Thursday, September 19, 2024
5:00 pm – 6:30 pm
Welcome Reception
Friday, September 20, 2024
8:00 am – 9:00 am
S1 - Keynote Speaker - Parents as Partners: NICU Discharge Feeding Decisions
Gabriella Bluett-Mills, MD, Ochsner Medical Center
Many babies admitted to the neonatal intensive care unit (NICU) have prolonged lengths of stay due to feeding difficulties. Discharge decisions, including remaining inpatient, placing a gastrostomy tube and being discharged with a nasogastric (NG) tube are often institution dependent. Ochsner’s NICU and outpatient complex care team worked collaboratively to design a program to safely discharge babies with NG tubes. Parents and families along with inpatient and outpatient teams work using principles of shared decision making to determine appropriate goals for discharge and beyond.
At the end of this session, participants will be able to:
- Describe data on the number of NICU graduates with feeding difficulties who require long term tube feeds.
- Adapt the five foundations of shared decision making in designing discharge feeding plans for infants in the NICU.
- Identify the roles involved in making a successful feeding plan for transition from hospital to home.
Level: Intermediate
S2 - Leveraging State and Community Resources to Care for Children With Pediatric Feeding Disorders
Sarah Fleet, MD, PNS; Anna Rouse, MSW, LICSW; Ryan Davidson, PhD; Boston Children’s Hospital
During this session, we will discuss the resources available at the state and local level to improve care for children with pediatric feeding disorders (PFD) including applied behavior analysis, feeding therapy, nutrition counseling and financial support. Attendees will then be able to develop a comprehensive, interdisciplinary care plan for children with PFD using available community and government resources and feel empowered to refer patients to these agencies when needed.
At the end of this session, participants will be able to:
- Summarize evidence-based treatment strategies for pediatric feeding disorders.
- Explain what resources are available to provide children with PFD necessary support such as applied behavior analysis, feeding therapy, nutrition counseling and financial support.
- Forumlate a comprehensive, interdisciplinary care plan for children with PFD using available community and government resources.
Level: Intermediate
S3 - Oral Feeding Decision-Making in a Level III NICU
Casey Lewis, MS, CCC-SLP, CNT, CLC, NTMTC; Chloe Choquette, MS, CCC-SLP, NTMTC; TexScope, LLC
Neonatal therapists are well accustomed to the fact that the ability to consume all intake by mouth is a discharge criteria from the NICU. Therefore, infants are often pushed to consume oral nutrition when not clinically appropriate or when demonstrating disengagement. To improve developmental outcomes, collaboration, provider buy-in, as well as parent satisfaction, a NICU Oral Feeding Algorithm© was created by the lead author and implemented in a Level III NICU. As a result of this initiative, perceptions of neonatal therapy strengthened, team members saw themselves as active participants in the infant’s feeding plan and provider buy-in expanded. During this session, the lead author and coinvestigator will educate regarding the development and implementation of this evidence-based process improvement.
At the end of this session, participants will be able to:
- Describe risk factors associated with oral feeding decision-making associated with the hospitalized neonate in the NICU.
- Define the various team members involved in the multidisciplinary feeding plan of the hospitalized neonate.
- Recognize how NICU Oral Feeding Algorithm© is implemented into practice and its benefits regarding facilitating infant-directed oral feeding among the entire NICU team.
