Image courtesy of bookdragon on Pixabay.com
Remember, if you’re a practicing SLP, chances are you’re a relatively young, white, middle class woman. After all, we are a field composed of 96% women and 92% white/mainstream culture.
Let’s assume you’ve stopped asking questions about MAE use during your speech-language evaluations. Let’s assume you’ve stopped touching your clients’ hair. Let’s assume we agree you’re providing therapy and not training. Let’s assume you’ve taken a critical look at the materials in your “stash” and have made a conscious effort to use materials that are more inclusive and reflective of the clients you support.
Now, let’s talk about the foods you discuss when you work with clients with feeding or dysphagia issues. Yep, here again, there can be some situations in which you need to use some cultural humility and cultural responsiveness when it comes to feeding and dysphagia issues.
There’s a trend in early intervention to ask about a young child’s ability or willingness to eat “family foods.” Yet (in my experience anyway) I was the only one to ever ask what was meant by “family foods.” Because – news flash here- that phrase means different things to different people.
And, if you don’t ask specific questions about “family foods”, you are being a “Karen” SLP. Because you’re making assumptions about what a family eats. Alternatively, if you only make suggestions or recommendations based on a typical, meat-based mainstream culture diet, you also are being a “Karen” SLP.
The number one way to not be a “Karen” SLP: Remember, therapy isn’t about you!
Let’s take rice as an example. In mainstream culture, rice dishes are generally short-grained and relatively highly processed. They also tend to be served as a side dish which may or may not be eaten with foods of other textures. Often, the rice dish includes a sauce that helps the person eating it form a bolus (e.g., risotto).
In many other cultures, rice dishes form a staple carbohydrate eating as part of the main course (e.g., sushi; Indian curries). Some variations, like sushi rice, are prepared in a way that the natural ‘stickiness’ in the rice helps the person form a solid bolus. Other rices, like jasmine or basmati rice, are longer grained and are not naturally ‘sticky.’ The person is expected to have the ability to use their tongue, jaw, and lips to form a bolus along with the other, chunky foods and spices that are included in the curry/stew portion of the entrée.
If you have dysphagia or have behaviors/issues that put you at-risk for aspiration (e.g., using a munching chewing pattern; missing teeth; “shoveling” food into the mouth), rice can pose a substantial danger. That’s especially the case if your family uses rice as a primary carbohydrate in meals and snacks. It can be hard to form a bolus with rice on its own. It can be hard to keep track of all of those little grains in your mouth, especially if you have a tendency to pocket food in your cheeks or under your tongue. It can be a challenge to deal with the mixed textures of dishes like curries if you have any of these issues.
So, what does the non-Karen SLP do? She asks questions. She asks what a typical breakfast, lunch, and dinner and snacks look like for the family. She asks the family to provide foods they’ve already prepared so she can see how the family typically prepares foods.
The non-Karen SLP takes the time to find out if the family follows any dietary protocols, like keeping Kosher or being vegetarian. The non-Karen SLP asks about snacks in addition to meals. The non-Karen SLP asks what the family eats and when and how they eat the foods before making recommendations and suggestions for diet textures and compensatory strategies.
The non-Karen SLP asks the client and/or family about foods that appear to be challenging for the individual to eat. The non-Karen SLP asks to see how these foods are prepared. The non-Karen SLP asks about how safe foods are provided to the person with feeding or swallowing issues. This includes the use of adaptive equipment. The non-Karen SLP talks to the OT or COTA about these issues. Adaptive equipment can include a variety of things from non-slip mats under dishes to adapted utensils and cups. The non-Karen SLP talks to the PT and OT about different positioning options for people who are unable to sit on their own and how long each individual client can remain in a seated position. The non-Karen SLP asks where the person usually eats (e.g., in a hospital bed in a bedroom, at a table in the kitchen, in a busy cafeteria, etc.) and how they are able to eat safely (e.g., with full assistance from others, with monitoring/verbal prompting, etc.) The non-Karen SLP asks the family about the importance of having the family member with feeding or swallowing issues participate in family meals, including celebrations. The non-Karen SLP ensures that all caregivers understand why adaptations in the way foods are prepared, compensatory, and positioning techniques are being recommended, even caregivers who may not speak English. The non-Karen SLP takes the time to explain how the swallow mechanism works and where the person has difficulty. The non-Karen SLP working with clients with long-term feeding and swallowing issues recognizes this is an on-going process that likely will require revisiting from time to time, even if the person is medically stable. (This is especially the case in situations like long-term care facilities or the schools where staff turnover happens on a relatively frequent basis!)
When making recommendations or suggestions, the non-Karen SLP remembers to use language like, “What if we tried pureeing the rice to make it safer to swallow? That way, you could still mix it in the curry sauce.” Or, “what if we mixed a little water or milk into the rice to make it more like a pudding? That would make it easier for you to swallow.” Or even, “I know you really like mango, but it’s hard for you to swallow. What if we put a piece in cheesecloth so you can get the flavor while we work on chewing?” The non-Karen SLP makes sure to talk about the foods she knows the family eats because she asked.
Are you an SLP who works with clients with dysphagia from culturally diverse backgrounds? What issues have you run into? How have you addressed those barriers?
As always, thank you for reading. I look forward to your comments or suggestions!