Child Led Therapy open letter

An Open Letter to Parents From Your Child’s Occupational Therapist

Dear Parents,

Sometimes it feels like I went to school for three and a half years just for you to think that I’m a “glorified babysitter” or “play friend.” Like many pediatric occupational therapists, I’m sure, I’ve encountered this opinion far more times than I’d been warned about in school. I don’t mind if you think this, I just hope that you’d ask me what I’m doing rather than assuming it’s nothing but fun and games, with no plan in sight.

Much of my work is done in my head: my clinical observation skills are often one of the primary driving forces in adapting my treatment sessions to prioritize meeting the ever-changing, most pressing needs of my kids. Here’s a tiny glimpse into what goes through my mind on a moment-to-moment basis thought my day:

  • The other kids in the gym with us and how they may influence (positively or negatively) my session with your child
  • Our session’s sensory environment (lights, smells, sounds, toys, colors, etc.)
  • Your child’s health — if you inform me that they are getting over a cold or illness, I may alter my treatment plan for the day to best meet their current needs and abilities

I could create the most beautiful treatment plan for your child, and I could appear so organized and ready for our session, but if I don’t keep my eye out for little signs that a change needs to be made, then I can’t maximize the benefit of our session. In each little exercise or activity that we do, I am looking to create the just right challenge for your child.

Just right challenge means that I am adapting an activity to just above your child’s skill and comfort level, but within reach of achieving success.

Imagine reaching up to grasp an item that’s just out of your reach, extending just a bit further, and getting that feeling of satisfaction when you successfully obtain that item. The benefit of this is that I observe where your child is today in terms of health, attention, sensory needs, etc. and I create a situation that I know will push them to a successful limit, without creating an over-the-top, frustrating situation for them. To accomplish this, I am constantly assessing and reassessing their needs and responses on a moment-to-moment basis. You may not realize it, but based on this information, I make changes or accommodations accordingly to increase or decrease this challenge.

Another technique I use in my sessions is making them child led. This is where occupational therapists hear the typical “you just play with kids all day” comment. Yes, I play with kids all day, but no it’s not an 8-hour day of letting them run the show. Far from it . . . although I’m sure it looks like that half the time so again, please ask questions, and trust me on this!

Child led therapy is called different names by various professions, but basically, I set up an environment for my session that I feel will optimize success for your child.

Some of the goals I may be striving toward when using child led therapy may include building rapport with your child; fostering a trusting, positive working relationship; allowing them free rein of the room so I can observe their natural interactions with toys, materials, etc.; allowing them to problem solve and explore various ways that they come up with to play with toys or items in the room. I may implement components of child-led therapy in order to accomplish some of these goals, as well as to allow your child to feel comfortable.

However, this must occur within reasonable limits, otherwise, yes I am aware that they will, in fact, end up leading the session. This brings me to another method that I like to use . . .

At my clinic, as with many that I have gotten to experience, an obstacle course is generally used at some point during the session. This is one way that I may create environmental and sensory opportunities.

Environmental and sensory opportunities are methods in which the environment is used to create a safe and engaging session to facilitate success in achieving goals.

Creating environmental and sensory opportunities may include setting up the environment in some of the following ways:

  • By the toys I set out. If we are working to increase attention, I may use specific toys or activities to do so. I also may hide some of the more distracting toys or place them to be used as a motivator, earned during the session. I know you’re probably thinking “they’re just toys in a room,” right? But each likely has a specific, thought-out purpose for our session.
  • The placement of the toys in the room. I place toys in various locations throughout the therapy gym, dependent upon the other kids in the gym during our session, the sensory environment, the anticipated needs of your child, and the goals we are working to address.
Some of these placements may include the following: in the waiting room as a motivator to enter the session; next to the “shoes off” chair, as a motivator so we can begin our session and start to play; at the far of end of the room to encourage walking or navigation around obstacles to get to the item; inside a tunnel to promote crawling or a good motor movement warm-up; hidden inside a less-preferred toy or item (for example, to be discovered once the child opens the button-up shirt)

As with any part of this process, I feel that it is essential we work as a team to develop an actionable plan to implement strategies in your home to carry over some of the work done during therapy sessions. I would love to work with you to implement some of these strategies in your home to increase your success and that of your child, as well as hopefully alleviate some stress and answer questions along the way.

If you ever have any questions or wonder what I’m doing or why, I really hope you’ll ask me. I can assure you that my apparent silence on the outside comes with a caring heart for your child, as well as a great deal of training, observations, and planning happening on the inside.

Warm Regards,

Your Occupational Therapist

About Lauren Elitzak, OTR/L, PT, DPT

Lauren Elitzak, OTR/L, PT, DPT
Lauren received her Master's in OT in 2012 & her Doctorate in PT in 2013. She enjoys working in pediatrics, and believes that her greatest teachers are the kids she works with!

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2 comments

  1. Bridget McNamara

    I really appreciate the explanations in this article, and think parents do really want to know the methods to our sessions and what we are doing with their children every day! I do feel that we can avoid these feelings/ miscommunications in many situations by talking with the parents during our sessions. I found this to be a challenge in both of my fieldworks, and something my CIs worked with me and modeled for me a LOT! I found myself caught up in holding the perfect session, sometimes forgetting all about the parents and the bigger picture. I also had to really work to be able to attend to the child fully and be engaged with my session while also explaining myself. In my experience at my jobs since, I’ve noticed that explaining what I was doing and why I was doing it really helped me foster a positive relationship with the parents and caregivers, which in turn helped my relationship and progress with the child grow and develop even faster. I love the ideas and how they are presented, and really enjoy the intent behind the article- thanks Lauren!

    • Lauren Elitzak, OTR/L, PT, DPT

      Hi Bridget,

      Thank you for your comments and feedback. I definitely agree with you, that talking to parents and encouraging them to be involved in the process – be it during sessions, at home, school, etc. – is so key to fostering positive relationships, which can translate to making huge gains with our kids! The language and terms used in this article, are just add-ons to the main show, which of course is talking to parents and keeping them involved. As OTs, especially in pediatrics, I feel we work hard to disguise our treatments as play.. which make sense as play = occupation for kids! However, in doing so, sometimes parents may miss some of the subtleties of changes we make as a result of reading their child and his/her needs in that moment. That’s where these explanations and terms come in, to remind them that while we share a lot of what we’re doing with them, there may be so much more.

      Thank you!
      Lauren

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