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Early Intervention Occupational Therapy: What You Need to Know

by Chelsea Jancewicz, MOT, OTR/L, and Bridget McNamara

Are you considering early intervention OT?

As OTs, we are both fortunate and unfortunate to experience so many different settings and populations that picking a single one can be both exciting and overwhelming—so much so that the choice becomes daunting. If you want to work in pediatrics, but don't know where to start, know that positions in different settings provide dramatically different benefits and challenges.

Early intervention services are for children under three who have developmental delays, established risk, or are determined to be at risk. One of the most exciting parts of working with this population is the potential for progress!

A child at this stage of development is often able to make significant gains in a short amount of time, validating your hard work as a therapist. That, and the ability to treat the entire family in their natural environment, makes this pediatric setting particularly appealing.

If you're considering early intervention occupational therapy, you should be aware of the rewards, the challenges, and tips to set you up for success in this setting.

The best parts of early intervention occupational therapy

Different environment with every client

For those of us who thrive on change and mixing up your work environment, this is definitely a positive aspect of early intervention OT.

Some people feel that being in a constant state or environment can be draining and can cause loss of attention or motivation. Others mix up their environment in order to increase their attention and alertness. Being in a constant environment can be draining matter how stimulating or non-stimulating it may be. Being therapists, we tend to prefer to be on the go with chaotic schedules and hustling from client to client.

Intimate setting

Being in someone’s home is like entering their private safe haven. It is where the child plays, eats, sleeps, and interacts with the most important people in his/her life. Entering that space and establishing a bond is one of the most intimate experiences for an occupational therapist. You also establish a very intimate relationship with the child’s caregivers. This is also the caregivers’ house where they play, eat, sleep, and interact with their loved ones. This intimate relationship can often result as the family trusting the therapist as a family member or close friend (but always be careful to remember the client-therapist relationship!).

Work with materials in family’s everyday lives/good carry over

Seeing the child in his/her home allows you to see what materials they have access to and what occupations they are most drawn to within their home. Being an early intervention OT allows creativity in using everyday items and materials to encourage sensory integration as well as the development of ADL and IADL skills, fine motor, gross motor, and sensorimotor skills. Having the caregivers present and seeing how the OT uses their own materials is often encouraging for the caregiver and makes carry over of therapeutic activities seem less daunting to implement.

Play is the model

Early intervention OT is very child-centered and child-directed. So, you get to be a kid in the kiddo’s home with his/her toys! Getting on the floor and meeting the child at his/her level is a fun treatment model. Floortime is one of the most used treatment models when working with the EI population. Channelling your inner child and creating ways to help shape their behavior into something more functional can be a great way for those of us who haven’t fully grown out of our childhood days.

The challenges of early intervention occupational therapy

Driving all day

Home-based care takes a toll on your car. Adding mileage, frequent trips to the gas station, car maintenance, accidents, tickets, oh my! This can be scary for someone who is not especially fond of driving to begin with. Driving from client to client can not only be exhausting on your car but also your mental health.

There are days when traffic is so crazy that it’s hard to even stand to be in the car for one more minute. The process of stressing out between clients due to traffic, time constraints, or just being alone in your car all day can really affect your life both during and outside of work. It is all too common to see someone’s personal life unravel due to overworking oneself or misery in the workplace.

It is important to set yourself up for success. Always allow extra time between clients in case there is bad weather, traffic, or even just to allow yourself 5 extra minutes for you to relax in your car and take a mental break before walking in the door.

Your access to resources can be limited—and they're all in your car

In early intervention OT, you should be using the family’s materials and toys to teach the family how to utilize the resources they already have to promote development. However, there are going to be instances when it is challenging to only use toys the families already have, and you'll find yourself in charge of buying your own therapeutic tools and toys. This is doable through garage sales, secondhand children’s stores, and the hand-me-downs from friends and family members whose children have outgrown their toys.

While it does require an initial investment on your part, you should be able to make your money back quickly! When you're interviewing for an early intervention position, discuss this with potential employers, especially if you don’t feel ready or able to purchase your own supplies.

I have sensory integration equipment in my car that I often trial with kiddos and their family, but while that's convenient, it can make it feel like work is always with me. Having items like these in your car can turn your private car space into a mini office. Often EI therapists find that their car is where they finish writing their notes, sending emails, making phone calls, or even eating their lunch.

To offset this feeling, it helps to find a clinic that allows you to have a home base. This also allows you to have time to return phone calls, answer emails, or keep materials in a more office-type environment rather than having a mobile office.

Lonely factor = therapist burn-out

The EI setting requires a certain level of independence to be a successful therapist.

Early intervention services often take place in the home or a daycare (the child’s natural environment). That means that the OT is required to travel to the child’s environment, leaving the potential collaborative support of a clinic setting and venturing out on your own. If you are the type that loves to jump in head first and figure things out, this setting could be a great fit! It is also a way for you to build confidence as a new practitioner, developing your skills independently without looking to others for help.

Keep in mind though, this means there is no co-worker there if things don’t go according to plan. While solving your own problems is one of the best ways to grow as a practitioner, it can be overwhelming. Even for someone who takes pride in being independent, it’s a great idea to have a mentor to support you in your new role.

