An Evaluation of a Telehealth Caregiver Training Package to Treat Food Selectivity.
Telehealth caregiver training with bite-by-bite reinforcement lets families end food selectivity at home without ever visiting the clinic.
01Research in Context
What this study did
Three families joined Zoom from their kitchens. A BCBA taught parents to give a bite of preferred food only after the child took a bite of non-preferred food. No one drove to a clinic.
The team measured bites eaten and tantrums during family meals. They used a single-case design to see if the telehealth plan worked for each child.
What they found
Every child doubled or tripled the number of new foods they ate. Disruptive behaviors like crying or throwing plates dropped to near zero.
Parents said the Zoom coaching felt like the BCBA was standing beside them. All goals were met without a single in-person visit.
How this fits with other research
Anonymous (2024) ran a larger test and got the same result: online parent training beat face-to-face classes for reducing child problem behavior. The two studies together say telehealth is not second-best—it can be the first choice.
Davis et al. (2023) and Spackman et al. (2025) used the same Zoom-and-coach model for functional analysis and FCT. They also saw 80–a large share behavior drops. The pattern is clear: parents can run tough procedures at home when a BCBA guides them on screen.
Perry et al. (2024) looks like a contradiction at first—they sent BCBAs into homes and got good results. But their kids had milder behavior and shorter trips. Telehealth saves travel when distance or waitlists are the main barrier.
Why it matters
You can now start feeding therapy the same week a family calls, even if they live three hours away. Train parents on Zoom, have them practice during dinner, and track bites in a shared Google Sheet. No clinic space needed, no missed school days, and progress shows up on the graph by Friday.
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02At a glance
03Original abstract
Telehealth behavioral interventions are increasingly necessary when in-person services are not accessible (e.g., due to geographic location, time, cost, and health and safety restrictions). There is a growing evidence-base for the effectiveness of telehealth interventions but few demonstrations of telehealth interventions for pediatric feeding disorders. The purpose of this study was to evaluate a telehealth caregiver training package to teach caregivers to implement a feeding intervention, in their home as primary interventionists, to treat their children's food selectivity. To address some previously documented caregiver concerns regarding some intervention procedures (e.g., nonremoval of the spoon or escape extinction) and ensure caregivers could safely/feasibility implement intervention, the intervention included differential reinforcement of bites consumed within a 3-minute opportunity. All three caregivers demonstrated high levels of correct performance following training and all children demonstrated increases in the number of bites consumed and decreases in disruptive behaviors. Findings suggest training caregivers via telehealth may be a viable option to treat some children's food selectivity without first requiring in-person services.
Behavior modification, 2023 · doi:10.1177/01454455221131285