Public, school and private therapy: who provides what

Terms used

• Dictamen — The dictamen is the school guidance team's written report on your child's educational needs, needed for specialist teacher support.
• EOEP — The EOEP is the school guidance team that assesses pupils' educational needs and advises the school.
• CAIT — A CAIT is an early-attention centre for children aged 0 to 6.
• Certificado de discapacidad — The certificado de discapacidad is the official disability certificate issued by regional social services, which unlocks many aids.
• Cl@ve — Cl@ve is the government electronic identification system used to complete procedures online.

Key rules

• School support: Schools give free educational support, not clinical therapy such as speech therapy, psychology or occupational therapy.
• Health referral: Public health referrals start with your family paediatrician.
• Early attention: CAIT early-attention centres only cover ages 0 to 6.
• Associations: Non-profit association fees are often lower than private prices and sometimes depend on income.
• Regions: Each region sets its own waiting times, age limits, subsidies and therapy hours.

The short version

Schools provide free educational support from specialist teachers and the guidance team, but not clinical therapy. Clinical help comes from the public health system, from non-profit associations or from private providers. Which of these you can use, how fast and at what cost depends on your region.

What the school provides

Two kinds of specialist teacher work in public and state-funded schools:

• PT teachers (pedagogía terapéutica) give specialist learning support to pupils with specific educational support needs.
• AL teachers (audición y lenguaje) work on language and communication difficulties.

They help in class or in small groups. The number of hours depends on the school's resources and your child's needs. Support follows an assessment by the school guidance team (EOEP, or the departamento de orientación in secondary schools). The team then writes a report called the dictamen. Ask the school what is available and how to request the assessment.

What the public health system provides

Start with your family paediatrician (pediatra de atención primaria). They can refer your child to:

• neuropaediatrics;
• child and adolescent mental health (USMIJ or CSMIJ);
• hospital rehabilitation.

Early-attention centres (CAIT) cover ages 0 to 6 only. School guidance teams assess educational needs separately, so a school report does not replace a health referral. Waiting times vary widely by region, so ask early.

What associations provide

Non-profit associations for autism, Down syndrome, dyslexia and other conditions usually offer speech therapy, psychology, occupational therapy, social skills groups and family support. They are funded by regional subsidies, donations and family fees. Fees are often lower than private prices and are sometimes based on income. Some centres work under agreements (conciertos) with regional social services, which can reduce what you pay. Local associations also tend to know the current regional and municipal aid.

Private providers

If public waiting lists are long or the hours are too few, you can pay a private therapist directly. You pay the full fee. Many families combine private sessions with school support while they wait for public services.

How it varies by region

Spain's regions run their own health, education and social services. Madrid, Catalonia, the Basque Country and Andalucía all have school PT and AL staff, public child mental-health units and early-attention services. They differ in waiting times, age limits, subsidies and therapy hours. Catalonia and the Basque Country often have denser networks. Some regions subsidise therapy through social services or through agreements with associations.

Do not assume a service you read about for one region exists in yours. Check these, in this order:

1. The regional education department and its inclusion service (atención a la diversidad).
2. The regional health service, for early care (atención temprana) and child mental-health or rehabilitation units.
3. Regional social services, which issue the disability certificate (certificado de discapacidad) that unlocks many aids.

Many procedures can be done through the region's electronic office and may need a digital certificate or Cl@ve.

Use the decision, checklist and questions below to match your child's needs to the right service.

Which system pays for speech therapy, psychology or occupational therapy?

Who pays for your child's speech therapy, psychology or occupational therapy?

• The school pays: The need is educational and your child has a recognised need for specific educational support (NEAE), confirmed by the school guidance team's evaluation and a written report. This covers specialist PT and AL teachers (learning support, and language and communication support), not clinical therapy.

• Early intervention pays: Your child is under 6 and has a developmental delay or risk. Atención temprana is usually free from 0 to 6 years through social or health services, and your region decides who runs it and whether it ends on the sixth birthday or at the end of the school year.

• The public health system pays: Your paediatrician refers your child for diagnosis, neuropaediatrics, child mental health or hospital rehabilitation. Regular outpatient speech therapy, occupational therapy or psychomotricity after age 6 is rarely offered, and waits can run from months to a year or more.

• An association pays or subsidises: Your child has a disability certificate or your income qualifies. Associations charge a fee or a reduced fee, and the terms depend on the association and your region.

• You pay privately: Your child is over 6 and early intervention has ended, the public wait is too long for a young child, there is no disability certificate or NEAE recognition, you have just arrived and are not yet registered, or the therapy (such as ABA or sensory integration) is not covered. Only limited cases let you deduct the cost.

Start with age: under 6, ask about early intervention first. Over 6, check whether the need is educational (school) or clinical (health system, association or you). Then check what you hold: a written report, a disability certificate and your region's rules. If public help will not start soon enough or does not cover the therapy, plan to pay privately.

Documents you need

• Disability certificate (certificado de discapacidad), issued by your region's social services or disability department. It unlocks many aids.

• School psychopedagogical report (dictamen), issued by the school guidance team. It is needed for PT and AL support in school.

Checklist

• Search your regional portal for "ayudas alumnado con necesidades específicas de apoyo educativo" plus your region's name.

• Ask your family paediatrician for a referral if your child needs neuropaediatrics, mental health or rehabilitation.

• Visit the municipal social services office to ask about the disability certificate and local aid.

• Contact local associations for your child's condition to learn the current regional and municipal aid.

• Ask about waiting times, age limits and therapy hours in your region before you plan around a service.

Frequently asked questions

Who can refer my child to child mental health or neuropaediatrics?

Your family paediatrician (pediatra de atención primaria) makes the referral to neuropaediatrics, child mental health (USMIJ or CSMIJ) or hospital rehabilitation. Book an appointment with them first. The school guidance team only handles educational assessment, so it cannot open this door.

What does a school PT or AL teacher do for my child?

A PT teacher (pedagogía terapéutica) gives specialist learning support, and an AL teacher (audición y lenguaje) works on language and communication difficulties. Support happens in class or in small groups.

Do non-profit association centres cost less than private therapy?

Yes, fees at association centres are often lower than private prices, and sometimes they depend on income.

Is the disability certificate needed to get therapy aid?

Yes, the disability certificate (certificado de discapacidad) unlocks many aids, so ask regional social services about it early. It is granted by the regional social services or disability department.