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!