Current Model of Related Therapy Services

Current Model Of Pediatric Therapy IEP's, CPSE's, SBS & ESY--OH MY!-

Families and children who've overcome all the previous therapy delivery transistors and settled into their school-based program, might feel a sense of relief knowing that their IEP is in place and services are being provided regularly.   However, relief is short-lived when families realize IEP services are for the school year and only while school is in session. And another fight ensues.


One of the harder in-school therapy services to have included on a child's IEP's is 'year-round services', not because children with disabilities stop having disabilities during summer or other school breaks, but because it's an additional expense city, state and local school districts prefer not to incur, if they can get away with  it.  However, weather or not a school district approves medically prescribed, year round therapy services doesn't negate the fact, they're still medically prescribed and needed. 


So two things happen; the kids not approved for year-round services have to find new therapy providers on their own and kids who amazingly get approved are given a list of department of education approved providers to choose from. Providers who are not typically in the child's existing school or district 


The process of finding new, even if temporary, school or home based therapy services is difficult. Families must again travel to schools or facilities outside of their own community or school district to receive minimal services with another new provider, one who has no connection or prior knowledge of the child’s history and specific needs and in a new environment, causing more stress to the child. Moreover, in-school services received under IEP’s and 504 plans are limited. A child’s doctor may write a prescription for physical therapy 5x per week for 30-minute sessions, however, that’s extremely unlikely to happen.  School resources are limited and that child is more likely to receive physical therapy 1-3x week for 30-minute sessions instead. And 30-minute sessions, believe it or not, start from the moment the physical therapist takes the child out of class and ends when the child is returned to class, making the actual time spent on therapy 15 to 20-minute per session.

Current Delivery Of Medically Prescribed Pediatric Therapies In & Out of Early Intervention Programs

The current delivery of medically prescribed pediatric therapies, which include speech, occupational and physical therapy, vary depending on the age of the child and if they qualify for services under their states Early Intervention Program (EIP) and if the family /child has insurance 


For children who do not qualify for services under EIP but none-the-less require them, have two choices;


Families with health insurance that covers services, can secure therapies on their own from any provider they choose who accepts their insurance. Seems pretty straight forward and stress free, however, most insurance policies have co-pays and cap services, limiting children to a specific allowable number of therapy sessions per year.- typically not nearly the amount they need, leaving the family to pay for the remaining services, in full out-of-pocket - or due to financial inability -they don't and the child goes without needed services.


Families that do not have insurance, must pay completely out-of-pocket - which gets very expensive very quickly. Or, due to financial inability - they too don't secure required therapies and their child goes with needed services.


In either instance, the cost of therapy services is extensive and takes a tremendous toll on families financially and emotionally.  


Children whose disability qualifies to receive services under their states EIP program are subject to the programs evaluations, service providers and are limited to number of and often types of, services they provide and usually it's not in line with what was medically prescribed by the child's physician.


Each states Early Intervention Program (EIP) works with independent facilities to provide services to children from birth to 3 years.  Although most EIP providers will come to the home or where-ever the child is spending their day, they are not always locally available and are not required to make home visits, in such cases, families must bring their child to the various providers for each service being received. The turnover rate of therapists in those facilities are often high causing a lack of continuity of care and undue stress to children who are, sometimes often, assigned new therapists.


This is especially true once children age-out of EIP and transition to their states committee on preschool special education (CPSE) services program from ages 3-5yrs old, if they’re eligible and  the family wants to continue. The Committee on Preschool Special Education (CPSE) in the child’s school district (even if they're not yet in school) takes over providing services much in the same manner as EIP.


CPSE will create an Individualized Education Plan (IEP) that will stay with the child throughout their academic years or until it is either voluntarily discharged or no longer medically necessary.  Under CPSE, families again either bring their child to the various CPSE authorized service providers or if possible, have therapists come to the child.  Unfortunately, the little flexibility that exists under both EIP and CPSE programs enabling families to find therapists (within those programs) who they and their children like and are compatible with ends once children enter school full time, usually at 5yrs upon entering kindergarten, services are transitioned again to school-based - again with new and different therapists.

School-Based Therapy

The child's  transition to new school based therapy and new therapist(s) is not always an easy one.  They have no connection with the provider, the therapy models have substantially changed from what the child has been used to previously and the therapist(s) may or may not have experience working with the child’s specific issues or disabilities.


Additionally, the actual amount of time spent on therapy activities is drastically different.  If a child had previously been receiving occupational therapy three-times per week for thirty-minute sessions, as mandated on their IEP, they actually spent thirty minutes in each session. However, school-based therapy sessions actually start from the time the child is removed from the class and end when the child is returned, leaving sometimes as little as fifteen to twenty minutes spent on actual therapy.


