Referral for Dysphagia Procedures

What We Do

The following procedures have been established in order to determine if a student presents with swallowing difficulties that impact the student’s education.  These procedures will seek to optimize safety and efficiency of any and all oral feeding.  

Requirements for Students with documented dysphagia:

  1. Maintain medical clearance for oral feeding via a physician’s order

  2. Have a plan of care developed by the speech-language pathologist (SLP) who is the specialist in swallowing disorders in collaboration with The IEP Team.  The swallowing plan will be reviewed and and documented in the student's IEP to ensure the student's safety and efficiency during oral feeding.

  3. Have all staff who supervise and/or may feed the student trained by campus SLP and/or by the district dysphagia specialist, to correctly implement the student’s swallowing plan.

  4. Receive ongoing observation by the SLP or district dysphagia specialist as deemed appropriate by the swallowing plan.

Note: The district maintains the right to discontinue oral feeding when the SLP or the school nurse deems that the oral feeding poses an immediate threat or danger to the child.

Process to Obtain Dysphagia Services:

1. School personnel (classroom teacher, paraprofessional, cafeteria personnel, campus nurse, etc.) identifies a concern with a student’s swallowing or feeding skills based on direct knowledge of a previous or existing swallowing problem or from direct observation of difficulties during eating and drinking.  These problems may include, but are not limited to, coughing, choking, spitting holding food in the mouth, excessive drooling, spillage of most of all of food and drink from the mouth, gagging and absent chewing skills.

2. School personnel notifies the campus SLP and/or the district dysphagia specialist of the concerns via email, by phone, or in person.  One or both of these professionals will conduct a “hands-off” observation of the student during mealtime within 5 school days of being notified. At the time the observation is conducted, any potential intervention for swallowing must consider the impact and relevance to the student’s educational performance.

Note:  From that point on, all communication by the Dysphagia SLP (or designated SLP), including contact with the student, the family of the student, the staff, and/or related services including physicians’ offices, will be documented on the “Dysphagia Flowsheet”. 

3. The SLP will contact the staff and parent (or legal guardian) with the findings of the observation.  If further assessment is not needed, the SLP may provide recommendations; such as including seeking a physician’s order to modify the child’s diet, implement swallowing strategies as precautions against choking and/or to promote efficient eating and drinking, or discontinuing strategies no longer needed.  All strategies suggested will be provided in written form for the staff. In the event that strategies are ineffective and swallowing difficulties persist or change, the designated SLP should be notified immediately.

4. If further assessment is needed, a functional swallowing evaluation by the SLP will be recommended. This will may require convening a meeting with the ARD committee to review data to determine if this is in the student’s best educational interest.  In this meeting, a recommendation is made for a functional swallowing evaluation and parental consent for assessment is obtained. A physician’s order will be obtained before the evaluation can be completed.





Guidelines for ARD/IEP Meetings

1. If the district dysphagia specialist recommends assessment and the student does not have an identified special education eligibility then the campus Nurse will be responsible for notifying parents of concerns and options for the student.

2. If the district dysphagia specialist recommends assessment and the student has an identified special education eligibility the campus personnel will schedule a meeting to complete a REED, or a review of existing evaluation data in order to determine need for additional testing.

3. The following staff should be encouraged to attend the meeting:  Parent, district dysphagia specialist, campus nurse, campus occupational therapist, campus SLP, diagnostician, administrator, teacher, special education teacher, or any other relevant staff.

4. At the meeting, obtain the following:

  • Parent Notification

  • Written Consent

  • Medical Release of Information with the student’s physician

  • Establish an interim diet plan for the child optimizing safety and efficiency of oral intake.

5. Campus personnel should send the following documents to the district Speech Coordinator after the ARD meeting:

  • Copy of the REED

  • Pages 1 and 2 of the IEP document, and the deliberations of the ARD meeting

  • Parent Notification

  • Written Consent

  • Medical Release of Information

      The Dysphagia SLP will make contact with 5 school days of notification. 


Evaluation Process

  1. The district dysphagia specialist/SLP will send the appropriate forms to the physician to obtain release of information and endorsement for the SLP to evaluate via a Functional School Based Swallow Assessment to order a modified barium swallow study).

  2. Upon receipt of physician order and parental consent to evaluate, the district dysphagia specialist  will complete the assessment at the student’s campus.

  3. An evaluation will be written and shared with staff so that a plan of care can be established based on educational need.

  4. The assessment should be completed within 45 school days of the meeting; every effort should be made to complete the assessment sooner.

  5. An ARD meeting should be held no more than 30 days after the assessment is complete.

  6. If student is diagnosed with oral and/or pharyngeal dysphagia, a swallowing plan is created.  Each classroom, cafeteria manager and campus nurse will receive a copy of the student’s swallowing plan. First aid posters including information on how to recognize the signs of choking and providing assistance to the student are already posted in cafeterias in compliance with food service regulations.

  7. Staff training on the swallowing plan for the student will be completed; however, it is the nurse or a campus CPR trained staff member who must be called if a choking event occurs.

Students with Dysphagia may receive services in a variety of ways:

  • Individual Education Plan (IEP) –  Campus SLP and/or district dysphagia specialist is responsible for monitoring and reporting any changes in the student’s oral intake status.  The IEP will be created by the dysphagia specialist in collaboration with campus SLP. This is used if the student requires regular observation or ongoing staff training in order to implement the swallowing plan.

  • Individual Health Plan (IHP) – If the student does not take any nutrition or hydration orally and is solely receiving all nutrition and hydration through a feeding tube, then the Special education staff and campus nurse are typical implementers of the IHP.  Other medical recommendations or orders related to oral or tube feedings may also include those considerations outside the scope of practice for the SLP such as gastroesophageal reflux precautions (e.g. positioning during and after tube feeds or oral feeds), oral hygiene (before or after feedings) and other feeding related precautions.   The IHP is created by the nurse and may involve collaboration with the district dysphagia specialist and/or SLP.

  • Behavioral Intervention Plan (BIP) – Student exhibits dysphagia but due to severe aversions, sensitivity issues or behavioral difficulties is unable to eat efficiently or effectively. Special education staff and occupational therapists typically implement the BIP that is developed due to sensory based issues. The special education teacher is responsible for monitoring the student’s progress.  The BIP will be created collaboratively by the teacher, district dysphagia specialist and campus SLP.

  • Dysphagia recommendation are now included in eSped under "Health Form" and "Safety Plan"

Additional Resources