Meet Michelle Dawson, M.S., CCC-SLP
It’s safe to say I have a professional crush on Michelle Dawson. About a month ago, I had the privilege of attending her lecture, Pediatric Dysphagia: Establishing the Brain-Mouth-Gut Connection in Silver Spring, MD. Not only was her lecture incredibly informative and clearly evidence-based, but her energy, story telling, and cheeky humor kept me engaged and excited throughout the six hour course.
Michelle owns her own private practice, Heartwood Speech Therapy, and is bringing evidence to early intervention. Through her lectures, PodCast, leadership, and example, she is changing the EI world for the better. She is a self-proclaimed “SLP nerd”, but this only goes to show how well-read, intelligent, and in touch with the literature Michelle is. She is an advocate for best practices in EI, and proudly stands on several soap boxes, encouraging core vocabulary instruction, a holistic approach to care, “bagless” therapy in the natural environment, interprofessional practice, and to quit using non-speech oral motor exercises (NSOMEs) already!
Michelle’s path is certainly less traveled. Not only is she kicking up dust along rural dirt roads in South Carolina as she visits her patients each day, but she is also traveling against antiquated practices and misunderstandings in her state’s health care system. This drove her to become the President of the South Carolina Speech Hearing Association (SCHA) and to share her knowledge and passion throughout the country through developing and presenting CEU courses.
I interviewed Michelle over the phone, and was humbled that she was so willing to share her experiences and insights with me, despite her busy schedule. As we spoke, she balanced our thoughtful conversation with disciplining her pup, Chewbacca, screeching excitement over news of an exciting guest for her PodCast, and extinguishing several fires between a 3 year old dressed as Wonder Woman and a 5 year old with a launchable ice cream cone. Needless to say, I am so inspired by Michelle’s ability to ‘do it all’. Not only is she a fabulous SLP, but she is a nurturing mother, volunteer president for her state association, and relentless advocate for the needs of her patients.
Early intervention is way more than “just play”, and Michelle Dawson is a leading voice on this soap box.
Her path: Michelle has been a speech-language pathologist for over 10 years in a variety of settings including public schools, inpatient and outpatient rehab hospitals, and early intervention. After earning her BS from Old Dominion University in 2005 and MS in Communicative Sciences and Disorders from James Madison University in 2009, she completed her CF at Riverside Walter Reed Hospital, where she was the first full-time SLP in the hospital’s history. In 2012, she moved to South Carolina. Since then, she has primarily worked as an Early Intervention/Home Health SLP, specializing in the treatment of medically fragile and complex pediatric cases. Michelle is constantly working to improve herself as a leader, professional, and clinician. She was one of 30 individuals from the nation accepted into ASHA’s 2016-2017 Leadership Cohort, and is currently working toward her BCS-S licensure. She is also the current President-elect of the South Carolina Speech Hearing Association (SCSHA) as well as their Vice President of Governmental Affairs. Michelle runs her own private practice, Heartwood Speech Therapy, and lectures throughout the country on topics including pediatric dysphagia and sensory integration for the SLP. Her podcast, First Bite, is informative, entertaining, and presents unique insights and interviews surrounding EI, all redeemable for ASHA CEUs. Beyond all of this, Michelle is a supervisor to USC graduate students, a wife, and a Mama to two sweet boys.
“Early intervention is not where I thought I would be, but it’s where I find myself. I love it and it fits me. I get to help families connect the dots, which I love.” – Michelle Dawson, MS, CCC-SLP
Mallory: Alrighty, so let’s start from the beginning. What advice would you give to a new graduate about to begin their clinical fellowship?
Michelle: In your clinical fellowship, your one job is to be a sponge. As clinical supervisors, we know that you have baseline knowledge, but it’s our job to make you grow. Take as many classes as you can. Read as much as you can. Go to as many things as you can. That year is a weird switch. You go from having someone look over your shoulder to finding who you actually are as a therapist, which is really hard. But, you won’t be successful unless you are a sponge and learn from everyone around you. It’s a really cool year where you get to find your own style, so enjoy that discovery, but be a sponge.
Mallory: Definitely. Finding your clinical style is so important. In my CF, it was the first time I wasn’t working for a grade or trying to impress a supervisor. It was a weird, hard adjustment.
Michelle: And we lose sight of that, on the older side. We forget that you’re still figuring your own self out. The mid to late 20s, when you’re finishing grad school, is a huge age of discovery in an individual.
