Supporting Students With Complex Paediatric Feeding Disorders in a New Zealand Specialist School: Identifying Barriers and Facilitators to Enable Behaviour Change

Abstract

Background: Complex paediatric feeding disorders (PFDs) are common in children with physical, behavioural, and cognitive needs. This study 1) identifies barriers and facilitators to supporting students with complex PFDs in one specialist school and 2) provides early implementation strategies to change school and health SLTs' behaviour when supporting students with PFD. Method: During the Observe phase, three data sets were collected: 1) 113 school records, 2) 42 meal observations, and 3) interviews with five teachers, six speech-language therapists (SLTs), and two parents. A Capability Opportunity Motivation and Behaviour (COM-B) analysis was used to identify barriers and facilitators from the data sets to supporting PFDs. In response to the COM-B findings, two implementation cycles were completed, evolving in response to environmental factors and stakeholder involvement. To achieve co-identified behaviour goals, the Behaviour Change Technique Taxonomy (BCTT-v1) was used to identify and implement techniques. Results: The COM-B analysis established that 34% of students had documented eating and drinking difficulties, and 14% had documented enteral feeding. Inconsistent documentation of management strategies, such as mealtime and enteral feeding plans, occurred, and no standardised assessment procedure was in place. SLTs experienced stress when supporting students with complex PFDs and were concerned about being held liable for students’ health in the school setting. Eating and drinking with acknowledged risk (EDAR) occurred in the specialist school but was not consistently documented or monitored. Families used PFD recommendations flexibly, leading to differences in mealtime management between home and school. School-based SLTs felt professionally isolated, and hospital-based SLTs did not know what support students in specialist schools required. Throughout the implementation cycles, school SLTs were enabled to use various behaviour change techniques to develop their service provision. Gaps in the service provision for school-aged students continue. Conclusions: SLTs supporting students with complex PFDs in specialist schools need support themselves, often feeling isolated and sometimes fearful. Better collaboration between families, health, and school professionals, alongside more explicit service structures of school-based PFDs, is required to provide students with a holistic, equitable service. Risk is evident in school-aged PFDs, and school SLTs need to better understand the New Zealand legal context to support students and families. Implementation science successfully enabled some behaviour change within a specialist school setting.