In this post, you’ll find many of the disciplines and services that make up speech therapy’s unique and talented team.
To practice person-centered care is to understand—and follow through on—what your patient wants, needs, and prefers. As much as we want to help, these are often beyond speech therapy’s scope of practice!
Many of these referrals will be made by the patient’s primary care provider. This list will help you get the ball rolling by making informed recommendations to the patient and their PCP.
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- When & Where to Refer Out Speech Therapy Patients
- 911/Emergency Call Button
- AAC Companies
- Adult Protective Service
- Gastroenterologists (GI doctor)
- Home Health Aide
- Medical Social Worker
- Occupational Therapist
- Orthopedic Specialist
- Otolaryngologist or ENT
- Hand Therapist
- Physical Therapist
- Physical Medicine & Rehabilitation (PM&R or Physiatrist)
- Primary Care Provider (PCP)
- Psychologist, Counselor, Marriage and Family Therapist, or Social Worker
- Registered Nurse
- Respiratory Therapist
- Support Groups
- More Resources
When & Where to Refer Out Speech Therapy Patients
When referring patients out, always communicate with a supervisor if concerns about patient safety arise. Each setting will have its own referral procedures, so take the time to learn them.
911/Emergency Call Button
Call for emergency help when you suspect an urgent medical condition (e.g., chest pain, signs or symptoms of a stroke, loss of consciousness, etc.)
Refer to an AAC company for AAC patients in need of high-tech device trials. If their needs are temporary, consider finding a local AAC organization that offers short-term loans of devices.
Adult Protective Service
Refer to adult protective services if you suspect or observe abuse or neglect. Your country, state, and local governments will have their own laws and procedures about how and when to report abuse towards vulnerable adults.
Refer to audiology for suspected hearing loss and help with: hearing aids, balance, tinnitus, and related sensory and neural problems.
Refer to a dentist when you observe or suspect poor dental hygiene, TMJ, orofacial or myofunctional disorders (for diagnosis—or refer to myofunctional therapist), and for help with dentures.
Refer to a dietician or nutritionist when your patient would benefit from nutrition services, especially if you suspect malnutrition or insufficient hydration.
Dieticians and nutritionists can provide medical nutrition therapy for patients with:
- Swallowing disorders
- Heart disease
- Kidney disease
- Patients on enteral feeding
- After a kidney transplant
- A preventive measure to guide patients towards healthier eating
- RDNs and Medical Nutrition Therapy Services
- Stroke Prevention & Treatment: Diet & Nutrition
- UCLA Health: Enteral Feeding
Gastroenterologists (GI doctor)
Refer to GI when you suspect esophageal dysphagia or other GI-related impairments (e.g., UES dysfunction, esophageal strictures). Also, connect with GI with concerns about feeding tubes or for help managing GERD. or LPR.
Home Health Aide
Refer to a home health aide if your home health patient needs help taking care of themselves at home (ADLs and IADLs). For example, a patient reports difficulty bathing, isn’t eating regularly or nutritiously, has frequent falls, or otherwise needs consistent help with ADLs, daily health management, and personal safety.
- Home Health Aides: When Your Loved One Needs Help With Personal Care
- Medicare Coverage of Home Health Aides
Medical Social Worker
Refer to medical social work to address your patient’s social, financial, and psychological needs related to their healthcare. These include:
- Coping with diagnosis, illness, and hospitalization (answer questions about care, comfort family members, etc.)
- Discharge planning (coordinate where a patient goes after discharge, get pre-authorization for post-acute rehab, where to access medical equipment, etc.)
- Grief, loss, or end-of-life issues
- Financial difficulties (find generic versions of medications, etc.)
- Lodging and transportation issues
- Housing concerns
- Anxiety, depression, or other psychiatric concerns
- Substance abuse issues
- Finding support groups
- Violence in the home or community
- Trauma and crisis intervention
Refer to a neurologist if you suspect your patient has an undiagnosed neurological impairment (e.g., dementia, encephalopathy, ALS). Or a worsening neurological condition (e.g., progression of Parkinson’s disease, Parkinson’s medication no longer seems as effective, stroke symptoms progressing atypically, etc.) And for follow up after a neurological event (TBI).
