Two Paths to OT in EI

In House v.s. Contracting

For many occupational therapists either option can be a great path to early intervention. Each provides something different and can support your career in EI differently. Described below are some of the main differences between each, with some advice, perspectives, and pros and cos shared by OTs working in EI via both paths.

In-House

Often thought of as more of a typical work week and path to early intervention. Many therapists in this setting work 8am-6pm four days a week, with Mondays or Fridays off as a part of their weekend. There are therapists who prefer a typical work week of 9am-5pm, five day work week. Often hours and work load are measured a bit differently at these in-house sites and may include a specified number of contact hours a week. For example at one site the expectation for full time therapists is to be engaged in 23 contact hours a week. These contact hours include sessions with clients, evals, IFSP meetings, transition meetings, etc. Other organization may measure full time as a certain number of hour worked in a month, or a certain productivity marker.
As a part of an in house team you will also likely be expected to participate in meetings. Meetings in early intervention are often not what we would think of when we think of work meetings. EI team meetings are amazing! Meetings revolve around providing support for one another, working though issues that others are facing, working together to come up with ideas for kiddos, and making sure that the therapists on the team are feeling supported. Often other meetings will be held to support specific trainings and topics such as an autism focus group and workshop, a presentation on how to recognize Gestalt language learners, information on how to most effectively request assistive technology for a family, etc. If you are working in house for an early intervention broker, you will likely also have access to trainings and continuing education via the organization. It is common for agencies to bring in speakers and trainers for in-demand workshops and seminars for all therapists

Another key component of working in-house is the documentation system. As a part of an in house team you will likely be expected to submit notes for every session, along with billing. Many organizations and early intervention brokers have their own electronic medical record system. One of the main benefits of working in-house is that billing is often handled by the organization rather than the therapists.

Pros

Benefit Packages

Protection and compensation despite cancelations

Sick Leave

Vacation Time

More security and predictability with flow of clients

Access to trainings and continuing education

Lots of support from a team and weekly meetings

Gas Mileage Reimbursement

Assistance with trainings and on-boardings

Great for supporting therapists new to EI

Support via 1:1's, note reviews, etc.

Access to organizational resources such as a billing department, legal assistance, training, assistive technology offices, etc.

Access to the lending library

Access to required and useful assessments

Cons

Less control over your schedule

Many sites will assign you clients rather than you choosing the caseload you are looking for

You will likely need to meet a productivity standard

You will also likely undergo performance and note reviews

EI Brokers often require more robust notes and documentation

You will likely be required to attend weekly meeting, removing some of the flexibility in your schedule

EI brokers may require more robust in-house trainings, and education on organizational procedures

Lower hourly/visit rates

Contracting

Being an early intervention contractor can look many different ways. Contracting can be part-time, full-time, for a small business, under your own LLC., etc. This is one of the common themes with contracting for early intervention, flexibility!

The majority of EI contractors own their own LLC. and take on contract work with local EI brokers. Contractors will often take contracts with multiple EI brokers at the same time. This provides more flexibility for scheduling, for taking clients that fit with your needs, and for taking on a caseload that represents your interests.

Contractors that work under their own LLC often do not have access to built in teaming opportunities via weekly meetings. It is also unlikely for contractors have access to the continuing education and training opportunities offered by organizations. Therefore, many contractors will seek out their own continuing education, conference opportunities, trainings, etc.

Another opportunity for contractors is to work for an independent organization that manages contracts for its employees. For these contractors, it is likely that they are working in a more traditional in-house way, working to meet organizational requirements for hours/productivity, and attending team meetings. However, one difference is that these contractors are likely receiving a much higher hourly rate, upwards of $75 per visit. However, in these organization it is likely that full benefits, gas mileage reimbursement, and cancelation coverage can not be provided.

Depending on how independent the contractor is, i.e. owning and managing one's own LLC v.s. working with a contracting company, the contractor may be responsible for their own billing. Many therapists will higher out their billing, as an added expense. Other therapists may try to manage their own billing at home. It is important to remember that medicaid billing is often a different process.

Additionally, many contractors are not required to complete or submit daily notes to an employer. Many therapists still keep records for their own protection and to help them organize their practice.

In general it is common to see therapists turn to early intervention contract work in search of more flexibility, or a higher hourly rate. Some therapists who have reported thriving in a contract role include but are NOT limited to parents looking match their kiddos' schedules, therapists who are moving towards retirement, young therapists who don't mind inconsistency and who are looking for a higher hourly rate, therapists who want to work part time in other settings and in EI, therapists looking for a better work life balance, and much more!

Pros

High hourly rate

More flexibility

More control over your schedule

More choice over location of clients and work

More choice over type of caseload

Lower requirements for documentation

Lower organizational requirements

Allows for more freedom and less supervision

Cons

Often no healthcare or retirement benefits

No protection for cancelations