Exploring the Evolution of Care

[00:00:00] Speaker A: When supporting a loved one with feeding differences, it's easy to feel like you're alone. At Feeding Matters, our hope is for you to find the community resources and support that you need. Through our Power of two parent to parent mentoring program. Parents in need of support are matched with one of our volunteer family coaches who have lived experience with their own child and can offer emotional support, resources and guidance to lessen the isolation that families often face with pediatric feeding disorder [00:00:34] Speaker B: as well as avoidant restrictive food intake disorder. [00:00:38] Speaker A: Families can request a one time phone call or a three month or six month match by filling out the request form on our website. A family coach will make contact via text or email first to set up a phone or video call, typically within two to three days. For more information, please contact us at 623-242-5234, extension1oreedingmatters.org and please remember, you're not alone. [00:01:08] Speaker B: Presented by Feed Matters with host Jacqueline Peterson and Dr. Haley Estrom. Feeding DOES Matter. Hello everyone. Welcome to Feeding Does Matter. My name is Jacqueline Peterson, CEO of Feeding Matters. [00:01:28] Speaker C: Hi. And I'm Haley Estrom, an associate professor of nursing at the University of North Carolina, Wilmington. [00:01:36] Speaker B: Hi, Haley. Nice to see you today. [00:01:38] Speaker C: It's nice to see you too, Jacqueline. How are you? [00:01:41] Speaker B: I am doing pretty well. We at Feeding Matters have a long history of different people who have leveled us up and who have been integral into our efforts. And so the guest that we have today is one of those key players. And so I was so excited when we were talking about who would be great to have on the podcast and different things. And this woman is just one of the most inspiring people I've ever met and has been a personal mentor of mine. So it's very exciting to be able to talk to Rhonda Anderson today. And Haley, I knew you and Rhonda would hit it off because you both have nursing as a background and are both nurses and I think you take that into every other area of your life as well. But Rhonda came to us as CEO of a children's hospital and then was our board chair for several years, especially like key transition years for us. So. Hi, Rhonda, welcome. [00:02:42] Speaker D: Hi, Jacqueline. It's great to be here. Thank you for inviting me. Haley, it's nice to meet you. [00:02:48] Speaker C: Nice to meet you. I am always excited to be talking with another nurse. [00:02:53] Speaker B: Yeah, yeah, it's you guys talk, speak your own language sometimes. For better or worse. I don't know. Right. Well, Rhonda, as we get into it, I thought maybe the first Question we could talk to you about is maybe sharing a little bit about your career history and trajectory. Kind of like from starting off as a nurse all the way through when we engaged with you at feeding matters to what you do today. [00:03:22] Speaker D: Okay, thank you for the invitation to do so. I've had a long career and I'm really excited about the various types of things that I've been able to do. And that's what's so wonderful about nursing. The first position that I had was at the Chicago Maternity center and we delivered babies in the projects of South Chicago. Then I went to Decatur, Illinois and worked as the night nurse at an adult orthopedic unit. 72 beds and we didn't have anybody in the emergency department. So the paramedics would ring the bell and I'd go downstairs and manage that and then come back upstairs with the rest of my team. And there I also taught LPNs and helped them develop help the organization develop a cardiac care unit which they did not have. So I've had great experience with adults and pediatrics throughout my career. I went to desert here in Arizona after Illinois, then I was recruited to Connecticut with Hartford Healthcare Corporation and then was recruited back here to start the pediatric hospital here with the Banner system. So I've been all over and had great opportunities when I was in Connecticut, helped build the Children's hospital there. So that's what was helpful here in Arizona when I was able to build this hospital. My most recent position full time was with Banner as the CEO of Cardin Children's Hospital. I left that and do what I call preferment and I'm on 14 boards which I put into various categories. One is startup companies with venture capitalists, one is my professional groups. And I just left the presidency and still am on the board of American Nurses Credentialing center, was the president of ANCC and then also have been the past, the past president of AOL. So I a lot of the national organizations on which I serve and was a regent for ache, so the American College of Healthcare Executive. So try to really spread and draw people together and get a larger network. I don't call this retirement. I call it preferment because you can say yes or no and I'm not very good at saying no I guess. But I do have my own consulting business and have set up some children's hospitals in Southern Arizona and also in California during that time and also work for Global Healthcare accreditation and we accredit medical travel programs all over the world, both domestically and internationally. [00:06:20] Speaker B: Isn't