Here’s a list of red flags from the National Institute of Health and Care Excellence that should trigger a neurology referral for adult patients. Click the link for more details.
- Sudden onset dizziness and vertigo
- Facial pain and/or numbness not caused by trauma
- Gait unsteadiness (progressing gait ataxia and apraxia)
- Sudden onset handwriting difficulties with no obvious musculoskeletal causes
- Sudden onset, rapidly progressive, or slowly progressive limb or facial weakness
- Memory failure and cognitive deterioration
- Dystonia (involuntary muscle contractions causing repetitive or twisting movements)
- Sensory tingling or numbness, especially if rapidly progressing and symmetrical
- Sleep disturbance that is suggestive of new-onset epileptic seizures
- Transient, repetitive smell or taste hallucinations
- Sudden onset of speech or language disturbance
- Any evidence of new swallowing impairment
- Isolated and unexplained persistent dysphonia
- Tics (involuntary movements of face, neck, limbs, or trunk) that can’t temporarily be compressed by mental concentration (don’t refer for small involuntary muscle twitches unless associated with muscles wasting, weakess, or rigidity)
Refer to neuro-ophthalmology if you suspect visual problems related to the nervous system (not caused by the eyes themselves). These can include:
- Visual field cuts
- Visual neglect
- Abnormal eye movements (shaking, nystagmus)
- Double vision
- Eyelid abnormalities (drooping eyelid, etc.)
- Forced eye closure
- Unequal pupil size
- Vision disturbances (flashes of light, etc.)
Neurological conditions that can cause visual symptoms include:
- Brain tumors
- Intercranial hypertension
- Multiple sclerosis
- Myasthenia gravis
- Parkinson’s disease
- Pituitary disorders
Referrals to neurosurgery will most likely be made by a physician/PCP after they’ve done a pre-referral assessment. However, here are possible reasons a neurosurgery referral may be appropriate for some speech therapy patients:
- New onset upper motor neuron signs and symptoms (only with MRI evidence of pathology)
- Cranial tumors
- Malfunctioning cerebrospinal fluid shunt
- Cerebrovascular problems
- Facial pain (trigeminal neuralgia)
- Carpal tunnel syndrome (only after a nerve conduction study showed moderate to severe involvement)
- Ulnar neuropathy (if nerve conduction study showed moderate to severe involvement or if the issue originates in the elbow)
- Spinal cord-related problems (only after a recent MRI indicates a neurosurgery referral). Consider a physical therapy referral for spine problems, including pain
- Arm pain (brachalgia) or leg pain (sciatica) which is of a radicular nature and physical therapy hasn’t helped.
Refer to occupational therapy when your patients would benefit from help with ADLs and addressing underlying conditions that stop them from doing the activities that are meaningful to them, including:
- Self-feeding (hand-to-mouth coordination)
- Preparing meals
- Self-toileting and showering
- Transferring between surfaces (wheelchair to bed, etc.)
- Fine motor (poor grasp, poor fine motor skills including writing, hand, arm, and postural weakness, muscle contractures, etc.)
- Visual neglect if you need additional support
- Cognition treatment if you need additional support (inattention to task, managing finances, medications, shopping, home maintenance, managing mail, phone calls, etc.)
- Energy conservation (patients with multiple sclerosis, respiratory failure, ALS, congestive heart failure, on hospice, etc.)
- Joint protection (patients with arthritis)
Common medical diagnoses that benefit from OT include:
- Parkinson’s Disease
- Multiple sclerosis
- Joint replacements
- Metastatic cancer
- Generalized weakness
Refer to an optometrist if you suspect general visual acuity issues, if your patient needs a new vision prescription, and/or they need new glasses or contacts.
