Purpose: This article describes how participation in activities/routines can be used as a basis for understanding children's communication and language skills and how that knowledge can be extended to collaborate with families and caregivers to develop meaningful early intervention outcomes. Method: The approach is centered on children's use of communication and language skills to participate in typical activities/routines. Implementation of the approach is based on an understanding of children's performance abilities/disabilities and their use of those abilities to participate in family-identified activities/routines in their natural environments. Discussion and case examples illustrate how communication and language skills can enhance or enable participation in such activities. Family-centered procedures for gathering information about activities/routines from caregivers are described, and strategies for developing outcomes in collaboration with caregivers are presented. Implications: Participation-based outcomes offer speech-language pathologists an option for embedding skills within important activities/routines, thereby promoting children's communication and language growth in natural contexts.