Free early intervention template

Early intervention home programme with sample ideas for parents

A plain-language early intervention home programme that fits practice into meals, bath, and play, with sample ideas for parents.

  • Built around routines families already have
  • Uses things already at home
  • Weekly log any carer can fill

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What's inside
  1. What We Are Working On
  2. Ideas for Everyday Routines
  3. Play Ideas
  4. How to Help
  5. Weekly Log
  6. Questions for Our Next Visit
Preview · 6 sections

Early Intervention Home Programme

ChildDate given
Therapist or teamReview date
Languages used at homeWho will practise

What We Are Working On

Our goals in plain wordsOne to three goals the family chose, written in the family's words.

Ideas for Everyday Routines

RoutineWhat to DoWhat to Look ForHow Often
Waking up and dressing
Mealtimes
Bath time
Play time
Going out (shop, temple, park)
Bedtime

Play Ideas

Play ActivityHow to PlayThings at Home to Use

How to Help

  • Get down to your child's level and face them
  • Wait a few seconds before you help or speak
  • Follow what your child is interested in
  • Use the language you speak at home
  • Show, then let your child try
  • Stop and try later if your child is tired, hungry, or upset

Weekly Log

DayRoutine or ActivityWho PractisedWhat Happened
Mon
Tue
Wed
Thu
Fri
Sat
Sun

Questions for Our Next Visit

Questions or things we noticed

How to fill it in

  1. What We Are Working On

    One to three goals in the family's words, one short sentence each.

    More guidance

    Write one to three goals in the family's words, not the language of the goal plan. Each should say in one short sentence what the child is learning to do. If the plan says 'will request using a sign or word', the home programme can say 'asking for more at snack time, with a sign or a word'.

  2. Ideas for Everyday Routines

    Two or three steps per routine, what to look for, and how often.

    More guidance

    For each routine the family chose, write what to do in two or three short steps, what to look for so they know it is working, and how often. Delete routines that do not fit this family and add ones that do, such as a temple visit or a ride on the scooter. Keep the frequency concrete: 'every breakfast' is clearer than 'three times a day'.

  3. Play Ideas

    Two or three play ideas using things the family already has at home.

    More guidance

    Suggest two or three play activities that use things the family already has: steel bowls and spoons, a dupatta for peekaboo, cardboard boxes, a ball. Explain how to play in a sentence or two and say which goal it supports. Avoid recommending toys or apps to buy.

  4. How to Help

    Keep the strategies you have shown the family, in the words you used.

    More guidance

    These are general strategies the family can use anywhere. Keep the ones you have shown them, edit the wording to match how you explained it, and add any that are specific to this child. Each item should be short enough to remember during a busy morning with a toddler.

  5. Weekly Log

    One line a day: the routine, who practised, and what happened.

    More guidance

    Ask the family to write one line a day: which routine or activity, who practised, and what happened. Make it clear that a missed day is fine and that 'it did not work' is useful information. A photo of the paper log or a short note on the phone is enough to bring to the next session.

  6. Questions for Our Next Visit

    Space for the family's questions, read together at the start of the next visit.

    More guidance

    Leave space for the family to write questions and observations as they come up during the week. Read this section with them at the start of the next session. What the family notices here often becomes the next goal or the next change to the programme.

Early intervention home programme with sample ideas for parents: filled sample

Fictional entries, initials only, showing the level of detail to aim for. Impression and summary sections are left for the treating clinician.

What We Are Working On

1. Asking for 'more' at snack time with a sign or a word. 2. Holding the cup with both hands at breakfast. 3. Staying with Amma in the bath until the end of the song.

Ideas for Everyday Routines

Mealtime: give one small piece of chapati. Wait and look at A. with a smile. If A. signs or says 'more', give another piece straight away. Look for A. looking at you or reaching towards the plate before you help.

Play Ideas

Bowl drumming: turn two steel bowls upside down and take turns banging with a spoon. Stop and wait. Start again when S. looks at you or bangs once.

How to Help

Added for R.: 'Say the word once, slowly, while you hold up the object.'

Weekly Log

Wednesday. Bath, with Paati. He stayed until the end of the song for the first time, then splashed and laughed.

Questions for Our Next Visit

He says 'baba' for the dog next door every time he sees it. Is that a word?

Routine-based home programme vs separate practice time

Routine-based home programmeSeparate practice-time activities
When practice happensDuring meals, bath, dressing, play, and outingsAt a set time, often sitting at a table
MaterialsThings already in the homeWorksheets, flashcards, or bought toys
Who can do itAny carer present for the routineUsually one parent with time set aside
How often the skill comes upSeveral times a day, as part of the dayOnce a day, if the session happens
Fit with a toddler's dayFollows the child's existing dayHarder to keep up with a busy or restless toddler

Tips and mistakes to avoid

Do

  • Fill it in with the family in the last ten minutes of the session, using their words.
  • Write it in the language the carer reads, and ask a colleague to translate if you need to.
  • Show a grandparent the strategy once and watch them try it before you write it down.
  • Agree how the family will share the log: a photo of the sheet, a message, or a voice note.
  • Look at the programme every session, and ask why something is not happening before adding more.

Avoid

  • Giving five or six activities when a family with a toddler and a job will manage one or two.
  • Writing therapy terms like 'facilitate bilateral coordination' that a carer cannot act on.
  • Suggesting toys or apps to buy when household objects work just as well.
  • Forgetting to ask about the log, which tells the family it does not matter.

About this home programme

An early intervention home programme is a short, plain-language plan showing parents and carers how to practise their child's goals inside everyday routines and play. This free template has space for the family's goals in their own words, routine-by-routine ideas, play activities using things already at home, simple ways to help, and a weekly log.

  • At session end, to leave one or two routine ideas
  • When a new goal is added to the plan
  • Before a festival break or a hometown trip
  • When a grandparent or helper becomes the main carer
Read more

Young children learn most at home, during ordinary routines with the people who love them. A home programme (home program, in US spelling) reminds the family what was practised and how to carry it through the week.

Fill it in with the family at the end of a session. Write it for whoever will use it, often a grandparent or helper, in the home language and without clinical terms.

Questions

What is a routines-based home plan in early intervention?

It is a home programme built around the family's daily routines. The child practises goals during meals, bath, dressing, play, and outings with whoever is caring for them, so there is no need for a separate practice time.

Is there a filled sample of this home programme?

Yes. Each section on this page shows a fictional sample entry, such as a mealtime routine or a play idea, using initials only. The programme itself is blank, and choosing the activities stays with the therapist and family.

What home activities can parents of young children do?

Activities inside routines the family already has, such as waiting for the child to ask at snack time or taking turns rolling a ball. The therapist chooses them with the family, based on the child's goals.

How much practice should a family do each day?

There is no fixed amount. Short, frequent moments inside routines are easier to keep up than one long session. Agree with the family which routines they can use on most days, and adjust at each visit.

Should the home programme be written in English?

Write it in the language the person practising reads most easily. Use the home language for the words the child is learning, since that is the language the child hears most.

Can I print this home programme?

Yes. Fill it in online, download a PDF, and print it or send it to the family. It opens in your browser without sign-up, and your draft stays in your browser.

Is a home programme the same as a parent coaching plan?

They work together. The home programme is a short sheet the family uses during the week. The parent coaching plan is the therapist's record of what is coached, in which routines, and how the parent is getting on.

More early intervention templates

Home programme formats for other therapies

Write every report inside your clinic system.

Keep these as your clinic's own templates, write from reviewed session notes, publish branded PDFs, and keep families updated.

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