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What If You Didn’t PLAY with Toys on Your Next Visit?

Dustin has been collaborating with Mandy’s family for about 3 months. He typically visits with Mandy’s grandmother every Tuesday at 10am and shutterstock_164667287they play in the living room. Dustin has been doing well with transitioning from bringing toys to the home to using Mandy’s toys. He’s also worked very hard to include Mandy’s grandmother in the play. His next goal is learning how to use coaching during their visits, but he’s struggling with coaching during play, because Mandy’s grandmother isn’t able to get down on the floor. He’s not sure what to do next.

Why Do We Think EI=Play?

I think the answer to this question is, on one hand, an issue of tradition. We’ve always played in early intervention, that’s just what we “do,” so we continue to do the same thing. On the other hand, we also know that young children love to play and it represents a context for much of their learning. Play is fun, for the child and for us. Play-based interactions are how many of us were taught to teach children too. There’s nothing wrong with play. Perhaps, though, it shouldn’t be the only, or even the main way we interact during visits.

Play – When Does It Really Happen?

Did you know that play typically happens within two contexts for infants and toddlers? The first is independent play, with the child playing alone but near the parent. The second context is play that occurs during caregiving routines. What’s missing here? Play on the floor, or play with toys. Many parents play with their children with toys, but for many families, it’s not among the most frequent ways that they interact with their children. If we think beyond play with toys, we can recognize the value of helping caregivers learn to be playful during daily routines, and within these playful interactions  is where and how the child learns.

Now Let’s Help Dustin

Maybe you’re feeling like Dustin, trying to adopt coaching and more routines-based practices but you’re struggling. One great suggestion that I heard from Dathan Rush (co-author of The Early Childhood Coaching Handbook) is to make it a goal to have intervention sessions that DON’T involve playing with toys. You might think, “well, what would I do?” Here are a few suggestions for you and Dustin:

Prepare the family – Dustin could talk with Mandy’s grandmother about how he’d like to try a new practice he’s learning about. He could explain coaching to her, describing what it looks like in practice. They could then plan for what to address on the next visit. Dustin should probably be specific, that he’d like to try helping her with other parts of her day, other than playing – so that she knows what to expect.

Revisit routines learned about during the IFSP meeting or other visits – Dustin and Mandy’s grandmother could talk about what parts of her day go well with Mandy and what parts are challenging. Together they could identify a routine to target on the next visit and discuss a plan for how to tackle it. This might mean that the visit schedule changes so that Dustin visits during the routine.

Don’t sit down on the living room floor – On the next visit, Dustin could start by breaking the “sit down” habit and reminding Mandy’s grandmother about their plan. They would then move right into the routine that they planned to focus on.

Explain coaching again and debrief afterwards – When an opportunity for coaching arises, Dustin could re-explain it by asking for permission to coach during that activity. They can then proceed into the routine, share ideas and problem solve, coach and model intervention strategies as needed, and then debrief about the coaching session afterwards. This prepares the grandmother for creating the joint plan for how she’ll use the strategies during the week.

Keep the focus on Mandy’s grandmother as an important learner – Mandy is still important and she is the purpose of Dustin’s visit. Mandy’s grandmother, though, is the person who will be interacting with Mandy when Dustin isn’t there, so focusing on what she can learn and use during her typical activities with Mandy is extremely important.

By shifting the focus from providing intervention to Mandy during play to supporting Mandy’s grandmother in intervening with Mandy during their typical activities, Dustin can broaden the impact he can have on Mandy’s development. They might still play in the future, and will certainly be playful with each other, but opening up the intervention context beyond play can open up natural learning opportunities Dustin might not have known existed – and wouldn’t have, had he continued to play on the living room floor.

What are your thoughts about NOT playing during your visit? Have you tried it? Let us know how it works for you if you try to move beyond playing with toys on your next visit!

 

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9 Comments to “What If You Didn’t PLAY with Toys on Your Next Visit?”

