an overview of the play project and teaching play beth brennaman, m.ed. diana holderman, m.ed., pc...

An Overview of the PLAY Projectand Teaching PLAY

Beth Brennaman, M.Ed.Diana Holderman, M.Ed., PC

Anna McKinney, BACertified PLAY Project Consultants

Greene County BDD / Four Oaks Early Intervention

Agenda

• PLAY Project• The 7 Circles of PLAY• Teaching PLAY• Research• Application

The PLAY Project intervention for young children with ASD is the first

developmental, relationship-based, parent training model with research results that show improvements in

autism symptomatology?

Did you know . . .

Our Team

• Medical DirectorRichard Solomon, MD

• Executive DirectorLisa Johnstone, MS

• Director of Learning and DevelopmentOnna Solomon, MSW

• Events and Marketing CoordinatorElizabeth Lyons

• Supervision CoordinatorSara Huvaere, M.Ed

DIR Model / Floortime (Greenspan)

• DIR - Developmental, Individualized, Relational• 1:1 intensive engagement• Child centered – meet them where they’re at• DIR theory ; Floortime the practice• 15-25 hours/week besides school; NSF recommends

30-40 hours of intervention/week• Parental committment• 6 Functional Developmental levels

Our Vision“All parents will be supported in developing a joyous relationship with their children with autism spectrum

disorders in a way that will help each child reach their full potential.”

Our Mission“To train a global network of pediatric professionals to

deliver an evidence-based, low-cost, intensive developmental intervention to families of young children

with autism spectrum disorders.”

What Guides Us

Where you can find us

• Over 100 licensed agencies in nearly 30 states and 9 countries

• 80% of counties in Ohio through EI system• A variety of settings:

• Strong Easter Seals affiliation• Rehab Centers and private practice• Education: Birth-3, Special Ed Pre-Schools, Schools • Hospitals and Health Centers• Community Mental Health Centers

• Masters Degree or equivalent• Experience working in child development

– Occupational Therapists – Speech/Language Pathologists – Social Workers – Early Intervention Specialists – Teachers & Special Educators – Psychologists – Community mental health professionals

Profile of a PLAY Project Consultant

PLAY & Ohio DODD EI

• Ohio is in the forefront of serving children with developmental delays

• 80% of counties Provide PLAY Project through DODD Early Intervention system

• Goal of early diagnosis and intensive intervention for all young children with developmental delays and ASD symptoms

PLAY & Ohio DODD EI

Early ID ADEPP Screening

Early Intervention

(0-3)

PLAY Project

Preschool (3-5)

Teaching PLAY

Impairment in: • social interaction• language /

communication

Lack of :•shared enjoyment •social or emotional reciprocity•varied spontaneous make-believe or social imitative play

• Stereotyped and repetitive use of language

• Restricted or repetitive patterns of behavior or interests

Autism Symptoms andDevelopmental Delays

Autism prevalence is on the rise and children need accessible, high-quality services.

There are many more children needing more intensive

intervention.

Need: Intensive Intervention

National Research Council (2001)– Begin early: 18 month-5 years– 25 hours/week– 1:1 or 1:2– Engaging– Strategic Direction– Comprehensive programs address ASD

The Challenge

More children with ASD

Need Intensive

intervention

More services needed!

The Solution

Train More Parents

Train More Providers

Developmental Course of Autism

How PLAY Project is meeting the need

The PLAY Project Autism Early Intervention Program

• Is cost-effective, easy to learn, and easily disseminated model.

• Is evidenced-based and meets the intensity requirements.

