Team-Based Craniofacial CE Program Benefits Clinician and Client Alike Two SLPs on a cleft palate-craniofacial team were so concerned about a lack of progress in their patients that they created a collaborative continuing-education program to tackle the problem. SLP Anne Bedwinek interviewed them about it. Overheard
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Overheard  |   December 01, 2015
Team-Based Craniofacial CE Program Benefits Clinician and Client Alike
Author Notes
  • Anne Bedwinek, PhD, CCC-SLP, is an adjunct associate professor in the Department of Communication Science and Disorders at the University of Missouri. She is an SLP emerita at the Cleft Palate-Craniofacial Anomalies Center at Mercy Children’s Hospital in St. Louis. Bedwinek also serves on the Coordinating Committee of ASHA Special Interest Group 5, Craniofacial and Velopharyngeal Disorders. bedwineka@health.missouri.edu
    Anne Bedwinek, PhD, CCC-SLP, is an adjunct associate professor in the Department of Communication Science and Disorders at the University of Missouri. She is an SLP emerita at the Cleft Palate-Craniofacial Anomalies Center at Mercy Children’s Hospital in St. Louis. Bedwinek also serves on the Coordinating Committee of ASHA Special Interest Group 5, Craniofacial and Velopharyngeal Disorders. bedwineka@health.missouri.edu×
  • Lynn Marty Grames, MA, CCC-SLP, is a speech-language pathologist at the Cleft Palate-Craniofacial Institute of St. Louis Children’s Hospital-Washington University. She is an affiliate of ASHA Special Interest Group 5, Craniofacial and Velopharyngeal Disorders. lynnmg@bjc.org
    Lynn Marty Grames, MA, CCC-SLP, is a speech-language pathologist at the Cleft Palate-Craniofacial Institute of St. Louis Children’s Hospital-Washington University. She is an affiliate of ASHA Special Interest Group 5, Craniofacial and Velopharyngeal Disorders. lynnmg@bjc.org×
  • Mary Blount Stahl, MA, CCC-SLP, is a senior speech-language pathologist at the Cleft Palate-Craniofacial Institute of St. Louis Children’s Hospital-Washington University. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders. maryxb@bjc.org
    Mary Blount Stahl, MA, CCC-SLP, is a senior speech-language pathologist at the Cleft Palate-Craniofacial Institute of St. Louis Children’s Hospital-Washington University. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders. maryxb@bjc.org×
Article Information
Professional Issues & Training / Overheard
Overheard   |   December 01, 2015
Team-Based Craniofacial CE Program Benefits Clinician and Client Alike
The ASHA Leader, December 2015, Vol. 20, 28-29. doi:10.1044/leader.OV.20122015.28
The ASHA Leader, December 2015, Vol. 20, 28-29. doi:10.1044/leader.OV.20122015.28
Anne Bedwinek: Tell us about the Collaborative Care Program you created at St. Louis Children’s Hospital.
Lynn Marty Grames: In Collaborative Care we invite the child, the parents and the local treating speech-language pathologist to the hospital for a one- to three-hour visit. We listen together, agree on articulation errors, and discuss and try therapy techniques. We map out a treatment plan, discuss home practice activities and discuss further medical care for the child. The local clinician receives ASHA CEUs for the visit, classified as an independent study.
We consider this a patient-focused continuing-education program. It provides local speech-language pathologists with tools and information they need to address their client’s specific needs. This has an advantage over other continuing-education experiences, because the information pertains to their particular patient. Conferences or online tools provide a broad overview of information, some of which may not pertain to a particular patient. If clinicians have limited training or experience in cleft palate and craniofacial disorders, they may have difficulty deciding what information to use and what information to discard.
Mary Blount Stahl: Collaborative Care is designed to meet the child’s needs and ensure that therapy is targeting correct speech sounds using the most effective techniques to correct articulation errors. The program pulls together the primary speech teachers in the child’s life (parents, local SLP and team SLP). This model ensures that all parties are focused on appropriate targets and approaches. Our goal is continuity of care.
Bedwinek: What problem did you want to solve by creating this program?
Stahl: We needed a face-to-face model to ensure that we were observing exactly the same cleft-related error patterns and to create an appropriate therapy plan. When we collaborated over phone or email, there was a delay between our communications and when the local SLP saw the child again. Also, the team SLP would have to deduce problems and make recommendations based on descriptions of error patterns. It was hard to steer therapy appropriately if both SLPs did not “hear” the error pattern in the same way.
In addition, a face-to-face model ensures that appropriate therapy techniques were implemented, versus use of non-speech oral-motor activities that do not facilitate articulatory placement. In Collaborative Care sessions we can clarify functional versus structural deficits and how to treat each. We also prevent inappropriate early dismissal from speech therapy when the local SLP thinks a child cannot progress without further surgery or orthodontics.
In the past, a child would return to the team one year later even farther behind because the local SLP was unaware of the best treatment approach. The SLP was not aware that speech therapy can be beneficial even before surgery or to prepare a child for velopharyngeal imaging, or that surgical management may not be appropriate for the child’s error patterns. If the local SLP recommended early dismissal from therapy, the team SLP was then in a position to make appropriate recommendations for therapy and risk destroying confidence in the local provider, when our goal should be to support our fellow SLPs and families.
Bedwinek: I’ve heard you call this a win-win program. Why do you call it that?
Grames: The family wins by getting coordinated care from their medical and local speech-language pathologists. The community SLP wins with patient-focused education and ASHA CEUs. The child wins by getting therapy that is designed and coordinated by the local and medical care teams. The hospital team learns from the school/community SLP and also is able to bill for the time, which is considered “productive” by their administrators.
This program has been such a joy for me personally. It is great to meet and learn from clinicians who are in the child’s school, home or community. They know the child much better than we do and have excellent insight into a child’s day-to-day functioning. It is great to share therapy ideas and have help solving complex problems. I have learned a great deal, and I think the medical team, in turn, provides better care when we are actively collaborating with the community providers.
Bedwinek: How have SLPs responded to your program?
Stahl: SLPs have been very positive about the program. They have commented on what a great idea it is to combine hands-on learning for their specific patient/client and ASHA CEUs. They have been grateful that we take the time to meet together, identify error patterns and discuss specific therapy techniques. They express having more confidence in their role in the child’s care, in therapy techniques, and in advocating for the child.
Grames: We did a long-term follow-up with our first 51 participants. One-hundred percent of participants indicated that the program has been of value to them and worth the CEUs they received for it. Some have referred colleagues to the program or advised a child’s new clinician to participate in collaborative care.
Bedwinek: It’s my understanding that you have expanded Collaborative Care to other specialty areas of speech-language pathology.
Grames: In fact, we were so excited about the program that other specialty teams at St. Louis Children’s Hospital have adapted the program to their patients. We now offer Collaborative Care in cochlear implant, augmentative and alternative communication, and feeding/swallowing disorders as well, and the participant responses in those programs have been equally enthusiastic.
What has been especially gratifying is to see the Collaborative Care model adapted by other craniofacial programs. You were the first to do it, Anne, when you adapted our model to your cleft center at Mercy Children’s Hospital. Since then, a number of other clinics around the U.S. are using the model as a tool to build collaborative relationships with community SLPs and to assist in ensuring appropriate therapy for their patients with cleft palate and craniofacial disorders.
1 Comment
December 16, 2015
Judith Trost-Cardamone
Collaborative Speech Care for Cleft Palate Speech Disorders
Dear Colleagues, Thank you so much for putting this in print. You have hit a home run with this article that now can be read and acted upon by CLP/craniofacial team and school-based SLP's alike.
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December 2015
Volume 20, Issue 12