Rehab Dynamics, Inc.

3160 Central Park West Drive

Toledo, Ohio  43617

Ph: 419-841-1840

Fax: 419-841-1841

rehabforkids@

rehabdynamics.com

THE P.L.A.Y. PROJECT

Play and Language for Autistic Youngsters

The Floortime/DIR Model

One of the most promising new approaches is to teach the family to interact with the child through play activities.  Stanley Greenspan, MD, a nationally recognized child psychologist, and Serena Weider, Ph.D, developed the Developmental Individual Difference Relationship-based model (DIR), also known as ‘Floortime’. In this approach the child’s natural strengths, as well as challenges, are identified and incorporated into play activities designed to expand their abilities. The overall goal is to enhance the child’s ability to interact appropriately with the people and things in their environment.

In 2001, the National Academy of Sciences made the following recommendations for the education of young children with autistic spectrum disorders:

They reported that following these recommendations could significantly improve language and social interaction. The PLAY Project uses the DIR model and instructs parents in how to provide this intervention in a manner that also follows these recommendations.

The PLAY Project

WHAT IS IT?
The PLAY Project is an intensive parent training program created by Dr. Richard Solomon based on the work of Greenspan and Weider with young children who have autism.  It has been piloted for 5 yrs. with over 400 families in sites all over the Midwest.  In this project PLAY consultants work with families and caregivers on a regular basis to teach them how to provide intensive, one-on-one, play-based services for their young children with autism using the DIR/Floortime principles. The consultants receive intensive training from Dr. Solomon and his supervisory staff throughout this process.

WHERE CAN IT BE DONE?
The program may be provided in the home, clinic, community program, or school, depending on the parents needs and funding options available to the family. Training sessions with the family and the child are generally one-on-one. Additional small group play opportunities may also be incorporated in the clinic and the community as appropriate.

HOW IS IT SET UP?
First, a comprehensive evaluation of the child’s strengths and challenges is completed with the assistance of the parents. The child’s current level of functioning in many different aspects of development is identified. Parents, as well as other significant caregivers, are then coached on specific DIR/Floortime strategies designed to enhance the child’s ability to interact with people and objects in their environment via modeling, written feedback, and videotaping. As parents learn different techniques to use while interacting with their children they are encouraged to use them with their child a minimum of several hours per day.  One of the advantages of this model is that parents can easily incorporate the methods into both ‘structured interventions’, as well as into routine activities of daily living like meals, bath time, bedtime, etc. 

WHO ARE THE KEY PEOPLE?
Parents and other significant caregivers are key aspects of this model. They work intensively with a PLAY consultant to develop an intensive individualized intervention program during regularly scheduled visits with the consultant. During these visits DIR/Floortime principles and methods are reviewed based on the child’s level of functioning.  Specific suggestions are then provided and coaching is done during play activities on each visit.  

HOW IS FEEDBACK AND SUPERVISION PROVIDED?

The PLAY consultant will provide regular verbal or written feedback to the family every session after completion of the initial evaluation.  In addition, both the consultants and the caregivers are frequently videotaped engaging in the Floortime activities during visits.  This provides a means for the PLAY consultant and the parents to go back after the play session to identify strategies used to elicit higher levels of engagement and performance.  With this on-going record of strategies available the family can assist other family members and caregivers to incorporate the activities into their interaction with the child, thereby increasing the frequency of the overall interventions the child receives. In addition, using the videotapes allows the PLAY consultants a means of receiving supervision and feedback from Dr. Soloman and his staff regarding the DIR/Floortime strategies used. 

WHERE DO WE START?

A referral from your physician for The PLAY Project-Occupational Therapy is required for participation. After this is obtained please call our office to schedule an intake appointment and evaluation.  At this time the office staff will discuss scheduling and payment policies. In general, for private insurance to cover services they must be provided in the clinic setting and are often limited to 60-90 min. sessions. If the home visiting model is preferred private pay options are available and can be discussed with the office staff. We are also providers for the Autism Grant Program that may also cover program costs.  In some cases a combination of home and clinic based services can also be provided.  Small groups using the Floortime approach may also be available if they meet your child’s social needs and will be discussed with you if appropriate. 

