Behavioral Science and Feeding Support

[00:00:00] Speaker A: Did you miss the live International PFD conference? All conference sessions are now available on demand, including every presentation from the live event, plus additional on demand only sessions. And to keep the conversation going, we are hosting live Q and A sessions with conference speakers, giving you the chance to explore the topics people are still talking about. Go to feedingmatters.org conference and log in or register today and start watching before the Sessions close on April 30th. [00:00:35] Speaker B: Presented by Feed Matters with host Jacqueline Peterson and Dr. Haley Estrom. Feeding does Matter. [00:00:47] Speaker C: Hello, everyone, and welcome to Feeding Does Matter. I'm Jacqueline Peterson, CEO of Feeding Matters. Hi. [00:00:54] Speaker D: And I'm Haley Estrom. I'm an associate professor in the School of nursing at UNC Wilmington. [00:01:00] Speaker C: Hi, Haley. How are you doing this morning? [00:01:02] Speaker D: Oh, I'm pretty good. How are you, Jacqueline? [00:01:04] Speaker C: Doing well amidst all of our tech challenges this morning? [00:01:07] Speaker D: Yeah, we're. We made it. We're here. [00:01:09] Speaker C: We're here, we're here. And we're here and excited to chat with Yev, the Verka, who is coming to join us just to share about her world, her profession. Yev, I would love for you to introduce yourself. You've been in the Feeding Matters kind of universe forever. You've presented at conference. You do such a great job of really sharing and encouraging people to think differently about the field and about the capacity in the field. And that's where I think we can focus our time today. But our first question is always kind of, how did you get into feeding? [00:01:43] Speaker D: What. [00:01:44] Speaker C: What led you here? [00:01:46] Speaker D: Okay. [00:01:46] Speaker B: Yeah, thank you. And thanks for that really nice introduction and for having me. I'm so excited to speak with you both. Yeah. So I'll, I'll share a little bit about how I got into the field because it's, I mean, I think this is pretty common, but a non traditional path into it. So I worked as a behavior therapist in the field of ABA with children with autism in their homes and schools. And I was in school to become a board certified behavior analyst, the bcba and just doing like kind of general comprehensive programming for children with autism. And I want to say about every child, but probably like 95% of the kids I worked with had some sort of mealtime or feeding challenge. And families kept asking me to support that. You know, they said like, you know, you, you work on dressing, we work on chores, we work on homework and all these other skills. We really need help with meal time. And I found myself falling short trying to apply kind of what I know to mealtime and realizing I don't know anything about it. And so it's not just like your regular adaptive living skill. But then I started looking into the literature because again I was a student and eager to learn and started looking into the literature just in the behavioral field about feeding. And I started going to conferences and I saw these, these presentations and these papers of really amazing results focused on eating, like on actual consumption. And, and so and I watched kind of videos of like before and after and look at these great results. And so I went back into these homes and said okay, I think I can do something about it. I'll say right now too. And I'm sure this will be a theme that comes, comes up is I've been very humbled by making a lot of mistakes and learning through those. So I'll be the first to admit them because I think it's important. But yeah, I made mistakes. I've gone back to these families and talked through these with them years later, but tried and trying to apply this behavioral, the behavioral science to something that's so complex. So while I was making progress on consumption and families were happy with consumption, nothing about it really felt good in most of the cases. So it was a lot of like these kids who would come running to the door to come to play with me started to kind of not want to have me come into the kitchen and there was crying and, and I always say you know, like the graphs looked so good, the like consumption graphs looked good but nothing felt good. And so that kind of took me onto this like I won't get too much too far into it, but took me onto this journey of then in my PhD program saying I want to learn more, getting to learn from interdisciplin colleagues, getting to learn in like early learning settings instead of clinical settings and finding you all with feeding matters and learning so much in the last however many years I've been had the honor of collaborating with you all. [00:05:00] Speaker C: Oh amazing. Um, yeah. Cause that's kind of a shift. Where do you find yourself? I mean you kind of walked us through like how you got into it and then you like so many people in feeding across discipline had to do your own self education, maybe share a little bit about that journey for, for you in terms of like I think you having been a student in trying to shift you on you, you pursued it your yourself. But what were you finding now that you started to make that