Physical, occupational and speech therapy services are provided in many different settings. Therapy for children can be in an inpatient or outpatient facility, as well as in a school setting or natural setting (home or daycare). There are three models of therapy services which differ in their eligibility, treatment settings and goals. The three models are the early intervention (EI) model, school model and medical model. To be eligible for therapy in the early intervention and school models, a child must demonstrate a 33 percent delay in one area of development, or a 25 percent delay in two or more areas of development. Therapy in the medical model is based on medical necessity, which includes any delays in development and impairments in function.
The early intervention model provides therapy services to children between the ages of 0-3 years in the natural setting, which is where the child spends most of his/her day. The early intervention model was established to provide family-oriented therapy. The therapist comes into the home and discusses with the parents or caregivers what goals they would like to see their child achieve, and the therapy is based upon those goals. Once a child turns 3, he/she no longer qualifies for services through early intervention.
The school model provides therapy services to children in school, which begins at the age of 5, unless the child qualifies for classification in a specialized program, and then it can begin as young as 3 years old. School-based services are solely provided to improve a child’s function in the school setting. If a child is demonstrating difficulty transitioning from class to class, carrying a lunch tray, sitting during circle time, maintaining an upright sitting posture at his/her desk, keeping up with peers in physical education class, expressing and articulating language, or holding and maintaining a pencil grip, a child might be referred for school-based therapy evaluation. The school therapist evaluates the child in the school setting and sets goals. Once the child functions at peer level in the school, the child is discharged from therapy.
The medical model provides therapy to children 0-21 years of age. A child qualifies for therapy based on the therapist’s observations, as well as standardized testing tools. The goals established for the child are determined by the therapist based on the child’s ability to function in his/her environments. A child is only discharged from therapy once he/she has met the goals set forth and is able to function optimally in all environments.
Although there are three separate models of therapy, a child might receive therapy from more than one model at the same time. A child might qualify for physical therapy (PT) through the early intervention model, but the parents might want additional services, and therefore also utilize the medical model. Likewise, the medical model might supplement the school model. School-based PT might be addressing a child’s walking speed so he/she can keep up with his/her classmates, but it may not address the quality of movement (i. e. , how the child is walking). Because the child may have achieved the goal of walking with his peers, he would have been discharged from PT in school even though he might be walking by scissoring his legs. In this case, the parents would then take this child to physical therapy in an outpatient pediatric setting in order to address the quality of movement. In addition, a child might get school-based occupational therapy (OT) services during the school day and seek private OT services after school in a pediatric facility to enhance or work on skills that are not being addressed in the school setting. Similarly, a child might qualify for group speech services in school, but benefit more from individual private therapy to hone in on the areas of difficulty.
Implementing the medical model independently or in addition to the EI and school models can augment the outcomes of the therapy. The Therapy Gym in Teaneck provides physical, occupational and speech therapy services via the medical model and can be reimbursable by insurance. If your child demonstrates difficulties or delays and you are seeking therapy, please call 201-357-0417.
By Elisheva Fuchs