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Scenario-Based Training and Teaching Safe Eating Practices

The impact of online scenario-based training on direct support professionals’ implementation of safe eating and drinking practices with individuals with intellectual and developmental disabilities


Dysphasia (a swallowing disorder) is estimated to affect the majority of individuals with life-long disabilities and can increase the risk of choking especially as one ages. This study will investigate whether online training paired with coaching sessions can properly prepare DSPs to implement safe eating and drinking practices.


65 Direct Support Providers were randomized to either an group who received online scenario-based training only, or a  group who received the same online training plus a 20-minute coaching session with a nurse. The coaching session also included the use of a visual poster to cue participants to diet order specifications reviewed in the course.  Pre and post measures were used. All participants took a pretest and post test that measured client specific knowledge of safe eating and drinking practices. Forty-two of the sixty-five participants also completed pre and post hands-on interviews  with physical meals that measured adherence to client specific diet orders. Post-tests were given between 6-10 days after the training interventions. 

The online course, “Bon Appeitit: Overview of Safe Eating and Drinking for Individuals with IDD”, was delivered online through Relias. The course taught DSPs through interactive scenarios and feedback to:

  • Recognize when a person is choking
  • Identifying dangerous situations in pictures of meals for individuals with modified diets
  • Identifying the onset of new problems and reporting them to appropriate people

safe eating and drinking coursesafe eating and drinking course


Both groups significantly increased from pre to post test that measured knowledge of client specific risks in pictures of meals. There was no significant difference between the groups that received online only vs online + coaching, see Fig. 1.safe eating knowledg

There was a more dramatic increase in scores with the in-person assessment measuring adherence to diet orders. Again, there was no significant difference between groups that received online only vs online + coaching, see Fig. 2. Interestingly, when asked what training activity was most effective, DSPs scored that the coaching session was better at preparing staff to implement safe practices even though the data did not support this finding, see Fig. 3safe eating interviewsocial validity


Overall, these results indicate that the online training program is effective in increasing knowledge of client specific risks and increasing adherence to diet orders. The results also show that the coaching session did not seem to make a significant increase in knowledge and adherence although it was more enjoyable for staff. This may be due to the fact that it was only 20 minutes in a group format. The results of this study emphasize the importance of training on safe eating and drinking practices for DSPs. Baseline scores for staff averaged 69% for knowledge of risks and 41% for adherence to diet orders. Even after training, knowledge scores averaged 76% while adherence increased to an average of 56%, leaving a lot of room for improvement. What additional staff training and supports can be put in place to increase knowledge and diet order adherence even more?  

*This study is being presented at the American Association for Individuals with Developmental Disabilities in June 2018.