1. The P.L.A.Y. Project
Model Overview & Application to Occupational Therapy
and Speech & Language Pathology
Ashley Case, OTR/L
Training Director
ashley@playproject.org
www.playproject.org
Play and Language for AutisticYoungsters

2. Presentation Overview
1. Introduction to the P.L.A.Y. Project Model
2. Community Workshops
3. Training & Home Consultation Programs
4. Implementation & Therapeutic Use
5. The Research Evidence for The P.L.A.Y. Project

3. Part 1
Introduction
(The P.L.A.Y. Project Model)

4. About The P.L.A.Y. Project
The P.L.A.Y. Project is an evidence-based
developmental intervention for families of
young children with autism spectrum disorders
(ASD). The P.L.A.Y. Project is the pragmatic
application of the theory of DIR/Floortime™
and emphasizes the importance of
empowering parents to support their child
through the early stages of development.

5. D.I.R.® Model/Floortime
• Developmental, Individual differences
Relationship-based (Greenspan & Wieder)
• DIR is the theory, ‘Floortime’is the approach
• Uses 6 Functional Developmental Stages
(AKA Levels)
• Goals include:
1. Following the child’s lead
2. Bringing the child into a shared world

6. The P.L.A.Y. Project
was founded in 2001 by
Richard Solomon, MD
in response to the lack
of intensive early
intervention services for
children with Autism.
The P.L.A.Y. Project is a
cost effective, parent
training model.
History of The P.L.A.Y. Project

7. The P.L.A.Y. Project envisions that
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.
The P.L.A.Y. Project’s mission is 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.
P.L.A.Y. Project: Vision & Mission

8. Playful & fun
Evidence-based
Family & child centered
Relationship-based
Addresses the core deficits
of autism
”By doing what your child loves,
your child will love being with you”
-Dr.Solomon
P.L.A.Y. Project Values

9.  Fun with people: doing what the child loves
 Put in the time: 2 hours per day
 Play at the right level (Vygotsky)
 Accurately profile the child in terms of their: Comfort Zone,
Sensory-Motor Profile & Functional Developmental Levels
P.L.A.Y. Project Principles

10. Part 2
Community Workshops

11. Community Trainings
PLAY Project Workshops
• Workshop I: Introduction to PLAY/DIR
• Workshop II: HFA & Social Skills
• In-depth Case Studies/Watch & Learn
• Teaching PLAY in Schools
DVD (Workshop 1) –for parents & professionals
• Skill Sequence
• Dozens of Examples of Parents Playing
Semi-Annual Trainings in Michigan
• During which, professionals are trained as Home
Consultants

12. PLAY in the Education System
– Parents training plus training of pre/school staff
guarantees ‘intensity’ (15 hrs/week, 1:1)
– Cost effective, naturalistic, integrated into classroom
– PC trains selected teachers, staff and/or
paraprofessionals as PLAY Partners
– Continuity between home and school=generalization
– DIR Framework informs all interactions
– IEP Goals: Attention, engagement, initiation:
– “1000 circles a day” & much less prompting

13. P.L.A.Y. in the Community
• Private lectures (library, university,
community center, etc.)
• Keynote speaking events at national
conferences
• P.L.A.Y. Project Advance Conference
• P.L.A.Y. Project Reunion Retreat
* International presence

14. Part 3
Training Program &
Home Consultation Program

15. P.L.A.Y. Project Programs
(1) Home Consultation
The Home Consultation Program is devoted to
helping parents develop a better connection with their
child through play with the close guidance of a trained
Home Consultant.
(2) Professional Training
The Professional Training Program is an international
training program designed to prepare pediatric
professionals to implement P.L.A.Y. Project services
in their communities.

