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Educational Model vs. Medical Model in Pediatric Therapy

Children can receive therapeutic support for developmental needs through a number of environments such as inpatient/outpatient clinics, the home, and public schools. The location of service for children with therapeutic needs depends on factors such as the child’s age, needs, and funding source. In some cases, a child may receive support from more than one option at the same time. The goal of care may vary depending on the setting.

Let’s discuss these services which are broken down into two primary models: (1) Educational Model (also known as School-Based Services Delivery) and (2) Medical Model. While both models offer beneficial support for children and their family, understanding the differences between the two models can help service providers offer the most effective services within their current environment.

Individuals with Disabilities Education Act
Before any further conversation about the two models, it is helpful to remember that the Educational Model is governed by the Individuals with Disabilities Education Act (IDEA). IDEA is a law that makes available a free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children1. It was first passed in 1976 and subsequently amended numerous times, most recently in 2011. IDEA provides rights and protections to children with disabilities and to their parents or legal guardians2. Also, IDEA governs how early intervention (Part C) and public education (Part B) supports are granted. Today we will focus on IDEA Part-B for students ages 3-21.

IDEA Part-B for students ages 3-21
Within this law, there are six primary components that shape how children are evaluated, supported, and how parents or legal guardians are engaged through the process. The six principal ideas within IDEA are:2

  1. Free and Appropriate Public Education – that each child has the right to a free and appropriate education that recognizes their unique needs and prepares them for “education, employment, and independent living”1. This includes providing Individualized Educational Plans to children who qualify which offer “meaningful educational benefit”1.
  2. Least Restrictive Environment – that each student will be educated with their peers to the furthest extent possible given accommodations and modifications.
  3. Appropriate Evaluation – that each student needs to be offered an evaluation free of biases and in their native language, in addition to English, as is feasible in order to determine ability and guide eligibility determination for Special Education.
  4. Individual Educational Plan (IEP) – a comprehensive plan based on the student’s educational eligibility which outlines academic and functional supports including related services, accommodations, and modifications in order to support the student’s ability to access educational instruction. The IEP includes academic and functional present levels of performance, goals, supplemental aids, supports for personnel, educational placement, extended school year, and transition planning for children ages 14.5 and older.
  5. Parent Participation – a provision that parents or legal guardians are a part of the decision-making process for Educational Placement.
  6. Procedural Safeguards – the rights of the parents and students under IDEA meant to help inform families of their rights and to resolve disputes.

Building on this summary of IDEA, we will review a comparison of the Educational Model vs. Medical Model in the areas of Privacy, Referral Source, Eligibility, Service Delivery, Progress Monitoring, Dismissal, and Governing Bodies for licensure and certification.

Privacy
Private information is protected in both the Educational and Medical Model.

  • For the Educational Model, the protective law is called Family Educational Rights and Privacy Act (FERPA), which serves to protect what can be shared and with whom regarding educational records. FERPA allows families access to their own child’s records and to request corrections as needed.
  • For the Medical Model, there is the Health Insurance Portability and Accountability Act (HIPAA). HIPAA protects a patient's private information, governs patient rights, and information storage.  

Referral Source

  • Within the Educational Model, a referral can come from a parent or member of an educational team. Additionally, referrals are mandated by Child Find, a component of IDEA which mandates that the local educational agency “identify, locate and evaluate all children with disabilities”1. A physician can additionally refer to services within public schools. The physician’s referral does not automatically indicate that a student qualifies for Special Education services within the school system, however, this information can be considered by the educational team in addition to other information sources available.
  • Within the Medical Model, referrals are typically initiated by a physician, or a parent/legal guardian, depending on the funding source. 

Eligibility

  • Within the Educational Model, eligibility is determined within a lens of adverse effect on academics. The theme of academic impact and functional performance is central in the considerations of the Educational Model. The U.S. Department of Education states, however, that “a student with a disability cannot be denied service even if there are no concomitant problems” (Eligibility and Dismissals in Schools). There are 13 primary eligibility categories for which a student can qualify. Services, including related services, will be determined given the area(s) of eligibility.
  • In the Medical Model, eligibility is based on clinical assessment and observations.

Services Delivery
An area of most notable difference between the Educational and Medical Models may be found in service delivery.

