still having issues? - occupationaltherapy.com · 2020. 6. 9. · 3. the demonstration or exercise...

If you are viewing this course as a recorded course after the live webinar, you can use the scroll bar at the bottom of the player window to pause and navigate the course.

This handout is for reference only. Non-essential images have been removed for your convenience. Any links included in the handout are current at the time of the live webinar, but are subject to change and may not be current at a later date.

No part of the materials available through the continued.com site may be copied, photocopied, reproduced, translated or reduced to any electronic medium or machine-readable form, in whole or in part, without prior written consent of continued.com, LLC. Any other reproduction in any form without such written permission is prohibited. All materials contained on this site are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of continued.com, LLC. Users must not access or use for any commercial purposes any part of the site or any services or materials available through the site.

Technical issues with the Recording? Clear browser cache using these instructions Switch to another browser Use a hardwired Internet connection Restart your computer/device

Still having issues? Call 866-782-9924 (M-F, 8 AM-8 PM ET) Email [email protected]

https://www.continued.com/browser-instructions

mailto:[email protected]

1

Together at the Table: Working With Families Stephanie Cohen, M.A., CCC-SLP, CLCKaren Dilfer, M.S., OTR/L

1

© 2019 Stephanie Cohen and Karen Dilfer

Disclosures§ Karen and Stephanie are co-directors and founders

of the Chicago Feeding Group, a 501(c)3organization

§ Karen Dilfer maintains a private practice in Illinois.§ Stephanie Cohen maintains a private practice,

Cohen Speech and Feeding Solutions, PLLC, inIllinois.

2

2


Learning OutcomesAfter this course, participants will be able to:§ Participants will be able to describe 3 ways a child’s feeding

feeding challenges may impact the daily routine of a family.§ Participants will be able to list at least four emotions a

parent may feel when parenting a child with feedingchallenges.

§ Participants will be able to describe three ways clinicianscan support the mental health and wellbeing of parents asthey work with children with feeding challenges.

3


Feeding and Bonding4

3


Photo by Luiza Braun on Unsplash

Child trusts parents will feed her

Parent trusts child will want to eat

5

The Feeding Relationship, Interrupted

ParentChild Feeding Difficulties

6

https://unsplash.com/@luizabraun%3Futm_source=unsplash&utm_medium=referral&utm_content=creditCopyText

https://unsplash.com/s/photos/breastfeeding%3Futm_source=unsplash&utm_medium=referral&utm_content=creditCopyText

4


Impact on Bonding Process§ No feeding issues: Parents spoke of the parent–child

relationship only within a positive frame, specifically aboutfeeding being a time of bonding and an opportunity to getto know the infant.

§ Feeding difficulty: Parents did not talk about the effect offeeding on the parent–child relationship and focused moreon how difficult it was for them to feel like they could notfigure out the problem and help their child.

(Pados & Hill, 2019)

7


“Controlling feeding may arise when children experience problems in feeding or growth, such as recovery feeding after illness.

Under these circumstances, recommendations tend to be guided by a children's nutritional needs, focusing on the quantity and quality of food and the frequency of feeding.

As a result, health and nutrition counselors may not focus on parent responsivity and parents may interpret the recommendations as a mandate to use controlling strategies to "get their child to eat.”

This strategy has the potential to undermine the child's trust in an otherwise responsive parent.”

(Black & Aboud, 2011)

Controlling Feeding

8

5


Mealtimes Occur

8-12 times/day for infants 5-8 times/day for toddlers

9


The Parent Experience10

6


Parents Feel:

Grief

Impatience

Frustration

Failure

Confusion

Parents May

Experience

11


Parents May Experience

§ Thomlinson, Elizabeth. (2002). The lived experienceof families of children who are failing to thrive.Journal of advanced nursing, 39, 537-45.10.1046/j.1365-2648.2002.02322.x.

