An Overview of the PLAY Project
and Teaching PLAY
Beth Brennaman, M.Ed.
Diana Holderman, M.Ed., PC
Anna McKinney, BA
Certified PLAY Project Consultants
Greene County BDD / Four Oaks Early Intervention
Agenda
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PLAY Project
The 7 Circles of PLAY
Teaching PLAY
Research
Application
Did you know . . .
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?
Our Team
Richard Solomon, MD • Medical Director
Lisa Johnstone, MS
• Executive Director
Onna Solomon, MSW • Director of Learning and Development
Elizabeth Lyons
Sara Huvaere, M.Ed
• Events and Marketing Coordinator
• Supervision Coordinator
DIR Model / Floortime (Greenspan)
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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
What Guides Us
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.”
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:
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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
Profile of a
PLAY Project Consultant
• 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
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
Autism Symptoms and
Developmental Delays
Lack of :
•shared enjoyment
•social or emotional reciprocity
•varied spontaneous makebelieve or social imitative play
• Stereotyped and repetitive use
of language
• Restricted or repetitive patterns
of behavior or interests
Impairment in:
• social interaction
• language /
communication
Autism prevalence is on
the rise and children
need accessible, highquality 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
Comparison:
Intensive Approaches
PLAY Project
Focus on interactions
Unstructured: naturalistic
Follow child’s lead/intent
Internal reinforcement: fun
ABA/EIBI
Teach skills
Highly structured
Train child in small steps
External reinforcement
Intensive 20+ hrs/wk
One-on-one to begin
Harder to measure: capture
the butterfly
Intensive 30-40 hrs/wk
One-on-one to begin
Measurable, strong research
More generalization
Less expensive
Less generalization
More expensive
Intro to the PLAY Project
1
Ready, Set
PLAY! An
Introduction to
Principles and
Methods
7
Change and
Growth:
Revising the
Plan as Child
Develops
Understanding
Your Child:
Creating a
Unique Profile
7 Circles
of The
PLAY
Project
6
Visit Review:
Video and
Written
Feedback
2
3
5
4
Engagement:
PLAY time
Between
Parent and
Child
Family
Guidance:
Coaching,
Modeling, and
Feedback
The PLAY
Plan:
Individualized
Techniques &
Activities
7 Circles of the PLAY Project
1
Ready, Set
PLAY! An
Introduction
to Principles
and Methods
7
Change and
Growth:
Revising the
Plan as Child
Develops
Understanding
Your Child:
Creating a
Unique Profile
7 Circles
of The
PLAY
Project
6
Visit Review:
Video and
Written
Feedback
2
3
5
4
Engagement:
PLAY time
Between
Parent and
Child
Family
Guidance:
Coaching,
Modeling, and
Feedback
The PLAY
Plan:
Individualized
Techniques &
Activities
Circle 1: PLAY Project Principles
• 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 Methods
• 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
7 Circles of the PLAY Project
1
Ready, Set
PLAY! An
Introduction to
Principles and
Methods
7
Change and
Growth:
Revising the
Plan as Child
Develops
Understanding
Your Child:
Creating a
Unique Profile
7 Circles
of The
PLAY
Project
6
Visit Review:
Video and
Written
Feedback
2
3
5
4
Engagement:
PLAY time
Between
Parent and
Child
Family
Guidance:
Coaching,
Modeling, and
Feedback
The PLAY
Plan:
Individualized
Techniques &
Activities
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
Circle 2: Sensory Motor Profile
The unique way a child experiences the world through
the various sensory modalities and movement:
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•
•
•
•
•
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
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
6 Functional Developmental Levels
– 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)
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
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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
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•
•
•
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
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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
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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
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•
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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
1
Ready, Set
PLAY! An
Introduction to
Principles and
Methods
7
Change and
Growth:
Revising the
Plan as Child
Develops
Understanding
Your Child:
Creating a
Unique Profile
7 Circles
of The
PLAY
Project
6
Visit Review:
Video and
Written
Feedback
2
3
5
4
Engagement:
PLAY time
Between
Parent and
Child
Family
Guidance:
Coaching,
Modeling, and
Feedback
The PLAY
Plan:
Individualized
Techniques &
Activities
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 Techniques
Functional Developmental Level (FDL) 1- 4
Attention/Engagement and Two Way Communication
1. Being With / Going for Affect 7. Sense of Humor, Suspense,
Surprise
2. Sensory-Motor play
8. 1 and 2 Step Commands
3. Theme and Variation
9. Making them work
4. Taffy Pulling
10. Big, Little, and Micro Circles
5. Salient Language
11. Playful Obstruction
6. Rhythm and Music
12. Making Behaviors Purposeful
PLAY Techniques
Functional Developmental Level (FDL) 4 - 6
Shared Meanings and Emotional Thinking
1.
2.
3.
4.
5.
6.
7.
