School Speech vs. Outpatient Speech: Understanding Both

Many children with speech and language difficulties and differences receive speech services at their public schools through the support of an Individualized Education Plan (IEP). These services are crucial for children who have communication differences and disorders that impact their reading, writing, spelling, and overall socialization in the school setting.

However, not all children receive services through public schools. Some children who do not attend public school, or who require more intensive support outside of the academic environment, may benefit from outpatient speech therapy — either instead of or in addition to school-based services.

In this post, we’ll explore the key differences between school speech therapy and outpatient speech therapy, why a child might benefit from one or both, and how families can make the best decisions to support their child's communication growth.

Purpose & Eligibility

• School Speech Therapy: Focuses on educational impact. Services are provided to support a student’s ability to access and progress through curriculum materials, such as:

  • Reading: Decoding words, comprehension

  • Writing: Spelling, grammar use

  • Communication: Self-advocacy, social interaction

• Outpatient Speech Therapy: Focuses on overall communication needs, including:

  • Speech intelligibility

  • Language development

  • Social communication

  • Feeding/swallowing

  • ...and much more!

Service Delivery Model

• School-Based Therapy: Often provided in group settings, with shorter, less frequent sessions due to higher caseloads and scheduling demands. Students may miss sessions due to absences, assemblies, or standardized testing.
  *Benefit: School-based SLPs often collaborate closely with teachers, push into classrooms, or co-teach to support language and communication within the learning environment.

• Outpatient Therapy: Typically individualized, with longer session times depending on the child's needs. Therapy can take place in a clinic or even at home, providing meaningful opportunities for generalization (like discussing favorite toys or pets).
  *Consideration: Insurance coverage can vary, and group therapy options are not always available if needed.

Goals & Documentation

• School Services:
  The IEP (Individualized Education Plan) is a legally binding document outlining goals connected to academic success. Schools are accountable for implementing the plan under federal and state laws.

• Outpatient Services:
  Documentation is based on both medical necessity (to meet insurance requirements) and caregiver input. Goals typically focus on everyday communication needs, including speech, language, feeding, and social skills.

Team Involvement

• School-Based Team:
  Includes teachers, SLPs, other service providers (OT/PT, etc.), administrators (special education directors, principals), parents/caregivers, and the student (typically starting in high school).
  ➔ Annual IEP meetings are required, but parents/caregivers can request a meeting anytime concerns arise.

• Outpatient Therapy Team:
  Caregivers are heavily involved in regular communication and therapy participation. Family coaching is a key component. With a signed release, outpatient SLPs can collaborate with school teams, OTs, PTs, or any other relevant professionals.

Why Might a Child Need Both?

While school services are valuable, the time spent 1:1 with a provider is often limited. Children may qualify for minimal services based on school eligibility criteria but would still benefit from more intensive or specialized support outside of school.

In school settings, SLPs often support a wide range of communication needs but may not specialize deeply in areas like Childhood Apraxia of Speech, stuttering, literacy disorders, or swallowing. Outpatient SLPs often pursue focused training in specific areas, offering an additional layer of expertise.

Final Thoughts

Both school-based and outpatient speech therapy provide unique benefits.

They aren’t competing — they complement each other!

When families understand the strengths of each system, they can better advocate for comprehensive, well-rounded support to help their child thrive.