School Based Therapy vs. Medical Based Speech Therapy

School Based Speech Therapy Services

This model of therapy focuses on the skills impacting the child’s education performance or their ability to access the curriculum. This means that there has to be a negative impact on academics to qualify. States and districts have guidelines that they follow and are governed by IDEA (Individuals with Disabilities Education Act).

Cost: Free

The criteria to qualify in the school system is a lot more involved and can be more lengthy than in a clinic.

To qualify in the schools, the answer has to be yes to the following questions:

1.    Is there a disorder/disability present? (typically in the moderate to severe range that meets state/federal guidelines)

2.    Is there an educational need?

3.   Is there a need for specialized services?

Qualifying can not be based on the results of one test and can not be due to a lack of educational opportunities or second language acquisition.

Process in Texas:

• Referral Meeting

• Notice and Consent to Evaluation

• Initial evaluation (SLP has 45 school days to complete the testing once consent is signed)

• Initial ARD/IEP Meeting (scheduled 30 school days after testing is completed)

Should the student meet the criteria as a student with a speech impairment:

• Therapy Model: Student is pulled from their class one - two times per week in a group setting (depending on their IEP schedule of services)

• Re-evaluation: Students must be re-evaluated every 3 years to determine eligibility for school services.

Clinic or Medical Based Speech Therapy Services

This model of therapy can vary per facility but it typically focuses on building skills to improve the quality of life. Many facilities use a patient centered or strength based model. This model may qualify students with mild to severe disorders/disabilities if the services are determined to be medically necessary through an evaluation.

Cost: Depends on insurance coverage or if your provider is private pay only.

Qualifying: It is not governed by a specific agency. Most require a referral from a physician and some or all of the following:

1. Results of standardized tests and observations that indicate below average skills.

2. Clinical judgement/professional opinion of the therapist.

3. Criteria set by Medicaid or Insurance (some require pre-authorization).

To qualify: A child is typically scheduled for an evaluation that is completed within one or two appointments. The therapist will administer standardized tests, observe the child, interact with child (typically through play), and give the caregivers checklists/forms to fill out. A child will receive a diagnosis if a disorder is present to begin therapy (in the applicable areas for speech, occupational, or physical therapy).

Medicaid/Insurance: Some require the initial evaluation to be submitted for approval before they will pay for therapy sessions. The number of sessions authorized may be limited by the insurance policy (i.e. 12 sessions per term).

Private pay: If your provider is private pay only, you may be able to begin therapy immediately after a disorder or delay was determined by the initial evaluation.

Re-evaluation: This varies by insurance and by providers, but typically a child must be re-evaluated every 6-12 months.

Therapy model: Usually, this is offered through individualized interventions. Sessions are at a clinic or in the client’s home, if it is home health services. The therapist will determine how many sessions per week the student will need to make progress.

FAQ

Why did my child qualify in the clinic but not in the school?

• Your child may have presented with a mild delay or disorder (not meeting state or federal guidelines for eligibility)

• Your child may not have a negative educational impact (their grades are good, they are performing on grade level, etc..).

• Your child may not need specialized services (their teacher can assist them in the general education classroom).

Why does my child receives direct services in the clinic but only consult services in the schools?

• Your child’s therapist may be able to provide staff training, observations, and consultations with the teacher to meet your child’s needs without having to remove them from class regularly. They may meet with your child periodically (remember least restrictive environment? )

Can my child receive both clinic/medial and school based therapy services?

• Yes, you may choose to take your child to outside therapy services even if they receive school services (you will be responsible for the cost). It is helpful if you provide your plan of care with the school therapist and the IEP with the private therapist. In a perfect world, the providers would work together but remember, school services have to focus on helping the child succeed in the school environments (private SLPs are not bound to this). You may notice a difference in goals based on this.