shift in your day to day. [00:05:31] Speaker B: Yeah. So that shift happened when I moved to Seattle and went to the University of Washington and went to my advisor and said I was Failing here, but I want to learn how to do better. What do I do? Um, and she sent me to some clinical settings, but she also connected me with folks who were in preschool settings who had knowledge on feeding. So an occupational therapist, a nurse, a registered dietitian, a speech language pathologist, educators. And most of my learning came just from listening to stories and hearing kind of how they've problem solved from their lens and learning, you know, that, that this learning how to look at it holistically at mealtime and feeding. And so I always talk about like I do mealtime support. I don't say I'm a feeding therapist because I want to be very clear, especially with our early learners, our two year olds, that it's so much more than just that consumption I was focusing on before. Of course that matters for so many reasons. But when we're thinking about building enriching, inclusive meal times for a two year old, a three year old, a kindergartner. I've learned so much from my, my interdisciplinary colleagues about how to kind of bring it all together, like their sensory experience and the way they're sitting and the way they're experiencing hunger and their medical history and just kind of all the things that complement kind of my work and motivation and like embedding some learning strategies. Teaching strategies. [00:07:08] Speaker C: Yeah, yeah. Really that approach to learning, mentioning kind of the interdisciplinary work and really being able to pull some of that into how you worked with kids and how you continue to work with kids, maybe share a little bit about. Because that's where we, it's such a balance of. We want to help people think broadly about all of the domains of pediatric feeding disorder and just in general, like you were mentioning holistically. But we also know that that's not always going to be like you have this person representing medical, this person representing feeding skill, this person representing psychosocial and this person representing nutrition. How have you kind of played that within the community for your own self in terms of how you approach being interdisciplinary, but also maybe pulling in the awareness of everything into that mealtime learning. [00:07:59] Speaker B: Yeah, I love that question. And I think that is something that we all need to continue to ask and learn. And I'm very early in that journey. But have you all ever heard that the analogy of like the, like. Oh gosh, the, there's like a metaphor about the soup, the salad, like the multidisciplinary, interdisciplinary, transdisciplinary. [00:08:24] Speaker C: I mean I've heard of the soup and salad based on like a different, like a different. Not applied to this but yeah, interesting. No, I'm gonna mess this up. [00:08:34] Speaker B: Cause I didn't plan on bringing this in, but I always think about this. So there's like the. The salad approach where like all the ingredients have their separate thing. And that's kind of where I started. Right. Like, and then there's soup where they blend together and. And they create a different thing, add their own, like, create a new flavor. And that's our multidisciplinary. But then when you, like, take a bunch of ingredients, I think it's. Bake a cake. It completely changes everything, right? Like the flour on its own and the baking powder, and that's that trans. Where we cannot be siloed. We have to, like, I have to know some things about the sensory system and I have to know the very basics about the medical. Like the medical experience. And so really aiming to. To be okay with having some of that overlap and bringing that into my scope. And this is something I've been talking about loudly within my field too, is we have to learn. We can't just say, this isn't within my scope. This is where my lane ends. But then on the other side, we also have to be willing to people into our lane and to share things. So I love when people learn a little bit about like, strategies to increase motivation and like, something we call shaping, of taking these little steps towards a final goal and how can we take data. And so really that. That cake analogy of. I can't. Kind of can't believe I. I tried to bring that up and butchered it. But that cake analogy of like, we all have to kind of mix and learn from each other and be okay with that, or we're just going to keep on with our silos and try. And then, like, there's just been so much of unfortunately of this, like, kind of stay in your lane feeling. And I want to be like, let's. Like, let's switch lanes. Let's learn a little bit. Let's share the road. You know, like, let's. I don't like metaphors this much, but sometimes they're appropriate. [00:10:30] Speaker C: Sharing the road. [00:10:31] Speaker D: Sometimes they're very helpful. [00:10:33] Speaker C: Yeah, they can be very helpful. Well, and that leads me to one of the topics that I wanted to touch on, which was a lot of bcbas. There's. There's just a lot of conversation about what's appropriate for feeding in bcbas and sometimes what's done well, maybe where there's improvement. What are your thoughts around that? Or maybe