Level: Advanced
S4 - Nasogastric Tube Weaning in Medically Complex Infants: The Benefits of Promoting Human Milk and Evidenced-Based Nuanced Nutritional Provisions
Kristen Cole, MSN, PNP-PC; Lillian Scott, CCC-SLP, IBCLC; Kelly Brower, RD; NC Children’s Hospital
Development of full oral feeding often delays discharge from the neonatal intensive care unit (NICU) (Viswanathan & Jadcherla, 2019). In efforts to reduce length of hospital stay, reduce gastric tube placements and improve quality of life, NICUs have started discharging infants home with nasogastric tubes (NGTs) (Mago-Shah, 2021). Weaning from NGTs to full oral autonomy in the least amount of time has many health benefits, including promotion of oral feeding skill and accompanying motor development, improved cognition and neurodevelopment and decreased parental stress (Lainwala, S. et al. 2020, Lagetta et al. 2021). These infants are often medically complex beyond prematurity alone with accompanying unidentified genetic/chromosomal abnormalities. These infants warrant close monitoring of weight gain and growth trends due to known differences is growth trajectories in children who have underlying growth impacting medical diagnoses. This phenomenon can affect many practitioners’ comfort level in allowing such infants to develop hunger, cue based feeding and direct breastfeeding when weaning from NGTs tubes. This session will discuss an interdisciplinary approach to such infants, utilizing the combined expertise of a pediatric nurse practitioner, speech language pathologist, International Board Certified Lactation Consultant and a registered dietitian. This team of professionals will weigh risks and benefits of nasogastric tube weaning in medically complex infants, the benefits of promoting human milk in this population and nutritional provisions that are both evidenced based and nuanced. This session will include case studies to further educate the audience in the care of medically complex infants successfully weaned from NGs.
At the end of this session, participants will be able to:
- Assess nutritional provision for medically complex infants when weaning nasogastric tubes.
- Describe three health benefits of using human milk for medically complex infants and how they can be supported in nasogastric tube weaning.
- Explain the importance of using specialized growth charts, monitoring weight/length trends and placing realistic expectations for growth on medically complex infants who are candidates for weaning from nasogastric tubes.
Level: Advanced
S5 - The Development and Implementation of the ABCs of Feeding Caregiver Education Program Across two Feeding Institutions
Adina Seidenfeld, PhD, Nationwide Children’s Hospital; Colleen Lukens, PhD, Children’s Hospital of Philadelphia; Hannah Hull, CPNP, Nationwide Children’s Hospital; Loretta Martin-Halpine, PsyD, Children’s Hospital of Philadelphia
Pediatric feeding disorder (PFD) is a multidisciplinary problem with a complex case conceptualization. Not surprisingly, caregivers are frustrated, overwhelmed and confused about care. However, no known service exists that targets caregiver understanding of this disorder. This session aims to share a novel program, The ABCs of Feeding, that supports caregiver understanding of PFD to empower caregivers to become an active member of their child’s treatment team.
Using a quality-improvement approach, three Plan Do Study Act (PDSA) cycles (total N families attended = 68) evaluated program feasibility, changes in parent understanding and parent satisfaction. The resulting 3-session program was offered to 42 families and 23 families signed up for the program. It achieved high attendance: 83 percent of those who signed up also attended, with 74 percent of families completing all three sessions. Effectiveness was evaluated by assessing changes in families’ feeding goals. A majority (64 percent) of families made positive, more specific feeding goals by the end of the program. Parents also rated satisfaction highly through quantitative and qualitative data. The ABCs of Feeding was then piloted at a second feeding institution. Data are being collected on provider-identified need and caregiver interest. Program adaptations for dissemination to Site 2 will be discussed.
Presenters will describe the misconceptions and challenges with caregiver understanding of PFD and its development and implementation across two feeding institutions. Attendees are encouraged to evaluate their own practices in relation to supporting caregiver understanding of PFD.
At the end of this session, participants will be able to:
- Explain the need for program on caregiver education in pediatric feeding disorders.
- Describe three intervention sessions for caregivers to gain more information about PFD.
- Identify practices to identify areas (considering common misconceptions) where caregivers may need additional knowledge/support.
Level: Introductory
S6 - Ask the Expert Panel (Open Forum)
There will be an encore presentation of our highly rated “Ask the Experts” session. We invite you to bring your challenging cases, clinical questions and programmatic conundrums for discussion with our experts and other attendees. Our experts for this session will include representatives from the disciplines in our membership. Please join us, and spread the word to your colleagues!
Modeled after one of our best rated webinars, this reprise of “Ask the Experts” is an optional session, where experts from each of the domains will be available for participants to ask questions, review challenging cases or gain insight on developing or expanding a program for PFD. This flexible, drop-in session can be attended for a short time to ask a single question, or attended in its entirety to hear what others are asking.
At the end of this session, participants will be able to:
- Explain the four domains of PFD and how to apply them in designing feeding programs.
- Apply evidence based multidisciplinary care to care planning for pediatric feeding disorders.