she incredible, Haley? [00:06:22] Speaker C: Yes. I mean, yeah, listeners. You can't see my face, but I'm just. I'm nodding, and I'm just. I'm looking in awe here. I'm. I'm very impressed. Color me very impressed. [00:06:35] Speaker B: Yeah. And, Rhonda, you brought that expertise when you were started as kind of just like a strategic consultant with Feeding Matters and just active volunteer in that sense, and then continued on and was on the board and then was our board chair. Do you want to share with me a little bit about kind of how you found out about Feeding Matters and, like, your history with Feeding Matters? Yes, please. [00:07:00] Speaker D: So at the children's hospital, we had children who had feeding disorders, but at that time, they weren't called that. They were just either kids that were picky or something. And we were really very concerned. And then we met a founder of Feeding Matters who had children who had feeding disorders and had to go out of the state to have some care. So we became very interested in what can we do, how can we do that at Cardin Children's, as well as work at a state level and maybe eventually a national level or international level to help children and families who have feeding problems and they aren't quite sure what it is or how to get it diagnosed. And pediatricians and others were not so sure they knew either at that time. This was a long time ago, obviously, but we were persistent with that with a couple of the staff that I had in my rehab program with the children and worked closely with the leaders at Feeding Matters, which was just a neophyte organization at the time. And we were able to work with them to help both develop it, make sure that people understood it was different than just having a picky eater. There is a diagnosis here, and there is chronic illness here that needs to be managed. [00:08:42] Speaker B: Yeah. And you did such a great job of helping us think through strategically and kind of organize our thoughts around, like, what we need to do and how we need to be approaching this, both kind of from, like, an organization level, as well as how we are approaching this field in general and how we're trying to evolve the field as well. And I think that that was really beneficial to, as we went through that, like, naming process and the consensus process and all the other things that kind of took place. [00:09:21] Speaker D: And I think the partnerships, like with Children's Action alliance, et cetera, really important to not just stay in your own little world, but to really reach out and make certain that people and significant organizations that work with children understand what really is happening here. And evolve in their understanding and learning as the organization evolved and understood the differences, et cetera, all the way to getting their ICD codes to really have a diagnosis that is accepted nationally. [00:10:01] Speaker B: We really couldn't have done that ICD process without strong partnerships. And that was something that you continued to help support us in thinking through. And it still rings true today. Because even today, one of our values is collaboration. And we believe that collaboration happens in many different forms, but it takes kind of that two way street. But being supportive of each other because your values are aligned, your mission is somewhat aligned, and you're working towards something together. Yeah. [00:10:30] Speaker D: And I would also add that I think as I left the board and the position, I was adamant that we needed to be sure we were serving these individuals all the way through their life. And the transition of being a teenager into being a teenager and all the issues that they face, different eating than their colleagues, sports, all the kinds of things that we worked with there and then off to college and the same kind of thing. So the transition of life experiences and how a feeding disorder affects them and can be in a positive way, but could be in a negative way. And we were really able to, I think, help navigate that so that we helped those individuals as they moved forward into college, et cetera. [00:11:29] Speaker B: Yeah, that's so true because so kind of even backing up Haley, and this is just storytelling to you. Rhonda was board chair when I took on the CEO role. So it was like middle of the pandemic, still trying to figure this out. We knew we had a leadership transition. Luckily we had a strong board chair and leader in Rhonda to help kind of get us through a leadership transition in the middle of a pandemic. And so Rhonda's always been so good about mentoring me and kind of like challenging me to be kind of like the best leader I am for this organization. And some of that was like, like, let's not be too siloed in what we're thinking. And Rhonda's right. Like, she was very much about, like, are we forgetting or leaving behind as these kids grow up and what happens as they grow up? And what support does that look like? Like, what support is needed or what does that support look like as they grow up? And Rhonda, I think even fast forwarding through that, something that's been a great lesson for us in really diving into the lifespan span thought process has been, I think, this realization that not only are we trying to bust silos a lot at feeding matters, like between disciplines and how disciplines are communicating