2/29/16. Background story. Developmental Sequence. Relationship-Based Model. Floortime Strategies:

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1 Andrea Davis, Ph.D., Director Lahela Isaacson, LMFT Greenhouse Therapy Center Pasadena, CA Floortime Strategies: A User s Guide to the DIR Model Background story Developmental Psychology research and theory reveals social-emotional growth in attuned relationship How to help adults learn to attune and connect in the effort to facilitate children s and teens development?? Trying to teach a complex and highly personal approach to parents and interventionists: mixed results Developmental Sequence 1. Regulation & Attention 2. Social Engagement 3. Reciprocal Interaction 4. Complex Communication 5. Symbolic Play 6. Emotional and Logical Thinking 7-9. Complex Thinking Individual Differences in Processing Profile Assessing and Using Understand and factor into interventions: Motor Planning & Sequencing Sensory Registration & Modulation Visual-Spatial Integration Speech and Language Functionality Executive Functioning Relationship-Based Model Development is enhanced through attuned relationship Brain integration (neural connectivity) is enhanced through play/positive affect Developmental intervention must occur all day long to be intensive enough Families and school staff must learn how to provide developmental support balanced with just-right challenge Autism as a Problem of Reduced Neurological Connectivity Smaller integrative structures Fewer integrative networks Overcrowding Underorganization Underefficiency Lack of automaticity requires excessive mental effort, fatigue, avoidance Lack of efficiency produces overreliance on repetitive behavior 1

2 Floortime Enhances Connectivity Floortime interventions use affect/ emotions to connect neurological functions Affect is processed across many different brain structures and systems Cross-system processing builds richer neural structures Richer neural structures produce efficiency, meaning, deeper learning Empowering Parents and Interventionists to Promote Growth How to teach on the fly.when parents and staff are information overloaded How to learn on the fly.(e.g., when things are flying at your head ) Empowering therapeutic staff, school aides, relatives Pedagogical efficiency for those who are information overloaded Unique Emphasis on Adult Behavior DIR/Floortime books & training videos often help us see kids/teens with new eyes: assess individual differences & how those differences constrain or support developmental milestones. This Guide focuses on simplifying/ systematizing adult actions to support growth at each developmental capacity and across capacities. Simplifying Floortime Teaching DIR Using a Progression of Step-by-Step Strategies Floortime Strategies to Promote Development in Children & Teens A User s Guide to the DIR Model Floortime Strategies Sequence & Structure Core Methods A Core Methods B 1. Regulation & Attention 2. Social Engagement 3. Reciprocal Interaction 4. Complex Communication 5. Symbolic Play 6. Emotional & Logical Thinking 7-9. Complex Thinking X. Reducing Problem Behaviors 2

3 Using the User s Guide Parent Coaching Treatment Planning & Session Notes Staff Training Floortime Outreach & Education DIRFloortime : Finely attuned relationships foster brain development Pretend Expand Respond!Strategies!to!Promote.! Reflect Expand! Respond! Pretend! Reflect!!Challenge! 789.!Complex!!!!!!!!!Thinking! 6.!Emo.onal!!!!!Thinking!&!!!!!!Logical!Thinking! 5.!Symbolic!!!!!!Play! 4.!Complex!!!!!Communica.on! 3.!Reciprocal!!!!!!!Interac.on! Connect! Attune D A@une! 2.!Social!!!!!!Engagement! 1.!Regula.on!&!!!!!!!A@en.on! R Using the User s Guide: Parent Coaching Created a structure and guide for the way we did parent coaching. Tangible resource for discussion and reflection with parents. Incorporated into: Check-in Intervention ( in action ) Reflection Using the User s Guide: Parent Coaching - Choosing a strategy - Explaining, fostering self-reflective discussion - Reviewing the adult s experience of using the strategy Treatment Planning & Session Notes Narrative style of report was changed to be more clear and concise. Funding reports have strategies tied to specific goals. Staff is able to write and update more efficiently and effectively. Clear measurable progress in follow-up reports. Session notes have a strategy that correlates with each client goal. Assessment/Funding Reports Functional Emotional Developmental Capacities: Initial Treatment Goals and Methods Capacity I: Regulation and Attention Method: In this intervention, reciprocal exchanges of emotional communication ( co-regulated affect exchanges ) are the goal and the means of. Month 20XX Baseline/Current Status: XX XX Month 20XX Goal: 1a) Strategies to Support Month 20XX Goal: 1a) Capacity II: Engagement and Relating Method: This intervention relies on continual individualized observation and assessment of a child s interests and needs.! 3

4 Follow-up Reports/Tx Plans SOCIAL-EMOTIONAL DEVELOPMENT GOALS Capacity I: Regulation and Attention January 2010 Baseline: X has a pattern of engaging in one activity for. January 2013 Child Goal: 1a) X will maintain focus on age-appropriate task for 1 minute, 4x per intervention session. July 2013: Goal partially met, 1 minute, 2x per play session. July 2013 Child Goal: 1a) X will stay regulated and receptive to parents at meal times even when new foods are presented in 4/5 opportunities. Strategies to Support July 2013 Goal: 1a.1) Notice and adjust own intensity level to support X s optimal arousal level and downregulate as needed (Strategy 1.2). 1a.2) Use Strategy 1.6 to offer emotional and sensory support when X. is beginning to escalate in order to help him calm and prevent an emotional outburst. Capacity II: Engagement and Relating January 2010 Baseline: X tends to avoid his sister M. but does not. Session Notes Specialist: Session Date: Goals Worked on: 1a) Client will remain regulated during non-preferred activities for 5 mins 2x per session. 3a) 4b) Method Used: 1a) Used strategy 1.1: help client get regulated before expecting more. Coached parent to use sensory input to establish regulation before beginning challenging activity. 3a) 4b) Staff Training Initial staff training & orientation Supervision groups Ongoing quarterly trainings Outreach & Education Succinct and concise way of getting the message of Floortime across. Used in school district trainings and with lay audiences (volunteer groups, religious and community organizations etc.,) Core Methods A - Short Titles: Core Methods A Strategies to Promote Social-Emotional and Intellectual Development A.1 Follow Cues A.2 Be Responsive A.3 Build Upward A.4 Use Play A.5 Use Natural Interests A.6 Use Problems A.7 Pretend Play A.8 Embrace Feeling A.9 Enrich Ideas A.10 Self-Reflect 4

