Deonna Hughes MS RD CD
LEND Nutrition Trainee ‐ Leadership Project
LEND Nutrition Trainee Leadership Project
Obj ti fS
Objective of Survey
Evaluate level of involvement and impact of
E l t l l fi l t di t f
registered dietitians (RD) at ESIT programs and
neurodevelopmental centers (NDC) of WA
State
Goal
Offer nutrition services by a RD to all children at
Offer nutrition services by a RD to all children at
nutrition risk served by ESIT and NDCs
Stats
1997–2008 National Health Interview Surveys: DD
affect approx. 15% of children age 3‐17 years old (1)
Survey of children 10 years
Source of Financial Support
8
6
6 5 5 5
4
4
2 1
0
Medicaid Private Family co
Family co‐ Part C
Part C Program Other
insurance pay funds fundraising
N=7
Other: family scholarships
Who determines which children see
Who determines which children see
the RD?
8
7 7
6
4
4
3
2
0
Parent request FRC Therapist Routine Other
screening N=7
Other: team recommendation, physician request, ARNP
Services RD provides
8
7
6
6
5
4
4
2
2
0
Individual Ongoing Consultation w/ Parent Other
nutrition eval individual other therapists education
follow‐up N=7
Other: Ongoing team training, feeding team lead, coordination of
care with medical doctors/ other service providers
Average # clients per month seen by
RD
6
5
4
2
1 1
0
1‐3 4‐6 7‐9 10‐12 13‐15 Unknown
# Clients
Average # hours/month RD provides
nutrition services
4
3
3
2
2
1 1
1
0
1‐5 6‐10 11‐15 16‐20 21‐30 >30
Hours
Do you think there is a need for more
hours from RD? (# per month?)
( p )
4
3 3
3
2
1 1
1
0
1‐5 hours
1‐5 hours 6‐10 hours
6‐10 hours 11‐15 hours
11‐15 hours No Not sure
Not sure
4 Average yearly amount spent on
nutrition services
3
3
2
2
1
1
0
$1500
$7500
Results from those that do not have RD
Results from those that do not have RD…
Do you provide nutrition referrals to
Do you provide nutrition referrals to
RDs in the community?
25
21
20
15
10
7
5
0
No Yes
Yes provide referrals to:
Yes, provide referrals to:
Hospitals (x7)
Hospitals (x7)
County/public health department (x5)
PCP k f l ( 5)
PCP makes referral (x5)
WIC RDs (x3)
RDs within larger health care system (x2)
Consult with RD from local ESIT program (x2)
CHDD (x1)
Community RD holds monthly consults (x1)
Home care company (x1)
Do you regularly consult with a RD
through an informal arrangement?
25
22
20
15
10
7
5
0
No Yes
Yes: PHN works at WIC w/ RD, RD part of feeding team, consult via
email within a large healthcare system, contact CHDD, home care co.
Biggest barrier to
/
employing/consulting a RD?
14 13
12
10
10
8
6 5
4
2 1
0
Lack of funding Not enough Do not know of a Other
nutrition needs to RD to work with
Other: justify
RDs already within Health Care System
y y
local schools provide most of Birth to Three services
not many families identify nutrition as an area of concern
Do you believe the families served by
Do you believe the families served by
your EI program would benefit from
i f RD?
services of a RD?
30
26
25
20
15
10
5 2
0
Yes No
If you could overcome major barrier(s),
about how many hours/month would you
utilize services of a RD?
16 14
14
12
10
8 7
6
4
2 1
2
0
1‐5 6‐10 11‐15 16‐20 21‐25 26‐30 >31
Hours
Actual vs. Desired RD Hours
16
14
14
12
10 Yes Dietitian
8 7 No Dietitian
6
4 3
2 2
2 1 1 1
0
1‐5 6‐10 11‐15 16‐20 21‐30 >30
Hours
Questions for all on Feeding Therapy
Questions for all on Feeding Therapy
Provide Feeding Therapy? Yes Dietitian
No Dietitian
30
25
8
20
15
10
18
5 11
0
Yes No
Who is on the Feeding Team? Yes Dietitian
No Dietitian
25
20
15 8 8
10
12 12 3
5 5
2 1 5
2 3
0
SLP OT PT RN Pediatrician RD Other
N= 22
If children see a RD at another location do you Yes Dietitian
receive a copy of the report? No Dietitian
20
18
16 6
14
12
10
8
6 2 13
4 8
2 5
3
0
Yes No Sometimes Not sure
Summary of Observations
Summary of Observations
Majority of ESIT and NDCs do not offer nutrition
Those who have RD seem to serve more clients per
year
Funding is provided from a variety of sources
RDs are offering variety of services to programs
Programs not employing RD perceive a need for 10
g p y g p
or less hours/month from RD
Biggest barriers were lack of funding and not
Biggest barriers were lack of funding and not
enough perceived need
Li i i
Limitations
Unable to contact all EI providers
Limited response
p
Surveys subject to bias of responder
N S
Next Steps
Create a profile of programs with RDs to serve as a
model to those that do not
Provide education to ESIT and NDCs that do not offer
g py
nutrition services or feeding therapy on the need and
potential model
Thank you
Thank you
Questions or comments?
Resources:
1. Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin‐
Allsopp M, Visser S, Kogan MD. Trends in the Prevalence of
Allsopp M Visser S Kogan MD Trends in the Prevalence of
Developmental Disabilities in US Children, 1997–2008. Pediatrics.
Published online May 23, 2011 (doi: 10.1542/peds.2010‐2989).
Published online May 23, 2011 (doi: 10.1542/peds.2010 2989).
2. Bayerl CT, Ries JD, Bettencourt MF, Fisher P. Nutrition issues of
y p g p y
children in early intervention programs: primary care team
approach. Semin Pediatr Gastroenterol Nutr. 1993;4:11‐15.