What To Do Next? Early Intervention Practice Guided by One Question

In early intervention, the session does not always go as planned, but it can still be therapeutic.

Introduction

It’s a scene that’s familiar to early intervention occupational therapy practitioners. You walk into a home with a dream activity planned. Maybe it’s a seasonally appropriate art project - visual processing, fine motor skills, and direction following! Maybe it’s an elaborately themed obstacle course - sensory input, motor planning, and play ideation!

You set everything up with a smile about how fun this will be while you check in with the family. Then, the predictably unpredictable happens. The child ignores it. They run into another room, pushing small toy cars into a pile of laundry. The child shows little or no acknowledgment that you’re even in the room. The caregiver apologizes for the laundry as the child dumps the hamper onto the floor.

For that brief moment, it can look - and feel - like nothing therapeutic is happening.

Occupational therapy practitioners are trained with a holistic foundation. Our profession uses the power of occupation to support engagement, participation, and change. However, we work in a system where expertise is often expected to be demonstrated through materials, direct intervention, and visibly productive therapy sessions.

So, there you are. With your carefully planned activity sitting untouched while someone drives a Matchbox car into a sock.

It’s easy to feel the need to get the session ‘back on track’. Bring the child back. Make the activity more exciting or pull something else out of the bag - there’s got to be something in there that will work!

But before we reach for the next toy, we have a decision to make: What does this moment need from me?

The child has given us something to work with. An interest. An opportunity to see how they initiate and maintain play, handle a problem, and invite - or avoid - another person’s involvement. The caregiver has information we don’t have yet. And the laundry is part of the fabric of this family’s lives.

That doesn’t mean every pile of laundry needs to become a therapy activity. It means we have enough reason to pause before deciding that the session has gone wrong.

A very simple decision guide

As an early intervention occupational therapy practitioner, I use one of five possible actions when deciding what to do next: observe, ask, explain, model, and step back.

These aren’t five steps to complete in order. They’re choices within a visit, guided by what the caregiver and child need, what we’re working toward together, and what we still need to understand.

Back in the laundry pile, that might look like this.

Observe. Before joining in, watch for a moment. Is the child hiding the cars and finding them again? Trying to drive over an uneven surface? Looking toward the caregiver when a car disappears? We need to see what’s happening before we decide what it means.

Ask. “Does he usually play here while you’re folding?” Or, “What happens when you try to join him?” The caregiver may tell us that this is their daily struggle: the child wants to be nearby, but laundry time becomes a cycle of dumping, redirecting, and frustration. Now we have a clearer idea of what might actually be useful.

Explain. If the caregiver says the child is ignoring everyone, a teaching moment might help: “I noticed he looked toward you each time the car disappeared. That might be an opening for joining him.” Keep the explanation tied to what we can see and what the caregiver wants to understand.

Model. If the caregiver wants to join but isn’t sure how, ask whether it would help to see it in action. You might sit nearby, make one small tunnel with a towel, and wait. The useful part of the demonstration may be the pause - the space you leave for the child to respond. Then give the caregiver room to try, adapt, and see what happens.

Step back. If the caregiver makes the tunnel and the child starts bringing cars over, let that interaction develop. You don’t have to add another challenge immediately. Watch what they figure out together. There will be time to reflect on what worked and whether any part of it could make the next laundry day easier.

You may use only one or two of these moves. You may observe, ask, and realize that the family needs help with something entirely different today. You may model briefly, step back, and return to a question when the caregiver notices something new.

These action choices help us stay responsive and engaged without losing our focus.

Find expertise in occupation

Creative materials, playful ideas, and having something ready to play are important ways to prepare. Preparation gives us the possibility to meet families where they are, not where we hope they are. Clinical reasoning helps us decide which possibility belongs in this particular home, with this particular family, at this particular time.

Sometimes the art project will be useful. Sometimes the towel tunnel will be useful. Sometimes the most useful thing we can do is ask a question and listen to the answer.

The expertise isn’t in the toy. It’s in noticing what’s happening, understanding what matters, and choosing what to do next.

References

Rush, D.D., & Sheldon, M. L. (2020). The Early Childhood Coaching Handbook (2nded.). Paul H. Brookes Publishing.

Snyder, P. A., Hemmeter, M. L., & Fox, L. (2022). Instructional Coaching in Early Childhood: Practice-Based Coaching. Guilford Press.

Tomlin, A. M., & Viehwag, S. A. (2016). Tackling the Tough Stuff: A Home Visitor’s Guide to Supporting Families at Risk. Paul H. Brookes Publishing.