what do people misunderstand about behavior analysis? And feeding or where do you hope that the field goes? [00:11:00] Speaker B: Yeah, there's so much just even within, within the field of different philosophies and tension, honestly. So I think there's the kind of. The area where I was describing where I started of kind of like ABA can be the foundation and we can work on consumption and we can do this and then let other people do their thing. And I think that has, I've seen it cause some harm of not kind of seeing it as part of the puzzle. So there's, there's that piece. There's. There's also. I think that as a field we've. I like to say I'm a critical friend of the field. Right. Like I think we've caused some harm and I think I like the story I told was part of it of not understanding kind of long term impacts, focusing solely on kind of one area of feeding without knowing enough about the skill and the nutrition and the medical and like the relational things. And I think that the science is really valuable and can be applied in a way that is compassionate and responsive and, and aligned with some. How some of folks, some folks in our related disciplines think and feel about feeding. And I've, I've seen this within the work in Feeding Matters because we have, you know, wonderful interdisciplinary teams on conference committees and um, we're all very aligned and bring, also bring some differing opinions and can kindly push. Um, and so I think that there's, it's an ant. Like it's a. There's been harm and there's still good to it. Let's not just kind of throw the whole behavioral science out. Let's just try to find kind of that middle ground. But it's, we're, we're early in the process. It's painful to see kind of some of the discussions and arguments out there. [00:13:00] Speaker C: Yeah. And it's hard to move a field forward when there is so much tension. And I think one of the things that we really align with in terms of feeding matters and what you're out there in the world really promoting is that there are such a shortage of qualified feeding specialists and just feeding support for kids in general. Tell me how you think about capacity building in the field and specialty pathways and some of that educational pursuit. [00:13:28] Speaker B: Yeah, I love this question. The other thing I've run into with ABA is when somebody asks, you know, can I work on feeding? There's there a continuum of responses. So there's people that say absolutely not. You're going to cause harm. That's not in Your scope. And then there's people that say, of course, yeah, that's an adaptive living skill. We can use our science for anything. And then there's everything in the middle. Right? But I think, like, that kind of binary question of like, can I or can I not is. Is causing some challenge, some of that tension. And so capacity building is like a. Something I'm really passionate about because we can switch the question to, with the skills I have and the knowledge I have, what can I do? And so I love helping BCBs who have no feeding experience, but have experience with creating positive routines think about, well, you can make mealtime fun. You can make mealtime a place where children want to be. You can bring, you know, regulating, fun things to the table if that's where they're eating. You can help families see how their responses to their children might increase or decrease a behavior. So we have a lot that's in our toolbox, our behavior science toolbox, that we can do just to, you know, like, set up an environment that is proactive, that's positive, that's nurturing, and then we can build onto that. And so I like, I love, love. Starting with the team I've worked with at the University of Washington, we created something called the tiered approach to mealtime support. And so this starts with this kind of, like, bottom block of universal strategies that everyone can do. And I really strongly believe that everyone, families, teachers, childcare providers, should have those very basics about, like, what matters about mealtime and how do we set it up successfully, and then how do we identify when we have all these things in place, all these supports in place. Then it's pretty quick to see when a child needs a little bit more, when they're still, you know, crying and don't want to be there or gagging. Then we can flag for ourselves, like, I need to learn more, I need to do more, I need to collaborate or refer or something. So I think capacity building really starts with that kind of, like, I have these skills. What can I do? And then what else? [00:15:50] Speaker D: What. [00:15:50] Speaker B: What do I need to learn next? What little thing can I learn? To answer your question? [00:15:56] Speaker C: Yeah, no, it was great. I. Because I think as we try to figure out how do we improve, who can help children and families, I really have been thinking a lot about, like, what does that mean as it relates to skill set improvement? Because there's so much that feels advanced, but like you're saying, there's also so much that is very approachable and can be supported by many different adults in a Kid's life. What we. Yeah, go ahead. [00:16:34] Speaker B: Sorry. I was just thinking, too, like, even on the caregiver side of things, I always kind of laugh. You