already started screening. You're observing. You notice their mouth— their mouth is open at rest, their tongue is sitting low, right, on the floor of their mouth. You notice they might have more head-neck forward posturing. Maybe while you're talking with the parent, you ask a few questions just to probe a little bit. Hey, do you know if they snore? Like, do they sleep with their mouth open? Do they wake up rested? Because then maybe you ask the child to lift their tongue and you observe lip seal, and you take a quick look at palatal shape, right? That's it. You've just taken a quick little look-see, but you haven't completed a comprehensive myo assessment, right? You haven't diagnosed an orofacial myofunctional disorder. You've just gathered enough information to ask, is there something here that deserves a closer look? That's it. But here's the thing, you know, screening— and this is really important— screening can happen inside almost any evaluation or even a treatment session that you're already doing, right? So let's just use the eval as an example. If you're an SLP completing a speech eval, you can screen, right? If you're an OT completing a feeding eval, you can screen. If you're a PT working on posture, you can screen. If you're a dentist, an ortho, a dental hygienist, you can screen. The goal isn't to become an expert in every discipline. The goal is to recognize when another piece of the puzzle may exist. That's good patient care. That starts to work towards interdisciplinary care and referrals and, you know, collaborative care, right? Now, if you're already trained in myofunctional therapy, your step might actually be moving directly into that comprehensive myofunctional evaluation, that assessment, right? Because it's already in your scope, you're trained in it, right? But if you aren't, your next step is making an appropriate referral. They're good clinical decision, you know, making processes, right? You know, because remember, a screening isn't supposed to answer every question. It's only supposed to answer the one question: does this patient need a closer look? That's it. And honestly, if every clinician simply became better at answering that one individual question, I think we'd identify a whole lot more kids way sooner before they build more compensation and before those— that compensation becomes years of dysfunction, right? So screening answers the question, should I look closer? Then assessment— let's go there next, right? Assessment answers a completely different question: what's actually going on here? And those are not the same thing. A screening gives you some suspicion and enough information to say, yes, I need to explore further. An assessment gives you an understanding of what's actually going on. And this is where I think clinicians sometimes underestimate what a true myofunctional assessment actually is. It's not just checking tongue elevation. It's not just measuring it for, you know, tongue range of motion. It's not just filling out a form. It's clinical detective work, my friends. You are trying to understand why this patient functions the way they do. And I think that's one of the things that I love most about myofunctional therapy, right? You're constantly asking, what is driving this? Not what's the symptom? What's driving the symptom? Because symptoms can fool you, right? Two patients can present with mouth breathing. They both have it. For completely different reasons, right? Two patients might have a tongue thrust and the root of them might be completely different. Two children can be picky eaters for completely different reasons, right? If we only treat what we see without understanding the why, we're probably gonna miss something really important. So what does a comprehensive assessment actually look like? Well, first it's gathering history, and honestly, I probably care about history more than most clinicians do because history tells a story. How was this child born? Were there feeding challenges as an infant? What happened in utero? Let's even back it up further, right? Is there a NICU history once they were born? Any sleep concerns since birth? Allergies? Asthma? Chronic constipation? Congestion? Thumb sucking? Pacifier use? Orthodontics? Any previous therapy? Surgeries? I'm building a timeline, okay? Because dysfunction rarely appears overnight, right? There's usually a story. And then I'm looking at structure. What does the palate look like? How much room does the tongue actually have? What's happening with the jaws, the lips, the dentition, the airway, right? But here's something I want you to remember. Structure, right? The way it looks, the anatomy itself is never the end of the conversation. It's just a part of the conversation because after structure comes what? Function! And if you've hung around my world, you know function, function, function is so important. Function is where everything gets super interesting. Where does the tongue actually rest when no one is paying attention? How is this person breathing? What happens when they chew? What happens when they swallow? Can they separate tongue movements from their jaw movements if they're over 18 months of age? Do I see compensation? Do I see tension? Do I see efficiency or do I see a body that's working so much harder? Right? Because that's really what we're looking for. Not for, not for perfection, right? But efficiency. And listen, our bodies are incredibly smart. If something can't happen one way, the