With an estimated 15% of children presenting with a disability according to Pediatrics, coordination between medical and supplemental care is crucial to ensure that these children receive the medical and educational support they need to thrive in school, at home, and in their communities. Coordinating care is therefore a big piece of what makes a medical home effective and a reliable resource for a family. Part of a medical home’s support system is the speech language pathologist (SLP), an important member of a child’s support team. In this post, we’ll cover the work an SLP does, how pediatricians can work with SLPs to inform a child’s IEP, coordinate care, and even integrate into pediatric practice.
Pediatric Speech and Communication Disorders
Effective verbal and nonverbal communication helps a child learn, share their needs and desires, form social bonds, and develop feelings of community and belonging, leading to lifelong success and well being. For some kids with speech and communication disorders, which are as varied as the kids themselves, communication might be a mix of tools and abilities, such as some spoken words with American Sign Language, or the use of augmentative and alternative communication methods and tools (AAC).
Pediatricians tend to study communication disorders in the routine course of wellness checks, such as those suggested by Bright Futures guidelines, and from questions from parents. More commonly, concerns are observed by an educator or parent or by a speech language pathologist. Currently, the most common way communication disorders or delays are detected in pediatric clinical practice is via standard developmental surveillance, along with infant hearing exams, Ages & Stages Questionnaires. In Pediatrics in 2015, a US Preventive Services Task Force found insufficient evidence that standard speech and language screening was beneficial or harmful for children under age 5 without specific existing language concerns. More specific screenings do exist, such as this parent & teacher questionnaire from CHADIS.
Common Concerns in Communication Disorders
According to speech language pathologists Alyssa Pierce, MS, CCC-SLP and Ana O'Neill, MS, CCC-SLP, both practicing in school systems in Vermont, there are many reasons a child may present with a language, speech, and/or communication disorder, including hearing loss, developmental delays, cleft lip and/or palate, birth anomalies, or injuries affecting communication. Communication delay or difficulty is also a core feature of autism spectrum disorder. Any of these conditions may result in delayed speech, difficulty in communication, or anxiety related to speaking or listening.
“I feel like society has held onto the notion that speech therapy is only for developing a language, which is in our name. But more and more, we're doing more obscure skills like executive functioning or swallowing or cochlear implants and hearing, and those little bit more rare aspects that we don't see all the time, which is really cool.” Alyssa Pierce, Speech Language Pathologist
As to how common one disorder or condition is compared to any other, Ms. O’Neill said that in her community, “The short answer is that [the prevalence of disorders] depends on the year.” She says that concerns are most often discovered by educators or parents, or by a specialist such as herself during routine observation. “Schools have a system to observe and put students on a track for appropriate special education or other support. They are not automatically put into special education, but we can observe if a concern is raised to get them the support they need.”
While most concerns are caught at school or home, there are important milestones and markers for pediatricians to note, according to the American Speech-Language-Hearing Association (ASHA). Here are some things to watch for during routine well visits that may warrant a look into a potential communication disorder:
- Hearing and/or vision impairment
- Autism spectrum disorder
- Cleft lip/palate
- Delayed speech milestones
- Caregiver concerns, such as reported selective mutism
- Difficulty understanding and/or being understood outside of the home (such as at school or daycare)
- Feeding, latching, and/or swallowing concerns
- Voice issues (hoarseness or nasality)
If that seems like a long list, it is -- for good reason. Ms. O’Neill says that because a young child learns language through their senses, it is invaluable to her to know if a child is struggling with vision, hearing, motor skills, or other physical or developmental impairments, as well as their unique learning and medical needs. Both she and Ms. Pierce report that their professions allow them to work with children as young as newborns to detect concerns and support their language skills -- and the earlier concerns are noted and addressed, the better.
With this knowledge in mind, pediatricians may be able to address medical aspects of the patients’ condition, such as counseling parents on feeding concerns, and can then refer patients to an evaluation by an SLP or pediatric otorhinolaryngologist (otherwise known as a pediatric ENT, or ear-nose-and-throat) for further treatment.
Coordinating Care with Speech Language Pathologists
Speech language pathologists are specialists in communication disorders resulting from many of the concerns listed above. Their training allows them to be specialized in many diverse areas that could affect a child’s language development, such as neurological, physical, emotional, cognitive, socioeconomic, and cultural factors. Pediatricians may well have the opportunity to exchange information with these specialists to enhance a child’s medical care and their everyday life experience. As healthcare specialists, pediatricians and SLPs may exchange information about patients under HIPAA; SLPs also operate under the educational privacy act, Family Educational Rights and Privacy Act, FERPA.
An SLP’s consistent contact with a child also enables them to see real time changes in a child’s development a pediatrician might not have the chance to: “Perhaps this isn’t a great analogy, but I compare it to being a doctor at an ER,” says Ms. O’Neill, “A little triage, a little surprise. You have to get up to speed [each time].” Despite the constant change, students’ growth is an aspect Ms. O’Neill loves about her work, especially if she has the chance to be a constant presence in a child’s life.
While it’s possible for an SLP to practice within or closely alongside a physician or outpatient clinic, in smaller towns like the ones Ms. Pierce and O’Neill practice in, they more often work as a member in many different teams on behalf of a child, such as with a case manager, social worker, and parents.
How Pediatricians and SLPs Can Bridge the Gap
What can pediatricians do to help improve the care of children with speech disorders? First, both SLPs say that communication from practice to specialists via meetings or indirect support through data or reports is very helpful. Both specialists also said that referrals are crucial to help get a child on a support track as early as possible. According to Ms. O’Neill, learning about what SLPs do is also a great start: “I think awareness is great, what SLPs do. Another thing that happens is sometimes pediatricians may say, for a toddler, ‘They’re still young, don’t worry, if they haven’t met this milestone,’ but I think I would love to see pediatricians be more proactive in their referrals. It’s worth it to at least look into it.”
Communication between these educational, social, and healthcare teams isn’t always seamless, but Ms. O’Neill is open and eager for this to change for the kids’ benefit, as SLPs are often part of a wider support ecosystem that could be utilized by the child’s medical home. “I tend to work with other therapists and special education teachers and outside agencies, and maybe the parents. Then usually a parent or case manager connects to the medical aspect. I would love to see that change! It would be nice to have a bigger bridge between the two.” She mentions that she’d like to see more communication between physicians and SLPs, even once or twice a year to check in, and the exchange of information to keep a child’s care updated.
Both O’Neill and Pierce say that hiring an SLP directly is not necessarily the only way to offer patients the benefit of a coordinated healthcare team. “Ideally, it’d be great to have an SLP in house even part time, but I also love the idea of consultation,” Ms. O’Neill says. “Especially with the younger kids!” Pierce agrees and says that regular check-ins could be helpful for many of her students: “I would say scheduling a meeting [would be effective]. Maybe not super often, but it could be like a bi-annual school year meeting, where it's a really concrete way to touch base.”
Speech language pathologists are just one of many members of a strong healthcare team. Another member you may be familiar with is a behavioral health counselor, psychologist, or social worker. Just as hiring a speech specialist is one excellent way among many to expand access to care for children, there are many paths to integrating behavioral health. Learn more about how your practice can integrate if you haven’t already in our ebook below.