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Background: Unmet needs for children in the foster care system lead to hardships with social participation, healthy relationships, and occupational engagement. Despite an understanding of these needs, there is minimal research on occupational therapy’s role for young children transitioning from foster care back to their biological parents. Method: A single case report was completed via occupational-based interventions focused on psychosocial development, such as emotional regulation and appropriate social skills. All nine interventions were intended to be provided via 45-min individual treatment sessions followed by biological parent coaching for 15 min with strategies such as role-playing, sensory techniques, and trauma-informed care. Emotional regulation and appropriate social skills were tracked through Goal Attainment Scaling, the Canadian Occupational Performance Measure, the Developmental Assessment of Young Children- Second Edition, and a parent interview. Results: All assessments provided significant results in the improvement of child engagement in social participation, education, and play. The parent interview demonstrated increased biological parent knowledge and decreased stress. Conclusion: Overall, the child’s occupational engagement and biological parent’s satisfaction enhanced their skill sets to improve their quality of life, occupational participation, and relationship quality. Through a coaching strategy, the biological parent gained confidence to take on social-emotional challenges during the child’s transitional phase.