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Raatz M, Ward EC, Marshall J, Burns CL, Afoakwah C, Byrnes J. A time and cost analysis of speech pathology paediatric feeding services delivered in-person versus via telepractice. J Telemed Telecare 2023; 29:613-620. [PMID: 33966525 DOI: 10.1177/1357633x211012883] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Telepractice models of care have the potential to reduce the time and financial burdens that consumers may experience accessing healthcare services. The current study aimed to conduct a time and financial cost analysis of paediatric feeding appointments accessed via telepractice (using videoconferencing) compared to an in-person model. METHODS Parents of 44 children with paediatric feeding disorders (PFDs) residing in a metropolitan area completed three questionnaires relating to (a) demographics, (b) time and cost for in-person care and (c) time and cost for telepractice. Both cost questionnaires collected data required for direct and indirect costs comparisons (e.g. out-of-pocket costs associated with the appointment (direct), time away from usual duties (indirect)). Average number of services accessed by each participant, and PFD appointments conducted annually by the service, were collected from service statistics. Analysis involved cost minimisation and cost modelling from a societal perspective. RESULTS The telepractice appointment resulted in significant time (p = 0.007) and cost (AUD$95.09 per appointment, SD = AUD$64.47, p = < 0.0001) savings per family. The health service cost was equivalent for both models (AUD$58.25). Cost modelling identified cost savings of up to AUD$475.45 per family if 50% of appointments in a 10-session block were converted to telepractice. Potential cost savings of AUD$68,750.07 per annum to society could be realised if 50% of feeding appointments within the service were provided via telepractice. DISCUSSION The telepractice model offered both time and cost benefits. Future service re-design incorporating hybrid services (in-person and telepractice) will help optimise benefits and minimise burden for families accessing services for PFDs.
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Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Australia
| | | | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Australia
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Haney SD, Ibañez VF, Kirkwood CA, Piazza CC. An evaluation of negative reinforcement to increase self-feeding and self-drinking for children with feeding disorders. J Appl Behav Anal 2023; 56:757-776. [PMID: 37522307 DOI: 10.1002/jaba.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/02/2023] [Indexed: 08/01/2023]
Abstract
Self-feeding with utensils represents an important step in a child's progression toward age-typical eating and emerges in the absence of intervention for most children. In contrast, children with feeding disorders may lack the skill or motivation to self-feed, which impedes progress toward age-typical eating. In the current study, experimenters used a multielement design to evaluate negative reinforcement in the form of meal termination to transition six participants with a feeding disorder from caregiver-fed to self-fed bites and drinks. Caregivers conducted meals in which they fed the participant or prompted them to self-feed. During self-fed meal-termination sessions, participants had the opportunity to end the meal contingent on self-feeding the presented bite(s) or drink(s). Self-feeding increased during meal-termination sessions for all participants. The experimenters discuss these results relative to their potential to inform interventions for children with feeding disorders that progress the child toward age-typical eating.
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Affiliation(s)
- Sarah D Haney
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Vivian F Ibañez
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | | | - Cathleen C Piazza
- Children's Specialized Hospital, New Brunswick, NJ, USA
- Graduate School of Applied and Professional Psychology, Rutgers University, USA
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Alaimo CM, Seiverling L, Weisberg HR, Ortsman JT, Jones EA. An Evaluation of a Telehealth Caregiver Training Package to Treat Food Selectivity. Behav Modif 2022:1454455221131285. [DOI: 10.1177/01454455221131285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Telehealth behavioral interventions are increasingly necessary when in-person services are not accessible (e.g., due to geographic location, time, cost, and health and safety restrictions). There is a growing evidence-base for the effectiveness of telehealth interventions but few demonstrations of telehealth interventions for pediatric feeding disorders. The purpose of this study was to evaluate a telehealth caregiver training package to teach caregivers to implement a feeding intervention, in their home as primary interventionists, to treat their children’s food selectivity. To address some previously documented caregiver concerns regarding some intervention procedures (e.g., nonremoval of the spoon or escape extinction) and ensure caregivers could safely/feasibility implement intervention, the intervention included differential reinforcement of bites consumed within a 3-minute opportunity. All three caregivers demonstrated high levels of correct performance following training and all children demonstrated increases in the number of bites consumed and decreases in disruptive behaviors. Findings suggest training caregivers via telehealth may be a viable option to treat some children’s food selectivity without first requiring in-person services.