§ Constant fear§ Feelings of helplessness§ Feelings of Isolation§ Disappointment by

comparison§ Not being heard

12

7


One Family’s Story:

13


The Worry Cycle

Image used with permission Q7

14

8


Parents Do Not Feel Heard

Parents must be heard and included Parents need support Do not feel heard by healthcare professionals

63% reported that healthcare providers did not address their

concernsin a sample of 300 parents

(Zucker, 2015)

15


Individual trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

http://www.integration.samhsa.gov/clinical-practice/trauma

Parents May Have Experienced Trauma

16

http://www.integration.samhsa.gov/clinical-practice/trauma

9


17


(Walkey & Cox, 2013)

Normal Developmental Stress

Traumatic Stress

Chronic Stress Continuum

18

10


Parent TraumaTrauma§ Separation from Child§ Hospitalization§ Feeding Tube Placement§ Diagnosis§ Acute Event

https://blog.cincinnatichildrens.org/post-traumatic-stress-disorder-ptsd-in-parents-of-medically-fragile-children

19


Parent TraumaPost-Traumatic Stress Disorder (PTSD): mental health problem that some people develop after experiencing or witnessing a life-threatening event. § 10-20% of parents with medically fragile children

may have PTSD

https://blog.cincinnatichildrens.org/post-traumatic-stress-disorder-ptsd-in-parents-of-medically-fragile-children Q8

20

11


Parent TraumaPost-Traumatic Stress Disorder§ Re-experiencing§ Avoidance§ Negative Thoughts and Feelings§ Hypervigilance

https://blog.cincinnatichildrens.org/post-traumatic-stress-disorder-ptsd-in-parents-of-medically-fragile-children

21


(Walkey & Cox, 2013)

Normal Developmental Stress

Traumatic Stress

Chronic Stress Continuum

22

12


Trauma Informed Care§ Realizing the impact that trauma has on people,

and that reactions to a past trauma may inform theperson's current response to a potentially traumaticsituation

§ Recognizing the signs and symptoms of trauma inpeople and the staff caring for them

§ Resisting traumatization to prevent a situation thatrepresents a tolerable stress from evolving into atoxic stress (SAMHSA, 2014)

23


Working with Parents Photo by Polina Zimmerman from Pexels

24

13


Relationships with Parents Building Trust§ Rapport§ Therapeutic alliance

§ Listen: parent experience§ Identify: parent goals

The parent and practitioner have § mutual trust§ working partnership§ shared goals

25


Building Trust Starts with Us!

1. Therapeutic Process2. Language and Judgement

26

14


Therapeutic Process: Parent Coaching and Intervention“The Early Childhood Coaching Handbook (Rush and Shelden, 2013) defines coaching as “an adult learning strategy in which the coach promotes the learner’s (coachee’s) ability to reflect on his or her

actions as a means to determine the effectiveness of an action or practice and develop a plan for

refinement and use of the action in immediate and future situations.”

27


Including Parents in Assessment and Goal Setting§ Seeks to understand child’s therapeutic needs from

the parent’s perspective§ Seeks to understand the parent’s lived experience

§ Work together to identify goals§ Therapist explains the therapeutic partnership and

process: clarifies expectations

28

15


Including Parents in Treatment§ Allow parent to identify progress: What is working?§ Ask parent to share new concerns à What would

you like to work on today?§ Parent helps to choose activity

§ Parent is primary mealtime partner§ Therapist may demonstrate strategies or prompt

parent to try something new

29


Strategies for Verbal Communication

“I’m noticing that ____________.”

“What would happen if ____________.”

“Could we try__________?”

“What would you think about_________?”

“Would it be okay if ___________?”

30

16


Including Parents in Treatment§ Therapist prompts parent to reflect on what

worked§ Therapist actively listens§ Therapist shares reflections

31


Session Reflection Prompts§ What was your favorite part of that mealtime?§ What do you think went well during that mealtime?§ How do you think your child felt when…?§ How did you feel when…?§ I’m noticing that…/I noticed that…§ What else could you try?

32

17


Home Program§ What worked today?§ Offer a few options for integrating new strategies

into routines§ Parent helps choose what to implement next§ Give the parent a game plan for every mealtime

33


Home Program: Caregiver Considerations

Emotional resources (anxiety, depression, stress)

Financial resources Time

Outside support (mental health, family, community)

Cognitive ability Cultural practices

Personal history

34

18


Cultural Considerations§ Cultural responsiveness is about reciprocity and

mutuality. The process involves exploringdifferences, being open to valuing clients’knowledge and expertise, and recognizing theunique cultural identity of each individual client(Munoz, 2007).

