Hello, it’s been awhile, and I would like to discuss our preferred therapuetic delivery model, home-based therapy. Home-based therapy is rare, and for that reason deserves some explanation. Many types of feeding therapy can be delivered in the home, such as behavioral, speech and occupational therapy. Professionals who work with children in the home feel that this environment provides many advantages, and we do too. It may be difficult to secure approval for insurance funding outside the clinic, but we feel it can be worth the time and effort.
Therapy in the home can be consultative, or focused/intensive (not “intense”, just concentrated). The consultation model typically involves the therapist coming to the home, observing a meal, deciding what needs to be done next, modeling the technique, having a caregiver practice the technique and giving feedback so the technique is used correctly. Focused/intensive involves a 1-5 day visit, with the therapist working with the child for most of the time, developing a protocol, and then training caregivers. The focused, home-based model allows for multiple practice opportunites, the ability to make a great deal of progress in a relatively short amount of time, training of multiple caregivers and across multiple environments such as home, school and restaurants. Clearly, this focused/intensive model can only be accomplished at home or a clinic. This is a huge benefit of home-based treatment, the ability to offer a more focused therapuetic experience. This can also be accomplished in a clinic, but for reasons about to be discussed, home-based can often be a great choice.
First, your child will feel more comfortable in their own home, especially if they have a negative feeding history and are fearful of offices and hospitals. In between meals, they can play with their own toys, spend time with their loved ones, take naps, go to Dr. appointments etc. Therapy is associated with fun, not just the hard work of learning to eat. Another benefit is financial. Clinical settings, such as hospital programs, require familes to travel if they don’t live in the area. Home-based therapy allows both parents to continue working. You do not have to take weeks off of work to relocate temporarily to where is the hospital is located. Plane tickets and hotel fees are not an issue as therapy takes place in the families home and the therapist comes to you. Another very important benefit is maintenance. This is true with the focused or consultative approach. This means that the child learns to eat at home, and will continue to do so even after therapy is over and the therapist leaves. Just because a child can eat in a clinic does not mean they will go home and do so. When therapy occurs in your home, with your food, your dishes and with “real life” going on, your child is more likely to continue to eat well after the therapist leaves. You also learn how manage meals with your other children/pets/husband/wife/nanny/mom/plumber in the picture, which isn’t always easy! The therapist can brainstorm ways to manage the complexities of your unique life.
Of course, there are benefits to clinic programs as well as office visits. With very young children, under 18 months, a focused program may not be appropriate and a weekly visit at home or the therapists office is best. If your child has complex medical issues, a hospital setting is necessary and the best approach. In a clinic or office, other professionals are nearby and can consult on a moments notice. Insurance companies are also more likely to fund such programs. In any case-follow-up is crucial and should be conducted on a weekly or monthly basis for an hour or so per visit.
Again, this approach is rare, and funding can be difficult. Some insurance companies are catching on and will pay for this model. If your child has an autism spectrum disorder, insurance funding may be easier to secure. Some programs will offer discounts and payment plans for private-pay families. The cost of private pay can offset the need to take time off of work and pay for plane tickets.
Whatever you decide, before starting a feeding program, we recommend speaking with families who have been through it themselves. Have you been through feeding therapy before? What is your experience and perspective regarding clinic-based, home-based and the consultative approaches? Please comment below, we would love to hear about your experience.
Our next topics will include the use of appetite stimulants and picky eating. Do you have a question or topic you would like addressed? Please comment below and we will do our best to discuss it soon.