both have kids, too. So when you have your baby and you are sent home from the hospital, you learn about, like, breast and bottle feeding. And you learn right now, whatever the hot thing is, back to sleep, right? Like, whatever it is. And then you're just, like, on your own for everything else. No, teach them how to eat. And then you get these, like, well, child checks where they're like, are they doing these things? And you might check off the thing. The box is like, no, I'm a little concerned. And. And then they don't know what to tell, what to tell you. Not for any fault of theirs, because it's specialty knowledge. But I always think, like, gosh, if we had those at those checkpoints, just, like, the right support of those universal strategies. We're not. We don't have to teach anybody about, like, swallow studies and chewing and tongue movements at that point, but we can say, you know, like, when your child refuses a food, don't. Don't just stop presenting it. Here's how you can make it fun. Here's how you can do this. Here's how you can, like, show them that you're listening to their behavior, like, reading their behavior cues, and you're moving it back and we're making it fun and motivating and so, like, just these little things that I think just need to be embedded everywhere to prevent some of the things. But prevention is hard to sell. [00:17:56] Speaker C: Prevention is hard to sell. I do. I am. I feel like there's positive momentum and hopefully we can continue to build that in partnership with others that are in the field doing similar and parallel work. So I'm hopeful. Me too. And what do you feel like are maybe ways that. Because you mentioned a lot of mentors or others that you got kind of sent to when you were pursuing your journey, we've heard that a lot in terms of how you advance some of those skill sets, kind of maybe beyond that, like, base tier. But as you get higher up in your advanced skill set practice, what do you feel like the role is for mentorship in the field, training in the field in that way? [00:18:46] Speaker B: I think getting out of our silos is a big piece of it. It's really hard when our continuing education requirements have to be behavior analytic. So it's hard to find that motivation to be like, well, I need to learn from a speech therapist. But I've told people that the Biggest thing that I've done is like saying, like, make. Make my friends, like, make my speech therapy friends. They don't even have to be working on the same cases, but someone that I can call up and say, I can't figure this out. What am I missing? What do I need to learn next? And they point me to the right direction and the same way like they can call me. It's bidirectional. So just finding that community, I always tell people to fight it in feeding matters. I mean, most of the many of the people I reach out to I found through this community. And so it's really nice to have all these folks at my fingertips that if. If they don't know the answer, they might know someone who does and to continue to build the community that way. And then the other thing that I think is the scariest thing I've been doing in the last five years, but I've been reaching out to people I'm scared of. Not people I'm scared of like. But essentially like people who have openly, you know, said they. They don't agree with my philosophy or they. Or have said things about behavioral science or whatever it is and have asked for a conversation with the. Not to prove myself. That was like, old, probably like baby. Baby docs didn't me. But. But to really truly understand, like, what happened, like, what made you feel the way you feel now about ABA and feeding. And I've learned that there's so many good reasons why people have, you know, behavior has a purpose. Right? That's my core belief as a behavior scientist. So there's so many reasons why that behavior and that kind of like, close. [00:20:47] Speaker D: The. [00:20:48] Speaker B: That thought process has been shaped over time. So really understanding that has helped. It's been vulnerable. But just like I've. I've made some really good friends and people who. I would have never thought to speak to you about it. [00:21:01] Speaker D: So what do you think people most often under misunderstand about BCBA and feeding, that maybe that maybe triggers those kinds of conversations? [00:21:17] Speaker B: You know, I don't know if it's a misunderstanding or if it's just like, our field has shipped, it's new and it's shifting fast. And so it's very. Like, if I watched myself first doing feeding, I would also be like, no, I'm not sending a kid there. I don't like that. And so I think it's just like, maybe a misunderstanding that there are. There is a shift because, you know, like, what. What gets published in our field is really rigorous research studies. And there's very little qualitative information on feeding and mealtime of, like, how it feels. How do we measure some of these other things? What about, like, joy and connection? And so if you just look at our literature base and say, this is the ABA approach to feeding, I don't think it's misunderstanding. I think it's just reading. What's right there is that it's rigorous, it's intensive, it's clinical. Um, but there are folks. There are way. There are so