body finds another way to accomplish it. Right? That, my friends, is compensation. And compensation isn't inherently bad. It's actually brilliant until it isn't, until it starts creating problems somewhere else, right? And that's why my assessment is never about simply checking boxes. It's about recognizing patterns. Because one finding, right, a low tongue posture, okay, that's interesting. Forward head posture, okay, also interesting. Mouth breathing, interesting. Now let's put those three together along with poor sleep, along with, you know, difficulty chewing, along with they've got a high narrow palate. Now I'm starting to see a pattern, and patterns are what my clinical reasoning, and they should drive yours too. These are no longer isolated findings, right? Because by the end of the comprehensive evaluation, the assessment, I'm not just saying, oh, that child's got a tongue thrust. I'm now answering much bigger questions. I now know what's driving the dysfunction, what's compensatory, what needs to be addressed first, who else needs to be on the team. Does the child need to go see an ENT, an ortho, a sleep study? If— do they need feeding therapy, myotherapy, right? Or several of these things may be co-happening at the same time because Here's something I wish every clinician understood. A really good assessment doesn't necessarily tell you what treatment to do. Sometimes it might say, hey, you're not even ready for treatment yet. Sometimes the first intervention might be another referral, right? Sometimes it's getting that airway open so we can breathe safely, and then we can address functional impact, right? Sometimes it's addressing pain. Sometimes it's waiting until another piece of the puzzle falls into place. And honestly, That's just as valuable, right? Because the goal isn't to start treatment as quickly as possible, always. The goal is to start the right treatment at the right time. And this is why assessment is so important. Not because it's longer than a screening, not because it includes more measurements, but because the moment where— it's the moment where information becomes understanding, right? And that's what allows us to move into treatment. So, okay, now we've screened, now we've assessed, right? Now comes the part everybody gets excited about: treatment. And honestly, I think treatment is probably the part of our profession that everyone talks about the most, right? Everyone just wants the exercises. What's your favorite tongue exercise? What's your favorite lip exercise? What do you do for tongue thrust? What protocols do you use? I get these questions all the time. And while I understand why people ask them, I actually think y'all are asking the wrong question. I'm just going to, you know, you can hate me for it, but it's true. Treatment isn't about having the perfect exercise. Treatment is about changing function. And I want to say that again because I think it's really, really important. Treatment isn't about changing exercises, it's about changing function. Okay, the exercises are simply one of the tools that we use to get there. Okay, so think about it this way, right? If I teach someone where their tongue belongs during a therapy session, but for the other 167 hours that week it's just chilling on the floor of their mouth, it's resting down there, Did we actually change anything? I did not. Probably not, right? If they're breathing through their nose beautifully while they're sitting in my therapy room, but they're mouth breathing the rest of the day when they know I'm not watching them, I haven't changed the pattern yet. If they can perform every exercise perfectly in isolation, but then they go right back to their old swallow when they eat dinner, we're not done, right? Because the goal isn't to create somebody who is quote unquote good at exercises. The goal is to create somebody whose body no longer needs them. Right? That's treatment. That's why myotherapy is really about habit building and healthy habits, right? You're helping the body replace one automatic pattern, habitual automatic pattern with another, a healthy one, right? And anyone who's ever tried to break a habit knows it's not easy. It takes repetition and consistency and feedback and problem solving, troubleshooting, all the things, right? And probably a whole lot of patience, right? Especially with younger kids. So what are we actually trying to change? We're trying to establish nasal breathing when it's appropriate, when it's actually available to the patient, the child. We're trying to establish an appropriate resting posture for the tongue, the lips, and the jaw. We're trying to eliminate habits that continue to reinforce dysfunctional patterns, right? Those we call noxious oral habits. We try to eliminate those. We're improving coordination, efficiency, strength when strength is something that may be needed, right? Mobility when mobility is the limitation. We're helping entire oral mechanism work together instead of fighting itself. And I didn't say we're doing tongue clicks, right? Or we're doing lip pulls, because no exercise is magic, my friends. Do we use them in therapy? Absolutely. The right exercise though for one patient may be completely wrong for another. And this goes back to what I talked about, you know, earlier today. Your assessment should tell you exactly what your treatment priorities are. If it doesn't, it's going to say, I'm seeing some issues here and I'm seeing some issues