Educational vs. Medical Models for Speech, OT, & PT Services

A Guide for Parents and Physicians

This will provide an understanding of the differences between educational and medical therapy models as they pertain to a child’s therapy needs and how each is beneficial. An example to help differentiate . . .A school-age child who is unable to pronounce the “R” sound but is not carrying the deficit over into spelling or writing assignments, and is still intelligible to a listener would not qualify for therapy services under the educational model because while there is an impairment present, there is not an educational need. However, this child’s articulation deficits and mispronunciations of the “R” sound affect their social interactions and appropriate communication exchanges during activities of daily living, hence this child would qualify for therapy services under the medical model.

Educational Model

The Educational Model focuses on the skills impacting educational performance in all subject areas. Deficits are addressed through an Individual Education Plan (IEP) that is agreed upon by the school-age child’s educational team. A child’s IEP in this model will focus solely on the outcome that enables a child to benefit from his/her educational program. Therefore, the school therapist(s) (Physical Therapist (PT) or Occupational Therapist (OT) or Speech Therapist (ST) (or a combination thereof) will direct therapy so the child will gain skills to maximize his/her opportunities within the school environment. Therapy services are provided in school and most often within a group setting.

Eligibility: Eligibility for related services must be based on assessment, must include an educational need for service, and have approval of the Admission, Review Dismissal (ARD) committee.

Medical Model

The Medical Model generally focuses on the impairment regardless of severity level to ensure that the child can successfully perform the basic activities of daily living (i.e.., putting on their clothes, feeding themselves, speaking clearly their wants and needs, walking). Services are performed on a one-on-one basis in an outpatient clinic.

Eligibility:  The physician or other certified practitioner along with a child’s parents/ guardian and licensed therapist determine the severity and impact on developmental areas or self-care skills and develop a Plan of Care (POC) for the therapist to follow.

Is one better than the other?

Both models of Education and Medical Therapy services can coexist to meet all of the needs of a client. According to the Texas Education Agency’s (TEA’s) School Health and Related Services (SHARS) policy, a child can qualify for simultaneous Medical and Education Model therapy services. It typically works best for the child’s parent/guardian to share any assessment given by the Educational Team with the child’s physician and vice versa. This approach helps to ensure that both your child’s school professionals and physicians/specialists are fully aware of the impact a child’s impairment or disability has upon the whole child in all environments.

Educational Model

• Educational team includes parents, educators, and therapists. Using therapists’ evaluations, the team collaborates to determine focus on service as well as frequency and duration based on the student’s educationally-related therapy needs
• Therapy focuses on intervention to improve the student’s ability to learn and function in the school environment.
• Services are provided primarily on school grounds during the school year.
• Services are provided in the student’s educational environment, primarily in a group setting.
• Student’s ages range from 3-21.
• Services are provided at no cost to parents.
• Services are provided during the school year.
• Goals are reviewed or updated every 12 months.
• Re-evaluations are completed once every 3 years.

Medical Model

• Medical team recommends and prescribes focus, frequency, and duration of therapy. Third party (insurance carrier) may be the ultimate decision maker, as each carrier as specific criteria for Medically Necessary services.
• Therapy focuses on treatment to alleviate or cure specific underlying medical pathologies.
• Treatment settings are in the clinic and are one-on-one in a clinical setting.
• Clients span range is birth-18.
• Payment is on a fee-for-service basis, covered by private insurance, government assistance, or family.
• Services are provided year-round and focus on continuity of care.
• Goals are reviewed or updated as needed or minimally through monthly progress notes.
• Re-evaluations are completed every 3 months or as appropriate as determined by the specific insurance carrier to update levels of performance and target individual needs of the client.