Dad passing toy to child

Collaborative Approach

Collaborating with Caregivers

Home-based therapy requires collaboration between the therapy team and caregiver. Working together, therapists and caregivers can design therapy content that is meaningful and motivating for the caregiver and child.

Collaborative Goal Setting

Setting goals for therapy is often the first opportunity for collaboration. Setting goals that are meaningful to the caregiver leads to increased motivation and engagement. Collaborative goal setting involves actively engaging caregivers in making decisions about goals. Goals are set in a conversation, with the caregiver sharing their expertise on their child and their values, preferences, and motivations. The occupational therapist shares their expertise on the intervention. Everyone asks questions and discusses options. For a goal to be selected, everyone needs to agree on it. The sections on Motivational Interviewing and the Applied Coaching Model introduce ways to approach the collaborative goal setting conversation.

Goals should then be used to individualize therapy content, as outlined in the section on Therapy Content.

SMART Goals

Goals should be Specific, Measurable, Attainable, Realistic, and Time-bound (SMART). The occupational therapist and caregiver should discuss and agree upon each component below:

  • Specific:
    • What does the caregiver want their child to accomplish?
    • What level of assistance will the child need?
    • Which resources are involved?
  • Measurable
    • How will I know when the child achieved their goal? Must be observable.
  • Achievable
    • Is this goal realistic, considering time and intervention constraints?
  • Relevant
    • Is this goal meaningful and does it address the child and caregiver’s needs, priorities, and preferences at this time?
  • Time-bound
    • When will the child achieve this goal?

The Canadian Occupational Performance Measure (COPM) is often used by therapy teams for collaborative goal setting. More information about the COPM can be found at https://www.thecopm.ca/ 

Updating Goals

During a therapy program, new priorities and goals may emerge for the caregiver. Their child will develop, gain skills, and change interests. The therapy team should routinely review goals with caregivers and update or add new goals as needed.

mom and toddler waving at computer

Therapy Appointments

Therapy appointments are an opportunity for clinicians (occupational therapists and/or therapist assistants) to problem-solve with the caregiver, not for clinicians to deliver therapy.

Start the session by asking the caregiver to share challenges and successes from the previous week. This discussion will likely guide the session. Clinicians can observe the caregiver delivering therapy and provide feedback. It may be appropriate to demonstrate something to the caregiver, and then observe them practicing. Note that sometimes the child may not be interested or available (e.g., sleeping) for the session. End the session by asking caregiver to summarize what has been discussed and reinforce any plans that were made.

Virtual Appointments

Often, appointments can be done virtually over video call. Virtual delivery allows therapists to see the home environment and may make therapy more accessible for families.

As certain elements of therapy are best coached hands-on, it may be beneficial to adopt a hybrid format with some in-person and some virtual sessions. The ideal delivery mode, whether in-person or virtual, is likely child-specific and should be selected by the family and therapist.