In 2013, Avoidant/Restrictive Food Intake Disorder (ARFID) was introduced as a new diagnosis. Prior 2013 there was great variability in professionals’ understanding of children’s food intake. Children with a restricted intake of food had limited recognition amongst health services, which the ARFID diagnosis aimed to change. Over time, it is useful to evaluate whether the formulation of this eating disorder has improved understanding of food refusal or ‘picky eating’ to ultimately enable effective outcomes for children and their families. This study explored changes in perspective from 2013 to 2018 regarding understanding of picky eating amongst health professionals (medical practitioners, dietitians and speech-language therapists) working with children and feeding difficulties in New Zealand. An online survey conducted in 2013 and 2018 targeted understanding of food refusal and consensus within the medical field for the labelling of picky eating. Responses were analysed with descriptive statistics, and qualitative content analysis. Health professionals in both years reported there was no consensus in the labelling of picky eating, with a significant increase in those reporting ‘no consensus’ in 2018 (n = 141, p = .035). However, health professionals demonstrated an increased awareness from 2013, by seeking further information regarding labelling of the condition portrayed. Despite an increase in awareness since 2013, health professionals are yet to agree on the diagnosis and treatment of ARFID. The impact of picky eating on parental stress may be underestimated in the literature. Consensus and guidelines are necessary to support health professionals, individuals and their families to obtain necessary services and resources.

Purpose: Highly-experienced allied health professionals have the opportunity to perform at the expert-level by sharing knowledge and skills with more junior staff, with the aim of upskilling the workforce. The study explored the current motivators, aspirations and the role of work in the life of highly-experienced practitioners, revealing factors that hinder or support them to further develop their own expertise and be inspiring role-models and mentors for less experienced staff.Design/methodology/approach: Taking a grounded theoretical research design, we report on interviews with 45 allied health practitioners with at least seven years of professional experience from different professions and across organisational sectors. Transcripts were coded iteratively in conjunction with reviewing the literature, and cases were categorised to form a conceptual typology of work orientation.Findings: Four work orientations are characterised capturing the diversity of the allied health workforce, particularly in relation to two dimensions of personal fulfilment and future ambition. The relationship between the types and expert-level performance is discussed, leading to recommendations for support that can be implemented to develop and sustain expert-level performance within a community.Originality/value: A new view of work orientation is introduced that relates expert-level performance with meaningful work. The findings highlight a diversity of work orientation for highly-experienced allied health professionals, that all require managerial awareness. Once recognised, the four types would benefit from different supports that could develop and maintain expert-level performance in those that seek it. Alternatives are also available for those that do not. Implications for workforce policy are discussed.

Purpose: The current healthcare environment provides several challenges to the existing roles of healthcare professionals. The value of the professional expert is also under scrutiny. The purpose of this paper is to generate a construction of professional expertise amongst practitioners in the current healthcare environment. It used the speech-language therapy community in New Zealand (NZ) as an example. Design/methodology/approach: Speech-language therapists currently practicing in NZ completed an online survey including qualitative and quantitative components. The range of experience and work settings of participants (n=119) was representative of the workforce. Findings: Participants clearly identified being “highly experienced” and “having in-depth knowledge” as essential elements of professional expertise. Thematic analysis generated two interconnected themes of a professional expert being a personal leader and teacher, and a highly experienced, knowledgeable and skilful practitioner. Additionally, practitioners needed to be seen to contribute to the community in order to be known as experts. Clinical practice was valued differently from research generation. Originality/value: This study is novel in exploring a construction of professional expertise amongst practitioners in a current healthcare community. Within that community, experts could be viewed as highly effective practitioners that visibly contribute to the professional community. The study draws attention to the role of reputation and the impacts of being a clinical teacher or leader compared with pursuing a research role. This could be particularly relevant in the promotion of evidence-based practice.

Swallowing difficulties are common and complex in children with physical, behavioural, and cognitive needs. This study (i) describes mealtime management and (ii) identifies barriers and facilitators to implementation of a guideline for school-aged children with feeding difficulties in one specialist school. Three data sets were collected: (i) 51 school records, (ii) 48 meal observations, and (iii) seven staff interviews. The model of behaviour COM-B (Capacity Opportunity Motivation and Behaviour) was used to identify barriers and facilitators. 28 school records stated diet modifications and five children were enterally tube fed. Seventy percent of children had mealtime assistance. Only 25% of children had written plans and these did not contain all strategies observed. When feeding plans were vague or disagreements occurred, policy did not support decision-making. A coordinated approach is needed. Target areas for change include staff and family education; defined processes for cross-agency documentation and more detailed plans for all children.