• Reduces autism symptomology

PLAY Project ABA/EIBIFocus on interactions Teach skillsUnstructured: naturalistic Highly structuredFollow child’s lead/intent Train child in small stepsInternal reinforcement: fun External reinforcementIntensive 20+ hrs/wk Intensive 30-40 hrs/wkOne-on-one to begin One-on-one to beginHarder to measure: capture the butterfly

Measurable, strong research

More generalization Less generalizationLess expensive More expensive

Comparison: Intensive Approaches

7 Circles of The PLAY

Project

1Ready, Set PLAY! An

Introduction to Principles and

Methods

2 Understanding

Your Child: Creating a

Unique Profile

3The PLAY

Plan: Individualized Techniques &

Activities4Family

Guidance: Coaching,

Modeling, and Feedback

5Engagement:

PLAY time Between

Parent and Child

6Visit Review:

Video and Written

Feedback

7

Change and Growth:

Revising the Plan as Child

Develops

Intro to the PLAY Project

7 Circles of The PLAY

Project

1Ready, Set PLAY! An

Introduction to Principles and

Methods

2 Understanding

Your Child: Creating a

Unique Profile

3The PLAY

Plan: Individualized Techniques &

Activities4Family

Guidance: Coaching,

Modeling, and Feedback

5Engagement:

PLAY time Between

Parent and Child

6Visit Review:

Video and Written

Feedback

7

Change and Growth:

Revising the Plan as Child

Develops

7 Circles of the PLAY Project

• Fun with people—doing what the child loves• Put in the time—2 hours per day broken up into

15-20 minute sessions….or smaller• Accurately profile the child in terms of their

Comfort Zone, Sensory-Motor Profile & Functional Developmental Levels

• Based on the child’s profile, play and interact at the right level

Circle 1: PLAY Project Principles

• Read the child’s cues and intent• Slow the pace of play, observing and waiting for the

child’s idea• Follow the child’s lead, responding to what the child

wants• Open and close circles of communication (back and

forth interactions)• Build on the child’s interests

Circle 1: PLAY Project Methods

7 Circles of The PLAY

Project

1Ready, Set PLAY! An

Introduction to Principles and

Methods

2 Understanding

Your Child: Creating a

Unique Profile

3The PLAY

Plan: Individualized Techniques &

Activities4Family

Guidance: Coaching,

Modeling, and Feedback

5Engagement:

PLAY time Between

Parent and Child

6Visit Review:

Video and Written

Feedback

7

Change and Growth:

Revising the Plan as Child

Develops

7 Circles of the PLAY Project

Circle 2: Creating a Child’s Unique Profile

• Functional Developmental Levels (FDLs)

• Sensory Motor Profile (SMP)

• Comfort Zone (CZ)• Complete Assessments

and Gather Information

Circle 2: Comfort Zone

• What the child does when you let them do whatever they want to do

• Focused on repetitive interests• In their own world, not ‘with us’ • Examples:

– Lining up trains– Visually self stimming on wheels, lines,

objects– Watching TV, videos– Stuck on the same topic: planets,

trains, dinosaurs

The unique way a child experiences the world through the various sensory modalities and movement:• Visual-ability to process & interpret sights • Auditory- ability to process & interpret sounds• Gustatory- ability to process & interpret tastes• Olfactory- ability to process & interpret smells• Tactile- ability to process & interpret touch• Proprioceptive- ability to process & interpret input through

muscles and joints.• Vestibular- ability to process and interpret where they are

located in space

Circle 2: Sensory Motor Profile

What is a Circle of Communication?

• The back and forth process of communication. • Opening a circle means initiating an

interaction.• Closing a circle means responding to a social

overture. • We refer to this process as the ‘ping-pong’ of

relationships.

Why are Circles of Communication important?

• Circles of communication are the basis of relationships.

• This reciprocal process of initiating and responding can be measured by counting how many circles of communication are opened and closed in a row.

• This process is voluntary, meaning that one cannot force another to respond. Important to keep track of:

- who is opening the circles - whether or not the other person is responding - how long the ping-pong effect lasts

– Self regulation and shared attention (FDL 1)– Engagement (FDL 2)– Two-way Communication (FDL 3)– Complex two-way Communication (FDL 4)– Shared Meanings & Symbolic Play (FDL 5)– Emotional Thinking (FDL 6)

6 Functional Developmental Levels

FDL 1: Self-Regulation & Shared Attention

• Can remain calm and regulated enough to share attention with people -

• Regulation derailed by CZ activities• How much is the child with us?• What is their attention? Intention?

Comfort Zone FDL 1

• Insert Video of C.R.

