What is the Intensive Feeding Therapy Program Like at MetroEHS?
As we dive into the details of the Intensive Feeding Therapy Program at MetroEHS, hear from the experts at MetroEHS and how they collaborate on the most wholistic approach to Intensive Feeding Therapy.
Jessica Hunt (Occupational Therapist/Feeding Specialist): When it comes to treating children who have complex feeding difficulties and pediatric feeding issues, there's a multitude of things that are typically at the root of the problem. So what's very unique about the program that we have here is that we have involvement from both occupational therapy, speech and language therapy, physical therapy, a dietician, as well as psychology.
Rose Britt (Registered Dietitian): So it's all five disciplines. Spending time together with the family, with the patient, with each other, all talking at one cohesive time, making a plan instead of grabbing pieces from all over the place and putting them together. I think it makes it a lot smoother for us and the families as well.
Kris Krajewski (Director PT, OT, and Speech Services/SLP): Each of our disciplines really does have something to offer to this process, but when we work all together, we have the ability to help our kiddos make more progress more quickly.
Kayla Daniels (Physical Therapist): At Metro, we really take a whole body approach. We don't just look at one aspect of the child. And a lot of people don't think of physical therapy as part of the feeding team, but in order to eat, you have to use all of these posture and muscles, you have to hold yourself up. You have to hold your head up to be able to swallow. So really focusing on all of those aspects of your body is really important to be able to make the progress.
Azari Haygood (Psychologist): As a psychologist on staff for the Intensive Feeding Program, I offer mental health services to the families and to some of the clients. It's very stressful for a lot of these families. It's stressful for the clients that we see. And so, I offer just another support for them, where I'm helping them kind of overcome some of the stressors that they're experiencing around feeding.
Rose Britt (Registered Dietitian): It's not just me telling you what to do. There's so much more going into that, and you get to really listen to the families and hear why it's not working and problem solve together.
Kayla Daniels (Physical Therapist): The impact you can make, not only on the child's life, but on the family's life as a whole is huge.
Azari Haygood (Psychologist): Seeing that improvement in their family's lives feels really great all around.
Jessica Hunt (Occupational Therapist/Feeding Specialist): One in 23 children have a pediatric feeding issue. And so, to truly be able to address all of the aspects of that in one place, that's where we get to make a difference every single day.
Kris Krajewski (Director PT, OT, and Speech Services/SLP): It's like when you have a jigsaw puzzle and you're missing one piece, you can still tell what the picture of the jigsaw puzzle is going to be, but when you have all of the pieces together, integrated into this treatment, the result is just something so much more beautiful.
Once a child has been diagnosed with a Pediatric Feeding Disorder due to oral dysphagia or sensory processing disorder or, if diagnosed by a psychologist, ARFID (Avoidant/Restrictive Food Intake Disorder), they will likely be referred for treatment. Eating is a learned behavior. It is only instinctive for the first 6 months of life. Older children must either teach themselves, or be taught (Toomey). Treatment for a feeding disorder can be completed by a Speech-Language Pathologist (SLP), Occupational Therapist (OT), Board-Certified Behavior Analyst (BCBA), Dietician, or Psychologist. All of these disciplines have overlapping and unique approaches to treatment, so a Pediatric Feeding team that involves more than one specialist may be best for your child. As an SLP who is part of a feeding team that involves an OT and BCBA, some approaches to treatment that I utilize alongside the team include the Food Chaining Approach, The Sequential Oral Sensory approach (SOS), and the Escape Extinction approach.
Food Chaining has become recently popular due to a book written by Fraker and Cox called Food Chaining: The Proven 6 Step Plan To Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. To summarize this approach, clinicians and parents would “chain” from food that children currently enjoy by changing 1 aspect of the food at a time: either color, texture, flavor, or shape. For example, if a child enjoys cheetos, you might “chain” to orange veggie sticks (changing flavor), then to green veggie sticks (change in color), then to green veggie chips (change in shape), then to zucchini cut in a circle and placed on the chip (change of texture), then remove the chip. The child is now eating zucchini, and it was introduced slowly in a non-threatening manner! In this procedure, food is not forced on children- they are able to touch and explore it themselves, the clinician models eating it, and children are encouraged to take a bite, but they decide if they would like to try it or not. Using food chaining, children will slowly and positively increase their repertoire of acceptable food.
