Therapies

What each one does, how many hours you can get, and how to tell it's working

Therapy is where most of your child's week goes and where most of the arguing with insurers happens. The single most useful thing to understand is that there are two separate therapy systems, and your child is entitled to both.

School therapy and medical therapy are not the same thing

School-based therapy exists to help a student access their education. It is written into the IEP, delivered during the school day, free, and measured against educational goals. Medical therapy — in a clinic, at home, or at a PPEC — treats the underlying condition and is billed to Medicaid or your insurer.

A district cannot refuse services because your child gets private therapy. A health plan cannot deny services because the school provides some. If either one tells you otherwise, ask them to put it in writing, then appeal — this is one of the most commonly reversed denials there is.

The disciplines, plainly

• Speech-language pathology. Far more than pronunciation — receptive and expressive language, social communication, and AAC devices. Many SLPs also treat swallowing.
• Occupational therapy. The work of daily life: dressing, feeding, handwriting, fine motor skills, sensory processing, and self-regulation.
• Physical therapy. Gross motor skills, strength, gait, positioning, contracture prevention, and the evaluations behind wheelchairs, walkers, and orthotics.
• Feeding and swallowing therapy. For dysphagia, aspiration risk, oral aversion, and tube weaning. Often a specialized SLP or OT; ask about a swallow study before anyone changes textures.
• Behavior analysis. Covered by Florida Medicaid with prior authorization, most often for autistic children. See Tab F for how to choose a provider.
• Respiratory therapy. Airway clearance, nebulizers, vent management, and family training on equipment.
• Vision and hearing services. A teacher of the visually impaired, orientation and mobility training, audiology, and deaf-and-hard-of-hearing services — all available through the school as related services.
• Aquatic, music, and equine-assisted therapy. Coverage is inconsistent and often out of pocket, but for children who shut down in a clinic room, these are sometimes the only settings where progress happens.

How much is enough?

There is no universal answer, and any provider who gives you one without evaluating your child is selling something. Ask instead: what are the three goals for the next six months, how will you measure them, and what frequency does that require? Then weigh it against the rest of your child's life. A four-year-old with thirty scheduled hours a week has no childhood left over, and exhaustion undoes therapy gains. Hours are a cost, not just a benefit.

When they say your child has "plateaued"

Plans deny continuing therapy by claiming a child has stopped progressing. Two responses work:

1. Maintenance is a covered purpose. Preventing regression, contracture, or loss of a skill is a legitimate medical goal. Progress is not the only justification.
2. Ask what data they used. Often it's an outdated progress note. A fresh evaluation with objective measures, plus a letter of medical necessity that names the specific criterion in the denial, flips a large share of these.

Signs it's working — and signs it isn't

• Skills show up at home, not only in the therapy room. If they never generalize, say so out loud at the next session.
• You're being coached. In early intervention especially, the model is teaching the parent, because your child spends 168 hours a week with you and one with the therapist.
• Goals get retired and replaced. Goals unchanged for two years mean nobody is looking.
• Your child doesn't dread it. Distress at every session is information, not defiance.
• The therapist talks to the other therapists. Ask for one shared set of goals rather than four competing ones.

Esta sección aún no se ha traducido al español. Se muestra en inglés.