Engaging Children in Play: Alternative Strategies to Hand Over Hand Facilitation

As a pediatric occupational therapist, I am passionate about exploring alternative strategies to engage children in play and promote meaningful participation in daily activities. In this blog post, I will share insights gained from an interview with Dr. Diamond Rashad, an occupational therapist, on the topic of “No more hand-over-hand” facilitation in pediatric therapy. Dr. Rashad provides valuable perspectives and practical examples to help us better understand the importance of consent, environmental support, and sensory accommodations in engaging children in play.

Understanding Hand Over Hand Facilitation

According to Dr. Rashad, hand-over-hand facilitation involves physically guiding a child through an activity by holding their hand or arm. It is a physical prompt that is often used in pediatric therapy to assist children in tasks such as drawing or using scissors. Dr. Rashad emphasizes the need to explore alternative strategies to hand over hand facilitation to ensure active participation, consent, and meaningful engagement for children.

Performance Areas to Consider

Dr. Rashad highlights the importance of considering various performance areas when a child does not engage with a tabletop activity. These areas include emotional regulation, sensory processing, attention, motor planning, and overall regulation. By understanding these areas, therapists can tailor activities and provide appropriate support to meet the child’s individual needs.

Alternative Strategies in Practice

Dr. Rashad suggests several alternative strategies that therapists can utilize to engage children in play effectively:

1. Environmental Modifications: Tasks can be made more manageable by breaking them down into smaller steps or providing adapted tools such as loop scissors for children with fine motor barriers.

2. Visual Prompts: Using picture and visual prompts as well as visual modeling can support children, especially those who process information visually, to understand and engage in activities effectively.

3. Music as a Cue: Introducing music as a cue for specific activities or transitions can serve as a powerful environmental support, marking the start and end of tasks in a clear and engaging manner.

4. Sensory Accommodations: Providing sensory accommodations, such as dimming lights or using headphones, can help children regulate their sensory experiences and fully engage in play and activities.

5. Seeking Consent: Dr. Rashad emphasizes the importance of seeking consent from children before providing assistance, promoting autonomy, and active participation in the task.

Impact on Practice

These alternative strategies can transform pediatric therapy by fostering meaningful engagement, consent, and active participation for children. Dr. Rashad’s insights provide a comprehensive approach to understanding and addressing the diverse needs of children in therapy settings, ensuring that the focus remains on the child’s strengths and individuality.

In conclusion, the interview with Dr. Diamond Rashad sheds light on the significance of moving away from hand over hand facilitation and embracing alternative strategies to engage children in play. By considering environmental, sensory, and consent-related factors, therapists can create a conducive space for children to actively participate in activities while also respecting their individual needs and preferences. 

Using this perspective, pediatric occupational therapists can better understand how to tailor interventions, provide support, and promote meaningful engagement with children in play, thus enhancing the quality of care and outcomes for the children they serve.