Working With School-Aged Children With Neurodisability and Oropharyngeal Dysphagia Who Require Mealtime Assistance: A Survey of Speech and Language Therapists' Clinical Practice.

backgroundSchool-aged children with neurodisability and oropharyngeal dysphagia who need mealtime assistance have an increased risk of premature death. Speech & Language Therapists (SLTs) provide assessment and recommendations to optimise mealtime nutrition and hydration, but little is known about current clinical practice including mealtime recommendation provision and carer adherence support strategies. Before developing any intervention, the context needs to be known.

aimsThis survey aimed to explore the practice of UK SLTs working with school-aged children with neurodisability and oropharyngeal dysphagia that require mealtime assistance. This included describing workforce and service delivery; assessment practices; mealtime recommendations targeted for example, carer use certain pace, specific utensil; current approaches used to provide mealtime recommendations including the people worked with, delivery modality and adherence support techniques. METHODS AND PROCEDURES: An online ethically approved survey was developed using research literature, with SLT stakeholder consultation and piloted prior to dissemination. The survey comprised 36 questions focusing on demographic and caseload information, typical assessment and intervention practice. Questions were multiple choice and free text responses with an upload option for intervention implementation documents. The survey was disseminated using professional networks and social media (summer 2021). Descriptive statistics were used with qualitative analysis for free text and submitted documents. OUTCOMES AND

resultsSLT participants consented and completed demographic and assessment practice questions (n = 139) with 102 continuing to the final question. Participants worked across all UK regions, with different employers (NHS, education, independent) and in acute, school and community settings and frequently shared care. Some SLTs had no access to instrumental assessment; videofluoroscopy (n = 5, 4%) or FEES (n = 88, 63%), and there was limited published assessment use. Participants (n = 122) commonly used 17 different mealtime recommendations, most frequently targeting carers to change pace, environment, food consistency (n = 120-121, 98%-99%, sometimes-often). Qualitative analysis identified two practice styles: 'collaborative creation' or 'informative prescription'. 37 SLTs provided 59 intervention documents, (n = 39, 66%) were accessible information mealtime mats. There were 28 unique mat templates with 19 different names. Formats and recommendation target frequency differed for example, drink texture (n = 27, 96%), pace (n = 14, 50%). CONCLUSIONS AND IMPLICATIONS: This work provides contextual information on UK SLT practice with school-aged children with neurodisability and oropharyngeal dysphagia who require mealtime assistance. Further work is required to support research into practice implementation (e.g., assessments), alongside exploration and evaluation of meal mat use and potential SLT consultation styles. These findings contribute to a project creating a resource to improve SLT-family-carer working. WHAT THIS PAPER ADDS: What is already known on this subject SLTs working with children with oropharyngeal dysphagia are typically specialists that work across various settings each week. They, and other health care professionals, report limited use of published assessments but recommend a range of changes which carers need to make within a mealtime (e.g., communicate with their child, make change to food textures, etc.,). What this study adds to existing knowledge SLTs have variable time allocated to working with children with oropharyngeal dysphagia while working with diverse children with different diagnoses and needs. SLTs frequently share care with other SLTs have limited use of published assessment tools and frequently provide a range of mealtime recommendations requiring carers to change the mealtime. SLTs frequently use an accessible 'mealtime mat' to provide written recommendations but these are highly variable in name, format and content between services. SLTs had two styles when working with family-carers. They always provide personalised recommendations following assessment, focussing on information provision, but only one style uses fully person-centred practice. What are the potential or actual clinical implication of this work? SLTs would benefit from workforce support to implement evidence-based practices into their practice when working with children with neurodisability and oropharyngeal dysphagia. SLTs could consider using published assessment(s) to enable good shared-care communication. Consideration of which mealtime mats is most effective is needed. SLTs may wish to reflect on their personal style-personalised or truly person-centred.