The TR-eat™ Model

The Transdisciplinary Effect Assessment and Treatment (TR-eatTM) model was developed by Elizabeth Clawson, PhD and Carol Elliott, OTR/L in their search to find a treatment model for children with complex feeding problems that was consistently successful, easy to administer and met the needs of the child and family. They found that “two heads” or should we say “two disciplines” were better than one.

Where it started

Elizabeth, who was trained at the Kennedy Krieger Institute, saw the value of behavioral psychology methods for children with feeding difficulty but also struggled with the limitations a stringent behavioral model had when it came to teaching skills. Elizabeth began working at Children’s Feeding Program at Children’s Hospital of Richmond in 1999. There she partnered with Carol, who had been working in the field of Pediatrics for 7 years and shared her expertise on oral motor skill development, sensory integration treatment and a passion for feeding therapy. Together, they developed the TR-eatTM model that blended behavioral principles with therapeutic skills to address even the most difficult feeding problems. In 2008 Elizabeth relocated to St. Mary’s Center for Children in Evansville, Indiana to develop a program that replicated the framework that she started in Richmond. Elizabeth and Carol have dedicated their professional practice to working solely with children who have severe feeding disorders. They have been able to watch for trends and evaluate long-term outcomes. Treatment at Children’s Hospital of Richmond and St. Mary’s Center for Children has been sought out by patients from around the country many of whom have not had success elsewhere.

The TR-eatTM model is research based and has outcome data to support it since 1999.  The model has been used in a variety of clinical settings and found to have consistent positive results across all areas. The TR-eatTM model is based upon the following principles:

  • This is a transdisciplinary model where disciplines work together and become crossed trained in oral motor skill treatment and behavioral interventions.
  • The model is collaborative not consultative, all disciplines working together.
  • Treatment is closely integrated with medical intervention and nutrition as this is typically the underlying cause of feeding difficulties.
  • Positive reinforcement strategies are used to not only teach, but increase the rate of learning new skills.
  • This is a child guided rather than child directed approach. We look for subtle signs from the child to find the “just right challenge” to work within. There is structure; however treatment is advanced at a rate where the child is able to develop skills and confidence.
  • The program is respectful of sensory deficits. Although traditional sensory integration treatment is not directly incorporated into the model, however systematic desensitization (slow progression with sensory challenges) is used as part of treatment and found to be highly successful.
  • The model is easily adopted in a variety of treatment settings.
  • Treatment is systematic, structured and built on individual successes.
  •  It is easy to learn and teach caregivers.
  •  No specials tools or certification is needed.

Our Workshops

Carol and Elizabeth began conducting workshops with the goal of helping therapists by sharing the TR-eatTM model, tips and experiences based upon their years of work in this field. The course provides multiples case scenarios, videos, hands on demonstration, written instructions and handouts that can be put to immediate use.  Positive feedback from course participants has been overwhelming.  We look forward to sharing our knowledge with you and reaching out to help more children with feeding challenges.

Treatment Centers Using the TR-eat™ Model:

The model was originally developed and tested over the 10 years that Elizabeth and Carol worked together at Children’s Feeding Program at the Children’s Hospital of Richmond. Care via this model has now been extended to the Midwest where Elizabeth directs the Behavioral Feeding program at St. Mary’s Center for Children in Evansville, Indiana.  Both programs offer interdisciplinary assessment and treatment including feeding clinic evaluations, outpatient therapy, and intensive day program services. For more information and patient referrals please use the following contact information.

St. Mary’s Medical Center, Pediatric Feeding Program
3700 Washington Avenue
Evansville, IN 47714
812.485.7425
www.stmarys.org
epclawson@stmarys.org

Children’s Hospital of Richmond
2924 Brook Road
Richmond, VA 23220
www.childrenshosp-richmond.org
celliott@chva.org

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