Why can my child see an SLP in a private clinic but still not qualify to receive services in the schools?

Whether a child’s difficulties lie in speech articulation, expressive language development, literacy, or fluency and stuttering behaviors, this is a question that causes tension and confusion across the board for parents of children who are struggling with speech and language skills. So what is the real difference between speech and language therapy at school compared to in a private clinic? 

First, we have to understand that therapists in each setting are working from two different models, with different funding sources and governing bodies.

School-Based Model

In schools, speech and language therapy services fall under the umbrella of special education, which is ruled by the Individuals with Disabilities Education Act (IDEA) and the right to Free and Appropriate Public Education (FAPE). School-based speech-language pathologists (SLPs) provide services to children with disabilities who might otherwise not be able to make progress on their own in the general education environment. The simplest way to understand why a child might or might not receive speech and language services in the school setting is to look at IDEA. In order for a child to qualify for services at school under IDEA, he or she must meet the following requirements: 

  1. They must have an impairment.
  2. The impairment must have an educational impact.
  3. The child must be unable to make progress in their curriculum without the support of the SLP.

Because school districts are held to specific “qualifying” criteria (such as 1.5 standard deviations below the mean) they often take the “wait and see” approach, during which parents are told to hold a perspective of waiting to see if their child will outgrow the delay before stepping in for intervention. This often leads to strict cut-offs for scores on assessments. Therapy in the school-based model targets goals and difficulties that affect a child’s ability to learn and participate in a classroom environment.

Medical Model

SLPs practicing in a private clinic setting, however, do not need to follow state and federal guidelines under IDEA, and are not restricted by cutoffs set by a school district. Rather, a child’s need for speech therapy is determined by a therapist’s clinical judgment. Simply put, a clinic-based SLP provides services to children who demonstrate a need and would benefit from the service. In addition to standardized assessments, a clinic SLP is free to exercise their clinical judgment to determine a child’s need for speech and language therapy.

Another key difference is that clinic services are either covered by insurance or paid for out-of-pocket by the family, allowing for an SLP in the clinic setting to target specific areas of need that a school-based therapist may be restricted from. If a child has any error or delay and the difficulty is demonstrated during a clinic-based assessment, that child may receive services to remediate the difficulty.

This means that if a child receives a score by a school assessment that is above the district cut-off for qualification, they may still receive services in a private clinic setting to remediate the difficulty. Therapy in the medical model targets specific underlying pathologies that might functionally affect a child’s skills. 

Regardless of what setting they practice in, SLPs have some of the biggest hearts out there.  At SDOT, our SLPs are no exception! We are here to build your child’s foundation for life!