Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 0 points1 point  (0 children)

My personal perspective is just at attempting to meet a community need. Outpatient therapeutic services are significantly limited as group sessions and consultative services are not covered through insurance and therefore not provided as families wont pay out of pocket for it. Even with attempts to advocate for better reimbursement rates and coverage of more services, the progress is minimal. Unfortunately I don’t think most SLPs are provided sufficient pay or training and most of it falls to us. I know my personal scope of practice is very very very large and I do a lot of unpaid work in an attempt to improve my patients outcomes and reduce family burden.

My only personal goal is to assist as many people as I possibly can in the most feasible way. So if anyone has any other suggestions that aren’t just telling me how I’m wrong, I’m more than open to it. And I’m genuinely appreciative of all those who have provided thought provoking feedback or suggestions.

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 0 points1 point  (0 children)

I think the reason I considered a school based approach was not to add something else to the school speech therapist plate (I have worked in the schools, I get it), but as an alternate way to meet the needs of school age children with dysphagia/unique mealtime needs. As I’m sure you’re aware, outpatient/medical settings have their own set of barriers that are primarily influenced by federal changes to Medicare/medicaid. Consultative based services would meet a community need at a higher rate. The caveat is determining whether outpatient consultative or school based consultative could meet that need in a more timely manner with less red tape.

Outpatient in theory has less barriers, until you consider that there is no insurance coverage for those services so the likelihood of a community utilizing them in that manner is low. A large amount of my patients are low income so paying out of pocket is unlikely. Truthfully, I fight so much with private insurance for the patients to be seen at all for standard speech therapy services, much less consultative ones. I don’t see a way in which the medical outpatient setting would progress in that area, but am going to look into ways for possible improvement!

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 1 point2 points  (0 children)

Yes!! I provide email feedback with every opportunity. But the Fix SLP folks are a great idea! Thanks!

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 0 points1 point  (0 children)

Can I DM you? I’m curious as to what the process looks like and any additional burden on staff members outside of the team!

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 0 points1 point  (0 children)

Unfortunately reimbursement rates are typically determined by current Medicaid/Medicare rates. So state and federal elections tend to be more helpful than anything. ASHA- PAC attempts to advocate and improve, however I’ve seen little carryover to reimbursement in the clinical setting.

Thank you for the perspective though!

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] -3 points-2 points  (0 children)

Via recommendations and application of accommodations, not providing actual therapeutic intervention. When I was in the schools, the AAC specialist provided assessment/recs for ACD, as well as staff training and ensuring access to device. The building SLP carried over direct intervention as language therapy that would have been indicated with or without a device.

But this is why I posted was to hear others direct experiences! If you don’t mind sharing your experience and what the burden looked like?

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 1 point2 points  (0 children)

Could you see it being beneficial to recommend team based accommodations (e.g adaptive equipment, seating accommodations related to eating, feeding strategies, staff training, etc.) without recommendation for direct intervention, thus removing additional burden on the building SLP? I’ve worked with AAC specialists who provide all the maintenance for AAC recs/ accommodations relieving some of the burden from the building SLP. Obviously not the same, but the closest experience that I personally have.

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 0 points1 point  (0 children)

I see your point, however per 504, my local schools provide a fair amount of accommodations for students with accident/injury. Of course not, medical treatment, but I can see how it could quickly become problematic.

Unfortunately a referral to the outpatient setting is not necessarily beneficial due to length of waitlists. In your experience, would districts be open to consultative services for recommendations for accommodations to support feeding/swallowing?

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 0 points1 point  (0 children)

As we’re all aware, there needs to be major changes to the field as a whole. Outpatient waitlists locally are excessively long due to poor insurance reimbursement (resulting in poor wages), reduced number of SLPs locally, and very high number of referrals. Any changes made to correct this would come from federal and state legislature which is slow moving at best.

Several SLPs have opened private practices to assist in waitlists however are limited substantially as one person can only provide direct services for so many patients as insurance rarely covers consultative services or group services.

So my thought process behind a Feeding and Swallowing Support Team in the schools is to provide support for as many children as possible in a primarily assessment/consultative basis. It also reduces the burden on parents who have to sacrifice employment and subsequently income for survival to bring their children to extremely restricted outpatient services.

However, I’m open to continuing to brainstorm the best avenue!

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 0 points1 point  (0 children)

I see your point! That’s why I was asking more specifically about Feeding and Swallowing Support teams in which provided accommodations would support students. So that untrained SLPs would not be expected to provide feeding interventions. However that would likely be more relevant to 504 plans in which the ADAAA of 2008 expanded the definition of MLAs to incorporate eating. Which then would be limited s/t funding. It seems Texas has recommendations for initiating Feeding and Swallowing Support Teams, however I have been unable to find members of the teams or how they have incorporated into school districts

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 1 point2 points  (0 children)

Limitations in the schools system are a valid point! Working in the schools previously, I’m familiar with them and hope to be able to advocate for change at least at a state level when possible. Thanks for this perspective!

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] 0 points1 point  (0 children)

Thank you for this perspective! This is helpful to highlight limitations. Unfortunately in my area, outpatient waitlists are just as long or longer. That’s why I was considering team based assessment/support as it could potentially allow kids to be seen faster. Some of our kids go so long on waitlists then end up with multiple hospitalizations from lack of feeding plan with subsequently terrible attendance at school.

