Learn more about the differences between a school therapist and a clinic based therapist.
One of the most challenging parts of being a school therapist is defending the decision not to recommend therapy services in the educational setting. I have sat through numerous IEPs and MFEs during which this has been a huge point of contention. And, I, as a non-confrontational person who hates to have people mad at me, stutter and stammer my way through the explanation every single time….even after 18 years of experience!
Luckily, there are some strict guidelines for determining eligibility for OT or PT in the school setting to rely on. Some are VERY clear, but others aren’t.
School therapy interventions focus on access to and safety of the environment (classroom, hallways, cafeteria, playground, bus). According to IDEA, school based therapy as a related service provides assistance to a child with a disability so that they can benefit from special education. Clinical therapy focuses on a child’s ability to functionally access their home or the community and tends to be more specialized with a focus on things like modalities and bracing to improve function.
School Based Therapy
In the educational setting, therapists work as part of a team that can include teachers, psychologists, interventionists, and other therapy staff to create goals that can assist a child to maximize their ability to participate in the school environment. Any child who meets a diagnostic criteria under IDEA or who needs therapeutic assistance to help with IEP (Individualized education plan) goals is eligible. Teachers, a parent or any member of a child’s educational team can refer a child for therapy services.
Upon appropriate referral, a therapist may evaluate a child using observations and appropriate tests to determine the need for intervention in the educational environment. Together, the child’s team determines eligibility and frequency for therapy and helps to establish IEP goals that are educationally relevant for each individual child. School based therapy services can be provided within the classroom (Pushing In Model), via direct intervention in a one on one setting with the child, or in a small group setting. School based therapists also provide consultation and collaboration with school staff and parents/guardians.
Documentation for school therapists is in the form of the multifactored evaluation (initial evaluation and a re-evaluation every 3 years or upon transition from preschool to school age services) and on the IEP which is written in understandable language for the whole team. The services are free of cost to families under IDEA; however, some districts may bill Medicaid eligible students with a parent’s permission.
Clinic Based Therapy
Clinic based therapists work with any child with a medical diagnosis that requires the expertise of the therapist to address an impairment related to that diagnosis. Children are referred to a clinic based therapist by a physician or other medical professional — unless a state has direct access.
Evaluation by occupational or physical therapists includes use of appropriate tests and observation within the clinic, home, or community setting. The evaluation report is used to create a plan of care that is shared with the physician and other team members. The plan of care establishes goals and frequency of therapy and services are provided through direct intervention that is typically on a one-on-one basis.
Documentation for clinical services is typically in the form of daily treatment notes in a patient’s medical chart and is usually written using appropriate billing codes with compliance for insurance reimbursement. Reimbursement for services may be limited by insurance coverage or patient’s ability to pay privately.
There is a lot to think about when comparing and contrasting these services for children. Parents want the best, and the most, for their children. Sometimes it is difficult to help them understand why we are unable to provide the services they think their child should have in the educational environment.
The free printable above would be a great handout to use during these discussions.
Learn more about how to tell when kids need physical therapy in school.
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