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  • Sarah Cicconetti, MA, CCC-SLP

Fall into Therapy - How to Manage School Based and Outpatient Therapies

The retail stores are already rolling out jack-o-lanterns and twinkly lights in anticipation for end of year festivities, but some of us just aren’t ready to let go of the dog days of summer. As we are all forced to transition from summer to fall, many end up juggling a combination of summer and school schedules and activities; leaving an important question lingering in the minds of many parents: where does outpatient/private therapy fall in the fall? When bus schedules, car-pools, extra-curriculars, and school-therapy are back in session, what happens to outpatient therapy? Is school therapy enough on its own? Do we need both outpatient and school therapy? Do we have time for both? Is it too much for my child? Heck, is it too much for me?

There is not one, right answer. Each family unit is different, and that’s okay. Each child is different, and that’s okay, too. But hopefully, providing a few facts and narrowing down a few details can help if you’re contemplating any of these questions for your own child, self, and family.

The facts about school therapies

School therapy is only provided for children who require specialized services/instruction to help them access what goes on in their classrooms (that includes moving around in the classroom, handwriting, articulation, etc.) Each district writes a plan, called an Individualized Education Program or IEP, to follow in regards to targeted skills, time, and where the services take place. These services can vary slightly based on the school district. Some districts write the number of therapy minutes based on weeks, months, quarters, or semesters. There is a big difference between 90 monthly minutes and 90

quarterly minutes, which breaks down to 30 minutes per month over 3 months...which is less than 10 minutes a week. The unfortunate truth about school based therapy is that high caseloads and small budgets force therapists to see students for the fewest minutes needed to make minimal progress. Some districts specify that services are provided “individually” (one student and one therapist) and some by groups (2 or more students, or even a whole class) and some don’t specify. There’s a big difference between a child getting the undivided attention of a therapist versus a therapist attending to 3 clamoring children simultaneously. If an IEP doesn’t say “individual”, then a therapist could present a lesson to an entire classroom of 20 or more kids--when that happens, IEP minutes get met, but children don’t get the guided, directed, and individual time and attention they need. School therapy is geared toward academic progress, which is a great start, but sometimes misses the whole/bigger picture of the child’s needs, and sometimes misses the needs altogether. School therapies often times aren’t able to work on muscle strength, joint mobility, sensory processing, timely articulation skills, feeding, and many other important occupational, physical, and speech therapy needs. These issues are not able to be covered simply because of the rules, laws, and way school therapy is set up. School therapy is free; it doesn’t require additional transportation, scheduling arrangements, or packing the entire family up to go to therapy.

The facts about outpatient therapies

Outpatient therapy is almost always one-on-one, with one therapist and one child. This gives children the full attention of a therapist, whose only responsibility is to specifically help your child. If needed, outpatient therapists have more opportunities to collaborate with other therapy providers, encouraging all disciplines to work together for a child’s best interest. Outpatient therapy goals are not required to be purely academic, but rather

focus on any area that is not age appropriate. School therapy must wait to see negative impacts on writing, reading, spelling, or navigating (i.e walking in a classroom, walking up/down stairs) before they are able to intervene. Outpatient therapy is able to address problems immediately to jumpstart the healing, improving, and therapeutic process. Areas like feeding therapy, equipment management, orthotics, joint-mobility, sensory diets, vision, memory, and more usually don’t “hurt” how a child performs in a classroom, but they do have a huge impact on how children function in their day-to-day lives. These areas do matter, but can only be addressed in private therapy. Therapists and companies decide the timing and frequency for each patient as an individual, and it varies based on discipline (i.e. speech 2x a week for 30 minutes or PT 1x a week for 60 minutes). That means that children could get 240 minutes of therapy time each month. Because of the significant amount of time private therapy provides, therapists have the ability to target multiple goals and skill areas each session. This helps keep children’s minds engaged, their bodies active, and their skills sharp. Private therapy emphasizes family involvement and carryover, which gives siblings, grandparents, and parents/caregivers ideas on how to target and correct skills at home, and how to encourage practice outside of therapy time. Private therapy could potentially require a lot of calendar rearranging, transportation configuring, and maybe even a copay or payment to reach deductible.

