#55 - Why Are Home Programs Important in Occupational Therapy?

If you’ve been taking your child to see a pediatric occupational therapist, there’s a good chance they gave you homework, also known as a home program, at the end of the session. The thing is…although you nodded your head as if you would do it, in the back of your mind you really can’t fathom adding yet another thing to your to do list. Or maybe you had the best intentions of practicing it at home…but the day got away from you and you just can’t keep up. Maybe you were able to give it a shot 1 time, but certainly not repeatedly. 

Then, when you go back to therapy, you feel guilty because your OT asks if you did the homework…and you really don’t want to tell them that you didn’t. Sound familiar? 

Believe me - you are absolutely not alone.

However, home programs and homework after the therapy sessions really do make all the difference in your child’s progress, and that’s what I want to talk about with you today - why are those home programs so important? And how can you make them fit into your routine, so that it’s not just another thing on your to-do list?

Why are home programs so important in pediatric occupational therapy?

If you were hoping you were going to come into this episode, and I was going to say - nope, don’t worry about those home programs, I am truly sorry to disappoint you.

Unfortunately, occupational therapy really isn’t one of those things where you can just drop your child off and hope that all your concerns resolve (although I know you really wish it was). I really do believe that home programs are necessary for real progress - and here’s why.

Here’s the thing - most children receive occupational therapy services for 30-60 minutes 1-2x a week. In the span of an entire week, that’s really a short amount of time. To be exact, if your child gets 60 minutes of therapy a week - that’s only 6% of their week. That means that 94% of their week is spent not in therapy.

But why does that matter?

When it comes to learning new skills, consistency is extremely important. Let me give you some examples. 

Example #1

Say your child is going to occupational therapy to work on handwriting. A huge part of handwriting is learning how to hold the pencil and how to form the letters. Both of these require motor patterns. 

A motor pattern is essentially a movement that we’ve learned in our head, and done so many times over and over, that we don’t even need to think about it any more.

So when you go to write a letter, or pick up a pencil, you’re using the motor pattern you have in your head. 

When a child is going to occupational therapy, it’s likely that the motor pattern they’ve previously been using isn’t very functional, or it’s causing issues for them.

So in the session, the occupational therapist works on teaching them a new motor pattern. And they practice for those 30-60 minutes. 

But then what happens when they go home? The majority of the time, if there’s no one there to cue the child or help them, they’re going to use that old, non-functional motor pattern - again, and again, and again. For 94% of their week!

But here’s the problem - which motor pattern do you think is going to be more ingrained then - the one they’ve practiced for only 6% of the week? Or the one they kept doing for 94% of the week? 

Now, does that mean they’ll never make progress? No, usually with repeated therapy we can still start to help ingrain that new motor pattern, but it certainly happens a lot more slowly and inconsistently. 

On the other hand, when I have parents who have gone home and practiced these new patterns with their child during their usual homework time, they have progressed MUCH more rapidly. Yes, it might be a little frustrating at first for the child, but when they’ve done the skill over and over it becomes easier, and they quickly start to replace the nonfunctional one.

Example #2: 

Say you’re taking your child to therapy for sensory processing, regulation, and meltdowns. 

You drop them off, or even sit in the session and watch for those 60 minutes, and then you go home and go throughout your day, never really carrying over the strategies. 

You begin to notice that your child is more regulated after therapy sessions, but that there’s not much progress happening through the week.

And then you begin to think - occupational therapy isn’t helping. 

But here’s the thing - our body changes on a minute to minute basis. Sure, your child may be super regulated immediately after receiving that input, but what happens when they go to school the next day and the fire alarm goes off, dysregulating them again? What happens if they have a hard time sleeping, and then are sluggish the next day? Your occupational therapist isn’t at home with you - in those moments, you as the parent need to know how to support your child and help their body regulate. 30 minutes on Monday isn’t going to carry over all the way to Sunday. 

And example #3: 

Let’s talk about feeding therapy this time. As you know, when it comes to feeding therapy, I’m a big fan of the SOS Approach to Eating, where you help kids overcome that anxiety interacting with new foods step-by-step. And that’s exactly what we do in feeding therapy sessions. We work 1:1 with a child on exploring new foods in fun ways. And you can see A LOT of progress here. What makes it so successful is that we consistently offer ways for a child to interact with food that’s fun, and meet them where they are at, in a non-pressure way. But again, that’s only 6% of the week. It’s literally 1 out of 35 meals and snacks that week. If the other 34 meals and snacks are a constant fight, too hard, and end in tears, it’s going to be a lot harder for us to make progress. 1 good experience with food during the week likely is not going to outway 34 bad experiences. That’s why it’s so important to carry over the recommendations your therapist is giving you. We need to integrate those recommendations into your usual routine, so that they’re having the same experience at home that they are in therapy - that’s where the magic is.

