Analysis of a Cam Feeding Therapy Modality, Research Paper Example

Since 1997, Pasadena Child Development Associates, Inc. (PCDA) has offered physician supervised Complimentary and Alternative Medicine (CAM) multidisciplinary feeding intervention therapies to children birth to 14 years of age. Services are provided by a range of clinical professionals, including: Developmental Pediatricians, Dieticians, Nurses, Occupational Therapists, Speech & Language Pathologists, and Child Behavior Specialists. Children with special health care needs are at increased risk for the development of feeding problems (www.pasadenachilddevelopment.org). The foregoing essay is dedicated to a positive assessment of PCDA’s Feeding program as a viable CAM therapy service provider, with capacity to meet all five (5) selected core competency criteria: 1) Chronic care population; 2) Referral relationship with traditional hospital and physician providers; 3) CAM Therapy with program statement, curriculum and assessment; 4) Physician informed professional training of staff and colleagues in recommended best practices of CAM model (i.e. DIRÒ Floortime™); and 5) Insurance and/or state provision of patient allocations.

At the forefront of direct service to the special needs communities of Los Angeles, PCDA offers client-learners a comprehensive curriculum of individual assessment, counseling, parent instruction, and therapy through the agency’s eleven core programs. According to the State of California Department of Developmental Disabilities (DDS), ‘a ‘developmental disability’ is a condition that originates before an individual reaches age 18; continues, or can be expected to continue indefinitely; and constitutes a substantial impairment in three or more areas of major life activity. Developmental disabilities include mental retardation, epilepsy, cerebral palsy, autism, and disabling conditions closely related to mental retardation or requiring treatment similar to that required by people with mental retardation.’

While other feeding programs are offered in the region, most are exclusively hospital based programs. PCDA Feeding Programs incorporate dietary consultation, nutritional practice, and DIRÒ Floortime™ physical recreation curricula. The universal translations of DIRÒ Floortime™ ‘free play’ in the various interdisciplinary contexts have been especially effective in bridging the gap between cultural diversity and service delivery. Due to the complex of disorders that a child may be experiencing, even outside the range of complications related to feeding, services are delivered by the PCDA multi-disciplinary Feeding Team.

Designed in accordance with the United States Agricultural Department (USDA)’s Dietary Guidelines, the PCDA Feeding Program is specifically for children with developmental disabilities, autism and/or special health care needs. Assessment is based on medical and developmental history, dietary analysis, feeding history, anthropomorphic measurements and feeding observations. Occupational therapy (i.e., oral health & safety)  is also provided for children who may have oral-motor difficulties with chewing or swallowing, sensory aversion to touch, smell or taste of foods, and who may be underweight or overweight, have medical problems that affect hunger and digestion, and/or have behavioral challenges around eating. The primary goal of the program is to promote eating as a pleasurable experience for the child; using various feeding strategies embedded in a play-based interaction to support feeding. In addition, parent education and professional training of colleagues informs caregivers and colleagues directly engaged with client development, as well as serve to promote the efficacy of PCDA as a leader in nutrition education in the field of developmental services.

Growing Together, is based on a group feeding model for infants and toddlers 7 months to 3 years old who are at risk for developing feeding issues. The program has two (2) main clinical foci: 1) Addressing the individual dyad of mother and child through their inclusion in a feeding group, and; 2) Increasing the awareness of feeding issues, their treatment and the services to address feeding among pediatricians in the community. Between 12-18% of children in the United States have a special health care needs (American Dietetic Association, 2004)  Children with special heath care needs (CSHCN) are those who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who require health and related services beyond those typically required by children This would include children with developmental disabilities, congenital deformities (cleft palate), chronic illness (renal disease, diabetes), metabolic disorders (PKU), sensory disorders (visual impairment) and children born prematurely.

Within this group, feeding concerns are extensive. In a study involving almost 400 CSHCN, Sullivan (2000) reported that feeding problems were prevalent: 89% needed help with feeding and 56% choked with food; 20% of parents described feeding as stressful and un-enjoyable. Prolonged feeding times (3h/day) reported at 28%. Medication use and timing can interfere with naturalistic feeding patterns – up to 90% of children enrolled in an early intervention program had at least one indicator of nutritional risk (Ekvall 2000).

An initial individual nutrition screening prefaces the Growing Together program course. The group meets for one hour per week on a continuous basis. The program’s nutritional content is based on the American Academy of Pediatrics (AAP) guidelines for infant and toddler feeding. Each client is assessed at the beginning of the program and at quarterly intervals. The screenings are put into comparative analysis with existing findings known as “normative” within feeding skills development charts generated by the program on a quarterly basis. Quarterly reports will be sent to referring physicians.

