Outpatient Therapy Vs. School Based Therapy: What’s The Difference?
Navigating the landscape of pediatric therapy services can be complex, particularly when differentiating between outpatient and school-based therapy services. Both offer support but target distinct aspects of a child’s development and learning.
This webpage is dedicated to shedding light on the unique features and benefits of outpatient versus school therapy services, providing clarity for parents and caregivers embarking on this important decision.
Outpatient pediatric therapy delivers targeted, customized care for children facing developmental, physical, and cognitive challenges, conducted in specialized clinics or hospitals utilizing a broad range of therapeutic techniques.
In contrast, school-based therapy is designed to enhance students’ academic and social success directly within the educational setting, seamlessly integrating therapeutic interventions to support learning engagement and peer interaction.
Frequently Asked Questions
School-based therapy services allow your child to receive therapy related to the school environment and achievement of academic goals. Outpatient therapy services allow your child to receive therapy focused on goals within the home and community environments. If you are currently receiving outpatient therapy services, please consult with your child’s therapy provider about receiving services concurrently and what questions or concerns you may have.
Attending OT services in the school and outpatient settings enables the child to receive intervention across all environments to thoroughly address their needs within the school, home, and community environments. While school-based services support the child’s academic achievement, outpatient services can support the child’s independence and engagement in age expected skills in a variety of areas such as self-cares, play, emotional regulation, independent living skills, and social skills through interventions targeting strength, coordination, sensory processing, motor planning, regulation and executive functioning.
A child would benefit from PT in both settings if they are having difficulty in both the school setting and home/community setting. Services at school are focused on accessing the school environment and the student’s education. The medical model of an outpatient clinic can focus more on home, community, and specific medical needs. Just because a child is getting PT in one of the settings, does not mean they automatically need PT in both settings nor does it mean that they cannot receive PT in the other setting.
For some children, the frequency or intensity of physical therapy they receive at school will not meet all of the child’s needs for physical therapy. There may be goals that are not addressed by school-based therapy that would require services from the medical model of an outpatient clinic.
Speech therapy in an outpatient setting allows a child to receive services related to deficits or difficulties that present related to overall communication (e.g. speech, language, social pragmatic language, AAC, feeding/oral motor, fluency, etc) within the home and community environment. School-based services can begin when a child turns 3 years old and focus on if there is an educational impact, such as speech/language impairments that impact the student’s performance educationally. If there are concerns with overall communication abilities within the home and community environment, outpatient speech therapy may be beneficial. Outpatient speech therapy can focus on early language speech/language intervention, speech sound production, feature matching for speech generating devices and AAC trials, feeding and swallowing goals, social pragmatic language, fluency, apraxia of speech, and carryover/home programming for families related to speech/language areas of need.
In short, yes! Following an evaluation, the outpatient speech language pathologist will determine qualification. It is common for patients to be discharged from school-based speech services prior to discharging from outpatient, as well as qualifying for outpatient despite not qualify for school-based services. School based services are often picked up if their speech and/or language delay is directly impacting the child’s educational performance. For example, a student might not have their /r/ sound, which might not negatively impact their reading or spelling scores. Therefore, the student would not receive services within the school setting. In outpatient services, goals are established directly addressing family concerns.
Occupational Therapy
School
Clinic
School Focus
Focus
School-based occupational therapists work with children to help them develop the physical, cognitive, and sensory skills necessary for greater independence and academic achievement. This support may encompass academic, social-emotional, or sensory processing areas.
Clinic Focus
Occupational therapy services in the outpatient setting assist children in improving their overall well-being and maximizing independence in all areas of their day-to-day lives. This includes self-care, play and leisure, social participation, transitional/work skills, independent living skills, emotional regulation, executive functioning, fine motor skills, strength and coordination, and sensory processing.
School Eligibility
In order for a student to receive occupational therapy in the school environment, they must qualify for special education services under one or more of the 13 disability classifications listed under the Individuals with Disabilities Education Act (IDEA) and have an Individualized Education Program (IEP).
Occupational therapy serves as a related service, not a standalone special education service in schools. A related service may be required to assist a child with a disability to benefit from special education but cannot be the sole service they receive.
The criteria for occupational therapy fall within a related service’s definition: Does the child need occupational therapy to benefit from special education? Related services are provided only when they support an educational need.
