SP140: Transition and Discharge

• Why do we conduct Re-Assessment?

  ● To check if there is a progress in therapy

  ● If there is a need to modify the goals or more

  intervention

  ● To check what strategies that are working or not

  working

  ● Re-assessment can be conducted in the clinic or

  upon the request of Dev Peds

  ○ Can ask for re-evaluation or progress

  report para madali
• What is transition in therapy?

  ● Change of therapist from one to another

  ● From being supervised to being independent

  ● Transition from a precursory to school age

  intervention to practical life skills
• Transition


  Basic Definition

  ● Modifications, alternatives or changes to the

  current service/mode of delivery
• Transition


  Focus

  ● “Safe and timely passage of patients between levels of healthcare and across settings”

  ○ Can be transitioning towards to OTs or across settings (classroom to workplace to more functional activities)
• Transition


  • Moving on from therapy
  • Focus is on independence/generalization of skills
• What we do

  1. Reevaluate patient's skills

  2. Gradual decrease of therapy intensity frequency

  3. Intensity transitions: 1 Hour Sessions → 30-minute sessions → 15 minutes → 5 minutes

  4. Frequency transitions: 1x a week → 2x a month
• Documents used

  • Reevaluation Report
  • Home program
• Reevaluation Report


  • Same as initial evaluation report (differ when it is made)
  • Compares initial skills with current skills → parents appreciate it more if they can see the progress from initial evaluation to reevaluation
  • Serves as post test
• Home program


  • Contains client's therapy goals, and activities and techniques that can help target goals
  • Individualized to the client
  • A document that enumerates activities that should be done at home
  • Contents: laman ng program, things to take note of, paano gamitin, layunin/goals
• Transition reason #2


  Unwilling to participate, poor attendance, seeks a new service provider, or relocates to a new location
• Modify current program


  1. Gestalt Language Processing (new method being used)

  2. Can switch from clinician directed to parental coaching

  3. Can be child-led to clinician-directed
• Find new mode of delivery


  Face to face to teletherapy
• Referral to a new SLP

  Check with the PASP directory
• What we do


  • Discussion with client and family/caregiver
  • Look into other therapy programs/mode of delivery
  • Endorse patient to new speech pathologist
• Endorsement Notes


  • Summary of client's performance at the end of intervention period
  • Required when there is a change in therapy provider
  • Also used when having reevaluations with the client's developmental pedia to align their goals
• Content of Endorsement Notes

  • Intervention period (from when to when were they seen)
  • Number of sessions attended
  • Baseline and progress
  • Recommendations (home program, medical results, test results)
• Transition reason #3


  Treatment no longer results in measurable benefits, cannot tolerate treatment due to condition, behavioral difficulties
• Transition


  1. Modify current program

  2. Referral to other professionals (especially if case is not the therapist's specialization)
• PASP directory

  Directory used to make referrals to other professionals
• What we do


  1. Find new therapy programs

  2. Make referrals to other professionals
• Referrals for behavioral difficulties


  • Occupational therapist, psychiatrist, psychologist
• Referrals for unrepaired cleft palate

  • Plastic surgeon, ENT
• Documents used


  1. Referral letter / report

  2. Endorsement notes

  3. Discharge report
• Referral letter / report content

  Reason for referral, current communication skills, summary of what was done during the sessions
• Endorsement notes


  Notes to occupational therapists, etc.
• PASP Standards of Practice for Referral and Endorsement

  1. Referred contacts must be clearly informed about:

  2. Nature and costs of services offered

  3. How soon an appointment for an initial evaluation can be set

  4. Required reports to bring for initial meeting

  5. Need to refer to other professionals and/or agencies
• SLP cannot provide a slot within a month or at the most immediate time necessary


  SLP should refer the client to other practitioners or agencies
• Always obtain a client's and/or parent's/legal guardian's consent before making a referral
• Discharge


  ● Decided as a team

  ○ Client

  ○ SLP

  ○ Parent/guardian/family

  ● Shared uniform understanding is crucial

  ● May occur due to various reasons
• Discharge

  • Cessation of therapy services; cutting of ties with

  the client
• Discharge Planning

  • Activities that help a patient transition back to their

  home, or another setting
• Discharge Decision

  • Use of therapist’s professional reasoning,

  knowledge, and expertise for formulating discharge

  recommendations
• Discharge Recommendations

  • Suggested course of action to ensure a smooth

  transition with a patient’s release from a hospital
• SP’S ROLE IN THE DISCHARGE PROCESS

  Review and analyze all aspects of past services

  2. Identify specific modifications that have the

  greatest probability of yielding improved outcomes

  3. Implement these with ongoing monitoringAfter discharge, communicate with the

  client to check their progress until you are

  sure they have generalized the skills
• Factors that must be addressed

  • Provide appropriate assistive technology supports
  • Address cultural and linguistic concerns
  • Use relevant and accurate criteria to evaluate intervention
  • Provide relevant health, educational, environmental, and other supports for communication
  • Make necessary referrals to other professionals
  • Specify appropriate intervention goals and objectives
  • Provide sufficient instruction time
  • Use current and suitable intervention methods
  • Collect and analyze meaningful and functional data on an ongoing basis —> monitors and evaluates progress
• We should always look for ways we cross-check our evaluation to make sure all areas are covered
• Discharge reason #1


  Communication disorder has been remediated, or compensatory strategies have been successfully established
• Most frequent scenario


  • Identified disorder is within normal limits
  • Abilities are comparable to peers
  • Consistent with premorbid status
  • Achieved goals and objectives
• Current level of functioning

  • Does not adversely affect the patients activities and participation
• Augmentative or alternative comm. system (AAC)


  • Optimal across environments and comm. partners