Monthly Topic-October 1999
"Educational Vs. Private Occupational Therapy"
Introduction:
Many parents have come to my clinic very uncertain on the differences between educational vs. private occupational therapy. This is often a topic of dispute between school administrators and private occupational & physical therapists. The fact of the matter is that there is no reason why the quality of each of these types of therapy should differ. However, certain factors exist that can decrease the quality of these services.
If a school system is providing appropriate and quality therapy services in an appropriate setting, this should be equivalent in quality to what could be provided in a clinic.
1)A school system needs to provide appropriate & quality therapy services. This entails employing certified occupational therapists and certified occupational therapy assistants. It is also beneficial that these therapists have ample experience not only in pediatrics, but also in educational based therapy. Many pediatric therapists work solely in hospitals and rehabilitation clinics. This often times limits their scope of experience to disabilities commonly found in those settings(i.e. stroke, head trauma, upper body trauma, hand therapy etc..). Therefore, many of these therapists, although extremely competent, lack the expertise in addressing school-based issues such as handwriting, perceptual skills, and fine motor skills for classroom use and specialty areas such as sensory integration. School administrators need to strive to employ therapists, who have had some direct experience in the schools, as well as relevant continuing education, so that they can best serve the needs of that population. If a therapist lacks the education and expertise in a specialty area such as sensory integration, then private occupational therapy with an occupational therapist trained in sensory integration is a viable and appropriate option.
2)A school system needs to provide appropriate & quality therapy services in an appropriate setting. However, my experience in many(yet not all) public schools has revealed services that are often provided in compromised settings(hallways, closets, breezeways, etc..) and with little available equipment if any. There have also been other instances where a certain type of equipment designed for sensory integration work was not available(suspended equipment, physioballs, scooters etc...). This lack of space and equipment is often blamed on inadequate funding and budget cuts. However, be aware that under the laws governing therapy school systems are required to provide "quality therapy services". Therefore, some monies, funding and school space must be allotted to therapy programs. If this is not the case in your public school, both you and your school therapist should work together to advocate for this space. Hypothetically, this situation is similar to a dentist who would be forced to work in a 5x5 room, with you sitting in a lawn chair, with low lighting and violin tools instead of dental tools. Would you want to go see this dentist? Even though his intentions might be good and he may be a very qualified dentist, the quality of service is not adequate. This is an extreme example, but I feel it makes my point well understood. You need a delineated space and equipment to be able to provide the best quality services. If this is not the case despite your advocating through your local school board, then private occupational therapy becomes a viable and appropriate option.
When are occupational therapy services indicated in school based and private settings?
The school system is only required to provide therapy services as a form of assistance, for those skills, which are needed to complete grade level school activities. This statement leaves a great deal of room for interpretation and bias. What it does clearly delineate is that the school is only responsible to provide therapy services in attempts to help areas that impact educational success. An example of a skill that is not educational based for the most part, is bike riding. A child does not need to be able to ride a bike to succeed in kindergarten. This is not to say that there may be a physical reason that she cannot perform that skill(such as decreased muscle tone, upper body strength, coordination etc..) nor that she could benefit from therapy. However, to receive therapy services in the school these issues must impact educational performance. So another angle that could qualify this child for services would be if she had inadequate strength to maintain an upright posture in her chair during class. A parent in this situation may want to seek outside therapy services to work on the components preventing the child from riding a bike and bike riding as an isolated skill.
Therapy frequencies also vary between school based and private settings. For example, a child may receive one thirty-minute session per week in the school to address their school related issues. A parent may disagree that this is ample time to work on those issues and pursue additional therapy through a private therapist as a compliment. Another aspect that factors into this situation comes back to funding and budget restraints within the schools. Some(but not all) school systems will try to minimize the frequency of therapy services in attempts to stretch their dollars and therapists. This is not acceptable nor is it legal. If you feel that this is the case in your school, advocate for your child, call a formal meeting with your team, seek outside assistance from a private therapist if necessary and execute your due process legal rights.
Another aspect that is considered in qualifying a child for therapy services, is how well a child performs a skill. The school is only responsible to make that child succeed at an acceptable or average range. For example, if a child can cut out the shapes required for a project at their grade level somewhat accurately, they often do not qualify for therapy services. It is not the school's responsibility to make them the "best scissor cutter" in the class, although a parent may desire for their child to have slightly better skills than just average or low-average. This is another instance where private occupational therapy becomes a viable and appropriate option.
Conclusion:
I hope that this has helped to uncover the mystery of school-based vs. private occupational therapy. It can often be a very complicated situation for parents to understand. Parents are then often left only to trust their local school board, some of which are very biased. It is often hard to find unbiased individuals/advocates available to parents to explain and present facts, not opinion. In closing I want to stress that this article in no way is assuming or claiming that all school systems are bias and untrustworthy sources. One would hope that their school board would be just the contrary. School boards have extensive experience with education but not specifically with therapy services. There is much that they do not understand about therapy. Parents and therapists need to continue to educate schools about therapy and the best ways to provide these services.
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