here, and I think the root cause of this is here, right? And wherever that root cause is, that's gonna drive where we're gonna start targeting treatment first. Okay? And if you can't figure that out, you probably need to go back and ask more questions or take one of my courses. Just gonna plug that. One of the biggest shifts that I made as a clinician happened when I stopped asking, okay, what exercise is next? What exercise should I use? Because when I was actually taught, I was given a manual and in said manual there were a ton of exercises and I was taking everybody through a very similar program. And my friends, that is prescriptive exercises. That is not therapy. It's not. I eventually started to realize not every patient needs every single one. And how do I know who? And I figured out who needed what, when they needed it, how much they needed it, and how quickly we could move to the next goal. And it just, it was a big, it was a massive dance between art and science. And that is why I teach my program the way I teach it so that you all can do the same thing. Okay. But I stopped asking what exercise can I use? And I started asking what pattern am I trying to change? Because everything became so much easier after that. Because once you understand the pattern at play, the intervention becomes way more obvious. And here's something I also think is really important. Treatment is very rarely linear. A lot of programs out there teach that. It's rarely the case that that actually works. And can I tell you how many clients we and patients we have gotten that have gone through programs like 12-week programs that are prescriptive and walk all the same order of exercises and all the things, and they come to us and they look like they've never had myo a day in their life. Just gonna put that out there. Okay, probably an unpopular— it's not even an opinion, it's a fact. So I'm just gonna put that out there and let y'all do with that whatever you want, right? Some weeks though, your patient may also jump huge leaps forward. Other weeks they may feel like there's a complete plateau happening. And so sometimes you think you've solved one problem only to realize that it actually uprooted another. And you know, then we've got families who might struggle with carryover at home. Sometimes life gets busy, sometimes a child gets sick, I've been there. I've been the mom of the patients. I was not perfect. I get it. We also have orthodontic treatment and that changes everything, right? But that's normal. I want to normalize that because we're humans. We're not robots. We're humans. Progress isn't measured by whether every week is perfect. There's no such thing as perfection. So let's also get that idea out of our heads. It's really progress is measured by whether function is becoming more automatic over time. And I think that's something that families need to hear too. We are not chasing perfection. We're building new habits that eventually become the body's default. That's why treatment requires clinical reasoning, right? Every single session. And you're constantly asking yourself, what's improving? What's staying the same? What's getting in the way? Do I possibly need to bring another provider into the team, get them involved? Do we need to collaborate? Do I need to refer, right? Has something changed medically? Am I still treating the right problem that I thought was the root issue? Do we still think that's root issue? Like, those are questions that experienced clinicians ask all the time. All the time. I won't say every day or every session, but like all the time. Not like, what's my next exercise? Because here's the truth: a great myofunctional therapist isn't someone who knows the most exercises. It's someone who knows exactly why they're choosing the ones they do. And I think that's a really important distinction. Okay, now by now you might be thinking, all right, Hallie, I understand it. I get the definition. Screening is different than assessment. Assessment is different than treatment. But does it really matter? It matters more than most clinicians realize. So when we blur these three together, or even two of the three, that's when clinical decision-making starts to fall apart. I want to give you an example. So let's say you're completing a feeding evaluation, and during the eval you notice mouth breathing, right? Then the low tongue posture, the forward head posture, maybe the parent casually mentions the snoring. You recognize those as red flags. Amazing, great, you screened. Now imagine you skip the next step. Instead of asking whether this child needs a comprehensive myo assessment, you jump straight into treatment, and you're like, oh, I'm already doing a feeding eval, I don't really need to assess myo, right? So you work on chewing, you work on tongue lateralization, introducing harder textures, And none of those things are necessarily wrong. But what if the feeding challenges aren't the primary driver? What if they aren't the primary problem or the root problem? Right? What if they're a symptom of something bigger going on? If we never stop to understand what's driving that dysfunction, we run the risk of spending months treating symptoms instead of addressing the system that's creating those symptoms. And I think, I think we've all seen this happen, right? I'm guilty of it. I'm sure you are too. But let's, let's just give another example, right? A child makes progress, but much slower than expected, or they