Understanding Training Needs in Pediatric Feeding for Allied Health Professionals: An Australian Perspective

Read the Feed: High-Emotion Simulation of Preterm Feeding to Enhance Graduate-Level Training

PURPOSE

Therapeutic bottle feeding is a critical skill for speech-language pathologists (SLPs) managing the increasing and medically complex neonatal intensive care unit (NICU) and early intervention caseloads. Thus, we explored the role of a high-emotion preterm simulator, known as "Paul," to increase knowledge, skills, and confidence related to infant feeding management for speech-language pathology graduate students.

METHOD

A randomized controlled study compared learning outcomes of 27 participants following either a 1-hr lecture or 1-hr training with a preterm simulator. Outcomes included knowledge demonstrated on written examination, accuracy in identifying stress cues during simulated feeding, and self-reported anxiety levels related to clinically assessing infant feeding.

RESULTS

No baseline group differences were found on written examination or during a simulated bottle feeding. Both groups improved in written examination scores and identification of stress cues (p < .001). Gains in written examination scores did not significantly differ between groups; however, after training, the simulator group correctly identified more stress cues during a simulated bottle feeding (p < .001), and the lecture group reported reduced anxiety related to clinically evaluating infant feeding compared to simulator-trained students (p < .05).

CONCLUSIONS

All students demonstrated gains in written knowledge and identification of stress cues; however, simulation-based training was superior in developing the feeders' ability to identify stress cues during a hands-on simulated bottle-feeding scenario. Lecture-based training may have inflated students' perceptions in their clinical skills as they were less accurate in identifying stress cues during a simulated feeding but reported significantly reduced anxiety for administering a clinical evaluation of infant feeding compared to simulation-trained students. Hands-on training using high-fidelity simulation may capitalize on experiential learning to better build clinical feeding skills for future SLPs who may serve in NICU and early intervention settings, while eliminating the risk of potential errors during learning that could affect fragile neonates.

Experiences of Allied Health Clinicians Accessing a Pilot Project ECHO® Program to Support Learning in Pediatric Feeding

INTRODUCTION

Pediatric feeding disorder is increasing in prevalence, yet low clinician confidence regarding its management is a barrier to care. Targeted clinician training is needed as traditional didactic training programs are limited in both their accessibility and capacity to provide opportunities for the application of theory-based learning.

METHODS

This study examined the experiences of a group of clinicians involved in a multidisciplinary PedFeed ECHO® network, a virtual community of practice established to support speech pathologists, occupational therapists, dieticians, and psychologists in Queensland, Australia, working with children with pediatric feeding disorder. Sixteen clinicians (34% of the total PedFeed ECHO network) from different professional backgrounds, clinical settings, and locations participated in semistructured interviews three months post completion of eight ECHO sessions.

RESULTS

Inductive thematic analysis revealed three themes: (1) broad-ranging outcomes of PedFeed ECHO, (2) participant experiences of PedFeed ECHO, and (3) facilitators for future success. PedFeed ECHO was viewed very positively and provided participants with a valuable opportunity for information sharing and collaboration as a multidisciplinary team. Participants described impacts on their professional practice, knowledge, confidence, and professional isolation, as well as service and patient-level impacts. Several facilitators for the success of future PedFeed ECHO cohorts were provided.

DISCUSSION

Insights from participants will serve to improve the design and delivery of ECHO training for future cohorts. Monitoring clinical skill development over a longer period of time and exploring clinician perceptions regarding direct impact on patient care are needed to further validate the impact of ECHO.

Examining the Outcomes of Project ECHO® as an Interprofessional Community of Practice for Pediatric Feeding Clinicians

Project ECHO® is a virtual, interprofessional, cased-based peer-learning model. To date, no studies have explored ECHO as a model for pediatric feeding education. This study examined the outcomes of establishing a pediatric feeding ECHO network. Using a prospective, mixed-methods design, two cohorts of allied health professionals were recruited. Each cohort participated in eight, 90-min videoconference sessions incorporating a didactic presentation and clinical case presentation. The case was presented by a participant, with questions and recommendations provided by the ECHO network. Participants completed: (1) a learning needs analysis before the ECHO series, (2) a self-reported confidence questionnaire pre, post, and 3-month post, (3) a satisfaction questionnaire after each session, and (4) an overall satisfaction questionnaire post-ECHO series. Time spent by hospital allied health clinicians providing impromptu phone/email feeding support to external clinicians was recorded for 8 weeks prior to and 8 weeks during the ECHO series. Forty-seven participants were included in the study, attending an average of 5.8 sessions. Significant improvements in self-reported confidence were observed across the three time points (p < 0.01) with less experienced participants demonstrating greater improvements. Participants reported high satisfaction with ECHO, with 93% (40/43) wanting continued access to ECHO in future. The multidisciplinary format, interactivity, structure, and case-based nature of ECHO were considered beneficial. A 75% reduction in requests for support from clinicians in the same catchment area was noted during the ECHO series. Results demonstrated that Project ECHO is a viable model for pediatric feeding education for clinicians working in the field. Further research is needed to investigate the long-term effects and impacts on clinical care.

Virtual nourishment: Paediatric feeding disorder management with telepractice amidst COVID-19: An allied health perspective

PURPOSE

The rapid adoption of telepractice services by health professionals was necessary to maintain service continuity for children with paediatric feeding disorders during the COVID-19 pandemic, during periods where in-person therapy was restricted. The aim of this study was to explore clinical perspectives and reflections on the use of telepractice for managing paediatric feeding disorders during the pandemic.

METHOD

A post-positivist qualitative approach using thematic analysis was adopted. This study seeks to understand participants' experiences and thoughts from allied health professionals from speech-language pathology, occupational therapy, and dietetics working with paediatric feeding in Western Australia. All participants delivered at least 10 telepractice sessions to children from birth to 12 years with a paediatric feeding disorder. Braun and Clarke's six-step thematic analysis process was used to analyse the data inductively.

RESULT

Eleven allied health professionals representing eight clinical settings in Western Australia, including speech-language pathology, occupational therapy, and dietetics, working with paediatric feeding were recruited. The results revealed four themes: families becoming the catalyst of change, clinician comfort over confidence, insights into authentic mealtimes, and the paradox of choice.

CONCLUSION

This study highlighted the need to build clinicians' confidence and competence, and the provision of service guidelines and training. Although many clinicians had positive experiences with telepractice, most returned to in-person delivery once COVID-19 restrictions were lifted, emphasising the importance of comfort in service delivery selection. We recognise that the findings of this study are constrained by the fact that it was conducted in a single geographical region and utilised a small qualitative sample. While telepractice was successful in managing paediatric feeding disorders, further development and implementation of telepractice guidelines are needed for telepractice to be a viable service delivery option for families and children with feeding disorders.