In pediatric therapy, no two children share the same journey. Each child’s story is shaped by unique strengths, challenges, family routines, priorities, and home and community environments. That is why individualized care that adapts to the child and family is essential. With best practice concepts related to medical necessity, dosage, goal writing, and the unique therapy journey for children with chronic, lifelong, or progressive conditions in mind, let’s explore how practitioners turn the concepts behind individualized care into action.

The Foundation: Participation Matters Most

The International Classification of Functioning, Disability & Health (ICF) model (World Health Organization [WHO], 2001) reminds us that health is about so much more than body structures and functions, health conditions, and diagnoses. True health for children is reflected in their ability to participate, play, learn, communicate, and join in family and community routines. The “F-Words in Childhood Disability” framework adds to this philosophy, emphasizing Function, Family, Friends, Fun, Fitness, and Future as guiding principles (Rosenbaum & Gorter, 2012).

When practitioners anchor their work in participation, goals become more than a checklist of developmental skills or test items. Instead, therapy becomes about meaningful activities such as helping a child dress themselves in the morning, joining siblings in play, or communicating needs at mealtimes. These participation-based outcomes highlight why therapy is not only medically necessary but also deeply personal for children and families (Anaby et al., 2021; Crespo et al., 2013; Family-Guided Routines Based Intervention (FGRBI) & Caregiver Coaching, 2020; Laverdure & Beisbier, 2021; WHO, 2001).

Listening First: Caregiver Perspectives Drive Care

Individualized care means leading with child and caregiver priorities, routines, hopes, and dreams, rather than with a list of missing skills and deficit areas. How practitioners communicate with caregivers makes all the difference. Asking the right questions is key. Instead of “What do you want from therapy?,” a question that is often too broad while simultaneously limiting, practitioners are encouraged to use more meaningful open-ended questions (Destination Imagination Washington, n.d.; Conversation Starters, n.d.), such as:

• What is one thing that would make the biggest difference in your day?
• What part of the day feels most challenging right now, and why?
• Tell me about a typical day for you and your child.

Questions like these shift the focus from deficits and diagnoses to lived experience, where caregivers are the experts, emphasizing the importance of relationship and collaboration from the start. These types of questions help to uncover priorities that shape therapy plans with caregivers as equal partners, enhancing engagement and ensuring that intervention supports unique daily needs (Rush et al, 2008).

Medical Necessity With a Meaningful Lens

Individualized care is also about clinical responsibility. Therapy services must be justified as medically necessary, especially when billed through Medicaid or insurance. The following four guiding questions offer a practical framework for determining medical necessity.

• Disorder? Does assessment data show a disorder of body structure, function, or participation?
• Medical Need/Risk? Does the disorder create risks such as safety hazards, caregiver burden, or loss of independence?
• Skilled Intervention? Can only a trained practitioner (not a caregiver or community resource) address the issue effectively?
• Readiness? Is this the right time for the child and family to benefit from therapy?

Using this process to support adherence to clinical standards and best practice allows practitioners to balance the needs of families with the requirements of health plans, while also keeping the child and family at the center.

Goals That Reflect Real Life

As therapists work to apply SMART (specific, measurable, achievable, relevant, time-bound) goal criteria, Ferro & Quinn (2020) note that goals often end up “over-engineered” (too complex or detailed, jargon-heavy, difficult to measure). Goals may also feel abstract and disconnected from family priorities. Approaching goal development with the following three components in mind ensures goals meet SMART criteria and are also meaningful and effective:

• WHY—Participation-based outcome: Why does this goal matter? How does it reduce risk or increase independence?
• HOW—Measurable, meaningful activity: What functional daily activity is important to measure (e.g., walk from the front door to the car, instead of walk 10 feet)?
• WHAT—Body structure/function deficit: What underlying skill deficits or environmental needs are creating barriers?

When goals are created with these concepts in mind, objective data and functional updates within visit notes and re-evaluations become clearer, demonstrating both medical necessity and meaningful change. Caregivers see their child’s growth reflected in everyday life—not just in test scores—which is especially important for children with chronic, lifelong, or progressive conditions. Health plan reviewers also notice and appreciate the value occupational therapy brings to these clients.