or even how two different fields are communicating between like the pediatric PFD space and the ARFID eating disorder, like feeding disorder, eating disorder worlds. But there's this like lifetime silo busting that we're trying to like, I think stepping our toes in a little bit and getting a little bit better at of just like I think when you're in the pediatrics world, you think only pediatrics and you forget that there's this like cliff and I, you know, like families experience that Cliff very drastically. And so what is it that we need to do to not only stay as an early identification organization, but a supportive organization for the lifespan and even the handoff or what that looks like for adults too as they grow up. Because kids grow up and we still need to support them and their families. [00:13:30] Speaker C: And I keep wondering about, because my family's very much in that stage right now, like what happens when like there's a care cliff, but your child is developmentally kind of staying in a plateaued spot. Like if you were to, if you were to look at my child who is chronologically 18, you would guess that he's maybe 9 and developmentally younger. So. And he has, I'm going to still call it pfp but you know, now they call it arfid. So you know, what, what can we do for families like this like mine? And it feels, you know, it becomes very awkward to navigate care when we're, it's beginning to be, you know, kind of dropped by some of the providers so. [00:14:31] Speaker D: Well, and that's one of the things that we really tried to focus on was the interprofessional understanding of this child. And each child is different. So not. So this 18 year old and two other 18 year olds aren't the same. And how the interprofessional team interacts with them is really important. And that's where the family comes in so strongly as well, where the interprofessional team needs to listen to the family as opposed to telling the family first what to do. And so we had a lot of conversations with our interprofessional team at Chuck Hardin Children's to kind of role model a lot of that so that they were doing the individualized care, listening to the family and making certain that they weren't making judgments without really having the full assessment done. Yeah. [00:15:27] Speaker B: And I, I know a lot of families that are strugg that struggle with how do you advocate for that care? What sort of feedback do you have for families that maybe they have A gut feeling or they want to ask questions but are afraid to do so or don't necessarily know how to navigate conversations like that in a power dynamic that is often at play, it looks like, Haley, you've got something to add to the question. [00:15:51] Speaker A: Yeah, right. [00:15:51] Speaker C: Like if, if they don't want to be labeled as. Yes, you know, that family or. [00:15:59] Speaker D: Yeah. [00:16:00] Speaker C: Or as combative, you know, they're, they're just trying to advocate. [00:16:08] Speaker D: So first of all, a lot of the people that I work with now, because I work with, make a wish and I wish granter and all and talk with the staff there about the kinds of questions they should ask for any child that has a chronic illness in talking with parents. When I was at Cardin and I did a lot of that, it wasn't just my staff, you know, and I sat in an office, but I was really out with everybody. I would ask them to journal and journal their observations and their questions of the last week, you know, each day, what went on at the table, how was the child acting, et cetera. And how are they doing in school and other places, not just with the feeding issue, so that they had their journals that they were able to then bring with them and ask their questions. And our goal was to make sure that our staff asked them to talk first. And so Haley, talking about your comment, I think it's a two way street. We have to teach the staff, if they aren't already there in that process. And I know, Jacqueline, we've had lots of classes on that, our annual meetings and things like that, and to then have some practice sessions. And I honestly believe. And you. This is a little different. Jaclyn, we haven't had this conversation, but I'm working with some students at one of the colleges to talk about and work with AI so that AI can be programmed to be that parent and to ask those questions. And we can teach the student how to be a good nurse in listening and then asking their questions and together making a plan. So I think we have opportunities, especially now with technology even to do a lot more of that. But the two things that have to happen is we have to help encourage the families to keep enough information so that it's clear for the care provider. And we have to teach the care providers how to ask the question to begin with and then listen and not just tell if you will and. Or label. And I have a great example. I have a situation right now that I've been coaching in. Child is at home on bed rest, has some eating disorders, but also has Other disabilities. And the visiting nurse that came in, my friend. This is a friend in Pennsylvania, and I've been coaching her from here. My friend has been asking questions. And the nurse took the questions as that she was incompetent as opposed to. She wanted to learn. [00:19:13] Speaker B: Right. [00:19:14] Speaker D: And so, so sad. Because she wanted to