Use of parent report to screen for feeding difficulties in young children

AimsThis study aimed to collect data on Australian children with regard to feeding difficulties using a standardised questionnaire, compare these data to international data collected using the same tool, assess the short-term reliability of this tool and determine the sensitivity and specificity of this tool in detecting feeding difficulties

Telepractice for the delivery of pediatric feeding services: A survey of practice investigating clinician perceptions and current service models in Australia

The provision of speech-language pathology (SLP) services via telepractice is expanding. However, little is known about the use of telepractice to deliver pediatric feeding services. The current study aimed to investigate SLPs perceptions, and current use of, telepractice in pediatric feeding. An electronic survey was distributed to SLPs with pediatric feeding experience within Australia. Questions pertained to general demographics, feeding experience, telepractice experience and perceptions of telepractice. Most questions were multiple choice, with some short response questions. Eighty-four complete responses were received. Overall, 41% of the cohort were interested in providing telepractice services but only 20% reported experience delivering pediatric feeding services via telepractice. Most telepractice users reported commencing telepractice services within the last 12\ua0months. Most clinicians identified a range of age groups and feeding services that they believed could be offered via telepractice and a range of benefits to telepractice feeding services were identified. Benefits included natural environment, reduced distance and travel, opportunities to increase services and increased supervision and support. Although most respondents reported access to technology, most had difficulty accessing this on a daily basis to establish regular telepractice services. Clinician concerns regarding the safety and efficacy of conducting pediatric feeding assessments via telepractice were also identified. Overall, although the delivery of pediatric feeding services via telepractice remains limited, many clinicians were interested in using telepractice and had positive perceptions regarding its use. Continued efforts to enhance clinician access to technology and further evidence for the efficacy of this service delivery model for pediatric feeding will aid clinical implementation

Developing the system architecture for conducting synchronous paediatric feeding assessments via telepractice

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

“It Takes a Whole Day, Even Though It’s a One-Hour Appointment!” factors impacting access to pediatric feeding services

Feeding disorders can have a significant impact on children and their families. Access to supportive multidisciplinary care is central to improving outcomes; however, there are numerous factors that can impact service access. Using a mixed methods design, the current study examined parents' experiences and satisfaction with accessing a state-wide government-funded tertiary pediatric feeding clinic in Australia. Parents of 37 children (aged 7\ua0weeks to 17\ua0years) participated in the study, residing 6-1435\ua0km from the service. Each completed questionnaires regarding satisfaction (Client Satisfaction Questionnaire-8 Child Services) and costs, and participated in a semi-structured interview. Costs were measured as both direct (e.g., accommodation) and indirect (measured as lost productivity) associated with accessing their feeding appointment. Results revealed parents were highly satisfied with their child's feeding services, but considerable impacts were reported in accessing the service with 85% of the group noting that attending their child's appointment took at least half a day. The total cost per appointment ranged between $53 and$508 Australian dollars. Interviews identified three main barrier themes: distance and travel, impact on daily activities (e.g., work, school), and parent perception of inaccurate representation of their child's feeding skills within the clinic environment. The issues raised were also tempered by an overarching theme of parental willingness to do "whatever was needed" to meet their child's needs, regardless of these barriers. Service providers should be cognizant of the factors that impact access for families and consider alternative service-delivery models where appropriate to help reduce family burden associated with accessing necessary care

A time and cost analysis of speech pathology paediatric feeding services delivered in-person versus via telepractice

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.</p