Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Program. In this Evidence Connection article, I describe a case report of a young child receiving early intervention services and outline the occupational therapy evaluation and intervention processes for supporting this child’s activities of daily living in the home and early childhood education setting. Findings from the systematic reviews on this topic were published in the March/April 2020 issue of the American Journal of Occupational Therapy and in AOTA’s Occupational Therapy Practice Guidelines for Early Childhood: Birth–5 Years. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The purpose of the study was to examine the effectiveness of a parent-mediated, in-home feeding intervention (parent training, direct intervention, and parent coaching) over 6 months for families with children with autism spectrum disorder (ASD). The findings support preliminary evidence that the intervention improves eating skills and mealtime behaviors in children with ASD and the need for more targeted feeding interventions for children with ASD that involve the parents in the natural context of the home. Primary Author and Speaker: Karla Ausderau Additional Authors and Speakers: Brittany St John, Libby Hladik, Shannon Kant, Jessica Muesbeck, and Holly Romaniak

This case report describes occupational therapy services provided in consultation with a primary care practice for a community-dwelling older adult dyad with mild coronavirus disease 2019. The occupational therapy evaluation included administration of the Canadian Occupational Performance Measure through telehealth to identify priority areas for intervention; the clients selected participation during activities of daily living and mealtime, fall prevention, cooking together, and leisure participation. The intervention process focused on addressing the dyad’s identified priorities as well as managing caregiver stress and preventing hospitalization. Positive outcomes were achieved while adhering to social distancing guidelines set forth by state and national agencies.

Importance: Rehabilitation researchers and occupational therapy practitioners frequently conduct projects that involve the provision of services or the dissemination of knowledge in low- and middle-income countries (LMICs); however, the needs assessment process underlying these transcultural projects is often underreported. Objective: To identify a comprehensive set of feeding-related training needs that reflect the culture, resources, and service delivery practices in the West Bengal region of India and that will be used to develop video-based training modules that are contextually relevant and support decentralized training of community-based rehabilitation workers and caregivers of children with cerebral palsy (CP). Design: Mixed methods design using focus groups and observations. Setting: Community setting in rural, suburban, and urban locations in West Bengal, India. Participants: Caregivers of children with CP and community-based rehabilitation workers with experience working with children with CP. Outcomes and Measures: Focus groups and in-home mealtime observations. Results: Several findings suggest training priorities that were not anticipated. Caregivers commonly fed children by means of hand feeding while sitting on the floor. Children were fed a limited variation of food consistencies, often in positions of neck hyperextension. Water was frequently used to stimulate swallowing. Caregivers struggled to help children with oral hygiene practices after meals. Conclusions and Relevance: A thorough needs assessment yielded insights that can favorably alter the trajectory of transcultural service and research projects. For occupational therapists who provide advice on practice, continuing education, or research in a transcultural project, the findings underscore the value of engaging local stakeholders and using firsthand observation. What This Article Adds: The rigorous, multistakeholder needs assessment process described herein can serve as a road map for researchers and occupational therapy practitioners conducting transcultural projects in LMICs.

OBJECTIVE. We identified and described the strategies parents use to support the mealtime participation of their child with autism spectrum disorder (ASD). METHOD. Twelve families with children with ASD (ages 2–7 yr) participated in videotaped mealtime observations. Qualitative content analysis was used to identify strategies families used to facilitate participation. RESULTS. Six categories were identified: (1) parent intervening and ignoring, (2) meal preparation and adaptability, (3) play and imagination, (4) distractions, (5) positive reinforcements, and (6) modeling. Props—common child objects that support the child’s mealtime participation—were used in the context of multiple strategies. In addition, increased parental vigilance emerged as an important component of all family mealtimes. CONCLUSION. Families used multiple strategies within and across mealtimes, highlighting the individualistic nature of feeding challenges. Understanding parent mealtime strategies allows for further investigation into the efficacy and development of intervention strategies to promote mealtime participation of children with ASD.

OBJECTIVE. Systematic approaches are needed to help parents with young children adopt healthy routines. This study examined the feasibility (home data collection, protocol adherence, intervention acceptance) of using a behavioral activation (BA) approach to train parents of children with sensory food aversions. METHOD. Parents of young children (18–36 mo) were trained using the novel Promoting Routines of Exploration and Play During Mealtime intervention. Measures included video-recorded meals, Fidelity Checklist, Treatment Acceptability Questionnaire, and Behavioral Pediatrics Feeding Assessment Scale. Descriptive statistics were used. RESULTS. Eleven children and their parents completed the study. Two of three feasibility benchmarks were met. Intervention acceptance was high (mean score = 43/48). On average, parents used three more intervention strategies after training than at baseline. CONCLUSION. Using a BA approach to parent training shows promise for altering daily mealtime routines. Delivering this intervention in the home is feasible and received acceptable ratings among this sample.

Feeding interventions that support family relationships enhance children’s daily participation in meaningful occupations at home. A critical review of the literature yielded several premises that support the development of a relationship-based feeding framework. The proposed theoretical framework, based on the Biopsychosocial Model of Pediatric Feeding ( Berlin, Davies, Lobato, & Silverman, 2009 ) and the Ecological Model of Occupation ( Dunn, Brown, & Youngstrom, 2003 ), is presented to guide feeding interventions for children with significant feeding difficulties. A case example that illustrates the practical application of this framework is provided. Further development of relationship-based feeding theory and research is recommended to improve the occupational performance and quality-of-life outcomes for children and their families.

A mixed-methods design was used to explore the outcomes of a 6-wk, occupational therapist–led Comfortable Cafeteria program designed to build cafeteria supervisors’ and students’ capacity to create a positive mealtime environment so that all students can successfully participate in and enjoy a healthy meal and socialization with peers. Students whose scores were in the low and mid-range at the outset had statistically significant improvements in pretest–posttest visual analog scale ratings of participation and enjoyment. Cafeteria supervisors demonstrated statistically significant improvements in their perceptions of knowledge and skills to supervise and to encourage healthy eating. Qualitative findings add further insight into the program, suggesting that students learned prosocial values (e.g., being kind, helping others), supervisors actively encouraged positive social interaction, and occupational therapists enjoyed implementing the program and recognized positive supervisor and student changes as a result of integrating services in the cafeteria.

OBJECTIVE. This systematic review evaluated the effectiveness of environment-based interventions that address behavior, perception, and falls in the home and other settings for people with Alzheimer’s disease (AD) and related major neurocognitive disorders (NCDs). METHOD. Database searches were limited to outcomes studies published in English in peer-reviewed journals between January 2006 and April 2014. RESULTS. A total of 1,854 articles were initially identified, of which 42 met inclusion criteria. CONCLUSION. Strong evidence indicates that person-centered approaches can improve behavior. Moderate evidence supports noise regulation, environmental design, unobtrusive visual barriers, and environmental relocation strategies to reduce problematic behaviors. Evidence is insufficient for the effectiveness of mealtime ambient music, bright light, proprioceptive input, wander gardens, optical strategies, and sensory devices in improving behavior or reducing wandering and falls. Although evidence supports many environment-based interventions used by occupational therapy practitioners to address behavior, perception, and falls in people with AD and related major NCDs, more studies are needed.