A reflective evaluation of a feeding clinic intervention—Parents as a reflecting team

Abstract

Background This feeding clinic engaged parents as active participants in a group intervention. Parents' participated behind a two‐way mirror. This novel approach to practice in this domain largely evolved from an integration of theory, service user feedback, service development and the local context. This review sought to understand how parents experienced being part of a reflecting team in this way. Methods Semi‐structured interviews were completed and analysed using thematic analysis. The researchers took a critical realist approach to the research, data analysis and report writing. Findings Parents talked about benefiting from perspective taking that enabled them to see the child in context, which in part supported novel understandings of their child's feeding and their relationship to it. Three themes were identified: “Connection and Distance” explored parents' experience of being behind the screen in terms of the dialectic potential that was created by being simultaneously close to and distanced from their children and the other parents. “Playing with Techniques” describes the way parents valued learning in the group through discussion and working on techniques between sessions. In particular, they moved from looking for techniques to thinking about how and when to use “techniques” that is, second‐order change. “Unexpected Gains” describes how parents came to new and unexpected insights about their understanding of their children, the presenting issues and their relationships to these issues. Conclusion Parents' experiences suggest that there is merit in engaging parents in a reflecting team in a feeding clinic. This way of working with parents supports their engagement in change and positions them as active agents of this change. Parents taking up this position has the advantage of moving from passive consumers of health care to active and critical collaborators.

Approaches for Children with a Disability Who Are Restricted Eaters: A Scoping Review

“…Restricted eating behaviours were analysed to understand the reasons for behaviour (PBS) in some studies [52,57,58]. Behavioural supports were provided that indicated they were responsive and considerate of a child's skills including supporting a child's communication abilities at mealtimes [52,58], encouraging agency for the child and supporting autonomy, supporting positive child and parent interactions [52,58,59], protecting the parent-child relationship, and individualising interventions to a child's specifc skill level [52,58]. Examples were provided, indicating the need to support a child's autonomy.…”

“…Contrary to this, group environments were found to be motivating [7] with the inclusion of peers providing social interaction which may support participation in a mealtime [57]. A parent group where parents refected on children's performance behind a two-way mirror enabled group problem solving and was reported as benefcial [58]. However, logistical problems with organising group therapy were identifed [55,56].…”

“…In accordance with PBS, reasons for behaviour were explored. Anxiety was identifed as an underlying reason for some mealtime behaviours, leading to the inclusion of anxiety management strategies [27,58] including cognitivebased interventions [57], sensory systematic desensitisation [52,57,58,60], and reframing thoughts around anxiety, encouraging parents to consider roles in the worry cycle [58]. Supporting children to understand why mealtimes are tricky for them and helping them to develop individualised strategies to cope with difcult situations [57] foster their emerging autonomy and support the development of internal drives to eat.…”

“…Food play was used for a variety of reasons including systematic desensitisation [52,58,60]. Food play including cooking was identifed as providing opportunities for visual and tactile exposure to food, where children and parents could be invited to taste food with decreased pressure for eating [59], with suggestions that this approach may be efective for children with less severe problems [60].…”

“…Food play including cooking was identifed as providing opportunities for visual and tactile exposure to food, where children and parents could be invited to taste food with decreased pressure for eating [59], with suggestions that this approach may be efective for children with less severe problems [60]. Playbased interventions were found to be more acceptable to parents and clinicians, thus providing good social validity [58,60].…”