Mallory: You’re speaking to my heartstrings on that one. So, you’re a Mom, running your own private practice, and traveling the country to lecture. Is there any habit, practice, or routine you have to stay sane?
Michelle: I have two things and I can tell immediately when I don’t do both of them. First, I have a coffee date with my husband every single morning. We wake up at the crack of dawn, hope that the children sleep in a little bit, and we have coffee together. I know that sounds super cheesy, but we do that because it’s the only time when we’re awake enough and energetic enough to actually talk to each other and nurture each other. He’s my partner and we need that time. Then, after he goes to work, I do my bible study. That’s huge. I’m supposed to do the good Lord’s work on this side. If I’m not spiritually and emotionally there, then the rest of my day is shot.
Also, for my mental health, I sweat it out in the garden. And, I mean sweat it out. I have clay dirt and you have to have a pick ax to put anything in it. Welcome to the deep south, y’all. But, I’ve got jasmine crawling my fence, roses in front of the house. I love gardening. When I’m stressed and I have too much clutter in my life, I pull weeds. When I need something to grow or I’m working on a new project, I start planting. So, it’s really cool to me how my garden is a reflection of whatever thing I’m doing.
Mallory: That is so mindful; I love that! So, I remember from your lecture that you completed your CF in a hospital. Can you refresh me and tell me more about your CF experience?
Michelle: My CF was at a super rural hospital, and I mean super rural. I did everything. I did adult inpatient in the morning, ICU, med surge, everything. In the afternoon, I worked at the clinic and I saw everybody from 2 years old to end of life geriatric care. My mentor, although very sweet, was not very involved. My actual mentors were other professionals like the GI doctor, the chief hospitalist, and the nurse practitioner. They invested so much time in me to help me see how everything was connected. Even though I don’t work in a hospital now, that experience was fundamental. The ENT would pull me into the OR to watch the surgeries happen, and then I would have those patients. For example, he pulled me in to see a kid have her adenoids out, he talked me through the surgery, and then, later, I treated her for artic/phonology. So, that was fundamental in shaping me to treat these complex pediatric patients. I got to see that our job is more than the oropharynx. Being a new grad and the first full-time SLP working in the hospital, they didn’t even have the proper paperwork created. I had to do all the things. Then, I left that to work early intervention. I felt like “this is horrible. I don’t like tiny humans. I want to get back into the hospital.” Yet, my work kept drawing me back there. Early intervention is not where I thought I would be, but it’s where I find myself. I love it and it fits me. I get to help families to connect the dots, which I love.
Mallory: Do you think there was a moment when you changed from disliking early intervention to loving it?
Michelle: Actually, yeah. An early interventionist called and said “I hear you can help the kids nobody can fix.” I was like, “wait, what?” And then she said, “Yeah, you get the hard cases, the kids nobody can really figure out.” I had been enjoying my work, but I didn’t realize how unique I was at it. It wasn’t until she said that to me that it truly clicked. It was a very ‘aha’ moment in my career.
Mallory: Wow, that’s so awesome. Sometimes it takes an outside perspective to realize you have a gift. I know you self-proclaim yourself as an SLP nerd. Is there a book that you frequently recommend, clinical or nonclinical?
Michelle: Gulp by Mary Roach. Gulp is the history of the alimentary canal. It’s fantastic and so much fun to read. Also by Mary Roach is Stiff. Stiff is the history of cadavers, which sounds horrible. But, the very first strong female lead that I had exposure to was my great, great aunt. She was a nurse when people said women couldn’t be a nurse, when women were just starting to go into the medical field. And, she donated her body to science. She had a locked-in syndrome where her body was crippled and she couldn’t talk. Looking back now, I think how much she would have benefited from an AAC device with eye gaze, but they didn’t have that. I remember being 6 and watching this woman who used to be a powerhouse to being an invalid in bed and watching my great, great Uncle Henry take care of her till the end. When I found Stiff, I thought it was amazing because it goes through what happens to bodies scientifically and how that knowledge has changed our understanding of the world. The book explains how cadavers have been used to improve seat belt safety or pinpoint time of death to fight crime. All I can think of is how my aunt was so selfless at a time when it was hushed in our family. We were not allowed to talk about how she wasn’t buried, because she wasn’t going to be resurrected if she wasn’t buried. But I thought, “no, that’s awesome”. She’s helped so many other people.
