State licensing boards and/or EI regulatory agencies may have requirements for the profession of speech-language pathology; if so, an SLP must meet those requirements in order to work in the EI setting. These requirements are set forth in a document called a state practice act.

You may want to contact the regulatory agency that oversees EI programs in your state—an agency like the state Department of Health—to determine if such regulations exist. Your employer may also be able to provide this information.

Your state’s practice act will determine if feeding and swallowing therapy is a part of your scope of practice—and if you can perform this role in the home setting. Some state regulations prohibit feeding and swallowing therapy in EI settings—in which case, patients will instead need to be referred for outpatient services. Contact your state licensing board for further clarification on state regulations.

Here are some clarifying questions to ask your state licensing board or regulatory agencies:

• Does our state have a practice act that includes feeding and swallowing therapy?
• Are there any practice regulations that center around providing feeding and swallowing therapy in home-based, Part C, or outpatient EI?

Even if the EI SLP cannot perform direct feeding and swallowing therapy in the home due to state regulation restrictions, they can continue to address related skills—like maintaining oral care, engaging in sensory exploration, and communicating preferences—and coach families and caregivers to support child autonomy, child‒family/caregiver feeding relationship, and positive mealtime routines. Addressing feeding-adjacent skills should be in line with the individual SLP’s competency and scope of practice.

Resources

• State by State: This ASHA online resource links to individual state webpages that contain further information on the EI requirements within a given state.
• States With Specific Instrumental Assessment Requirements: This ASHA webpage provides further information on states that have a practice act with specific requirements for completing instrumental swallowing evaluations.
• Scope of Practice in Speech-Language Pathology: ASHA’s scope of practice for SLPs details skills and responsibilities around feeding and swallowing services.

Because SLPs provide EI services across a variety of home-based, outpatient, and private settings, funding sources may vary—and can include the Part C system, state Medicaid programs, and/or private health plans. You will need to know and follow any regulations that the individual payer has around funding or reimbursement for pediatric feeding and swallowing services. Your state licensing board’s scope of practice may influence payer coverage for services; for example, if feeding and swallowing therapy are not in your state’s scope of practice, then your state’s Medicaid program may not provide coverage for certain services. If you have questions about reimbursement-related issues, contact reimbursement@asha.org.

Resources

• Early Intervention Practice Portal: Describes the Part C early intervention process for children birth to 3 (and their families), including eligibility, IFSP development, service delivery, and legal/funding considerations
• Medicaid Coverage for SLP Services: Explains how Medicaid covers SLP and audiologist services, including eligibility, state variation, and billing issues.
• Private Health Plan Coverage for SLP Services: Outlines considerations for reimbursement under private insurance, including plan types, billing practices, and insurer policies.

ASHA does not require additional certifications or training to practice in the EI setting or to provide pediatric feeding therapy. ASHA-certified SLPs are ethically obligated to be competent in any area of practice in which they are engaged, per the ASHA Code of Ethics:

ASHA does not require clinicians to document competency in specific practice areas. Your employer may have a process for verifying and documenting competency, which you will need to follow. If your employer does not have a policy around establishing competency or practice standards, you may want to consider working with your administrators to develop a process, as regulatory agencies may want to review this documentation, and to protect yourself from liability.

Resource

Dysphagia Competency Verification Tool [PDF]: A resource created in collaboration between SIG 13, Swallowing and Swallowing Disorders and the American Board of Swallowing and Swallowing Disorders for verifying clinician competency in dysphagia assessment and intervention.

Your employer may have policies surrounding pediatric feeding and swallowing therapy as part of your responsibilities and scope of practice. Ask your administrators if the organization has policies or procedures that you as an SLP need to follow—examples may include

• communication, documentation, or interprofessional collaboration standards or
• clinical pathways for specific diagnoses, like dysphagia management in tracheostomy-dependent patients.

Your employer may require specific training or certifications prior to providing pediatric feeding therapy. This is not an ASHA requirement but, rather, an employer or agency consideration.

