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(If you're reading this, you've likely already read Part 1, Part 2 and Part 3 of the "4 Things Counselors Should Know About Food Allergies" series. If not, I'd suggest you read those first). In the previous three posts, I covered topics focused on the many layers of food allergy-related anxiety and fear, food labeling concerns, and the lack of support that many find from schools and family. The final post in this series has to do with the counseling considerations that counseling professionals should be aware of when working with clients managing food allergies. #4 - A Collaborative Team Approach Is Crucial.... And Be Mindful With Exposure Therapy Techniques  Photo Credit: Pixababy (AR130405) A Collaborative Team Approach is Crucial Ideally, those diagnosed with food allergies would routinely see their allergist, as well as their GP doctor, but they would also be given referrals to allied healthcare professionals in case they may be useful. This list might include counseling professionals, dietitians, dermatologists, gastroenterologists, and even educational consultants w/food allergy knowledge. Some larger medical hospitals and institutions already take a true collaborative team approach within their food allergy departments, including having a counseling professional on staff. However, you'll typically be working with food allergic clients in your own office and therefore, will need to create your own collaborative team approach with your client's medical doctors and other allied healthcare professionals. Food allergic clients typically visit their allergist annually (or more often, if necessary). Allergists will determine or confirm food allergy diagnoses, and help their clients establish emergency action plans and safety guidelines. Therefore, at the very least, you'll want to connect with your food allergic client's allergist for continuity of care if the client allows. Sometimes perceptions and statistics don't align when it comes to evaluating risk factors. Therefore, especially if you're not well-versed in food allergies, being able to reach out to their allergist will prove useful in situations where you may want to clarify the likelihood of reactions or other food allergy facts, as they pertain specifically to your client. Additionally, the allergist will find it useful knowing what may be causing the client increased food allergy fears, anxiety, or emotional distress, as well as the progress being made and overall goals for counseling. A Few Words on Specific Counseling Concepts and Goals While exposure therapy type of techniques may benefit many clients presenting with specific fears and anxiety, even those with food allergies, you'll need to be mindful of one very important point: The goal of counseling should never be to work up to exposing the person to their allergen in order to eliminate food allergy fears! Any allergen exposure needs to be determined by the client and their allergist together, not the counselor. After all, the core of food allergies lies within the medical realm. With that being said, a counselor can still be very helpful in guiding the client through the progression of food allergy appointments, testing, treatments, and fears. For those managing food allergies, appointments can include skin tests, blood draws, and even food challenges, where people actually ingest their allergen if deemed appropriate (this is typically based on lab results and determined by the allergist). Many, especially kids, may have fears or anxiety about these appointments, so helping them develop coping strategies and tools to navigate these scenarios is a great counseling goal. Clients managing food allergies would benefit from Cognitive Behavioral (CBT) work, which will help them identify and manage stress, acknowledge unhealthy (and healthy) thoughts and behaviors that may play a role, and learn how to challenge them and establish new ones. However, CBT isn't the only type of counseling that will help clients with food allergies. A variety of counseling theories and techniques may be useful in working with food allergies, as long as they're proving effective with the client. Here is a sampling of other clinical counseling goals you may establish when working with food allergic clients (goals will vary widely depending on the client): Kids:
Parents:
FINAL THOUGHTS...... Living with food allergies can be an extremely emotional experience, so there will be many opportunities where you'll need to help the client reality test to find a balance between emotions and facts. Balance is a key necessity for living with food allergies, since it's a marathon and not a sprint. Balance of emotions, balance of facts, balance of coping strategies. As food allergies threaten to throw that balance off kilter, sometimes on a daily basis, it's crucial to think about the bigger picture when working with food allergic clients. The work will be hard and gut-wrenching at times, but extremely rewarding, especially when you see a child or its family learning how to live an empowered life with food allergies as a direct result of the work you've done together. If you're working with a client who has food allergies and feel you need more information to educate yourself, check out the following resources, in addition to the links within this post:
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(If you're reading this, you've likely already read Part 1 and Part 2 of the "4 Things Counselors Should Know About Food Allergies" series. If not, I'd suggest you read those first). When people receive a food allergy diagnosis, it has the potential to turn their world upside-down. I shared some of my personal thoughts and feelings from when my youngest was diagnosed with a peanut allergy in my article, "Navigating the Emotional Seas of Food Allergies: One Parent's Journey Towards Resilience." ""In an instant, it feels as though your world has been turned upside down, and that everything you envisioned for your child’s future is no longer possible. While he had a moderate anaphylactic reaction after two bites of a peanut butter and jelly sandwich just days before, I was still living in denial. I didn't feel that I could handle the reality of what my gut knew was true. That all changed with one phone call. In that moment, it didn’t matter that I was a licensed clinical professional counselor, trained in helping others cope with their feelings; these emotions were too raw for me to process." Once past the initial shock of the diagnosis, people must immediately get to work on creating new guidelines and routines in order to ensure safety. That requires absorbing a lot