Guidelines for Feeding and Swallowing Programs in Schools Texas

Addressing swallowing and feeding in the school system is a complex process that is not typically part of the scope of practice of school district therapists. And when you're first beginning to implement a district-wide plan, it can be a daunting task.

Many questions surround this topic, including:

• Who should be addressing swallowing and feeding in the school setting?
• What does swallowing and feeding intervention in the school setting look like?
• Is it possible for school districts to address swallowing and feeding?
• Should the district provide feeding therapy?
• Why should school districts address swallowing and feeding? Is this medical condition educationally relevant?

These are just some of the questions that many school-based SLPs, OTs, PTs, and nurses are asking when approached with the possibility of addressing swallowing and feeding.

But let's talk about the answers.

Why Do Districts Need to Address Swallowing and Feeding?

The first step in moving toward addressing swallowing and feeding in the school setting is to understand these four reasons why districts must address swallowing and feeding:

1. Individuals with Disabilities Act (IDEA) and Educational Relevance—in other words, the obligation to provide a free and appropriate education (FAPE) and to ensure student safety
2. Legal Mandates and Precedent—health as a related service, provided in order for students to access their curriculum
3. School Food Service Regulations—regulations that require food service programs to modify or adapt school lunches when a student's disability affects their ability to eat the typical school lunch
4. Professional Codes of Ethics—the responsibility of speech pathologists, occupational therapists, physical therapists, and nurses to take reasonable precautions to avoid harm to recipients of their services according to their Code of Ethics

What Should a School District Do?

Swallowing and feeding disorders can be challenging to address in a school system, particularly because school systems lack the medical supports available in other settings such as hospitals.

The following are some essentials when addressing swallowing and feeding in the school system:

• Implementing a system-approved procedure, used throughout the district for every student with the signs and symptoms of a swallowing and feeding disorder
• Adopting a team approach, with every team member trained on the procedure, as well as on the roles and responsibilities of all team members
• Documenting the procedure, done throughout the process with forms that accompany each step
• Keeping parents informed and involved throughout the process
• Developing a process for ongoing monitoring of all students with swallowing and feeding plans to ensure that the plan continues to be appropriate and safety is maintained

Who Makes Up School-Based Swallowing and Feeding Teams?

School-based teams should consist of the following:

• Speech-language pathologist
• Occupational therapist
• Physical therapist
• School nurse
• Parent
• Special education teacher
• Regular education teacher
• Paraprofessional
• School administrator
• Social worker
• Cafeteria workers

The school-based team works collaboratively with the medical-based team which is typically made up of the following:

• Student's physician(s)
• Hospital-based SLP
• Radiologist
• Dietician

How Does a School System Address Swallowing and Feeding?

Safety is the primary consideration when addressing swallowing and feeding in the school setting.

Children often eat at school twice a day, with snacks provided between meals. A step-by-step procedure with accompanying forms will help a district make sure that nothing is overlooked and that all issues and concerns are addressed.

The necessary steps for addressing swallowing and feeding in the school setting are:

1. Referral process (referral form)
2. Parental/guardian interview (parental interview form)
3. Interdisciplinary observation of a meal (interdisciplinary observation form, similar to clinical evaluation)
4. Swallowing and feeding plan established and classroom staff trained (swallowing and feeding plan with verification of training); individualized health plan established
5. Cafeteria procedure (prescription for meal modification form or individualized education plan [IEP])
6. IEP meeting (IEP form, release of information forms signed)
7. Referral for instrumental evaluation if indicated (pre-VFSS/MBSS form to send to hospital SLP)
8. Revision of swallowing and feeding plan, if indicated following MBS or when there are changes in the student, using the swallowing and feeding plan form)
9. Ongoing monitoring through consultation and collaboration (documented on IEP and therapy logs)
10. Therapeutic intervention, if indicated (documented on IEP and therapy logs). Students with oral motor or oral sensory motor disorders may need functional therapy goals for eating.

Every school district in the country has children with swallowing and feeding issues and concerns. The IDEA, legal mandates, USDA regulations, and Code of Ethics for therapists and nurses require that districts address these concerns in order for students to be safe at school and to receive adequate nutrition and hydration to access their curriculum and attend school.

While there are many questions, there are also some concrete, logical answers that will help school districts establish an approved procedure utilizing a team approach with the result of safe mealtimes at school for students.

Be prepared to address a range of issues surrounding swallowing and feeding disorders in schools with the following MedBridge courses:

• Getting Started Addressing Swallowing & Feeding in the School Setting
• A System-Wide Procedure for Addressing Swallowing & Feeding in Schools
• Management & Treatment of Swallowing & Feeding Disorders in Schools
• Addressing Behavioral and/or Sensorimotor Feeding Disorders in Schools

Emily Homer, MA, CCC-SLP

Emily Homer, MA, CCC-SLP, has worked in school systems for the majority of her career in speech language pathology. She provides presentations and consultation services to school districts throughout the country on addressing swallowing and feeding in school systems. She is the 1999 recipient of the Louis M. DiCarlo Award for the establishment of an interdisciplinary dysphagia team in her district and served as Chair of the ASHA Committee on Swallowing and Feeding Disorders in the Schools.

She is the author of Managing Swallowing and Feeding Disorders in Schools, Plural Publishing (2016). In addition, Ms. Homer has published articles on swallowing and feeding in the school setting in Language, Speech and Hearing Services in the Schools, Seminars in Speech and Language, Communication Disorders Casebook: Learning by Example, Survival Guide for School-Based Speech/Language Pathologists, and Division 13 and 16 newsletters. She has also been featured in the ASHA Leader and Advance magazine.

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Source: https://www.medbridgeeducation.com/blog/2020/08/school-based-swallowing-and-feeding-answering-common-questions/

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