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Ibañez VF, Peters KP, Bacotti JK, Lloveras LA, Van Arsdale A, Vollmer TR. Teaching behavior analysts in an early intensive behavioral intervention setting to conduct a structured mealtime protocol. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Vivian F. Ibañez
- Deparment of Psychology University of Florida Gainesville Florida USA
| | - Kerri P. Peters
- Deparment of Psychology University of Florida Gainesville Florida USA
- Department of Psychiatry University of Florida Gainesville Florida USA
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Ibañez VF, Peters KP, Vollmer TR. A Comparison of re-presentation and modified chin prompt to treat different topographies of liquid expulsion. J Appl Behav Anal 2021; 54:1586-1607. [PMID: 34329488 DOI: 10.1002/jaba.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/07/2022]
Abstract
Treatment of one behavior in the chain of consumption might be associated with the emergence of other problematic behaviors. For example, some children with feeding disorders expel liquid. Moreover, the form in which children expel liquid might vary and influence whether a treatment to reduce liquid expulsion will result in clinically meaningful outcomes. In the current investigation, we first identified topographies of liquid expulsion (e.g., forceful, run out) for each child. We then compared and evaluated the effects of 2 procedures, a modified chin prompt and re-presentation, on the liquid expulsion of 3 children with feeding disorders. For 2 participants, expulsion decreased to clinically meaningful levels with a modified chin prompt or re-presentation. However, for 1 participant, expulsion decreased to clinically meaningful levels only when we combined the modified chin prompt and re-presentation as part of a treatment package. We discuss possible mechanisms underlying the effects of a modified chin prompt and re-presentation, in addition to areas for future research.
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Peterson KM, Ibañez VF, Volkert VM, Zeleny JR, Engler CW, Piazza CC. Using telehealth to provide outpatient follow-up to children with avoidant/restrictive food intake disorder. J Appl Behav Anal 2020; 54:6-24. [PMID: 33145801 DOI: 10.1002/jaba.794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022]
Abstract
The COVID-19 global health crisis compelled behavior analysts to consider alternatives to face-to-face services to treat children with feeding disorders. Research suggests telehealth is one method behavior analysts could use to initiate or continue assessment of and treatment for feeding disorders. In the current paper, we conducted pilot studies in which we analyzed chart records of patients with Avoidant/Restrictive Food Intake Disorder; who graduated from an intensive, day-treatment program; and transitioned to an outpatient follow-up program. In Experiment 1, we analyzed the data of participants who received follow-up both in-clinic and via telehealth. In Experiment 2, we analyzed goal attainment for participants who received outpatient follow-up either in-clinic exclusively or via telehealth exclusively. Results of both studies showed that outcomes were equivalent along most dimensions for in-clinic and telehealth services. We provide recommendations for telehealth feeding services and discuss other considerations relevant to telehealth service delivery.
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Affiliation(s)
- Kathryn M Peterson
- Children's Specialized Hospital, New Brunswick, New Jersey.,Graudate School of Applied and Professional Psychology, Rutgers University
| | - Vivian F Ibañez
- Children's Specialized Hospital, New Brunswick, New Jersey.,Graudate School of Applied and Professional Psychology, Rutgers University
| | - Valerie M Volkert
- Children's Multidisciplinary Feeding Program, Marcus Autism Center, and Emory School of Medicine
| | - Jason R Zeleny
- University of Nebraska Medical Center's Munroe-Meyer Institute
| | | | - Cathleen C Piazza
- Children's Specialized Hospital, New Brunswick, New Jersey.,Graudate School of Applied and Professional Psychology, Rutgers University
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Raatz M, Ward EC, Marshall J, Burns CL. Developing the system architecture for conducting synchronous paediatric feeding assessments via telepractice. J Telemed Telecare 2019; 25:552-558. [DOI: 10.1177/1357633x19872091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Telepractice systems should be acceptable to users and meet end-user needs. Whilst the system requirements to conduct adult dysphagia assessments via telepractice are established, key differences exist between adult and paediatric swallowing assessments. This study was conducted to develop the system architecture required to conduct paediatric feeding assessments in patient homes via telepractice. Methods The study used a four-phase iterative design, informed by human-centred design principles. In Phase 1, two telepractice researchers and two paediatric feeding clinicians identified assessment tasks and explored potential system design solutions. Initial system testing was completed using clinical simulations (Phase 2). Live trials with 10 typically developing children were then conducted (Phase 3). Phase 4 involved user-centred feedback from clinicians and parents. Feedback from the development team, clinicians and parents was used to continuously refine the model. Results A combination of synchronous and asynchronous methods enabled all assessment components to be successfully completed. Clinician and parent feedback established the optimal technology (e.g. phone, tablet) and key camera positions necessary to optimise visual/auditory information for the online clinician. End-user feedback identified greater time efficiencies could be achieved through collecting some data (e.g. intra-oral pictures) via asynchronous methods prior to the session. Information sheets were deemed necessary to enhance the user experience. Clinicians and parents responded positively to the final system design. Discussion Modifications to standard videoconferencing were necessary to develop a clinically viable process for conducting paediatric feeding assessments in the home via telepractice. End-user feedback was integral to the design of the final model.