plateau. Or one goal, right? Well, two other, you know, new issues kind of pop up and you're like, oh, we've got some new concerns that we didn't— we weren't aware of or weren't really seeing before, right? Sometimes that actually happens because we haven't fully understood what we're treating or the root cause, or we haven't tackled the right root cause, right? Now, does that mean that every child needs myofunctional therapy? Absolutely not. I mean, if they're in braces or expanders, yes, they do, because orofacial myofunctional disorders are present in 100% of children who need expansion. They have a mild disorder by definition. Their palate is too narrow, there isn't enough room for their tongue. They may have crooked teeth and teeth are, you know, that's going to impact their airway, right? We've just described a kid with an OMD. But sometimes, you know, I just want to be clear that what I'm describing here, it doesn't mean that every child needs myo, okay? And I want to be clear about that. Not every child with feeding challenges has an orofacial myofunctional disorder. Not every child with mouth breathing necessarily needs myo either. They were just sick and they fell into mouth breathing, and we can, you know, easily move them back to nasal breather if they were successfully nasal breather prior to that illness, right? You know, not every tongue-tie needs treatment. Clinical reasoning is knowing the difference. That is why these distinctions matter. And that's why I'm spending so much time on this. A screening, again, helps you recognize there might be something more going on, right? An assessment helps you determine whether there actually is, and treatment addresses the dysfunction, the dysfunction that you identified. Each one has its own sole purpose, right? A different purpose. And if we skip one or we combine them or we assume they're all the same, our clinical reasoning starts to suffer. And here's another reason why I think this matters. It protects your scope of practice is what I was trying to tell you. One of the things that I love most about healthcare is collaboration, right? None of us are supposed to know everything. We're not supposed to be the speech expert, the feeding expert, the airway expert, the orthodontic expert, the ENT, the pediatrician, right? All this, all at the same time. That's not realistic. Most of us didn't go to school for all these things. Great clinicians know when another provider needs to enter the team, right? When they should be a part of the collaborative team. And it's not because you as a clinician or me as a clinician, it's not because we're not capable. It's because we're thinking about what's best for the patient, right? And I actually think referring is one of the biggest signs of clinical confidence. Newer clinicians, when I talk to them, sometimes they worry that referring makes them look inexperienced. I've actually found it to be the exact opposite. The clinicians that I respect most and that have the highest levels of experience, they refer all the time. All the time, right? And it's not a weakness, it's actually a strength. They know exactly where their expertise ends and where someone else begins, and they know what that child potentially needs or what needs to be explored further. And they're like, I want you to see the specialist that I frequently collaborate with so that we can rule out X, Y, and Z, right? They know why they're referring, who they're referring to, that that provider can handle it. There's a lot that goes into it, right? And that's good medicine. And here's probably the biggest takeaway from this entire episode. These aren't just different words, right? They're different decisions. Every evaluation asks, should I look closer, right? You know, screening, what's actually happening, that's assessment, and how do I create meaningful change, that's treatment, right? So it's not really that each eval asks those 3 questions. I should say each, each part of this process asks a different, you know, question between these 3. 3 different questions, 3 different clinical decisions that are all equally critical, arguably. And when you're clear on which question you're answering, Everything else becomes so much easier. Your evaluations become more organized, your referrals become more intentional, your treatment becomes more focused, and your patients are the ones who benefit from all of this, right? All right. So I feel like I've been on a soapbox, but I wanna go on another one for just a minute because there's something I've been thinking about for a long time. And honestly, I think this is one of the biggest problems in our profession right now. We've become really good at collecting interventions before we've become really good at clinical reasoning, right? And those are not the same thing. Right? They're not the same. I can't tell you how many times someone has asked me, "What's your favorite exercise for tongue thrust?" or "What's your protocol for low tongue posture?" or "What do you do for mouth breathing?" or "What do you do with a kid has a tongue tie and you're prepping them for a release?" Right? And every single time my answer is, "It depends." Now, do I give you actual exercises and explain when to use them and why and everything inside my courses? Yes. Yes, I do. But still, it depends. I know that's not the answer y'all want. Y'all, you guys want the magic exercise. We go wave our magic wand and poof, you're fixed, right? You want