WHAT SHOULD I EXPECT ON THE FIRST VISITS?

It is essential to understand the DIR/Floortime Model in order to fully benefit from the program. The PLAY consultant will spend some time with you identifying the different levels of social-emotional development and the types of play that facilitate development in each of these levels.  A Parent Handbook will be provided and there is a CD that discusses this information and gives many examples that can be reviewed with the consultant, or purchased for personal use. 

Following this discussion you will work with the consultant to complete intake and release forms, as well as several assessment measures while playing with your child.  These include the following:

In order to complete some of the assessments we will be videotaping certain play activities set up for you and your child.  You will be asked to play with your child as you normally do using the materials provided.  In addition, you may be asked to videotape the PLAY consultant interacting with your child while she is trying some of the Floortime strategies with your child.

Once the initial intake information and assessments are complete the PLAY consultant will do the scoring and edit the videotapes to make sure they provide the information needed. An initial set of recommendations and feedback regarding how to begin the intervention program will be provided to the family on the next visit.  A copy of the materials will however also be sent to Dr. Solomon and his staff for additional review and suggestions.  As a result, more detailed feedback and suggestions will be provided only after this is returned to your PLAY consultant.  In addition, you will then be provided with a video copy of the visit, as well as any other supplemental handouts that we feel would be beneficial. 

ARE SERVICES COVERED BY INSURANCE?

The PLAY Project model is based on once a month 3 hr. home visits.  If you choose to have services in your home, or other community setting, insurance will generally not reimburse for this type of service. A private pay option can be arranged to cover our costs associated with providing this.  This package of services includes the assessment, monthly or bi-monthly home visits, videotaping, and phone consultations.  Several options are available based your needs and the needs of your child. In order to offer this prompt pay option a deposit covering the first month’s services is required and then subsequent payments may be made prior to additional visits, or a payment plan can be established.  Please feel free to discuss this option with our office manager.

Many insurance companies do cover some occupational therapy services if a written referral from your physician is obtained, and if the diagnosis given by your physician is one recognized by your insurance company. Often children with autism or PDD already receive OT services to address the sensory integration/sensory processing issues and working on these issues may be an important aspect of your child’s treatment plan. In this case however insurance may not be available to cover additional OT services. 

In addition, some companies only cover services at certain facilities and Rehab Dynamics may, or may not, be in the network covered by your insurance. Contacting your insurance company prior to participating in the PLAY Project will assist you to know what your coverage is. This often depends on whether we are covered as ‘in’ or ‘out of network’.  Our Office Manager can help you get this information if you have difficulty.  If occupational therapy services are a covered benefit, O.T. services will need to be provided in the clinic.

Typically clinic visits are 50-60 min. in length and to complete all of the initial assessments for the PLAY Project it will require 2-3 sessions. Home visits can be from 1-3 hrs. in length depending on what works best for you and your family. After the initial assessment is completed additional visits can be set up for a minimum of 1x a month to complete videotaping and do parent coaching.  The frequency of your program will be determined after discussing the results of the evaluations with you and providing you with initial feedback and coaching suggestions. 

HOW CAN I GET READY TO BEGIN THE PLAY PROJECT?

In order to begin services you will need to call our office to schedule a time for an evaluation. To most effectively complete an evaluation of interactive and play skills, as well as sensory processing, it is helpful to schedule that time in our office. Please call 419-841-1840 to schedule this appointment which will take approximately three hours. We generally schedule this in 1 -1 1/2hr. sessions.

To help us prepare for your visit we need the following items:

FOR MORE INFORMATION...

call our office and ask for Maureen Kane-Wineland, PhD.