- Define awareness of possible disorders that may contribute to individual patient PFD using case review.
S7 - How to Conquer PFDs out of the NICU: Early Feeding and Enteral Tube Programs
Anna Ermarth, MD, MSc, University of Utah School of Medicine & Primary Children’s Hospital
As many as 20 percent of NICU infants leave the hospital with a feeding tube; or many infants remain inpatient until overcoming their feeding dysfunction, prolonging their length of stay. Over the last decade, several NICUs have started earlier discharge programs to improve this conundrum of care. These programs have proven to be safe and effective at discharging infants on NG or G-tubes earlier, allowing families to spend more time with their babies. Parents and caregivers can then work on weaning enteral tubes and/or overcoming dysphagia at home.
As the creator and medical director of one of these programs, this session will focus on the multidisciplinary staff and efforts needed to start a home feeding tube program out of the NICU, as well as discuss the known causes of prolonged feeding dysfunction in NICU infants and how best to support these from an outpatient perspective. I will review recent literature on existing programs and review best patient selection and practices for discharge, safety and efficacy of home enteral tube use outside the hospital and controversies related to this topic of care.
At the end of this session, participants will be able to:
- Identify home enteral tube program development and known literature for NICU patients with feeding dysfunction.
- Explain multidisciplinary support needed for earlier infant discharge to home with feeding tubes.
- Identify risks for infants who may require prolonged enteral tube use, versus those that may have better success at tube weaning from home.
Level: Advanced
S8 - Nourishing Resilience: The Value of a Trauma-Informed, Multidisciplinary Infant Feeding Intervention
Sandra Galbally, MS, CCC-SLP, The Children’s Hospital of Philadelphia; Dena Dunn, PsyD, IMH-E® (IV-C), Acorn Psychology and University of Pittsburgh
Infants born prematurely or with special healthcare needs often have complex regulatory and developmental challenges, especially with feeding and eating. An estimated 80 percent of premature infants experience difficulty with oral feeding during neonatal intensive care unit (NICU) hospitalization (Pineda, et al., 2020). This constellation of healthcare and feeding challenges causes significant caregiver stress and is often experienced as traumatic, impacting both the functional and relational aspects of feeding for babies and their families. Families with these “fragile feeders,” must learn the skills to feed their baby, while also managing a myriad of stressors including birth trauma, hospital visitation, navigating the medical system, work-life balance, postpartum adjustment and ultimately transition home. Given the impact on the family system, treatment of feeding disorders in early childhood should address not just the safety and skill of feeding, but should also treat caregiver stress and prompt positive caregiver-child attachment and bonding. Thus, a trauma-informed, multidisciplinary intervention to support fragile feeders and their families is indicated. Through clinical case studies and supportive literature, this session will illustrate the importance of not only addressing an infant’s feeding skills and safety, but also caregiver psychosocial, emotional and relational needs through a trauma-informed lens. An early childhood psychologist and speech language pathologist will discuss the benefits of a bi-disciplinary treatment model developed in 2018: The Fragile Feeders Clinic. The session will conclude with a comprehensive review of this pilot program including implementation, outcomes and limitations.
At the end of this session, participants will be able to:
- Describe the impact that early childhood feeding difficulties have on caregiver stress and the feeder-infant dyad.
- List at least three factors that should be considered when treating infant feeding in a trauma-informed model.
- List two identified positive outcomes of the Fragile Feeders Clinic pilot program.
Level: Intermediate
S9 - Long-Term Anthropometric Outcomes in a Consultative Multidisciplinary Pediatric Feeding Disorders Clinic
Ryan Davidson, PhD; Laura Distel, PhD; Sarah Fleet, MD, PNS; from Boston Children’s Hospital
Pediatric feeding disorders (PFDs) are common (1 in 23 children under the age of 5 meet criteria) and higher rates are noted in populations with public insurance. Multidisciplinary visits are the gold standard in care. However, there is limited data investigating long-term outcomes in consultative models of multidisciplinary PFD care.
Long-term BMI z-scores for one multidisciplinary PFD clinic were analyzed. Patients with at least two visits between 2000 and 2014 were included (n = 316, M = 27 months at first visit, SD = 20.2, range = 1 month to 10 years; 56% male). Nearly a third of patients had public insurance (primary or secondary; 36.9%).