learn to be able to take care of her child. [00:19:21] Speaker A: Yeah. [00:19:22] Speaker D: And turned her in to say that she was not an adequate mother. And so she's had DCS out investigating all kinds of things because the nurse wasn't listening and didn't really hear. So the goal is for us to teach both the parent and the staff, whatever interdiscipline person that is or interprofessional person that is, to really listen first and not judge. Yeah. [00:20:01] Speaker B: And that kind of gets to what I think we try to do at Fitting Matters, which is like, we can't solve everything by just focusing on one population. Like, we want to be there for families and support them even when there aren't answers. But we need to be supporting the professionals who are trying to find answers and navigate this as well as, like, the system side of it, too, and making those system changes. [00:20:28] Speaker D: I do want to add one other thing that's a little bit different, but one of the things that we did at Carden that I really think helps is we know that children are bullies as well. Some of them are. And they don't necessarily embrace somebody that comes in. They've had cancer and have no hair, or if they have an ED disorder or whatever, and they bully them. So what we did was we had our child life. People go talk to the class before a child went back to school and share with the class that there were reasons that they were going to see some differences there in how the person ate what they ate, et cetera. And then their first couple days back, the child life person would go back to the school and just be sure that people understood. Teachers were great and helped us a lot. So did the school nurse. But really that re entry is what we called it into the school system was such a key. And I would just say how important that is as well for our children with feeding disorders. [00:21:37] Speaker B: For sure. [00:21:38] Speaker A: For sure. [00:21:38] Speaker B: And actually that's so timely that you share about that because we just launched our school toolkit for PFD and arfid and it allows families at least gives them some information on how to help with, like, inclusion, because it can be really foreign if you haven't engaged with. With a child or a family that is going through this. And has this. And so. And we've had really terrible stories from families about how school districts have interacted with mealtimes and what that looks like and. And. And situations that they've had. So we're hoping to help support that inclusion. But you also mentioned the child life people, and I think that they are, like, such a great resource to tap into to help, like, support function of daily life for families and like a huge, huge, huge benefit to families. [00:22:29] Speaker D: Well, and I wouldn't want to forget the school nurses. I know that there are some schools that don't have them, but here we had a grant the last two years that I was working on, and we placed school nurses in the rural schools and we had a curriculum for them, and we focused on many of the chronic illnesses so that they were really helpful to the families and to the other staff at the organization. And we gave some national or statewide programs at the state annual meeting, and national loved it. So that they've picked up some of the programs with the national school nurses as well. So really looking at the school nurses and how they can be a partner in our life, how. [00:23:20] Speaker B: What do you think the best way to get, like. Because I. With so many people not knowing about PFD or ARFID or feeding disorders in general, what's a way to make sure we're getting the education in the right places where they're picking it up? Is it like those school nursing conferences? Would that be a great place? [00:23:36] Speaker D: Absolutely. And they have one every summer here, and then they have the national one as well. So I would say just get in touch with the national. I mean, the state school nurses association and. And though they can connect you with national also. [00:23:49] Speaker B: Yep, Great, great suggestion. Wonderful. Um, we talked a little bit about families interacting with their healthcare professionals, but one thing that I think comes up a lot is we have such passionate and amazing healthcare professionals. Oftentimes they are like feeding specialists or even dietitians who really understand it from the family's perspective. They are the family's, like, kind of. They are their partner in this and they do such a great job of that, like active listening and really helping empower them. But a lot of times we see that they even have challenges when they're engaging with either other partners that are other, like physicians or subspecialists or even like healthcare administration and some of the bureaucracy there. Since you've had many different roles and have interacted in different way and really offer a lot as it relates to leadership, what advice do you have for maybe especially some of the Younger feeding specialists out there and how they're approaching communication or this, like, interprofessional practice, what some guidance you can offer to them. [00:24:58] Speaker D: I would say a couple things when I. When I do mentorships with these people through some of those organizations I mentioned I'm a part of. I talk about them not using their language, but being