Occupational Therapy, Speech Therapy, and Sensory Processing Support in Finnish Schools

One of the first questions families navigating special education in Finland ask is: who provides the therapies? In the US or UK, it is common for occupational therapists and speech-language pathologists to work directly within schools, delivering services as part of a child's IEP or EHCP. In Finland, the division of responsibility between the school system and the healthcare system is drawn differently — and understanding it correctly saves families months of asking the wrong people for help.

The Basic Division: School vs. Healthcare

In Finland, occupational therapy (toimintaterapia), speech-language therapy (puheterapia), and physiotherapy (fysioterapia) are primarily delivered through the healthcare system, not the school system. These are clinical services, and they are coordinated through either the municipal health center or the regional hospital district's rehabilitation services — not through the school.

This is a significant departure from the Anglo-American model. If you ask a Finnish school principal to arrange occupational therapy for your child, they will likely redirect you to the healthcare system. This is not a refusal — it is how the system is designed. The school's role is pedagogical intervention; the healthcare system's role is clinical therapy.

However, the two systems are supposed to coordinate. A school's support implementation plan can reference the child's therapy needs and note that healthcare services are involved. The school's erityisopettaja and the child's occupational or speech therapist are expected to communicate about the child's goals so that school-based strategies reinforce the clinical work.

In practice, this coordination varies enormously. In some municipalities and schools, the collaboration is structured and regular. In others, the school and the therapy provider operate in parallel with minimal communication. As a parent, you may need to actively facilitate this coordination yourself.

How to Access Occupational Therapy Through the Healthcare System

To access occupational therapy for your child, the pathway starts with a referral from a healthcare provider — typically the child health clinic (lastenneuvolalääkäri or neuvolalääkäri) for younger children, or the GP (yleislääkäri) at the municipal health center for school-age children.

If the GP agrees that occupational therapy is warranted, they issue a referral to the relevant rehabilitation service within your hospital district (HUS, TAYS, TYKS, OYS, or KYS). There are waiting times for assessment and therapy commencement, which vary by region and by the severity and type of need.

For children with diagnosed conditions — autism spectrum disorder, developmental coordination disorder (DCD), ADHD with significant motor or sensory processing components — occupational therapy referrals are more straightforward once the diagnosis is in place. For children whose needs are not yet formally diagnosed, the referral process may take longer as the healthcare provider assesses whether OT is the most appropriate intervention.

Kela (the Social Insurance Institution of Finland) funds occupational therapy as rehabilitation for children who meet specific criteria. If your child has a diagnosis and their treating physician has recommended OT as part of a rehabilitation plan, Kela can fund the therapy sessions — including sessions at private providers — under its discretionary or statutory rehabilitation programs. This is distinct from the diagnostic assessment cost, which Kela generally does not cover.

Speech Therapy in the Finnish School Context

Speech-language therapy (puheterapia) follows the same division of responsibility: primarily delivered through healthcare, not school. However, there is an important nuance for school-age children.

Finnish schools have some internal capacity for speech and language support through the erityisopettaja (special education teacher), some of whom have specific training in language and communication difficulties. This school-based support is pedagogical — it focuses on classroom-based communication strategies, reading and writing adaptations, and language-based learning support. It is not clinical speech therapy.

For children who need formal speech therapy — articulation therapy, language intervention for developmental language disorder, AAC (augmentative and alternative communication) support — the healthcare referral pathway is the route to access it.

For expat children who are also learning Finnish as a second language, coordinating speech therapy becomes more complex. Clinical speech therapists working with Finnish-medium assessments and treatment protocols may have limited capacity to work in English. If your child needs speech therapy in English, private providers are the most reliable option. Ask the school's erityisopettaja whether they can suggest English-speaking speech therapists who work with expat families in your area.

Sensory Processing in the Classroom

Sensory processing differences — under-responsiveness, over-responsiveness, or seeking behaviors that affect a child's ability to regulate and learn in a classroom environment — sit at the intersection of the school's responsibility and the healthcare system's.

The school is responsible for making reasonable environmental accommodations. These are pedagogical measures that do not require a medical referral or formal diagnosis:

• Seating adjustments (away from high-stimulation areas, near the teacher, at the front or back of the classroom)
• Noise-reducing headphones or ear defenders for children who are acoustically sensitive
• Movement breaks built into the school day
• Calm-down spaces or designated quiet areas within the classroom or corridor
• Modified transition routines to reduce sensory load during noisy hallway periods

These measures can be requested from the class teacher and erityisopettaja immediately — they fall within the scope of group-specific support and require no formal administrative decision. If you know your child has sensory processing differences, request these adjustments in writing through Wilma before the school year starts or at the first teacher meeting.

For children with significant sensory processing difficulties that are affecting their daily functioning beyond school — affecting sleep, eating, home routines, or community participation — occupational therapy with a sensory integration specialization is the clinical intervention. This again follows the healthcare referral pathway.

What the School Can Arrange Directly

While therapies are healthcare responsibilities, Finnish schools can and do arrange for some services within the school context:

School assistant services (koulunkäyntiavustaja): A dedicated or shared classroom assistant who supports the child's daily functioning, including sensory regulation strategies, during the school day. This is arranged through the formal support process and is specified in the child's support implementation plan.

Assistive technology: Equipment such as tablets, text-to-speech software, adapted keyboards, or specialized seating can be arranged through the school as part of a formal support decision.

Coordination with external providers: If your child receives OT or speech therapy outside of school hours, the school can schedule meetings with the therapist to align school-based strategies with the clinical goals. This coordination needs to be explicitly requested — it is not automatic.

For families navigating both the school support system and the healthcare system simultaneously — which is the reality for most children with significant developmental needs — the Finland Special Education Blueprint covers how to coordinate across both systems, what documentation the school needs from healthcare providers, and how to escalate when either system is moving too slowly.

The parallel-system structure is not intuitive, but once you understand the division of responsibility, you can push the right people for the right things — and stop waiting for the school to provide services that are actually the healthcare system's job.

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