Supervising clinical fellows and graduate students may be a part of your job responsibilities, especially if you provide valuable pediatric feeding and swallowing therapy experience. You and your supervisee will need to follow any employer and payer policies and state licensing board regulations surrounding mentorship and supervision. You and your supervisee will also need to meet ASHA’s graduate student and clinical fellowship requirements if the supervisee is seeking ASHA certification.

Resources

• Supervision Portal: Details guidance, roles, and best practices for supervising clinicians including clinical fellows, students, and assistants.
• Practice Portal: Clinical Education and Supervision: Presents guidance and resources for clinical education, mentorship, and supervision in SLP/Audiology training.

If you are an SLP working for a Part C program, you will be a part of the IFSP team, which has its own requirements and timelines around considerations like eligibility, frequency and duration of services, team member roles, documentation, communication amongst team members, and transition planning. These requirements will need to be followed to be compliant with state program regulations. See ASHA’s Early Intervention practice portal for more information on Part C programs and IFSP teams.

Resource

The Early Intervention/IFSP Process [PDF]: A visual flowchart summarizing the steps and timeline of the Individualized Family Service Plan (IFSP) process.

Interprofessional team collaboration is essential to providing comprehensive, developmentally supportive care to children and their families/caregivers in the EI setting. Speech-language pathologists may collaborate internally with other developmental specialists like physical therapists and occupational therapists and support staff like social workers, as well as externally with pediatricians, subspecialty physicians, and dietitians. Per the ASHA Code of Ethics, individuals should use every resource available and work collaboratively to provide the highest level of care to the child and family/caregivers (Principle I, Rule B; Principle IV, Rule A). 

A successful interprofessional team enables each discipline to provide their unique expertise and lens when working together to form an assessment and treatment plan that centers around the child and their family/caregivers. Interprofessional practice (IPP) may be fluid, as additional team members move in and out based on the child and family/caregiver’s needs in the short and long-term.

For example, the SLP may refer an infant to an otolaryngologist due to concerns of noisy breathing at rest and during feeding. After a diagnosis of laryngomalacia is made, the SLP collaborates and communicates with the otolaryngologist and pediatrician to align treatment strategies (positioning, flow rate modifications) with the medical plan of care, requests imaging as needed, and provides valuable feedback about the infant’s feeding and swallowing skills that may inform the need to progress to a surgical plan of care. Additionally, the SLP refers the family/caregivers to a dietitian to optimize the infant’s feeding plan and caloric intake to support growth and nutrition targets.

Let’s explore how the SLP interacts and communicates with the IPP team (see table below).

Resources

• ASHA Code of Ethics: Specifies ethical principles and rules governing SLPs/audiologists’ professional conduct, emphasizing responsibility, integrity, and consumer welfare
• Interprofessional Team Collaboration: Introduces interprofessional education and practice frameworks and their importance for collaborative care.
• Case Study: IPP Team Develops Surgical Management Plan for Laryngomalacia in the Neonatal Intensive Care Unit: Describes how an interprofessional team collaborated to diagnose and surgically treat laryngomalacia in a premature infant, resulting in improved respiratory stability and feeding coordination post-surgery.

Defining your role on the IPP team—especially as it relates to pediatric feeding disorder—is important due to the overlapping scopes of practice between providers (e.g., SLPs and occupational therapists may have shared responsibilities and skills, dependent upon competency and state licensing regulations). ASHA maintains that SLPs are the preferred and most qualified provider for dysphagia services based on our unique knowledge and skills, experience, and professional leadership.

ASHA’s resource, Working on an IPP Team as an SLP, provides more detail on how to advocate for yourself on the IPP team. Here are some other tips for highlighting your specialized knowledge and expertise:

• Keep open lines of communication between yourself and other team members around what aspects of pediatric feeding disorder you are competent to treat and where opportunities for collaboration may arise.
• Establish “team norms,” or consider a process that can help determine which discipline takes the lead on specific diagnoses or aspects of care.
• Seek opportunities for cross-disciplinary learning, knowledge sharing, or mentorship—which can strengthen relationships and build trust among professionals.

