Clinicians at Integrated Pediatric Therapies (IPT) often work with those they support in public or everyday settings—such as coffee shops, bookstores, the mall, and even their homes—to help them apply the skills they learn in the clinic to real-world environments. This process is called generalization.  

“For some kids, generalizing from the clinic is harder than for other kids,” said IPT Director Jennie Marble. “We try to work on that in a lot of different ways, and we make it a priority to include parents or caregivers in the process.” 

When a mother requested additional help with her 4-year-old’s difficulty leaving the mall, Speech-Language Pathologist Allison Liwanag met them there to work on this challenge.  

“This little girl already understood the social expectations, but the ease of leaving a space wasn’t happening in the mall environment. We needed to help with the consistency of strategies being used,” Allison said. “With supports in place, it was nice to see her use her newly developing skill sets to be successful in this space.”  

A trip to the mall also gives children a lot to look at and discuss, she said. In addition to toys or stores, children notice other kids and learn from their behavior. 

“Families are working on real-life problems of saying ‘no, you cannot have all of these toys,’” she said. “Additionally, you are teaching responsibility outside the home, for example: ‘You played with these toys, you can only pick one. You have to put the rest back because other people are looking for these toys,’ or ‘we can’t leave a mess.’” 

Children enjoy the clinic because it has swings and toys and other playful resources, but Allison noted that public spaces offer more dynamic interaction and practical opportunities to reinforce the skills learned in the clinic. In turn, being in public provides valuable insight into strategies that can be replicated in the clinic and recommended for parents to practice at home. When it’s not possible for a clinician to join a client in the community, we have alternatives such as parent coaching, video review, or having our paraprofessionals help families generalize skills.  

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IPT Paraprofessional Marizela Linares has worked with a teen at the mall several times, often arriving early when there are fewer people and less distractions. 

“In the clinic, routines are more scheduled, and we have a finite number of opportunities,” Marizela said. “When we practice skills in the community, we have an opportunity to learn more about what a person likes or doesn’t like.”  

Unlike children who have trouble leaving stores, this teenager was apprehensive about going into them, she said. He has expressed an interest in travel, and being in the mall allowed him to discover a luggage store. 

This interest provided motivation for the teenager to practice navigating the mall and going into stores.  

Their frequent visits to the mall have been effective, resulting in him taking the escalator, riding the elevator and pushing the button himself, ordering and paying for his own food and choosing where he wants to sit. 

“This kind of repetition is really helpful for getting kids comfortable and engaged for long-term growth,” Jennie said. “As we practice in real life, we also may find unexpected things they are interested in because they had the opportunity to be exposed to something new.”  

Marizela agreed, saying, “It opens up their world and everyone we’ve engaged with has been really nice.” 

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Allison also supports a teenager who has outgrown the equipment in the clinic, so they started working on skills at a coffee shop. When the teen said the music there was too loud, they moved to a bookstore. 

“He is sensitive to the fact that his needs may differ from others, so for him to be comfortable to participate in a new space and also verbalize what aspects of the environment were difficult for him has been really great,” Allison said. “It’s demonstrating a sense of self advocacy and knowing what he needs.” 

And the community has stepped up, too. Bookstore employees and customers alike have been accepting of people’s differences.  

“It’s really great to see just how much we have grown as a society,” Allison said. “Instead of our kids with disabilities conforming to society, mainstream society is becoming more open to seeing the contributions everyone can bring through participation and inclusion.”  

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The child that Occupational Therapist Marci Kreiner has been working with outside of the clinic only has to go as far as his own kitchen to practice his skills. Marci visits his home in the morning and the two cook together. 

“It’s really nice that it’s a natural environment,” she said. “It’s been wonderful because it’s helping him develop his executive functioning, fine motor and visual perceptual skills. He’s having to follow a recipe, find the ingredients, identify and locate what materials he might need, and use a variety of kitchen tools (i.e., knife, peeler, spatula, whisk).” 

Although he is sometimes hesitant, Marci said that once they make something new, it’s heartwarming to watch his excitement in wanting to share it with his family. She said that after they made crepes together, he had the confidence to make them again for his grandfather’s birthday.  

“It’s really fun to see how our work is carrying over and how he has been able to appreciate those skills,” she said. “It’s a meaningful success.”