  1. I have been trying not to play, at least as part of therapy for my first visit recently. Or I did with my last new client. Instead I observed what mom and the child were doing during there typical lunch time and after lunch routine. It was interesting. It was both easier and harder then just playing. I found it easier because I was able to focus on talking to mom and answering her questions and supporting her while watching them, I noticed that I observed and noted all the things mom was doing well, and there were lots of those and I could be more specific about where I might suggest she try something new. It was more difficult because I came up with so many ideas and I had a hard time suggesting them all to mom and didn’t have time to model all of them. This was my second visit with the family though and I thought it went well. Its odd not playing directly with teh child on the other hand I know the suggestions I gave will probably be used by mom since they were made about her daily routine..

    • What fantastic insights, Sarah! I’m so glad you shared them! Yes, I agree that not playing can be both harder and easier. It’s hard not to jump in and “do” because we know we can and we’re usually pretty good at it. I love how you observed, gave positive feedback, and shared suggestions and ideas. Like you, I’m usually full of ideas so it can be challenging to focus them and not give too many. Lots of suggestions aren’t necessarily helpful if they overwhelm the receiver, so taking it a little slower than how fast my brain could crank them out was often a good idea for me. You’re exactly right, though, that the suggestions that the mother can use everyday are much more likely to be used repeatedly throughout the week!

  2. I love this idea, and as an OT I think it is easy to implement. I have found when I focus on the daily routines, the sessions are much more productive and I feel the family has a better understanding of what the goal is. This is also a great opportunity to help parents incorporate play into daily routines and may help cut down on stress levels between the child and caregiver during meal times or when trying to get out the door in the morning!

    • I completely agree, Allison, that focusing on routines can be much more productive and meaningful. When we can help reduce stress, rather than adding to it, we are doing our jobs well! What kinds of activities have you used to help families with decreasing the stress level during the morning “get out the door” routine?

  3. Please elaborate what daily routines play can be incorporated and how for a 2 year old child that is getting EI for lack of speech and little eye contact. What advice should be given to the parent? What play is helpful? Please advise asap. Thank you.

    • Thanks for the great questions. The daily routines you’ll use will depend on what the child and parent like to do or what routines are challenging for them. To encourage communication and engagement during routines they enjoy and routines that occur often, I’d encourage you to look for opportunities to help the parent be playful with the child during the day. For instance, playful interactions can happen during the dressing routine in the morning, during snacks and mealtimes, when getting in the car to go run errands, while working in the garden – during whatever the family likes to do. You can use your expertise to help the parent recognize these opportunities and embed intervention in them. For example, the parent could prompt the child to say “open” to get in the car. The parent could get down on the child’s level, model “open” with an expectant voice, then wait a few seconds for the child to respond. If the child says anything like “open” or gazes at the parent, the parent responds with “Open! I’ll open the door!” and lets the child climb in the car. This same strategy could be used to open snack bags, open doors, etc. If the parent can use this strategy frequently throughout her day, her child will learn to use a sound, his eye gaze, or the word “open” to communicate. He’ll get much more practice doing it than he will if you are the only one working on it with him during your visit.

      Look for daily routines that are challenging for the parent too. Ask her what’s hard about her day, then try to join that routine to help her problem-solve how to improve it or how to get the child to communicate during it. If meals are hard, then observe a regular mealtime, ask the parent what it would look like if the routine was going well, then work together to come up with a strategy or two. Coach the parent as she practices the strategy. You might have to model it first with the child, but always encourage the parent to practice it after she’s watched you and you’ve explained what you’re doing. Coach her to practice it during the actual routine, then work with her to plan for how she’ll use the same strategy when you’re not there.

      I hope these examples help. Check out these posts for more info:
      http://veipd.org/earlyintervention/teaching-early-turn-taking-engagement-skills-an-example/
      http://veipd.org/earlyintervention/being-playful-vs-playing-with-toys-whats-the-difference/
      http://veipd.org/earlyintervention/which-activity-is-really-routines-based/
      http://veipd.org/earlyintervention/6-specific-questions-to-ask-when-exploring-family-routines/

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