School-Based and Outpatient Services
Both school-based and outpatient services can help children reach their communication and/or
feeding goals. However, some key differences can make decisions about which services are best
for your child a little complex! Feel free to reach out to us with any questions you may have!
The Similarities
In Wisconsin, speech therapists in both settings:
- Have master’s degrees with supervised clinical practicum from an accredited program.
- Passed the speech-language pathology PRAXIS examination.
- Completed a postgraduate clinical fellowship in speech-language pathology.
- Are licensed by the state to provide therapy services.
In both settings:
- Evaluations are completed using assessments, formal/informal observations, caregiver/client interviews, etc.
- Deficits impacting communication are addressed using evidence-based practices.
- Speech therapists can collaborate with your child’s other clinicians, like physical or occupational therapists.
The Differences
Location (Where do services take place?)
Outpatient services occur in a therapy clinic in your community. Outpatient clinics can exist
within a hospital or could be free-standing, like CI! Kids are often seen in individual treatment
rooms. Treatment often mimics a child’s natural play environment and focus goals on
functioning in their home, community, or other environments.
School services occur in your child's school, whether in their classroom, a 5-minute pull-out
session, or a speech therapist's office. Treatment occurs in a school environment, often with
peers. Goals focus on functioning and participating in school.
Eligibility (How do children qualify for services?)
Outpatient centers follow a medical model. Any concerns about a child’s communication
development that impacts their life. Evaluations indicate a disorder or delay, meaning
performance is below what is typical for their age. Insurance companies can cover services based
on a doctor’s prescription for services after communication disorders are diagnosed. There is also
the option to pay out of pocket for services.
Schools follow an educational model. Concerns about communication that impact their ability to
access their education or participate in school. Goals are targeted through an Individual
Education Plan (IEP), that an educational team agrees on. Evaluations indicate a disorder or
delay that is below what is expected for their age. The Individuals with Disabilities Education
Act (IDEA) provides free services for children with speech, language, and hearing disorders. The
Wisconsin Department of Public Instruction (DPI) has specific criteria for each area that decide
whether services will be provided. For example, for speech sound disorders in Wisconsin, in
2022, criteria include that the student’s speech sound production is documented to be delayed,
the delay in communication adversely impacts the student’s educational performance or social,
emotional, or vocational development, the student is less than 30% stimulable (can imitate the
sound accurately less than 30% of the time) for errored speech, and their intelligibility is below
the expected range for their age and have an impact across environments. If deficits don’t
significantly impact their education, children with communication deficits may not qualify for
school-based speech services.
*Just because a child qualifies for services at an outpatient center using the medical model, it
doesn’t mean they will qualify using the educational model.
Service Delivery (What do sessions look like?)
Outpatient: Follow a medical model. Children are seen individually most of the time, but group
sessions are also utilized. The majority of speech sessions are 30-60 minutes long 1-2x per week.
One SLP could see 20-40 kids weekly.
School: Follow an educational model. Children are seen typically seen in groups of 2-4 kids but
individual sessions are also utilized. The majority of sessions are 5-30 minutes long 1-3x per
week. One SLP could see 20-60 kids weekly.
FAQ:
Do their therapists update each other on progress or share information? Information
relevant to your child’s care can only be shared if you have a release of information (ROI) on file
for their school/school therapist.
Are the therapists working on the same things? In both settings, therapists can work on
different things based on what the child’s goals are. They could also be working on similar goals
with different settings in mind.
Can my child have outpatient and school-based services? Yes! School therapists are focusing
on ensuring your child has what they need to access and engage in the curriculum in the
educational setting, but they may need outpatient services too, which are centered on other
settings or goal areas.
References
https://dpi.wi.gov/sped/laws-procedures-bulletins/laws/eligibility
https://www.asha.org/advocacy/state/info/wi/licensure/
https://www.asha.org/slp/schools/school-services-frequently-asked-questions/