Comparing Educational vs. Medical and Non-Educational Models

The school-based SLP uses the following approaches for feeding and swallowing:

• Ensures that students can maintain adequate nutrition and hydration so that they can access the educational curriculum.
• Develops a school-wide feeding and swallowing plan based on a doctor’s orders and/or recommendations from a modified barium swallow study (MBSS) or a fiber-optic endoscopic evaluation of swallowing (FEES). This can also include developing an individualized health plan.
• Provide initial and ongoing training to staff regarding safe feeding and swallowing for students based on students’ modified diets.
• Periodically monitor and confirm that staff are appropriately and correctly using the school-wide feeding and swallowing plan.
• For each student receiving speech-language services: Make recommendations to parents and educational team to refer the student for a feeding and swallowing evaluation to determine appropriate food consistencies and liquid viscosities for that particular student.

The medical SLP uses the following approaches for feeding and swallowing:

• Conducts comprehensive swallowing evaluations, including non-instrumental (e.g., clinical, bedside) and instrumental assessments (e.g., MBSS, FEES).
• Develops individualized plans of care—including compensatory strategies and restorative exercises as needed.
• Aligns treatment plans with patient and family goals, considering medical status, prognosis, and quality of life.
• Educates patients, families, and health care team members on the plan of care.
• Collaborates with interprofessional teams to support effective nutrition and hydration across the continuum of care.

• Family Educational Rights and Privacy Act (FERPA)
• Health Insurance Portability and Accountability Act (HIPAA)

• eligibility (assessment)
• continued eligibility (service delivery and interventions)
• no longer eligible

• admission/evaluation
• intervention
• discharge

A student is no longer eligible for speech-language services as a related service when the SLP provides documentation to their IFSP or IEP team regarding any or all of the following criteria—and when the team agrees with that dismissal recommendation:

• The student has achieved their goals and no longer has a speech-language impairment.

• The student’s speech-language impairment no longer has an adverse effect on the student within the educational setting.

• The student has maximized the benefit of speech-language services.

Discharge is recommended when

• the individual no longer demonstrates medical necessity of services or functional progress toward goals or
• does not require skilled services for maintenance of skills.

The SLP discharges when any or all of the following conditions are present:

• The patient no longer medically needs skilled speech-language services to improve or maintain their current abilities
• The patient is not making functional progress toward their established goals.
• The patient has achieved the goals specified in the plan of care.
• The patient or family/caregiver elects to stop services.
• Insurance coverage for services ends, and the patient chooses not to—or is not able to—continue via private contract.

• encounter/daily therapy notes
• data collection
• assessment and/or reevaluation reports
• IEP progress notes
• annual IEPs
• 504 plan notes
• feeding plans*

See ASHA webpage on Documentation in Schools.

*The SLP develops a feeding plan within school district in coordination with the student’s IEP team to (a) help assist SLPs periodically monitor and train educational staff about safe feeding and swallowing strategies and (b) inform the IEP team members of appropriate consistencies and viscosities for that student to consume based on an outside feeding evaluation and/or a doctor’s order

• evaluation
• treatment SOAP (subjective, objective, assessment and plan) notes
• progress notes
• discharge summary

See ASHA webpage on Documentation in Health Care.

• Free and Appropriate Public Education (FAPE) from IDEA funding
• Medicaid (funded jointly by federal and state governments)

• private insurance
• Medicare (funded jointly by federal and state governments)
• Medicaid (funded jointly by federal and state governments)
• self-pay (cash or credit)

Therapy is provided in special education and general education within the following school-based settings:

• public schools
• non-public schools
• private schools
• charter schools
• residential schools
• Head Start centers

Therapy is conducted in clinical environments such as the following:

• hospitals (acute care, inpatient rehabilitation, long-term acute care, Veterans Affairs [VA])
• outpatient clinics
• skilled nursing facilities (SNF)
• home health
• private practice
• early intervention

SLPs in the academic support model typically deliver speech-language services to students primarily through group sessions conducted in the speech-language resource room or in the student’s classroom.

However, SLPs can implement a variety of service delivery models based on the students’ needs and their often varying levels of performance. See the ASHA resource on School-Based Service Delivery in Speech-Language Pathology.

*The SLP can use a variety of service delivery models; however, this section highlights the primary mode that SLPs use to deliver services.

SLPs in the medical model typically provide services to patients primarily through individual sessions.

However, SLPs can implement a variety of service delivery models based on the wide variety of patient/client needs.

See the ASHA resource on Varied Service Delivery.

The following individuals can initiate referrals:

• parents
• teachers
• IEP team members

The following individuals typically initiate referrals:

• a physician
• a health care provider
• self-referral

• individualized education program (IEP)—updated annually
• Section 504 Plans—updated periodically as needed
• individualized family service plan (IFSP)—updated annually

• plan of care (POC)—updated frequently, as specified by payers
• individualized family service plan (IFSP)