School-based physical therapy vs. clinically based physical therapy for school-aged children

Pediatric Physical Therapy in Public schools: Medical vs. Educational Model

There are primarily four ways a child can receive pediatric physical therapy once a need has been identified.

• a hospital or an outpatient clinic; served by medical model

• outpatient clinic; served by medical model

• home based services; served by medical model

• school based services; served by educational model only when physical therapy is

required to meet educational needs

The factors determining need for intervention may be very different in these two

models. This can sometimes be very confusing.

In the medical model:

• Referral is initiated by the physician based on a particular diagnosis or observed

delay in one or more areas of development

• The parent is then referred to a hospital or clinic for an evaluation and/or

treatment by the appropriate professional.

• Need for service is primarily based on testing and clinical observations. The

assessment would take all settings into consideration.

• Children with mild, moderate and severe deficits may qualify for services.

• Therapy can address movement quality as well as function.

• The parent is responsible for obtaining the needed services as well as payment for

those services.

• Health insurance may frequently assist with payment, but not always.

In the educational model:

• Physical therapy is provided by schools as service only when it is related to

educational needs.

• Related services are possible only when they are “required to assist a child with a

disability to benefit from special education".

• Need for service is primarily based on testing, classroom observations and input

from the student’s IEP team. However, the child is only assessed for needs

associated with his or her educational program.

• The school district must establish whether the service is needed for the child to

benefit from his or her education. There are many "related services" that might

benefit a child with a disability, just as there are many services that might benefit

a child without a disability.

• In general, students with significant need qualify for as these services in order to

benefit from their special education.

• Related services, like physical therapy, are only provided when the student's

educational program would become less than appropriate without the service.

• A child who does not perform to what may be his/her full potential but does

function adequately, would not qualify for school based services.

• Related services are provided only when they support an educational need. They

are not provided when there is a transportation problem or other obstacle in

getting outpatient or home based physical therapy.

Some children will receive services through both models. For some children the

frequency or intensity of physical therapy they receive at school through the educational

model will not meet all of the child's needs for physical therapy. There may be goals that

are not addressed by school based therapy and would require home or community based

services from the medical model. In each setting, the child should be assessed

individually to determine the best way to meet his or her needs.