the protocol, the checklist, the 10-step system. But listen, our patients don't walk into our clinics as diagnoses, right? They walk in as people. People with different histories, anatomies, nervous systems, compensation patterns, goals, right? So why would they all get the same treatment? Because treatment without clinical reasoning is just guessing. And I know that's a little blunt, but you know, I can be that way because I think it's true. Knowing 100 exercises doesn't make somebody a great therapist. It's knowing when to use them, when not to use them, and why you're choosing to use the one that you are. That's what makes you a great therapist, right? I always tell my students, don't fall in love with an exercise. Yeah, okay, I have a few of my favorite exercises, but don't fall in love with them. Fall in love with understanding the patient in front of you because the patient is going to tell you what they need. Their body's gonna tell you what they need if you know how to listen. And I don't just mean listening to the parent and what they're saying. I mean actually listening to the body. What's the posture, the breathing, the movement, the swallow, the habits, the compensation? The body is constantly giving us information. Our job is to interpret it, right? It's a dance between art and science. We are not here to override it. We're here to interpret it. And here's another thing I think we're getting wrong while we're at it. We spend way too much time asking what exercise should I do? And not nearly enough time actually asking what pattern am I trying to change? Because those are completely different questions. Once you understand the pattern, my friends, the intervention usually becomes way more obvious. And if the pattern changes, the treatment changes. If new information comes in, the treatment sometimes changes. If another provider uncovers something medically, the treatment sometimes changes, right? Treatment should evolve because patients evolve. And that's why I don't believe in cookbook therapy, you know. And again, if we're being honest here, I don't think patients deserve cookbook therapy. They deserve clinicians who are thinking. Every single session. That's what clinical reasoning is. It's making decisions, not following recipes. And I know that can feel really uncomfortable when you're newer. When you have myofunctional therapy, it's normal to want certainty. I did too. I wanted someone to tell me, "Yeah, yeah, if you see this, do this." And listen, that works sometimes. But after treating patient after patient after patient after patient, I realized that's not how great clinicians think. Great clinicians stay curious. They're flexible. They keep asking, "What am I missing?" And that became my favorite question. What am I missing? Have we tackled everything, right? That's the question I probably ask myself more than anything else during an eval. What am I missing? Am I missing anything here? Because if you keep asking that question, your patients will continue making you a better clinician. All right, I want to spend a few more minutes talking about something that I think creates a tremendous amount of confusion, and that's the difference between anatomy and function, my friends. Okay, so these are different conversations. They're just not. So let me give you an example. A child comes in with a tongue tie, what's one of the first questions that people ask? They go, does it need to be released? Is this tongue tie— is this a tongue tie? Do we need to release it? Right? First of all, compared to what? But before I can even answer the question about whether a release is appropriate, we have to also say, hey, you know what, that's actually out of scope. I can't tell you whether or not we can release. Only the release provider can. But before we even decide if you should go see the release provider for a consult to determine if a release is appropriate, We gotta answer a really important question here. How is this child functioning? That is the question that drives everything. And this is what I've seen over the years, right? I've seen children with very obvious anatomical restrictions who function surprisingly well, and I've also seen children whose anatomy doesn't initially raise major concerns and their function is significantly impaired. So if I make my clinical decisions based only on anatomy, how that tethered tissue might look, or that tight tissue, that fascia, that frenula looks under the tongue or under the lip or, you know, the 4 buckles or whatever, I'm gonna get some of those decisions wrong. And that's why I always come back to function. How's the child breathing? How are they eating? How are they swallowing? How are they speaking? What's their tongue doing at rest? You know, what compensations have they developed? Where is the body seemingly working harder than it should? Now, does anatomy matter? Yeah, absolutely. Of course it does. But structure, right? What we need to look at is how structure influences function. Right? And we know that. You may know that now if you've hung around here. You know, a restricted tongue can absolutely contribute to dysfunction. A narrow palate can influence breathing and tongue posture. An airway that's obstructed is really important to take into consideration and address, right? Orthodontic relationships matter. Structure matters. But structure is just one piece of the puzzle. Function is what tells me how that structure is impacting the person's