Should My Child Receive Occupational Therapy in School and an Outpatient Clinic?


As an occupational therapist with experience in school-based therapy and now, my own private outpatient pediatric therapy clinic, I am uniquely qualified to explain the difference between the treatment in both settings.

Therapeutic Approaches Used in Each Setting

Occupational therapy (OT) in a school uses what we call a “top down” approach in which the therapist looks at the child’s needs within the school environment, basic factors that may affect their performance, and how to help the child better participate in school activities. On the other hand, outpatient therapy is a “bottom up” approach in which the therapist addresses the needs of the child in all of their environments, specific factors that are causing the difficulties, and focuses on remediation (actually correcting or improving the deficits). Both therapy approaches aim to improve function and success.

Therapeutic Focus of Each Setting

Therapy that occurs in the school must focus only on factors that affect school functioning. School-based therapy can reach beyond simple gross or fine motor skills (if the particular school allows it) to include things such as; social skills, transitions, and feeding (only within the confines of access to food or motor aspects-not picky or problem feeders). In outpatient therapy the focus can be more broad to include any factor that affect your child’s performance such as: clumsiness, poor attention, lacks confidence, problem feeders, difficulty with dressing, sensory processing deficits, and more.

What Treatment Looks Like in Each Setting

Another factor to keep in mind is that the more treatment a child receives, the quicker the progress. Typically, in a school setting, a child is seen by an OT aide for 30 minutes a week or less and only an occupational therapist once a month or less. Additionally, the focus is on adaptation or habit building. In outpatient therapy, children are seen by an occupational therapist or occupational therapy assistance at each and every visit. Outpatient visits should occur at least weekly with the added option of intensives (therapy visits 2 or more times a week) that allows for quicker progress with lasting neurological and behavioral changes. Therapy intensives is a very effective means to reach more pressing goals faster, followed by therapy once or twice a week to continue to work on less pressing deficits.

Each Setting Can Be Complementary

When your child has both therapies, they complement one another since the school-based OT will work on making quicker changes to improve function and the outpatient OT will work on improving neurological and behavioral changes that can be long-lasting. The outpatient therapist will help to remediate the deficits/difficulties that affect your child’s life so that they become less significant or obsolete and life becomes easier moving forward.

If you feel your child could benefit from outpatient occupational therapy find a clinic near you, get your child assessed, and help your child get the therapy they deserve. As you seek for an outpatient pediatric therapy clinic be wary of long waiting lists, therapy that will only occur less than weekly, or clinics that have a one-size-fits-all approach.

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Contributed By: Kaylyn Ellis, MOTR/L


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