Getting Started in Pediatric Hospitals

Pediatric speech-language pathology includes the evaluation and treatment of patients from birth to 18 years old. As such, it can require specialized skills in several differing age groups, including infants, toddlers, preschoolers, school-aged children and adolescents. Common disorders found in the pediatric population, particularly in a medical setting, include apraxia and other articulation or phonology disorders, autism, language disorders, central auditory processing disorders, and stuttering. Dysphagia is very common in a pediatric medical setting. The evaluation and treatment of children with dysphagia requires a special knowledge of the anatomy and physiology of babies and children and the usual causes of dysphagia in the pediatric population.

Children referred for communication or swallowing problems often have one or more of the following etiological factors: cleft lip/palate, craniofacial anomalies, velopharyngeal insufficiency, dental malocclusion, macroglossia, oral-motor dysfunction, neurologic disease/dysfunction, head trauma, brain stem injury, respiratory compromise, tracheostomy, vocal fold pathology, paralysis/paresis of the vocal fold, developmental delay, mental retardation, prematurity, autism, psychosis, hearing loss/deafness, environmental deprivation, or traumatic birth history.

Reimbursement Mechanism

Reimbursement for services in pediatric speech-language pathology can come from a variety of sources. These include various third party payers, such as Medicaid, private insurance and state funding programs. In some cases, patients are self-pay.

Referral Process

Patients are usually referred for a communication or swallowing evaluation by a physician, and the majority of the referrals tend to be from the primary care physician, such as a pediatrician or family practitioner. Referrals are also commonly received from other medical and dental professionals, including neonatologists, neurologists, neurosurgeons, physiatrists, gastroenterologists, plastic surgeons, oral surgeons, otolaryngologists, orthodontists, dentists, psychologists and psychiatrists. In some cases, referrals are initiated by teachers or the parents, but most facilities require a physician's referral prior to providing services.

Collaboration with other Disciplines

Because children with chronic or complex conditions have multiple medical and treatment needs, it is important for the pediatric speech-language pathologist to take an interdisciplinary approach to the care of pediatric patients. Depending on the patient's diagnosis, functional skills, current needs, and age level, the pediatric speech-language pathologist may collaborate with any of the following professionals: physicians (particularly those noted above), nurses, social workers, dieticians, occupational therapists, physical therapists, recreation therapists, psychologists, teachers, audiologists, aural rehabilitation specialists, and others. SLPs may participate on specialized teams within the facility, such as a cleft palate or feeding team. Speech-language pathologists often provide co-treatments with another discipline (usually occupational therapy or physical therapy) for patients with various neurological conditions. For patients who are undergoing inpatient (and often outpatient) pediatric rehabilitation, the interdisciplinary treatment team works together to develop an integrated team treatment plan.

Documentation Requirements

The primary purpose of clinical documentation is to provide a means of communication between professionals regarding patient care. However, clinical documentation also serves as a means of recording and communicating for billing and reimbursement, providing proof of compliance and quality improvement, recording data for research purposes, and serving as a basis of legal evidence.

The most important documents in pediatric speech-language pathology include the following:

• Diagnostic reports
• Treatment plans
• Progress/discharge reports
• Progress notes for each session
• Charge documents
• Letters regarding the patient

The exact format, style, and length of documentation reports vary widely across work settings. Proper documentation, including the use of appropriate procedural (CPT) and diagnostic (ICD-9) codes, is very important for billing purposes. Reimbursement from third party payers is usually based upon the documentation and coding information.

Resources

Go to the SLP Health Care area of the ASHA Web site to access:

• ASHA Speech-Language Pathology Health Care Survey
• Health care frequently asked questions (FAQs)
• ASHA member forums

Go to ASHA Practice Policy to access documents on preferred practice patterns, etc.