Getting Centered For Play:

Transcription

1 Getting Centered For Play: Supporting Parents Regulation and Attention to Promote Engaged Partners for Play Based Therapy by Mike Harlowe, OTR/L & Diane Harlowe, MS, OTR, FAOTA

2 Introductions: Mike Diane

3 Learning Objectives After participating in this session participants will be able to Describe the therapeutic benefits of engaging parents/caregivers in play based activities to support targeted outcomes. Identify barriers to parent involvement in play therapy. Identify therapeutic approaches to address these barriers.

4 The playing adult steps sideward into another reality; the playing child advances forward to new stages of mastery. Erik Erikson The purpose of play - a primary occupation of childhood.

5 Why would you NOT engage parents/caregivers during an OT session?

6 Why Include Parents In OT Sessions?

7 The most effective play therapy involves parents/caretakers Carryover Generalization Caregiver understanding of therapeutic process Caregiver buy in Caregiver empowerment Frequency (1 hour a week vs. every waking moment) Identified Patient: constrictions to occupations may stem from family system

8 Involving Parents Is Hard But Powerful

9 DIR /Floortime Developmental, Individual Differences, Relationship-based Approach Developed by Dr. Stanley Greenspan, MD and Dr. Serena Wieder, PhD. Provides a comprehensive framework for understanding and treating children. Rather than focusing on symptoms alone, helps children master the foundational building blocks of: Relating Communicating Thinking

10 What is DIR? Developmental, Individual Differences, Relationship-based Approach Developmental Capacities: Measured by performance within particular milestones. Reaching these functional/emotional milestones lays the foundation for healthy, emotional and intellectual growth. Individual Differences Identifying individual differences is key. Each child has a unique way of responding to his or her environment, and individual biological challenges can impact a child s ability to learn and grow. Relationships This element promotes warm, interactive relationships to help the child engage, connect, and participate in rich back and forth social exchanges. Utilizing this relationship-based approach facilitates the child s ability to progress through the developmental and emotional milestones.

11 What is Floortime? Floortime is the DIR model treatment approach which involves. Meeting a child at the current developmental level. Building upon a particular set of strengths and motivational drives. The Floortime method helps children s ideas become broad and rich by Providing opportunities for success while gradually incorporating increased demands. This allows a child to climb the developmental and emotional ladder, learn to relate in a meaningful and spontaneous way, and become a flexible thinker.

12 The DIR /Floortime Model is Evidence Based DIR /Floortime has the strongest research of any intervention to support its effectiveness in improving core challenges of autism including: Relating Interacting Communicating Parent-child relationships and Decreasing caregiver stress

13 Barriers to Play What are some barriers to parent participation in play with... typically developing children? Busy schedules Siblings Maintaining attention on boring games/themes Parents experience of play from when they were young Cultural factors Economic factors Lack of awareness of how important intergenerational play is to the child s sense of self and family identity Despite barriers, typical children can be very adept at enticing parents and other adults into play.

14 Barriers to Play What are some barriers to parent participation in play with... children with disabilities? Difficulty with successes More caretaking duties Fear of failure More of the play effort is taken on by the caretaker, whether it is to support a Physical limitation Repair breakdown in communication Entice into the act of play Parent Anxiety Therapist Anxiety

15 Therapeutic Process to Address Barriers and Engage Parents in Play 1. Education 2. Directly teaching coping skills 3. Therapeutic use of self during play 4. Structure 5. Deepen understanding

16 1. Parent Education Why play? Why parent involvement? Long term goals Session goals/focus

17 2. Directly Teach Coping Skills: Addressing Parent Anxiety Barriers to play lead to anxiety about play, anxiety becomes a barrier to play. Anxiety over prognosis, caretaking, and other life factors tends to inhibit play as well.

18 2. Directly Teach Coping Skills: Addressing Parent Anxiety Cognitive Behavioral Aphorisms Breathing Mindfulness

19 3. Therapeutic Use of Self During Play Empathize/Reassure Notice the positive (in parent and child) Modeling Own it: being imperfect Rapport building Where is the parents attention? meet them there notice the unusual or interesting Follow the fun Transformational stories

20 4. Structure During Play Invite parents into play Limit available props Games Repetitive action can become a game Item based play Board games Toy based play Rhythm Structure of session Transitions Visual schedules Address sensory needs

21 5. Deepen Understanding Parents experience of play When growing up Now Meet parents needs during play Sensory Emotional Attentional

22 Special Play Using the Special Play approach to coach parents can structure the process.

23 Educating Parents to use Special Play Special Play is a modified form of play therapy based on a child psychiatry technique developed by Dr. Kate Kogan. Kogan s Research: Pediatric psychiatric out-patients and parents Technique carried out at home 15 minutes every day For 8 weeks Results showed positive impact on: Parent-child relationship Mental health of the child

24 FAST: Families And Schools Together FAST is an evidence based, internationally acclaimed parent engagement program that helps children thrive by building strong relationships at home.

