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Outpatient vs School-Based Therapy Pediatric Settings

All therapists, no matter the discipline, have a common goal in mind and that is to help individuals achieve independence and improve daily functioning at any age of life. Despite the setting, therapists strive to construct an individualized treatment plan that addresses the goals and needs of both the client and families. Understanding the nuances of both outpatient and school-based services is important for proper advocation of a child's needs; however, can also be confusing at times. This blog's purpose is to help educate others on both types of pediatric therapy settings.


Therapies are considered a "related" service

  • Services will only be provided if they are "educationally necessary"

  • Educationally necessary means the concerns are impacting their ability to learn and access their educational environment

  • All skills addressed must directly help the child access their school and education, not necessarily their community or home environment

  • Governed by federal and state laws

The need for services is declared by the IEP (Individualized Education Plan) team

  • An IEP is developed to layout the special education, supports and services the child needs to progress in school

  • The IEP team is comprised of any discipline who works with the child such as teachers, therapists, psychologists social workers etc.

  • Parents are apart of the IEP team and are participate in the decision making process

  • The entire team helps develop the frequency, duration, and amount of therapy a child may need (if needed)

  • Parents, teachers or staff at the school can refer a child for therapy services

  • Services can only be stopped with approval from the IEP team

Therapy can take place individually, in small groups, or in a "push in" style

  • Some children may only require consultations, which means that related service team members may provide staff training, classroom modifications and provide strategies for stakeholders to implement directly with the child

Some children may require a 504 plan instead of an IEP plan

  • A 504 plan helps to modify and provide changes to a child's regular educational program in a regular classroom environment

  • A child with a 504 plan will not receive services or support in a special education classroom

  • Participation from parents to create a 504 plan is not necessary unlike an IEP plan


A medical model

  • The primary focus of this setting is to enhance functional independence in the community and at home, which can also mean educationally

  • Child is typically referred to this setting by a physician; however, referral can also come from a teacher or parent

  • Therapist can address any skills that are impacting the child's ability to participate and function independently in any environment, not just educational based skills

  • There is a chance a child would qualify for services in the clinic but, not at school because their type of needs may not be impacting their participation in an educational environment

Evaluation can take place in a clinic, hospital, or community based setting

  • Evaluation results are discussed with the family

  • Caregivers play an active role in goal creation alongside the therapist

Service Coverage

  • Some or all of therapy services may be covered by insurance or individual would be responsible for the out-of-pocket expense

  • Coverage for therapy is dependent on medical necessity and that the child presents with clear skill deficits that need to be addressed


Interdisciplinary collaboration

  • Collaboration between disciplines is very common in both settings

Discharge when goals are met

  • In both settings, a child will be discharged from services once goals are met or there is a plateau in skill development

  • Children may resume therapy at any point in time if they begin have difficulty with tasks or certain skills

We all want your child to flourish

  • No matter the setting, all therapists want to help your child, succeed, grow, and become independent individuals!


Region 10 Education Service Center. (n.d.). School based vs. clinical based therapy. Region 10 Website. Retrieved February 21, 2022, from

Mangano, J. (2017, August 1). Outpatient therapy vs. school based therapy. Arizona Orthopedic Physical Therapy. Retrieved February 21, 2022, from

Palladino , B. (2019, July 24). Outpatient vs. school-based occupational therapy. Outpatient vs. School-Based Occupational Therapy. Retrieved February 21, 2022, from


The content in this blog should not be used in place of medical advice/treatment and is solely for informational purposes. All activities/exercises posted in this blog should be performed with adult supervision, caution, and at your own risk. Big Leaps, LLC is not responsible for any injury while performing an activity/exercise that has been posted on this blog. If you have any information on the content of our blog, feel free to contact us at


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