Pediatric Rehabilitation Practice, Systems, and Transitions of Care
Educational law and entitlement
Early intervention under IDEA Part C serves children from birth to 3 through an Individualized Family Service Plan, which is family-directed and can be delivered in the home. From age 3, Part B provides school-based services through an Individualized Education Program for children whose disability affects educational performance. Section 504 provides accommodations for children who do not require specialized instruction. School-based therapy exists to support access to education, not to maximize medical function - clarify that distinction with families, who often expect outpatient-level intensity at school.
Care coordination and transition
Family-centered, culturally responsive care within a medical home improves outcomes. Health care transition planning should begin in early adolescence (roughly 12 to 14 years), well before the IDEA-mandated school transition planning at 16. Prepare the youth for self-management, identify adult providers, transfer records, and address insurance continuity. Decision-making options include supported decision-making, power of attorney, and guardianship; the least restrictive option that fits the young adult's capacity is preferred.
Systems and documentation
Equipment funding requires documented medical necessity, trials, and letters of justification; denials are commonly appealed successfully. Disparities affect access to therapy, equipment, and specialty care, so screen for transportation, language, and insurance barriers. Rehabilitation after acquired brain injury requires planned school re-entry with graded schedules and staff education.
Worked rule of thumb
A new disability before age 3 goes to Part C early intervention; at age 3 or later, it goes to the school district's Child Find process.