Examining adaptations necessary to support the implementation of a parent-mediated intervention for children with autism spectrum disorder and moderate feeding problems.
To run the MEAL Plan outside university walls, add clear billing codes, lighter handouts, and live coach back-up.
01Research in Context
What this study did
Ledbetter-Cho et al. (2023) asked, "What must we change so the MEAL Plan can run in a regular community clinic?"
They ran online workgroups with clinic staff and parents. The team listed every tweak needed for content, billing, and coach support.
No kids were treated yet; this was a road-map study.
What they found
The workgroups flagged four must-haves: shorter handouts, clear CPT codes, a parent hotline, and on-call feeding coach.
Without these fixes, staff said the plan would stall after the first session.
How this fits with other research
Burrell et al. (2023) shows the same MEAL Plan already works: 47% of families saw gains when it stayed in a university clinic. Katherine et al. simply tells us how to move that winning package into the real world.
Ibañez et al. (2019) sounds a warning: when feeding treatment moves from clinic to home, problem behavior can spike again. Katherine’s call for ongoing coach support lines up with Haney et al. (2021), who proved a short renewal-mitigation step blocks that exact relapse.
Sievers et al. (2020) and Stahmer et al. (2019) both dragged autism interventions into Medicaid Part C settings. Their lesson: add admin help and flexible billing. Katherine repeats the recipe for feeding, showing the pattern holds across targets.
Why it matters
If you run a community clinic, you now have a checklist: secure billing codes, shrink parent packets, and keep a feeding BCBA on speed-dial. Build these pieces into your program plan before the first family walks in.
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02At a glance
03Original abstract
Moderate feeding problems and disruptive mealtime behaviors are common in children with autism spectrum disorder. Although parent-mediated interventions are able to support feeding problems in autistic children, most research has occurred within specialty clinics when delivered by highly trained clinicians. Thus, the fit of these interventions within community settings is not clear. To address this limitation, this study explored adaptations to a parent-mediated intervention, Managing Eating Aversions and Limited Variety (i.e. MEAL Plan), to improve its fit and use within community settings. Participants were 14 multidisciplinary providers who attended one of the three intensive workgroups that included focus groups about the fit of MEAL Plan in their practice setting. Qualitative analysis was used to determine the main themes that came up within the focus groups. Specific themes included the appropriateness MEAL Plan for autistic and non-autistic children, how providers might adapt their delivery of MEAL Plan, billing and insurance considerations, administrator support for MEAL Plan, and the content and format of ongoing training and consultation. By proactively considering and responding to these factors, it may be possible to enhance MEAL Plan so that it is better able to be delivered and sustained within community practices that support autistic children.
Autism : the international journal of research and practice, 2023 · doi:10.1177/13623613231166181