Educational Vs Medical Model

School-based therapy provided under an IEP must relate specific educational outcomes to the interventions recommended by the therapists. Therapy provided under the medical model tends to focus on discipline-specific goals that may not have a direct relationship to educational performance. For example, a clinically based physical therapist may have lower extremity strengthening as the ultimate goal for a child who exhibits weakness. Improving muscle strength does not have a direct link to educational performance.

Although PTs and OTs who work in educational environments remain concerned about the underlying components of a child's motor disability, they must (under the law) be able to describe how these limitations affect the child within the context of the school environment.

More specifically, therapists must articulate how a limitation in fine or gross motor function inhibits a child's ability to benefit from special education. This is the principle of determining educational relevance. If the OT or PT believes that a child's need for therapy extends beyond the child's educational goals, the therapist has a professional obligation to inform the parents or legal care providers so that medically (or clinically) based therapy can be provided through another funding source.

OTs and PTs must extend the application of particular therapeutic techniques beyond the traditional medical model approach and adapt them to meet the needs of the child in the context of the school environment. The focus of intervention is directed away from achieving isolated motor skills that are practiced in one-on-one therapy away from the classroom, and directed toward the achievement of functional tasks required to participate and benefit from special education placement (Dunn, Brown, & Duigan, 1994). For example, an OT may recommend specific techniques for improving hand dexterity with the educational outcome being improved handwriting legibility. In the same vein, a physical therapist may recommend specific use of a piece of adaptive equipment that would allow more independent mobility within the school environment. Without these stated educational outcomes, the intervention would be more medically based.

Providing educationally relevant intervention extends beyond academic performance to the larger school environment. School-based therapists should recognize that educational performance for young children also includes self-help skills, mobility in the classroom and on the playground and physical education.

Sourced from

Dunn, W., Brown, C., & Duigan, A. (1994). The ecology of human performance: A framework for considering the effect of context. American Journal of Occupational Therapy, 48(7).

Hanks, B., & Place, P. (1996). The consulting therapist: A guide for occupational and physical therapists in schools. San Antonio, TX: Therapy Skill Builders.

Virginia Department of Education. (1991). Handbook for Physical and occupational therapists working in school settings.