A team approach for tamariki with eating difficulties

This study takes place within a MDT clinic supporting children with eating difficulties. The usual clinic sessions are considered normal/standard clinical care. At the clinic a Dietitian and Speech Language therapist oversee standard care, supported by Dietetic and Speech Language Therapy students. The current study involves the addition of a Psychologist, and Psychology students studying towards a Masters degree. Normal clinical care: ACTIVEating sessions occur in 60-minute groups that occur on Tuesdays. These involve 3-4 children and focus on introducing new foods and building eating skills. This study involves a change to clinical care 1. Collection of more detailed behavioural data and requirement for families to provide a home mealtime video 2. If clinically indicated for an individual child, addition of behavioural strategies to the clinic eating group session. The overall duration of participation is 10-12 weeks. The expected study visits are 10-12 (weekly Tuesdays when children attend the clinic). See further description below: Baseline (Pre-intervention) Approximate duration of baseline: 3 weeks Eating information: When enrolling with ACTIVEating, caregivers will already have provided information about their child and their eating. We will briefly review some of this information with parents, that we will include in this study. This includes the child’s age, medical history, and ethnicity. We will also review the foods/drink they currently accept, their eating skills, and any challenges families are facing. We expect that this review could take between 15-30 minutes. Home meal observation: We will ask that families provide us with a video recording of a home mealtime of their choosing (e.g., lunch, snack meal). We will watch this video, and collect behavioural data. Clinic session observation: We will also observe the child’s behaviours in a similar manner to the above, during weekly Tuesday ACTIVEating sessions. Data will be collected in a separate room via video link. During baseline, ACTIVEating sessions will occur as usual (i.e., ‘standard care’). After approximately three weeks, the research team will review data for each individual child and apply a decision-making process to determine if further behavioural strategies are required. Family/whanau will be involved in discussing their child’s progress and the decision-making. - If a child is making progress across at least three eating sessions (e.g., participating, approaching or consuming foods), the baseline phase and data collection will continue. We will also ask families to provide two further video recordings of home mealtimes: half-way through ACTIVEating (at approx. 6 weeks), and at the end of the ACTIVEating term (at approx. 11 weeks). - - In contrast, If a child is not making sufficient progress, behavioural strategies will be discussed within in the research team, prior to discussing with family/whanau. Insufficient progress may include a child who has consistently refused to sit with the group of peers, or has not started to approach any foods in at least three consecutive weeks. Behavioural strategies (Intervention) Start of Intervention period: Approximately Week 4 Baseline observations and team discussions will inform the choice of behavioural strategies that can be implemented for the individual child in a group setting. Generally, strategies will fall into the following categories: Pre-meal strategies [Antecedent-based strategies] - Adding or modifying instructions – Using visual or written supports, modelling by adults - Adding choice or incorporating preference – offering a range of foods to the child - Reducing the effort of eating – pre-loading a spoon, smaller bites, reduced texture, adapted utensils Encouragement [Consequence-based strategies] - Providing specific attention or interaction after approaching or eating foods (e.g., song, toy interaction) - Providing a break after approaching or eating foods (e.g., physical break out of seat) The planned strategy will be discussed with family/whanau. Whanau are freely able to decline the use of any behavioural strategy – in this case baseline observations would still continue in the same manner as described above. The strategy will be implemented during weekly group clinic sessions (Tuesdays, 60 minutes) by the CI and/or Masters student under supervision, with data monitoring continued. If data indicate that the strategy is not helping (no improvement, signs of discomfort), we will stop using these immediately and return to decision-making regarding alternatives with the research team. Alternatives will be discussed with families. At around 6 weeks, we will ask families to provide a further home mealtime video. Post-intervention (End of study) At the end of the ACTIVEating term (10-12 weeks), we will collect the following data: Eating information: We will briefly review the child’s progress with family/whanau, this may take 15-30 minutes. We collect information regarding the foods/drink they currently accept, their current eating skills, and any challenges families are still facing. Home meal observation: We will ask that families provide us with a final video recording of a home mealtime of their choosing (e.g., lunch, snack meal). We will watch this video, and collect behavioural data (see outcome measures section). Clinic session observation: As noted earlier, clinic sessions are observed every week, continuing until the end of the study.