During the COVID-19 pandemic, many students, including those who have feeding and swallowing disorders, are receiving special education services virtually through telepractice. This page is designed to guide school-based speech-language pathologists (SLPs) who are pivoting to effectively provide these services via telepractice.
On this page:
Services for students who have an established swallowing and feeding plan in the school setting typically include the following:
According to the U.S. Department of Education, if a local educational agency (LEA) continues to provide educational opportunities to the general student population during a school closure, the school must ensure that students with disabilities also have equal access to the same opportunities, including the provision of a free appropriate public education (FAPE). For more information, see 34 CFR §§ 104.33 (Section 504) and 104.4, as well as 28 CFR § 35.130 (Title II of the Americans With Disabilities Act of 1990 [ADA]). State educational agencies (SEAs), LEAs, and schools must ensure that, to the greatest extent possible, each student with a disability can be given the special education and related services identified in the student’s individualized education program (IEP) developed under the Individuals With Disabilities Education Improvement Act of 2004 or can be given a plan developed under Section 504 of the Rehabilitation Act of 1973 (see 34 CFR §§ 300.101 and 300.201 [IDEA] and 34 CFR § 104.33 [Section 504 of the Rehabilitation Act]).
The U.S. Department of Education understands that there may be exceptional circumstances that could affect how a particular service is provided. In addition, an IEP team and—as appropriate to an individual student with a disability—the staff members responsible for ensuring FAPE to a student for the purposes of Section 504, would be required to make an individualized determination as to whether compensatory services are needed under applicable standards and requirements.
It is the school district’s responsibility to provide all students equal access to the educational curriculum so that they may learn alongside their peers. Students should also be safe while attending school.
When students with swallowing and feeding disorders are participating in school virtually in the home setting and not on campus, the requirement to implement safe feeding no longer falls on the school district but, rather, on the parents. The services that students receive via telepractice, however, continue to be consistent with their IEP.
Telepractice services may be not be appropriate for some students. When a student is not a candidate for services via telepractice, they may make up the missed sessions when they physically return to campus. Services may be an approximation of the goals to assist the child in maintaining some level of skills until on-campus school resumes.
Services may be refused or ineffective because the delivery of telepractice services require a facilitator. If the parents/caregivers or their surrogate are unable to participate and support the student during the session, then the SLP will document all attempts to provide support and education to the family. Services will resume once school is occurring on campus again. Schools—not parents/caregivers—are required to provide a FAPE. Parents have the right to refuse services at any time (see §1401 of IDEA 2004).
When a school district goes completely virtual, it typically has a plan for how to implement virtual instruction. Therapists and school teams should comply with the directives of their school district; however, in situations where the therapist is concerned about a student’s safety during mealtimes or an ethical concern arises, the therapist should meet with the district supervisor to inform them. The school district should document all safety and ethical concerns in writing—along with how such concerns will be addressed.
When swallowing and feeding services are not provided during virtual school, the SLP may do the following, if supported by the district:
The U.S. Department of Agriculture (USDA) School Food Services Program issued a waiver during COVID-19, targeting students whose in-person school programs were halted. According to the USDA School Food Service Program waiver, school lunch programs will be provided for all of the children in a family if at least one child attends a school that is closed due to COVID-19. See the USDA Food and Nutrition Service COVID-19 Questions and Answers for States.
If a student requires a modified diet, then the school district’s food services program is required to offer the meal accommodations recommended on that student’s swallowing and feeding plan during the time period of school closure. More information can be found in the document titled Guidance Q&As for Accommodating Disabilities in the School Meal Program.
Therapists should consult with their schools’ food services supervisors to determine the current status of the federal meal waivers in their school district and to ascertain how distribution is being handled now that school districts are using hybrid models that provide some on-campus classes and some virtual ones.
A teacher, parent, or therapist may have a concern about a student’s swallowing and feeding skills during virtual instruction. If the parent or a team member has an immediate safety concern for the student eating at home, then a meeting with the parents/caregivers (either virtually or in person) is recommended so that teachers, SLPs, and administrators can hear concerns, offer support, and advise the parents/guardians/caregivers to bring these concerns to the attention of the student’s physician.
According to IDEA 2004, the school district has the responsibility of continuing to conduct evaluations for eligibility as well as reevaluations. If a student has a suspected swallowing and feeding disorder during the evaluation process, then the report would indicate that once the student returns to on-campus instruction, the swallowing and feeding team would (a) identify the student’s swallowing and feeding concerns and determine how the student can be safely fed at school, (b) establish a plan, and (c) train staff according to the procedures followed by the school district’s food services team.