life. And that's what I want to drive home here. That's the difference. I think sometimes clinicians feel pressure to immediately answer questions like, should we release or should we wait? And again, you guys can't decide that as clinicians, okay? Dentists, orthodontists, doctors, you know, they can decide— oral surgeons, right? They can decide if a release is appropriate or not. That is— it's a surgery, and they're deciding, saying yes or no to— they're saying yes or no to a surgical procedure. That is out of scope as SLPs, OTs, PTs, right? And RDHs, right? So when people say, should we release or should we wait? Aside from letting them know that's out of scope, it's okay, let's understand what's happening first here. Right? Because if a patient's making meaningful functional progress, why would I interrupt that progress without a really good reason? I actually got this question during Feed the Peds from going through Module 8, where we talk about myofunctional therapy, OMDs and myo, and how it applies to our birth to 5 kiddos before they're ready for traditional myofunctional therapy. Because that's when that starts. You need the cognitive age of a 5-year-old to truly start myo, and some kids are arguably not ready at that age either. But my whole point here is it's like, we gotta understand what's going on here. And I— there was a case that was asked, and does this kid need a revision? Another provider diagnosed a, you know, they think tongue is still restricted, but it was really traumatic for this kid, and there were aversions afterwards, and, you know, the first go-around, and there were so many things happening, and the therapist is like, but the child's making progress. Okay, if a patient's making meaningful functional progress, why would I interrupt that progress without another really good reason to do so, right? Right. Now, on the other hand, if someone has significant functional limitations and they've hit a plateau in therapy despite the therapy being exactly what they need, their compensation patterns aren't changing, right, and I believe anatomy is becoming the limiting factor, then yeah, I'm going to make that referral to the release provider. That's a very different conversation and referral happening, right? So notice what changed— not the anatomy. The anatomy held true in both of those examples. It's the function that shifted from the first example to the second, right? That's what shifted the clinical decision. And I think that's a really important mindset to hold around this because I never want families to think we're treating a tongue-tie. We're treating the impact that it's having on function. And those are, again, two very completely different things. The same goes for mouth breathing and tongue thrust and low tongue posture. And, you know, these are not just labels, right? They're functional patterns. And our job is to understand why those patterns exist before we decide what we can do with them, right? What do we do with them? What do we do about this? Well, we got to know why it's happening. Right? Sometimes the answer is therapy. Maybe it's an ENT referral. Maybe they're going into orthodontics. Maybe there's a release consultation that's going to happen. Maybe it's improving sleep. Maybe it's multiple providers working together. Again, clinical reasoning, right? Not protocols. And honestly, I think this way of thinking is incredibly freeing because it takes the pressure off trying to memorize what you do for every diagnosis, right? Instead, you learn how to think, you learn how to evaluate, You learn how to ask better questions. And once you start thinking that way, you realize every patient is actually teaching you something, right? And not because every patient is different, but because every patient has a different story, right, of how they got to where they're at and how they're presenting right now. And our job is to understand that story before we decide how to help write the next chapter, if you will. So I want to leave you with something that I've been thinking about for a long time. And honestly, I think we're watching our professions evolve in real time. When I first started as a speech-language pathologist everything lived in silos, and arguably a lot of it still does today outside of my world. Speech was speech, feeding was feeding, myo was something completely separate if you even knew about it. Airway belonged to someone else, posture belonged to someone else, sleep belonged to someone else. Everybody had their own lane. And to be clear, I'm not saying specialists are a bad thing. They're not. We absolutely need specialists. But I do think, I do think that we've reached a point where the silos have become so rigid that sometimes we're treating the body parts instead of treating people. Right? Because here's the reality: the child who's sitting in front of you doesn't know where our professional boundaries begin and end. You know, they don't know if feeding belongs to one or two disciplines, and then posture belongs to another, and airway belongs to another. They're just struggling. They know eating is hard, or maybe sleeping is hard, or maybe breathing is hard, or speaking is hard, right? They only have one body, one airway, one nervous system, one oral mechanism, right? Everything is so connected, whether our professions decide to acknowledge it or not. And I think, I think that's where healthcare is going, not towards clinicians who know a little bit about