many of us that are practicing, but maybe not publishing, that are doing work that's more aligned with kind of how other. Other folks are thinking about, like, responsive feeding practices. [00:22:32] Speaker D: Yeah. [00:22:33] Speaker C: Oh, go ahead, Ailey. [00:22:36] Speaker D: Well, what does it look like when it's done well, [00:22:41] Speaker B: yeah, so when it's. This could be the rest of our time together. I'll try to keep it quick when it's. When it's done well, I think the first thing is understanding the family and the individual's kind of vision for an outcome. So removing all of these arbitrary. Like, we need to get to the point. We need to get from eight foods to 20 foods. There's so many of these kind of arbitrary goals out there, which I get have to happen for research purposes to show progress. But I've had families I worked with that say, we just want him to be able to go to a birthday party and join the kids and not gag just because there's a cupcake. Like, we don't. We don't care if we have to prepare special meals. And there's other people that say, you know, we can't afford to keep eating like this, and we need to. We can't keep going to get the fries every single evening or the specific pizza. And we really need to expand. And those are. Those two families could look very similar on paper. But I think for it to be done well, you have to understand, like, the outcome that's going to impact their quality of life in a meaningful way. Not just what I decide is right by numbers. So I think that's first. And then what I tell families is that. And I don't know, I mean, anyone can push back, but I think that this is kind of the way we should be shifting forward is as a behavior analyst, I think our skill set is to really break things down into their smallest achievable steps. And so I tell a family, you know, like, you want to be here. You're currently here. My job is to connect the dots, like, in as many steps as possible. So if you're wanting your child to be able to, you know, be around a cupcake without gagging, but they, you have to put them in the car to eat and that's the only place they eat. Like some small steps are to be able to happily and joyfully eat in different locations. And we might plan some silly programming around like let's, I just worked with a family on this. Like she likes fun little games. So like let's spin a spinner and see where we're going to eat our snack and it's going to be silly and fun and mom's going to be with you to do your favorite activities and then we'll switch but like taking those little snacks steps and showing families that like we're still making progress, we don't have to do this intensive like tolerate the cupcake and then I'll take it away kind of program. So just, I guess little steps in alignment with family values is the kind of shift I'd like to see. [00:25:23] Speaker D: Yeah. So it's not just, it's not about just like showing this lockstep increase in consumption on a chart or a graph, but it's about aligning with the family centered goals and, and really listening to them and what would be meaningful to, for all of them. [00:25:40] Speaker B: Exactly. [00:25:40] Speaker D: And having it be customized. [00:25:43] Speaker B: Exactly. And they never say, I will say like zero. They've never said I want them to eat 10 more foods or I want them to consume this. Like they don't use words like consume or refusal. They say things like when I say, you know, if I had a magic wand and you're, and you had a perfect meal time, what would that look like? Say we would just sit together and eat and talk about our date. Nobody talks about like consumption at all. I mean they talk about consumption. They're like, they'll, you know, we'll all eat the same meal without you know, a lot of distress or any, or things like that. But most people use words like we, we sit together, we're, we talk, we're connected, we are happy. It's not stressful. [00:26:30] Speaker C: Right. Well, and you're touching on something that we've talked a lot about. Both, I mean two things. A lot of the like shift between individual versus like the need for standardization and families, individual needs, but also how important language is. And there's this like translation that we're just trying to navigate through which is like a lot of the field or different disciplines have their own language for things and families have their own language for things and even kids have their own language for Things. And how do you kind of be that translator or. Or help support what's a shared meaning or understanding of things? And because you're calling it out right there, just like families are saying this, and that's what they're telling you their outcome is. [00:27:13] Speaker B: Right. And I think our common language is like. I was going to say English, but not English. It's like human language. [00:27:19] Speaker C: Right. [00:27:20] Speaker B: Like, it's not our jargon from our field. So it's on us to. I'm not going to say, like, we increase intrinsic, like, motivation. [00:27:27] Speaker C: Right. [00:27:28] Speaker B: Like, it looks like your kid wanted to be there. [00:27:31] Speaker C: Yay. [00:27:33] Speaker B: And like, we're. And no family's talking about, like, tongue lateralization or all the different