Therapy for Nasal Emission within the school setting.

Hello, I'm a school based SLP. I'm currently assessing a 6 yo student ,who seems to have a nasal emission on almost all consonant sounds. I suspect VPI / ? Sub mucous cleft.  What is the scope of speech therapy to address this issue within the school setting ?.

Here is a brief background info. This student was initially screened by a school SLP in fall 2011, and the SLP had directed the parent to seek medical opinion. His PCP referred him back to the school therapist and wrote a "prescription for speech therapy" . Now, he is being assessed per doctor's note.

I would love to refer him to a craniofacial team , but the factors like health insurance,PCP referral etc., are involved. I would really like to help that student but unclear about the ways to help him. Your input is appreciated ! .Thank you.
I'd refer his parent to the PCP again. Unless you're doing language therapy, I don't think you could ethically see him him for anything artic/voice until the medical side is checked out. Especially voice.</p>

It's all about educational need in the schools. Is there an educational need? I know in my district if we get a DRs note, we don't have to assess, the child still goes through RTI and based on that process, gets referred.

After you finish your assessment, and decide whether or not he qualifies, or even before, send the mom back to get PCP. If he's more than voice, you could qualify him for language and see him, but I wouldn't touch his potential voice disorder until he sees a craniofacial team.

I'm in a similar boat with a kiddo who has a short lingual frenum. My RTI committee requested medical interventions first before any evaluation can recommended.

(Anonymous)
Have you determined if he does have a submucous cleft or not? Before re-referring him back to PCP, I would do an oral mech exam, looking specifically for a submucous cleft. Also, it is possible that he has VPI not due to a cleft. In that case, as an SLP you can work with him on reducing his nasal emissions. If through doing your oral mech and assessing his VPI you determine that he would benefit from physical management, then it would be appropriate to refer him back to his PCP.
(Anonymous)
As part of the eligibility here, the child has to be seen by an ENT before we determine eligibility for voice. I agree about sending him back to the doctor and having the medical cleared before proceeding.