When To End Services

Admission and Discharge Criteria in Speech-Language Pathology

Speech-language pathology services end when treatment is no longer needed, is no longer effective, or no longer fits the person’s goals. These decisions are based on the speech-language pathologist’s (SLP's) clinical judgment; measurable progress; and shared decision making with the person and, when appropriate, their family or representative.

Other factors affect service length as well—such as the requirements mandated by insurance companies, schools, employers, or regulatory agencies. These programs may limit coverage or may require certain documentation before authorizing services to continue.

Discharge may be appropriate when any of the following conditions have been met:

• Goals are met: The person has achieved all established treatment goals and objectives.
• Feeding and swallowing needs are met: The person can eat and/or drink in a way that meets their personal goals or that otherwise meets their nutritional and hydration needs.
• Skills are age- or culturally appropriate: The person’s skills are in line with those of other individuals of similar age, gender, culture, or language background.
• Skills have improved: The communication, cognition, or feeding and swallowing disorder has resolved, or the person’s abilities meet their daily needs.
• There is no ongoing impact on function: Skills no longer interfere with learning, work, social interaction, well-being, or health and safety.
• Personal expectations are satisfied: The person and/or their care partners feel that their daily needs and quality of life are being met.
• Strategies are effective: The person and/or their care partners use augmentative or alternative communication (AAC), cueing, or other strategies effectively across settings and with different partners.
• Self-discharge: The person and/or their care partners or representatives choose to stop services.

Barriers to Progress and Participation

Services may also end when barriers prevent progress, even when goals are not yet met. A key consideration is whether there is a reasonable expectation of benefit. This means the person is or can be expected to show meaningful progress that can be measured and linked to therapy goals. If meaningful change is not happening, then it may be appropriate to revise the plan or end services.

Before ending services, the SLP should review all aspects of care—including goals, methods, data, supports, and outside factors such as social determinants of health—to determine whether adjustments could improve outcomes.

Discharge may be appropriate if any of the following situations affect progress or service delivery:

• The person is showing no measurable improvement: The person is not making documentable progress, and further skilled services are not likely to help following multiple trials and adjustments. The SLP may consider reevaluation later if circumstances change.
• The person cannot consistently participate in therapy: A medical, psychological, or social factor interferes with participation and the SLP cannot sufficiently address it in the current plan of care.
• The person poses safety concerns: The person’s behavior creates safety risks for themselves, the clinician, or others involved in their care, and the clinician, care team, and family or care partners cannot adequately reduce those risks. Safety risks include the following scenarios:
  • Behaviors that are unrelated to the underlying diagnosis—such as making threats or sexually harassing staff. Such behaviors are not compatible with a safe therapeutic environment.
  • Behaviors that are linked to a diagnosis or medical condition—such as hitting, biting, or showing agitation to express distress. In these cases, the SLP and team should evaluate whether they can reduce risk through approaches such as environmental changes, strategies, or supports. If the team cannot manage the risk to establish a therapeutic context, then discharge may be appropriate.
• The person’s needs extend beyond the SLP’s personal competence: The person’s needs fall outside the SLP’s scope or competence, requiring the SLP to refer the person to another qualified provider.
• The person and/or care partner decline services: The person and/or care partner or representative chooses not to participate or withdraws consent for services.
• Administrative requirements are not met: Discharge may occur when a person does not follow organizational policies— such as attendance, no-show, or payment requirements — provided these policies are applied consistently, without discrimination, and the person has been given adequate notice. Before discharge, the SLP makes and documents good-faith attempts to contact the person or their representative.

The SLP and care team do not make discharge decisions solely on a person’s diagnosis, the dynamics they have with their family members or care partners, or difficult interactions. Such decisions should align with disability rights laws such as the Americans with Disabilities Act [ADA] Section 504 and IDEA. Conflict or tension with family members or care partners is not, by itself, a reason to end services. However, discharge may be appropriate—with clear documentation and referrals—if

• a situation creates ongoing risk to the safety or well-being of
  • the person receiving services or
  • the clinician and
• if the care team cannot reduce those risks.

When Provider Availability Affects Continuity of Care

Sometimes, services end for reasons that have nothing to do with the person’s progress— the provider may leave, staffing may change, or the organization may lose its funding or no longer offers a needed service. In these situations, the organization and the clinician are responsible for managing the transition in an ethical way.

ASHA’s Issues in Ethics: Client Abandonment states that ending care without arranging an appropriate alternative goes against the duty to “hold paramount the welfare of persons they serve professionally.” Both the SLP and their employer share responsibility for preventing client abandonment. Two key expectations support this responsibility:

• The SLP provides reasonable notice. Leaving a position without giving the employer adequate notice—limits the organization’s ability to cover services and may lead to allegations of client abandonment.
• The organization ensures continuity during leave or staffing gaps. SLPs’ time off or staffing gaps are not considered valid reasons to end services. If a person still needs skilled care, then services cannot simply stop because a clinician is on leave or because an organization is experiencing staff turnover. Organizations must make every reasonable effort to ensure continuity of care—even when staff members are off or positions are vacant.

When services end for any reason, the SLP is advised to document

• the rationale,
• the person’s status related to their goals,
• changes over time,
• the effectiveness of strategies or supports,
• any remaining needs,
• the clinician and person’s expected outcomes of ending care, and
• any recommendations for future or follow-up services.

Some impairment may remain even after the person has met their goals or has attained standardized test scores that fall within typical limits. If impairment no longer interferes with a person’s daily functioning or safety, and if further skilled intervention is unlikely to bring meaningful change, then discharge is appropriate.

Understanding External Requirements

Just as rules can shape the decision as to when services should begin, the same rules can also affect when services should end. School districts, early intervention programs, employers, and insurers may set discharge requirements.

• In school districts: SLPs may discharge a student when that student no longer needs services to support their learning. The IEP team determines discharge in line with federal, state, and local regulations.
• In early intervention settings: SLPs determine discharge criteria by considering the child’s age, progress toward IFSP goals, and state eligibility criteria.
• In health care and private practice: Payers may stop coverage when (a) documentation shows little or no progress toward functional goals or (b) the person has reached their maximum number of authorized visits or duration of care. Some plans allow additional visits if the person’s care team can show medical necessity. The SLP can check with the person’s insurance plan or plan manager about the process of requesting additional visits or appealing coverage determination.

Although these policies may affect payment, they do not replace clinical judgment. When services end because of external rules, SLPs should document the circumstances and, when appropriate, advocate for continued care based on the person’s needs and potential for benefit.

Planning for Next Steps

From the beginning, SLPs plan services with speech-language pathology services are planned with discharge in mind. This end goal helps the clinician ensure that therapy stays focused, goal directed, and aligned with the person’s changing needs. In some cases, discharge from skilled services does not mean that the person no longer has needs. Sometimes, it means that skilled services are not driving meaningful progress and that other supports may be more appropriate. Services may resume later if conditions change.

At discharge, the SLP considers what support the person may need next, such as

• a home program or care partner–led strategies to maintain or generalize skills;
• referrals to community resources or other professionals; and
• guidance about
  • what signs or changes should trigger re-entry into services or
  • when to return under an episodic care model.

Changes in health, environment, life course, motivation, or access to care create new opportunities for intervention. Planning for follow-up helps set the expectation that services may resume when needed—and reinforces that discharge is not always permanent.