vitamin. I mean, maybe they are if they're, like, looking into that specialty. But when it comes to meal time, not like that nutrient analysis or the oral motor skill analysis, when it comes to mealtime as a whole, it's really simple language. [00:27:53] Speaker C: Yeah. [00:27:54] Speaker B: On us. I think that's a great point, Jacqueline, that, like. [00:27:57] Speaker C: Well, it's leading me to my next question for you, which is actually something that the conversation that Haley and I have had on this podcast before, it's been a struggle of ours, like, as we've heard from our Person and Family Centered Feeding Research Consortium about the impact of words and how words feel can feel a certain way for families. And I would expand that to many different disciplines based on their experiences and everything. We've always struggled with behavior in general because, like you said, behavior has a purpose. And we've had certain circumstances where behavior has felt really harsh or behavior has been just approached like it is a field. And so our struggle in really trying to navigate how do we have, like, a person and family centered, almost like Dictionary of Words has been in things like, especially behavior. And because there's so much tension in that space, particularly, I mean, there's certainly other words as well. But what are your thoughts on that? Or do you have any solutions? Because we've navigated of, like, I unders. I completely understand that it's a field. It also feels harsh to some people. [00:29:06] Speaker B: I mean, I think it's a question I grapple with, too. And especially because, yeah, behavioral science is a field. Like, when I say behavior, there's no connotation. It's just a thing a person does. And so part of me just, like, wants to blast that and be like, everybody. Like, it's okay, behavior isn't bad, but it's too. I mean, the damage has been done. Right. And so I don't. I Mean, I think there's ways for us to describe, kind of like, act like how the environment and other people's responses influence a child's responses in a way that's not getting too much into the behavioral jargon. I think that's the point. There is like, when I say all behavior has a purpose, I think about behaviors we want to see more of and behaviors we want to see less of. But the whole point is that, you know, like, I'm looking for a response to the environment to show me kind of what, what's happening and what's going to happen in the future. So if I present the green beans and the kid turns away, that's a behavior, but it's not a bad behavior. And so anyway, without getting too much into the jargon, I think that it's really about that environment, a response to the environment and response to all the different contextual things around mealtime that we're focusing on. And I think as a field, we probably could do better focusing on that. Like, we can still use our, our language to describe kind of why something might be changing or explain it, but with families and with other professionals, just really kind of bring it to what, what happened and what can we change in the environment to support those child. But I, yeah, I don't know what. I want to know what everybody else thinks about that. [00:30:57] Speaker C: I mean, it's just been a constant, like, challenge in the sense that, you know, I really think of ourselves at feeding matters as problem solvers. And that just feels like one of the hardest problems to solve. Not just in the feeding world, but sometimes we butt up against system challenges even beyond our world. And that just feels like one of them, but doesn't mean we can't make forward progress and have those conversations. And that's why I really appreciate that you're interested in having conversations with those that maybe have been critical of you or your philosophies are different things. I think that's the only way we can kind of start to make some forward momentum in building bridges in this space, especially because of how many people are involved, how many people need to be involved, how many disciplines and just to, to advance this field. [00:31:44] Speaker B: You're making me think of the flip. Can I share, like the flip side of this that I've experienced? So it's like a. Sometimes I feel like it's a lose. I have hope too, but sometimes I feel like I'm in like a weird lose, lose situation. Kind of translate where it, like I do put out even within my field. I Put things out. And I use language that is not behavioral often. And I have gotten some pretty intense feedback on, like, you know, you can't be putting this out as a ABA continuing education unit because it's not rooted in behavioral science. And so then I'm having to, like, reverse it and be like, well, it actually is rooted in behavioral science. When I say joy, I'm like, you know, and so I'm having to, like, almost prove myself. Like, when I say joy, I'm thinking about these behaviors, like smiling, leaning in, coming to the table, staying. And so I've also. I've also felt the other side of it. You're not a real. No, nobody said I'm not a real behavior analyst. But people have questioned the ethics of it. Like, it's gotten. People have. Have said things like, you know, the stay in your lane comment of, like, this isn't truly behavioral science. It's not