12/12/2019
Proceeding to open this can of worms...I see this come up a lot in SLP discussions. Often, when a child presents with a potential disability that requires either medical diagnoses and treatments or a specialty that a particular school SLP is not equipped to provide and wants to refer out to the appropriate specialist, someone will caution the SLP with something like..."Don't do it/Be careful. If you refer out the school will have to pay for it." Then many other SLPs co-sign this statement. While I understand that this statement may be true that a parent could sue the school stating that they are responsible to cover services the district and its employees recommend, I don't think that should stop us from doing what is right for a child. So what, the district may have to pay. When did the district's pocketbooks start taking precedence over the health and well being of a minor? Now I get that in some cases, seeing an outside provider might just be a preference or suggestion that would offer slight benefit. For example, if there is a specialty clinic focused on reading but the school also provides reading interventions it would be a nice bonus for the child to get both but the child is not in grave danger if they do not and the school staff should be at least somewhat competent in this area. However, if a child has apparent yet un-diagnosed difficulty with breathing, swallowing, or voicing, how can you not refer out to an Ear, Nose, and Throat Doctor (otolaryngologist/ENT)?
I refused to let a child sit in school and not get help with these basic living functions just because the school MIGHT have to pay - which is not even a guaranteed outcome. (Besides, if the child doesn't get the right help, they will not be able to do their best in school anyway. Imagine how well you would do on an academic test when you are sick vs. how you would do when you are felling well). Do other school employees follow this unethical rule? If the nurse sees a kid who fell and broke their arm during gym class, is the nurse going to refuse to call the parents and recommend that they take him to a doctor? SLPs, when did we lose our backbones? When did we start putting bus duty over our ethical duties? Yes, you can sometimes word things strategically to give parents the idea of a specialist almost as if they arrived at it on their own, and I have done that in some instances by saying something like, "I am SLP and have been for over half a decade but if this were my child, even as an experienced SLP I would still take my child to an SLP who SPECIALIZES in motor speech disorders like Apraxia and Dysarthria." Okay, so in that instance, I did not tell the parent what to do but told them what I might do. Said emphatically enough, they certainly get the picture and will have follow-up questions. However, when it comes to something like problems with breathing, swallowing, or a potential laryngeal injury manifesting as a voice disorder, where we don't have the equipment in a school to visualize the problem, I will tell the parents exactly what specialist can diagnose the issue and impress upon them the importance of getting the child to that specialty. My ethical code will not allow me to withhold the proper referral from a child and parent. I hope yours doesn't either and I hope more school SLPs get on board with speaking up when our students need us to advocate for their healthcare needs.
