WRITING AN EFFECTIVE HOME PROGRAM FOR CHILDREN

1. WRITING AN EFFECTIVE HOME PROGRAM FOR CHILDREN BY TRISEL M. DAVIS, OTR, MOT

2. KNOW YOUR FAMILY • Establish a rapport with the family. Do not pre- judge the family. The therapist/family relationship is very important. However, remember your professional boundaries. • Have some idea of the parents/family’s daily routines and/or schedule. In addition, make note of any special circumstances, whether temporary or permanent. Make sure the home program will fit into the family’s schedule. • Have some idea of the “personality” of the family. For example, I had a grandmother that would not work with raw beans because she did not like the raw beans to get on the floor and roll under furniture and the refrigerator.

3. WHY ARE HOME PROGRAMS IMPORTANT ? • Home programs empower the parents and family members by lessening the fears the parent may have about the child’s disability. • Home programs may help the family accept the child’s disability and be in less of a denial. • Home programs help build a bond between the family and therapist, by promoting team work (family and therapist). • Home programs help tear down barriers and help the parents feel more comfortable with asking questions. • You should not wait until discharge to provide the child with a home program. If you wait until the child is discharged, you will not have the opportunity to provide the parent with feed back. In my professional opinion, if you wait until the patient is discharged, the parent is less likely to carry out the home program.

4. CHOOSING A HOME PROGRAM • What goal(s) would you like to work on? • Can the home program be carried out easily in the child’s natural environment? • What supplies would be needed for the home program? • Are the supplies easily attainable? Consider items the family may already have in the home are can purchase at a low cost. • How much time will be needed to carry out the home program?

5. ITEMS FOUND AROUND THE HOUSE THAT MAY BE USED • Magazines/Sales Papers, coloring books, construction paper or card stock, index cards. • Cookie sheet covered with wax paper, sprayed with whipped topping for tactile stimulation. Colorful sprinkles and/or chocolate or butter scotch chips. • Raw noodles (such as penne and/or macaroni). Raw beans and/or raw rice. • Yarn, shoe strings. Pipe cleaners • Measuring Cups (the nesting kind), washing powder scoops. • Tweezers, small erasers, funnels, tongs • Playing cards, index cards • Dominoes • Shoe boxes (card board or plastic) • Cloths pins • Cotton balls • Take out containers with lids for storage • Pieces of card board, one whole punch

6. WRITING THE HOME PROGRAM • Keep the instructions simple and clear, (use layman’s terms). • Avoid the use of medical terminology as much as possible. • Be carful not to make the parent feel belittled . Again, know your family. For example, if you know the parent is a health care professional, it may be ok to use medical terminology. • You may also use reproducible handout that explain the home program. Make sure the author has given written permission to reproduce handouts. The permission is usually found in the front of the book, on the copy write page (I have samples of some books that grant permission to reproduce the home programs).

7. IMPLEMENTING THE HOME PROGRAM • If supplies are needed, make sure the parent/caregiver has all of the supplies needed. This may include the therapist purchasing low cost items (dollar store items). • Encourage the parent/caregiver to keep supplies together. Therapist may provide the parent/caregiver with a large zip lock bag. Shoe boxes (card board or plastic) and tin cans may also be used as storage containers. Plastic shoe boxes may be purchased at your local Wal-Mart or dollar store. • Demonstrate and verbally explain the home program to the parent. Have the parent perform the home program, after you have demonstrated and explained the home program. • Give the parent some accountability by providing the parent with a document to record the date he/she performed the home program as well as any difficulties he/she may have experienced with the home program. • Make sure you collect the document (S) for your records once the parent have completed all entries about the home program (I have provided you with sample accountability documents). Make a copy of the completed form to give to the parent. Some parents like to keep records of their child’s progress. • Try to use home programs that have a visible end result.

8. ACCOUNTABILITY FORM

9. Sample of a Home program

10. HOME PROGRAM CONTINUED

11. TIPS AND TIDBITS • Monitor the home programs frequently. I would recommend once a week initially, (when a new home program is implemented); then every two weeks. • Close monitoring will give the therapist an opportunity to modify the home program as needed and to reinstruct the parent/guardian if needed. • Reward the child with stars, stickers and certificates for completing home programs. When you reward the child, you reward the parent/family. • If you have parents that are not compliant with the home program, try simplifying or shortening the home program. Communicate with the parent, find out what their obstacles may be. Don’t give up on the parent so quick. • For the parents that are not compliant with the home program, document everything that was provided for the parent.

12. TIPS AND TIDBITS CONTINUED • If you see a child at a day care, try to schedule a special visit with the parent to go over the home program. You may try to meet the parent at the day care either in the morning when the child is dropped off or in the afternoon when the child is picked up. You can also try to schedule a special home visit if possible. If all else fails, send the home program home with the child. Make sure you communicate with the parent/guardian first. Let him or her know that you will be sending the home program home with their child. Follow-up with the parent/guardian by phone, to make sure he/she understands what to do regarding the home program. Instruct the parent/guardian to return the accountability document within a week, and every two weeks after that. Continue follow up.

13. REMEMBER……… • IT DOES NOT MATTER HOW MUCH YOU KNOW UNTIL YOUR PATIENT, PARENT AND FAMILIES KNOW HOW MUCH YOU CARE.

14. QUESTIONS