Driving from home to home can be very lonely at times, especially if you have just had an emotional session or an overall emotional day (we all have those when working with people in challenging situations). There will be times when I leave a client’s home and want to scream or even cry.

Being occupational therapists, we tend to take on our client's emotions and feel exactly what they feel. A parent may come to you crying and asking you to explain why her child has autism, or why he won’t stop hitting himself. Conversations like these can take a toll on you, too. It is important to really establish a support system whether it be co-workers at your clinic, colleagues on the child’s team, or a mentor. However you can, it is important to keep yourself balanced and level-headed, especially on those tough days.

Having someone to call after a tough session, someone to ask about a family you are struggling with, or someone to help you identify your mistakes and ways you can improve is a vital part of being a successful occupational therapist.

Salary and finances

Many early intervention positions offer a higher hourly rate, such as $60-$80 in an area that typically pays around $40/hour. While this may look enticing, there are a few things to keep in mind. An early intervention OT salary is different depending on who you work for and what state you live in. You can be an independent contractor, work for a private clinic, or work for a government agency such as the county. Depending on your state, the pay can be a challenge. You may work in a state with poor finances, and therefore pay can be inconsistent at times due to the state’s funding. 

However, many early intervention OT jobs pay per visit as opposed to per hour. You would get $80/hour if you were seeing two kids within that hour back to back, but that does not include travel time between sessions, or time spent documenting those visits. Any time spent outside of billable hours, a.k.a. time spent actually treating clients, is not paid for at the high hourly rate. Some places will pay if a client happens to do a “no call, no show,” but many employers don't have this system. So if a client does not let you know they need to cancel in advance, then you cannot schedule another client to see in their place. This means that you won’t get paid for that hour that was meant to be spent treating the client.

So, plan for cancellations! Create a safety net and figure out the bare minimum of how many clients need to be seen per week or per month in order to not have a financial crisis.

Some companies will reimburse mileage, and this is something to make sure you ask about during your job search. Again, this requires you to keep track of your mileage and submit the proper paperwork so you are able to get paid, and can help you manage your finances if you carefully plan your schedule.

Positions often have new therapists start with a smaller caseload and building the number of clients as they go. This means you will need to have a flexible budget. It is an investment in yourself, and there are many children who are in need of services, but it does require a leap of faith and an ability to live on a smaller paycheck at the beginning.

Here's what you can do to set yourself up for success

Still considering early intervention occupational therapy? Excellent.

  • Find a clinic that contracts EI and has an onsite office building for paperwork. Build in time to your schedule for paperwork and consultation time with team members
  • Establish a support system with co-workers to reduce burn-out and the lonely factor of being in your car all day
  • Use blogs and websites dedicated to OT practice as another support system. Reading what others have written and connecting with other clinicians who are going through something similar can help you keep yourself balanced

If you're currently on the hunt for an EI job, these are some more crucial elements to keep in mind.

Prioritize organization and flexibility

This is where organization and flexibility are key. Organizing your schedule early and communicating that to your parents (parents of your clients, not your ACTUAL parents) allows for you to have first dibs on those highly sought after spots (before lunch, not during nap time, etc.). This proactive step is the best way for you to organize your schedule and increase your billable hours so you aren’t stuck driving all over the place, getting paid next to nothing!

Children often get sick, go on vacation, or have various other life events that come up and cause disruption in your carefully planned schedule. This is also where it pays to be close with your families, relying on communication from the parents and families to save you an unpaid trip.

One of the greatest things about being in charge of your own schedule is the flexibility it can afford. Especially if you have two incomes, have young kids, or are able to work on a part time basis, this flexibility allows for work life balance. It also allows you to control the number of children on your caseload, giving you the option to see more kids and make more money! There are tips of the trade to make scheduling your day less hectic and more productive in the event of cancellations.

Build relationships with parents and families

With this population, the legislation specifically states that the family is your client too. One of the best parts about early intervention services is the chance to work so closely with the family. Communication with family is a vital part of pediatric practice in any setting and can be challenging. Building trust with the family leads to increased likelihood for carry over of treatment, increased chance for progress, and increased job satisfaction!

And while you are not in it for the recognition, building a positive relationship can lead to better compliance with home treatment plans. A better understanding of the family’s situation can lead to services better suited for that family. It can also lead to a special bond between therapist and family.

Families often work with the same therapist for years, and the family really comes to appreciate the work that you do as the OT. This meaningful connection with family can be much more difficult in other settings where parent interaction is not as readily available.

At the same time, working so closely with parents can also be incredibly challenging. Because services are state funded, the OT services are free of charge for the families. As with many free services, there can be those who take these services for granted. There are also those who will not think you are as amazing as we know you are, and will not appreciate what you are trying to accomplish. You also may run into parents who would prefer a more experienced therapist and will they will make it clear.

There are ways to work with challenging parents, but in the end, working with parents is an awesome part of this setting and pediatrics in general.

There are many things to consider when choosing an early intervention OT job. If you consider yourself independent, organized, and flexible, early intervention OT job could be the perfect fit! It is very important to explore your options and find the position that is right for you.

Not sure which Occupational Therapy setting is right for you? Take our quiz to find out:

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