Integrating Play Project into Community Mental Health

1. An Introduction and Integration into Community Mental Health The Play Project

2. The Guidance Center • 73% of client in DD unit are children • 60% of clinical caseload is children on the spectrum • The Guidance Center’s willingness to attempt and support of the method • Flexible structure of the agency and unit to facilitate and educate staff and parents on programming

3. Autism Information • Between 1 in 80 and 1 in 240 • Average of 1 in 110 in the U.S. (cdc.gov) • Unclear if there are more cases, or better diagnosis occurring • Can usually reliably diagnosis by age 2, but often this occurs much later

4. Integration into Community Mental Health • Screening for appropriateness • parental ability/ level of commitment • Billing for services- labor intensive analysis • Childs ability to handle clinical vs. home environment

5. Flowchart of Implementation at the Guidance Center

6. Issues in Mental Health Setting • Other diagnosis which affect functional outcomes • Parental compliance issues • Cultural and language barriers- values • Billing coding for level of intensity

7. Parental Feedback • Child more affectionate • Parents feel more connected to the child • Child more connected to the environment • Child more easily engaged • Less tantrums • Better relationships with peers and siblings • More interest in peers and siblings • Child improved communication

8. CMH Outcomes • Net decrease in total services over life time- higher functional developmental level • Inclusion in school program decreased need for center based schooling • Improve parent child bond • Complementary not exclusive-Incorporate all disciplines’ techniques into treatment • Child/ Parent- not clinician directed.

9. As Engagement IncreasesPerseveration Decreases Naturally P E S E V E R A T I O N E N G A G E M E N T Point of initial engagement

10. Perseveration/ Stereotypies • Repetitive, restrictive behaviors. Child seems like they don’t want to be part of our world. • P/S are not ‘bad’. They are a form of comfort the child uses to stay in their comfort zone. • Help child regulate a chaotic world. • May become habits & keep the child isolated. • ‘Joining’ P/S helps engagement. • As the child’s world view enlarges P/S will diminish naturally.

11. Comfort Zone • Comfort Zone model can be used to define play sequences to engage child. • Start engagement with sensory motor play. • Turn the play into games. • Add language. • Then imagination, • And thereby establish simple relationships • Leading to more complex relationships

12. Comfort Zone Strategies • Sensory Motor Play • Games • Language • Imagination • Simple Relationships (FDL 1,2,3) and • Complex Relationships (FDL 4,5 & 6)

13. Zone Of Proximal Development Zone of Potential Development Zone of Proximal Development Comfort Zone

14. Principles of the Play Project/DIR • Relationship-based & affect (feeling) oriented-important to parents • Designed to improve Functional Developmental Level (FDL) by engaging the child • Flexible curriculum based on individual profile • Child Centered BUT not passive. (Meet ‘em where they are at and take them where they need to go.) • Directed at child’s inherent potential (Vgotsky) • Strengthens areas of weakness for ASD children

15. PLAY Project principles Cont. • Focus on young children 1.5-6 years old • One-on-one AND group as indicated by functional developmental level. • Time intensive: 15-30 hours/wk (20-25 probably optimal) • Can be used in diverse contexts (daily events & as “therapeutic intervention”) • Family and school personnel as PLAY Partners

16. PLAY Strategies • Assess/profile child’s interests and capacities by considering: • Comfort Zone & World View • Functional Developmental Level (Language Abilities and Needs) • Sensory-Motor Needs and Type • Clinical & standardized evaluations

17. Play Project Methods • Use the following standard PLAY methods • Use comfort zone strategies • Follow child’s lead, cues and intent. • Build on natural interests (‘woo-ing’) • Open and close circles of communication • Extend circles with playful probes to. . . • Broaden child’s interests (Zone Prox. Dev) • Tailor interactions to individual differences • Use methods to generate techniques

18. Play Cues • Cues can be obvious or very subtle; positive or negative. • Examples of obvious cues include: • Frowning (-) • Moving away (-) • Smiling (+) • Giving eye contact (+) • Examples of subtle cues include: • Stiffening • Permitting • Pausing

19. Purpose of Play Techniques • Help parents/professionals be more resourceful. • Increase alertness and awareness • Improve initiative & flexibility • Increase numbers & complexity of circles of communication • Improve ability to solve problems • Go for AFFECT (feelings). Have FUN together!

20. Charlie's Information • 6 yr old diagnosed with Autism • Both biological parents in home with 2 year old brother • Initial impression - poor shared attention, appears to be at FDL 2

21. Charlie's Progress • Several months after initial evaluation • Both Mom and Dad are following his lead more • Both using more waiting and other techniques to increase circles • The use of sensory play has increased • More opportunities for him to initiate circles of communication • Charlie responds to almost all circles of communication

22. Jackson's Information • 2 1/2 year old diagnosed with Autism • Both biological parents present in home with one older brother and siste • Initial impression • -”Holes” at FDL 1 and 2 • -Beginning abilities at Levels 3 and 4

23. Jackson’s Progress • Improvement at Level 3 and 4 • Increased Levels in a single play session • Increased opening and closing of circles of communication

24. Learning More • Training opportunities are offered multiple times in a year • Complete Initial Training • Supervision provided for 12-18 months • Level 1 workshops • www.playproject.org