Speech therapy, occupational therapy and behavioural intervention are all typically quoted as a rate per session. That is the least useful way to think about the cost, because what determines whether you can sustain a plan is frequency multiplied by duration — and duration is the number almost nobody puts in writing.
Do this arithmetic before anything else
Take the quoted session rate. Multiply by the recommended sessions per week. Multiply by forty — a school year, roughly, allowing for holidays. That is your year-one figure for that one therapy.
Now do it again for the second therapy, if two have been recommended. Most families discover at this point that the plan they were about to agree to is not the plan they can afford, and it is much better to discover it now than in month seven, because a plan abandoned halfway through is worse than a smaller plan completed.
Then take that number to the provider and ask them to help you build the most useful version of it that fits. A good one will do this readily. It is a genuinely revealing request.
What drives the rate
- Discipline. Different professions carry different rates, and within a discipline, seniority and specialism move it further.
- Setting. Clinic sessions are usually cheaper than sessions delivered at your home or your child's school, because travel is real time. Sessions in the child's own setting are also frequently more effective, so this is a genuine trade rather than an upsell.
- Who writes the plan. Some rates include assessment, planning and report-writing; some bill them separately. Neither is wrong, but they are not comparable.
- Blocks versus open-ended. A block of ten sessions with a review at the end is a different commitment from an ongoing weekly slot, and usually a better one for a family who wants a decision point.
The recommendation is the expensive part
A recommendation of three sessions a week rather than one costs three times as much, and it is usually made by the organisation that will deliver them. That is not an accusation — most clinicians are recommending what they genuinely believe helps. It is a structural point, and the structure is worth naming out loud.
Two questions do most of the work here. Does anybody's pay depend on the number of hours recommended? And what would make you reduce it? A provider with an answer to the second has thought about the ending, which is the thing you are actually buying.
Watch for the things that are not sessions
Reports, school meetings, phone calls, emails, travel, and the writing-up between sessions are all legitimate work. Charging for them is legitimate too. But a per-item model quietly discourages you from asking for the coordination you most need — and coordination is where most children's support falls apart.
If you are being billed per item, budget for it explicitly. If you are not, check what happens when you need three school meetings in a term.
What the cheapest useful version looks like
For a family whose budget is fixed, the most cost-effective thing available is rarely more direct therapy hours. It is usually:
- One good assessment, giving you a written plan you own and can take anywhere
- Parent coaching, so what happens in the other 167 hours of the week is working with the plan rather than against it
- A lower frequency of direct therapy, with clear home practice between sessions
- A review date with a defined question attached to it
That is a legitimate plan, not a compromised one. Ask any provider what they would do if this were their child and the budget was fixed. It is the single most revealing question on this page, and the answers vary far more than you would expect.