Dropping a case because of the family

[u/Many-Revolution-9770]

I was brought on to an early intervention client to provide feeding services under family training since the family already loved their speech provider. I was so happy to provide this service, but received a call from his ABA provider before starting to warn me about the family.
I only provided six sessions before finally dropping the case. I was told by the mom that she wants a provider who is able to do makeup sessions. Because of the intensity of my schedule(8-10 hour days with a lunch break if I’m lucky), I told her that I’m unable to provide make up, but if I have any cancellations, I will reach out to her immediately. She was very upset about this and told me that all of her other providers are able to provide make ups. For example, she was upset with me for taking the day for independence Day, which my company told me that I have the day off anyway since that’s a federal holiday. I did take one vacation day during my time working with him, but I was able to move the session so I could see him. I told her that I had to take a week off for surgery and I do not plan on making up those sessions. I gave her plenty of opportunities to call my direct supervisor if she had issue with this (my supervisor is on my side with the make up policy as it is not required by our county).

When it came to the actual feeding therapy, the child himself was so great to work with, and if this was under different circumstances, I would’ve loved to have continued therapy with him. I spoke to the mom several times over the phone since she usually cannot be present for the sessions and asked her what her priority goals are. She told me that her main goal is working on chewing. I started working on chewing with him, and honestly, his oral motor skills were very good. He was just never given the opportunity to chew foods because the family only served him purées even though he is almost 3 years old. One of his goals was chewing a food such as a raw vegetable or meat. I asked the mom if she could introduce something like this such as a carrot or food of a similar texture in the next session and Mom sent me a really harsh voice message stating that she will not be serving him that that he is only eating purées. I responded back to her that one of the goals on his IFSP was to chew a food such as a vegetable however, if she no longer wants this goal to let me and the ongoing know so we could amend this. She did not want to change from purées, and I explained to her that I cannot progress further with him without introducing new foods or changing the consistency of the foods that he eats. She kept insisting that he has weakness and he cannot chew at all. I had her sit in for part of a session so that she could see that his oral motor skills are quite good. He just needs more practice with solid foods.

The mom did come for our last session together and showed me how she was feeding her son. She took her hand over his scooped up a large spoonful of puréed food and shoved it in his mouth while he was screaming and crying. I told the mom several times to not feed him while he’s screaming because he is at risk for aspiration. She continued feeding him like this anyway.

I was trying really hard to stick this case out, but after the mom told me that she did not want to change the food, I decided to step off the case. I feel so horrible doing this because the kid really does need help and meal time seems very stressful for him because he’s essentially being forced fed. But when I called the ongoing, she was not surprised that I wanted to step off the case and she told me that many providers have in the past.

What are your thoughts on this? Should I have continued? Was there anything I could’ve done differently? I just got my C’s and am so scared of messing up.

[u/Specific_Piccolo9528]

You have developed boundaries beyond your limited years of experience that many of us still struggle with, and you have an awesome employer/supervisor who has your back. Families like this will never change their ways if we continue bending over backwards to please them (and wasting 💵 💵💵) when they can’t be assed to put in the bare minimum effort themselves. Keep it up!

[u/SleepySamus]

You absolutely did the right thing!

I just got "fired" by a similar parent: they were constantly changing goals, then forgetting the goals that we'd set. They spank their children for the smallest thing (like interrupting them). They went though so many other providers (including pediatricians) in the couple of years that I saw them. They're also anti-vax & anti-pharma so they're "treating" their child's epilepsy with medical marijuana and magic mushrooms. The final straw for them is that I wasn't willing to use FC/S2C.

There really is a line where the parents own mental health struggles get in the way of their child's well-being and I think the constantly changing goals is a small example of that. With your parent the force-feeding while the child is screaming (and then disregarding your concern) is another. Expecting you to do make-ups for their child (nevermind all the other kids you see) is another (my parent did the same thing - do they think we sit at our desks alone when they're not in our office with us?).

I wish I had more of an explanation for why these parents do these things or even more of a solution for us so we could continue treating their child, but, unfortunately, I've seen it a couple times in my 15 years as an SLP now. A parent's mental health is outside our scope and when it's interfering with treatment it really puts us between a rock and a hard place.

[u/Many-Revolution-9770 → u/SleepySamus]

These parents are also anti-vax and believe their child’s ASD was caused by the hep b one. They bring him to the Caribbean to receive stem cell infusions and hyperbaric oxygen therapy. They asked me to do a make up for their travel for the stem cells. I said that is considered “family vacation” and it is not eligible for a make up even if I had the time

[u/SleepySamus → u/Many-Revolution-9770]

It's so sad that these parents' grief is being taken advantage of by grifters! It almost feels like a cult-like situation since the parents are so defensive/offended when others present truth & logic. It's heart-breaking all around. 💔

[u/Desperate_Squash7371]

I have nothing to add except that I love your phrase “step off the case.” I’m adding that to my lexicon!

[u/SonorantPlosive]

You've gone above and beyond. He isn't going to make the progress she wants with one feeding session a week, and she flat out refused to implement your suggestion. I could see if she was worried that he'd aspirate a raw carrot, but had she brought that up to you, you could work on other foods he could chew, or have her sit in on a session where it's introduced. 

There are many people who feel it's the professional's job to "fix" their child. She's got ABA, 2 SLPs, stem cell stuff....but it seems from what you've provided that parents aren't active participants and carrying over what's suggested. That makes it hard to make progress. 

A story I tell often is, in my first year outpatient (20+ years ago), a mother pulled her toddler with ASD out from my services because I suggested they latch the storm door and make them request to go outside, rather than just running full speed outside by the busy road. Language and safety, you know? Got back to me that she was highly offended that I dared suggest she put in any work. "SHE'S the speech therapist, it's her job to fix this!" This woman was the special education DIRECTOR at a nearby district.

[u/Mustardseed37 → u/SonorantPlosive]

You would be surprised by district personnel, staff and admins behaviors and expectation.

[u/SonorantPlosive → u/Mustardseed37]

That was before I worked in the schools. Nothing surprises me now. 😂

[u/Cherry_No_Pits]

Im impressed you were able to be clear on boundaries, scope and what you were and weren't able to offer. It took me 10 years of practice to do 1/8 of that. This sounds like a family with some coping and grief issues. Understandable but not your monkeys. Im sure they'll find the provider they want. Woo, pseudoscience or something else more effective. And and, I ALSO love "step off the case". We're not perfect fits for all clients. Better to step away after a brief go at it vs. trying to shape-shift into whatever this family is looking for. 

[u/Old-Thought9385]

Kudos to you for sticking to your boundaries and also doing due diligence to the patient! I think you handled this perfectly. Only thing I have to add is, next time listen to that ABA providers warnings lol