Of course, all of these examples are extremely simplified. It’s a little more nuanced. But what I really wanted to show you is two things:

1. Repetition and consistency matters - if they’re doing one thing in therapy for only ½ an hour, and a totally different thing at home the rest of the week, progress is going to be a lot slower.
   
   
2. Your therapist isn’t with you 24/7 - it’s not realistic for a child to always remember the techniques they learned in therapy 5 days ago. To really help integrate it into their brain and their daily routine, they’re also going to need your help and support. 

Ok, so now that you know WHY i really do believe home programs are that important, let’s talk about how you actually can integrate this into your day.

How to integrate home programs into your daily routine

Let’s be totally honest here - if its too hard, or too time consuming, or too much mental energy, you’re likely not going to do it. You’re a busy parent and you’ve already got enough to think about. 

When I first became an OT, I had a hard time understanding this. I would give homework to parents based on what we worked on, and then I couldn’t figure out why they weren’t doing it at home. 

The truth was - it was too much, and too energy consuming. What we really need to do is figure out how you fit it into your normal day.

So say your OT wants you to practice doing some heavy work (because that is a common recommendation). If you don’t know what heavy work is, make sure to check out episode #50 - Why Did My OT Recommend Heavy Work?

Ok, so if at the end of your therapy session, your OT wants you to practice heavy work at home - here’s what I want you to be thinking - and even to talk about with them. 

How can I incorporate this into something I’m already doing every single day, in a way that actually works for my child and won’t lead to a meltdown.

For example:

• If my child goes to the playground every day after school - perhaps we can take turns pushing each other on the swing.
  
  
• If you already have a bedtime routine of brushing your teeth - perhaps we can carry a load of laundry to their bedroom together on our way to the bathroom
  
  
• If you always wipe down your counters each day, and your child already wants to get involved - perhaps they can wipe down the table for you

Essentially - where is somewhere you can fit it into your routine. I want you to actually think of where this can fit in while you are still with your occupational therapy. And then…I want you to plan how many times this week you are actually going to try to do it.

Is it once? Twice? What is realistic for you. Everyday probably is going to be a lot. You want to feel successful and like you met your goal, so how many times is realistic for your family that week? 

When we plan things out, we’re actually more likely to do them and carry them through. So taking those 2 extra minutes with your therapist can make all the difference in practicing at home. 

Now something we haven’t talked about yet is education:

Another thing that may be holding you back from carrying over your occupational therapy programs at home is that you don’t really understand why you’re doing it, or how it’s going to help your child.

Unfortunately, in our current therapy system, therapists often don’t have the time or ability to fully educate parents. Now, I’m not saying this is right - because I really don’t think it is, but it is the reality. 

At many clinics, occupational therapists are expected to pick up the child, walk all the way back to the room, take off their shoes, do a sensory prep activity, a functional activity, clean up, put their shoes back on, and educate the parents all in 30 minutes.

Any parent who’s tried to get their child’s shoes on and get out the door knows that this alone can take 30 minutes. So it’s a lot to get done in a small amount of time.

Which usually leaves only about 1-2 minutes for parent education. Which honestly, simply isn’t enough. As a parent you need way more education than this.

You should know exactly what is going on in your child’s therapy session, what skills they are working on, how this impacts your overall goals, and how to carry it over at home. 

And that’s where I come in! My goal is to provide you with as much amazing education as possible so you can FINALLY understand sensory processing, decode your child’s unique needs, and navigate the challenging moments. 

When you actually understand what’s going on, and what you can do to help you are going to feel much more EMPOWERED to actually do it. And that’s exactly what I teach you in my online courses, and in our membership The Sensory Toolbox. 

But first, I want to help you get a bit more organized with your home programs. This week I’m sharing a brand new freebie with you - my "Home Program Planning Sheet": it’s a customizable worksheet made for parents, to help you to keep track of the homework your therapist has recommended, write down activity ideas, and schedule it into your routine.

To grab your copy simply go to www.drsamgoldman.com/homeprogram

See you next week friends!

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