Within subject BMI z-scores were analyzed across four time points (initial visit, final visit, approximately 1-year post-discharge, approximately 5 years post-discharge). BMI z-scores improved from clinic initial visit (M = -1.31: SD = 1.28, range = -6.91-1.89) and discharge visit (M = -1.18; SD =1.13, range = -5.23-2.58) to both 1 year post discharge (M = -0.66; SD =1.24, range = -4.43-3.07) and five year post discharge (M = -0.49; SD = 1.22, range = -3.61-2.4). BMI did not significantly improve between start and discharge of PFD clinic, but continued to improve over time (both 1- and 5-year post discharge). Current analyses did not identify differences in BMI z-scores based on insurance.
The current findings indicate the importance of understanding long-term outcomes of multidisciplinary team visits. Further investigation of factors impacting outcomes are needed to understand how to optimize care for patients with PFDs.
At the end of this session, participants will be able to:
- Explain long-term risks of rapid weight gain in infancy and early childhood.
- Describe short- and long-term outcomes of one multidisciplinary pediatric feeding clinic.
- Identify potential factors of short- and long-term outcomes of a multidisciplinary pediatric feeding clinic, including early life medical factors and socioeconomic factors.
Level: Intermediate
S10 - No Safe Swallow: Improving Health Care Utilization for Children With no Safe Drink Consistency on Outpatient Videofluoroscopic Swallow Studies
Rachel Kassel, MD PhD, UAB
Introduction: Aspiration places children at risk for pulmonary and nutritional sequelae, although the significance of that risk remains unclear. How to immediately manage outpatients lacking feeding tubes found to have no safe drink consistency (NSS) on videofluoroscopic swallow studies (VFSSs) performed by speech language pathologists (SLPs) in isolation presented a clinical challenge for SLPs), patients and caregivers.
Smart Aim: We aimed to avoid immediate unplanned admissions by increasing the frequency of ambulatory discharges post outpatient NSS (ADPNs), from a control line of 0 ADPNs between outpatient NSS to two ADPNs between NSS, with secondary outcome goals of shortening median length of initial admission 25 percent and increasing percent of patients seen in Aerodigestive Clinic 50 percent.
Methods: We aimed to decrease immediate admissions and redirect patients, when clinically appropriate, to urgent outpatient multidisciplinary clinic appointments to enable shared decision-making. The No Safe Swallow Guideline includes an on-call aerodigestive physician to assist the SLP and caregiver, availability of urgent clinic appointments and willingness of the aerodigestive team to engage caregivers in decision-making.
Results: Management data from children with NSS on outpatient VFSS for two years prior to guideline initiation served as baseline. One year after NSS guideline initiation, ADPNs increased from 0 to 2.4 per NSS. Median admission length decreased.
At the end of this session, participants will be able to:
- Apply quality improvement methodologies to care of patients with oropharyngeal dysphagia.
- Apply shared decision making to care of patients with oropharyngeal dysphagia.
- Forumlate strategies to adapt patient care based on local resources.
Level: Intermediate
S11 - Using Family-Centered Needs Assessment to Optimize Multidisciplinary Feeding Referrals
Matthew Riley, MD, Providence St. Vincents Medical Center
Infants and children present with diverse feeding and swallowing challenges that are often not easily identified using standard referral medical records, despite lengthy nurse and physician chart review. This process often resulted in a mismatch between the needs of the child and the disciplines assigned for a new feeding evaluation. Children may not receive the services they require and/or clinician time may be suboptimally utilized. Current screening tools are lengthy and time-consuming, presenting a barrier to equitable and timely care.
Our feeding program designed a 15-item, family-centered feeding and swallowing needs assessment tool, administered by a medical assistance, to guide scheduling of new patient evaluations. The tool was administered to 197 consecutive new referrals for feeding/swallowing concerns in children ages 2 weeks to 15 years over the course of 6 months.
The tool was widely accepted by families and staff and allowed us to tailor the disciplines scheduled for each patient with their specific needs and concerns. Nurse time devoted to chart review was eliminated. In addition, we were able to identify patterns of multidisciplinary needs that will inform future clinician scheduling patterns and utilization.
