In Early Intervention Speech Therapy, there are many ways to support a child’s communication development. Two commonly used approaches are Routine-Based Intervention and more traditional, direct therapist-led therapy models. While both approaches aim to improve communication and language skills, they differ in how therapy is delivered, where learning takes place, and how caregivers are involved in intervention.
What Is Traditional Speech Therapy?
Traditional Speech and Language Therapy often takes place in a structured setting (usually a clinic, but could also be the home or school setting), where the Speech and Language Therapist works directly with the child on targeted communication goals. Sessions may include therapist-led activities, structured play, drills, visual supports, or specific tasks designed to teach new skills. Typically, parents/caregivers observe sessions and may receive feedback/advice at the end of the session. Sometimes they are given homework to complete with their child between sessions.
This model can be highly effective for introducing and practising targeted speech and language goals. However, as Early Intervention therapists, we know that children spend more time at home with their parents and caregivers than they do in therapy with us. In fact, according to calculations shared by Roffwarg, Muzio, and Dement in 1966 (cited by Dunst et al, 2016), two one-hour therapy sessions a week (without caregiver involvement) account for just 2% of the total waking hours of a one-year-old.
So the traditional therapist-led approach is not always appropriate, and this is where routine-based intervention comes in.
What Is Routine-Based Intervention?
Routine-based intervention is an approach commonly used in Early Intervention services that embeds communication support into everyday activities and interactions. Rather than focusing only on structured therapy tasks, Early Intervention professionals (including Speech and Language Therapists) collaborate with caregivers to use daily routines, such as meals, playtime, dressing, bath time, and community outings, as opportunities for learning and communication practice.
This approach is grounded in the understanding that young children learn best through meaningful interactions with familiar people in natural environments (McWilliam, 2010). Routine-based intervention also emphasises caregiver-coaching, helping families confidently support communication throughout the day rather than relying solely on therapy sessions.
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Key Differences Between the Two Approaches
1. Where Learning Happens
Traditional therapy often occurs within designated therapy sessions, usually in clinics or school settings. Whereas routine-based intervention typically takes place at home and focuses on naturally occurring activities throughout the child’s day. There is also more of an emphasis on encouraging carryover and home practice between sessions.
2. Who Leads the Intervention
In traditional models, the therapist typically directs activities. In routine-based intervention, caregivers are active participants and are encouraged to support communication during everyday interactions. The therapist and caregiver are partners in the intervention, often working together to decide therapy goals, activities, and plans.
3. Opportunities for Practice
Routine-based intervention creates frequent, repeated opportunities for children to practice early language skills across multiple environments and routines, which can support generalisation of skills (Crawford and Weber, 2014).
4. Functional Communication
Because learning occurs during real-life activities, routine-based intervention often focuses on functional communication that is immediately meaningful to the child and family.
Why Routine-Based Intervention is Widely Used in Early Intervention
Early Intervention services increasingly use routine-based and family-centred approaches because they align with how young children naturally learn. Research supports the importance of responsive caregiver interaction, participation in everyday routines, and intervention delivered within natural environments. This model of service delivery is recommended by both the Royal College of Speech and Language Therapists (RCSLT) in the United Kingdom, and the American Speech-Language-Hearing Association (ASHA) in the United States of America.
Routine-based intervention can also help caregivers feel more confident and involved in supporting their child’s development. Rather than adding extra “therapy time” into busy schedules, strategies are embedded into activities families are already doing each day.
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So, Which Approach is Best?
Both traditional, direct Speech and Language Therapy interventions and routine-based intervention can play valuable roles in supporting communication development. The main difference between the approaches lies in how and where learning occurs, and how carryover is encouraged.
Importantly, the two methods are not always mutually exclusive. Support must be individualised to the child and family, and many Speech and Language Therapists combine structured teaching with naturalistic and routine-based strategies depending on the child’s needs and goals.
So it isn’t so much about which approach is best, and rather, which approach/intervention best meets the child’s and family’s needs at this time. By understanding the differences between these approaches, Speech and Language Therapists and families can make informed decisions about how to best support a child’s communication development in ways that are practical, functional, and sustainable.
Do you have a preference of which therapy approach you use in your sessions? Have you tried routine-based interventions in your EI sessions? Comment below and let us know!
References
Dunst, C.J., Raab, M. and Hamby, D.W. (2016) ‘Interest-Based Everyday Child Language Learning’. Logopedia, Foniatría y Audiología, Vol.36, pp.153-161.
Dunst, C. J., Bruder, M., & Espe-Sherwindt, M. (2014). Family capacity-building in early childhood intervention: Do context and setting matter? School Community Journal, 24(1), 37–48.
McWilliam, R. A. (2010). Routines-based early intervention: Supporting young children and their families. Paul H. Brookes Publishing Co.
Crawford, M.J., and Weber, B. (2014). ‘Early Intervention Every Day: Embedding Activities in Daily Routines for Young Children and Their Families’. Paul H Brookes Publishing Co., Baltimore, MD.