Simple Pretend Play
8. Essays
More Complex Pretend Play
9. Answering ‘wh’ questions
Multiple circles of communication 10. Time Concepts
Feelings, Empathy
11. Practicing Pronouns
Outings
12. Model, Rehearse, Expect
Using motivation
13. Theory of Mind: Puppet Play
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 blanket
Levels 3 & 4
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
– Chase: “I’m gonna get you”
– Get the bubbles, balloon, etc.
– Ball play (rolling it back and forth)
7 Circles of the PLAY Project
1
Ready, Set
PLAY! An
Introduction to
Principles and
Methods
7
Change and
Growth:
Revising the
Plan as Child
Develops
Understanding
Your Child:
Creating a
Unique Profile
7 Circles
of The
PLAY
Project
6
Visit Review:
Video and
Written
Feedback
2
3
5
4
Engagement:
PLAY time
Between
Parent and
Child
Family
Guidance:
Coaching,
Modeling, and
Feedback
The PLAY
Plan:
Individualized
Techniques &
Activities
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
Seven
Circles
of the
PLAY
Project
1
Ready, Set
PLAY! An
Introduction to
Principles and
Methods
7
Change and
Growth:
Revising the
Plan as Child
Develops
Understanding
Your Child:
Creating a
Unique Profile
7 Circles
of The
PLAY
Project
6
Visit Review:
Video and
Written
Feedback
2
3
5
4
Engagement:
PLAY time
Between
Parent and
Child
Family
Guidance:
Coaching,
Modeling, and
Feedback
The PLAY
Plan:
Individualized
Techniques &
Activities
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 of
thethe
PLAY
Project
Seven
Circles
PLAY
Project
1
Ready, Set
PLAY! An
Introduction to
Principles and
Methods
7
Change and
Growth:
Revising the
Plan as Child
Develops
Understanding
Your Child:
Creating a
Unique Profile
7 Circles
of The
PLAY
Project
6
Visit Review:
Video and
Written
Feedback
2
3
5
4
Engagement:
PLAY time
Between
Parent and
Child
Family
Guidance:
Coaching,
Modeling, and
Feedback
The PLAY
Plan:
Individualized
Techniques &
Activities
Circle 6: Visit Review
Video & Written Feedback
• 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
7 Circles
of of
thethe
PLAY
Project
Seven
Circles
PLAY
Project
1
Ready, Set
PLAY! An
Introduction to
Principles and
Methods
7
Change and
Growth:
Revising the
Plan as Child
Develops
Understanding
Your Child:
Creating a
Unique Profile
7 Circles
of The
PLAY
Project
6
Visit Review:
Video and
Written
Feedback
2
3
5
4
Engagement:
PLAY time
Between
Parent and
Child
Family
Guidance:
Coaching,
Modeling, and
Feedback
The PLAY
Plan:
Individualized
Techniques &
Activities
Circle 7: Change and Growth: Revising
the Plan as the Child Develops
• 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.
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.
PLAY Project Research
• Journal of Developmental and Behavioral
Pediatrics, online publication October 2014.
• The PLAY Project - ‘evidence-based’ parentmediated model
• Working on…..
– Autism Speaks
– National Professional Development Center
– Covered by insurance and Medicaid
Model Effects
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)
Research: Primary Findings
• Significant improvements in:
 caregiver/parent and child interaction
 social interaction of children with autism
 social-emotional development of children
with autism
 autism symptomology
Research: Secondary Findings
Additional outcomes:
• Improved parent stress and depression
• PLAY Project consultant fidelity
More Evidence for PLAY
1. PLAY parents interact with more skill
2. PLAY children improve in their development
– Better interaction
– Better language
– Less autism severity
3. Effectiveness of parent-mediated model
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
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•
•
•
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•
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
80
70
75%
60
50
Pre-test
40
30
37%
20
10
0
Average score on knowledge test
Post-test
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.
100% Agree or
Strongly Agree
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.
Participant Self Perception
I feel confident that
I can effectively
engage the student
I understand the
student’s sensory
needs
I feel confident
following the child’s
lead and building
on his/her interests
Before:
60% Agree
40% Neutral
Before:
60% Agree
20% Neutral
20% Disagree
Before:
40% Agree
40% Neutral
20% Disagree
After:
50% Agree
50% Strongly
Agree
After:
50% Agree
50% Strongly
Agree
After:
50% Agree
50% Strongly
Agree
2nd Teaching PLAY OH Pilot
2014-15
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
Research: Implications and
Applications
• 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
Impact
Together we can
change the course of
life for children with
autism.
7 Circles
of of
thethe
PLAY
Project
Seven
Circles
PLAY
Project
1
Ready, Set
PLAY! An
Introduction to
Principles and
Methods
7
Change and
Growth:
Revising the
Plan as Child
Develops
Understanding
Your Child:
Creating a
Unique Profile
7 Circles
of The
PLAY
Project
6
Visit Review:
Video and
Written
Feedback
2
3
5
4
Engagement:
PLAY time
Between
Parent and
Child
Family
Guidance:
Coaching,
Modeling, and
Feedback
The PLAY
Plan:
Individualized
Techniques &
Activities
Thank you!