Of everything researchers have looked at, the support a therapist gives around a home program is the factor clinics can influence most. Here are seven practical, research backed ways to help families keep up between visits.
In our first article, we looked at how often families struggle with home programs and why. This one is about what helps.
Small therapist habits make a big difference
One of the most practical studies on this surveyed 219 parents of children with developmental disabilities at 18 early intervention centers in Spain. It looked at specific things therapists did and how much each one raised the odds that parents followed the prescribed frequency:
| What the therapist did | How much more likely parents were to adhere |
|---|---|
| Shared information about the child's progress with the exercises | 3.75 times |
| Gave advice on fitting exercises into the daily routine | 2.54 times |
| Checked the parent's skills during follow up | 2.21 times |
| Asked about home adherence | 2.20 times |
| Explained why the exercises are useful | 2.17 times |
Source: Medina-Mirapeix et al., 2017. Odds ratios from a survey of 219 parents.
Seven ways to help families keep up
The rest of the research points the same way:
Build the relationship. In a systematic review studying parents of children with cerebral palsy, a parent's sense of a supportive, collaborative relationship with the therapist was one of the factors most strongly linked to keeping up at home (Niyonsenga et al., 2024). Unlike a child's diagnosis or a family's circumstances, it's something therapists can build.
Show, don't just tell. In a US survey of 446 parents of young children with motor delays, parents said a therapist modeling the activity was the most helpful technique for keeping up at home. And 63% said they wanted more time spent on coaching (Gmmash et al., 2021).
Explain the why. In a speech therapy study of 199 parents, how important parents felt a recommendation was, along with their confidence in doing it, predicted whether they followed it at home (Williams et al., 2024).
Build parent confidence. Self efficacy shows up again and again as a predictor of adherence. Showing, practicing together, and checking skills all help.
Fit the program to the family, and make it fun. In the same US survey, home activities that fit daily routines and the home environment, and that the child enjoyed, were linked to better adherence (Gmmash et al., 2021). A 2026 focus group study of speech and language therapists also found that individualizing the program was central to making home practice work (Pritchard et al., 2026). Practical ideas from a scoping review of 41 studies of kids with musculoskeletal conditions include keeping the number of exercises small to limit time demands, using games and crafts with younger children, letting teens pick their own music or turn exercises into a competition, and inviting siblings or friends to join in (Holt et al., 2020).
Start with the child's goals, and decide together. The 2026 APTA guideline for developmental coordination disorder strongly recommends task-oriented intervention guided by the child's goals. It also recommends shared decision making with the child and family to set goals and build the home program, with activities the child enjoys and the family can realistically fit into daily life (Sargent et al., 2026). A large systematic review of pediatric occupational therapy found the same ingredients in the most effective approaches: start with the child's goal, practice real activities in everyday settings, repeat often at home, and keep the challenge "just right" so success feels good (Novak and Honan, 2019).
Stay connected between visits. Asking about home practice and sharing progress keep the program alive between sessions. In the Spanish study, simply asking about home adherence made families 2.2 times more likely to follow the prescribed frequency (Medina-Mirapeix et al., 2017).
Where we still have work to do
We still have work to do on goals. The APTA guideline notes that many parents don't feel fully included in goal setting, and research it cites found low agreement between parents and therapists on what goals a child was actually working toward (Sargent et al., 2026).
What this means for your clinic or health system
If you lead a pediatric therapy team, the research gives you a clear place to start:
Treat adherence as a team problem, not a family problem. Many families struggle. Plan for it.
Make the why easy to share. Parents follow through more when they understand what each activity is for.
Keep programs realistic for busy families. Help parents fit practice into routines they already have.
Support the parent, not just the child. Confidence and stress shape what happens at home.
Make staying connected sustainable. Checking in and sharing progress are linked to better adherence, so look for ways to make that support part of how your team already works.
Read next: How We Designed YourSteps® Around the Research
Every child deserves the chance to make the most of their therapy, and so much of that happens at home. If you'd like to see how YourSteps® helps therapists support families between visits, request a demo.
References
Medina-Mirapeix F, et al. Predictors of parents' adherence to home exercise programs for children with developmental disabilities, regarding both exercise frequency and duration: a survey design. Eur J Phys Rehabil Med. 2017;53(4):545-555. doi:10.23736/S1973-9087.17.04464-1
Niyonsenga J, et al. The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: a systematic review. PLOS ONE. 2024;19(6):e0305432. doi:10.1371/journal.pone.0305432
Gmmash AS, Effgen SK, Skubik-Peplaski C, Lane JD. Parental adherence to home activities in early intervention for young children with delayed motor development. Phys Ther. 2021;101(4). doi:10.1093/ptj/pzab023
Williams P, Slonims V, Weinman J. Turning up and tuning in: factors associated with parental non-attendance and non-adherence in intervention for young children with speech, language communication needs. Int J Lang Commun Disord. 2024;59(2):762-778. doi:10.1111/1460-6984.12961
Pritchard K, Stojanovik V, Titterington J, Pagnamenta E. Team Speech Sounds: how speech and language therapists work with parents of young children with speech sound disorder. Int J Lang Commun Disord. 2026;61(2):e70224. doi:10.1111/1460-6984.70224
Holt CJ, McKay CD, Truong LK, Le CY, Gross DP, Whittaker JL. Sticking to it: a scoping review of adherence to exercise therapy interventions in children and adolescents with musculoskeletal conditions. J Orthop Sports Phys Ther. 2020;50(9):503-515. doi:10.2519/jospt.2020.9715
Sargent B, Mueller M, Iverson E, Frazier M, Kaplan SL. Physical therapy management of children with developmental coordination disorder: a 2026 evidence-based clinical practice guideline from the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2026;38:296-333. doi:10.1097/PEP.0000000000001284
Novak I, Honan I. Effectiveness of paediatric occupational therapy for children with disabilities: a systematic review. Aust Occup Ther J. 2019;66(3):258-273. doi:10.1111/1440-1630.12573