Monday, December 01, 2008

Professional collaboration and referrals

Notes from NSSLHA meeting, 11-17-08
Guest speaker: Dr. Maryann Abbott

CCS (California Children’s Services) provides medical, OT and PT services for children aged birth to 21, as well as durable medical equipment, with Medi-Cal dollars. Doctors who identify children with physical impairments should refer to CCS. They cover equipment such as wheelchairs, bath chairs, splints, braces, and communication devices. CCS needs SLP referral for communication devices, as well as written permission from doctors. SLP must refer with proof of medical necessity. CCS covers medical aspects—e.g. helping children to walk. The OT/PT at school provides services for access to the curriculum, so the eligibility is a little different than CCS eligibility. A student may potentially be eligible for one (CCS or school services) but not the other. OT’s, PT’s, doctors and case workers work for CCS, so they need to go through a private SLP, a non-public agency or a school to get speech-language reports.

The Regional Center is state funded. Depending on where you live, you are covered by a separate Regional Center. Each is a separate entity and may provide different services. Anyone can refer to the Regional Center for disabilities birth to 3. After the age of 3, services are taken up by the school district. If there is a cognitive or physical impairment, the Regional Center services are life-long. They provide services that are mostly related to daily living, such as diapering. They may cover respite care. They also pay for one conference a year for parents to go to, and after-school activities such as swimming lessons. This may even include transportation.

If a child has a disability, we have to go through CCS, which uses MediCal dollars, to get something like a communication device. If a student has either aged out of CCS or is not eligible for other reasons (e.g., undocumented) the Regional Center may provide services. Neither of these services employs SLP’s directly. It’s great to collaborate with specialists from the Regional Center (e.g., behaviorists) if possible, and have them come to the IEP meetings.

Low incidence disabilities includes: severe orthopedic, vision and hearing impairments. Some federal money is allotted for these students, so larger school districts may be able to purchase devices for these students. For students with autism, we may need to depend more on MediCal dollars or private insurance to cover communication devices. This works the same way as going to the doctor, including co-pay, deductible, and whatever else isn’t covered by insurance (e.g., 20% of cost).

Referrals: We might refer to OT’s if students are having trouble forming letters but can spell. Young children should be sitting independently by 6-7 months. Some children crawl late. Most children are beginning to walk by 12-15 months. Young children rake things in that they want, then use palmer grasp, then pincer grasp. Many children don’t get a hand dominance until the age of 5 or 6 years. There are some good developmental milestones online, but look at the Department of Health, National Institute of Health, or another reputable source. With autism there are usually referrals to OT for sensory integration or motor planning. However, some problems may be due more to attentional problems or sensory overload. Attention spans should be your developmental age, minus one (e.g., four minutes for the age of five), and it is also affected by interest level. If OT’s try something with them but it doesn’t make a difference for their attentional level, it’s probably not a sensory integration issue.

Make sure that you keep within your realm of practice and expertise. If we don’t, we breach ethics and may lose our license. OT’s work on tasks that require physical manipulation, motor planning or sensory integration. In the schools, it’s OT’s (not SLP’s) who provide swallowing services. Physical therapists work on range of motion. On a school campus, they may look at whether students can travel over different kinds of terrain and keep their balance, or whether they need equipment such as walkers or helmets.