FDL 2: Engagement and Relating

- More sustained attention- You call and they respond - Circles start!- Peek-a-boo is the classic Level 2 game- How easy is it to engage the child?- “Sweat level” - parent does most of the work- Watch out for visual activities

Engaging in Sensory-Motor Play & Closing Circles of Communication

• Insert video of CR

FDL 3: Intentionality & Two-Way Communication

• 6-10 circles• Simple cause and effect games• Is the child initiating?• Want to “create a monster” - child won’t leave you

alone• “Wait level” - parent has to wait to see if the child

will initiate• Beginning of routines• Beginning of use of words

Opening Circles of Communication

• Insert video of CR

FDL 4: Social Problem-Solving, Mood Regulation, & Formation of Sense of Self

• 10-30 circles• Solid - totally with us; continuous flow of interaction• Gestural communication along with words, imitation• 50+ words• Follows spontaneous 1 step commands• Feelings more organized• Problem solves ; has own ideas• “Gets” meaningful sequences• Simple Pretend play - phone to ear, bottle to baby mouth

Continuous Flow of Interaction

• Insert video CR

FDL 5: Creating Symbols & Using Words and Ideas

• Classic 2 yo communication• 1-2 word phrases• What, where, who actions, yes/no• One theme pretend play / symbolic• Follows 2 step commands• Greetings emerging• Compliance - can follow their lead less and

see if they can follow

Playing games: creating ideas and expressing and responding to emotions

• Insert vide of M.E.

FDL 6: Emotional Thinking, Logic and a Sense of Reality

• Talking in sentences• “why” – can recall immediate past• Fluid bridges between ideas• Identifies own and others’ feelings• Recognizes relationship between feeling, behavior,

and consequences• 2 theme play• Simple conversations• Peer play• Misbehavior is developmental accomplishment

Pretend Play: Creating rules and negotiating the relationship

• Insert video of M.E.

7 Circles of The PLAY

Project

1Ready, Set PLAY! An

Introduction to Principles and

Methods

2 Understanding

Your Child: Creating a

Unique Profile

3The PLAY

Plan: Individualized Techniques &

Activities4Family

Guidance: Coaching,

Modeling, and Feedback

5Engagement:

PLAY time Between

Parent and Child

6Visit Review:

Video and Written

Feedback

7

Change and Growth:

Revising the Plan as Child

Develops

7 Circles of the PLAY Project

Circle 3: PLAY Plan Techniques

The Purpose of the Techniques:• Provide parents and professionals with ideas

for engagement• Increase alertness and awareness• Improve initiative & flexibility• Increase numbers & complexity of circles of

communication• Improve ability to solve problems

PLAY TechniquesFunctional Developmental Level (FDL) 1- 4

Attention/Engagement and Two Way Communication

1. Being With / Going for Affect 7. Sense of Humor, Suspense, Surprise2. Sensory-Motor play 8. 1 and 2 Step Commands3. Theme and Variation 9. Making them work4. Taffy Pulling 10. Big, Little, and Micro Circles5. Salient Language 11. Playful Obstruction6. Rhythm and Music 12. Making Behaviors Purposeful

PLAY TechniquesFunctional Developmental Level (FDL) 4 - 6

Shared Meanings and Emotional Thinking

1. Simple Pretend Play 8. Essays2. More Complex Pretend Play 9. Answering ‘wh’ questions3. Multiple circles of communication 10. Time Concepts4. Feelings, Empathy 11. Practicing Pronouns5. Outings 12. Model, Rehearse, Expect6. Using motivation 13. Theory of Mind: Puppet Play7. Playing dumb 14. Social Stories 15. Meta-cognitive Strategies

Circle 3: PLAY Plan Activities

• Activities are generated based on the child’s profile:

- Functional Developmental Level - Sensory Motor Profile - Comfort Zone Activities

Sample Activities by Functional Developmental Level

Levels 1 & 2•Gently shaking arms or legs •Gently squeezing arms, leg, head.•Rolling child up in a rug•Swinging in a blanketLevels 3 & 4

– Chase: “I’m gonna get you”– Get the bubbles, balloon, etc.– Ball play (rolling it back and forth)

Levels 5 & 6

Pretend: dress up, crashing cars, tea party, dolly sleeping, dinosaurs chasing a man, etc.

