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Promoting Family Centered Practice in the Pediatric Oncology Setting Through Program Development: Expansion of Therapy to Go

Jessica McNatt, MOTR/L 08/24/2026

08/24/2026

Purpose of the Program

Occupational therapy (OT) contributes to the holistic care of young children with cancer through family-centered practice. Family-centered practice recognizes caregivers as essential partners in the therapeutic process, emphasizing collaboration and equipping families with the knowledge and resources needed to support their child’s participation in meaningful occupations beyond direct therapy sessions (American Occupational Therapy Association [AOTA], 2020).  In the pediatric oncology setting, family-centered practice is vital to a patient’s developmental growth, as children enduring catastrophic diseases such as cancer are often limited in their occupational engagement by environmental and personal barriers. Caregivers play a critical role in supporting developmental experiences throughout a child’s cancer journey. Equipping families with meaningful, developmentally appropriate activities can promote continued participation in everyday occupations such as play.

For a child, engagement in play is crucial to achieving developmental milestones. Play is defined in the Occupational Therapy Practice Framework as “active engagement in an activity that is intrinsically motivated, internally controlled, and freely chosen and that may include the suspension of reality” (AOTA, 2020 p. 34). For children receiving cancer treatment, play is not only a source of enjoyment but also a primary means through which developmental skills are established and maintained. Therefore, ensuring opportunities for play despite medical challenges is an important component of pediatric oncology rehabilitation.

Context is the term used to describe the various patient-specific factors related to environmental and personal barriers (AOTA, n.d.). Each patient encountered by occupational therapists has a unique combination of environmental and personal factors within their context that influences participation in desired occupations such as play. “Environmental factors are aspects of the physical, social, and attitudinal surroundings in which people live and conduct their lives. Personal factors are the background of a person’s life and living and consist of the unique features of the person that are not part of a health condition or health state” (AOTA, 2020).

Understanding the influence of these environmental and personal factors is essential because they directly affect a child’s opportunities to engage in play, emphasizing the need for family-centered interventions that promote developmental participation across treatment settings. In this population, barriers to engagement in play may include the type of treatment received, sedation, hospitalization, housing arrangements, and access to available support.

Engagement in play can be greatly disrupted for the pediatric oncology population, resulting in the underdevelopment of their performance skills during this phase of required medical care (Sparrow et al., 2023). Although occupational therapy addresses developmental needs during direct intervention, caregivers often have limited resources to support therapeutic play and developmental skill acquisition outside of therapy sessions. To address these contextual barriers and extend developmental support beyond direct intervention, Therapy to Go was developed using principles from the Developmental Frame of Reference and the Model of Playfulness (Bundy, 1997; Kramer & Hinojosa, 2010).

This family-centered program provides patients with developmentally appropriate items that facilitate developmental skill attainment. The contents of each Therapy to Go kit are individualized to the needs of the patient and are also influenced by recommendations received from rehabilitation staff involved in the patient’s care.  Each kit includes developmentally stimulating play items and associated educational handouts that provide caregivers with practical strategies for using the materials to support their child’s development throughout oncology treatment.

Development of the Program

The Therapy to Go program evolved from a needs-based assessment that was conducted by assessing needs and gaps in the occupational therapy service delivery for young children receiving oncology- related treatment. Information was gathered through interdisciplinary collaboration with occupational therapists, speech therapists, physical therapists, and caregivers.

This collaboration aimed to identify barriers affecting children’s opportunities for developmental play and occupational engagement during oncology treatment. The needs-based assessment revealed gaps between scheduled therapy sessions and children’s daily routines across inpatient, outpatient, and home settings. Although children received direct rehabilitation services, families often lacked developmentally appropriate materials to support milestone acquisition outside of therapy. Treatment-related factors, including fatigue, medical procedures, hospitalizations, and abrupt transitions from home communities for specialized care, further limited access to familiar toys and opportunities for meaningful play. These findings demonstrated a need for accessible developmental materials that families could use across settings to promote continued play, participation, and developmental progress.

The program began by supporting the needs of children presenting at an age range of 0–3 years. Appropriate developmental toy items were identified by collaborating with occupational therapists, speech therapists, and physical therapists. The following items were selected for inclusion in the Therapy to Go kits for these children: a puzzle, wooden blocks, a textured ball, a push-pull toy, a string with beads, a ring stacker, paper with large crayons, a rattle, and first word picture cards.

Patients were eligible for the Therapy to Go program if they were newly referred to rehabilitation services (occupational, physical, or speech therapy) and demonstrated developmental skills within the birth-to-3-year age range. The treating therapist identified eligible patients, collaborated with the interdisciplinary rehabilitation team to determine individualized developmental needs, and submitted desired items needed for patient to the program manager.

The contents of each Therapy to Go kit were tailored to the child’s developmental needs and existing therapy goals, ensuring that each family received materials that were meaningful and relevant to their child’s plan of care. Once assembled, the kit was delivered to the treating therapist, who introduced the program to the family during a treatment session. Therapists demonstrated the recommended play activities, reviewed the purpose of each item, and incorporated the materials into the child’s home exercise program while providing caregivers with opportunities to practice the activities and ask questions.

Families kept the Therapy to Go kit to support developmental play across treatment settings, including the hospital, temporary housing, and the home. Each item included a QR code linking caregivers to an online resource with detailed instructions and additional play ideas to encourage continued engagement outside of therapy sessions.

Expansion of Therapy to Go: Young School Age

In pediatric oncology, the environmental factors impede the continuum of advancement of developmental milestones because of the complex medical treatment required by the patients. This can result in patients being away from in-person learning and group play opportunities. Because of these known factors, it is crucial that we as practitioners fill the gaps to promote continued advancement.

Occupational Therapy Practitioners (OTPs) have a vital role in the cancer care continuum to ensure that children are engaging and participating in age-appropriate development and meaningful activities of daily living (ADLs). OTPs should increase providers’ awareness of available services and programming to specifically promote age-appropriate skills in pediatric oncology patients (Braveman & Newman, 2025).

As a result of this knowledge and from the needs-based assessment that was previously completed it was evident that expanding the program was vital and that continuing to fill the gap of providing family-centered care in the pediatric oncology setting was crucial. The results of an additional needs-based assessment utilizing feedback from parents indicated that, in the pediatric oncology setting, there was a large gap related to family-centered practice and continued advancement in developmental skills for patients aged 4–6 years.

The literature shows that many developmental milestones continue to be advanced through the ages of 4–6 years. According to the Peabody Motor Developmental Chart, a child in this age range should be able to demonstrate the skills listed in Table 1.