§ When cultural considerations are addressed,outcomes are better (Davis-McFarland, 2008)

35


Frequency Considerations§ Different families may need different levels of

support§ Creatively support parents between visits

§ Sharing of videos§ Text/messaging support§ Phone calls or email

§ Considerations: Personal Boundaries

36

19


What Gets in the Way?Barriers to Trust§ Parent/family factors§ Practitioner factors

37


What Gets in the Way?Parent & Family Factors§ Past Experiences§ History of Trauma

§ Mistrust of Professionals§ Past Food History§ Mental Heath§ Cognitive Impairment or Other Disability

38

20


What Gets in the Way?Practitioner Factors§ Past Experiences§ Implicit Bias/Judgment§ Inability to grade communication§ Difficulty identifying progress/focusing on

impairment

39


Language & Judgment40

21


Judgment:Noun1. an act or instance of judging.2. the ability to judge, make a decision, or form an opinion objectively, a

uthoritatively, and wisely,especially in matters affecting action; good sense; discretion:a man of sound judgment.

3. the demonstration or exercise of such ability or capacity:The major was decorated for the judgment he showed under fire.

4. the forming of opinion, estimate, notion, or conclusion, as from circumstances presented to the mind: Our judgment asto the cause of his failure must rest on the evidence.

5. the opinion formed: He regretted his hasty judgment.

41


Judgment & Bias

How do we assess and describe:

§ Children?§ A child’s eating

patterns?§ Foods?§ Parents/Caregivers?

42

22


Language We Use to Describe Children:

AVERSION FOOD REFUSAL DELAYED HYPERSENSITIVE “BEHAVIORAL”

43


Alternative Language We Use to Describe Children:

AVERSION FOOD REFUSAL DELAYED HYPERSENSITIVE “BEHAVIORAL”

• She iscautious

• She has hadbad pastexperiences

• He is sensitive• He is choosing

to say no• He’s not yet

ready for this

• She is learningat her own pace

• Sensitive• Cautious• Careful• Protective

• She is having astrong reaction.

• What do youthink she is tryingto tell us?

44

23


Judgment and Food

§ Health beliefs§ Cultural beliefs§ Religious beliefs

45


Parents do What Works§ Offer the same food in the same way§ Feed the child separately§ Use of screens§ No eating out

(Klein, 2015)

46

24


How do we talk about parents?What’s wrong with you? à What happened to you?

What has been your experience?

47


Isabelle § Background:§ Born 37 weeks§ SGA (4lbs, 4oz birthweight),

placenta began failing at 36 weeks§ Moderate pulmonary valve

stenosis§ Bronchiolitis at 5 weeks

(hospitalized 1 week)§ Attended daycare

48

25


Isabelle § Parent concerns:§ Turning away from breast at

feeding§ Falling asleep at the breast and

with bottle feeding§ Mother pumping and offering

expressed breast milk- verychallenging to manage withtoddler and working FT

§ Slow growth/weight gain§ Congestion with bottle feeding

49


Isabelle § Multiple Assessments:§ SLP/IBCLC evaluation: diagnosed

with lip and posterior tongue tie,labial frenulum revised only,recommended pumping 8x/day tostabilize supply

§ Another IBCLC recommendedputting to breast 1x/day(previously doing 5x, then 3x),trialed using breast shield

§ Saw SLP during pediatrician visit§ Registered dietician consult:

fortification of EBM recommended

50

26


Isabelle § Parents’ Goals:§ Parents felt stress from multiple

providers and varying advice:mom requested one team, oneplan, one specialist

§ Mom felt breastfeeding was tooexhausting for her; wanted to useup supply of frozen milk andtransition to formula

§ Improved endurance for feedingsto support growth

51


Isabelle § Recommendations:§ Change in positioning to side lying§ Hold bottle horizontally§ Slower flow nipple§ Paced bottle feeding§ Consider swallow study if

congestion with feeding did notresolve

52

27


Isabelle § What Happened:§ Congestion resolved§ Compensatory strategies

improved endurance for bottlefeeding

§ Slowly increased intake over time§ Transitioned to formula, which was

later concentrated to 22cal/oz tomaximize caloric intake

§ At five months, showed significantinterest in solids

§ Parents wondered what was bestway to introduce solids

53


Isabelle § Parents’ Goal: Transition to Solids:§ Addressed positioning at mealtimes§ Planned slow introduction of taste

experiences

54

28


Isabelle: 5 months

55


Isabelle § What happened?§ Continued exposure to solids at

family mealtimes§ Isabelle enjoyed sitting on a parent’s

laps vs. high chair§ Watched others eat and reached for

pieces of food§ Accepted purees but prefers finger

foods

56

29


Isabelle

57


QuestionsKaren Dilfer:[email protected]

Stephanie Cohen:[email protected]

58

http://eatwithkaren.com

http://cohenspeechandfeeding.com

still having issues? - occupationaltherapy.com · 2020. 6. 9. · 3. the demonstration or exercise...

Documents