#if you plan to read this wall o text and have complex or trauma feelings about that topic then be careful

[dickgoblinpi]

i just want to vent about work a bit

yesterday i was working with a boy i know v v well. i am his key worker and have been the main (or only) person responsible, other than himself and his mum, for creating his care plan and routine. he has a significant eating aversion and over the past 8 months i have put a lot of work into developing a mealtime routine with him that he enjoys and that helps him eat and drink a good amount and variety while he is at our service. the routine is pretty specific and takes up two packed a4 pages in the care plan. 

we’ve reached a point now where he eats a moderate breakfast and has some juice when he comes in, then has a large late lunch of sandwiches, pasta, soup or something like that, plus maybe some yoghurt, cake, crisps or similar, and some more juice. he can now eat a slice of cake with the other young people when someone has a birthday. if we all do cooking or baking activities he can eat the fruits of our labours. when he first started attending, that first day he drank a capri sun and that was it. so this progress and achievement is a big deal to everyone involved. im v proud of him and myself. there is 1 problem

for some reason people think anything i say is open to interpretation? at all times? most people know that this boy’s eating plan began at home with his wonderful mum, and from there has been the work of him, me, myself and i while he is at our service. like pretty much every time he eats a meal here it is the direct result of the 8 months i alone have spent collaborating with him to make his routine work for him. most people know that. certain people seem to live in opposite land. quite apart from that, his care plan says ‘do X’ and when a care plan says that, unless X is flatly unethical or you have observed X to lead to terrible things, you DO X. im talking specifically about things like ‘molly stands to get personal care support’ and ‘jimmy requires support from 2 staff to go on trips’ and ‘sandy drinks from a straw’ 

you dont just go ‘meh, i feel like getting molly to lay down today’ or ‘i dont see why sandy can’t just drink from a sports bottle’ or ‘im sure jimmy will be just fine going to the cinema one-to-one’ but when it comes to the support notes i have written, PEOPLE KEEP GOING ‘i can feed this young person by myself’ ‘he doesnt really need a straw’ ‘im sure he will learn to like having reggae music on with his meals’ ‘i should put my arm around him and hold his head to keep him still’  

when i arrived at work yesterday, a supervisor who has been somewhere else not here for 6 months, came up to me and immediately started telling me her awesome new ideas for how best to support this boy to eat. her main idea was that, because he has involuntary arm movements as well as an instinctive reflex to bat away the food, instead of holding on to his arms i could tuck them under his arm rests and very gently put my arm on top of his so he cant get them out, because “that’s half the battle”

it’s really complicated to talk about how we support him not to bat away the food, because whenever i say ‘choice’ i go down the rabbit hole of how a choice isn’t necessarily a choice and the entire surrounding environment and their life to this date and everyone’s expectations of them and 100 other factors have so many complex and interwoven impacts on the choices someone is truly able to make :/

with that said, the general idea of lunch support for this boy is that he can and does choose (gah) not to eat or not to take a given bite, but when he is hungry and willing to eat and drink, he needs gentle support to enable him not to make those movements. like i can maybe think of six bites over the entire period i have worked with him where he has kept his arms still to take a bite without support. and i really am talking the lightest of pressures. if he moves his arms, the pressure comes off. it’s a very communicative process and kind of goes like this

1. his table is set up with his preferred music on and staff are sitting with him. he is smiling and bobbing his head to the music with his hands in his lap or drumming on the table. staff gently lay their hand or arm on his forearm or hand. sometimes he holds their hands and twiddles their fingers. one staff member offers a mouthful of food to him and after a moment or two he stills his head, opens his mouth and takes the bite

2. staff present another bite, but he raises his arms and motions to bat it away. staff take their arms and the bite of food away, and he has a bit of a shake or a dance. he might cuddle staff briefly or pull faces at them and laugh with them. he starts drumming on the table again and staff resume the light pressure and offer the bite, which he takes

3. he raises his arms and pulls them into himself, frowns and makes a groaning noise. staff joke with him and he laughs but staff understand through his body language and vocalisations that he does not want the next bite. staff ask if he wants a drink and he smiles and relaxes his posture. staff resume the light pressure and offer him the drink, of which he has several sips. after this he resumes eating

those three stages are kinda what you can typically expect. sometimes he’s eating happy as you like, sometimes he wants a drink and sometimes he needs a moment. if he is feeling unwell in some way or the process isn’t working for him, he will groan, grimace or maintain constant motion and you know he is saying a clear ‘no.’ it happens. it was very very hard at first to feel as if you were overriding his ‘default no’ at every mealtime, but the unfortunate fact is his health would be at risk if his involuntary or reflex actions dictated when he eats. gastrostomy has been considered as an option but it would impact him negatively in certain ways and carry a number of risks, and would be considerably less of a choice than he has currently :/ ahhhh it’s a minefield

the more fortunate fact is that he does genuinely enjoy his food and mealtimes if his routine is followed to the letter and staff listen to him and keep the whole thing light-hearted. recently we’ve reached a point where at lunchtime, he will sit with his mouth open waiting for you to hurry up and load the spoon, goddamnit. laughing and smiling and joking around with staff the entire time, and eating everything in 10 minutes flat and looking around for more like ‘eating challenges who?’ 

sooooo anyway, when this fucking supervisor decides to tell me soemthing that amounts to restraint and completely misses the point of how this boy eats, it pissed me off all day. 

then when lunchtime rolled around the only staff available to join us for lunch support was someone i really get exasperated with. this staff member insisted on taking the more active role (generally one staff member does the majority of the physical act of feeding, but it isnt a hard and fast rule and sometimes this boy prefers that you switch it around a lot) and i took what i thought would be the path of least resistance as we were a bit pinched for time, but ohhhhh my god! you would not think i had written two pages about how to support this boy, or at least you wouldnt think that this staff member read them. has he? idek. 

it was just so slow! so inexplicably slow! he was using a dessert spoon which was too big and wide and scoopy which was resulting in very tiny bites being taken from the tip of the spoon through necessity. he insisted ‘[name] prefers metal spoons’ which is not my experience. size and shape is more important - he prefers a smaller, flatter spoon because of the shape of his mouth and how he opens it. he had a large portion of fresh mac and cheese from our cafe that i thought would get finished in 10-15 minutes considering we had had such an active day and i knew he would be hungry and it’s his fav, but it wound up taking 40 minutes because this staff member was literally delivering 1-2 pieces of macaroni at a time, and he KEPT PAUSING WITH THE SPOON IN MID-AIR JUST TO TELL ME A FUCKING ANECDOTE

sometimes mealtimes are long and it’s fine, that goes for so many of the kids who like to take their time, but this person knows when something is going on longer than it needs to and he loses patience. wouldn’t you? sometimes he likes to take his time but he doesn’t like to wait around for you to wrap up your fucking self-aggrandising little story about someone you used to work with who was just like him and how good you were at it

the macaroni was cold by the end and so was my heart