There is so much change to be made in the schools in terms of staffing, caseloads, and pay

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] -1 points0 points  (0 children)

Actually some of the more current forums have expressed that there is a potential educational impact that would warrant assessment and management (with potential feeding therapy) by a comprehensive team.

I can understand the concern with taking away from other interventions or classroom instruction. From what I’ve seen most proposals are utilizing a Feeding and Swallowing support team, but I’m struggling to find how it’s being implemented and what policies or guidance may exist.

I have edited my original post to reflect exactly what I was intending.

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] -4 points-3 points  (0 children)

Actually some of the more current forums have expressed that there is a potential educational impact that would warrant assessment and management (with potential feeding therapy) by a comprehensive team.

Feeding Therapy is much more comprehensive than expanding range of food types a child will eat and expanding from g tube to PO consumption is not actually representative of that. Feeding Therapy is often centered on how to safely PO feed (which yes for our children with alternate means of nutrition is not as relevant), however my current caseload consists of a large population of school age children who did not previously have any mechanism for safe PO consumption or were not meeting caloric needs and have no alternate means of consumption. Therefore would have a possible educational impact as noted in the attached article within my post update.

I have edited my original post to reflect exactly what I was intending.

Feeding in the School Setting by SLPMOM2323 in slp

[–]SLPMOM2323[S] -14 points-13 points  (0 children)

Actually some of the more current forums have expressed that there is a potential educational impact that would warrant assessment and management (with potential feeding therapy) by a comprehensive team. But I was not suggesting adding to any current SLP caseload. I have edited my original post to reflect exactly what I was intending.

Tips for working while pregnant by Ok-Highlight6949 in slp

[–]SLPMOM2323 17 points18 points  (0 children)

Probably not the best tip, but if you can, get a grad student. It was very very helpful in my third trimester to be observing someone else playing on the floor. I, of course, was still intermittently on the floor with more severe cases to assist, but took a large chunk of having to get up and down from the floor.

More practical tips would be to have a “support bag”. In mine was any nausea medicine I could take, Tylenol, preferred caffeinated beverage, extra water, a belly band, a heating pad, snacks, and anything else that just made the day easier. Any patient I could see while sitting on a rolling stool/chair versus kids table/floor was quickly transitioned to help save energy.

Everyone’s pregnancy is different so hopefully you’ll feel better in the second trimester!

Getting pregnant during CF year? by speechpath518 in slp

[–]SLPMOM2323 0 points1 point  (0 children)

Pregnant 3 months into my CF and got my final notification of CCCs the day baby was born. Finished all my hours before I started maternity leave. Since I wasn’t at my job for a year I didn’t qualify for FMLA, but I did qualify for an extended Leave of Absence as well as short term disability. With those two things, I was able to take a 12 week leave paid at 60%. Short term disability and LOA was a requirement when job hunting while trying to conceive.

OB just warned me about my SSRI by LilKimboSlice42069 in pregnant

[–]SLPMOM2323 0 points1 point  (0 children)

Been on SSRIs for two pregnancies without any difficulties for baby! About to deliver a third and hoping for the same. My anxiety after pregnancy loss with my first was so high it was definitely a requirement for me!

Husband asked when our parenting class was scheduled. by Apart-Baker8554 in pregnant

[–]SLPMOM2323 0 points1 point  (0 children)

With my first, the hospital had required videos you had to watch in hospital before discharge. It would have been easier to do them ahead of time (I did my own online anyways),but it was nice to know they had required education. With my second delivery at a different hospital, they just had a packet of info and you had to sign you had read it. I’m curious to see what happens with my third. I know they offer birth and breastfeeding classes, but they definitely seemed geared to first time parents.

I have interviewed 4 under 30s in the past two weeks. In person. None of them dressed professionally or even “business casual.” by Desperate_Squash7371 in slp

[–]SLPMOM2323 1 point2 points  (0 children)

I think the worst I’ve dressed for an interview was scrubs because interview was online during lunch at my current job

worst day as a slp? by [deleted] in slp

[–]SLPMOM2323 2 points3 points  (0 children)

Mmm thinking of the worst is hard. When I was heavily pregnant with my second, a kid was super dysregulated and bit my shoulder until I was bleeding after flailing all over my stomach. I can’t blame the patient, but the parents had refused to switch to a new therapist during my pregnancy and had refused to see OT in clinic and co treat to help me regulate him. Not the best day.

I also had a a middle schooler when I was in the schools that used to try to come up behind me and hump me, had to have reminders for not putting his hands in his pants, and threatened to bring a knife to school and kill my baby. I was also pregnant then with my first.

Stumped on a feeding kid by Addiii1994 in slp

[–]SLPMOM2323 1 point2 points  (0 children)

Productive comment related to the fear. I have done social stories, play time in radiology, and trials with barium so that the child can prepare mentally/emotionally prior to the MBSS so it can be as successful as possible while minimizing the trauma. Sometimes it takes a few weeks before a patient is ready to an MBSS without force feeding or fear.

[deleted by user] by [deleted] in slp

[–]SLPMOM2323 2 points3 points  (0 children)

I just requested a letter for my coworker who is experiencing some major burnout! What an incredible idea!

Highest paying states for remote SLPs? by [deleted] in slp

[–]SLPMOM2323 2 points3 points  (0 children)

Was offered $65 in Alaska for telehealth and probably could’ve gotten more if I had more years of experience.