the translator into the language of the person to whom they're speaking. So if it's a finance person, transition into finance language, know it and know how, like, patient outcomes make a difference to the finances. So that's the first piece. Really don't use your jargon, if you will, and expect them to embrace it because they don't know how it fits. You have to translate and tell them how it fits, but using their language. So that's number one. Number two, in interprofessional teams, I always encourage them to listen before they speak, just like I do with the patients, because there's probably a dietician and somebody else there, a physical therapist or whomever, depending on what patient types we're talking about, that have maybe more of a primary role or they think they do and they. They want to be heard usually first, and so listen and then gather that information from those individuals based on what they've said and your knowledge, and then put it into a question or the conversation. So that's how I help them integrate into an interprofessional role. And just to go back to the AI, what we have said is AI is one of those team members. So don't just take whatever it says and everybody agree. If you're talking with each other and using your critical thinking critically, think and ask the same types of questions about what AI says to you as well. [00:27:04] Speaker B: I love that because there's so much opportunity with AI, but it also comes with such guardrails or things that we need to be aware of as well. [00:27:16] Speaker D: And I would just say I worry about all this suicide that we've seen based on children of different ages and AI. And I think in our particular situation, we have to be very careful about that. I know we have psychologists and everything, and we need to use them, I think, very effectively and make sure that these children are safe. [00:27:48] Speaker B: Yeah, safety is key, for sure. Yeah, definitely, Rhonda. So as we kind of start to close out a little bit, I've got a few remaining questions for you, of course. So you've been with us as we've gone through a lot at Feeding Matters, from growing from Arizona to national to international work, from the code and the consensus paper coming out to really like starting to think about our leadership transition and what our legacy and society sustainability looked like. Where do you think the future of Feeding Matters should go? Or even just the field in general? Feeding disorders with PFD and arfed? [00:28:28] Speaker D: Well, I don't, I don't want to leave out technology because the families and the ages that we're talking about when we say future are, that's their life. [00:28:41] Speaker B: So true. [00:28:42] Speaker D: So how do we get ahead of that game, if you will, what is appropriate for the use of technology in the feeding disorder space? And then how do we test it and do some research with it with a university or wherever to make sure that what we put forward for 20, say 40 or 2030 is going to really be the vehicle that doesn't leave out the people. And that's such an important statement, but it helps shape it differently. And so how is strategically the Feeding Matters team going to be moving something with the technology forward? I'm still in the adult space, though, also. I don't think we've. [00:29:39] Speaker B: No, we haven't solved that by any means. We haven't. [00:29:43] Speaker D: And I'm still a little bit in the college space because when we talk about bullies in the schools, college is even worse sometimes. And so how are we really helping our individuals that are going into college be prepared for that? And then what is their touchstone while they're there to keep them sane going forward? Learning and being a productive college student and then citizen. [00:30:17] Speaker B: Yeah. As we evolve how we support families, what is the evolution of how we need to support our kids as they're growing up too? That's very true and gives a lot to think about in those different categories. [00:30:31] Speaker C: There's just so many different parts to consider with that with the use of AI. I, I was just thinking about how a lot of people are using AI to self for like self therapy and self counseling lately. Like they'll use it as a conversation partner. Right. And, but, but yes, with what Jacqueline was saying, with the guardrails too. I mean, that's very important. And it, and I'm just wondering like, how, how those conversations can go off into a questionable direction. So. [00:31:12] Speaker D: Well, and I would say yes, AI is what we have today, but who knows what we're going to have in 2030. And so to answer, to go back to the question, staying knowledgeable and ahead of the technology and how it can effectively be used. [00:31:30] Speaker C: But we do have. And you were talking about what sounded like kind of simulated conversations or therapeutic conversations for nursing students. Right. But yeah, I mean, we can also do, you know, simulated conversations between families and providers, you know, for them to [00:31:55] Speaker B: learn, like training agents is what it sounds like. [00:31:59] Speaker C: Learn how to better or more confidently competently advocate for care or maybe like feeding in the schools and that kind of thing. [00:32:10] Speaker B: Well, it's so interesting you both mentioned that because that was actually a conversation