Speech Therapy and Occupational Therapy in Hong Kong Schools: What SEN Students Should Receive

When a child has a speech and language impairment, autism with communication needs, or sensory processing difficulties that affect their ability to participate in school, the question parents often arrive at quickly is: does the school provide speech therapy or occupational therapy? The answer in Hong Kong is: sometimes, and it depends heavily on which school your child attends, which tier they are classified under, and how actively you have pushed for it.

Who Provides Therapy in Hong Kong Schools?

In Hong Kong's public sector, speech therapy and occupational therapy within the school setting are funded through a combination of sources:

The Learning Support Grant (LSG): Schools can use their LSG funds to purchase external therapy services from registered speech therapists (ST) or occupational therapists (OT) to supplement internal SEN support. EDB guidelines explicitly state that schools may deploy LSG funds to procure external clinical services for students who require them — this is not optional once the clinical need has been established.

Department of Health (DoH) services: The DoH provides free speech therapy and occupational therapy through its Child Assessment Centres and Child and Adolescent Psychiatry services, but demand massively exceeds capacity. Waiting times for DoH therapy services routinely extend 12 to 24 months or longer.

School-based programmes funded by NGOs: Some NGOs, including Heep Hong Society and SAHK, provide school-based therapy support under government subvention. These are not universally available and their deployment varies by district and school.

Private therapy: Many families end up in private speech or occupational therapy out of necessity. Private speech therapy typically costs HK$1,000 or more per 45-minute session. Private OT is in a similar range.

Speech Therapy in Schools: What It Should Look Like

Speech and language therapy in a school setting is appropriate for students with:

• Diagnosed speech and language impairment (SLI)
• ASD with communication challenges
• Developmental language disorder
• Childhood apraxia of speech
• Selective mutism
• Fluency disorders (stuttering) that impact classroom participation

School-based speech therapy should be functionally focused — working on the communication skills the child needs to participate in classroom learning, social interactions, and daily school routines. A one-off assessment with no follow-through, or a referral to an external clinic the school does not coordinate with, does not constitute school-based support.

For students at Tier 2, speech therapy groups run within school hours (or after school in a structured, small-group format) are the expected provision. For Tier 3 students, individual speech therapy sessions delivered by a registered SLT should be part of the IEP, with specific communication goals measured at review intervals.

The critical question for parents is whether the therapy is being paid for from the LSG (school's obligation) or whether the school is simply recommending that you arrange private therapy yourselves. Schools occasionally conflate "we recommend speech therapy" with "we are arranging speech therapy." These are different things. If the recommendation is for you to find and pay for private therapy, ask in writing whether the school has explored using LSG funds to provide this through an external service provider.

Occupational Therapy in Schools: What It Should Look Like

Occupational therapy in schools addresses the sensory, motor, and self-regulation difficulties that affect a child's ability to participate in classroom activities. It is most commonly recommended for:

• Children with ASD or sensory processing differences who struggle with the physical and sensory demands of the school environment
• Students with dyspraxia or DCD (Developmental Coordination Disorder) affecting handwriting, physical education, and fine motor tasks
• Students with ADHD where sensory regulation strategies are part of the clinical recommendation
• Students recovering from neurological events or injuries affecting physical function

School-based OT support should translate clinical recommendations into the actual classroom environment. A therapist who assesses the child and recommends a sensory diet, a fidget tool, movement breaks, or a slant board for writing, and then communicates these directly to the class teacher with implementation guidance — that is meaningful school-based OT.

An assessment report recommending OT that the school files without any change to classroom practice is not occupational therapy support. It is paper compliance.

For students at Tier 3, the IEP should include specific OT goals with measurable outcomes and scheduled sessions. The IEP review should include data from the OT on progress against these goals.

What to Do When the School Isn't Providing Therapy

Step 1: Establish in writing what is currently being provided. Ask the SENCO: "Is my child currently receiving speech therapy or occupational therapy as part of their school-based support plan? If yes, who is delivering it, how frequently, and is it funded through the LSG?" If the answer is no, ask why, and what criteria would need to be met for it to be provided.

Step 2: Reference the LSG explicitly. Under EDB guidelines, schools are permitted and expected to use the LSG to purchase external clinical services when student needs require it. If your child is at Tier 3 with a clinical recommendation for therapy, the school's claim that "there is no budget" is a claim about internal allocation decisions, not about the existence of funds. Schools at Tier 3 receive approximately HK$34,445 in LSG funding per student per year — ask how your child's share is being deployed.

Step 3: Provide clinical documentation. If a registered speech therapist or occupational therapist has assessed your child privately and made specific recommendations, submit this report to the school formally. Under the DDO Code of Practice, the school must refer to valid professional data. A request for the school to implement specific therapy support, backed by a registered clinician's formal recommendations, is significantly harder to dismiss than a parent's general request.

Step 4: Escalate if necessary. If the school acknowledges a clinical recommendation for therapy and still declines to arrange it through LSG-funded external providers, and the denial is not based on a credible unjustifiable hardship argument, this is potentially a failure of reasonable accommodation under the DDO. A formal letter citing the DDO Code of Practice and giving the school a response deadline is the next step before escalating to the EDB Regional Education Office.

Private Therapy: Reducing the Burden

For families who are paying for private speech or OT therapy, maximise the school's use of those private reports. Request that the therapist prepares a brief school liaison letter after each assessment or at regular intervals — a single page stating what they are working on, what the classroom teacher can do to reinforce the goals, and what environmental adjustments support the child.

Deliver this letter to the SENCO and the class teacher. Ask for a response acknowledging the recommendations. This creates a paper trail showing that clinical input has been provided and documents whether the school acts on it.

Private therapy is expensive and should not be the permanent substitute for what the school should be providing. The Hong Kong Special Ed Advocacy Playbook includes guidance on formally requesting school-funded therapy and escalating when LSG-funded clinical services are refused without adequate justification.

One More Thing: Government Therapy Referrals

If your child has not yet had a government-sector therapy assessment, it is worth initiating the referral process even if the waiting time is long. A referral from your family doctor to DoH services, or a referral through the Child Assessment Centre process, puts your child in the queue for subsidised therapy. Private therapy can fill the gap while you wait. The two are not mutually exclusive, and having a DoH therapy record strengthens your school advocacy case — it demonstrates that the clinical need has been recognised not just by a private assessor but by the government health system as well.

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