Of all the areas in my practice, feeding therapy has presented me with some of the greatest challenges, but has also yielded some of the greatest reward. As a new graduate, I recall reluctantly entering feeding therapy during my earliest work in early intervention. At the time I was practicing in California, where occupational therapists hold a seemingly prominent role in feeding, eating, and swallowing. This was a stark contrast to my exposure as a clinical student in Connecticut, whereby I observed feeding and swallowing to be primarily carried out by Speech-language pathologists. Through colleagues and mentors, I learned of advanced practice certification in Swallowing Assessment, Evaluation and Intervention (SWC) as granted by the California Board of Occupational Therapy. I began the process, though upon my move back to the east coast, sought out a comparable certification granted by the Massachusetts Board of Allied Health. No such certification exists. Moreover, the scope of practice within Massachusetts seemed to offer little additional guidelines. Feeding therapy can be provided by both an occupational therapist or speech language pathologist. It is further variable dependent upon state specific practice guidelines and individual provider qualifications, creating further ambiguity. When I entered the doctoral program, I knew I wanted to focus in part on furthering my knowledge and competence in pediatric feeding therapy for neuromotor populations. I set a goal to Examine role delineation and identify interdisciplinary practices for collaborative care in the efficient treatment of children with complex feeding, eating and swallowing disorders in an outpatient setting.

My eight artifact (complex feeding course) details my earliest experience of beginning to understand the varying providers and unique roles within feeding therapy. I was fortunate to have a speech-language pathologist colleague with whom I have a strong working relationship. The ability to attend an advanced training course together was immensely valuable. Prior to attending the course, we compiled a list of our collective questions and most challenging cases. This allowed us to directly relate the course content back to our clinical practice in the moment. I found this made an immense difference in my ability to learn and meaningfully apply the content. Additionally, the course allowed each of us to identify gaps within our own respective areas of practice. For myself, as an occupational therapist by training, I felt I was most lacking in my knowledge surrounding oral motor anatomy, swallowing physiology and interventions. Through elective courses, namely Anatomy and Physiology of Speech and Swallowing and Clinical Anatomy of the Upper Quadrant and Select Cavities, I was able to strengthen the breadth of my foundational knowledge. Both of these courses were taught by professors of differing backgrounds than that of my own, namely a Speech-language pathologist and physician specializing in faciomaxillary surgery. I felt incredibly fortunate to have access to a curriculum that actively promotes interdisciplinary learning. It afforded me the opportunities to not only learn through a differing lens, but also offer up the perspective of an OT.

My nineth artifact (revised feeding intake) entailed the experience of consulting across disciplines to develop a revised feeding therapy intake form. Our initial criticism was the prior feeding intake items were embedded within a larger general intake form. Additionally, we felt the questions were too broad and not effective to extrapolate the primary concerns and impairments. Our initial efforts to be more specific resulted in a form that was far too cumbersome. This required developing multiple drafts until arriving at a more concise, while still comprehensive version. One of the challenges was determining which pieces of information and details should take prioritization. Coming from two different perspectives, we each held our own specific thoughts. Ultimately, we arrived at prioritizing open ended questions at the beginning of the form, to allow parents to share concerns, perspectives and experiences in their own words. The subsequent items, while still being detailed at 6 pages, was thoughtfully formatted to ensure optimal efficiency. Features such as easy to check off boxes and minimal required writing allow for a timlier ease of completion. We also made efforts to omit relevant though redundant information that would easily be found elsewhere, such as full detailed medical history. Instead, we opted to include only the details we though to be most pertinent to feeding therapy. The final draft was piloted for several weeks by staff prior to finalizing and implementing. This provided another opportunity to gain further perspective of both staff and caregivers, taking care to address any details we may have overlooked. To further ensure the effectiveness of this new form, I held a brief in-service prior to implementation. This in-service held a twofold purpose, through further educating staff on the role of OT in feeding therapy, as well as touching upon role delineation. First, new practitioners with an interest in feeding therapy or therapists new to our practice, were provided with a foundational overview of the current evidence and best practices. Additionally, through making this presentation staff-wide, patient care coordinators and all disciplines could obtain a more detailed comparison and understanding as to when an OT, SLP or both disciplines may be warranted. Ultimately, this served to educate the team to ensure optimal timely and efficient referrals for feeding therapy services.

Through my tenth artifact (feeding team competencies checklist), I was able to demonstrate my ability to integrate and apply knowledge in interdisciplinary practices as it specifically relates to the provision of feeding, eating and swallowing therapies. Determining what skills a clinician needs to be an effective feeding therapist was, and continues to be challenging! Feeding therapy is such a delicate and unique area of practice as it is not only immensely physical, but also a social-emotional experience as well. While there are undoubtedly certain foundational competencies for a feeding therapist, there are also many other factors to consider. A clinician's experience, respective discipline, patient population and access to collaborative care are all directly related to one's success. In developing this checklist, my colleague and I sat down together and reflected on all the qualities and skills we felt we acquired, collectively. We were mindful to include items that either of us, even as the most seasoned feeding therapists on the team, may still be working on. This really challenged me to assess my own relative strengths and opportunities for growth. I also think it's important appreciate that I don't have to always be the most skilled in every aspect of care. What is important, is being aware of my own limitations and recognizing when to seek guidance and refer to another colleague. For example, through my coursework at NYU, I have had the opportunity to develop much greater knowledge and understanding in swallowing anatomy and physiology. However, I still recognize this is an emerging skill set for myself, and identify cases and situations in which I feel I am beyond my current scope of abilities. Likewise, I look to my colleagues to do the same, drawing upon each of our points of strength to provide the most effective care possible. Developing the competencies checklist exemplifies the successes and benefits of collaborative care. Analyzing our treatment from assessment through intervention really allowed us to more deeply critique our approaches and reasoning. I found this experience ultimately helped me to also better comprehend and synthesize everything I had learned in regard to feeding, eating and swallowing practices.

Above all, this process has reframed my perspective of interdisciplinary collaboration as it relates to feeding therapy. Initially, I approached collaboration from more of a reactive place, utilizing it as a tool when I identified struggles or challenges beyond my own scope and abilities. Through this I have learned value of being proactively collaborative, rather than reactive. I have recognized I don't need to wait until I encounter a challenge, to seek another perspective. Rather I wholly appreciate the unique skill set of both disciplines from initial inquiry through evaluation, intervention planning and treatment.

Collectively, these artifacts demonstrate my acquisition of advanced knowledge in feeding therapy practices, through interdisciplinary learning and clinical experiences. My confidence and ability to provide high quality care within my scope of practice has grown immensely. The insights imparted by colleagues of diverse backgrounds has also strengthened my appreciation for collaborative care.