that went around internally in our app. One of our family coaches was asking, has anybody else used AI to help their, their mentor mentee think about how to better communicate? And I think that's one of the things that it helps with is like how to like really succinctly get your message across or how are you communicating or advocating. So it's. [00:32:37] Speaker C: Well, there are existing curriculums like the parents as collaborative leaders that came originally out of Vermont. I mean, and so there's things like that and they, they have, you know, they, they break out and do practice things. And so, you know, things like that could be converted into AI. Right. [00:32:57] Speaker D: And they. What I've seen also is that AI will tell you if there's a better word to use than this particular word, that if you're practicing and those kinds of things to get a parent ready to have the conversation with will be key. But also conversation with their child. [00:33:18] Speaker B: Yeah, yeah. On how to explain things or anything. [00:33:20] Speaker D: On how to explain things depending on age groups and things like that. [00:33:25] Speaker C: But I mean, also you can think about it as, and like we don't have to lose that in person part of it. Either we have the AI to, to augment or to, to make the in person parts better to give us feedback on making our in person and high touch experiences even better. [00:33:46] Speaker B: Even better. [00:33:47] Speaker D: Yeah, absolutely. I think that's such a. [00:33:49] Speaker C: It doesn't have to be a substitute. [00:33:51] Speaker D: No, no. And, and I, I think we need to be really clear about that. It shouldn't be a substitute. It is an enhancement to how we manage and how we talk, how we communicate, etc. Yeah, yeah. [00:34:08] Speaker C: There's so much that you just cannot accomplish without like two humans, at least two humans being in the room. [00:34:17] Speaker D: Right. [00:34:17] Speaker C: And like, you know, it has to like lay hands on the other person or actually see, hear, touch to know what's going on. [00:34:27] Speaker B: Yeah. [00:34:28] Speaker D: You know, I guess the other thing that I would identify when you say what, what do we see for the future is I really think staying ahead of the research that is done on what the different generations want because we know that some of them only want the screen for most of the time we don't know what in 2030 they're going to want. But understanding that research because it's done and it's out, it's going to continue to be done and it's out there. But really then using that information to develop whatever. [00:35:07] Speaker B: Yeah, like how our programs evolved from who we're supporting is going to change [00:35:12] Speaker D: differently based on, I would also say, and testing it with focus groups locally so that we have the research, but it isn't always 100% applicable. And so testing it with some focus groups, et cetera, of that age group is really a key. We're doing that and I'm the chair of the elders of my church and we are doing that right now because we've had an older group that have been sort of the foundation of the church. But we're looking to teenagers and younger people and young families. And so we're testing what do they really want from the service, et cetera. And I think we could do the same thing with Feeding Matters. Oh for sure. And we did a few of those a few years ago. [00:36:02] Speaker B: And that kind of approach is something that we do a lot too, which is like we need to like pilot and test and iterate and how can we like test quickly, fail fast that way it's not kind of stuck in this research and development phase for too long. Being headquartered here in Arizona is really helpful to be able to pilot some things and use Arizona as our playground. But what's also been really cool is we've got many other community councils. We had California and Ohio on, but we've got some other ones in Texas and Georgia and the Northeast region. And I'm definitely forgetting some, but we've got some other community councils where I think we'd be able to get more of that grassroots on the ground feel for not just outreach to get this issue in front of people, but to [00:36:49] Speaker A: test how are we supporting who we [00:36:51] Speaker B: need to be supporting and what are the ways that they want us to help support their journey. So yeah, that research is really important to us and it's interesting that we talk about AI too because I always think about like, because this issue still doesn't have as much research and then like from our perspective as much lived experience. Experience interaction with research. You always wonder like what is AI pulling from? And that's like my angle in wanting to have more of a interaction with research and making sure lived experience is a part of the conversation. Because I think as AI gets trained, it'll get trained on what is the expertise, like what are the peer reviewed journals we're pulling from but if they're pulling from everything right now versus what we hope to see in the future with more lived experience, I don't know. That's just been something I've been thinking about with AI too. It's like always, like, what's it pulling from and where does the research need to be? Which does lead me to. Oh, yeah, Haley, go ahead. You had a thought. [00:37:54] Speaker C: I would like to