IEP, DOE, RSA: Decoding School-Based Speech Therapy in NYC
Understand speech therapy in the school system, the option of private practice, and hold-over services with BKST.
The origin of school-based speech therapy, in brief (for the history curious).
Before 1975 children with learning barriers were excluded from the public education system. Barriers were things such as deafness, blindness, neurodivergence, or what are now known as significant learning disabilities. Many of these children were relegated to state institutions where they did not receive education or rehabilitation services. The civil rights movement ultimately led congress to pass legislation that granted the right to a free and appropriate public education to all children, regardless of their learning needs. This meant that schools were legally mandated to meet the individual learning needs of all students. The birth of school-based learning support services followed.
“Services” as they exist today include speech, occupational and physical therapy, special education programs and systems of evaluation.Thanks to this legislation, families have access to developmental therapies at no cost to them. As with any state provided service this comes with significant caveats and access challenges. Challenges that are especially familiar to families within the massive, and under-resourced NYC Department of Education.
A bureaucratic acronym index
The system is as complicated as it’s acronyms suggest, so let’s get on the same page about what some of the common ones mean.
DOE: Department of Education, the federal governing body of public schools nation-wide. Think: funding.
IEP: Individualized Education Plan. This is a legal document that lays out your child’s learning and developmental needs, along with a plan for how their school intends to meet them. There are goals, there is jargon, and there are family meetings associated with obtaining and maintaining an IEP. They are renewed annually, or at the start of each school year.
EI: Early Intervention, services that are provided to infants and toddlers. Managed and provided by the state via the Department of Health and Human Services. (EI is not a federal program).
IFSP: Individual Family Service Plan, an IEP but for Early Intervention. The focus on family reflects these services often being provided in the home with an emphasis on family education and support.
RSA: Related Services Agreement, a voucher for Speech/PT/OT/counseling services given to parents when their school cannot provide these services directly. Some private practices have a payment contract with the DOE to satisfy RSAs.
CSE: Committee on Special Education, conduct evaluations, develop IEPs and make service recommendations for children ages five-21 years.
CPSE: Committee on Preschool Special Education, conduct evaluations, develop IEPs and make service recommendations for children ages three to five years.
Why can it be difficult to access this system, or find a school-based speech therapist?
Before we get into the barriers, allow me to indulge in a moment of broad gratitude for the existence of these programs in the U.S. Public awareness, clinical specialization and diagnostics flow down stream from the legislation which mandated that children’s various learning needs be met. Most importantly, it would be impossible to estimate how many children have been able to connect and live more meaningful, independent lives because of this.
However…
It is an unfair and frustrating system that needs significant improvement. For monetary reasons, the bar is set quite high for children to “qualify” for these services. In the realm of speech, your child will not get therapy in school for a lisp, or unclear articulation if they do not have any other learning or developmental challenges. Similarly, and more concerning, your child will not get therapy in school for language or cognitive delays if they aren’t delayed enough. This means your child could be two levels (standard deviations) below average (the mean) and struggling, but not qualify because children need to be more than two levels below average to get therapy. The same applies to toddlers who are not yet speaking. Generally, if a child is under three, they won’t get therapy via EI for expressive language or speech if they demonstrate that they can understand and play appropriately. Not great.
More than 7,000 preschoolers went without speech or occupational therapy in the 2024-25 school year.
Sadly, that statistic does not capture students who eventually did get therapy but had to wait for a crucial five or six months in order to start (citation). There is a DOE reported shortage of service providers, and in special education generally. The decline has been sharp since COVID, but as someone in relatively close communication with speech therapists, I can confidently state the specific bureaucratic reasons for the professional drain. Therapists providing EI or school-based services are overworked, under-resourced (speech therapy in a closet or hallway!), and underpaid. They’re burnt out. The speech therapists that seek work in private practice are craving opportunities to do what they love in ways that are more impactful, with less red tape to navigate.
What about speech therapy through an RSA?
In NYC there are roughly 1,600 public schools. Schools in wealthy neighborhoods with powerful PTAs, tend to have speech therapists on staff (akin to suburban school districts.). Access is easier for kids in those schools. Families who are zoned for less resourced schools, or families in private schools where service provision isn’t mandated, need to go on a scavenger hunt for an RSA provider. I’ve seen schools provide lists to families for outside clinics that service RSAs. This is helpful, but parents are then in competition with one another during the leg work of getting their child on a clinic’s schedule. In many cases being seen means traveling away from home as often as three times per week for sessions.
Not all speech therapy practices work with RSAs. Contracting with the DOE to service RSAs is a mirror experience of the broader system. The paperwork is burdensome, the systems are outdated (fax!) and the reimbursement rates are insufficient. Many clinics who do service RSAs are able to do so due, in certain part, to the employment of speech therapists who are newly licensed and paid at a lower salary.
What does the alternative of private speech therapy look like?
This is not an ad pitch to lure you into the world of private pay services. Pursuing services through the DOE is something I often encourage the families working with BKST to do: either in addition to our work, or in place of. Especially for children who have a long road ahead in therapy, or require more broad based support. We are willing and happily able to create teams of private therapists and work with our families for as long as they need, but we also try to be mindful of their resource management.
Private speech therapy vs. school based speech therapy, or EI
Aside from the obvious location difference (at BKST we come to your home), private practice tends to be more flexible, bespoke and parent connected than services through the state or city. This is in large part to the lack of bureaucratic structures in private practice. Therapists working for the DOE are juggling large caseloads. They are required to jump through many hoops (paperwork) and dodge structural limitations (mandates that specify session frequency and duration) while planning and conducting therapy sessions.
In private practice we are free to think only about how to make sessions most engaging and impactful, and can work around a family’s schedule. The connection between therapist and parent in private practice allows for caregivers to be more centered and supported in the process. On the flipside, if therapy is in school, your child’s SLP will be able to work closely with their classroom teachers to make therapy academically relevant. DOE therapists bring the same spirit of wanting to do great work and help parents through the process of therapy, but they must work within the structures that employ them. The important trade off here is that private therapy can be a financial investment, whereas state-based services are free.
How BKST works in combination with school-based speech therapy and EI
It is frequently the case that families begin to work with BKST because their child did not qualify for therapy in the system. Almost as frequently, we are the first provider a parent has reached out to. If services through EI or the DOE are subsequently pursued, we do our best to act as a guide for families as they move through the process.
Sometimes we send families on their merry way into the land of free therapy services, but more common is a circumstance where BKST therapists continue to work with children in collaboration with their DOE service provider. Team building in this manner is beneficial to therapy outcomes, and taking on the softer, more creative and parent-friendly elements to service provision is a role we truly value. We have the time and space to help parents advocate for themselves in the school system, and ensure their child’s goals in therapy are consistent and appropriate. We’ve even joined in for IEP meetings!
Private therapy at BKST is an option to hold you over.
In our current climate of DOE speech therapist shortages, our practice warmly welcomes families who need to get started with some support while they await the assignment of a DOE provider. A great impact can be felt even in one or two sessions, and we do not want budgetary restrictions to keep a child or family waiting too long for care during a crucial time.