rigorous enough. And I'll say that that's a. It's a small. Like, it. It. I feel it in a big way, but it's. [00:33:06] Speaker C: Of course you're going to feel it. [00:33:08] Speaker B: It feels very personal, but it is. Like, it's. I can see why behavior analysts are kind of scared to put. Put themselves out there and say, like, I want to. I want to do this, and I want to do it in this way, because you're going to get pushback from all the sides. [00:33:23] Speaker C: All the sides. Yep. Well, so then, as you think about the future, where do you feel like the field needs to go next? [00:33:35] Speaker B: So many places. The field of behavior analysis. [00:33:37] Speaker C: Yeah, let's talk that specifically and then maybe zoom out to feeding in general. [00:33:42] Speaker B: I think learning from the different disciplines first, learning about, like, I think that we. Working with kids with autism, who is. Is most of what behavior analysts do, or developmental disabilities. And so I think that we have our responsibility, just like we do about learning about autism and the diagnostic criteria of autism and how it impacts the kids we work with and how they learn. We adjust to that. I think we have a responsibility to realize that almost all of these kids also have, whether, whether it's a diagnosed, like, pediatric feeding disorder or they're on their way and have some parts of it. I think we have a responsibility to know more about it and not just to pass it along. Oftentimes, behavior analysts work with families for hours in a week, and we do caregiver coaching and we send people into homes, and we're there a lot, sometimes all day at school. And so that means we're there when they Eat. And it's a missed opportunity if we're not doing something. And then on the other side it's a opportunity for harm if we're doing too much without knowing what we should be doing. So I think our field owes it to our clients to learn more about feeding and not just pass it off as a start point. Yeah, [00:35:13] Speaker C: yeah, I think, I think that's a great starting point. And it's. And kind of even goes back to how you, how you can kind of learn and integrate other awareness for other domains and disciplines as we kind of even zoom out from your specific discipline. And how do you feel like the future of the field looks in terms of that more transdisciplinary take approach or how the field can work together with other disciplines to better support either capacity building, specialty education or advancement of best practices? [00:35:51] Speaker B: I think it starts in, and this is specific to developmental disabilities first, but Birth to three and early intervention type services, though they already have all the disciplines and they don't have often feeding isn't a specific thing that is talked about or worked on. So you know, we've got our folks who might be working on routines, we have folks who might be working on the oral motor piece and folks who are working on the sensory piece, but kind of taking that next step of how do we bring it all together and think about mealtime or feeding. So I think if we kind of proactively thought about it in Birth to three and brought that awareness and education and resources to people who are already in homes and centers with children, starting there would be great. And then I think that could be like in my dream world, a model for how to then grow it past the area of like developmental disability. So how do we, you know, how do we make sure somebody's holding that information and putting it all together and realizing that any of us could be that person as long as we have all the necessary parts. So this makes me think of a friend. I have a friend who is experiencing some feeding challenges with her three year old with down syndrome. And she is on a, she has a G tube and she has all these other things going on. She was born premature. And my friend said something to me that like, stays with me daily. And she says, nobody wants to own feeding. And so it's this like I, I think if somebody were to just like gather the information and hold it so it's not the parents and say, you know, even if they're not the one calling the cardiologist, but they're gathering that and saying, what did you learn in the last month, like, what do I need to be aware of? And putting that all together and seeing it would be such a dream. But I think it's true. Nobody, nobody wants to own all the information. They just want to own their little sliver of it. And that's where we're failing, I think. And that's where we can do better as a positive spin. I think we're. We're improving there too. [00:38:05] Speaker C: Yeah, I do think that. I think it's been challenging because it's like, it's so much to own. So that's why it feels better to stay kind of in your little sliver and have awareness of all the other pieces. But you're right, I think in terms of being a better partner for families, it's often why I feel so. So it just feels so challenging for those out in the community because I feel like oftentimes our feeding specialists, our feeding therapists, or however they want to kind of call themselves end up being kind of that holding spot in partnership with a parent or a caregiver. Um, and so we do. We do need to. To shift that