Real hide and seek, not just peek a boo. Hide a doll and say “Where is the dolly?”Duck, duck, goose

7 Circles of The PLAY

Project

1Ready, Set PLAY! An

Introduction to Principles and

Methods

2 Understanding

Your Child: Creating a

Unique Profile

3The PLAY

Plan: Individualized Techniques &

Activities4Family

Guidance: Coaching,

Modeling, and Feedback

5Engagement:

PLAY time Between

Parent and Child

6Visit Review:

Video and Written

Feedback

7

Change and Growth:

Revising the Plan as Child

Develops

7 Circles of the PLAY Project

Circle 4: Family Guidance

• Gold Standard is home visiting• Can be adapted to a clinic setting• PLAY Consultant - Models PLAY Techniques - Observes and Coaches PLAY Partners - Provides written Feedback on PLAY session

7 Circles of The PLAY

Project

1Ready, Set PLAY! An

Introduction to Principles and

Methods

2 Understanding

Your Child: Creating a

Unique Profile

3The PLAY

Plan: Individualized Techniques &

Activities4Family

Guidance: Coaching,

Modeling, and Feedback

5Engagement:

PLAY time Between

Parent and Child

6Visit Review:

Video and Written

Feedback

7

Change and Growth:

Revising the Plan as Child

Develops

Seven Circles of the PLAY Project7 Circles of the PLAY Project

Circle 5: PLAY Time Engagement Between Parent and Child

• Playful & fun: “When you do what the child loves, the child will love to be with you.”

• 2 hours per day, broken up into 10-20 minute PLAY sessions

• Daily routines such as meal time, bath time, and bed time

7 Circles of The PLAY

Project

1Ready, Set PLAY! An

Introduction to Principles and

Methods

2 Understanding

Your Child: Creating a

Unique Profile

3The PLAY

Plan: Individualized Techniques &

Activities4Family

Guidance: Coaching,

Modeling, and Feedback

5Engagement:

PLAY time Between

Parent and Child

6Visit Review:

Video and Written

Feedback

7

Change and Growth:

Revising the Plan as Child

Develops

Seven Circles of the PLAY Project7 Circles of the PLAY Project

• Use 7 Circles of PLAY Project as guide • Video shows caregivers and Consultant playing

with child • Parent/Video Report Form:

– Gives parents feedback about interaction– Gives parents feedback about child progress

Circle 6: Visit ReviewVideo & Written Feedback

7 Circles of The PLAY

Project

1Ready, Set PLAY! An

Introduction to Principles and

Methods

2 Understanding

Your Child: Creating a

Unique Profile

3The PLAY

Plan: Individualized Techniques &

Activities4Family

Guidance: Coaching,

Modeling, and Feedback

5Engagement:

PLAY time Between

Parent and Child

6Visit Review:

Video and Written

Feedback

7

Change and Growth:

Revising the Plan as Child

Develops

Seven Circles of the PLAY Project7 Circles of the PLAY Project

• Children are dynamic and so is the PLAY Plan.

• PLAY Consultant will reassess the child’s progress and modifies the PLAY Plan to best meet the changing needs of the child and family.

Circle 7: Change and Growth: Revising the Plan as the Child Develops

PLAY Project Research: NIMH Randomized Controlled Trial

• Awarded Sept. 2009• 3 Year, $1.85 Million• Easter Seals & Michigan State University• RCT, multi-site, blinded study • 5 ES sites, 60 children per year x 2 years = 120• Largest study of its kind in US.

• Journal of Developmental and Behavioral Pediatrics, online publication October 2014.