The Sequential Oral Sensory (SOS) approach was developed by Dr. Kay Toomey, a psychologist who specializes in Pediatric Feeding Disorders. This procedure includes another slow process of children having repeat exposures to foods prior to being forced to take a bite. For example, a child would tolerate a new food, let’s say apple slices, on their plate without expectation of eating it. Once that is tolerated, the apple will slowly and systematically move closer to their mouth, again without expectation of eating. They will touch it first with a fork or toy, then their hand, then put it on their arm, then their cheek, then kiss it, then lick it, then take a bite and spit it out, then chew, and finally swallow the apple slice. This could take a couple of days or even weeks. The idea is to allow children to have positive interactions with the food so that eating is enjoyable and they control what is placed in their mouth according to their comfort level. Eventually the child will be able to more quickly and independently follow the above steps with a new food to independently increase their diet. Children will gain confidence and learn that new foods aren’t as scary as they once thought.
The Escape Extinction approach is an effective, evidence based approach used to aid with feeding problems across all ages and is often utilized in ABA therapy by a BCBA or Behavior Technicians under the guidance of a BCBA. Eating novel food items and non-preferred food items is broken down into easier steps to aid your child with succeeding in their feeding journey. Keeping the presentation of bites and the bite sizes predictable decreases anxiety and allows the child to feel more in control during meal times. We never move up in bite size until we are certain your child is able to handle the bite at that size and has the skills needed to properly lateralize the food item, masticate the bite, and take consecutive bites. Furthermore, this approach reinforces appropriate feeding behavior while extinguishing inappropriate or disruptive feeding behaviors by not allowing the child to escape from taking bites by using a non-removal of the spoon. Often times, children will spit out food, swallow food without chewing, pack bites, turn head away from the bite, or engage in aggression. When these behaviors occur, we do not remove the bite from their lips until the bite has been taken, and provide prompts and reinforcement for taking bites and chewing appropriately.
Children enrolled in the feeding program Metro EHS Pediatric Therapy are evaluated and treated as unique individuals, so these approaches, along with others, are often combined to best help your child experience success with eating.
Sources
Tooomey, Kay. SOS Approach To Feeding.
Tarbox, J and Tarbax, C. Training Manual for Behavior Technician Working with Individuals with Autism Spectrum Disorder. Retrieved from Sciencedirect.com.
Fraker, Fishbein, Cox, Walbert. Food Chaining: The Proven 6 Step Plan To Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. Da Capo Lifelong Books.
We love working in Southeastern Michigan as we get to work with hard-working families and amazing businesses like Emagine who intentionally create special experiences for members of the community that can get overlooked.
Join Emagine For A Sensory Friendly Movie!
Sensory Friendly Screenings provide modifications to the theatre atmosphere without modifying the film for those who experience sensory issues.
Sensory Friendly Film Screenings
Select Emagine locations will host a unique, sensory friendly screening twice a month, with specific modifications made to ensure an enjoyable experience for individuals with sensory needs and their supporters. Their sensory friendly programing makes going to the movies a more enjoyable experience for families, children, and teens with sensory needs. All sensory friendly films will be shown in 2D. *Note there are no modifications made to the film.
What does Sensory Friendly mean?
First, it means sensory friendly experience (lights up a bit, sound down a bit). Second, if your child needs to get up, move, dance, sing…No problem. Third, guests are welcome to bring a safe snack for any food allergies or food avoidance/restrictions.
First Showing of the Day. On-Sale dates vary. Check the website or Emagine app for theatres and showtimes.
The Little Mermaid Saturday, June 3, 2023
Elemental Saturday, June 17, 2023
Where
Tickets are available at the box office, online at Emagine-Entertainment.com or through the Emagine App. To purchase tickets and for a full list of showtimes visit Emagine-Entertainment.com On-Sale dates vary. All films, locations, dates, and times are subject to change.
Film Synopsis
The Little Mermaid (Rated PG) The Little Mermaid is the beloved story of Ariel, a beautiful and spirited young mermaid with a thirst for adventure. The youngest of King Triton’s daughters and the most defiant, Ariel longs to find out more about the world beyond the sea and, while visiting the surface, falls for the dashing Prince Eric. While mermaids are forbidden to interact with humans, Ariel must follow her heart. She makes a deal with the evil sea witch, Ursula, which gives her a chance to experience life on land but ultimately places her life – and her father’s crown – in jeopardy.