5 Core Methods A Core Methods B Understanding and Addressing Individual Differences in Processing Profiles Core Methods B Short Titles: B.1 Child s Profile B.2 Adult s Profile B.3 Adapt Yourself B.4 Calm or Energize B.5 Home Design B.6 Sensory Connections B.7 Practice in Play 1: Regulation & Attention Attaining a Calm, Alert, Attentive State 5

6 Capacity 1. Regulation and Attention: Attaining a Calm, Alert, Attentive State 1.1 Support Regulation 1.2 Notice and Adjust 1.3 Calming Choices 1.4 Lengthen Attention 1.5 Avoid Flooding 1.6 Practice Modulation Attune 1. Regulation and Attention - 6

7 Capacity 2. Social Engagement: Getting Involved and Connected 2: Social Engagement Getting Involved and Connected 2.1 Joint Attention 2.2 Gaze Tracking 2.3 Share Pleasure 2.4 Mirror Emotions 2.5 Emphasize Affect 2.6 Interact 2.7 Advance the Agenda 2.8 Be Necessary 2.9 Use Anticipation Connect 2. Social Engagement- 7

8 2. Social Engagement- 3: Reciprocal Social Interaction Initiating and Responding Purposefully Capacity 3. Reciprocal Social Interaction: Initiating and Responding Purposefully 3.1 Invite Circles 3.2 Total Communication 3.3 Wait Enough 3.4 Sportscaster/Narrator 3.5 Playfully Persist 3.6 Easy Choices 3.7 Communication Temptation 3.8 Consider Questions Respond 3. Reciprocal Social Interaction - 8

9 4: Complex Communication Using Gestures and Words to Solve Problems Together Capacity 4. Complex Communication: Using Gestures and Words to Solve Problems Together 4.1 Stretch Interactions 4.2 Don t Judge 4.3 Feign Ignorance 4.4 Assign Meaning 4.5 Playfully Obstruct 4.6 Devise Problems 4.7 Genuine Self 4.8 Social Flow Expand 4. Complex Communication - 9

10 Capacity 5. Symbolic Play: Creating and Using Ideas 5: Symbolic Play Creating and Using Ideas 5.1 Use Pretend 5.2 Animate 5.3 Thicken the Plot 5.4 Instigate Creativity 5.5 Vary Emotions 5.6 Challenge and Support 5.7 Enrich Play Pretend 5. Symbolic Play 10

11 6. Emotional and Logical Thinking Making Sense of Oneself, Others, and the World Capacity 6. Emotional and Logical Thinking: Making Sense of Oneself, Others, and the World 6A: Emotional Thinking 6.1 Narrate 6.2 Highlight Emotions 6.3 Emotional Curiosity 6.4 Encourage Empathy 6.5 Play Therapeutically Challenge 6B: Logical Thinking 6.6 Build Bridges 6.7 Elaborate 6.8 Incite Thinking 6.9 Make Connections 6.10 Event Planner 6.11 Organize and Summarize 6.12 Debate Challenge 6. Emotional & Logical Thinking 11

12 7-9 Complex Thinking Multicausal, Gray Area, and Reflective Thinking 7 Promote multi-causal thinking 8 Develop gray-area thinking 9 Encourage reflective thinking Reflect 7-9. Complex Thinking - 12

13 Appendix. Reducing Problem Behaviors Appendix Reducing Problem Behaviors X.1 More Floortime X.2 Find Behavioral Clues X.3 Choose Behaviors X.4 Take Manageable Steps X.5 Make Modifications X.6 Notice and Mention X.7 Preview X.8 Post Rules X.9 Provide Visuals X.10 Provide Support X.11 Grant Wishes Appendix Families Accessing Funding State of CA: SB946: insurance coverage for ALL evidence-based Behavioral Health Treatment for children and adults with ASD. BUT SB946 requires treating professionals must be vendored with their Regional Center as a Behavior Analyst or Assistant Behavior Analyst. DIR/Floortime Coalition of California, is working with a lobbyist to write and pass laws that ensure funding for all evidence-based approaches. 13

14 Floortime developmental intervention is now: - easier to teach and learn - easier to document/report - easier to research References Casenhiser, D., Shanker, S., & Stieben, J. (2013). Learning through interaction in children with autism: Preliminary data from a socialcommunication-based intervention. Autism, 17, Dewaay, R., Davis, A., & Clements, M. (2010). Parents Perceptions of Treatment Effectiveness for Autism Symptoms in a DIR/Floortime Home Intervention. Presented to Autism 2010, Toronto, November Greenspan, S. & Wieder, S. (1998). The child with special needs. Boston: Da Capo Press. Janis-Norton, N. (2012). Calmer, easier, happier parenting: Simple skills to transform your child. London: Hodder & Stoughton. Solomon, R., Necheles, J., Ferch, C., and Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program. Autism, 11,