IEP Related Services: The Difference Between School-Based and Clinic-Based Services
Eligibility and Cost
To receive school-based services, children have to meet the criteria for one of 13 qualifying diagnoses under IDEA, and cannot make adequate progress in school without special education services. You must go through the IEP process to receive services, even if the school district is paying for outside therapy.
Children have to qualify for services through a school-based need, explains Melissa Epstein, OTR/L-MA, owner of Thrive! Occupational Therapy. “If your child holds their pencil incorrectly but can keep up with the class and their writing is legible, they won’t qualify for OT. But if it’s inhibiting them from being able to write, they might qualify.”
School-based services are available up to high school graduation or the age of 21, and are provided at no cost to the child’s family.
When communicating the necessity for school-based PT to be included in your child’s IEP, consider what they need to access their education and the school environment.
- Can your child sit in their chair in the classroom?
- Are they able to safely move around the school?
- Can they successfully access necessary learning materials?
- Are they safe on the playground or schoolyard?
“The school is only concerned with the school’s goals,” adds Leslie Lobel, Director of Health Plan Advocacy at Undivided. “If you want PT to take place in school, your child’s IEP goals will have to be framed in a way that will be acceptable to the IEP team.”
Clinic-based services are prescribed by a physician.
Services are available for all ages, and are funded in many ways: schools (if the school does not have services on site), private insurance (either in-network or out-of-network, where superbills can be submitted for partial reimbursement), or government services such as Regional Centers, California Children’s Services, or in some cases, Medi-Cal.
If a clinic accepts insurance, they might be bound by what the insurance provider thinks is medically necessary, says Kimberly Gardener, OTD, SWC, CAS, who worked with LAUSD before opening her own clinic, OT 4 Kids. Gardener advises parents to use private insurance if they have it: “Sometimes you can access clinic services through Medi-Cal benefits, but a lot of facilities don’t accept Medi-Cal. If a child is three or under, a family can consult their local Regional Center to see if their child qualifies for early intervention.”
- School-based assessments look at skills through the lens of how they affect the child’s ability to access their education and school environment, Epstein says. “If a child is recommended for an assessment for school-based therapy due to difficulty remaining in a chair and inability to hold a pencil, the therapist would give a standardized test that provides scores on their current overall level of fine/gross motor skills and sensory processing skills. Specifically, they look for deficits that negatively impact their ability to fully access and participate in their education.”
"The clinics focus is on living skills and activities versus school-based skills." ~ Melissa Epstein, OTR/L-MA, owner of Thrive! Occupational Therapy
- Clinic-based assessments might use the same test but will focus on how it affects the child’s entire life: “The clinic will look at how it affects their ability to sit at a table and participate in a family meal, whereas the school looks at whether they’re able to eat their lunch,” Epstein says. A clinical assessment looking at medical interventions would not occur in a school environment, adds Prine.
The majority of school-based therapy services are provided in the school setting but can also be provided in a clinical setting if the school contracts with a clinic. These services can also be provided through telehealth. “We've created fun games and activities to do at home that address various impairment areas, including strength, balance, coordination, and range of motion to help prevent regression in their gross motor skills,” says Anne Osborn, DPT, a physical therapist who works with school-based and private clients through TherapyWest.
Services can be provided directly to the child or on a consultative basis, where the therapist provides suggestions to the teacher and classroom aides. “School-based therapy can look very different,” Prine says. “It can be more restrictive, where kids are pulled out of class and worked with one-on-one or in small groups, or a push-in model where the therapist gives instruction to the aides in the classroom.”
Treatment settings typically include clinics, hospitals, and homes. During the pandemic, telehealth is the best and only option for some families. Some clinics are also currently providing in-home services or the option to meet in a yard or park, with mask protocols in place for adults and kids who can tolerate them.
Some kids’ presentation does not work well with telehealth, Epstein says. “If you have a kiddo with autism and attentional issues, it can sometimes be very hard to help them virtually. Telehealth works best when the parent or caregiver is an active participant. The therapist is leading the session but describing to the parent how to do the physical cues.”