They are not provided due to transportation problems or other obstacles in obtaining outpatient occupational therapy. In a school setting, a doctor’s order alone does not determine the need for school-based therapy.
An occupational therapist (OT) does not require a written referral from a physician to provide services in schools to children with disabilities. Therapy is provided in the school as a related service to meet the student’s educational goals.
The IEP determines the need for therapy in a school-based setting.
School-based OT focuses not on medical needs, but on the student’s ability to functionally access the school environment.
If a student qualifies for accommodations under Section 504, they are also eligible for school-based OT
Eligibility
Clinic Eligibility
A prescription from the child’s doctor is required to begin the OT evaluation process. The occupational therapist will conduct an evaluation to determine if outpatient occupational therapy services are warranted and medically necessary.
School Intervention Delivery
As a related service, OT in schools can be delivered directly through one-on-one or group sessions, or indirectly via consultation and collaboration.
During collaborative consultation, the child’s teachers and therapists collaborate to identify daily needs and develop and implement strategies, ensuring the integration of occupational therapy into the student’s classroom or school activities. OT may also play a crucial role in two other areas of a student’s Individualized Education Program (IEP).
The first area is within the supplementary aids section, where the OT assists the IEP team in selecting any necessary adaptive equipment for the student, focusing on adapting the environment or providing accommodations to enhance the student’s participation in school.
The second area involves program modifications and supports, which are services or activities required by school personnel to effectively deliver services.
Intervention Delivery
Clinic Intervention Delivery
OT intervention can be delivered in community environments such as outpatient clinics, pools, daycares, etc., as well as in the home environment, depending on the needs of the child and family.
Physical Therapy
School
Clinic
School Focus
A school-based physical therapist evaluates how a child physically accesses and participates in their school environment. This includes assessing whether the child can safely navigate the classroom and school building, including curbs, ramps, and stairs. It also involves determining if the child can physically access educational materials, navigate busy hallways and common areas, safely use playground equipment, cafeterias, and restrooms, and participate in physical education classes.
School-based PTs also contribute by recommending environmental adaptations, ordering and overseeing the use of equipment such as adaptive seating, standers, and gait trainers, and providing training for staff on the proper use of this equipment and necessary student transfers, such as moving a student to and from their wheelchair.
Their overall goal is to support the student in achieving educational objectives and enhancing their access to and participation in the school setting.
Focus
Clinic Focus
Physical Therapy services in an outpatient clinic focus on evaluating how a child physically accesses and participates in their home and community environments, and on identifying ways to enhance that participation. Outpatient Physical Therapists also support environmental adaptations and are involved in the selection, ordering, and monitoring of equipment necessary for the child’s mobility and accessibility.
School Eligibility
To qualify for physical therapy in the school environment, a student must be eligible for special education services under one or more of the 13 disability classifications listed in the Individuals with Disabilities Education Act (IDEA) and have an Individualized Education Program (IEP). Physical therapy is considered a related service, not a standalone special education service. It is intended to assist a child with a disability to benefit from special education when necessary, but it cannot be the sole service provided. The need for physical therapy is determined based on whether it supports the child’s educational needs, as defined within the scope of related services: Does the child require physical therapy to benefit from special education?
Related services are provided only to support an educational need, not for reasons such as transportation issues or other barriers to accessing outpatient physical therapy.
In the school context, the necessity for school-based therapy is not solely determined by a doctor’s order. A PT does not need a written referral from a physician to serve children with disabilities in schools. Instead, therapy is provided as a related service aimed at achieving the student’s educational goals, as outlined by their IEP. The focus of school-based PT is on enhancing the student’s ability to functionally access and participate in the school environment, rather than addressing medical needs.
Additionally, students who qualify for accommodations under Section 504 are also eligible for school-based PT.
Eligibility
Clinic Eligibility
A doctor’s prescription is required to initiate the PT evaluation process. The physical therapist will then conduct an evaluation to determine if outpatient physical therapy services are warranted and medically necessary.
School Intervention Delivery
As a related service, PT in schools can be delivered directly through individual or group sessions, or indirectly via consultation and collaboration. In collaborative consultations, the child’s teachers and therapists collaborate to identify daily needs and devise and implement strategies, ensuring that physical therapy is seamlessly integrated into the student’s classroom and school activities.