25 FAST: 8 Weekly Multi-Family 2 ½ hr Group Sessions with 12 Activity Elements 1. FAST Hello 2. Singing 3. Family Meal 4. Structured Family Communication Exercises 5. Scribbles 6. Feeling Charades 7. Buddy Time 8. Children's Activities 9. Parent Self- Help Group 10. Special Play 11. Door Prize 12. Closing Ritual

26 Special Play During each FAST session, Special Play is carried out for 15 uninterrupted minutes with active coaching from the FAST team. Homework: Special Play is carried out at home for 15 minutes each day during the 8 weeks that the family is attending FAST.

27 5 Rules for Parents During Special Play Rule #1 The child is in charge

28 5 Rules for Parents During Special Play Rule #2 Don t boss Rule #3 Don t teach Rule #4 Don t Judge

29 5 Rules for Parents During Special Play Rule #5 Follow the child s lead: Watch your child carefully. Talk about what your child is doing. Comment on what your child seems to like or dislike. Mimic your child s actions. Play alongside or with your child. Ask your child how he or she wants you to play.

30 Coaching Parents During Special Play Cue Cards for Coaching Special Play Try asking your child how you should play. Try talking about what your child is doing. Try commenting on what your child seems to like or dislike. Try mimicking your child s actions. Try playing with the toys next to your child. Try letting your child lead you in play. Avoid giving suggestions. Avoid judging your child s play as good or bad. Avoid teaching. Try making the same sounds that your child is making. Try watching what your child is doing.

31 Thanks for Your Participation in This Session!!!

32 Research on the Efficacy of DIR /Floortime These research results show evidence supporting improvement in the core issues in autism through Floortime or developmental interventions based on Floortime. * Interdisciplinary Council on Development & Learning Measuring and supporting language function for children with autism: evidence from a randomized control trial of a social-interaction-based therapy. Casenhiser DM, Binns A, McGill F, Morderer O, Shanker SG. (2015) Journal of Autism and Developmental Disorders, 2015 Mar; 45(3): Abstract: Home-based DIR Floortime Intervention Program for preschool children with autism spectrum disorders: Preliminary findings. Liao S. et al. ( 2014) Physical and Occupational Therapy in Pediatrics, November, 34(4), pp Abstract: PLAY Project Home Consultation Intervention Program for Young Children with Autism Spectrum Disorders: A Randomized Controlled Trial. Solomon R, Van Egeren L, Mahoney G, Quon-Huber M, Zimmerman P. (2014) Journal of Developmental and Behavioral Pediatrics, 35(8): Abstract: A one-year prospective follow-up study of a DIR/Floortime parent training intervention for pre-school children with autistic spectrum disorders. Kingkaew Pajareya and Kaewta Nopmaneejumruslers (2012) Journal of the Medical Assocociation of Thailand, 2012 Sep; 95 (9); Abstract: A pilot randomized controlled trial of DIR/Floortime parent training intervention for pre school children with autistic spectrum disorders. Kingkaew Pajareya and Kaewta Nopmaneejumruslers (2011) Autism 2011 Sep, 15(5) Abstract: Floor time play with a child with autism: a single-subject study. Dionne M. and Martini, R. (2011) Canadian Journal of Occupational Therapy, 2011 Jun;78(3): Abstract: Learning Through Interaction in Children With Autism: Preliminary Data From a Social Communication Based Intervention. Devin M. Casenhiser, Stuart G. Shanker and Jim Stieben (2011) Autism, 2013 Mar, 17 (2) Abstract: Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program. Solomon, R., J. Necheles, C. Ferch, and D. Bruckman (2007) Autism, 2007, Vol 11 ( 3) Abstract: The Scottish Centre for Autism Preschool Treatment Programme II: The Results of a Controlled Treatment Outcome Study. J. Salt, J. Shemilt, et al., (2002) Autism, March 2002, Vol 6 (1) Abstract:

33 References Continued Special Play Kogan, K.L., (1978) Help seeking mothers and their children. Child Psychology and Human Development, 8, Kogan, KL, Gordon, BN and Wimberger, HC (1972). Teaching mothers to alter interactions with their children: Implications for those who work with children and parents. Childhood Education 49: FAST Program McDonald, L (2015) Families and schools together. In Ponzetti, J:Evidence- Based Parenting Education: A Global Perspective, Routledge Publishers New York, pages