School vs. Private Therapy Services

School vs. Private Therapy Services

What’s the difference between therapy a child receives through the public schools and therapy at a private clinic? Can’t I just get the same services for free at the school? My child receives therapy at a private clinic so why won’t the school provide him services as well?

As an SLP who has worked both in the public schools and now at a private clinic, I’ve seen how confusing this topic can be for parents. It’s difficult to understand why a child qualifies in one place but not the other or what the differences in services entail. While services seem similar at a surface level, there are important differences in the way therapy works between the school and private clinic environments.

Let’s start with some basics about environments. 

First, speech-language pathologists, occupational therapists, and physical therapists work in a variety of settings including: medical settings (e.g. hospitals, rehab centers, or skilled nursing facilities), educational settings (e.g. schools), private clinics, or in patients’ homes through home health agencies. Regardless of the setting a therapist ultimately chooses to work in, SLPs, OTs, and PTs undergo the same education, licensing and certification. That means no matter where your child receives services, they will be supported by a therapist with the same basic education and training.

Because we have the same training and education, we can address the same sorts of difficulties. If your child is struggling with a speech sound, a school-based therapist or private therapist are equally equipped to help. If your child is having trouble with handwriting and fine motor skills, OTs can help either privately or at school. However, it is important to note that while therapists are qualified to and often do treat the same difficulties, the primary focuses differ. In the school setting, the focus of therapy is success in the educational environment. This focus is heavily reflected in the qualification process.

Speaking of qualification, one of the primary ways school-based and private therapy services differ is the basis on which children qualify for services. Regardless of the setting, the first step in receiving services is evaluation. In a private clinic, a child qualifies for services when he or she demonstrates a disorder or disability based on that evaluation. In the schools, a similar evaluation is conducted, but school therapists are looking at additional factors when it comes to qualifying for services.

In the school setting, in order to qualify for services: 

1) A child must present with a disorder or disability.

2) That disorder or disability must adversely affect educational performance.

3) The adverse effect must require specialized services that cannot be provided by the general education teacher. 

The educational need part of the equation is critical. When children are receiving services at school, they are missing some other part of their school-day. Children are generally not allowed to be pulled from specials (music, art, PE) or non-instructional (but important) periods such as recess or lunch, so most likely they will be missing some sort of instructional time. Accordingly, the team making these decisions (teachers, parents, administrators), have the responsibility to make sure that the time spent receiving this therapy is worth the cost of what the child will potentially miss and that therapy is necessary for the child’s overall educational success.

So let’s look at a common example: a child who is having difficulty producing the “r” sound. Assuming the child is old enough that this is no longer an age-appropriate error, the child would qualify for services privately. However, this only meets the first criterion for qualifying for school based services. If this child is doing well in school, is unafraid to speak up in class, and has strong peer relationships, we don’t really see the error affecting the child’s educational experience. Therefore, it wouldn’t make much sense to remove this child from his or her regularly scheduled school day to receive therapy. But, what if the error is starting to show up in the child’s writing (e.g. “wed” instead of “red”)? What if the child doesn’t want to participate in classroom discussions because he or she is embarrassed of the sound error? What if peers are making fun of the child and the child is starting to resist participating or engaging in school? These are some of the factors that would indicate an educational need for speech therapy.

To make matters even more complicated, in the schools, OT and PT are considered related services. Related services cannot stand alone, but must be in support of academic goals laid out in a child’s individual education plan (IEP). That means that a child must first qualify for services under one or more disability categories, then require the related service in order to make progress on the goals established in his or her IEP.

Let’s look at handwriting as an example for this case. In the private setting, a child with fine motor difficulties affecting his or her handwriting would qualify for services. However, in order to receive OT at school, that child would need to have instructional goals under his or her individual education plan, for example in writing or language arts, that OT could participate in. If the child is otherwise performing on-level academically, as a related service, OT would not have any basis on which to qualify the child.

Service delivery models also differ significantly in the school and private settings. For speech in particular, school is almost always group-based (i.e. activities involve peer groups) and private is almost always individual (i.e. 1-on-1 sessions with the therapist). The amount of time spent in therapy each week can also vary, especially for OT and PT. 

Particularly with speech, in the school setting, therapy sessions are almost always group-based. With the number of children that SLPs have on their caseloads and the challenges of scheduling all those children while considering what parts of the day they will be missing, pulling children in groups is inevitable. The group setting provides its own set of benefits. Children are able to learn as they listen to their peers’ errors and successes. Socially and emotionally, participating in speech together helps children see that they are not alone in their struggles. Additionally, groups can help with carryover into natural environments since they’re already practicing new skills with peers. Despite these benefits, in the private setting, insurance often does not cover group therapy, so sessions are almost always individual. Individual therapy has its own benefits as well, often allowing for more repetitions and the undivided attention of the therapist on that child’s goals.

The amount of time in therapy may also look different. In my personal experience, school-based speech sessions were almost always 30 minutes, most often twice weekly, whereas in the private setting, my sessions are 50 minutes, most often weekly. Session length can vary from clinic to clinic, and obviously frequency is determined on an individual basis for each child. These are the most common service delivery models I’ve used. For OT and PT, most kids will spend more time in therapy on a weekly basis in the private setting than in the school setting. Part of this discrepancy comes from the focus of therapy. Whereas in the schools, focus must be on the educational environment and academics, in the private setting OT and PT are covering a much broader scope of functional, everyday activities. In the schools, kids may only need 30 minutes weekly or biweekly to meet their goals, but in the private setting kids often participate in hour-long sessions once or twice weekly (once again depending on individual needs).

Whew! That’s a lot of information. The most important takeaway is: whether your child receives therapy in school, privately, or in both settings, the ultimate goal of therapists is your child’s success across all environments.

Kristen Bradshaw, M.A. CCC-SLP

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