Communication between interprofessional team members can be challenging, especially if providers are not located in the same geographic area or do not have the same employer. Prioritizing clear communication can help all of you address arising family/caregiver concerns, facilitate timely referrals, and improve efficiency and quality of care.

ASHA’s resource, How To Set Up and Run Your IPP Team, provides details on structuring the collaborative process. Here are some additional tips for streamlining communication, especially among external IPP team members:

Identify preferred methods of communication—whether by phone, email, or in-person meetings. Ensure that communication aligns with Health Insurance Portability and Accountability Act (HIPAA) guidelines.

Consider setting up routine times for communication and collaboration.

Prioritize need-to-know information or questions first. This reduces inefficiencies and maximizes collaborative time.

Establish processes for common needs. For example, some agencies or facilities may create checklists or prewritten referrals for needs like an instrumental swallowing evaluation that the parent or caregiver can bring to an appointment with the pediatrician.

Resource

HIPAA Guidelines: Describes key HIPAA requirements relevant to SLP/Audiology practice, including privacy, security, and compliance issues.

Interprofessional collaboration between SLPs in the EI setting and SLPs in other settings is essential for children who are receiving feeding and swallowing services. Establishing early communication between providers can ensure that treatment plans and goals are aligned and complementary—and that families and caregivers are receiving clear, consistent messaging around their child’s feeding and swallowing skills and overall prognosis. Make it a part of your workflow to ask families and caregivers the following questions:

• Are you receiving feeding and swallowing services elsewhere?
• Do I have your consent to contact the child’s other providers?

Referring a patient for an instrumental swallowing evaluation also allows for a partnership between the EI SLP and the outpatient SLP. Below are suggested avenues for collaboration in this situation.

• If you have time in your day, if the facility allows it, and if the family/caregiver consents, ask if you can attend the instrumental swallowing evaluation for in-person communication.
• Provide the family/caregivers with notes about salient information that the evaluating SLP may need to know—your assessment of the child’s feeding skills, your concerns about swallowing function, therapeutic strategies you’ve trialed, and so forth.
• If time allows, schedule a time to talk with the evaluating SLP so you can ask clarifying questions.

Resource

Demonstrate Your Value: Pediatric Feeding Fact Sheet [PDF]: Summarizes evidence, outcomes, and the role of SLPs in diagnosing and managing pediatric feeding/swallowing disorders.

Transition planning is an important part of working with infants and children who require EI services and who may have medical complexities or needs that require SLP services in other settings.

During the child’s transition from the neonatal intensive care unit (NICU) to EI to school-based or other outpatient settings, take the following considerations into account:

• The NICU may want to have a process or a point person who facilitates referrals to the state’s Part C program or other EI settings—for example:
  • the treating SLP
  • other neonatal therapists (e.g., physical therapists or occupational therapists)
  • a discharge coordinator
  • a social worker

• Part C programs have requirements and timelines that care providers need to follow in order to facilitate timely referrals.

• If referring to other EI settings, like non-Part C home-based or outpatient services, the NICU may want to have referrals for families and caregivers in a variety of locations that accept payer sources like Medicaid and private health plans. This can be challenging, especially if your geographic region does not have access to SLPs who are trained and competent to treat medically complex or post-NICU infants. So, you may want to consider leveraging other resources like telepractice.

• Part C programs must comply with federal and state regulations that surround formal transition planning out of Part C to school or outpatient services when the child turns 3 years old. See ASHA’s Early Intervention practice portal for more information on Part C transition planning.

• Consider the family/caregiver’s ability to manage appointments when referring for post-NICU or post-EI services—and how continued feeding and swallowing therapy will fit into their schedule with other subspecialty follow-ups.

• Establish relationships with community providers, as time allows, to identify providers’ comfort with treating post-NICU infants and post-EI children and to streamline communication during transition planning.

• Ensure that families/caregivers are confident and competent to carry over feeding and swallowing plans—which may include special instructions for positioning, feeding modalities, or thickening.

• Ensure that families/caregivers have support from other providers—like pediatricians, dietitians, or home nurses—as their child transitions to home or out of EI.