• The PLAY Project - ‘evidence-based’ parent-mediated model

• Working on…..– Autism Speaks– National Professional Development Center– Covered by insurance and Medicaid

PLAY Project Research

Home Consultants Are True to the Model (AIM 4)

Parent Effectiveness Improves (AIM 1)

Parents Implement PLAY Project (AIM 3)

Child Development Improves (AIM 2)

Model Effects

• Significant improvements in: caregiver/parent and child interaction social interaction of children with autism social-emotional development of children

with autism autism symptomology

Research: Primary Findings

Additional outcomes:

• Improved parent stress and depression

• PLAY Project consultant fidelity

Research: Secondary Findings

1. PLAY parents interact with more skill2. PLAY children improve in their development

– Better interaction– Better language– Less autism severity

3. Effectiveness of parent-mediated model

More Evidence for PLAY

Teaching PLAY Pilot

Ohio Department of Developmental Disabilities (DODD)

Part B Preschool (ages 3-5)

Teaching PLAY OH Pilot 2014

Partnering with WestCON and OH DODD:• 1-day Teaching PLAY Workshop• 2 classrooms, 4 classroom visits for each• 2 parent information sessions• Pre/post assessment• Goal: develop teacher training protocol to

disseminate throughout Ohio

Training Methods

• Classroom Observation and video collection• Didactics (teaching the educators): lunch-hour

meetings with staff• Modeling: Teaching PLAY Consultant

(TPC)interacts directly with child• Coaching: TPC provides feedback in the moment

during staff/student interaction• Video and written feedback• Training manual with templates and worksheets

Content vs. Process

Content

Process

Content vs. Process

• Prompt vs. ‘Woo’• Lead vs. Follow• Prescribed vs. Open ended• Compliance vs. Engagement• Behavioral vs. Functional Development• Educational Goals vs. Relationship Goals

Findings: Participant Knowledge

Average score on knowledge test0

10

20

30

40

50

60

70

80

Pre-testPost-test

75%

37%

Participant Satisfaction

Teaching PLAY training has helped me to gain skills in

understanding the student’s unique profile (CZ, SMP, FDL)

Teaching PLAY training helped to improve my ability to

engage the student in circles of communication.

I have applied Teaching PLAY techniques in my every day

interactions with the student.

I am satisfied so far with the training I received during the

Teaching PLAY pilot.

100% Agree or Strongly Agree

Participant Self Perception

I feel confident that I can effectively

engage the student

Before:60% Agree

40% Neutral

After:50% Agree

50% Strongly Agree

I understand the student’s sensory

needs

Before:60% Agree

20% Neutral20% Disagree

After:50% Agree

50% Strongly Agree

I feel confident following the child’s lead and building

on his/her interests

Before:40% Agree

40% Neutral20% Disagree

After:50% Agree

50% Strongly Agree

2nd Teaching PLAY OH Pilot2014-15

Partnering with DODD: 4 counties participating (Preble, Logan, Miami, Shelby)

• Teaching PLAY Workshop• 6 classroom visits and 2 in-services with

teaching staff• Parent information session• Pre/post assessment• Goal: develop teacher training protocol to

disseminate throughout Ohio

Participant Voices

“The other children aren’t afraid of her anymore. I think when the adults in the room started engaging [the student], her peers were also more interested in being around her. One little girl started holding her hand and walking her to the bus each day.”– Teacher

Teaching PLAY Consultant Feedback

• “In the end, the changes were significant, but it was not about the methods, SMP, or techniques. It was about relationship.”

• “This absolutely can be done in the classroom. The staff were very busy, but they were still willing to make small changes and incorporate strategies.”

Why Teaching PLAY?• Continue work started in Early

Intervention and Preschools• Support teaching staff as ASD increases• Address social and emotional challenges

of ASD• Double intensity for families participating

in PLAY Home Consultation

• PLAY Project offers a replicable method • Using an efficient training and certification

model• At relatively low cost to parents and society• That can be broadly and quickly disseminated• To serve a growing need• Get children off of waiting lists and into

services

Research: Implications and Applications

Together we can change the course of life for children

with autism.

Impact

7 Circles of The PLAY

Project

1Ready, Set PLAY! An

Introduction to Principles and

Methods

2 Understanding

Your Child: Creating a

Unique Profile

3The PLAY

Plan: Individualized Techniques &

Activities4Family

Guidance: Coaching,

Modeling, and Feedback

5Engagement:

PLAY time Between

Parent and Child

6Visit Review:

Video and Written

Feedback

7

Change and Growth:

Revising the Plan as Child

Develops

Seven Circles of the PLAY Project7 Circles of the PLAY Project

Thank you!