of information, digesting it, and then putting it into practice. So it's no surprise then that this process is made easier if support is received, especially from family members and schools. In an ideal world, those managing food allergies would receive understanding, compassion, and support from all of their networks. Unfortunately, that's not always the case. #3 - Families Are Often Dealing With The Lack of Support From Somewhere - Usually Within the School or Family Systems  Photo Credit: Pixababy (JohnHain) Too often we hear of schools that aren't supportive, even with the least restrictive of safety precautions, or extended family members who believe that safety precautions are examples of over-reacting. It's crucial to know that while most can accept the fact that foods can be dangerous to those with food allergies, many people aren't as understanding or accepting when it comes to the specific details of living with food allergies or implementing food allergy safety plans. This lack of support can make those with food allergies feel like they're headed upstream without a paddle. Imagine if your child had diabetes and you had to convince others that it was a serious illness requiring specific protocols in order to keep your child safe. Those managing food allergies often find themselves needing to convince people just how serious in nature food allergies truly can be. Therefore, you can understand why it'd be frustrating and downright anger-producing for people whose support systems don't view food allergies as a serious condition, despite being able to accept protocols for other food-related medical conditions such as diabetes. When working with someone managing a food allergy, it's important to assess their support network in order to understand whether this is a source of relief or stress. To help with that assessment, here are some common areas where those managing food allergies may feel unsupported. SCHOOLS Food Allergy Guidelines - The CDC created a toolkit to help schools implement the Voluntary Guidelines for Managing Food Allergies. Therefore, in theory, schools that utilize these guidelines *should* have a decent understanding and use of food allergy protocols. Unfortunately, many food allergic families are still met with resistance and lack of understanding/adherence to their emergency action plans, even from schools with a food allergy policy in place. If that's the case with schools that have policies, can you imagine how difficult it must feel for those families that attend school districts *without* a food allergy policy? The daily uncertainty and fear associated with sending a child to a school that exhibits inconsistent or poor food allergy protocols would likely be insurmountable for many. Research about parent perspectives on school food allergy policies was published in 2018, and it supports many scenarios shared via online food allergy support groups. Some insights revealed from this research that may be helpful to know are:
504 Plans - Some families opt to have a 504 plan, which is a written document that outlines the accommodations the school will provide. This plan helps hold the school accountable by "guaranteeing that students with disabilities will receive the services necessary to get all the same benefits of an education as all other students." It typically addresses important information such as where the epi pen will be kept, and necessary accommodations for the classroom, lunchroom, and on field trips. However, for some, getting this 504 plan established is nothing short of a battle, as some schools use a variety of reasons to imply that those with food allergies aren't eligible for this plan. Therefore, some clients will need support and guidance through the 504 planning process, or at the very least, help coping with the emotions that arise when schools don't work with the family to accommodate food allergies in a reasonable manner. Bullying - There are many reports of bullying incidents against children with food allergies. A research study conducted in 2011 on this very topic revealed that "45.4% of the children and 36.3% of their parents indicated that the child had been bullied or harassed, and 31.5% of the children and 24.7% of the parents reported bullying specifically due to FA, frequently including threats with foods, primarily by classmates." Additionally, "parents knew about the child-reported bullying in only 52.1% of the cases." A longitudinal study on food allergy bullying was published in 2014, which concluded that any length of bullying was associated with lower quality of life for the child, and suggested that parental involvement was key in finding a solution to the problem. It might be assumed that all bullying that food allergic students experience comes from their peers. However, that's not always the case, as there are many reports of students being the recipient of negative comments and actions from adults, such as teachers or coaches. When these adults go out of their way to make comments that highlight a child's food allergy or single them out as the reason for changes to activities, it is humiliating and often interpreted by the child as bullying. Therefore, it's key to assess how food allergic child clients feel about navigating the social aspects of school, both relating to peers and adults. Be on the look out for other potential behaviors that might be masking how the child feels, especially if they're unable or unwilling to verbalize bullying or social exclusion incidents. FAMILY When family members offer understanding and are willing to adhere to food allergy safety guidelines to allow for inclusion, it can be as if a weight is lifted. But for those that are met with resistance or even disbelief from family members, that weight gets exponentially heavier since many are then faced with tough decisions, such as whether to miss holiday gatherings or even, in some cases, whether or not to sever relationships. Nicole Smith, the creator of the Allergic Child site, shared experiences where her own father suggested she was being over-dramatic about her son's allergies, even going so far as sending research studies suggesting she expose him to his allergens. It's not uncommon for the lack of support from family members to put additional strain on the marriage or relationships within the immediate family. Because emotions run high when it comes to food allergies and family conflict, it will be important to gain an understanding of the family dynamic as well as the conflict. Pay attention to generational divides and cultural upbringing within family systems, as these factors can impact how family members conceptualize food allergies. Families