Difference Between School Based and Clinic Based Occupational Therapy Services

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I am excited to have Dr. Holly Ann Six, OTD, OTR/L sharing a guest post with all of you today. One of the most confusing topics in Occupational Therapy for parents, teachers, and even other therapists is the difference between School based and Clinic Based Occupational Therapy Services. Today Holly is going to try and explain the differences with pros and cons of each.

What is the difference between school based and clinic based Pediatric Occupational Therapy Services?

I am often approached by parents who want to know if I can provide the OT services prescribed by their doctor. After all, therapy is therapy right? The school provides an occupational therapist and wouldn’t it make sense to save time and money and just have services provided through the school!! Unfortunately, that is not the way it works. I am going to attempt to explain the differences between school-based and clinic-based occupational therapy services.

What is Occupational Therapy?

Although most people have heard of, or have even had occupational therapy (OT), I find that they really don’t know what it is supposed to do. According to American Occupational Therapy Association, “In its simplest terms, occupational therapists and occupational therapy assistants help people of all ages participate in the things they want and need to do through the therapeutic use of everyday activities (occupations).

Unlike other professions, occupational therapy helps people function in all of their environments (e.g., home, work, school, community) and addresses the physical, psychological, and cognitive aspects of their well-being through engagement in occupation”.

I often find that the name of my profession confuses people. When they hear the term “occupational”, they think of jobs and vocational training, when it actually has to do with the tasks that “occupy” a person’s life. Occupational therapists try to help people be as independent as possible in what they want or need to do. This can be from helping an older client who has had a stroke relearn how to feed themselves to helping a young child learn self-regulation so that they can participate appropriately in play activities.

What are the “occupations” of children?

Like all of us, children have things they have to or need to do. Starting in infancy, children learn to be a part of a family and be social, they have to sleep, eat, and make their needs known. As they get older they learn to communicate with others, play, take care of dressing themselves, toileting and other self-care tasks, regulate emotions, etc.

Eventually, they start school and that becomes one of their primary occupations until adulthood. To participate in the learning at school, a child needs to be able to pay attention, follow directions, interact appropriately with others, hold a pencil, write effectively, organize their materials, not disrupt others, take care of their personal needs, etc.

What is the difference between OT in a clinic and OT at school?

The primary difference between school-based and clinic-based OT is the model which each of them uses. School-based OT uses an educational model that focuses on education and academic performance and is governed by IDEA (Individuals with Disabilities Education Act).

Clinic-based OT follows the medical model that focuses on working with the diagnoses is prescribed by a doctor and often directed by insurance. A child may need school-based OT, clinic-based OT or both.

The Medical Model

Clinic-based OT intervention usually starts with a diagnosis and a referral from a doctor. The costs are often covered by insurance. The child will be evaluated by the OT to determine the specific areas of concern in order to determine a treatment plan.

The interventions will address difficulties the child may have in a variety of environments such as home, school and/or the community. The goal of intervention is to assist the child to function well in all environments. Clinic-based OT will address all the environments in which the child may struggle with tasks.

The Educational Model

School-based OT intervention usually starts with the teacher, parent, or other involved person identifying a student who is struggling academically and requesting an IEP. School-based OT services are federally mandated under IDEA and are provided by the school at no charge to the parent. The IEP team, in consultation with the OT, will determine if OT testing is warranted and, if so, what areas will be tested.

School-based OT testing and interventions are ONLY done in areas that may be impacting the student academically. OT in the school is considered a “related” service, meaning it focuses on tasks that relate to the educational needs of the student. Some schools may include an OT as consultant in a 504 or RtI plan.

What are the some of the advantages vs. disadvantages of clinic-based OT?


  • Can address a wide variety of tasks and environments
  • Addresses a wide variety of diagnoses and conditions
  • The child usually has a good amount of one on one time working with the therapist
  • Really cool equipment and therapy rooms


  • Cost
  • Doctor directed-often the doctor does not have time to really determine all the child’s needs
  • Usually have to attend outside of school hours, taking away from family time

What are the some of the advantages vs. disadvantages of school-based OT?


  • During school
  • No additional cost to parents
  • Does not require a doctor’s prescription (Heather's edited note: Some states do require this, you will need to check with your individual state laws. As of this writing, the author's state of Colorado and also my state of Ohio do not require this).


  • The student often has minimal to no time one on one with the therapist
  • Therapy often provided in the classroom, hallways or whatever space is available
  • Limited to areas affecting academics only

Do you have anything you would add to these lists? Let us know below in the comments! 

Heather's Note: Please remember each therapist may have different views of what would be pros/cons based on their experience in their districts. This post is geared towards parents, so large therapy-related terms and words have been avoided on purpose. Each district and state can be completely different in resources they offer/funding available, spaces available for OTs to use, etc. Thanks for sharing!