a little bit. Uh, another thing I wanted to point out that you mentioned, Yev, was like, the. That kind of like, expansion of who can really support feeding, and that it almost feels like what you're thinking about for the future of feeding is that that tier one that you described of have having so many people have so much more awareness of hopefully that feeding development as its own standalone domain, that then everybody can kind of work on it together and before we need to advance levels of care or more specialty intervention or any of those other pieces. [00:39:16] Speaker B: Totally. Yeah. And it's not like, it's not a unique idea. This has been something that's been used in prevention health for. Since like the seventies, maybe before. So. [00:39:28] Speaker D: And. [00:39:29] Speaker B: And then in schools, there's the pyramid model of. With this philosophy of if everything is in place proactively, we can right away understand when somebody needs more. So what is that? What is that bottom block in feeding? Who needs to know what is, I think, is the question we've started to ask. I think we've answered it quite a bit in our little bubble in our developmental preschool here at the University of Washington. But I think it would be really neat to see that in all Head Start programs and all childcare programs. And just I'd love to walk in and see a meal time where food is described and people sit down and show kids how to interact with it. And I just really wonder how much that could kind of provide support proactively before they go to that three year, well, child check and be like, they just dropped 10 foods. What do I do? [00:40:26] Speaker D: Yeah, [00:40:30] Speaker C: well, yeah, we really appreciate your time today. This has been such a great conversation and so much that I think gives me hope at least where we're kind of hoping to see the field go as it relates to feeding development and as we're pursuing the center for Feeding Ethics and really trying to, like, get into a lot of these questions that we need to figure out. And then so much of what you're doing and really thinking about capacity building. So thank you for your time today. We have one last question, but I wanted to see, before we ask our last question, if you had anything else that you wanted to share that you maybe didn't get a chance to share. [00:41:04] Speaker B: I just wanted to say thank you. Even just doing this podcast and bringing folks on from different areas and philosophies is bringing so much awareness. So thank you for having me join and for all the work you two are doing. [00:41:18] Speaker D: Thanks. Yes. [00:41:21] Speaker C: Okay, well, so then if you. So we talked about the future of the field, mostly from like, the clinical and like, system perspectives. What is the shift that you hope that families see? Like, what's one shift you hope families in their experience of care in the next few years, what do you feel like you're hoping that they see? That I guess would maybe be our outcome for some of these changes in the capacity system side that we would like to see. [00:41:47] Speaker B: Oh, my gosh, I love that question. I hope they start to feel more listened to and feel more empowered to drive some of the, the decisions. I know a lot of families come to us as experts and like, you know, tell me what to do and I'll do it. I remember someone, a family member at Feeding Matters, saying, if you told me to do 10 jumping jacks before I feed my, my would do it, child, I'll do it. And so I want to, like, yeah, really empower us. Feel. I want to see families feel more empowered to say, I don't think, I don't think I can do that because we have soccer practice or because we in the car or whatever it is. So that's one thing. And the other thing is I, I'd like families to feel like they don't have to rearrange their whole life and context to, to access therapy. I'd like to see more bridges built to like, okay, we taught you these things. Maybe you have to come into a clinic and like, learn all these different parts and get the tests. But now our job doesn't end here. Now, let's see. How are we going to push that into your existing meal time with soccer practice and with the days you're eating in the car and. And being told that sometimes it's okay to just, like, you don't have to do the thing today, like, just get through it. And so I think families have so much pressure, and mealtime's supposed to be this connected, joyful experience. But if you're always thinking about, like, oh, I. I didn't. I didn't do the jumping jacks, or I didn't do whatever it is, then that's the way. So I'd really like. I'd like them to feel like their context matters and that somebody's asking them, like, where do you eat? How do you eat? How can we. Now that we worked on this, the skill. But your kid sits at, like, the counter on a bar stool, like, what are some things we can do to support that with, like, you know, their either physical support or motivation or whatever it is? I'd like to see the bridge. [00:43:54] Speaker C: Oh, I love that. And really looking at the whole family is to make it real. Yeah, to make it real. Well, thank you so much. Y. And we will see everybody next week, but this has been a great conversation, [00:44:09] Speaker B: so thank you both.