Abstract Introduction The COVID-19 pandemic had a significant impact on health and education, parents and children living in non-urban areas were severely affected. Objective To design and implement a telehealth based occupational therapy intervention aimed at improving the well-being of children under nine years of age living in vulnerability and confinement conditions, the latter due to the restrictions imposed due to the pandemic, through the provision of context-based occupational counseling to their parent/caregivers. Methods Before-and-after study conducted in families from rural and peri-urban areas living in conditions of vulnerability and in which children were attending online school. Descriptive and a bivariate analysis of the baseline conditions of the sample were performed, as well as before-after comparisons of the objectives achieved and their differences. Results 13 families completed the assessment and intervention processes (12 sessions, 94% attendance); the average age of children was 7.3 years, and in 92.3% of the families the head of the household was a woman. The before-after goals evaluation showed there were gains in all proposed goals, with the highest gains observed in the family social participation category. Conclusions Occupational therapy, telehealth and a context-based approach provide a broad array of benefits to families and children living in vulnerability and confinement conditions.