Educational vs. Medical Model of Physical Therapy Service Delivery

(adapted from APTA Academy of Pediatric PTís Fact Sheet on Educationally Relevant PT: Scope of School-Based Practice)

There are primarily three settings in which a child can receive physical therapy (PT) once a need has been identified:

       home based services (under a family centered model [i.e., IDEA Part C Infants and Toddlers with Disabilities Programs])

       a hospital or an outpatient clinic (under a medical model)

       school based (under an educational model)

The factors determining need for intervention may be very different under the medical and educational models. In some cases children may receive services through both models. For instance, the frequency or intensity of PT received at school may not meet all of the childís needs, or there may be goals that are not addressed by school-based therapy that would require home or community-based services [under the medical model] or vice versa. The following comparisons are outlined in hopes of clarifying some of the confusion between services under these two models.

Under the Medical Model:

       referral is initiated by a physician based on a particular diagnosis or observed delay in one or more areas of development

       the parent is then referred to a hospital, clinic, or [infant] program for an evaluation and/or treatment by the appropriate professional(s)

       the need for PT is primarily based on testing and clinical observations, is meant to address medical conditions in direct one-on-one treatments

       children with mild, moderate, or severe deficits may each qualify, goals are based on realizing full potential, and therapy can address movement quality as well as function

       the parent is responsible for obtaining the needed services, and fee for service may be paid privately, under government assistance programs, or through insurance coverage (which may dictate access, frequency, and focus of treatment)

Under the Educational Model:

       an educational team, including parents, student (if appropriate), educators, and administrators may request related service evaluations based on the studentís educational needs and possible supports required to assist a student with a disability to benefit from special education

       the parent provides written consent for the school-based PT evaluation which is then completed within 65 business days throughout the school environment (i.e., in the classroom, hallways, gym, playground, lunchroom, etc.)

       following the presentation of testing results and recommendations, the need for PT service is determined by the studentís IEP team only if necessary to support the studentís educational needs, and may include direct individual or group treatment, staff training, collaboration and/or consultation

       in general, students with significant needs qualify for related services in order to access their school environment and participate in their special education program, but a student who functions adequately within the school environment may not qualify for school-based PT services

       PT services found necessary to support a studentís education are provided free of charge (though the school district may seek reimbursement for some related services through Medicaid when possible)