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Outpatient Therapy Vs. School Based Therapy: What’s The Difference?

Sometimes, determining what kind of services your child needs and where to get them can be
overwhelming. The lists of questions can run a mile long. “Does my child need outpatient
therapy?” “How can they get school-based therapy?” “Why does my child get outside therapy,
but school says they aren’t eligible?” Let’s take a closer look at the differences between
outpatient therapy and school-based therapy for a clearer picture.

Clinic Based:

In outpatient therapy, therapists will receive a referral from a child’s pediatrician that will indicate
a need for therapy. Based on the evaluation assessment and caregiver concerns, the need for
therapy is determined, as is the plan of care. In a clinic-based setting, the scope of practice is
broad, and other areas outside of education can be addressed. This allows for more intensive,
frequent, and focused therapy. In OT for example, goals can address anything from self-help
skills to sensory integration therapy to play skills. There is typically more access to a variety of
sensory and gross motor equipment in a clinic, as well as the ability to see a child in a more
individualized setting. Goals are created in the plan of care and are updated frequently by
therapists in progress notes and re-evaluations.

School Based:

School based therapy can be confusing to parents and even teachers when determining
qualifications of services. In the educational model, Occupational Therapy and Physical Therapy
are considered “related services”. This means that in order for a child to be eligible for OT and
PT at school, they must have an IEP, or Individualized Education Program. A child can also
have a 504 plan to receive services, as deemed necessary by the IEP team. As related
services, OT and PT support the child in the classroom environment and focus on the academic
impact of the student’s needs. OT and PT typically do not have their own stand-alone goals in
the IEP, as they support the goals of the teacher and will often collaborate with the teacher of
record to ensure that the goals incorporate their OT or PT needs. Speech Therapy, however,
can be a standalone service in the school setting while the focus of goals and treatment will be
through an academic lens. Services in the school setting can also look a bit different than in a
clinic. This might look like one-on-one or group therapy (direct therapy), or it could include
talking with teachers to implement programs, provide adapted equipment, or adapt the
classroom environment to best suit a student’s needs (consultative service). When determining
services, it is also important to consider the student’s “least restrictive environment”, meaning
that direct therapy may not always be in the best interest of the student if it restricts them from
class time. Often times, therapists will provide therapy in the classroom in the student’s natural
environment. This helps with carryover and for the teacher and aids to see what is being worked

Take Away:

Clinic based therapy and school-based therapy can look very different, however, these
differences are there to help your child learn and develop in their most natural environment. If
you have questions about receiving outpatient therapies, talk with your pediatrician and request
a referral or screening. If you have questions about getting school-based therapies, ask your
child’s teacher, principal, or your school’s therapist for more information.

– Katie Collins Stotts, MSOT, OTR/L