Taking a Team Approach: The School-Based Therapist and Outpatient Therapist

Deanna Macioce, MS, OTR/L

A therapist is often defined by the arena or population s/he works in or with. For example, a person who works in a skilled nursing setting may be seen differently from the therapist who works in pediatrics or home health. Although their frameworks for treatment may be different, their foundational knowledge is the same, and they are a therapist, nonetheless. Whether physical, occupational, or speech specialists, they all hold the same title.

In the pediatric field, sometimes we can see a differentiation between school-based therapists and those who work in clinics or other types of outpatient facilities. However, these therapists are ultimately working from the same framework: helping a child improve a skill within his or her environment. Both therapists have their own sets of challenges and expectations, and when working on their own, it all makes sense. But what happens for those children who receive services both at school and an outpatient facility?

This can be seen as an ideal scenario: a child being able to work on functional skills in the school environment as well as getting additional support and strengthening on the outside. The challenges of being a school-based therapist are well-known in the therapy world. Huge caseloads, limited space and resources, and even minimal contact with parents and teachers sometimes make the life of a school-based therapist less than ideal. However, when a child is receiving services in both environments, school and outpatient, with a little bit of communication and collaboration, a beneficial relationship can develop. Here are some key points to make that happen.

Communication: As therapists, it is our responsibility to communicate to parents and guardians what our role is. Oftentimes, parents have very high expectations of the school-based therapist and his or her ability to re-create what happens in the outpatient setting. The parent may also feel that all therapists teach handwriting the same, so the approach being used at school would be the same one used in outpatient therapy. We know that this is impossible, on both ends. Therefore, taking the time to communicate to the parents will help give them a better understanding.

In addition, after being granted permission, it is crucial that therapists working with the same child communicate with each other. Although schedules are very busy, it is more of an injustice to work completely in separate environments than to have some carryover. There is little value that comes from working independently, and it can often be counterproductive. For example, it is likely that both therapists will work on shoe tying. There are multiple ways, songs, and approaches to do this, so if one way is being used at school and another in outpatient, how confusing this can be for a child. It does not have to be about who has the better way; a child will succeed better using the same way.

Focus: After communicating, both therapists should identify the focus of treatment planning within their environment. An outpatient therapist may not focus on writing as much, knowing that it is a child’s main goal at school. However, the outpatient therapist may focus on the core stability and fine motor strengthening needed to achieve the handwriting goal. Therefore, the needs of the child are being met in both areas.

We all know that behavior varies from child to child, and can be different in varying environments. How a child behaves at home is typically different from how he or she acts at school. The same happens in therapy. An outpatient therapist may not see the challenges a child exhibits during circle time because the same skills are not performed in therapy. Therefore, as therapists, it is sometimes hard to treat something you do not necessarily see.

In addition, many schools are not set up with an abundance of sensory resources. Therefore, therapists in the outpatient realm can maximize space and equipment resources to fully assess these needs, communicating to the school therapist what has worked so there is more focus in the school environment.

Team Approach: Although therapists are not working in the same facility or school, taking a team approach will help guide both treatment planning and therapy sessions. It will help utilize time better, focus on the appropriate needs for school, home, and community, and help a child succeed with greater ease.

So, whether you hold the title of school therapist or outpatient therapist, making an effort to work together will make this year breeze by, help parents know what is happening in both places, and help the child reach his or her goals faster!