Promoting Play Participation and Parent Competence in Early Intervention: A Program Effectiveness Study

PURPOSE: This study investigated the effectiveness of a playgroup in collaboration with local early intervention programs in the community. The research focused on two questions: Do community playgroups improve child playfulness, play participation, and social participation and caregiver sense of competence? Is there a difference between the method of service delivery and child and caregiver outcomes?

BACKGROUND: There is an established need for quality early intervention programs to reach not only the children with an identified developmental delay but also those who may be at risk, estimated to be about 15% of all children (Rice et al., 2014). The benefits of an integrated system of services using evidence-based practice extend across all developmental domains and reach out through the lifespan (National Early Childhood Technical Assistance Center, 2011). Collaborating with the family in the spaces and places where they typically interact are hallmarks of best practice in early childhood. Occupational therapy practitioners have an important role in establishing and implementing best practices that support child participation and family engagement (Case-Smith, 2013). Models of service delivery provided by occupational therapists include both direct and indirect intervention, such as consultation, as well as individual and group interventions. Playgroups can be an important part of comprehensive early interventions services supporting family goals for community participation. Community participation can be a benefit when the family and child are preparing to transition to school.

DESIGN: A quasi experimental pretest–posttest with control group design with a crossover component was used to determine the effectiveness of a playgroup intervention. The three playgroup conditions included two occupational therapy–led playgroups (OT playgroup), two existing developmental playgroups (control), and two developmental playgroups that were supported by occupational therapy (support). The crossover component was the control playgroups then support by occupational therapy after the 6-wk control period. Participants were recruited from early intervention and early childhood programs in the community. The ages of child participants ranged from 16 to 63 mo, with a mean age of 33 mo.

METHOD: We evaluated 36 caregiver–child dyads that participated in one of three playgroup conditions at four separate community locations. Child outcomes were established at pre and post 6-wk playgroup using the Test of Playfulness and the Assessment of Preschool Children’s Participation Play subscale, caregiver competence was measured using the Parent Sense of Competence Scale, and social participation of the group was measured using the Social Profile. A mixed between–within analysis of variance was conducted to assess the impact of the three different playgroups over time. Once a main effect was established, post hoc testing determined differences between the playgroup conditions. The analysis compared the interaction between pretest and posttest scores and playgroup condition, differences in the playgroups between pretest and posttest, and differences between the playgroup conditions.

RESULTS: Children participating in the playgroup demonstrated a significant main effect from pretest to posttest for child playfulness (Wilk’s λ = 0.860, p = .029), with a large effect size (n ² = .140). Children in each community playgroup showed an increase in playfulness after the playgroup intervention. Data were analyzed for simple main effects for playfulness in children between the three playgroup conditions. The main effect comparing the three types of playgroup intervention was significant (p = .023) with a large effect size (n ² = .255), suggesting a difference in the effectiveness of the occupational therapy–led playgroup when comparing the three different playgroup conditions. There were no significant effects for time on parent competence (Wilk’s λ = 1.835, p = .191, n ² = .088) or play participation (Wilk’s λ = .181, p = .181, n ² = .109). Social participation of all playgroups increased significantly over time, F(1, 3) = 18.753, p = .02, n ² = 812.

DISCUSSION: This study builds upon previous research identifying the effectiveness of early intervention playgroups led by occupational therapists (Fabrizi, Ito, & Winston, 2016). Further, this study suggests that playgroups can be implemented using a variety of service delivery models within early intervention. This information allows for a more feasible and sustainable implementation working within the existing early intervention service delivery model. The unique and valuable role of the occupational therapist as facilitator, implementer, and supporter of playgroup programs is established and demonstrated. Further research is needed to determine if participation in community playgroups supports the family as they transition from early intervention to school.

CONCLUSION AND IMPACT STATEMENT: Information about the effectiveness of playgroups will help support early intervention programs in planning, organizing, and implementing playgroups as part of comprehensive early intervention services. Evidence about successful implementation with child and family outcomes that support child development and the capacity of the family will impact occupational therapy practice within these settings as well as program funding and policy related to providing playgroup programs at the regional, local, state, and national level. This study also informs the role of occupational therapists in both health promotion and social justice in working with typical and at-risk populations. It is possible that community playgroups can be an effective intervention to support families as they transition from play at home to participation in the community and school.

References

Case-Smith, J. (2013). Systematic reviews of the effectiveness of interventions used in occupational therapy early childhood services. American Journal of Occupational Therapy, 67, 379–382. https://doi.org/10.5014/ajot.2013.007872

Fabrizi, S. E., Ito, M. A., & Winston, K. (2016). Effect of occupational therapy–led playgroups in early intervention on child playfulness and caregiver responsiveness: A repeated-measures design. American Journal of Occupational Therapy, 70, 700220020. https://doi.org/10.5014/ajot.2016.017012

National Early Childhood Technical Assistance Center. (2011). The importance of early intervention for infants and toddlers and their families. Retrieved from http://www.nectac.org/∼pdfs/pubs/importanceofearlyintervention.pdf

Rice, C. E., Van Naarden Braun, K., Kogan, M. D., Smith, C., Kavanagh, L., Strickland, B., & Blumberg, S. J. (2014). Screening for developmental delays among young children—National Survey of Children’s Health, 2007. MMWR Supplements, 63(2), 27–35. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/su6302a5.htm