What’s the Difference Between Outpatient and School-Based Occupational Therapy?
If your child has been referred for occupational therapy (OT), you may find yourself navigating a whole new world of services—and a lot of confusing terms.
As a pediatric occupational therapist, one of the most common questions I hear from families is:
“What’s the difference between school-based OT and outpatient or private OT?”
Great question—and an important one!
While both types of therapy focus on helping children become more independent, they differ in their settings, goals, and how services are provided. Let’s break it down in a simple, side-by-side comparison.
School-Based OT: Supporting Access to Education
Purpose:
School-based OT is part of special education services under the Individuals with Disabilities Education Act (IDEA). The main goal is to support your child’s ability to participate in their educational program.
This means therapy is focused on skills that directly impact learning and functioning in the classroom.
Common Goals Addressed:
Handwriting and fine motor skills for writing
Visual-motor and visual-perceptual skills (e.g., copying from the board)
Self-help skills at school (e.g., managing zippers, opening lunch containers)
Sensory regulation for classroom participation
Seating/posture for learning
Attention and transitions in the school environment
How Services Are Delivered:
Therapy may be individual or small group
Often done within the classroom, or in a therapy room at school
Collaboration with teachers and other school staff
Services are outlined in an IEP (Individualized Education Program)
Eligibility:
Your child must go through an evaluation and be found eligible for special education services. Even if your child has a medical diagnosis, school OT must show that the issue affects educational performance to qualify.
Outpatient / Private OT: Supporting Function in All Areas of Life
Purpose:
Outpatient or private OT is medical-based therapy, usually covered by health insurance or paid out-of-pocket. The focus is on developing functional skills across all settings—not just at school.
This therapy is often more intensive and individualized than school-based OT.
Common Goals Addressed:
Delays in fine motor, gross motor, or coordination skills
Feeding difficulties and oral-motor development
Sensory processing challenges at home or in the community
Emotional regulation and behavior support
Activities of daily living (ADLs) like dressing, bathing, or brushing teeth
Play skills and social interaction
Visual-motor integration for home tasks or sports
How Services Are Delivered:
One-on-one therapy in a clinic or private practice
Often includes parent coaching and home programs
May use specialized equipment (swings, climbing structures, sensory tools)
Eligibility:
Requires a referral from a pediatrician and an OT evaluation. Services are typically based on medical necessity, not educational impact.
A Few Key Differences
School OT follows the academic calendar – services pause during school breaks or summer.
Private OT often continues year-round and may offer more frequent sessions.
School OT focuses on access to the curriculum, not treating a medical diagnosis (even if your child has one).
Outpatient OT addresses the whole child—across school, home, play, and daily routines.
Final Thoughts from an OT
Both school-based and outpatient occupational therapy play important roles in helping kids succeed. They’re not in competition—they’re complementary.
If your child qualifies for school OT, fantastic! Just know that school-based OT won’t cover everything. If your child is still struggling at home, in social situations, or with emotional regulation, a private OT can help fill in those gaps.
Still unsure which is right for your child? A pediatric OT (like me!) can help guide you based on your child’s needs, your goals, and your available resources.