Author Bio: My name is Dr. Holly Six and I am a school-based occupational therapist. I initially started my professional career in mental health before taking a long break to be a stay-at-home mom. I have 2 grown kids who both just finished college and are both engaged.

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Heather Greutman, COTA

Heather Greutman is a Certified Occupational Therapy Assistant with experience in school-based OT services for preschool through high school. She uses her background to share child development tips, tools, and strategies for parents, educators, and therapists. She is the author of many ebooks including The Basics of Fine Motor Skills, and Basics of Pre-Writing Skills, and co-author of Sensory Processing Explained: A Handbook for Parents and Educators.

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  1. Kendra Loveland says:

    One point to make also is that research supports the carry out of services in the patient’s natural environment. One great advantage of school based OT is it is carried out in the child’s natural environment. Additionally, research supports the inclusion model where OT services are directed towards the classroom as opposed to the therapy room.

  2. carol conway says:

    School based therapy supports both academic and non academic areas of school by law. Non academic include support on playground, in cafeteria, for self help skills, social participation /self regulation skills, mental health promotion, prevention and intervention.
    School based therapist by law can provide at least 15% of their interventions at Tier 1 and 2. OT’s should have a seat at he table for district and school wide policies.

    I agree with above poster that research support practicing the skill in the environment the child needs the skill in; school based very effective therapy.

  3. Love this! I would add that a pro of school-based OT is that it addresses kids needs, real time, in one of their natural environments, so less generalization is required.

  4. This article contains several factual inaccuracies.

    A couple that are most notable –

    1. The idea that school based services are no cost to parents is incorrect. Many parents pay school taxes or county taxes that support Medicaid expenditures in schools. These programs come at a high cost.
    2. Stating that school based services do not require a prescription is incorrect. Many states require a prescription for any skilled therapy service. There may be some exceptions to this, based on individual state licensing laws.
    3. The idea that all clinic based OT uses a medical model is overly simplistic and incorrect. In fact, many different models might be used in any practice setting. Medical v. educational models is an overly simplistic and binary representation that does not represent what happens in actual practice in either setting.

    In total, I appreciate the intent of this article but it has more misinformation than it has correct information.

  5. While your comments have merit, They do not negate the facts in the article, but merely add some dimension, so your statement that it “it has more misinformation than it has correct information” is really a rude and wrong statement.

  6. I am unsure why it would be considered rude to point out factual inaccuracies. We should all do our best to provide accurate information, particularly if we are creating sites that may influence people’s access to a service.

    It would have been rude if I attacked the author personally and I was careful not to do that. Correct information does not ‘add dimension.’ It replaces incorrect information. If I can help provide correct information to clear up some of the factual inaccuracies in this article please let me know. I am actually happy to help.

  7. This article is written for parents who are just learning the basic differences between a medical and educational model. It should be simple and most people don’t know what a “binary representation” is , at least I don’t and I still provide great OT services. I think that we all understand that taxes pay for education and all other government services. the author simply wants parents to compare the extra expenses involved in the private pay/insurance funded medical model vs tax funded scool services. I think that while Dr.Alterio has good intentions to clarify, all his points could be made without using words like “misinformation” or “factual inaccuracies”. These language nuances make the difference between authors feeling accused as opposed to simply corrected. Just my humble opinion.

  8. The author’s state of Colorado does not require a doctor’s order for school services. My state of Ohio does not require them. I also polled a few therapists in my private Facebook group and quite a few stated their states did not require them. I have edited and added a note to let parents know to check their state’s specific laws on this point.

    I have also added a note that school services come at no additional out of pocket costs to parents. Yes there are taxes and government costs, but that is not the point of this post and I think parents would realize that.

    And yes, Barbara is correct that this post is geared towards parents, it was written simple for a reason. This post was not intended to go over every single model that a therapist may use in treatment. I think as therapists we know this, but parents don’t need to know the ins and outs of that for the purpose of this post. The different models used in treatment would make a great follow-up post, thank you for the idea.

    Thank you for sharing your thoughts.

  9. Anita Barnett says:

    OT involvement in Tier 1 and Tier 2 level kids in the schools is a great idea, but rare in my experience. It is definitely not reality in most schools, or at least the 3 states I have worked in. Also— “natural environment” really does include home and community as well—& that requires working with parents in an ongoing partnership, such as weekly/bi-monthly clinic setting. Parents are typically overwhelmed in MET and IEP meetings, and it is a rare parent who follows thru on an OT invitation to visit school therapy. Truly the ideal is both therapy settings for at least a short time, with both OT’s communicating on goals and strategies.

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