At the end of this session, participants will be able to:
- Identify the primary concerns reported by families regarding feeding and swallowing.
- Describe common patterns of multidisciplinary needs among children with feeding and swallowing issues.
- Identify the use of family-centered data to triage new evaluations for feeding and swallowing concerns.
Level: Intermediate
S12 - Guardians of the Airway: An interdisciplinary Approach to Preparing for Modified Barium Swallow Studies
Molly Golden, MS, OTR/L; Claire Warren, MS, CCC-SLP, BCS-S; Aaron Lesser, PhD, BCBA-D; Kennedy Krieger Institute
For children with complex medical histories and concerns for pharyngeal swallowing safety, diagnostic instrumental assessments are often recommended. These assessments, such as the modified barium swallow study (MBSS), are tools used to determine safe feeding and swallowing plans. Given the nature of these assessments and novelty of the environmental conditions present during these assessments, it can be challenging for the pediatric population to participate. As a result, conclusive images of the swallowing anatomy and physiology may not be obtained. Currently, the literature is limited in terms of best practices for preparing children with complex medical histories and behavioral needs for the MBSS. Our interdisciplinary team regularly collaborates on these cases and we designed a preliminary protocol to arrange the environmental conditions that are present during the assessment to prepare children for the assessment thus improving the validity of the imaging. This session will highlight the role of the interdisciplinary team working with this population, identifying key areas of treatment to improve overall participation, while demonstrating successes through several case studies.
At the end of this session, participants will be able to:
- Identify barriers to swallow studies.
- Identify treatment components to improve outcomes in participation.
- Describe the patient population that requires an interdisciplinary approach to swallow studies.
Level: Intermediate
S13 - Interdisciplinary Care to Increase Oral Intake in an Outpatient Setting
Lyndsay Fairchild, PhD, LP, BCBA-D; Jennifer Del Re, MS, CCC-SLP, CLC; Stephanie Brown, MSPH, RD, CSP, LDN; Kennedy Krieger Institute
The etiology of feeding disorders is complex, with many medical, psychosocial and skill based factors impacting oral intake (Goday et al., 2019). For many patients, an interdisciplinary approach is often clinically indicated, given the variety of feeding factors that are at play. However, for certain families and patients, participation in an intensive model using an interdisciplinary approach may not always be most appropriate. The purpose of these case studies will be to highlight an interdisciplinary approach to care in an outpatient setting. The first case study will review the role of each discipline to decrease nutritional supplements and increase oral intake to a skill and age-appropriate texture. The second case study will also review an interdisciplinary approach to decrease tube dependence and increase oral-intake to a level most appropriate for the child’s skills. These case studies will be presented by a registered dietitian, psychologist, and speech-language pathologist.
At the end of this session, participants will be able to:
- Assess when interdisciplinary care is clinically indicated.
- Identify strategies to foster appropriate mealtime behaviors.
- Identify strategies to promote feeding skill development.
- Apply meeting nutrition needs while weaning from supplements.
Level: Intermediate
S14 - Beyond the Chart: Balancing Clinical Information and Quality of Life
Ashley Worthington, MS, CCC-SLP; Nancy Creskoff-Maune, OTR/L; Arinn Makovsky, MS, RD; Patrick Long, MD; Children’s Hospital Colorado
A 22-year-old male with history for intellectual disability, autism spectrum disorder, motor and communication impairments, anxiety, epilepsy, hypotonia, dental caries and feeding difficulties was seen for a feeding evaluation with the Pediatric Oral Feeding Clinic at Children’s Hospital Colorado. This multidisciplinary clinic included a developmental pediatrician, dietitian, speech-language pathologist, occupational therapist and psychologist. Concerns to be addressed based on triage form completed by patient’s mother included: coughing, choking, poor chewing, challenges with self-help skills and general decline in motor abilities following a seizure approximately three years prior. Findings of the assessment were significant for oral motor impairment, concerns for swallow dysfunction and a need for further clinical and instrumental assessment including completion of his first videofluoroscopic swallow study and updated genetic testing. No behavioral concerns were noted. Language impairments and learning abilities were important to consider related to plan of care. Additional medical referrals following the initial feeding evaluation provided the patient with a genetic diagnosis of FOXG1-related disorders. After 20+ years of an undifferentiated neurodevelopmental disability, this diagnosis elucidated the pathophysiology of his feeding and swallowing dysfunction. This case provided an opportunity to illustrate the role of a genetic diagnosis in guiding, anticipating and mitigating physiological challenges related to feeding and swallowing while emphasizing quality of life during transition to adulthood.
