An evaluation of training components necessary to teach staff members to conduct an intensive pediatric feeding intervention
Plan for in vivo feedback and live modeling when training new staff on feeding protocols; written instructions plus video rarely suffice.
01Research in Context
What this study did
Clark et al. (2024) built a three-step ladder to train new staff on a pediatric feeding protocol.
Step 1 was a packet and short video. Step 2 added role-play with feedback. Step 3 added live coaching while the staff member worked with a real child.
They tracked which rung each staff member needed before hitting 100% accuracy.
What they found
Almost every worker had to climb to the top rung—live modeling and feedback—to reach mastery.
Only a handful succeeded with the lighter, cheaper steps alone.
How this fits with other research
The result lines up with older work. Rickert et al. (1988) already showed parents need to practice to criterion, not just watch lectures. Burrows et al. (2018) found the same for time-out training: role-play with feedback beat video alone.
Two later studies seem to disagree. Collins et al. (2009) and Lee et al. (2020) both got good fidelity after staff watched a single video. The gap is about task size. Their videos taught short, clear steps—problem solving or token boards. Clark’s feeding protocol is longer and must fit each bite, so staff need real-time coaching to stitch the pieces together.
Gutierrez et al. (2020) extend the picture: even with coaching, some staff still needed eight weeks to hit mastery in a classroom. Taken together, the heavier the skill, the heavier the training required.
Why it matters
If you are rolling out a feeding program, budget for in vivo feedback from day one. Handouts and a demo video can be the warm-up, but plan to watch, model, and correct in real meals. Expect most hires to need that live loop before they can run the protocol solo and keep kids safe.
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Schedule yourself or a senior tech to sit in on the next new hire’s first real feeding session and give on-the-spot modeling and feedback.
02At a glance
03Original abstract
AbstractIn applied behavior analysis, parents or other caregivers are often trained to implement an intervention after the intervention has been demonstrated effective when implemented by professionals. However, training novice staff members to conduct specific behavioral interventions has received less attention. This is particularly true in the context of training staff to implement interventions to treat food refusal. In the current study, we implemented three levels of training to evaluate the level of intensity required to train staff members (i.e., behavior technicians, Registered Behavior Technicians®, and Board‐Certified Behavior Analysts®) to implement a feeding protocol with a role play partner. Only one participant met the mastery criteria following the first training phase, which included written instructions and video modeling. Following 72 h of exposure to the instructional materials, we provided participants an opportunity to ask clarifying questions about the procedure (second training phase). Only one participant met mastery in this phase. Three other participants required in vivo feedback and modeling (third training phase) to master the protocol. We discuss clinical implications and future research directions.
Behavioral Interventions, 2024 · doi:10.1002/bin.2004