Low-Incidence Specialists in Schools An SLP tells how she and other specialists serve as district-wide resources for treating complex, specialty cases. School Matters
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School Matters  |   August 01, 2016
Low-Incidence Specialists in Schools
Author Notes
  • Gloria Petit-Clair, MEd, CCC-SLP, is a low-incidence specialist in the Anne Arundel County (Maryland) Public Schools. She is an affiliate of ASHA Special Interest Groups 5, Craniofacial and Velopharyngeal Disorders; and 16, School-Based Issues. slpublicpolicy@gmail.com
    Gloria Petit-Clair, MEd, CCC-SLP, is a low-incidence specialist in the Anne Arundel County (Maryland) Public Schools. She is an affiliate of ASHA Special Interest Groups 5, Craniofacial and Velopharyngeal Disorders; and 16, School-Based Issues. slpublicpolicy@gmail.com×
Article Information
School-Based Settings / School Matters
School Matters   |   August 01, 2016
Low-Incidence Specialists in Schools
The ASHA Leader, August 2016, Vol. 21, 38-39. doi:10.1044/leader.SCM.21082016.38
The ASHA Leader, August 2016, Vol. 21, 38-39. doi:10.1044/leader.SCM.21082016.38
Serving students with communication disorders related to craniofacial differences, injury or disease can significantly increase the workload of speech-language pathologists and other education specialists because all students—especially medically fragile students—must receive access to education in a safe and healthy environment.
My own experience in craniofacial disorders involved coursework, apprenticeship with a craniofacial team and mentoring. After serving on the same team for 23 years, I transitioned into a school setting. I worked in this new setting for a decade before I treated a child with a craniofacial disorder. It’s entirely possible to experience a long, productive career without treating these low-incidence disorders.
When they do arise, however, collaborations between SLPs with experience in medical settings and those in schools ensure our children receive that safe and healthy access to education. Through this type of teamwork, school-based SLPs gain added confidence to treat low-incidence cases, while health care practitioners learn about myriad issues involved with giving children equal access to public education.
One school district’s solution
How can schools provide knowledgeable services for students with these complex and infrequent disorders? Anne Arundel County (Maryland) Public Schools (AACPS) recognized the need and acted to provide continuing education in low-incidence areas. District administrators created two SLP resource positions in the areas of feeding/oral motor and craniofacial/voice management.
As the craniofacial/voice management specialist, I work with my feeding/oral motor colleague to increase school-based clinicians’ capacity for maximizing student progress. We have worked in these new positions since 2009, and our procedures and the school district’s policies continue to evolve.
The program—known as AACPS Related Services—incorporates a transdisciplinary model including speech-language pathology, audiology, physical and occupational therapy, vision, hearing, and augmentative communication specialists. The craniofacial/voice and feeding/oral motor positions are a subset of this office.
The feeding/oral motor specialist focuses on evaluation, treatment planning and development of a mealtime plan of care (MPOC) for students at risk for aspiration or malnutrition. The goal is to provide adequate nutrition and hydration while keeping the student safe and able to access learning. After receiving training from the specialist SLP, the school-based team—SLP, case manager, school nurse, teachers, physical and occupational therapists, aides and cafeteria workers—implement the MPOC.
As the craniofacial/vocal specialist, I help with the evaluation, treatment planning and coordination of care for students with speech/resonance disorders related to craniofacial diagnoses, dental/jaw discrepancies, and resonance and vocal differences. We both provide ongoing education to all district SLPs through in-service sessions, resources posted to an online guide, attendance at IEP meetings, parent conferences and visits to community providers.

As the craniofacial/voice management specialist, I work with my feeding/oral motor colleague to increase school-based clinicians’ capacity for maximizing student progress.

Two students’ stories
Let’s next take a look at how our services helped two AACPS students access education in a safe manner.
Nine-year-old “Sophie” is an English-language learner (ELL) who switched to our district from another county. Her teacher noticed gait issues and a cafeteria monitor noted her struggles with self-feeding. The school SLP initiated a referral process. Sophie’s ESL teacher acted as the communication link between school and home. She first passed along the feeding/oral motor specialist’s referral to a local medical center where Sophie received a physical evaluation.
The diagnosis came back as progressive neuromotor disease, so an MPOC was developed. The feeding/oral motor specialist trained school staff to monitor Sophie according to her mealtime plan of care. She’s now safely receiving hydration and nutrition in school and able to access the curriculum. And her ELL peers and school staff received education on how to provide extensive support for Sophie and her family.
In kindergarten, “Clay” had unintelligible speech along with a history of a repaired cleft lip and palate, suggestive of a genetic syndrome. I provided several sessions of continuing education to his school SLP and resources on treating children with compromised oral structures. I also helped re-establish communication with the craniofacial team that performed the initial lip and palate repairs. Clay’s parents were reluctant to meet with the medical team again, so I helped prep them. We explored their concerns and I helped them frame questions they wanted to ask. I accompanied them to the clinic for a meeting and follow-up videofluorographic study. Once the medical/dental team made recommendations, I facilitated implementing those suggestions in school.
Though SLPs all receive the same basic curricula in graduate school, we develop different proficiencies through internships, fellowships and our various work settings. Forming professional relationships across these different proficiencies and settings can benefit everyone involved.
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August 2016
Volume 21, Issue 8