'Wonderfully In-Between': OT for families in the waiting, wondering or wandering.

As a parent, you know your child better than anyone else. But when challenges arise - whether it's around their development, behaviour, routines or emotions - it can be hard to know what to do next. And so, you do what any parent would, you start seeking help.

In my experience as an OT, I have come across many families that tend to 'fall into the gaps'. Parents that may say or think the following:

• 'I'm ready, but the supports aren't': 'I am ready to receive help, but I have hit a roadblock... between all the waitlists in my area, it could be 6-months before I have an appointment'

  
  

  This is a significant challenge that's worth addressing because we know that it's best for families to access support as soon as possible to make the most of their motivation, and before challenges become habitual and more difficult to shift.

  
  

• 'We need a break... but not from support': 'We’ve been to OTs, Speech Therapists, Physios… you name it. We’ve seen so much progress, but we are so tired. I’m tired. My child is tired. Their siblings miss out.'

  
  

  Fatigue and burnout from endless appointments is real. Sometimes you need a break without losing momentum. Or sometimes, you need to try a new approach for a fresh perspective or to regain progress when things start to feel as though they are stagnating.

  
  

• 'We need help... but it's out of reach': 'I would love to access the therapy my child needs, but I’m up against real time or financial constraints. My child falls through the gaps and doesn’t qualify for funding, but I still need help.'

  
  

  Not every family has access to weekly therapy. Not every family has a suitable funding package that will comprehensively meet all of their needs. That doesn’t mean you should go without support.

  
  

• 'This particular challenge can't wait... but we're not in a position tackle everything yet': 'There are a few things I really need help with right now and I don't want to wait months just to start putting out these 'fires' or to start making small changes to make life easier for us all'.

  
  

  Sometimes, a child's need for support can be quite complex and require a heavy time investment, but that doesn't mean you have to do it all at once. Your child or family may not be ready, or you might not be able to access the specialist support you need to manage these complex challenges right now. Sometimes focusing on small and doable actions or putting out 'fires' that need attention right now can help you to manage the 'everyday' while you wait or prepare for longer-term therapy.

So… is there anything out there to support families who find themselves saying these things?

Yes, many Occupational Therapy practices will do their best to triage and support families who may find themselves in the above positions - and they do a great job! But the demand is simply greater than the number of OTs available, and too many families are left waiting or unsure in the meantime.

I wanted to create 'Wonderfully In-Between' as a place that parents can go when they find themselves stuck... waiting, wondering or wandering... but still in need of timely support.

I wanted to create a time-limited service based on real evidence that honours families - without replacing or undermining the important, long-term relationships that families may be building with their broader therapy team.

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What does 'Wonderfully In-Between' actually look like?

'Wonderfully In-Between' is all about meeting you where you are and making things feel manageable. It is:

• Time-limited: You are offered up to 5-hours of support, focusing on up to three everyday challenges, paying for only the time you use. This structure means...

  • You know what to expect,

  • There's a clear goal and timeframe

  • You can commit to support that feels manageable and achievable depending on your season of life.

• Parent-focused: While understanding your child’s strengths and challenges is part of the picture, this service is really about equipping you and making the most of your position as the person who's by your child's side every day.

  This service seeks to draw upon the strengths and resources you already have, while supporting you with a fresh new perspective grounded in experience and evidence-based practice.

• Straight forward and easily actionable: With every session, you’ll receive short, tailored summaries and resources to help you:

  • Implement strategies that actually fit your family

  • Feel confident and supported without needing to “do it all”

  • Take one clear step at a time

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What is the research behind this model? Will it truly help my child and family?

'Wonderfully In-Between' is based on parent-coaching frameworks and on a 'single session therapy' design. References for the below information can be found at the end of this blog.

Parent-coaching:

• There are different types of parent-coaching models, but the one I use is 'Occupational Performance Coaching' which is where OTs support parents in achieving goals for their families and children. It is highly collaborative, drawing upon the expertise of both the family and the OT.

• Studies indicate that this style of support is effective and has been well researched for children with Autism Spectrum Disorder, Cerebral Palsy and other developmental disorders.

• Positive outcomes in the research include:

  • Children engaging more fully in daily activities,

  • Increased parental confidence,

  • Reduced stress and frustration,

  • Enhanced family relationships and improved family quality of life.

Single-session therapy:

• The concept of single-session therapy has evolved over time, it is not strictly one session (as the name suggests), but a method of delivering a session.

• Every session is treated as complete and meaningful on its own. The goal is to leave with clarity, direction and confidence.