everything, clinicians who understand how systems influence one another. And that's again a really important distinction. I don't think every SLP needs to become an orthodontist, right? I don't think every OT needs to become an ENT. No, I don't think every dentist needs to become a feeding therapist. You don't want to go back to grad school either, right? That's not what I'm saying. What I am saying is that every clinician should understand enough enough to recognize when another piece of the puzzle exists. Because once you recognize it, you ask better questions, right? You can ask better questions. You can make better referrals. You can collaborate more efficiently and effectively. And ultimately, who benefits? Your patient, right? So I think one of the greatest compliments, hey, I'm sending you this patient because I know you're gonna look at the whole picture. You got this, right? It's not just the tongue or the swallow or the articulation. It's the whole person. And I get it. They have to put a diagnosis code on a script in order to get insurance to cover it. If the patient needs to go in network, right? We gotta look beyond that. We gotta look beyond the script, right? Look at the whole person. That's where healthcare is headed regardless of what the script says. At least I hope it is. That's where I feel it's headed. There's some work we're doing behind the scenes to— our goal is to help move that forward. And honestly, that's what's driven almost every educational program I've built over the last several years. So if you've followed me for a while, you've probably noticed something. Years ago I talked a lot about feeding at one point and myo, then I started to integrate more airway and then posture and then tethered oral tissues and nervous system regulation. And some people like, Hallie's just jumping all over with these different topics, but I'm actually not, right? I've been talking about the exact same patient this entire time. I'm just looking at them from a wider lens, right? Because the more patients that I worked with and evaluated, the more impossible it became to try and separate these things out. I couldn't ignore that breathing was affecting feeding. I couldn't ignore that posture was affecting oral function. I couldn't ignore that sleep was affecting therapy outcomes. I couldn't ignore that nervous system regulation was influencing everything we were trying to accomplish. And the patients are the ones who taught me this, right? Not a textbook, not a certification, the patients. And I honestly think that's one of the greatest gifts of clinical experience. Over time, you stop seeing those isolated diagnoses and you start seeing the patterns, and you stop asking, whose discipline does this belong to? And you start asking, What does this patient need? Obviously working in your own scope, right? I'm not saying work out of scope, so don't get me wrong here. But to me, that's what's been— that's what's not doing everything yourself, not replacing every other provider, but understanding enough to know another perspective could completely change the outcome. Because at the end of the day, our goal isn't to protect our discipline. I think people talk a lot about that. Our goal is actually to serve our patients, and those are not always the same thing. So if we can keep that as our North Star, if you will, I think the future of our profession is actually incredibly exciting, right? We shift perspectives over time as we learn new information, as we get more mentorship, as we work with more patients. And I think that's the beauty of being a really strong clinician is having the ability to acknowledge that, to welcome it, and to embrace it. So before we wrap up, I just wanna zoom out one last time. Okay. We've spent the last, I don't know how long it's been, 35+ minutes talking about screening and assessment and treatment and scope and clinical reasoning and all these really important concepts. But at the end of the day, this episode was never really about any of those things. It's about the child sitting in front of you. Because every time we become a little more thoughtful, a little more curious, a little more willing to slow down and ask one more question, there's a child who benefits from that. And it gives me chills to talk about this. That's a family who gets answers sooner too, right? There's a parent who finally hears, hey, I think I know what's going on with your kiddo. And if you've ever been that parent or you've sat across from one, you know how much that moment matters. I can't tell you how many parents have cried in my office because I connect the dots in ways that they never dreamed possible. And they're like, why are you asking me about their breathing in their sleep? Why are you asking me if their mouth is open when they're playing? I'm here because they're a picky eater. Yeah, yeah, of course you are. And these questions absolutely matter. And they're like, nobody else is asking these questions. Well, So it happens when you're an integrated therapist, right? You ask different questions, better questions, questions that help you see patterns, right? And so I just think sometimes we— the impact that we have, and I want y'all to pat yourself on the back for a second if you're truly an integrated therapist, because you know, to us it's another evaluation, it's another, you know, uh, kiddo's file, another patient on the schedule. But to that family, it's their entire world, and they're