The Playbook for Home Programs

Tips to do this week's prescription with ease

The hardest part isn't the session

Your child's OT is brilliant at what she does. She's figured out exactly what your child needs, written it down, handed it to you. And then you walked out of that clinic, got into the car, and thought: how am I actually going to make this happen every day?

You're not alone in that moment. Every parent who has ever held a home program has felt it.

The gap between prescribed and done is real. It has nothing to do with how much you love your child or how hard you're trying. It's about having a system. And systems can be built.

Here are five that work.

1. Attach it to something you already do

The number one reason play programs don't happen isn't laziness. It's that they live nowhere in your day. They become a thing you're supposed to do, floating around in your mind, until the day is over and it didn't happen.

Don't add a new routine. Attach it to one you already have.

After breakfast. Before bath time. While the school bag is being packed. Pick one slot your day already has and protect it. When the activity lives inside something that already happens, it stops being something you have to remember and starts being something you just do.

2. Set up the space before-hand

Activities that require setup rarely happen. By the time you've found the playdough, located the board, and cleared the table, the moment has passed, your child has moved on, and you're already exhausted.

Ten minutes after bedtime changes everything. Set out whatever you need. Lay it on the table, the floor, wherever you'll do it. When your child wakes up and it's already there, it becomes part of the morning. When you have to find it first, it's one more decision in a morning that already has too many. You could definitely choose another time of the day that works for your family e.g., right after school. 

Ready beats perfect every time. 

3. Start with less than you think

Your OT said 10 minutes. Start with 5.

This isn't about lowering the bar. It's about building the habit before you build the duration. A 5-minute session that happens every day will do more for your child than a 20-minute session that happens twice a week because the other days felt too hard.

Consistency is part of the prescription. Once 5 minutes feels normal and it will, faster than you expect, the 10 minutes your OT recommended will follow naturally. You're not falling behind. You're laying the foundation the routine needs to hold.

A word about play endurance

Before we go further, I want to name something that doesn't get talked about enough.

Play is hard. Not just for children who have sensory or motor challenges. For parents too.

You're managing a child who may resist the activity. Who may melt down before you even start. Who may do it beautifully one day and refuse completely the next. You're doing this after a full day of work, school pickups, meals, and everything else that falls on your plate. And underneath all of it, you're carrying the quiet weight of wanting to get this right for your child. 

That's not a small thing. That's enormous. 
Your nervous system matters too!

Play endurance isn't just your child's ability to stay in an activity. It's yours too. Your capacity to keep showing up, day after day, even when progress is invisible and the routine feels like one more thing.

The tips in this post aren't about adding pressure. They're about removing friction. Because when play is easier to start, it's easier to sustain. And when you can sustain it, that's when you start to see what your OT has been working toward all along.

4. Do it with them, then step back

The goal of your child's play prescription is independence. Not for them to need you to do it with them forever. So how you show up during the activity matters as much as whether you do it at all.

First time: do it together. Side by side, hand over hand, whatever they need.
Second time: help a little. Be there, but let them lead.
Third time: watch from a distance. Set it up and step back.

This isn't about withdrawing support. It's about giving your child the chance to discover what they can do without you. That moment when they look up and realize they did it on their own is where the real progress lives. I've found that both the child and the parent feel a sense of accomplishment when this happens. 

Your OT prescribed the goal. Your job is to gradually make yourself unnecessary.

5. Notice out loud

Children, especially children who have worked hard for skills that come easily to others, need to hear that you saw them try.

Not a performance. Not a party. Just a sentence.

"You did that yourself? Wow!"
"You kept going even when it was hard."
"Last week you needed help with that. Today you didn't."

You don't need to celebrate every step. But noticing out loud, naming what you saw, specifically, tells your child that effort is worth repeating. And effort that gets repeated becomes a skill. Noticing their wins like a sports reporter (sports-casting) has shown to have really good research to support a child when they are learning a new skill. 

This is the part of the play prescription no piece of equipment can deliver. It's entirely yours.

