Supporting Early Childhood Mental Health: Strengthening Participation in Meaningful Activities
A central element of occupational therapy is the study and promotion of participation in meaningful occupations or activities. Essentially, OTs work to ensure that our clients can participate in the things they want to do and need to do in a way that’s satisfying and fulfilling to them! This is actually one of the reasons I love the field so much- it means that clinically, I’m focused on whatever is important to the children in my care. My work changes each day because the interests of all the children and families I work with are different.
There is a strong connection between quality of life and participation in occupation. One way we can address early childhood mental health is by ensuring that children and caregivers are able to do the things that are most important to them as individuals and the things that are most important to their relationship with each other and their community.
Areas of Occupation
Occupational therapists are trained to think about activity in terms of 9 main areas of “occupation”
Activities of Daily Living- dressing, eating, toileting & hygiene
Instrumental Activities of Daily Living- shopping for needed items, preparing meals, providing child & pet care
Health Management
Rest & Sleep
Education
Work
Play
Leisure
Social participation
“[O]ccupations refer to the everyday activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do”. (OTPF 4th ed). We recognize that we do, make up our lives and relationships- whether that’s constructing a castle out of blocks in play, eating a meal with family, or picking out your own outfit and getting onto your body.
One important element of occupations that children participate in is that in addition to being meaningful in the moment, they also support and promote engagement in future occupations. By engaging in play with playdough and heavy building materials, young children develop the strength, coordination and planning skills they will later use to handwrite. By playing peek-a-boo as infants, babies develop the foundations for reciprocal interaction they will use in social participation as children and adults. For children, participating in life’s occupations is essential for day-to-day mental health, but also for building the skills and capacities children will want to have later.
Getting to Know What’s Meaningful
Through your evaluation and as you get to know your client, get a sense of what activities are most meaningful to them in addition to finding out what is most challenging. When working with young children, we really need to get to know 3 clients: the child themselves, the caregiving system, and the relationship between the child and caregiver.
Here’s an example of how we might consider all of these clients when thinking about what is important to address:
Working with a family for whom mealtimes are a main source of ritual and connection might mean that this is the first target area for treatment. The child has fun throughout meal time but they are up and down from the table, forget to eat enough food, and are loud and energized. The caregiver really wants to have family meals together where all members of the family sit together, eat their meals and connect, and then clean up so they can move on to the next task. Even though the child may not feel a need to change their meal time participation, this is important to the wellbeing of the family making it an important goal of treatment! Our focus as early childhood mental health folx is to consider the needs of all three clients
The child: needs to eat a little more but generally is happy with meal time
Parents: want the child to build the skills needed to sit with them for meals
The relationship: would benefit from some changes both for the child and the caregiver to make mealtime a time for connection and fun rather than stress and frustration.
Supporting Participation to Enhance Mental Health
Supporting participation in meaningful activities is a way to ensure engagement by kids and families in your intervention. It’s more motivating to work on what’s important than it is to work on a skill that’s not connected to a functional activity. It’s also a way to ensure that each person you’re working with has the ability to do the things they care about throughout the week.
Here are the ways I support participation in activities through my work. You might be thinking- that’s my specific job as an OT, and that’s true. But these are things I’ve also done during co-treatments with psychotherapists, speech therapists and teachers! They’re strategies that can work for early childhood folx in any discipline!
1: Find out what is important to your client (the child, the caregiver and the relationship!)
This may sound obvious but it’s a step that’s often overlooked. OTs use tools like the Canadian Occupational Performance Measure to find out how people feel about their performance in the various tasks they do each day and week.
If you’re not working with an OT, you can still include questions in your intake and pick up clues from conversation or the family’s home if you’re doing home-based work. Listen for when caregivers mention something they do repeatedly, have specific items like art supplies in their home, and how they react to the goals you suggest- are they excited to address this important thing or are they simply agreeing with you that it would be helpful?
2: Think about the skills needed for the activities that are important and work on those specific skills
OTs are experts in activity analysis but we all can think critically about what skills are needed for the various activities families do. Considering the skills that are within your scope of practice for the activities that are important to families is a way to target goals that are truly important to the family.
Some of the common goal areas for OTs, Speech therapists, teachers, and psychotherapists are
Self regulation- the ability to reach an arousal state that will support participation in the activity
Social participation- the ability to communicate ideas, feelings, wants & needs and to understand communication by others
Within your own discipline, you’ll have other elements of various activities that are important to you. OTs will think about sensory and motor function, speech pathologists will think about oral motor planning, teachers will think about how children are moving information to long term memory.
The OT Toolbox has a great post about activity analysis, linked below!
3: Do the actual activity during your sessions
By doing the activities that are important to families during your sessions, you’re able to accomplish lots of things: evaluating skills, practicing skills and building habits and routines, and giving caregivers the ability to observe new strategies and practice them with you in real time. You’re also more likely to get engagement because you’re doing things that your client likes to do! Some small examples are:
Eat snacks together to practice meal time skills
Fine motor skills: opening packages, grasp patterns
Language & communication: requesting and offering items, indicating preferences & needs
Social skills: sharing items, asking for needed items, waiting for needed items, mealtime conversation
Support families in using the restroom together during your session
Fine motor skills: clothing management
Language & communication: following one or multi-step directions, communicating needs & boundaries
Social skills: engaging in potty routine games, songs or rituals
Self regulation for caregivers and children: managing reactions to need for the bathroom and accidents, etc.
4: Play!
Play is one of the most important occupations of childhood and play with a caregiver is an amazing relationship builder. Don’t underestimate the power of play in your sessions without the expectation of answering fact-based questions. Supporting children in playing for extended periods of time builds countless skills. There are other times for quizzing on colors, numbers, animal names and sounds!
5: Include caregivers in your sessions
By including caregivers, they can learn and practice the specific skills you’re working with your child client on. This will also allow you to learn about what is important to them and what skills or ideas they might be learning
I hope this brought some new ideas about why participation is so important and how providers of any discipline can promote it! Don’t hesitate to reach out, I’d love to know your thoughts!
References & Resources
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001
