Turning Knowledge into Action: A Routines-Based Approach to Therapy

So, how do therapists and families turn their knowledge of routines-based approaches into action?

As a speech pathologist and key worker, my words and actions must clearly show that it is not just what happens within therapy that is important, but the frequent opportunities to practice strategies between therapy sessions that influence progress.

I always focus on supporting families to feel confident and competent to implement strategies that explicitly address their goals and priorities, and seamlessly fit into their everyday life.

Five of the top strategies for implementing a routines-based approach to therapy from the Introduction to Using the Routines-Based Interview (RBI) course include:

1. Use authentic assessment

When you interview caregivers using tools such as the Routines-Based Interview (RBI), you will gather the most comprehensive information about child and family functioning which helps you to form a positive relationship with them.

The RBI is an opportunity to identify child and family strengths, needs, preferences and interests, which can then be supplemented with observation of child participation in meaningful everyday activities.

2. Develop shared goals

At the end of the RBI, you will have a list of goals that you can start working on at your next visit. This is a collaborative process that allows children and families to choose goals that reflect their priorities and ensure children's active participation in everyday activities.

3. Build on existing strengths

When you observe how children and families participate in everyday activities, notice:

• How are families interacting with their child?
• How is the environment set up?
• What toys and everyday items are they using?

Let them know the positive impact these strategies are having on their child's engagement and participation.

I find it helpful to ask families, "What are your thoughts on how these strategies might help your child?" to help me understand if they feel strategies are likely to be effective. I can then support them to identify how they can continue using these strategies intentionally in everyday activities as frequently as possible.

4. Build confidence through practice

When I’m coaching therapists and teachers, I encourage them to explain what they are doing in the therapy session and how it directly relates to their goals.

It might feel uncomfortable at first, but when you invite them to try out strategies during visits, you create opportunities to provide positive and specific feedback about what they are doing. You might say, “I noticed that he was more engaged in what you were doing when you sat next to him at the kitchen bench.”

When you let families choose what they are going to try between each therapy session, you help them create a plan that is meaningful and achievable. You can ask questions to help them, such as, “Based on what we have done together today, what’s something you would like to try between now and our next session?”

5. Track progress together

At the start of each therapy session, you can ask families how they went with each specific strategy they were going to try. Find out if they feel that the strategy is working, and if not, whether there is anything else that you can be doing to help them make it more effective.

When you check in regularly with families to see how the strategies are working, you can adjust to ensure they are just the right fit for their family.

Importantly, take time to celebrate all the progress they are making and be curious about what else you could be doing to help them be successful.

A routines-based approach to therapy recognises that all children learn through repeated opportunities to practice new and existing skills within their everyday activities. 

There needs to be acknowledgment that families are busy, and that for our work together to be sustainable and effective, the strategies and adaptations that therapists are recommending must be a good fit for the family. 

Without this, we are at risk of not achieving the outcomes that children with disabilities and their families deserve.