An orthopedic specialist can be either an orthopedic surgeon or a physician’s assistant or a nurse practitioner specializing in orthopedics. Refer to an orthopedic specialist for:
- Chronic pain (arthritis, hip, knee, shoulder, cervical pain, etc.) that isn’t responding to physical therapy and other treatments and if the patient is open to surgery)
- A consultation for a hip or knee replacement
- After an orthopedic surgery to clarify precautions and protocols
Otolaryngologist or ENT
Refer to otolaryngology (also known as an Ear-Nose-Throat doctor) when you suspect anatomical impairment or a medical issue with the vocal cords or the nasal, oral, pharyngeal, or laryngeal cavities (e.g., velopharyngeal incompetence, paralyzed vocal cords, nasal air emissions). Also refer to an ENT if you suspect other medical conditions of the ear, nose, or throat:
- Head and Neck cancer (help with timing of stretches and exercises and modified diets)
- Sinusitis & Allergy (only after seeing an allergist or after a full medication management trial)
- Hoarseness with persistent, significant, audible change in voice strength and quality (without upper respiratory infection)
- Dysphagia: to determine the cause at and above the level of the vocal folds. Urgent referral if associated with Head and Neck cancer warning signs (e.g., neck mass, bleeding, weight loss, otalgia, voice change)
- Masses of the neck
- Trauma to the face and neck
- Ear infections
- Chronic dizziness (only after seeing an audiologist)
- Tinnitus (only after seeing an audiologist)
- Hearing loss (only after seeing an audiologist)
- Chronic nasal obstruction (only after a full medication management trial)
- Draining ear with pain (only after topical treatment)
- Other problems arising from the structures of the head and neck
A hand therapist is a specialist who can be an occupational therapist or a physical therapist. Refer to hand therapy if your patient experiences numbness, weakness, pain, and/or decreased coordination in any part of their upper extremity (fingers, hand, wrist, arm, shoulder, or neck).
Specific diagnoses hand therapists can help with include:
- Upper extremity arthritis to decrease pain and protect the joint from further deformity
- Lymphedema management
- Post-stroke to reduce upper extremity contractures and decrease pain
- Parkinson’s disease to treat tendonitis caused by repetitive movements
- Repetitive strain injuries such as tennis elbow
- Carpal tunnel syndrome
Refer to pharmacy for medication refills, questions about medication side-effects and drug interactions, and for minor ailments such as seasonal allergies.
As a fellow member of the rehab team, physical therapy may benefit many of your patients. Here are common reasons to refer to physical therapy:
- Fall risk
- Poor balance
- Difficulty walking
- Needs an assistive device for mobility (walker, wheelchair, etc.)
- Managing neurological conditions (Parkison’s disease, CVA, ALS, multiple sclerosis, TBI, etc.) including issues with range of motion and muscle tone
- Aftercare for joint replacement
- Arthritis (increase mobility and strength, improve function, maintain fitness, etc.)
- Urinary incontinence (improve pelvic floor muscle strength, etc.)
- Reduced participation in desired activities (can’t get on their knees to garden, can’t do stairs well, doesn’t get out as much, etc.)
Physical Medicine & Rehabilitation (PM&R or Physiatrist)
Refer to a PM&R doctor to manage muscle spasticity (Botox injections, etc.) or to get approval for a wheelchair.
Refer to a podiatric for foot neuropathy, foot wounds, toe and foot amputations, and diabetic nail care.
Primary Care Provider (PCP)
Communicate with the PCP to initiate a referral to a specialist, if you suspect serious medical issues (stroke, injury from a fall, etc.), to order diet modifications, to request instrumental evaluations, to request tests (such as X-rays), and to review medications.
Psychologist, Counselor, Marriage and Family Therapist, or Social Worker
Refer to a mental health specialist if you suspect unmanaged or exacerbated mental health issues that affect participation in therapy or daily life.
Refer to nursing if you suspect or observe non-urgent medical issues (swelling, bruising, wound, etc.), help with medication management (halving, crushing pills), and trach/feeding tube management and maintenance.
Refer to respiratory therapy for cardiopulmonary problems.
- Manage ventilation or oxygenation for patients on ventilators, CPAPs, and BPAPs
- Managing tracheostomies
- COPD treatment and disease management education
- Treatment of other breathing issues and lung conditions
Refer to support groups for patients and caregivers who would benefit from the emotional, social, and practical support these groups can provide. ASHA provides a list of speech, language, and swallowing support groups.
Refer to urology for outpatients who are ready to remove a catheter or have urinary incontinence, blood in the urine, enlarged prostate, prostate cancer, or frequent UTIs.