What to hand over to a nanny and how to do it well

If you have a nanny, a helper, or a family member who is part of your child's daily care, this section is for you. Because one of the most common things I hear from parents is: I want to hand this over but I don't know how. I don't want it done wrong. I don't know what they can actually do.

Here's how I think about it.

What you can hand over

The physical setup of an activity. The doing of it, once you've shown them how. The repetition on the days when you genuinely cannot be there. A nanny can run the activity, keep the time, follow the routine, and even use the support levels your OT prescribed. With a clear handover, most of what happens during a play session can be carried by someone else.

What stays with you

The noticing. The emotional attunement. The moment your child looks up to see if someone who matters saw what they just did. That moment lands differently depending on who is in the room. It doesn't mean a nanny can't be warm or encouraging. It means that your noticing carries a weight that cannot be fully transferred. Show up for that part when you can.

The decisions also stay with you. Whether to move up a level. Whether your child is having a hard week and needs to repeat. Whether the activity is working or needs to change. Those calls are yours, made in conversation with your OT.

How to hand it over well

Don't explain it. Show it. Do the activity with your child while your nanny watches, once or twice. Then do it together. Then let them lead while you watch. The same progression you use with your child works here too.

Give them the prescription pad. Not just a verbal instruction — the written sheet. It tells them the goal, the activity, the time, the level, and the support approach. It removes the guesswork and gives them something to refer back to without having to ask you.

Ask for a simple handover at the end of each session. Not a report. Just one sentence: how did it go today? Here's the blog where I discuss this in detail. 

Your OT prescribed the goal.
This is the system to get there.

Play-based home programs work when parents have a system. Not more time, not more equipment, not more willpower. Just a structure that makes the doing easier than the not-doing.

These five steps are that structure. Use them this week with whatever your OT prescribed. Next week, they'll feel like yours.

At The Toy Pharmacy, we build on what your OT started. Our Play Hub in collaboration with therapists, gives parents a guided weekly Play Plan with the activities your child needs, broken into daily doses, and the right level of support built in. It's not a replacement for your OT. It's what happens between sessions.

If your OT has given you a prescription and you want a system to make it stick, we built it for you. Try it and share with with a mom who might need this. 

References

Behaviour change and habit formation

Clear, J. (2018). Atomic Habits: An Easy and Proven Way to Build Good Habits and Break Bad Ones. Penguin Random House.

Fogg, B. J. (2019). Tiny Habits: The Small Changes That Change Everything. Houghton Mifflin Harcourt.

Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54(7), 493–503. https://doi.org/10.1037/0003-066X.54.7.493

Paediatric OT home program adherence

Novak, I. (2011). Home programme intervention effectiveness evidence. Physical and Occupational Therapy in Pediatrics, 31(2), 190–213. https://doi.org/10.3109/01942638.2010.533746

Segal, R., & Beyer, C. (2006). Integration and application of a home treatment program: A study of parents and occupational therapists. American Journal of Occupational Therapy, 60(5), 500–510. https://doi.org/10.5014/ajot.60.5.500

Wingrat, J., Price, C., & Wright, T. (2024). Facilitators of and barriers to caregiver adherence to home therapy recommendations for infants and children with neuromotor and neuromuscular diagnoses: A scoping review. American Journal of Occupational Therapy, 78(2). https://doi.org/10.5014/ajot.2024.050567

Goal Attainment Scaling

King, G. A., McDougall, J., Palisano, R. J., Gritzan, J., & Tucker, M. A. (2000). Goal attainment scaling: Its use in evaluating pediatric therapy programs. Physical and Occupational Therapy in Pediatrics, 19(2), 31–52. https://doi.org/10.1080/J006v19n02_03

Mailloux, Z., May-Benson, T. A., Summers, C. A., Miller, L. J., Brett-Green, B., Burke, J. P., Cohn, E. S., Koomar, J. A., Parham, L. D., Roley, S. S., Schaaf, R. C., & Schoen, S. A. (2007). Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders. American Journal of Occupational Therapy, 61(2), 254–259. https://doi.org/10.5014/ajot.61.2.254