Mallory: That is amazing. You have certainly inherited some of those courageous genes. Do you have a “favorite failure”?
Michelle: Ugh, yes. This was my favorite question on your list. I had been told, incorrectly, that we need to “wake up” the pediatric dysphagia patient’s face prior to PO trials. And, I was told to do that through vibration. I had a giant strawberry teether and was vibrating a nonverbal patient’s face by squeezing it all over their face to ‘wake up the muscles’ so we could do PO trials of puree foods. Bear in mind, the patient had a baseline seizure disorder. I mean, seriously, I went down in a flame of glory. The mom turns to me and asks, “so what are you doing?” The mom was probably only a year or two older than me, and I said, “I have to wake her face up to eat.” She looks at me and asks, “Is that a thing?” Of course it’s a thing! So, as I’m vibrating the patient’s face, the patient starts drooling more, and she’s arching and pulling away, and she can’t move because she has CP and she’s sitting in a giant bean bag chair. Now, in retrospect, I realize she didn’t have sufficient core strength and she’s not properly positioned… but I remember thinking, wait, what am I doing with this kid? I stopped and went home and started researching and realized, wow, I should not be doing this. It was the appearance of effectiveness without actually being effective. That’s when I started researching non-speech oral motor exercises and seizure disorders and then I quit utilizing all things vibration and plastic and went with a functional, holistic approach. Every patient since then has made better progress
Mallory: Wow. I just think about my own practice and I’m wondering, what are the things I’m doing right now that ten years from now I’m going to be like, what was I thinking?!
Michelle: You’re good. It’s all part of it.
Mallory: Well, clearly we have a lot of gaps to fill. What do you think is an area of growth in our field?
Michelle: We need to recognize the need for clinical hats in early intervention. This is not, “we’re playing with babies”. What we are doing is skilled. To grow from that, we need to sit down and have the crucial conversation about non speech oral motor exercises (NSOMEs). We need to sit down and align that fun, festive approach with the actual evidence. ASHA’s website and the motor-neural pathways tell us: there is no evidence behind this. We need to bring evidence to pediatric early intervention swallowing. It is the bane of my existence when I pick up kid after kid from other therapists and all they have done is NSOMEs and they’ve made no progress, but they haven’t thought about the fact that the child can’t breathe through their nose and is an obligatory mouth breather. Maybe we need to fix their airflow so they can safely swallow because respiration takes precedence over deglutition. Look with a holistic clinical set of eyes in EI. It’s not just using brightly colored toys to chew on to make them eat because its fun. This is a huge soapbox.
Mallory: Aside from NSOMEs, do you think there are any other bad recommendations in EI?
Michelle: Picture exchange communication system (PECS) is antiquated methodology. We do not need to take one hundred different pictures of nouns, laminate them, then Velcro them and put them in a binder for a kid to have to then manually flip through with compromised fine motor skills to hand off a picture of each noun they want to engage with in their world. Rawr. We should be utilizing core vocabulary on an AAC device that is set left to right like a sentence. Thank you Dr. Carol Page from the SC Assistive Technology office for making me better. I am totally recording her tomorrow for a podcast. This is huge.
Mallory: Do you think there was any turning point or shift in your career?
Michelle: There were two. One, when I first went back to work after maternity leave with my first. I realized how hard it was to be a working mom and a therapist. I had created unrealistic expectations for patients’ families on a week to week basis. I was giving ten goals for their home exercise program. Then I became a mom and realized, I can do maybe one thing new this week. Recognizing that they are all just trying to survive, and also grieve and accept their child’s disability. It was actually with the worst abuse case of shaken baby syndrome I have ever had. I was working with the patient’s foster mom. I remember leaving that kid, driving home to pick up my 4 month old, and just sobbing while I nursed him. It just clicked—how hard their walks were, their grieving process. The reconciliation of their new reality and their day to day life made me a much better therapist. It made me slow down and guide them with much more functional approaches.
My other big ‘aha’ moment for sharing and lecturing was when I was asked to do a guest lecture here in town to the neuro-track USC grad SLP program. One of the professors told me I should do this professionally. He said, “Not only did I learn a ton, but it was fun. You can really do this.” That’s what encouraged me to step out and do this lecturing thing.
Mallory: Well, I second that. I thought your lecture was amazing. I learned so much and you are hilarious. The whole time, I was thinking, “I need to get this woman on my blog…”. And then I started creeping on you.
Michelle: Creep away, baby.