While this process is individualized and designed for each client and family/caregivers, the general framework will be:

 

• Once interest has been identified, I will follow through by phone and/or email as requested to set up a free initial consultation by phone or Skype.

• Following this first consultation and conversation, I will offer initial recommendations to inculde service intensity and structure to include the fee schedule. Payment will be typically made and verified through Paypal links on this website

  • Session costs will reflect a range based on a per session charge (1 hour). While sessions will be scheduled for a minimum of one hour, they may also go longer by mutual agreement. Longer scheduled sessions may also lead to an adapted fee schedule. Specific office/administrative time will also be billed but at a lower rate.

    • I will work hard to make costs reasonable and manageable.

• Once services have been agreed to, a Service Contract will be signed between myself and the family/caregivers and/or selected Providers. Additional HIPPA and confidentiality paperwork will also be identified and completed.

• I typically request copies of previous history, relevant medical, educational and/or clinical services reports for review. I also send my own original assessment/self report paperwork to be completed to the degree possible prior to the first scheduled session or two. 

• The first session or two will review my completed paperwork and include a semi-structured functional behavior assessment interview to, hopefully, be able to include real time Skype observation. Video recordings may be requested.

• Individualized data collection will be requested.

• A session schedule will be identified to include submission of prerecorded videos along with real time Skype observation.

• Initial intervention/instructional suggestions to provide immediate support & feedback will be offered while the more comprehensive plan is still being designed.

• Following an agreed to time period based on the Service Contract, I will design a Behavioral Assessment Report that will, at the least, include specific strategies/interventions and related recommendations, timelines, & expected Outcomes.

 

 

 With mealtime/feeding as the primary target, my approach, the overall process and fee development will be very similar to that which I've reviewed under 'Behavioral Support.'

 

I also have my own original and copywritten behavioral feeding assessment materials which I will send to be completed and reviewed together. In that mealtime is usually a social event, I also look very closely at a range of other factors and variables to include those which may not typically be targeted by other clinicians.

 

Persisting food refusal can lead to deep frustration and stress, social isolation, child embarassment and a decreased quality of life as well as daily disruptions for the child, family/caregivers and other primary providers.

 

At worst, it can become a threat to health and well being.

 

Toileting issues, disrupted sleep, limited social and activity engagement/on task; medical, GI and dental stressors; lack of peer, community and school-based success and comfort, inconsistent compliance and difficult interactions, to name but a few, can take root in dysfunctional meal and eating routines. 

 

This behavior can also shape unintended interactive patterns around mealtime that actually reduce, rather than increase, the likelihood of success over time.

 

For instance, extra attention via specific premeal activities, extended time at the table, preparing multiple food choices, time spent 'discussing' the need to eat, offering too much food at a time, when adult stress is obvious to the child and/or the use of punitive responses when food is not accepted can easily intensify, rather than relieve, this problem area. As such, comprehensive and very individualized behavioral assessment, support and intervention become even more important. 

 

It is important to recognize that food refusal can also become related to context and other external variables even when there is a contributing medical history. Intervention must consider the reasons behind and structure surrounding mealtime/feeding issues combined with the awareness that the child is just one member of a very complex social system.

 

 

 

 

 

Behavioral Support, Intervention, Program Development & Mealtime/Feeding Issues: Tele Behavior Prioritized