16. Professional Training Program
1. 4-Day Intensive training includes
2. Implementation (following training)
– Trainee ready to begin home visits following
intensive training
3. Supervision & Certification
– 20 video reviews sent over 12-18 month period
– P.L.A.Y. Project Certification earned with
satisfactory completion of Supervision Program

17. Home Consultation Program
 Monthly home visits (can be adapted to a weekly
schedule or in-clinic service)
 Child development professionals train parents to
be front-line interventionists
 Video footage taken at each visit (15-20 minutes)
 Components of visit include: coaching, modeling,
and written feedback
 Written report based on Skill Sequence and video
analysis
 Intensive intervention provided by parents in
between visits

18. Professionals as HC’s
Full Time Home Consultant (HC):
 25 families at any given time
 6-12 visits per family per contract
 250 visits per consultant year
 5-6 half-day (3 hour) sessions per week
 In-clinic or home visits
 Flexible scheduling per HC’s schedule
 Service fees per 10 visit/1-year contract range:
$2,500-$5,000

19. Part Time Home Consultant (HC):
 1-15 families at any given time (10 families is
average for a part-time HC)
 6-12 visits per family per year
 # of total visits per year varies
 1 hour service radius (travel)
 In-clinic or home visits
 Flexible scheduling per HC’s schedule
 Service fees per visit range from $300-$500
depending on area
Professionals as HC’s

20. P.L.A.Y. Project Agencies
 Community Mental Health Agencies
 Birth to Three/Early Intervention
Programs
 Special Education Programs
 Private Rehab Centers
 Non-profits (e.g. Easter Seals)
 Hospitals and Health Centers
 Individual Private Practice

21. A Growing National Network
– >100 Licensed P.L.A.Y. Project in 27 States, and
agencies in 7 other countries
– >500+ professionals trained in the past 5 years
– >150+ Certified PLAY Consultants (PC) (with many
PCs in certification process)
– Ohio, Utah, D.C.: State-level implementation
– Strong Easter Seals Partnership
http://www.playproject.org/parents/play-project-near-you/

22. Part 4
Implementation
& Therapeutic Use

23.  Impairment in social interaction
 Impairment in language/communication
 Lack of shared enjoyment
 Lack of social or emotional reciprocity
 Stereotyped and repetitive use of language
 Lack of varied spontaneous make-believe or
social imitative play
 Restricted or repetitive patterns of behavior or
interests
 Developmental delays
Core Deficits of Autism

24. Implementation
P.L.A.Y. is in line with evidence-based best practices
• Parent involvement
• Modeling
• Child-led interactions
• Programmatic curriculum (Individualized to child’s
profile)
• Naturalistic environment
P.L.A.Y. looks at the child as a whole, while working
to improve:
• Joint attention
• Social communication (gestural and expressive)
• Self-regulation

25. Compatibility with OT & SLP
P.L.A.Y. allows the therapist use a holistic
approach to treatment
 Educate/coach parents
 Model recommended techniques/activities
 Affect-based/child led
 Programmatic curriculum (Individualized to child
profile) with room to incorporate speech & OT
 Takes place where child is most comfortable
P.L.A.Y. allows therapists to target core
deficits of ASD to improve:
 Joint attention & regulation
 Communication (gestural and expressive)
 Social interactions and symbolic thinking skills

26. P.L.A.Y. Project Skill Sequence
Skill Sequence
1. List Principles/Strategies Based on Comfort Zone (CZ), Sensory
Motor Profile (SMP) and Functional Developmental Level (FDL)
2.AssessChild’s unique: CZ Activities, SMP & FDL
3. Define/List Social Skills and Activities
4. Methods: Follow Cues, Lead & Intent to Increase Circles
5. Create Menu Of SpecificTechniques to Enhance Methods
6.VideoTape/Critically Review Interactions and Progress
7. Reassess and Adjust Curriculum, Methods &Techniques

27. 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)
• EmotionalThinking (FDL 6)
D.I.R.® Model/Floortime (Greenspan)

28. P.L.A.Y. Project Intake
• Family Intake Form
• Childhood Autism Rating Scale (CARS)
• Greenspan Social-Emotional Growth Chart
• Functional Emotional Assessment Scale
(FEAS)
• REEL-3 (Language)
• FDL Progress Charts
* Option for incorporating other assessments