• In child and adolescent mental health, it has been reported that short-term benefits of this model were maintained 18-months later, with 60% of the group studied making significant clinical improvements.

• Outcomes including reduced parental stress, and increased confidence in managing behavioural challenges has also been reported on in the research.

So basically, Wonderfully In-Between aims to capitalize on what the research is saying is beneficial and worthwhile - and the outcomes from the research speak volumes!

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What challenges could be discussed during 'Wonderfully In-Between' sessions?

As OTs, we are used to dealing with a variety of different problems that children and their families face, especially children who have developmental challenges or additional needs. Some common ones include:

• Family mealtime 'battles',

• Increasing independence for morning/night time routines,

• Helping children to settle to bed,

• Managing afterschool emotional highs and lows,

• Supporting children with transitions and changes,

• Self-care independence and confidence - showering, toileting, personal hygiene etc.

• Helping young adults to find their feet after graduating from high school,

• Managing sensory processing differences impacting daily life,

• Behaviours that are disruptive, unsafe or otherwise challenging.

• And more!

Some challenges may require a period of ongoing OT directly with the child to build their skills, some require input from other health professionals, and some benefit first from parent-led supports. Through assessment, we can discern what support is needed and most suitable.

An example of a challenge and how parent coaching can help is written as a composite case study below. This does not refer to a particular child or family but has been written based on many parent-coaching interactions I have had.

A boy with Autism is having frequent meltdowns upon arriving home from school. His parents report feeling like they are 'walking on egg-shells' and that any question could make him 'explode'.

• Together we talked about what already works well for this boy and what new strategies that align with the family, the boy's interests and strengths could be trialled. We came up with a plan including:

  
  

  • Supporting the school to understand and implement strategies throughout the school day,

  • Modifying the existing afterschool routine to provide the boy with the tools and time he needs to regather himself, while also allowing for necessary commitments.

  • Setting up areas and coming up with activities/strategies to allow the boy to 'retreat' when needed and to 'reset'.

    
    

• Upon review of the plan above, it was found that although minor improvements were made, the boy was struggling to initiate afterschool activities needed to reorganise himself and reset. This is because he perceived them as 'cutting into his screen time'.

  
  

  • More education was provided to the boy about why this 'reset time' was needed.

  • We evaluated the activities to ensure they aligned with his existing interests, his needs, and were easily accessible to him.

  • We made his 'reset time' more structured so that the boy knew when screen time would start/end.

  • We added some measures to assist the boy in regulating during screen time, and some guardrails to ensure his screen time was conducive to his age and needs.

The outcome was positive - the family found that the boy was becoming more aware of his need to 'reset' after many successful afternoons using his strategies. He was taking himself away to implement his strategies after school and at other times throughout the day when he needed to. They found they could have conversations in the car afterschool without 'setting him off' and that he could handle demands and changes in the afternoons upon arriving home better. His family reported a noticeable shift in the emotional tone of their afternoons—from tense and unpredictable to manageable and more connected.

I hope this blog answers your questions and provides greater clarity of what 'Wonderfully In-Between' can offer. It is my hope that this service helps families when they need it most.

References:

Chien, C.-W., Lai, Y. Y. C., Lin, C.-Y., & Graham, F. (2020). Occupational Performance Coaching with Parents to Promote Community Participation and Quality of Life of Young Children with Developmental Disabilities: A Feasibility Evaluation in Hong Kong. International Journal of Environmental Research and Public Health, 17(21), 7993. https://doi.org/10.3390/ijerph17217993

Gagnon, M., Couture, M., Hui, C. et al. Occupational Performance Coaching for Significant Adults of Preschoolers: Multiple Case Studies. Early Childhood Educ J 52, 233–241 (2024). https://doi.org/10.1007/s10643-022-01423-1

Headspace. (2022). Evaluation of the 2021 implementation of Single Session Thinking and Single Session Family Consultation. Retrieved from: https://headspace.org.au/assets/Reports/HSBR426_Single-Session-Report_V3_Amended-Copy_ONLINE.pdf

Jamali, Ali & Zarei, Mehdi & Sanjari, Mohammad & Akbarfahimi, Malahat & Saneii, Seyedhassan. (2021). Randomized controlled trial of occupation performance coaching for families of children with autism spectrum disorder by means of telerehabilitation. British Journal of Occupational Therapy. 85. 030802262110614. 10.1177/03080226211061492.

Perkins, R. (2006). The effectiveness of one session of therapy using a single-session therapy approach for children and adolescents with mental health problems. The British Psychological Society, Psychology and Psychotherapy: Theory, Research and Practice,79, 215-227.