At the end of this session, participants will be able to:
- Identify medical considerations for further diagnostic workup for a person with an intellectual disability.
- Describe the value of a genetic diagnosis in tailoring therapy in complex patients with feeding and swallowing dysfunction.
- Explain feeding/swallowing features commonly associated with FOXG1-related disorders.
- Identify compensatory strategies to support independence and optimal participation during mealtimes for a person with an intellectual disability.
Level: Intermediate
S15 - We Go Together: A Collaborative Approach Between Speech-Language Pathology and Behavioral Psychology to Treat PFD
Margaret Powell, PhD, BCBA-D; Anne Hollis Lipscomb, PhD, BCBA-D; Anne Elise Nicoladis, CCC-SLP; Mason Hosek, CCC-SLP, CLC; from Ochsner Hospital for Children
Pediatric feeding disorder (PFD) is highly prevalent and rates are steadily increasing (Kovacic et al., 2021). Without treatment, PFD can lead to increased caregiver stress, impaired development, poor nutrition and other health concerns (Kozlowski et al., 2015; Silverman et al., 2021). Specialized training and collaboration with an interdisciplinary team is crucial for both the accurate diagnosis and timely treatment of PFD to minimize associated complex clinical challenges. Because of their unique training backgrounds, speech language pathologists and behavioral psychologists are two valuable members of the interdisciplinary team (Gosa et al., 2020). This session will not only differentiate between the roles of speech-language pathologists and behavioral psychologists in treating PFD, but also help providers understand when collaboration between the two roles is indicated. Case examples will be discussed that further highlight the need and benefit of these collaborative efforts, as well as highlight specific feeding interventions that can be used within these collaborations. Finally, collaboration will be discussed in an innovative lens as a way to provide feeding services within service deserts.
At the end of this session, participants will be able to:
- Describe the roles of speech-language pathologists and psychologists on the PFD treatment team.
- Explain treatment techniques a psychologist and/or speech-language pathologist can utilize with patients diagnosed with PFD.
- Discuss the role of collaboration in overcoming service deserts.
Level: Intermediate
S16 - Increasing Access to Non-Dairy Beverages, Supplemental Caloric Beverages and Commercial Thickeners in Children With Complex Needs
Kathleen Carr, DNP, MBA, APRN, CPNP-PC, FNP-C; Ryan Davidson, PhD; Anna Rouse, MSW, LICSW; from Boston Children’s Hospital
Background and Significance: Pediatric dysphagia and cow’s milk protein allergies (CMPA) are common in pediatric feeding clinics. The incidence of pediatric dysphagia is rising due to improved survival rates of infants with prematurity and other co-morbidities. The incidence of CMPA in the United States in children <5 years old is ~2 percent. For both caloric beverages and thickeners, patients often require several trials to identify an appropriate accepted beverage.
Purpose: Assess whether financial support improves access to caloric beverages and thickeners, including increasing the pace of identification of tolerated product(s) within a pediatric feeding disorders clinic.
Problem: Many caloric beverages and thickeners are not covered by insurance. Decreased access to these products increases the risk for malnutrition and its associated complications that can negatively affect long-term growth.
Methods: Baseline data was collected followed by intervention phase and project was IRB exempt. During the intervention phase, patients were provided financial assistance to purchase products. If a product was accepted, insurance coverage was attempted.
Results: With financial support, patients were more likely to identify a tolerated non-dairy beverage or commercial thickener. Though tolerated caloric beverages were identified at similar rates, they were identified faster with financial support. Thickeners were identified at a faster rate with quicker time to insurance approval when provided with financial support.