29. The Sensory Profile
(Winnie Dunn)
Greenspan Social
Emotional Growth Chart
• Used to discriminate areas of
dysfunction within sensory
processing
• 3 main sections:
– Sensory processing
– Modulation
– Behavioral & emotional response
• Completed by parent
• Could be incorporated into 1st
P.L.A.Y. Project visit
• Assessment used during initial
home visit
• Provides insight into child’s
Functional Developmental
Levels
• Determines possible areas of
concern related to sensory
processing
• Based on parent report
P.L.A.Y./OT Evaluation (baseline)

30. P.L.A.Y./Speech Therapy Evaluation
• Assesses receptive and
expressive language skills
• Based on parent report
• Commonly used as the main
language measure
administered during 1st P.L.A.Y.
Project visit
• Easy to administer & score
• Assesses early language skills
• Based on parent report
• Easily incorporated into 1st
P.L.A.Y. Project visit
• Used in PLAY Project NIMH-
funded research
• Easy to administer & score
REEL-3 MacArthur-Bates

31. Using Speech & OT with PLAY
1. Educate the family about observations &
assessments results
2. Provide family with educational resources
3. Recommend separate OT or Speech
evaluations as is appropriate
4. Recommend specific techniques &
activities based on the child’s profile (Skill
Sequence)
5. Set goals based on the child’s current
functional developmental level

32. Clinical Outcomes of PLAY
 Joyful relating
 Child directed, affect driven, play-based
 Contingent, reciprocal, social interactions
 Shared social attention
 Simple and complex nonverbal gestures
 Long interactive sequences (e.g. 50+
 “circles” of spontaneous verbal
communication)
 Symbolic language related to affect
 Intact ego functions

33. Cost & Funding
A. Private pay: $3,500 to $5,000.
- Option for scholarships/sliding scale pricing
B. Medicaid
C. Private insurance
D. Early Intervention programs offer PLAY at
no cost to families

34. Medicaid Billing
Billing codes defined by discipline: SLP, OT, etc.
Individual therapy/treatment (modeling)
Family training (coaching)
Treatment planning (feedback)
Periodic review
Evaluation (1st visit)
Interpretation of assessment (write-up using video
assessment measure)

35. Part 5
The Research Evidence
for The P.L.A.Y. Project

36. • Prior to 1990s: 4-5 per 10,000 for autism
• Early 2000’s: 2-6 per 1,000 children for
autism spectrum
• Brick NJ: 4 per 1,000-AD; 6.7 per 1,000-ASD
• 2003 California study: Doubling in last 4
years
• 1 in 110. CDC 2009.
• Now, the CDC estimates 1 in 50 children
Autism Prevalence

37. 6 yrs old
Developmental
Age
2
FDL 1
3
4
5
6
Cognitive Impairment
Typical
Development
Autism: Natural Course
Autism: Intensive
Intervention
6 yrs old
Age
Developmental Course of Autism

38. 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
Scientific Basis for P.L.A.Y.

39. NIMH-funded Research Grant
Phase I: Pilot NIMH SBIR Grant (2005)
• 1 year study to pilot procedures for RCT
• Controlled, 40 children at 4 Easter Seals sites
• Partners: Easter Seals & Michigan State
University
• Small number of children, 5 month intervention

40. Research Continued
Phase II: NIMH SBIR Grant(Awarded 2009)
• 3 Year, $1.85 Million
• Easter Seals & Michigan State University
• Randomized, controlled, multi-site, blinded study
• 5 ES sites
• 60 children in each cohort (control and experimental)
= 120 children total
* Results to be published in mid-late 2013!

41. With positive results:
The P.L.A.Y. Project would show promise as a replicable
developmental model of autism intervention using an
efficient train-the-trainer model at relatively low cost to
parents and society that can be broadly and quickly
disseminated to serve a growing, unmet national need.
Research: Implication

42. • Our next P.L.A.Y. Project Agency Training takes
place May 17th-20th in Ann Arbor, MI
• Join us for the full 4 days to become a Certified
Home Consultant or:
• Join us for the first 2 days (Professional Conference)
to learn more about how to integrate P.L.A.Y.
Project methods and techniques into your practice
Next P.L.A.Y.Training

43. Conclusion & Discussion
For more information, please visit:
www.playproject.org
or contact us:
Phone: 734-585-5333
E-mail: info@playproject.org
Ashley’s e-mail: ashley@playproject.org