Developing a Successful Home Program
Deanna Macioce, MS, OTR/L
Who does not feel that they are on a hamster wheel of constant activity that does not seem to stop or slow down? Schoolwork and obligations are mounting, sport and extracurricular activities schedules are becoming more intense, and at the end of the day, you wonder how you can do it all? This has become the scene in almost every American home. For some of us, we have another obligated to-do…the therapeutic home program. This is becoming a dilemma for both families and therapists. Many therapists are not giving home programs because they feel families are not doing them; however, therapy is most effective when there is carryover at home. So, how do we meet in the middle?
Get Them to Invest: One of the biggest roles therapists play is to educate all the individuals on the team. This includes the parents, teachers and child, so that everyone understands why we do what we do in terms of what activities we do in a session as well as what we do professionally. As pediatric therapists of any discipline, much of our treatment sessions can appear to be nothing more than playing. However, if we take a moment to explain to a parent why we are doing cotton ball races with a straw or having the child search for puzzle pieces in a foam pit, then they tend to understand more and begin to make a connection. When there is conversation and communication with the team, there is understanding, and team members begin to look at even ordinary daily tasks and play activities differently. You will often hear parents creating their own ways to work on the skills you addressed during a session because they see the value in it.
Individualize: In most situations, the home program you develop for the three-year-old who is an only child and the three-year-old who is child three out four is quite different, even if you are addressing the same concerns. The parent who has one child is more likely to have the time to re-create an activity or spend the devoted time on something versus that mom who is up to her knees in laundry and school obligations of older siblings, and still sleep deprived from the newborn. Make sure you have some understanding of the home routines, what else the family is participating in, and truly how much time the parents can attend to what is being requested. That is why it is important to try to integrate tasks into what is already happening.
Integrate: If you are wanting a child to work on coordination and core strengthening by doing animal walks, suggest that when getting up in the morning and going to bed at night they choose a walk to move to and from the bedroom. Trying to give activities that can be completed in their already established routines is great. If you are having a toddler needing a proprioceptive program, incorporating it quickly during a diaper change makes it easy for mom to do the massage or tortilla roll up while she is already connected to her child. For the school-aged child who already has homework, giving extra worksheets that address handwriting is hard and really ineffective. Instruct parents on one or two letters to focus on, providing fun, helpful tips to address during homework. Work with teachers to get the OK to adapt homework papers with highlighted lines, boxes, etc., so that the child is able to carry over the strategies from your sessions. In addition, finding activities that can be fun and integrate siblings and parents helps to keep everyone involved, and sometimes lets older siblings take the lead.
In addition, so many therapeutic skills can be addressed through chores, from pushing garbage cans to the road for proprioceptive input to washing windows and mirrors for shoulder and core strengthening to writing a grocery list…it can be a win-win situation.
Keep It Simple and Fun: Do not expect families to have the time to do things daily. If giving specific activities, help them choose the best time to do it. And make sure you are not asking families to do something that the child already really dislikes during the therapy session.
So, open up the lines of communication with your team and build a successful home program.