Discussion/Conclusions: Interventions to increase access to thickeners and caloric beverages are important to decrease barriers for families and increase pace of identified products and insurance approval. Additional advocacy is needed to increase access to non-dairy beverages.
At the end of this session, participants will be able to:
- Analyze barriers to accessing trials of nondairy and dairy caloric beverages or commercially available thickeners.
- Describe impact of financial assistance in increasing identification of tolerated dairy and nondairy caloric beverages and thickeners.
- Explain issues around long-term access to nondairy and dairy caloric beverages and thickeners.
Level: Intermediate
S17 - Placing a Gastrostomy Tube to Preserve Feeding Integrity: An Unconventional Approach
Hannah Hull, CPNP; Miranda Gentile, RD, LD, CLC; Michael Neary, MS, CCC-SLP; Adina Seidenfeld, PhD; Nationwide Children’s Hospital
A common goal of feeding therapy is to decrease or eliminate the reliance on gastrostomy tubes (G-tube). There may be clinical utility, however, to initiating G-tube placement in the context of feeding therapy in order to progress and preserve oral feeding. This may necessitate placing a G-tube as part of the therapeutic process, rather than placing it after feeding failure or regression. The proposed session aims to use a case study to demonstrate why a G-tube was recommended in the context of treatment success.
The patient, Rachel, a 2-year 10-month-old girl with a history of autism spectrum disorder, self-injurious behaviors, dehydration, asthma, malnutrition and constipation presented to the Intensive Feeding Program with 100 percent nutritional reliance on formula from a baby bottle. By the end of the 8-week program, Rachel was consuming 43 percent of her calories from three different pureed foods via spoon and 57 percent from formula via a therapeutic squeeze straw; her baby bottle was only used for medication administration and times of illness. Treatment was complicated by constipation, medication administration and concerns for dehydration; mid-treatment, Rachel was admitted to the hospital to address some of these concerns. These complications and hospital admission may have been avoided if she had a G-tube.
The multidisciplinary team who treated this patient will present this case. Factors that led to G-tube consideration will be reviewed such as: medical needs, medication administration, hydration, promoting maintenance of feeding gains and cost effectiveness. Presenters also will review family’s consideration whether to proceed with G-tube placement.
At the end of this session, participants will be able to:
- Explain patient risk factors that warrant consideration for g- tube.
- Identifying family factors that may warrant consideration for g-tube.
- Explain the role of g-tube placement on treatment progress.
Level: Intermediate
S18 - The Research to Practice Gap Explained Using the CFIR Framework
Deirdre Muldoon, PhD, CCC-SLP, BCBA-D, The College of St Rose; Albany Medical Center
The field of implementation science (e.g., Dramschroder et al., 2009; Fixsen et al., 2005; Olswang & Prelock, 2015) focuses on the barriers and supports that individuals require when implementing evidence based practices (EBP) in clinical settings. The field arose from the need to understand the persistent research to practice gap that continues to exist in health care delivery. Implementation science is a dynamic way to bridge the research to practice gap and a way for practitioners to understand how they can improve their evidence based practice in clinical settings.
Damschroder and her colleagues (2009) devised a consolidated framework for implementation science (CFIR) that has five domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved and the process of implementation. Each of these domains is broken into more component parts, many of which are relevant for clinical practice (SLP, OT, RD etc.) Using the constructs of the CFIR this session will address the use of EBPs while also addressing some of the barriers that individual practitioners face when implementation EBPs. This session will focus specifically on the following components:
- 1.Intervention source and evidence strength and quality (from the intervention characteristics domain);
- 2.Individual knowledge and beliefs about the intervention (from the characteristics of individuals domain);
- 3.Adapting an intervention to make the implementation process more efficient, (from the intervention characteristics domain);
- Monitoring the process of implementation through planning, reflecting and evaluating to insure fidelity to the EBP so that the research to practice gap is narrowed.
At the end of this session, participants will be able to:
- Describe barriers in implementation of EBPs.
- Identify possible methods for implementation of EBPs.
- Identify data collection procedures to appropriately monitor goals in the EBPs addressed during this session.
- Describe the importance of visual analysis in the monitoring and modification of interventions.
Level: Intermediate