Interprofessional Group Addresses Unmet Community Feeding Need Speech-language pathology, dietetics, psychology and physical therapy join forces to help children with eating difficulties. Academic Edge
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Academic Edge  |   December 01, 2018
Interprofessional Group Addresses Unmet Community Feeding Need
Author Notes
  • Pam Holland, MA, CCC-SLP, is an associate professor and the director of clinical education at Marshall University. She belongs to a multi-agency coalition, Healthy Connections, to improve outcomes for children diagnosed with neonatal abstinence syndrome. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; and 13, Swallowing and Swallowing Disorders (Dysphagia). holland@marshall.edu
    Pam Holland, MA, CCC-SLP, is an associate professor and the director of clinical education at Marshall University. She belongs to a multi-agency coalition, Healthy Connections, to improve outcomes for children diagnosed with neonatal abstinence syndrome. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; and 13, Swallowing and Swallowing Disorders (Dysphagia). holland@marshall.edu×
Article Information
Speech, Voice & Prosodic Disorders / Swallowing, Dysphagia & Feeding Disorders / Academic Edge
Academic Edge   |   December 01, 2018
Interprofessional Group Addresses Unmet Community Feeding Need
The ASHA Leader, December 2018, Vol. 23, 34-36. doi:10.1044/leader.AE.23122018.34
The ASHA Leader, December 2018, Vol. 23, 34-36. doi:10.1044/leader.AE.23122018.34
Like many states, West Virginia is experiencing more children diagnosed with autism, greater survival rates of premature infants, and more infants born addicted to opioids (see “The Opioid Crisis on Our Caseloads,” November 2018). These children and families need assistance with all domains of development, including feeding and swallowing.
But access to specialized services can be challenging in rural areas. Until 2014, the only pediatric swallowing and feeding clinic in the state was at West Virginia University (WVU) in Morgantown—a four-hour drive for residents living in southern parts of the state.
Starting small
At Marshall University in Huntington—200 miles southwest of Morgantown—we wanted to bring these services to those southern regions. Marshall has a solid interprofessional education program that includes communication disorders, dietetics, nursing, social work, psychology, physical therapy, pharmacy and medicine.
So why not a multidisciplinary feeding and swallowing clinic at Marshall?
I visited the WVU Feeding and Swallowing Clinic to learn about its services, and its director put me in touch with Angel Casto, a registered dietitian with the West Virginia Center for Excellence in Disabilities and the state’s Children with Special Healthcare Needs Program.Determined to start a program similar to WVU’s at Marshall, we started small: That first summer, we evaluated two children with feeding tubes, one with a chromosomal abnormality and one with traumatic brain injury from shaken baby syndrome. Both received feeding therapy for an hour each week to improve their oral mechanism and increase the consistency of their food. After treatment, both children had expanded their food inventories, and one was able to have the feeding tube removed.
Since then, the clinic has completed 58 evaluations and provided 21 families with feeding and swallowing treatment related to a variety of meal-related needs: limited food inventory, preference for one consistency or color of food, poor oral skills necessary for chewing, and medical conditions—such as prematurity—that affect feeding development. The primary mission is to provide a positive mealtime routine with nutrition to support the child’s growth and development.
We have also added physical therapy and behavioral psychology to the team of professionals and initiated telepractice for appropriate families.
The program, in the Marshall University Speech and Hearing Center, is funded under a contract with the West Virginia Office of Maternal, Child and Family Health. The goal is to decrease state expenditures on supplemental nutrition, especially for children who can eat a variety of consistencies of food. This partnership ensures financial viability of the program and provides an excellent learning environment for students across disciplines.

The primary mission is to provide a positive mealtime routine with nutrition to support the child’s growth and development.

Building a team
Speech-language pathologists and dietitians are essential to a collaborative feeding team, but the goal was always to add other related disciplines. In 2016, a physical therapist joined the team, to help clients with seating, positioning, sensory integration and many other aspects related to the enhancement of the parent and child’s feeding experience.
Second-year graduate students in communication sciences and disorders who have completed the dysphagia course participate in every assessment and treatment session as an on-campus placement. All sessions are recorded and used in the classroom.
One of our first clients from 2014, the child with shaken baby syndrome, helps educate students across the nation—his case is in the library of a national developer of clinical simulations. He graduated from feeding therapy and now receives speech-language treatment. He came to us when he was 7, eating only food placed on a nacho chip and drinking no liquids. He is 11 now, and eats everything.
Scheduling logistics prohibit the involvement of physical therapy students and dietetics students in the interdisciplinary feeding clinic. Their curricula include full-time, off-campus clinical rotations and full-time, on-campus classroom education, leaving no time for integrated clinical education. We hope to integrate these students into the clinic in the future.
We also added a psychologist to the clinic to offer insights into the role of behaviors in family routines and meal time. Psychology students observe the collaborative evaluations. The long-term plan is to have the clinic serve as a practicum site for clinical doctorate psychology students, who would assist with evaluations and follow-up appointments under appropriate supervision.
Initially, Casto was the sole referral source. As she participated in nutrition clinics across the state, she identified children who were receiving supplemental nutrition via tube feedings or who refused to eat. She referred to me and the clinic began to grow.
We now receive referrals from schools, birth-to-3 providers, pediatricians, other SLPs, neurologists and gastroenterologists across the southern region of the state.
The psychologist and physical therapist are full-time faculty members who are passionate about participating in the clinic despite their other academic responsibilities. We believe in training families to be the true feeding therapists, as evidenced by families’ commitment to participate in feeding therapy and implement the strategies we suggest.

We now receive referrals from schools, birth-to-3 providers, pediatricians, other SLPs, neurologists and gastroenterologists across the southern region of the state.

Lessons learned
If you are considering a similar venture, the team offers a few suggestions.
  • Don’t reinvent the wheel. If you know of a professional or team already operating a successful clinic, ask to come to their facility and observe.

  • Think big and be prepared for expansion. Develop a strategic plan for how to handle growth by hiring additional team members to provide ongoing services.

  • Be patient. Each step along the way takes time. Consider it a marathon rather than a sprint.

  • Consider outcomes. Our focus has always been clinical, and we didn’t initially think about tracking outcomes. Now, however, we are formulating how to gather formal data.

  • Consider financial support and billing sources. Some academic programs integrate clinical service provision into faculty members’ academic load and don’t need additional compensation. Others may participate as contract providers. Consider establishing the program in an entity that can bill for service or establish the contract with a federally funded agency. Of course, free clinics are always an option, if feasible.

Involve students. To maximize the interprofessional education aspects of a clinic, consider the logistics of each discipline’s curriculum and schedule so that students from all disciplines can be involved from day one.
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December 2018
Volume 23, Issue 12