A school-based speech-language pathologist is assessing Eleanor, age 6, when she notes an unusual articulation pattern and nasal quality to Eleanor’s speech. Although Eleanor does not have a cleft palate, the SLP has concerns about palatal function and wants to refer her to a team of professionals specializing in disorders of resonance and velopharyngeal function for further assessment. She asks, “Where do I begin?”
Most people with a cleft palate begin working with an interdisciplinary team at birth. However, SLPs occasionally need to seek the guidance of such a team when they suspect velopharyngeal dysfunction (VPD) as a cause of a speech issue for a client. The SLP may refer to a team to establish a diagnosis, determine treatment, request specialized assessment of resonance and velopharyngeal function, or seek advice on managing the case.
SLPs might have several questions on how to proceed. What do I tell the family? Where do I find a craniofacial interdisciplinary team in my region? How do I make a referral?
Here are some answers to these questions and other details to help with making a successful referral for craniofacial issues:
Tell parents or caregivers why their child needs a referral to the cleft palate team. It might surprise parents to learn their child’s speech issues requires referral to a team of specialists, especially if the team includes a surgeon. Explain your concerns clearly in non-technical language that the perceived issue goes beyond your own experiences or expertise. Also share who will evaluate their child during the team visit—most likely the team SLP—and reasons why the information learned during this visit will benefit their child in terms of diagnosis and treatment.
I don’t recommend sharing information about possible causes or treatments—especially surgery—for their child’s speech disorder until you hear back from the team.
How to locate a team. To locate a team in your region, you can access the Cleft and Craniofacial Team Listings on the American Cleft Palate-Craniofacial Association (ACPA) Family Service website.
Steps for making a referral. Set up a telephone consultation with the team SLP who can help sort out relevant issues and provide guidance on what information the team needs. To facilitate setting up the appointment, you can give parents the team coordinator’s contact information to schedule a time or contact the team coordinator on the parents’ behalf and ask the coordinator to call the parents directly. In this case, make sure the parents know to expect a call.
Communicate your exact concerns with a referral letter. In your letter, describe your exact concerns, reason for referral, and what you expect to learn from the team. Include information about the speech symptoms and treatment history. Attach treatment goals and progress reports. Include other relevant medical, developmental and otologic history. Avoid making a diagnosis about speech problem and its etiology—this is what you want to find out.
Safeguard protected health information. Get caregiver consent and a signed release for making a direct referral and sharing information about the client.
Follow-up on the referral. Expect the team SLP to contact you and discuss the evaluation outcome, treatment recommendations—speech intervention, imaging studies, surgery—and any needed follow-up. You can also ask the team SLP to provide appropriate evidence-based strategies for treatment. If treatment is the best course of action, the referring SLP should provide the team a note about progress.
Through collaboration and open communication, referring clinicians and the cleft palate team work together successfully to ensure the best client-centered care and outcomes.
Linda D. Vallino, PhD, CCC-A/SLP, is head of the Craniofacial Outcomes Research Laboratory in the Center for Pediatrics Auditory and Speech Sciences and on the cleft palate-craniofacial team at Nemours/A.I. duPont Hospital for Children. She is also a clinical professor at the Sydney Kimmel Medical College-Thomas Jefferson University and an affiliate of ASHA Special Interest Group 19, Speech Science. Vallino has also co-authored two books on cleft palate: Evaluation and Management of Cleft Lip and Palate: A Developmental Perspective and Cleft Palate Speech and Resonance: An Audio and Video Resource. firstname.lastname@example.org