Once children start school-based servcies, they must have an annual review to determine if services are still required, if goals set have been met and what if any services should continue and to what extent. School systems will almost always try to cut services to reduce costs and often are successful, doing a grave disservice to the child. Parents will, more-often-than-not, find themselves fighting for services to remain and or not to be cutback, by no means an easy or simple process.


And, most important to note is the purpose of pediatric therapy services completely changes for school-age children with disabilities.

The Big Therapy Swap - Rehabilitation to Educationally Functional

We've found most families don't realize the job of school-based therapists and therapy is to help children become ‘educationally functional’ which often has little to do with addressing the child's actual disability.


What does educationally functional mean and how it’s different from previous pediatric therapy services.  If a child has an orthopedic or neuro-muscular physical disability, school-based therapists job is not to work on helping the child use or stretch or strengthen or necessarily address the physical disability in any way or help minimize progressive effects of the disability like atrophy and contractures or attempt to improve or maintain current function, if any.


The primary purpose of school-based therapy is to help the child become educationally functional, meaning can the child accomplish tasks in the classroom to complete given assignments, even if the child never uses the affected limb (s) or if their specific medical therapy needs are met.


EIP and CPSE program services are provided at no out-of-pocket cost to families, however, if a family has insurance and or if the child is on Medicaid, both programs can and do file claims for services rendered. This is important to know because it makes school-based therapy the only option for children as few families can afford to pay out-of-pocket for private services over-and-above what is provided in-school and they cannot utilize private providers who may accept insurance because it’s considered double-dipping – Although this may not be true for all states, it is for most. 


The continuity of care from pre-school-based to school-based therapy services is drastic. Does it mean there's no medical benefit to the child from school-based therapy, no, because every therapy, like every child, is different.

Disabilities Don't Take Summer Vacations

Families and children who've overcome all the previous therapy delivery transistors and settled into their school-based program, might feel a sense of relief knowing that their IEP is in place and services are being provided regularly.  However, relief is short-lived when families realize IEP services for the school year, actually means only while school is in session. Not Winter, Spring or Summer vacations or any non-school day. And another fight ensues.


One of the harder in-school therapy services to have included on a child's IEP's is 'year-round or Extended School Year Services (ESY), not because children with disabilities stop having disabilities during summer or other school breaks, but because it's an additional expense city, state and local school districts prefer not to incur, if they can get away with  it.  However, weather or not a school district approves medically prescribed, year round therapy services doesn't negate the fact, they're still medically prescribed and needed. 


So two things happen; the kids not approved for year-round services have to find new therapy providers on their own and kids who amazingly get approved are given a list of department of education approved providers to choose from. Providers who are not typically in the child's existing school or district 


The process of finding new, even if temporary, school or home based therapy services is difficult. Families must again travel to schools or facilities outside of their own community or school district to receive minimal services with another new provider, one who has no connection or prior knowledge of the child’s history and specific needs and in a new environment, causing more stress to the child. Moreover, in-school services received under IEP’s and 504 plans are limited. A child’s doctor may write a prescription for physical therapy 5x per week for 30-minute sessions, however, that’s extremely unlikely to happen.  School resources are limited and that child is more likely to receive physical therapy 1-3x week for 30-minute sessions instead. And 30-minute sessions, believe it or not, start from the moment the physical therapist takes the child out of class and ends when the child is returned to class, making the actual time spent on therapy 15 to 20-minute per session.

Delivery of Post Surgical Therapy

Children with disabilities, congenital or acquired, permanent or temporary, often face a childhood and or lifetime of therapy services and often, surgical interventions, which also require a range of post-operative therapies. 


Currently, most hospitals provide follow-up therapy services in their hospital facility, only while the child remains hospitalized.  However, upon discharge, the child, who still requires ongoing services, must obtain them either privately, or again, rely solely on early intervention and school based providers. 


The few hospitals that offer pediatric out-patient therapy services are often for children on Medicaid and not a practical solution for the child or family due to distance and travel expense to and from the hospital, several times a week, which can pose various hardships for families. 


For children who receive surgical services in out-of-state hospitals, it’s not possible to return for therapy, for obvious reasons and often, either the family must remain temporarily located close to the out-of-state hospital to receive services or returns home to hopefully find their own providers.


Today, overall pediatric medical care has improved greatly because pediatricians, hospitals, clinics and few remaining community medical centers are providing more low cost medical services and preventive screenings, at earlier ages, to catch, properly diagnose and treat childhood conditions including cerebral palsy, autism, asthma & scoliosis to name a few.  However, what hasn’t kept up with the great strides in pediatric medical screenings, care and treatment options available, is quality pediatric physical therapy services needed to continue, improve and or maintain the care children receive.

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