School Based OT vs. Clinic-based or Medically-based OT: What’s the Difference?

Sometimes there can be a lot of confusion around the similarities and differences between school-based occupational therapy (OT) services and clinic-based or medically-based OT services for children.

School-based OT services are dictated by federal and state education law in the United States, and the purpose of OT in schools is to support students in accessing their education. This means that children are able to receive OT support to help them benefit from participation in the educational environment. All children have the right to a free and appropriate public education (FAPE), including those with disabilities. Therefore, school-based OT services must be educationally relevant. That is, they must support the needs of students as related to their ability to participate and access the school environment and their educational programming. OT services, when provided through special education, must be directly related to supporting core standards of education for each state. School based services are funded by the government and are utilized for the primary purpose of helping students access their education.

Medically, or clinic-based OT services, on the other hand, are geared towards remediation or development of skills as needed to participate in one’s home life, community based activities, or to recover from illness or injury. Medically based services are usually either paid for out of pocket or through health insurance.

While there may be overlap between medically-based OT and school-based OT regarding skills development and therapeutic strategies used, school-based OT practitioners also need to be knowledgeable about the federal and state laws that dictate general education and special education, the educational environment, and the demands of academic curricula on children of different abilities. Occupational therapy evaluation, assessment, and intervention encompasses both the academic and non-academic contexts of the school day and environment.

Additionally, education law also states that occupational therapists are specialized instructional support personnel (SISPs) and can act on behalf of all students for early intervening services to help prevent referral to special education and to promote health participation for all students in school. The professional background knowledge of OTs about child development, disabilities, and the impacts of occupation and participation on health across the human lifespan help to shape the role of OT in schools.

It is important for parents, caregivers, and community-based healthcare professionals such as pediatricians, developmental psychologists, and psychiatrists to be aware of the differences between clinically-based therapy services and school-based therapy services. With the best interests of the child being the main focus, the assumption can be made that all practitioners do their best to advocate for children and their families regarding services and referrals to the proper practitioners. The context of the setting (ie., home vs. school) for therapy greatly influences the types of interventions and the goals of the interventions provided to children.

The families of children who seek out therapy services benefit from consistency and collaboration among the practitioners who serve them. Providing families with knowledge of systems, proper referrals, and combatting misinformation are essential to evidence-based care that minimizes stress and confusion for consumers.

Practitioners who are knowledgeable about the differences between clinically/medically-based therapy services and school-based therapy services can provide families with useful knowledge, support, and guidance as they navigate the variety of services that exist for their child.