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Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children’s Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children’s Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology & Audiology Department, Royal Brisbane and Women’s Hospital, Queensland, Australia
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Saini V, Kadey HJ, Paszek KJ, Roane HS. A systematic review of functional analysis in pediatric feeding disorders. J Appl Behav Anal 2019; 52:1161-1175. [PMID: 31523816 DOI: 10.1002/jaba.637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/16/2019] [Indexed: 11/07/2022]
Abstract
We conducted a systematic review of the functional analysis of inappropriate mealtime behavior in peer-reviewed studies in PsycINFO, ERIC, PubMed, and the Journal of Applied Behavior Analysis between 2000-2016. We identified 18 studies involving 86 functional analyses. We coded descriptive data and calculated summary statistics in addition to conducting a quality appraisal of the literature. We identified escape, exclusively or in part, as the maintaining reinforcer for inappropriate mealtime behavior in 92% of cases. Results indicate that differentiated functional analyses of inappropriate mealtime behavior can be obtained, and outcomes are consistent with etiological theories of food refusal behavior. We discuss procedural differences across studies as well as directions for future research.
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Peterson KM, Volkert VM, Milnes SM. Evaluation of Practice Trials to Increase Self-Drinking in a Child with a Feeding Disorder. Behav Anal Pract 2017. [PMID: 28630821 DOI: 10.1007/s40617-016-0147-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Self-drinking is an important skill for children to acquire as they transition from infancy to early childhood; however, the literature is limited (e.g., Collins, Gast, Wolery, Holcombe, & Leatherby, 1991; Peterson, Volkert, & Zeleny, 2015). We manipulated the consequences associated with self-drinking relative to those associated with being fed along the dimension of response effort. Results demonstrated that self-drinking increased when the child could either choose to self-feed one drink or be fed one drink and 5 practice trials with an empty cup.
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Affiliation(s)
- Kathryn M Peterson
- University of Nebraska Medical Center's, Munroe-Meyer Institute, Omaha, USA
| | - Valerie M Volkert
- University of Nebraska Medical Center's, Munroe-Meyer Institute, Omaha, USA.,Marcus Autism Center and Emory University School of Medicine, 1920 Briarcliff Road, Atlanta, GA 30329 USA
| | - Suzanne M Milnes
- University of Nebraska Medical Center's, Munroe-Meyer Institute, Omaha, USA
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Volkert VM, Piazza CC, Ray-Price R. Further Manipulations in Response Effort or Magnitude of an Aversive Consequence to Increase Self-Feeding in Children with Feeding Disorders. Behav Anal Pract 2016; 9:103-13. [PMID: 27606249 PMCID: PMC4893039 DOI: 10.1007/s40617-016-0124-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Although some children with feeding disorders may have the necessary skills to feed themselves, they may lack motivation to self-feed solids and liquids. Rivas, Piazza, Roane, Volkert, Stewart, Kadey, and Groff (Journal of Applied Behavior Analysis, 47, 1-14, 2014) and Vaz, Volkert, and Piazza (Journal of Applied Behavior Analysis, 44, 915-920, 2011) successfully increased self-feeding for children who lacked motivation to self-feed by manipulating either the quantity or the quantity and quality of bites that the therapist fed the child if he or she did not self-feed. In the current investigation, we present three case examples to illustrate some challenges we faced when using these procedures outlined in the aforementioned studies and how we addressed these challenges.
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Affiliation(s)
- Valerie M. Volkert
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE USA
- Marcus Autism Center and Emory University School of Medicine, Altanta, GA USA
| | - Cathleen C. Piazza
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE USA
| | - Rachel Ray-Price
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE USA
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