April 19, 2022 by Sarah Stromsdorfer, OTR/L

A Day in the Life of an Early Intervention Occupational Therapist

We’re thrilled to feature this article written by early intervention occupational therapist Allie Ruhl, OTR/L. Allie shares what a day in the life is like for her working in pediatric early intervention along with tips for working in this field of OT. To learn even more about early intervention OT, be sure to also check out our other article, Working in Early Intervention Occupational Therapy.

Choosing Early Intervention OT as a Career

When I first applied for my early intervention license, I was nervous. At this time in my career I had mainly been working with preschool age children in a special education school. I wanted to pick up some extra work and expand my skill set outside of my daily 8-3:30 job in the preschool setting, so I began to look into early intervention.

The first step in this process was to apply for my early intervention license. This process may differ in various states, however, applying for one in New York was a lengthy process. I found the application online and although it is long, it was worth taking the time to complete it. One important aspect of the application process is making sure that you have enough hours in relation to experience working with children in the early intervention age range, which is 0-3 years old. Once I submitted my application, it took the state about 2 months in order for me to receive my early intervention license number and I began to reach out to agencies.

As I said earlier, the process of starting as an early intervention therapist can be daunting. Instead of administering treatment sessions in an OT gym in a school setting, you are traveling to the homes that the children live in. Safety was always a concern for me so I made sure to only take on cases in areas in which I felt comfortable. Another aspect I made sure to keep in mind was the convenience of location. My commute from my home to the special education preschool I work in is about a 45 minute drive. Therefore I pass through many towns in order to return back home, so taking on a case along my commute home would be the best option for my busy schedule.

What a Day is Like as an Early Intervention Occupational Therapist

I am currently treating 5 children through early intervention in various towns in their homes. Three of these cases are in-person treatment sessions and two of them are teletherapy cases. A few years ago, I never would have imagined being able to conduct therapy sessions through a screen.

However, the more time that has gone on in our ever changing world, the easier and more normal it has become. Gaining experience in conducting teletherapy sessions and adapting to this type of treatment has been a very challenging yet rewarding journey as an occupational therapist.

I arrive at my first child’s home and my first step is to remove my shoes and wash my hands. At that point I begin to chat with the parents, they let me know if anything new has happened or changed that I should know about prior to starting the session. The parents also inform me of skills and activities that the child has been working on with other service providers (physical and speech therapists and special instruction teachers).

In addition to using the toys that the family already has in the home, I bring my own bag of toys. I have 2 separate bags of toys, one is filled with toys and activities to work on higher level skills and one is filled with toys to work on lower level skills. Depending on the child and their skill level and age, I choose the appropriate bag.

Common Early Intervention OT Treatments

For this age range, a lot of the focus of my sessions include increasing upper extremity and core strength, visual tracking, grasping and releasing skills and reaching and stacking activities. Most of my early intervention sessions are conducted on the floor and I often use an exercise ball during activities. I do a lot of work with the children in prone position as well as assist them to maintain balance on the exercise ball while engaging in reaching, stacking and grasp and release activities.

I make sure to explain why I am choosing to do certain activities and exercises to the parents so that they can gain a better understanding and also work on these skills on their own with their child. At times, I also ask the parent to be an active participant in the session and show them how to properly position the child and how to set up certain activities and tasks.

As the 45 minute session comes to an end, I take the last few minutes to clean up the toys that I used and go through any questions that the parent might have.

Planning My Day and Treatment Sessions

I typically plan my sessions very methodically time-wise so that once I finish with the first session, I can head straight to my next session and begin. I follow the same steps in regard to washing my hands and speaking with the parent prior to working with the child. My next child is older and higher functioning than my first child, so I brought my bag of activities and toys for higher skills. I tend to also make sure to print and bring a worksheet for this client, often seasonal or holiday appropriate.

For this child I like to start my sessions with a warm up strengthening activity. I often assist the child in completing adapted sit ups in order to reach and grab a puzzle piece of small item to containerize. Playdoh is also a staple in my sessions with this child, whether it is cutting it, rolling it or ripping it, it is one of my favorite hand strengthening tools! These children are young and their attention spans are often shorter than older children so I find that implementing a small obstacle course when completing either a hand strengthening or visual motor activity is a great tool in order to maintain the child’s attention.

My last session of the day is a teletherapy session so I am able to head home at this point. I find it important to text the parent either the day before or a few hours before the teletherapy session and give them a list of materials that would be helpful for them to have. This sense of preparedness makes it easier for both myself and the parent during these sessions. Most of the materials that I request are simple household items.

This is where the creativity of being an early intervention occupational therapist really shines through. With my teletherapy case, I walk the parents through setting up the activity and make sure that they are there to assist the child and also monitor the child for safety. Some teletherapy activities that I do with this child include using tongs or tweezers to pick up items, place cheerios or beads onto string or rods and of course more playdough activities if it is available. I walk the parents through how to fix the child’s grasp during coloring activities and have them assist the child in holding the scissors in the proper “thumbs up” position. Teletherapy sessions really focus on parent education and teaching parents how and why we do certain activities.

Wrapping Up the Day with Notes

After I am finished with the treatment sessions, I typically complete my documentation and billing. Each agency has their own requirements and process for this, some are handwritten and others are completed in online portals. The most important part of the paperwork aspect is getting a signature from the parent after each session. I try to keep my documentation concise and informative. At times, billing, documentation and progress reports can feel overwhelming but I find that time management is key to keeping it all under control.

_______________

At first, I was hesitant to take the jump and begin to work in early intervention. It was new to me, the children are young and it is a different process than most school-based occupational therapy jobs and what I had been comfortable with. However, I have had nothing short of a great experience. I have gotten the opportunity to get to know and help so many families.

Since you are in the home and working with the child right alongside the families, it allows you to really form a positive therapeutic connection with not only the child but their family support system as well.

If you are thinking about taking the next step and looking into taking on early intervention cases, I would highly recommend it!