Clinical-Based and School-Based Occupational Therapy: What’s the Difference?

Oftentimes the question is asked, “What is the difference between occupational therapy (OT) in schools in comparison to an outpatient clinic?”  There are many similarities and the differences may be subtle and challenging to identify. First, with the medical model (outpatient clinic), OT services can address any deficit area for a client, as long as funding sources allow.   In the school-based model, OT services address deficit areas that are related to and impact the student’s education so they must have an IEP (Individualized Education Program).  The purpose of school-based OT is to help a student benefit to their fullest potential from their educational program. 

Outpatient clinic OT services may directly work with areas of deficits such as:

  • Fine Motor /Visual Motor Skills
  • Cognition
  • Executive Functioning
  • Mental Health
  • Sensory Processing
  • Self-Regulation
  • Ocular-Motor Skills
  • Oral Motor
  • Life Skills
  • Strength
  • Range of Motion
  • Balance Coordination
  • Gross Motor

School-based OT services also address the above; however, the deficit must directly impact the student’s ability to access their educational program. For example:

  • Fine motor/visual motor skills to complete school-based tasks
  • Life skills that affect areas such as changing for gym class, independence in the lunchroom, donning/doffing coat for recess time
  • Executive function skills (organization, time management, attention to task, appropriate play)
  • Sensory processing challenges that affects the student’s ability to participate in their school day
  • Strength, which affects the student’s ability to maintain appropriate posture to complete school related tasks

Another important difference in a school-based setting is that not all students will qualify to receive OT.  School-based OT is a related service per IDEA (Individuals with Disabilities Education Act) and a student needs to have an IEP (Individualized Education Program) to qualify for related services.  A very basic example is the child who is receiving outpatient OT to help them become more independent with hygiene, brushing their teeth, washing their hair, and grooming. In a school setting, those tasks are not necessarily performed in school and may not affect the student’s ability to access their education, therefore, he or she may not receive that specific OT service. Another example is the 1st grade student who cannot donn or doff their coat independently and requires assistance from a teacher or staff member each time they prepare for recess or pack up to go home. If the student has related services at school on their IEP, then this area could be addressed by an OT in the school setting. 

It is a confusing difference to understand, but the best advice is to consult with your child’s physician, their clinic therapist and/or educational staff to determine which services are appropriate and necessary. 

Respectfully submitted by: JJ Schweikert, MOT, OTR/L

References: www.aota.org

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