1. Clinical swallowing evaluation and mealtime assessment
In the first phase, the speech pathologist will complete a clinical swallowing evaluation. This involves:
- Gathering a case history
- Oral musculature assessment
- Oral trials with food and fluid
- Trialling various techniques or interventions to find out what can help
Our speech pathologists use their training in anatomy and physiology of the head and neck, plus knowledge of body structures and functions, to identify the presence of a swallowing impairment. This includes drawing conclusions about the cause and prognosis for the dysphagia.
Going further, the speech pathologist will consider the broader mealtime context. What does a “typical” mealtime look like for the person? What might be working and not working? What are the person’s mealtime-related goals, interests, concerns?
We pull all this information together to form a comprehensive picture of the person’s current mealtimes. This phase would generally be considered the “science” part of the mealtime process!
2. Supported decision making
We respect every Australian’s right to self determination. We applying this to our mealtime service through supported decision making. We bring all the information we gather from a mealtime assessment to the person, their immediate support people, and other important people in the person’s life (e.g., family, friends, other service providers). We talk about what we have seen and diagnosed. We make sure we have the right information, and that we haven’t missed anything. We work together to identify the goals of the mealtime service, and make a plan to achieve those goals. We always aim to include the person in these conversations.
It is critical that the person agrees to the mealtime support that we eventually recommend.
3. Implementation and monitoring
The final phase in our mealtime service is the implementation and monitoring phase. This is when we write up a “Mealtime Management Plan” for the person. This outlines in detail, how to support the person to have safe and enjoyable mealtimes. We ask key personnel to sign and endorse the “MMP”. We then share copies of the MMP with the client and anyone who might support them at mealtimes.
We don’t stop there. It is important that the people providing the mealtime support know what to do and why. We always offer training to paid support staff, regarding an individual’s mealtime management plan. We make sure that our recommendations are practical and realistic for paid staff to implement. We set a date to come and review the MMP, but our training will also cover “signs that things are not working” so that staff know when and how to call for help if it’s needed.