Elemental (Rated Pg) Follows Ember and Wade, in a city where fire-, water-, land- and air-residents live together.
In addition to Sensory Friendly Movies
Join Emagine Entertainment For A Variety Of Specialty Screenings
Providing Open Caption, Sensory Friendly, Dementia Friendly, Breakfast & a Movie, and Lunch & a Movie Screenings
Join Emagine Entertainment this June as they host a variety of specialty screenings for their guests. Each month guests can watch some of the newest film releases with an enhanced experience. Open Caption screenings provide subtitles for those with hearing impairments. Sensory Friendly Screenings provide modifications to the theatre atmosphere without modifying the film for those who experience sensory issues. Dementia Friendly screenings provide exclusively selected classic movies and musicals and encourage audience participation while providing guests with special door-to-door service. The Breakfast and a Movie and Lunch and a Movie allow guests to enjoy a full meal and concessions while they enjoy their film.
Open Caption Film Screenings
Select Emagine locations will host Open Caption showings of some of the newest film releases on Sunday and Wednesday afternoons all month long. Guests who experience hearing impairments will be able to enjoy the movie-going experience with audio subtitles displayed on the big screen for all to see. All open caption movies are shown in 2D. *Note: there are no modifications made to the film.
Locations: (Michigan) Novi, Rochester Hills, Royal Oak, Hartland, Woodhaven, Quality 10 Powered by Emagine, (Minnesota) Eagan, Lakeville, Monticello, Rogers, White Bear, Willow Creek, (Wisconsin) Geneva Lakes, (Illinois) Frankfort, (Indiana) Noblesville, Portage
Films: On-Sale dates vary. Check the website or Emagine app for theatres and showtimes.
Spider-Man: Across The Spider-Verse Sunday, June 4, 2023 Wednesday, June 7, 2023
Transformers: Rise Of The Beasts Sunday, June 11, 2023 Wednesday, June 14, 2023
Elemental Sunday, June 18, 2023 Wednesday, June 21, 2023
The Flash Sunday, June 25, 2023 Wednesday, June 28, 2023
Dementia Friendly Screening
Dementia Friendly Screenings include exclusively selected classic movies and musicals presented in a unique setting with softer sound and ambient lighting. Guests are able to interact during the presentation and encouraged to talk back, clap, tap their feet, sway, sing along and get up and dance. Emagine works with Dementia Friendly Saline to provide guests with a special door-to-door experience guided by a team of dementia friendly “Purple Angels.” These staff and volunteers act as guides for the guests beginning the moment they arrive until the moment they leave. More information can be found on Emagine’s website. Tickets can be purchaseddirectly through Dementia Friendly Saline.
Location: Emagine Saline
Films: Showings are the second Wednesday of each month.
Meet Me In St. Louis Wednesday, June 14, 2023 Pre-Show Mingling: 1:15-2:00PM Film Begins: 2:00PM
Breakfast And A Movie Screening
Each month, Emagine hosts a Breakfast and a Movie showing, at select theatres, of one of the newest family-film releases. Tickets are $24 each and include a full breakfast buffet, a 44oz. popcorn, and a 21oz fountain drink as well as a ticket to the showing.
Location: Emagine Royal Oak, Emagine Palladium, Emagine Canton
Film: On-Sale dates vary. Check the website or Emagine app for more information.
The Little Mermaid* Sunday, May 28, 2023
Spider-Man: Across The Spider-Verse Sunday, June 4, 2023
Spider-Man: Across The Spider-Verse Sunday, June 4, 2023
Senior Lunch And A Movie Screening
Each month, Emagine Royal Oak hosts a special Senior Citizen Lunch and a Movie. Tickets are $24 each and include a full lunch buffet, a 44oz. popcorn and a 21oz. fountain drink as well as a ticket to the showing. This offer is valid for guests aged 55 and up.
Location: Emagine Royal Oak
Film: On-Sale dates vary. Check the website or Emagine app for more information.
About My Father Tuesday, June 20, 2023
Where: Tickets are available at the box office, online at Emagine-Entertainment.com or through the Emagine App.
Film Synopsis
Spider-Man: Across The Spider-Verse (Rated P) Miles Morales returns for the next chapter of the Oscar®-winning Spider-Verse saga, an epic adventure that will transport Brooklyn’s full-time, friendly neighbourhood Spider-Man across the Multiverse to join forces with Gwen Stacy and a new team of Spider-People to face off with a villain more powerful than anything they have ever encountered.