see PFD be a major subject heading term. I don't think it is yet. Do you remember when we were looking at the National Library? [00:38:07] Speaker B: Oh, yeah. It's still. I mean, there's still so many of those like, like PFD Identity Wins that we still need to have. And that's certainly one of them too. Yeah. [00:38:18] Speaker C: Needs to be a major subject because [00:38:19] Speaker B: there's even things that are out there like that. It's just still so new that there's still so much more that needs to be done. And that's. That type of stuff is the stuff that like evolves with the research and then also any outreach that happens. Rhonda. So I think we shared that this podcast is really born from our families and lived experience contributing to research in the direction of the field. So we always ask everybody that comes on the same question, which is what barriers do you think there are to patient and family centered research? And do you have any ideas for solutions for those? [00:39:01] Speaker D: So sometimes I think one barrier is time. With what they're doing with their children and school and all the kinds of things that they have, they just see this as piled on. I mean, research it is often. And that they really don't have the time. Again, I go back to technology, not AI, but just technology. With technology the way it is, and Haley's out in one part of the country and I'm someplace else, et cetera. There's no reason that some of the research can't be done with the use of technology. And I see more and more of that here in Arizona with the adult side and the Alzheimer's, et cetera. So I do think that that can alleviate that barrier. But I do think we have to be understanding of their time because most parents, both parents work many times and they have more than one child and they're all in sports and this and that and the other thing, band. So I. I just think that's one of the top ones from a research perspective. I think the second one, and I've heard off and on when I was at Carden, not about this particular research, but just research in general. They're A little afraid. They don't know what it really means. And because they don't know if they're the control group or who they will be, they're just not so sure they want to again, spend the time in it. But they're also a fear. A little bit of a fear factor. I think maybe a little bit more than just a little bit. [00:40:39] Speaker B: I could see that. And there's like an intimidating factor to research in general, too, of such an unknown. [00:40:46] Speaker D: I also think, though, that that can be alleviated, maybe not totally eliminated, but alleviated a little bit by better explanations. Because I've seen, you know, the physician researcher all excited about their research, but not very good communicator. [00:41:09] Speaker B: They need to translate it to the family's language. Like you were giving advice to the other professionals. [00:41:14] Speaker D: Exactly. So I think helping the physicians or those that are leading the research, because there's a lot of nurse researchers out there as well, although I see them better. And so do most of our patients see them better when they get the explanation from the nurse researcher versus the physician researcher. [00:41:35] Speaker C: Do you think it's a. Now I'm writing a lead question in my head, but you think it would be less scary if it was really a. Something that was written with patient and family partners from the start? [00:41:57] Speaker D: Yes, I actually was going to say something a little bit different, but with the same thought. And that was that there are other patients and families that are in it already and. Or have had other research. And I think if they could be the speakers say to a group that they're trying to get into a research project, they could eliminate some of that fear and concern. But writing something where we get it directly from those who have been in a research project, both a child, I think, and a parent, because depending on what research it is, the parent doesn't know really what the child is actually going to have to go through either. And so we really need both to be able to speak, I think. [00:42:45] Speaker C: Yeah. [00:42:46] Speaker D: Or. Or write or do whatever. And. And you do a video. I mean, do a video, show it to, you know, six states with a group set. [00:42:57] Speaker B: Well, that's so true. Like explainer videos are becoming more prevalent. [00:43:00] Speaker D: Exactly. [00:43:01] Speaker B: So many different ways to leverage technology and communication and what that looks like. I think there is a lot of opportunity there that's not even, like, fully tapped yet. [00:43:08] Speaker D: Right. [00:43:10] Speaker B: Well, Rhonda, thank you so much for joining us. It's always such a lovely and thoughtful conversation. And I know it's been a while since we've met, so it's also just a pleasure of mine to be able to connect with you again. Well, I'm glad. So glad you got to meet Haley because she's another nurse pioneer within Feeding Matters work. [00:43:25] Speaker C: And it's been a real pleasure to meet you, Rhonda. [00:43:28] Speaker D: Pleasure to meet you, too. Thank you. And thanks for inviting me. [00:43:32] Speaker B: Yeah. Thanks for joining. And we will see everybody next week. [00:43:36] Speaker D: Okay. [00:43:36] Speaker A: Bye. [00:43:37] Speaker C: Bye.