School-based Physical Therapy versus Medical Out-patient Therapy Services

I once came across an article on EasyStand that discussed some differences between school-based and clinic-based therapy. For example, a child with significant delays in motor skills may qualify for either school-based PT, Out-patient PT services, or both. I have had the worthwhile experience of working in the school setting and am currently involved in out-patient services. I agree with the merits of the article and can say from experience that there are differences between the two including, but not limited to, procedural qualification, end-goal of services, and payment.

The APTA describes school-based physical therapy as related services under the Individuals with Disabilities Education Act (IDEA). A child who has been qualified by the Committee on Pre-school Special Education (CPSE) or the Committee on Special Education (CSE), which handle the provision of therapy services for children aged 3-5 years old and 5-21 years old respectively, receives related services in the school. The therapy provided is geared towards allowing the child to function optimally in the school environment and follows the child’s Individual Education Plan (IEP). As a physical therapist, this may include helping a child develop muscle strength and balance sufficient enough to sit up independently during circle time, stand up independently from sitting, walk around the classroom, negotiate the school hallways, ascend/descend stairs, and play safely in the playground to name a few. The cost of school-based services is covered by the school district and the state.

In clinic-based settings, therapy is provided after a physician recommends it. The child must have a medical diagnosis that justifies the need for therapy. An evaluation by the therapist would then confirm the presence of physical limitations, sensory needs, speech delays, and/or feeding problems. The goal of out-patient therapy services may include any or all of the following: maximizing the child’s potential in terms of motor skills, behavioral control, nutrition, speech and communication. Out-patient therapy programs also allow for close monitoring of a child’s needs for adaptive equipment that can be used at home, in the school, or in the community. This may be in the form of seating/standing devices, walking aids, wheelchairs, upper/lower extremity orthosis, communication devices, etc. The cost of the clinic-based services is covered via private pay or medical insurance.

Despite the differences and whether the child receives either or both forms of therapy, there is only one end-goal…to help the child attain an optimal level of function and allow independence in the performance of age-appropriate activities.