The Therapy Journey: A Cycle or Continuum, Rather Than a Straight Line

The individualized care process recognizes that therapy is not always continuous. For children with chronic, lifelong, or progressive conditions, the journey often cycles through different phases. Throughout that journey, there are times where evaluation of medical necessity results in periods of direct intervention, times when frequency is low or consultative, periods of home or community transition to allow for generalization, as well as time for potential identification of new child and family goals and priorities (Bailes et al., 2008; Cramm, 2011; Enderby, 2012; Novak, 2012; Yoder et al., 2012).

This individualized care approach helps to prevent practitioner burnout, honors family routines, and supports children in experiencing life outside of therapy. It also builds caregiver confidence with solid integration of home programming and community resources. Research shows that when parents are empowered with strategies, outcomes improve and they are sometimes as effective as practitioners when given proper guidance (Law, et al, 2010; Roberts & Kaiser, 2011).

Dosage That Fits the Child

How much therapy is the right amount? The answer depends on the child, family, and goals. Medicaid and professional guidelines provide general ranges, but individualized care means dosage must be matched to readiness, priorities, and medical necessity. Sometimes that means frequent, intensive sessions; other times, a consultative model with check-ins and coaching is the best fit (Douglas et al., 2020; FGRBI & Caregiver Coaching, 2020; Graham et al., 2015; King et al., 2019, 2023; Lorio et al., 2020; Meadan et al., 2020; Rush & Sheldon, 2005, 2011; Seruya et al., 2022).

The key is flexibility, adjusting therapy dosage not only to clinical need but also to what fits at any given time for each child and their caregivers.

Beyond Requirements: Telling the Story

Individualized care is strengthened through strong documentation. Well-written notes don’t just fulfill compliance requirements; they tell the story of why therapy matters. By connecting participation-based outcomes with measurable activities and medical necessity, documentation validates the child’s unique journey and communicates value to families, health plans, primary care physicians, and other professionals.

Collaboration and Purpose

Individualized care is the heart of meaningful and effective pediatric therapy. It is about listening deeply, creating goals that matter, honoring natural cycles of therapy and life, and advocating for children and families. Whether working with a toddler learning to eat safely, a school-aged child gaining independence in self-care, or a teen preparing for adulthood, individualized care ensures that therapy is not just treatment. Commitment to individualized care leads to partnership, empowerment, and a meaningful, unique journey for each child and family.

References

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Bailes, A., Reder, R., & Burch, C. (2008). Development of guidelines for determining frequency of therapy services in a pediatric medical setting. Pediatric Physical Therapy, 20, 194–198.

Conversation Starters. (n.d.). Open-ended questions. https://www.conversationstarters.com/openendedquestions.htm

Cramm, H. (2011). Can interventions have negative impacts? The importance of seeing the bigger picture. Physical & Occupational Therapy in Pediatrics, 31, 217–221.

Crespo, C., Santos, S., Canavarro, M. C., Kielpikowski, M., Pryor, J., & Féres-Carneiro, T. (2013). Family routines and rituals in the context of chronic conditions: A review. International Journal of Psychology, 48, 729–746.

Destination Imagination Washington. (n.d.). Open-ended questions. http://www.wa-di.org/uploads/8/3/0/2/8302489/open_ended_questions.pdf

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Enderby, P. (2012). How much therapy is enough? The impossible question! International Journal of Speech-Language Pathology, 14, 432–437.

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Jennifer Lawson, OTR, MS, is an Occupational Therapist with more than 25 years of specialized experience in pediatric practice across school and home health settings. Throughout her career, she has designed and directed innovative programs, mentored and developed therapists and leaders, and created a wealth of practical resources that continue to shape the field. A seasoned educator, Jennifer has designed and delivered hundreds of hours of continuing education, equipping pediatric professionals with knowledge and tools that directly elevate the quality of care. Jennifer is recognized for her expertise in core pediatric therapy foundations.