The bottom line

Both school-based services and outpatient therapy are helpful, and the therapists really care about the progress and well-being of each child. If you’re already receiving private therapy, continue! If you’re already receiving school based services, continue! If you have a treadmill at home, that doesn’t mean there’s never a reason to go for a run outside or to head to the gym. Just because your kiddo is about to start (or restart) school based services, don’t stop coming to outpatient therapy.

School therapies are a phenomenal asset for our children in preschool and higher grades, but school therapy provides limited one-on-one interaction, time, and targeted skills simply because of the rules and laws in place that allow free, school-based therapy to qualifying students in need. As a former school-based speech therapist myself, I understand first-hand the frustration of large caseloads and limited time faced by dedicated school therapists. Outpatient therapies are able to provide undivided and individual, one-on-one time with a therapist for at least 30-60 minutes each week. By keeping your children in outpatient therapy even after school starts (or restarts), you’re giving your child the most opportunities to access the skills that they need for school, home, and life.

The compromise

Each location provides new and different challenges, advantages, and opportunities. Each location has its own special benefits for your child. And each location can help your child progress. School-based therapy compliments outpatient therapy, and outpatient therapy compliments school-based services. One cannot replace the other, but they can supplement each other. By keeping your child enrolled in outpatient therapy despite the school year starting, you’re given them more time to learn and grow. By keeping your child enrolled in outpatient therapy AND school therapy, you’re encouraging stronger carryover of skills and quicker successes. By keeping outpatient therapy and school therapy concurrently, you’re giving your child bigger and better chances to make progress. By keeping both services going at the same time, you’re learning more and so is your child. Children are little balls of energy and typically enjoy both services without getting worn out or over-therapized. Their young brains have more plasticity allowing them to absorb more and quicker than those of adults--so the more therapy they get, and the younger they are, the quicker they are able to learn and develop new skills.

The strategy

If fall extra-curriculars or bus pick-up/drop-off are crowding your therapy time, talk to your therapist and clinic they want to keep your child in therapy, and might have wiggle room in their schedules. Also, try explaining the situation to your school principal. Chances are, they want your child to stay in private therapy and are on board with additional services too, and will be a little flexible. Many schools are willing to let your child arrive slightly late one day a week, or leave slightly early, or skip lunch if schedules allow in order to attend outpatient therapy. If the idea of your kiddo missing classroom time makes you uneasy, talk directly to your child’s classroom teacher and ask their opinion and find out what exactly would be missed. Maybe with some extra information and the support of the teacher, you’ll feel more comfortable about making a decision to pick your child up a few minutes early from school. Also, consider picking up your child up directly from school on therapy day instead of waiting for the bus route. While outpatient therapy facilities don’t want your child to have to miss school to attend their session, they unfortunately are not able to accommodate every patient, as outpatient therapy facilities have a limited amount of after school appointments. Any flexibility you have in yours and your child’s schedule will allow them to continue outpatient therapy.

So, with fall and school-time right around the corner, schedules fill up and priorities might, like the seasons, change. When it comes to therapy services, there isn’t a single location that is best for your child. The honest answer, is that all therapy--outpatient and school-based--will be beneficial for your child. All therapies have pro’s and con’s. All therapies have their benefits, advantages, and sometimes, their frustrations. As a parent/caregiver, you don’t need to have all the answers...because in this case, there isn’t a single, right answer. Instead there are facts to think about, therapists, teachers, and principals to talk to, schedules to rearrange, and choices to make. If you can’t stick with both therapies, make the decision that is best for your family and your child. But, if you can stick with outpatient and school-based, it can help your child make bigger, bolder progress, setting them up for the brightest future that both services have to offer.

#SchoolvsOutpatientTherapy #SchoolTherapy #OutpatientTherapy

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