Parental/Guardian education is an integral aspect of the program. The program is intended specifically for families at risk for developing attachment or feeding disorders due to developmental or medical concerns that negatively influence feeding. Administered by Registered Dietitians, Occupational Therapists and Child Development Specialists, the focus of Growing Together is on developing positive parent-child interactions around feeding that promote health promoting eating and developmentally appropriate feeding progression. Through clinically guidance, group interactions and parent child interactions, the client’s feeding issues identified and addressed in the context of the child and/or parent-child dyad. Client screening for the program includes the following entrance criteria: 1) Children, ages 7 months to 3 years of age; 2) Identified as at risk for feeding concerns, which could include but is not limited to: Chronic illness (spina bifida, cystic fibrosis, bronchopulmonary dysplasia, metabolic disorders), Acute illness requiring prolonged treatment (congenital heart disease, cancer), Multiple food allergies, Acute or chronic family stressor (homeless, teen parent), Parental mental illness, Parental developmental disability, or Sibling with the diagnosis of autism.

Mother-child interaction is to be evaluated using the two (2) standardized assessment tools (Parent-Child Early Relational Assessment (PCERA) and/or Nursing Child Assessment Satellite Testing (NCAST) every six (6) months. Despite the long-term challenges presented by pediatric feeding disorders, referral to feeding specialists for assessment or therapeutic treatment is rare. CSHCN often have inadequate medical insurance coverage for specialized services, or are not referred to those specialists that can provide adequate treatments (Davidoff 2004, Kuhlthau 2001, Kogan 2005). This lapse in care is most pervasive amongst minority children; as they are more likely to be without health insurance coverage, access to health resources, coupled with lack of parent education on where to obtain existing resources (Newacheck 2002).

PCDA’s coordinated service model, and active referral relationship with lead hospital consortium service providers assists patients in securing agreement for services based on a sliding scale, and allocations from the Regional Center in the area, non-profit charitable contributions. Yet it is not only the access to and quality of medical care that facilitates the resolution of the feeding issue.  The cultural context of that family influences how and when a child is fed, what and when foods are introduced, who feeds the child, where the child is fed, and what types of equipment are acceptable (Olson 2004).  At times the cultural imperative is in conflict with the medical imperative.  Successful treatment of the feeding disorder seeks common ground between the two imperatives. PCDA offers the highest caliber integration in the Greater Los Angeles region with absolute precision in CAM integration with traditional medical referral. An example of application of analysis to PCDA’s current CAM therapy environment is illustrated in Table 1: SWOT (Strategies, Weaknesses, Opportunities, Threats) analysis of a children’s services agency:

Subject of SWOT analysis: Children’s Agency (CIPD, 2010)

References

American Dietetic Association (ADA) (2004). Providing Nutrition Services for Infants, Children and Adults with Developmental Disabilities and Special Health Care Needs JADA, 104 (1), 97-107.

Campbell, A. (1988). Tube feeding: Parental perspective. The Exceptional Parent, 18(3), 36-40.

Davidoff AJ., (2004). Insurance for children with special health care needs: patterns of coverage and burden on families to provide adequate insurance. Pediatrics. 114, 394–403.

Ekvall S, Ekvall  V. (2001). Early Intervention and Nutrition.  In. Stevens F Ekvall S. eds. Empowering Children Through Early Intervention with Good Nutrition-Focusing on Culturally Diverse Children with Special Health Care Needs. Manual IV. MCHB. Rockville, MD:HRSA, 7-20.

Kogan, M.D. et al. (2005). Association Between Underinsurance and Access to Care Among Children With Special Health Care Needs in the United States. Pediatrics, 116 (5), 1162-1169.

Kuhlthau K. et al. (2001). Who cares for Medicaid-enrolled children with chronic conditions? Pediatrics,108, 906 –912.

Newacheck P.W. et al. (2002). Racial and ethnic disparities in access to care for children with special health care needs. Pediatrics, 2(4), 247-54.

Olson, J., & Esdaile, S., (2000). Mothering young children with disabilities in a challenging urban environment. The American Journal of Occupational Therapy, 54, 307-314.

Pasadena Child Development Associates (2010). Retrieved from: http://www.pasadenachilddevelopment.org

Solomon, P.R. and Michalczuk, D.E. (2009).Toward establishing guidelines for evaluating cognitive enhancement with complementary and alternative medicines. Evaluation & The Health Professions, 32 (4), 370-92.

Sullivan P.B. et al. (2000). Prevalence and severity of feeding and nutritional problems in children with neurological impairment. Oxford Feeding Study Developmental Medicine & Child Neurology, 42, 674-680.

SWOT Analyses (2010). CIPD. Retrieved from: http://www.cipd.co.uk/subjects/corpstrtgy/general/swot-analysis.htm

Yu S.M. et al. ( 2004). Parent’s language of interview and access to care for children with special health care needs. Ambulatory Pediatrics, 4, 181 –187.