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Purchase Access"Our hopes and dreams are that Carson will live a typical life, and through the caring support of Easter Seals, he will certainly have that opportunity. The P.L.A.Y. Project has helped us to relate to our son at a level we were never able to before." (Bettina, Mother of four-year-old Carson).
The development of replicable, cost-effective intensive interventions for the treatment of young children with autistic spectrum disorders (ASD) is a priority for both the health and education systems in this country and internationally.
Additionally, there is a national shortage of personnel trained in these approaches even as the number of children identified with ASD is increasing. The National Academy of Sciences report (2001) emphasizes intensive (25 hours/week, 1:1 or 1:2 teacher: pupil ratios), engaging and comprehensive interventions that start early (18 months to 5 years of age). The high prevalence of children with ASD coupled with the need for intensive intervention means that very substantial resources are required to effectively address autism. Given that most states do not typically provide broad support for intensive interventions, the unmet national need is enormous.
The Play and Language for Autistic Youngsters (P.L.A.Y.) Project, a parent coaching model, is an innovative solution addressing this national need. The P.L.A.Y. Project is play-based, matched to the child’s developmental level, individualized to follow the child’s lead and interests, focused on building relationships, time intensive (two hours per day) and integrated with school and other therapies. Based on the theoretical DIR-framework of Stanley Greenspan MD, we have developed The P.L.A.Y. Project to help young children develop language and social skills. The DIR model focuses on social reciprocity, affect and functional/pragmatic communication. Preliminary clinical evidence shows that this parent-training model is effective. Early dissemination of the model into community agencies, schools and hospitals has also been successfully accomplished, leading to establishment of an alliance with a major national partner – Easter Seals. Each year, Easter Seals serves more than 1 million individuals with disabilities and their families. Currently, they have approximately 60 programs providing care to children and adults with autism in 33 states.
From a clinical viewpoint, The P.L.A.Y. Project has been designed for effectiveness. Program evaluation of 74 families participating in The P.L.A.Y. Project indicates that between 45-50 percent of children make good to very good progress within one year of beginning the project. Another 25 percent make fair progress. Parents are extremely satisfied with the model. A manuscript describing these results in detail is in press (2006). We are currently undertaking a randomized controlled trial of The P.L.A.Y. Project versus standard community interventions; this study is sponsored by the National Institute of Mental Health, and is being conducted in collaboration with Easter Seals,
From an economic viewpoint, The P.L.A.Y. Project has been designed for efficiency. Given that children with autism need intensive interventions, the cost can range from $25,000 – 65,000 when delivered by professionals. While it may represent a ‘gold standard’ of appropriate care to have trained staff deliver 20-40 hours of one-on-one interventions for children with ASD, this approach is not economically feasible in most financially strapped state departments of education and is well out of financial reach for most families to obtain privately.So, despite the promising research and clinical experience, only a handful of statewide programs support full or partial reimbursement for these approaches. In most states the resources are simply not available to meet the National Academy of Science recommendations.Additionally, there is a national shortage of personnel trained in these approaches, even as the number of children with ASD is on the rise. Fully informed parents want the most appropriate services for their child, but these are not readily available. What are parents to do in the meantime?
Easter Seals’ approach has been to apply The P.L.A.Y. Project methods to empower parents to effectively participate in intervention with their child. Where previously there was isolation and grief, this program has additional benefits of bringing parents and children together in engaging and playful relationships. While families learn to unlock the child’s potential, Easter Seals and The P.L.A.Y. Project are also educating entire communities to care effectively and compassionately for these families. This presentation describes this model for young children with autistic spectrum disorders as implemented at Easter Seals affiliates.
The PLAY Project Model: Program Description.
Over the last five years, The P.L.A.Y. Project, under the medical direction of Richard Solomon MD, has established itself as a multifaceted statewide autism training and early intervention program (www.playproject.org ).
The model focuses on parents as the child’s first and most important play partner. Parents are coached to play in a way that helps the child progress through a series of functional developmental levels. By embedding interventions into naturally occurring interaction and learning opportunities, parents become the primary interventionists, and the child is then able to receive the recommended intensity of services. The ability of parents to provide this level of intervention is supported in the literature. The P.L.A.Y. Project is financially affordable and empowers families as they experience success.
Easter Seals and the P.L.A.Y. Project have partnered to bring this effective and affordable model of intensive intervention to families across the country. There are three main features to these community-based programs: 1) diagnosis and referral; 2) home consultation, and 3) training.
1.) Diagnosis and Referral. Children with a diagnosis of autism spectrum disorder (ASD) benefit from this play-based approach. Therefore, it is important that families seek an official diagnosis from a professional experienced in ASD diagnosis. The program also refers families for occupational therapy, speech and language and other services.
2.) Home Consultation. Families with young children (1.5-6 years) receive the services of The P.L.A.Y. Project’s trained professional consultants. Consultants receive an intensive initial training, followed by a full year’s supervision. Videotapes allow supervision to occur over long distances. The cost of the program to families typically ranges from $3,000 to $4,500 annually. Following a structured “P.L.A.Y. Skill Sequence,” the home consultant assesses a child’s unique developmental profile -- including their “comfort zone,” sensory motor profile and functional developmental level (FDL*). The home consultant and family work together to create a curriculum of activities that fits the family’s unique needs, desires and goals. The child’s lead is followed during interaction to increase “circles of communication,” or responsiveness. Video feedback and a critical review of interactions help to refine the curriculum and approach. Each home visit uses modeling, coaching, video feedback and written objectives for the month to help implement and then refine the Skill Sequence. Videotapes subsequently undergo review by experts.
3.) Training Programs. The P.L.AY. Project offers a variety of training programs to support families participating in the program and to educate the professional community.
Community based trainings for parents, professionals and teachers
· CD ROM. An introductory P.L.A.Y. Project workshop is available on CD ROM disk. Internet and virtual education and training.A set of educational resources are available on internet (see www.playproject.org), further supporting the delivery system into communities. Developmental Progress in Children: Clinical Assessment The following table presents developmental progress of eight children enrolled in The P.L.A.Y. Project at one Easter Seals site. For each child listed we show the number of P.L.A.Y. visits completed, the functional developmental level (FDL*) measured at the first visit and the current FDL. Among the first six children, significant progress in FDL has been observed over a course of six to 13 visits. For two children no progress in FDL has been observed over three to five visits. Table of Developmental Progress
Initials Number of P.L.A.Y. Visits Completed Starting FDL* Current FDL* CM 13 2-3 5 ES 11 1-2 3-4 JD 9 3-4 5-6 AP 8 2 3 NM 7 2-3 3 JW 6 2 3 AB 5 2-3 2-3 JH 3 5-6 5-6
Learning Objectives:
Content Area: Early Intervention
Ellen Harrington-Kane, M.S., HSM, OT
Assistant Vice President of Autism and Medical Rehabilitation
Easter Seals
Julie Dorcey, BS
Vice President of Regional Operations
Easter Seals Michigan
Richard Solomon, MD
Executive Director, The P.L.A.Y. Project
The P.L.A.Y. Project, Ann Arbor Center for Developmental and Behavioral Pediatrics