Transformers: Rise Of The Beasts (Rated P-13) Returning to the action and spectacle that have captured moviegoers around the world, Transformers: Rise of the Beasts will take audiences on a ‘90s globetrotting adventure with the Autobots and introduce a whole new breed of Transformer – the Maximals – to the existing battle on earth between Autobots and Decepticons. Directed by Steven Caple Jr. and starring Anthony Ramos and Dominique Fishback, the film arrives in theatres June 9, 2023.
The Flash (Rated P-13) Worlds collide in “The Flash” when Barry uses his superpowers to travel back in time in order to change the events of the past. But when his attempt to save his family inadvertently alters the future, Barry becomes trapped in a reality in which General Zod has returned, threatening annihilation, and there are no Super Heroes to turn to. That is unless Barry can coax a very different Batman out of retirement and rescue an imprisoned Kryptonian… albeit not the one he’s looking for. Ultimately, to save the world that he is in and return to the future that he knows, Barry’s only hope is to race for his life. But will making the ultimate sacrifice be enough to reset the universe?
He Little Mermaid (Rated PG) The Little Mermaid is the beloved story of Ariel, a beautiful and spirited young mermaid with a thirst for adventure. The youngest of King Triton’s daughters and the most defiant, Ariel longs to find out more about the world beyond the sea and, while visiting the surface, falls for the dashing Prince Eric. While mermaids are forbidden to interact with humans, Ariel must follow her heart. She makes a deal with the evil sea witch, Ursula, which gives her a chance to experience life on land but ultimately places her life – and her father’s crown – in jeopardy.
Elemental (Rated PG) Follows Ember and Wade, in a city where fire-, water-, land- and air-residents live together.
About My Father (Rated PG-13) The hottest comic in America, Sebastian Maniscalco joins forces with legendary Italian-American and two-time Oscar® winner, Robert De Niro (Best Actor, Raging Bull, 1980), in the new comedy ABOUT MY FATHER. The film centers around Sebastian (Maniscalco) who is encouraged by his fiancée (Leslie Bibb) to bring his immigrant, hairdresser father, Salvo (De Niro), to a weekend get-together with her super-rich and exceedingly eccentric family (Kim Cattrall, Anders Holm, Brett Dier, David Rasche). The weekend develops into what can only be described as a culture clash, leaving Sebastian and Salvo to discover that the great thing about family is everything about family.
Meet Me In St. Louis St. Louis 1903. The well-off Smith family has four beautiful daughters, including Esther and little Tootie. 17-year-old Esther has fallen in love with the boy next door who has just moved in, John. He however barely notices her at first. The family is shocked when Mr. Smith reveals that he has been transferred to a nice position in New York, which means that the family has to leave St. Louis and the St. Louis Fair.
A: RBT certification is a paraprofessional certificate that is in the behavioral analyst field, and you work under the BCBA or BCABA treating and providing services to our kids.
Q: What are the requirements?
A: What it takes to become an RBT here at MetroEHS is you must be 18 years old, a high school diploma, you need the 40 hours of training, and then take a competency test with the supervisor, and then you apply at the BACB website, and take a test, and become an RBT.
Q: What does the training consist of?
A: The RBT training consists of like an interactive and comprehensive 40-hour training that you work in a small group or one on one with other technicians or your BCBA. You’re out in the clinic, hanging out with the kids, learning and watching how they run programs. That could be at the table time or out in natural environment and once you understand the new words in the ABA field, you take your competency test and take the test at the website.
Q: What is the competency test?
A: The competency test is when the supervisor comes out the clinic with you and they watch how you run programs, they interview you, ask questions about the terminology and it’s pretty much just one on one time or you and the supervisor and your client to make sure you understand the terminology and what you’re actually doing and it’s highly encouraged to actually take your RBT test within 90 days of your 40 hour training. It is free of charge. You take the test at the BACB website.
A: To maintain my credentials as an RBT here at MetroEHS, I track all my supervision hours, and I retake my competency test at the year mark or year anniversary of my RBT testing date.
Q: What are the benefits if earning an RBT certification?
A: MetroEHS offers two benefits for becoming an RBT. One is a raise and two, once you become an RBT, you have more opportunities to move up the ladder and become admin or fun stuff.
