Sequential Application of Caregiver Training to Implement Pediatric Feeding Protocols

Abstract

The purpose of this study was to evaluate the effectiveness of current caregiver training practices by implementing training components sequentially, to teach parents mealtime protocols. A multiple baseline design was implemented across two caregiver dyads. Therapist-fed meals were conducted prior to training to identify an effective intervention to increase food acceptance and decrease food refusal. The package consisted of seven components: observation, written and verbal protocol review, video review, structured observation, modeling, role play, and immediate feedback. Correct implementation of mealtime protocols, by caregivers, were evaluated throughout the training process by having caregivers conduct meal sessions following each training component to determine if additional training was necessary. Results showed that the training procedures were effective in teaching caregivers to implement mealtime protocols, and systematic introduction of the training components produced systematic and incremental changes in correct caregiver implementation. In addition, all participants completed training without requiring all seven training components.

The effects of a behavioral skills training and general‐case training package on caregiver implementation of a food selectivity intervention

“…This study extends the caregiver training and feeding interventions literature by providing an operationalized caregiver training procedure to teach caregivers to respond to a range of child mealtime behaviors that caregivers may encounter when attempting to implement an intervention with their child. Whereas some previous studies used ongoing training to maintain correct caregiver performance following initial training (Anderson & McMillan, ; McCartney et al, ; Pangborn et al, ), the current training procedure resulted in response maintenance and generalization of correct caregiver performance from role play without ongoing feedback or training, suggesting that combined BST and GCT may increase the likelihood that caregivers continue to implement an intervention with high levels of integrity without ongoing feedback.…”

“…In several studies, caregivers learned to implement feeding interventions using some form of behavioral skills training (BST; instructions, rehearsal, modeling, and feedback) after experimenters initially implemented the intervention (Ahearn, Kerwin, Eicher, Shantz, & Swearingin, ; Patel, Piazza, Kelly, Ochsner, & Santana, ; Patel, Piazza, Layer, Coleman, & Swartzwelder, ; Paul, Williams, Riegel, & Gibbons, ; Penrod, Gardella, & Fernand, ; Pizzo, Williams, Paul, & Riegel, ; Sharp, Odom, & Jaquess, ) or caregivers served as primary interventionists (Binnendyk & Lucyshyn, ; McCartney, Anderson, & English, ; O'Reilly & Lancioni, ; Penrod, Wallace, Reagon, Betz, & Higbee, ; Werle, Murphy, & Budd, ); however, often authors did not describe caregiver training or did so with insufficient detail to replicate. There are, however, a small number of studies that provide details regarding how caregivers learned to implement a feeding intervention (Anderson & McMillan, ; Gentry & Luiselli, ; McCartney et al, ; Mueller et al, ; Najdowski et al, ; Pangborn, Borrero, & Borrero, ). For example, Pangborn et al taught caregivers using various combinations of modeling, coaching, feedback, parental use of self‐monitoring checklists, weekly review meetings with role plays and problem solving to increase children's food acceptance and decrease children's food expulsions following therapist‐implemented treatment.…”

“…For example, Anderson and McMillan () found parents failed to implement a component of the feeding intervention on 60% of the bites of one target food and 22% of bites of another target food presented. Additionally, Pangborn et al () required changes to the feeding intervention when a child's problem behavior increased and consumption decreased during implementation of caregiver‐fed meals and caregivers needed additional training in the new intervention components. In Anderson and McMillan () and McCartney et al (), experimenters provided ongoing feedback to caregivers throughout the entire intervention, suggesting that caregivers did not implement the intervention independently.…”

An evaluation of a caregiver training protocol on the generalization and maintenance of successful pediatric feeding interventions

“…Recently, Pangborn, Borrero, and Borrero (), Najdowski et al (), and Penrod, Wallace, Reagon, Betz, and Higbee () documented positive outcomes with parents implementing feeding protocols conducted in the home setting. It is, however, unclear which training components contributed to the achieved caregiver accuracy in protocol implementation given the inclusion of numerous independent variables (written instructions, modeling, role‐play, and feedback).…”

“…First, concomitant changes in client behavior have not been consistently reported in this research; specifically, there is a lack of evidence on the impact of the treatment protocol implementation by caregivers on subsequent client behavior post training (e.g., Roscoe et al, ). Second, as previously mentioned, most caregiver training procedures included multiple components (e.g., Najdowski et al, ; Pangborn et al, ; Penrod et al, ) and as such which are the effective training components remains unclear. Given these potential gaps in the literature, the purpose of the current investigation was to evaluate the effects of instructions and feedback on the implementation of feeding protocols by two caregivers in the home setting.…”