just stressed and wondering, is my kid gonna eat? Are they going to sleep? Are they going to speak clearly? Are they going to be understood in this world? Right? They're carrying really heavy questions that they've probably been asking for months, sometimes years. And they don't necessarily need us to have every answer that day. They just need us to know how to think. They just, they need us to recognize when something deserves a closer look. And they need us to know when to say, this is within my expertise. And I think another provider needs to be a part of this, or, you know, or maybe I think another provider needs to be a part of this conversation. Right? That's not a weakness. That's a strength. That's exactly what I'd want someone to do for my own children. And I think about that a lot. It's one of, you know, it was always one of my goals. I never want to judge a parent for how they're showing up or how their child is presenting because they're coming to me for help. So I want to know why they're here, how I can help them, and I want to do everything in my power to be that clinician for them because I know how frustrating it is to be, you know, shipped around to different providers and get no answers. And it's exhausting, it's expensive, it's time-consuming. You know, and you're already exhausted when you're working with kiddos that have things going on, right? Especially feeding, sleep, breathing, right? All these things we're talking about, they impact every kid's life every day and then the family's lives, right? So if one of my girls walked into someone else's clinic, what kind of a clinician would I hope they, they meet? Basically, I would hope they meet someone who stays curious, who doesn't rush to conclusions, who isn't trying to just fit my kid into a protocol, who looks at the whole picture who's open to collaborating, who isn't afraid to say, "I don't know yet, but I know we're gonna figure it out," or, "Let me do some research for you," or, "Let me go talk to this colleague," right? To me, that's clinical excellence. Not knowing everything, but knowing how to think, knowing how to observe, knowing how to ask better questions, and knowing when another perspective will make the outcome better. That's what I hope you take away from today's episode. Not just the difference between screening, assessment, and treatment, but I hope you leave thinking differently about how you approach every evaluation from this point forward. Because if this episode changes the way think even a little, every patient you see from here on out is going to benefit. And that's the ripple effect that really excites me. Not one course, not one certification, not one podcast, but thousands of clinicians making slightly better clinical decisions day after day, patient after patient, year after year, right? That's how professions change. And honestly, I think we're just getting started and it's really exciting, right? So if this episode gave you a new way to think about screening, assessment, and treatment, I would love to hear from you. You can come find me over on Instagram @halliebulkin. Send me a DM, tell me what resonated most or what shifted in the way you're thinking about your evals. I genuinely love hearing how these conversations show up in your clinical practice. You know, we've got so many families out there who are constantly being gaslit and told their child is fine, or, you know, what they're seeing is not clinically relevant, and half the time it's actually— it is relevant, right? So anyways, if you found this episode helpful, I would be so very grateful if you would share this one with a colleague My hope has always been that these conversations don't stop when the episode ends, but that they continue in clinics and in hospitals and private practices and, you know, even schools, treatment rooms all over the world. And if you guys do want a free screening tool for myo, you can go to fastmyoscreening.com to download that. There's a fast myo screening packet. If you are ready to go beyond screening and you're like, Hallie, I really wanna dive into assessment, I'm gonna share this with you because I alluded to it a couple times during today's episode, but to really develop the clinical reasoning and the confidence to assess and treat orofacial myofunctional disorders as part of an integrated approach. I'd love to invite you to go to themyomethod.com to learn more about that course. And if you have any questions about it, let me know. You can always DM me @HallieBulkin. That's where we take everything we've talked about today and we go so much deeper, right? With the new mentorship and hands-on application that just simply isn't possible in a podcast episode. So anyways, go to themyomethod.com, check it out. We have some other programs available as well. If you're looking for more mentorship-based, less course-based type of— so again, just DM me @HallieBulkin. I can always help direct you towards what you need and what would be best for you. Thank you so much for spending part of your day with me. I will see y'all next time on the Untethered Podcast. Quick disclaimer: all information, content, and material of this podcast are the opinions of the speakers and serves as informational purposes only and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these myo-tots 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 at halliebulkin.com or pop over to @halliebulkin on Instagram to get all the latest updates.