navigating these issues will benefit from guidance on how to educate their loved ones about food allergies, develop a united front to address conflicts, create a plan on how/when to address the conflicts with the family member(s), and what to do should the outcome not be ideal. FINAL THOUGHTS.... Food allergies are typically a lifelong condition, so it's key to understand that there will be chronic stress as well as episodes of acute stress. Just as with any medical condition, support is essential for those managing food allergies. For some, your understanding and willingness to learn about life with food allergies might represent the only source of support they receive. For others, you'll be an additional layer of support to help them through the episodic phases that require more guidance. Being aware of the fact that true food allergy support can often be inconsistent and spotty will only help you better understand your food allergic client and the challenges they may be currently facing or have previously faced. June 2020 Update: Due to COVID-19, many school districts in the U.S. are currently contemplating various plans to accommodate schooling for the 2020-2021 school year. One of the suggestions in the CDC's recent recommendations for returning to school includes students eating lunch in their classrooms. For some with food allergies, this may pose an additional layer of risk at school. The following resources may be helpful in understanding this factor in more depth:
If you're working with a client who has food allergies and feel you need more information to educate yourself, check out the following resources, in addition to the links within this post:
(If you're reading this, you've likely already read Part 1 of the "4 Things Counselors Should Know About Food Allergies" series. If not, I'd suggest you read that one first). In Part 1, we explored some basic concepts about food allergy-related anxiety. We bridged the path between anxiety and its impact on quality of life. We touched on how the anxiety is different than generalized anxiety, as it's clearly connected to continual perceived and actual health threats. But wait! There's something else that tends to cause an additional layer of anxiety for those managing food allergies: reading (and trusting) food labels. #2 - Food Labeling Laws Often Create An Additional Layer of Fear  Photo Credit: Pixababy (Alexas_Fotos) It's often assumed that food products will have clear and consistent labeling, highlighting not only the ingredients, but also whether the food was manufactured on the same line or in the same facility as allergens. Unfortunately, it's not that cut and dry, which often adds an additional layer of fear and anxiety for those managing food allergies. Per this article on Kids With Food Allergies,
As stated, thanks to the Food Allergen Labeling and Consumer Protection Act of 2004, there are some guidelines for food labeling, but there's still lots of grey area for food allergic people to navigate. To begin with, in the US, only the top eight major allergens are required to be clearly listed if they're an ingredient, leaving those with allergies to other foods potentially unsure if it's in that food item. Additionally, given the fact that there's no requirement or standard language to use when a company *voluntarily chooses* to disclose that an allergen was used in or near the preparation of the item, that uncertainty continues to grow. Imagine if you already had fight-or-flight levels of stress due to day-to-day food allergy navigation, and then were tasked with trying to buy foods for your child that were deemed safe, despite the current labeling laws. It might feel like trying to solve a Rubix Cube without any directions - doable, but extremely challenging! With labeling laws that aren't required to be completely forthcoming, consistent and transparent, those uncertainties just get piled on top of the already high levels of anxiety, and that's where the work is needed. Here's what some people managing food allergies say on this topic:
Essentially, for those managing food allergies, buying food can feel a bit like playing Russian Roulette, especially for those that are newly diagnosed and may be feeling overwhelmed with most decisions. Most people don't know how much of their allergen their body can handle before reacting (this is also known as their allergen threshold). For some, reactions start by just touching the allergen (especially if they then touch their eyes, nose, or mouth), or by ingesting even trace amounts. It's important to know that all people with food allergies have varying degrees of comfort with their allergen. That comfort level is typically based on a combination of things - information from their allergist, any previous reaction experiences, and how much risk they're willing to take. Therefore, some of your clients may not pay much attention to the voluntary "may contain" labels and likely won't find food shopping as stressful. But for those that do avoid items with a "may contain" warning, expect the stress levels to be higher. It will be essential to help these clients assess potential risk levels when buying foods (or eating out), learn to navigate the intrusive fearful thoughts surrounding food choices, and establish their comfort zones with a variety of foods. Additionally, as is the case in working with anyone with a food allergy, it will be crucial to help them learn to accept that no matter what, there will be a degree of uncertainty in *all* choices, but that it doesn't always mean something is unsafe. FINAL THOUGHTS..... It's important to understand how current food labeling laws impact those managing food allergies, how it may present an increased risk of reaction, and how this combination of factors often adds an additional layer of anxiety. Without understanding this aspect of the food allergy puzzle, you'll be putting it together without all of the pieces in play. June 2020 Update: Due to the COVID-19 pandemic, the U.S. Food & Drug Administration (FDA) issued an announcement in May 2020 that they were allowing temporary flexibility in food labeling requirements to decrease supply chain disruptions. To learn more about these temporary changes and how they may impact those managing food allergies, the resources below may be helpful:
Subscribe, bookmark, or stay tuned for parts 3 & 4 of the "4 Things Counselors Should Know About Food Allergies" series! If you're working with a client who has food allergies and feel you need more information to educate yourself, check out the following resources, in addition to the links within this post:
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