Box #1: The model of functional therapy requires that services focus on improving concrete functional skills representing a child and family's priority areas that will help them more fully participate in everyday life experiences. The team can develop outcomes using the information around routines, daily life, and priorities that the family shares along with information obtained through observation and evaluation.

Outcome: Katy will use playground equipment, play in the sandbox, and explore the outdoors.
Why is this important? We like to take our kids to the park and want both of our daughters to enjoy this activity. We want Katy to have things she can do with her sister, on her own and with other kids whether she is at the neighborhood park, in our backyard, or in some other outdoor location on family visits.
How will you know you have met your outcome? Katy will have 3 things she likes to do and can do at the park with her sister, and one thing she likes to do by herself at home and in the park.

Box #2: Fill in the general routine in which this outcome takes place.

Routine: Playing outside at the park or family playground.

Box #3: Use of this box provides the team, which includes the parents, with an opportunity to analyze what is needed to achieve this outcome. Analysis needs to include identification of what is working and identification of what is not working. This not only includes skills that the child needs to establish, but supports and adaptations that could be made to the task and the physical, social, and cultural environment. (For additional information, please see the Appendix at the end of this document.)

Skills, Supports, and Adaptations Needed to Work on This Outcome
What's already working?

• Katy loves to be outside and is motivated to play
• Family is very supportive
• Park is within walking distance

• Walk on rough surfaces
• Climb stairs
• Hold onto the swing rope
• A willingness to explore a variety of textures with her hands
• Focus attention'
• Take turns, follow directions
• Use signs or words to indicate needs and respond to questions

• Encourage the use of a walking stick, as needed, on rough surfaces
• Use sandbox toys with varied textures, sounds, and colors
• Encourage Katy's sister to plan and lead games/activities at the park
• Use an adapted child swing

• Suggested activities
• Reassurance of safety

Box #4: This is the what question. What is, or could be, possible for this family and child to do within their everyday experiences that would allow them to focus on this outcome. These should be natural learning environments and activity settings that are easy for the family to access and where needed services can be provided.

Possible Learning Opportunities/Activities:
What possible opportunities exist within the routine or environment for meeting this outcome?

• Walking over the wood chips around the playground equipment
• Climbing up the ladder and going down the slide
• Playing games in the sandbox
• Swinging
• Playing a direction following game
• Walking around the pond to look for frogs or fish
• Going on a treasure hunt
• Crossing a bridge
• Searching in the grass for clovers

Box #5: This is the who question. Who, within the family, the community, and of all the possible providers, can assist the child in achieving this outcome?

Who can help? (Brainstorm a list of possibilities.)
Who are the family members, professionals/providers, and others who can help child/family achieve this outcome?

• Mother, Father, Sister
• Other children at the park
• PT
• Educator
• SLP
• Family friends

Box #6: This is the where question. Where would it be appropriate to work on this outcome?

Possible Locations:
Where could child/family work on this outcome?

• Neighborhood park
• Family's backyard
• Other outdoor locations visited by the family

Appendix: Skills, Supports, and Adaptations Needed to Work on This Outcome

(Information adapted by WPDP for the Wisconsin Birth to 3 Program from: W. Dunn, C. Brown, & A. McGuigan, (1994). The Ecology of Human Performance: A Framework for Considering the Effect of Context. The American Journal of Occupational Therapy, Vol 48, (9), pp.595-607.)

A child's overall function in daily life is not only the result of their unique experiences and skills, but it is also influenced by the environment or context in which they live. The contextual influences that impact function come from physical surroundings, social expectations, and cultural factors. Intervention to infants and toddlers must incorporate both working with the child to increase skills and experiences, and analyzing those contextual influences impacting their function. Providing contextual supports is an important aspect of influencing function, and one that should be considered above, or at least equal to, attempts to increase skill level within the child.

Consider the list below to ensure that the team has focused on all areas of potential intervention when analyzing what is needed to assist a child in achieving a particular outcome.

• Establish/restore: Working to improve the child's actual skill level.
  Example: focusing attention, producing signs or words, reaching for an object, climbing stairs
• Adapt: Adapting the physical, social, or cultural context to allow them to support function, thus reducing or eliminating barriers.
  Example: using a toy with a switch plate, providing a walker, increasing the time available to complete the task, having a sibling provide assistance
• Create: Creating circumstances or enriching the contextual factors in a child's life.
  Example: Providing ideas and support to the family on how to foster independence or expressive language. Setting up a physical, social, and cultural environment that will encourage a child to play.
• Prevent: Prevent the occurrence of physical, social, or cultural barriers that would influence function.
  Example: Provide information and support to a family to enhance the likelihood of success.