PT may also contribute to a student’s IEP in two additional areas. The first is within the supplementary aids section, where the PT advises the IEP team on any adaptive equipment the student requires, with a focus on modifying the environment or providing accommodations to enhance the student’s school participation. The second area involves program modifications and supports, which are services or activities necessary for school personnel to support the student. For example, if a student requires adult assistance for transferring from one chair to another—a supplementary service—a teacher or paraprofessional might need training from a PT on how to safely perform this transfer, which constitutes a program support for school personnel.
Intervention Delivery
Clinic Intervention Delivery
PT intervention can be provided in various community environments, such as outpatient clinics, pools, daycares, etc., as well as in the home environment, depending on the needs of the child and family.
Speech Therapy
School
Clinic
School Focus
School-based speech therapy is available to students who exhibit communication delays that negatively affect their educational performance and qualify for these services according to the Department of Public Instruction (DPI) Speech or Language Impairment checklist. On the DPI checklist, a student can qualify based on various areas, including language, speech sound production (articulation), speech sound production (phonology), voice, fluency, or augmentative and alternative communication (AAC).
Services can begin as soon as a child turns 3 years old and may continue throughout their school years, provided the student’s deficits significantly impact their academic achievement and educational performance.
Focus
Clinic Focus
Outpatient speech therapists focus on addressing communication impairments or deficits within the home and community environments. Patients can begin receiving services from birth through early adolescence. Individuals can qualify for speech and language services across all nine major areas that Speech-Language Pathologists (SLPs) address, including articulation (encompassing phonology, apraxia, and speech sound deficits), fluency, voice, receptive and expressive language, hearing, swallowing (including feeding concerns), cognitive aspects of communication, social aspects of communication, and a variety of communication modalities. These modalities extend to but are not limited to, sign language/gestures, the Picture Exchange Communication System (PECS), switch access, and Augmentative and Alternative Communication (AAC) devices, such as touch screens, head tracking, and eye gaze technology.
School Eligibility
Speech services in educational settings can function as either a related service or a standalone service. Students may become eligible for speech-only services after undergoing an evaluation by their school district, focusing on areas such as language, speech sound articulation, phonology, voice, fluency, or augmentative and alternative communication (AAC). Eligibility is contingent upon the presence of deficits that negatively affect the student’s educational performance, impacting areas like reading, spelling, and peer-to-peer social interactions.
Key exclusion factors must be considered during the evaluation process. It is crucial to ensure the student has had sufficient exposure to the language being assessed and to recognize that observed differences are not simply attributable to the student’s cultural background, native language, or dialect.
Eligibility
Clinic Eligibility
If a parent is interested in outpatient speech services for their child, the first step is to obtain a prescription from a physician or primary care provider. Following this, a speech pathologist will conduct an evaluation to determine the child’s eligibility for outpatient services. This evaluation may involve formal testing or informal measures, such as reports from the parent and observations by the speech pathologist.
Intervention Delivery
School Intervention Delivery
Speech services within a school system are typically delivered in two formats: push-in and pull-out services. With push-in services, the school’s Speech-Language Pathologist (SLP) works with the student in their regular classroom setting, facilitating the achievement of speech goals while allowing the student to remain engaged with the core curriculum. This approach supports continuous exposure to and participation in the educational content alongside peers.
When the SLP assesses that a student would benefit more from individualized or small group attention, pull-out services are recommended. In this model, the speech pathologist provides specialized support outside the regular classroom environment, which could be in the special education classroom, the speech pathologist’s room, or even a quiet space in the hallway. This method focuses on addressing specific speech-related goals in a setting that minimizes distractions and allows for targeted intervention.
Clinic Intervention Delivery
The majority of patients are recommended to receive outpatient services once to twice a week for 30 minutes to address speech and language concerns. If the therapist identifies that both speech and feeding concerns require intervention, the treatment duration is increased to 45 minutes to ensure there is sufficient time to address both areas comprehensively. Speech therapy can be provided in various community settings, including outpatient clinics or daycares, as well as in the home environment, depending on the specific needs of the child and their family. Additionally, episodic care is available on an as-needed basis to support achieving family goals.