Pathways through challenging tasks that are consistent across settings can be modified through altering the physical environment. Strategies can include educating carers and support staff, however balancing the individual clients needs with that of their family’s needs and those working with them can be extremely challenging to integrate into sessions when access to funding is limited. Flexibility with goal setting whilst continuing to work on all short and long term goals is essential for health and wellbeing for all involved. Clinical reasoning across a caseload and geographic area assists with increasing efficiency through identification of patterns and their length of presence within the environment. Identification of assistance strategies to support meeting all goals requires in depth analysis of the benefits and detriments of using those resources. Design and building of new resources is inherent within the Occupational Therapy process.