An assessment via telepractice should be equivalent to an in-person assessment. Given the nature of a swallowing and feeding assessment, SLPs should carefully consider whether students are appropriate candidates for virtual assessment. Dr. Georgia Malandraki and associates from the I-EaT Research Lab at Purdue University have developed a set of guidelines titled Telehealth Recommendations for Dysphagia Management During COVID-19, which includes information on telehealth evaluation and treatment procedures. Part C, Table 3 of this resource includes a chart designed to help determine appropriate candidates for assessment and services via telepractice. At present, there are varying degrees of positive research for swallowing assessment and treatment via telepractice.
When the IEP team determines that a student will receive feeding and swallowing services via telepractice, preparation and planning are essential. See ASHA’s Telepractice Checklist for School-Based Professionals [PDF]. When the school swallowing and feeding team (SLP, occupational therapist [OT], nurse, and physical therapist [PT]) is training the parents on the student’s swallowing and feeding plan, per the IEP, and is serving the student via telepractice for swallowing and feeding monitoring and/or therapy, a few things need to be in place prior to the first session.
When one of the goals on a student’s IEP is to improve functional eating skills and swallow safety, the SLP works with the family to schedule sessions. The facilitator (typically the parent/guardian/caregiver) is trained to work with the SLP to provide the therapy service with the student. In many cases, it may be necessary to make adaptations to accommodate the new service delivery model. There may be some limitations as to what the facilitator, SLP, and student can work on together via telepractice.
Suggestions for goals are as follows:
When parents are unable to participate or provide a facilitator for the therapy session, then the SLP documents the effort and provides the therapy when the student returns to campus or when the family is able to provide a facilitator.
Services and supports provided to students with disabilities may also include parent/caregiver training for safe swallowing and feeding, such as:
School districts offer students three service delivery scenarios: all instruction is delivered virtually via telepractice, instruction is delivered in a hybrid model (a combination of in-school learning and virtual learning) or all instruction and support services are delivered in person.
Students receive all instruction virtually via telepractice
When students receive their education program via telepractice, it is important to do the following:
When the school district provides school meals to a student who has a modified or mechanically altered diet, either the school-based swallowing and feeding team or the SLP collaborates and communicates with the food services staff to provide meals that meet the requirements of the student’s swallowing and feeding plan.
Students are educated in a hybrid model (combination of in-school learning and virtual learning)
In most cases, the swallowing and feeding services will be provided when the student is on campus with service providers who are also on campus. In some situations, the SLP may be virtual while the student is physically attending school. The following list details the various scenarios present in a hybrid model:
Students receive all instruction and support services in person
Swallowing and feeding services are provided on campus with direct services by the school swallowing and feeding team. When the students receive in-person, face-to-face services, school staff should follow all health and safety recommendations set by the local school district and state. Utilizing personal protective equipment (PPE), such as masks, gowns, gloves, or face shields are important to prevent virus spread during aerosol generating procedures such as swallowing assessment and treatment.
In order to effectively work with a student virtually, a facilitator must be present at all times to help the student engage and participate in the session. Parents/caregivers or other designees are now stepping into this role without training or experience. Therefore, the onsite facilitator should be trained and prepared to help the student benefit from the session.
Facilitators should be:
See the ASHA Facilitator Checklist for Telepractice Services in Audiology and Speech-Language Pathology [PDF] for step by step considerations when working with facilitators, from preparation to implementation.
Ongoing monitoring of the implementation and carryover of a student’s established swallowing and feeding plan is essential, regardless of the service delivery option being implemented. Because some if not all monitoring and consulting may be done through telepractice, it is important to set a schedule for monitoring and observing each student who has a swallowing and feeding plan when services are provided virtually. Frequency will depend on each student’s individual needs in the classroom and at home. Observations should be timed with intake of food or liquids, as appropriate.
Progress monitoring is also an important component of every swallowing and feeding plan. Swallowing and feeding team members should routinely document data and anecdotal observations for each session to determine student progress and safety.
Documentation is necessary to ensure compliance with IDEA (2004) as well as state and local mandates. Communication, services, and results should all be well documented. Telepractice involves some additional important steps that require documentation—such as obtaining informed parental consent with a signed consent form. See sample consent form on pg. 9 of FERPA & Coronavirus Disease 2019, Frequently Asked Questions (FAQs) [PDF], training facilitators, and reviewing and revising the IEP. ASHA’s Telepractice Documentation Data Checklist for School-Based SLPs [PDF] is a useful tool for organizing your documentation efforts.
ASHA thanks Emily Homer, MA, CCC-SLP, F-ASHA for this content. Some information within this document was provided through consultation with an attorney.