Speech language pathologists may work in a variety of settings including medical facilities, schools, universities, private practice, clinic and virtual. Swallowing and feeding disorders have blurred the line between medical and educational SLPs. According to the Individual with Disabilities Education Act, “if the services are supportive services that the student needs and are critical for the student to attend school and benefit from his education, and that they are not medical (do not need to be performed by a licensed physician) then the school division must provide them.” (IDEIA). As a result, school districts throughout the country employ SLPs, occupational therapists, physician therapists, school nurses, psychologists, and social workers to address students with medical based health needs.
Should these students be treated for dysphagia within the school setting?
Let me give you some examples of actual students within the public school setting:
Student “A” suffered a closed head injury in an automobile accident. When she returned to school, she needed an eye gaze device to communicate, a modified diet which consisted of puree foods and thickened liquids, and seizure medication.
Student “B” had a brain hemorrhage at birth which resulted in cerebral palsy. The parents and the school were very nervous when he was scheduled to begin school at 3 years old. He only ate baby food when he arrived at school.
Student “C” has oral and pharyngeal phase dysphagia, is diagnosed as autistic and has a severe seizure disorder that is not responsive to medications resulting in significant risk factors during meals.
Student “D”, a first grade student with muscular dystrophy has a trach with a passy miur valve, oral dysphagia
These are but a few examples of students who attend our public schools and have medical concerns. If students need the services of a nurse of other qualified professional (excluding physicians) then the school district has the responsibility to provide those services.
In addition, districts also have the responsibility to provide a Free and Appropriate Public Education (FAPE). In order for a child to benefit from his/her curriculum he/she must have adequate nutrition and hydration in order to be able to:
- Attend school without frequent absences
- Have stamina to access their curriculum throughout the school day
- Eat lunch at school within the designated time, safely and efficiently
- Socialize at lunch with schoolmates
Why all SLPs should care about swallowing and feeding in the school setting.
All SLPs, regardless of the setting they work in should have a vested interested in school-based SLPs working with children with swallowing and feeding disorders. There are a number of reasons for this statement.
First, all SLPs should be interested in the health and safety of all clients whether we work in the school or medical setting. As an SLP, it is important that our colleagues in other settings be familiar with the scope of practice and the services that are provided in each of the settings. As a school-based SLP, you may get asked about a co-workers friend whose mother had a stroke. As a hospital-based SLP, you may have a friend who has a child with cerebral palsy. It is essential to SLPs individually, and to the field as a whole, that we are able to provide information to consumers regardless of the setting.
However, the responsibility goes beyond information and advocacy. Medical-based SLPs are the “go to” professionals with swallowing and feeding disorders. They have the knowledge and experience that is extremely difficult to obtain in the school setting. A medical-based SLP can provide support and guidance when working collaboratively with school-based SLPs. Too often there is a disparaging element to the conversation regarding school-based swallowing and feeding services. This continues to be an area of growth in the school setting and one that needs encouragement and support, as opposed to criticism.
In addition, one of the most desirable parts of being an SLP is the ability to move from one setting to the next. An SLP never truly knows where he/she will eventually work. Many SLPs work in both settings or move from one to the other. We are all SLPs and bolstering one group can only help all.
Breakdown of settings
- Ways of working together with hospital SLPs, private clinic SLPs and feeding specialists
- University – SLPs teaching dysphagia courses have a role (including school-based swallowing and feeding issues in their lectures, preparing SLPs to address swallowing and feeding in the school setting). What needs to happen first? Professors need to learn about dysphagia in the school setting. Who are the students? What types of swallowing disorders are most common? What are the federal rules and regulations that must be followed? What is the role of the SLP?
- Private SLPs and feeding specialists – share info with school-based SLPs. No room for territorial issue. Early steps therapists must work on the transition. What if the school district doesn’t have a team or a procedure but you have a student with serious dysphagia concerns that is starting school? What do you do?
Research Info
- Stats on children in ICU that have ongoing swallowing and feeding disorders beyond 3 years.
- Stats on children with medical conditions that result in chronic swallowing and feeding disorders such as cerebral palsy, Down’s syndrome
- Make a link between the types of children treated in the hospitals and clinics and those that then move on to the schools. What conditions are common? How can we improve the communication between the two settings?
Attitude adjustment
- All SLP job setting involve very important work.
- SLPs in the medical setting can often specialize in one or two areas.
- School-based SLPs are generalists and do not have the option of specialization in most cases. Possible to have subgroups within a school district (AT specialist, autism specialist, swallowing and feeding specialist).