This is an easy resource that can be suited for any activity and any strategy - while targeting any outcome across developmental domains.
An example is included on the 2nd page.
I complete the top half with the family. The parent can complete the section titled "Reporting Back" before our next home visit, or we can do it together.
The last table ("New Information") and "Plan" is completed together at the end of the following home visit.
For more detailed instructions, I explain this further in the video product available in my store titled "An Introduction to Routines Based Intervention" (or feel free to email me with questions too)!