  • In the Educational Model, service delivery is governed by the Individual Educational Plan (IEP). The IEP outlines the student’s present level of performance for academic and functional abilities. Additionally, it will describe types of services, including related services, with information such as the location of service, consultative vs. direct services and primary services vs. related services. For each area of need indicated, goals will be created with a focus on increasing academic performance and/or access to non-curricular activities. The frequency of support, location of support, duration, and implementer(s) will also be specifically outlined. Finally, other details such as accommodation and modifications, training for staff, eligibility for Extended School Year, transportation needs, and the transition will all be outlined as appropriate. These services are all free through FAPE and are not contingent upon any third-party reimbursement, although some districts may bill Medicaid and receive reimbursement for a portion of the services for students who are eligible.
  • In the Medical Model, service delivery is determined by a Plan of Service or Treatment Plan based on clinical assessment and observations. The goal/treatment plan will vary and include considerations of the child and their family based on the evaluation, severity of need, and goals given the child’s therapeutic environment. It is the family’s responsibility to seek out the assessment and services. Additionally, the family will be responsible for covering the costs of the services with potentially full or partial support from public programs (such as Medicaid) or private insurance. 

Progress Monitoring
The concept of monitoring progress is consistent across the two models. Target areas should be written both with short-term benchmarks/objectives in mind as well as long-term goals. A system for data collection should be in place with consistent, objective data recorded throughout the therapeutic process.

  • In the Education Model, data is reviewed, consolidated, and delivered through Progress Reporting within the IEP, typically corresponding to the timeline of academic grades.
  • In the Medical Model, therapeutic notes will be recorded on a session-by-session basis, frequently following a SOAP (i.e. Subjective - Objective - Assessment - Plan) note format.

Dismissal

  • Within the Educational Model, each student is to receive a full re-evaluation every three years, at minimum, to determine if they continue to qualify for Special Education services. A parent can request a re-evaluation at any time, even if it is not within the three-year interval. Additionally, a team member can recommend a re-evaluation before the three-year interval if they suspect that the current eligibility is no longer the best representation of the student and their needs, or if they suspect that the student no longer qualifies for Special Education. Dismissal from Special Education is based on a full evaluation, which considers evaluation activities and the student’s academic and functional performance.
  • In the Medical Model, dismissal from services may be determined upon discharge criteria for the specific environment in which services are offered. This may include: functioning within typical limits, goals have been met, family indicates no longer interested, adequate progress is no longer noted, other medical complications, amongst other potential factors.

Certification and Licensure
Each state holds its own licensure guidelines for related services providers who offer services both within the Education and Medical Models. These are professionals such as Physical Therapists (PT), Physical Therapist Assistants (PTA), Occupational Therapists (OT), Occupational Therapist Assistants (OTA), Speech-Language Pathologist (SLP), Speech-Language Pathologist Assistants, Social Workers, Hearing and Vision Itinerants, Nurses, amongst other professionals. Many states hold an additional certification for those who practice in the public schools. For each state’s specific regulations, please see their professional regulations website and board of education websites.

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References:

1 “About IDEA”. Sites.ED.Gov. US Department of Education. https://sites.ed.gov/idea/about-idea/#:~:text=The%20Individuals%20with%20Disabilities%20Education,related%20services%20to%20those%20children.

2 Lee, Andrew M.I., J.D., Understood. Understood For All 2014-2020. https://www.understood.org/en/school-learning/your-childs-rights/basics-about-childs-rights/individuals-with-disabilities-education-act-idea-what-you-need-to-know.  

“Eligibility and Dismissal in Schools.” American Speech-Language and Hearing Association. https://www.asha.org/slp/schools/prof-consult/eligibility/.

Jacobson, Barbara, PhD CCC-SLP. [2018]. ‘Medical Speech-Language Pathology-Best Practices and Resources’. [PowerPoint Presentation]. Available at: https://ksha.org/docs/SLP10_Medical_SLP_Best_Practices.pdf.

Saleh, Matthew, J.D., M.S. “Your Child’s Rights: 6 Principles of IDEA”. SmartKidsWithLD. https://www.smartkidswithld.org/getting-help/know-your-childs-rights/your-childs-rights-6-principles-of-idea/.

Wright Pamela, Wright Pete, Esq. “The Child Find Mandate: What Does It Mean To You?”. Wright’s Law. January, 2019. https://www.wrightslaw.com/info/child.find.mandate.htm#:~:text=Child%20Find%20requires%20all%20school,education%20services%20to%20the%20child.

Tags: School-Based Therapy, Pediatrics